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August to Present.

September to July Director of Professional Relations Easter Seal Home Health Services Direct the development of and maintain contacts with the appropriate representatives from Health Maintenance Organizations, other managed care organizations and insurance companies to promote Easter Seal programs for business development. May to August November to August November to March November to April May to April January to July Staff Occupational Therapist Pitt County Schools Greenville, North Carolina Provide occupational therapy services to children in the school system of various diagnosis learning disabled, cerebral palsy, physically and mentally handicapped.

October May April June Louis, Missouri. Further studies should take into consideration other time points that may better reflect the disease trajectory, such as time of initial diagnosis, protocols alterations, and points of disease exacerbation or decline. A special focus on safety, risk for negative outcomes, and adverse effects for both the caregiver and care recipient should be noted.

Key variables to include in these studies are the type and stage of the disease and the treatments because they will be related to the types of continuing therapy. Are the demands on the caregiver such that they jeopardize his or her health? Research that uses carefully selected inception cohorts is needed so that variation in care demands can be understood.

Adverse patient care and caregiver situations, such as medication errors, falls, and subsequent hospitalizations, can be noted over time. We need studies that target caregivers that are from minority and economically disadvantaged groups if we are to better understand their own needs and interventions to support them in providing safe care. Furthermore, focus on variations or adaptations needed to minimize caregiver distress related to ethnic, racial, cultural, or socioeconomic diversity is needed.

We know very little about the distress and resource limitations of various vulnerable groups and the acceptability of various types of interventions to ethnically and racially diverse populations. We need to investigate the interplay between the formal and informal systems of care for the ongoing needs of patients as well as caregivers. There is very little research to suggest how variations in caregiver contact with the formal health care system interacts with the amount and types of responsibilities faced by family caregivers.

Can prepared caregivers contribute to the quality of patient clinical outcomes as well as patient safety? What does competent and appropriate family care contribute to patient clinical outcomes? How does it affect cost and care utilization? Future research should identify and test patient- and family-directed interventions and chart their impact upon the quality of care outcomes for patients. In addition, interventions should report the cost of care, as well as the cost of utilization of services.

What are the costs of negative outcomes that result when safety and neglect or abuse are involved? Interventions that can demonstrate improved patient outcomes are particularly essential to building a high-quality system of continuing care. Caregivers who face conflicts in competing demands related to caring for children, spouse, or parent and to maintaining their work roles are particularly threatened by and vulnerable to the demands for continuing home care.

More appropriate home care and home care support resulting in caregivers who are prepared to care and have adequate formal support may lead to fewer patient or caregiver hospital readmissions, fewer interruptions in treatment cycles, shorter periods of work loss, and better patient and caregiver mental health. Quality of care and patient safety are concerns.

We need to design and test interventions to assist patients and their families to increase their preparedness to deal with the overall care process, to deal with both the direct and indirect care demands. How do we increase their sense of control and mastery of their care situation? Future intervention studies should utilize multidisciplinary, randomized clinical trials including physicians to determine the unique contribution of educational programs versus social support versus psychological support on caregiver outcomes and patient outcomes.

Future studies should explore whether health care professionals can assist the caregiver to build effective buffers against being overwhelmed and distressed. Interventions that assist the caregiver to engage in activities that promote their own health should be carried out to identify strategies of health promotion. Research questions should address whether or not caregiver distress i. Do these have a negative impact on the patient or on themselves?

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Examining caregiver distress as it relates to quality of care is absent from the literature. Research is needed to understand the quality of care that family members provide and then determine how that care impacts the overall therapeutic plan and patient clinical outcomes. Longitudinal studies of caregivers are needed to explore the complex interactions of caregiver physical health and mental health, and how self-care and health-promotion practices of the caregiver are altered.

Exploration is needed of which self-care practices i. To better understand the effects of care on family caregivers and on patient outcomes, caregiver roles, responsibilities, knowledge, and skills need to be more rigorously explored and defined. For instance, what do caregivers do well? What do caregivers not do well? In what areas are the patient outcomes most likely to be compromised? In what areas is patient safety most in jeopardy?

What areas cause caregivers more distress? Once these questions are answered, we can target interventions at those who are at risk and intervene early in the care situation, rather than late. Finally, interventions must recognize professional or formal caregivers and family caregivers as partners in health care—partners who offer unique and vital skills and resources—and engage them in the entire plan of care.


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Such interventions are critical as we increase the focus on outcomes of care and as providers are paid for outcomes performance. Family members as partners are critical. Family caregivers are critical partners in the plan of care for patients with chronic illnesses.

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Nurses should be concerned with several issues that affect patient safety and quality of care as the reliance on family caregiving grows. Improvement can be obtained through communication and caregiver support to strengthen caregiver competency and teach caregivers new skills that will enhance patient safety. Previous interventions and studies have shown improved caregiver outcomes when nurses are involved, but more research is needed. There is more to be learned about the effect of family caregivers on patient outcomes and areas of concern for patient safety.

