Page 69 - Encyclopedia of Nursing Research

36 n CAREGIvER

life and minimal technological side effects et al., 2010). The state of the science report on
while maintaining the caregiver’s health computer-based algorithms that aid patients
C and quality of life (Smith, 1994). nursing to make step-by-step decisions about treat-
interventions have been found efficacious ment options concluded that improved knowl-
for caregiver problems of depression, sleep edge, attitudes, and lower health services
deprivation, social isolation, and lack of used resulted from patients’ use of algorithms
access to evidence-based information, care- (Agency for Healthcare Policy and Research,
giving, and complex technology problem 1998; Agency for Healthcare Research and
solving (Smith, Curtas, et al., 2003; Smith, Quality, 2010). The Cochrane review and the
Dauz, Clements, Werkowitch, & Whitman, randomized trial results concur, adding that
2009; Smith et al., 2006). These interventions patients with step-by-step decision aids had
include counseling, peer support, high- realistic treatment expectations, satisfaction
quality Internet information, and contacts with care, and lowered anxiety (o’Connor
with experts. There is a dearth of research on et al., 2002). The more successful problem-
caregiving with lifelong technology depen- solving algorithms included logical, easily
dence that begins unexpectedly in middle remembered steps, multiperspective (psycho-
life (when teenagers and elder family mem- logical and physical) information, long-term
bers also need assistance) and continues on access, and booster repetition, all tailored
a trajectory of intermittent disease exacerba- to a specific group with common problems
tions and slow, progressive decline (Winkler (Piamjariyakul et al., 2006; Smith, Koehler,
et al., 2006). Moore, Blanchard, & Ellerbeck, 2005).
Traditional education such as verbal Research should continue on the cultur-
instruction at discharge does not ensure that ally related aspects of caregiving strategies
caregivers will be able to understand and used in various ethnic groups (Dilworth-
integrate home care management activities Anderson et al., 2005; Dilworth-Anserson,
into daily routines (Albert, 2008; Clark et al., Williams, & Gibson, 2002; Evans, Crogan,
2009). Telehealth and Web-based support Belyea, & Coon, 2009). Another contempo-
in the homes are other interventions pro- rary focus in caregiving research should be
viding caregivers support (Piamjariyakul, the caregiving family, as research has clearly
Schiefelbein, & Smith, 2006; Piamjariyakul & indicated that multiple members of families
Smith, 2008; Smith, 2007). In two recent stud- are involved in providing direct and indirect
ies, family caregivers requested information care, both to the patient and in support of
on the most challenging aspects of providing the primary caregiver (Smith, 1996). In addi-
home care for chronically ill patients: dealing tion to the caregiving family, the caregiving
with patients’ dietary restrictions, monitoring neighborhood or parish should be a focus of
signs and symptoms, and obtaining infor- study. With appropriate outreached inter-
mation from health care providers (Pressler vention program, the “out-of-home caregiv-
et al., 2009; Wilkins et al., 2009). The most ers” can help provide a low-cost health care

widely recommended clinical yet unverified support to the patients such as monitoring
approach is to provide guidelines to manage symptoms, improving treatment adherence,
specific caregiving problems (Schulz, Lustig, prescribed diet, and lifestyle changes (Kalra
Handler, & Martire, 2002). Step-by-step guide- et al., 2004; Piette et al., 2008).
lines (including computer algorithms) can Historically, research on the topic of
guide systematic thinking and develop skills caregivers has come from the literature
for solving stressful caregiving problems and on aging in which burden and support-
communicate with their health care provid- ive interventions have been studied (Tong
ers (Given, Sherwood, & Given, 2008; Smith, et al., 2008). Interventions tested include
2010a, 2011; Smith & Blanchard, 2011; Smith teaching mastery of caregiving tasks, social