Nurses continue to play an important role in helping family caregivers become more confident and competent providers as they engage in the health care process. The research cited is a comprehensive but not exhaustive review of the caregiver literature. The search terms applied were usually kept very broad, and keyword searches were frequently employed more often than searches that relied upon the use of controlled descriptors, as the topics of patient and caregiver safety, which are often intertwined, are difficult to isolate through clearly defined identifiers.

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As a result, search results were large, and relevance was frequently determined through the reading and review of abstracts of large sets of retrieved publications. Relevant articles for this review were not always indexed using terms relating to nursing; the potential involvement of the nurse as a contributor to improved patient and caregiver safety was a determinant for inclusion. Some articles discussed the professional health care team in general terms, while others focused on the specific role of a nurse serving as a factor in safe family caregiving.

The broad search strategies delivered high retrieval levels and the need to distill relevant evidence. Turn recording back on. National Center for Biotechnology Information , U. Show details Hughes RG, editor. Search term. Author Information Authors Susan C. Reinhard, Ph. E-mail: ude. E-mail: ten. Background Most patients have families that are providing some level of care and support. Caregivers as Clients For centuries, family members have provided care and support to each other during times of illness.

Description of Caregiver Population The terms family caregiver and informal caregiver refer to an unpaid family member, friend, or neighbor who provides care to an individual who has an acute or chronic condition and needs assistance to manage a variety of tasks, from bathing, dressing, and taking medications to tube feeding and ventilator care. Caregiver Responsibilities Caregivers spend a substantial amount of time interacting with their care recipients, while providing care in a wide range of activities.

Patient Safety and Quality: An Evidence-Based Handbook for Nurses.

Research Evidence: Interventions for Caregivers as Clients The literature provides substantial evidence that caregivers are hidden patients in need of protection from physical and emotional harm. Interventions To Reduce Burden and Distress Recent meta-analyses of caregiver interventions found mixed results, which are important to note.


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Interventions To Improve Competence and Confidence Smeenk and colleagues 80 investigated the quality of life of family caregivers who received a home care intervention that consisted of a specialist nurse coordinator, a hour nurse telephone service with access to a home care team, a collaborative home care dossier and case file, and care protocols.

Caregivers as Providers Twenty-five years of research have documented that the work of family caregiving can be stressful. The Potential for Harm Caregivers can place their family members at risk in two ways, and both situations are preventable. The risk of elder abuse The presence of dementia and cognitive behavioral problems put the care recipient at risk for abusive behaviors by the caregiver.

Research Evidence: Interventions for Caregivers as Providers Interventions designed to help the caregiver become a more competent and confident provider are important to ensure that the patient receives safe and effective care.


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Developing Task-Specific and Problem-Solving Skills Despite the overall lack of interventional research with caregivers, there is some evidence that interventions designed to improve specific caregiving tasks are helpful. Psycho-Educational Interventions The majority of intervention studies for caregivers have utilized a psycho-educational intervention. Navigating the Service Delivery System Family members must interact with the health care system to obtain information, services, and equipment, as well as to negotiate with family and friends to enlist and mobilize support.

Evidence-Based Practice Implications A review of the literature found that society depends on family caregivers to continue providing care for their loved ones, but does little to teach them how to do it and support them in this stressful work. Respecting the Patient—Family—Professional Triad The most important practice implication of this review of caregiving research evidence is that nurses can meaningfully change the course of caregiving for both the caregiver and care recipient by respecting the role that each has in managing ongoing care beyond the classic boundaries of professional patient care.

Providing Information Nurses need to communicate effectively with clients and caregivers to develop cost-effective plans of care and achieve positive client outcomes. Linking Caregivers to Resources Caregivers need adequate resources to assure minimization of risk to the patient.

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Research Implications Taken as a whole, interventions to improve caregiver outcomes have been varied. Recommendations for Future Research Since much of the caregiving research remains descriptive, there are many gaps in the evidence-based research to promote patient safety and quality carefor caregivers as secondary patients and caregivers as providers to vulnerable patients. Conclusion Family caregivers are critical partners in the plan of care for patients with chronic illnesses.

Search Strategy The research cited is a comprehensive but not exhaustive review of the caregiver literature. References 1. Caregiving in the U.

Harvey E. Jacobs PhD, CLCP - Curriculum Vitae

Arno PS. In: McRae T, editor. New caregiving research. Department of Health and Human Services, U. Department of Labor.

Life Care Planning and Case Management Handbook

Report to Congress. The future supply of long-term care workers in relation to the aging baby boom generation. Milbank Mem Fund Q.