Hospital postdischarge intervention trialled with family caregivers of older people in Western Australia: potential translation into practice

Abstract

There is lack of a suitable assessment tool that can be used routinely and systematically by hospital staff to address family caregivers’ (FCs’) support needs. This paper describes a novel approach to identifying and addressing FCs’ needs following hospital discharge of the older person receiving care.Setting and participantsFC recruitment occurred on the patient’s discharge from a tertiary hospital in Western Australia; 64 completed the study; 80% were female; mean age 63.2 years.InterventionThe Further Enabling Care at Home (FECH) programme was delivered over the telephone by a specially trained nurse and included: support to facilitate understanding of the patient’s discharge letter; caregiver support needs assessment and prioritisation of urgent needs; and collaborative guidance, from the nurse, regarding accessing supports.ResultsSixty-four FCs completed the FECH programme. The top three support needs identified by the FCs were: knowing what to expect in the future (52%), knowing who to contact if they were concerned (52%) and practical help in the home (36%). The telephone-based outreach service worked well and was convenient for the nurse and the FCs, and saved on transport, time and money. Most of the FCs appreciated the systematic approach to identify and articulate their needs and were satisfied with the support they received, mainly navigation through the systems, problem solving, self-care strategies, explanation of illness, symptoms and medication and access to after-hours services.ConclusionsIn order to guide services which may consider adopting this systematic approach to supporting FCs and integrating it into their routine practice, this evaluation of the FECH programme has described the processes implemented and highlighted the factors that hindered or facilitated these processes to engage caregivers with appropriate services in a timely manner. Positive feedback indicated that the programme was a useful addition to hospital discharge planning.Trial registration numberACTRN12614001174673; Results.

Transitional care to caregivers of dependent older people: an integrative literature review

“…Half the sample were literature reviews with scientific methodology (21)(22)(23)(24)(25) . The primary studies had qualitative (2,12,26) , quantitative (9) , and quali-quantitative approaches (11) . Interpreting the information found in these sources allowed to answer the research question, despite the differences between them, including the different methodologies they applied.…”

“…The selected articles were published from 2016 to 2019 [2016 (1S), 2017 (4S), 2018 (5S)]. There was a marked geographic disparity in study distribution: three studies were Australian (9,21,26) , three were Brazilian (11,(22)(23) , two were carried out in the United Kingdom (12,25) , one in Portugal (24) , and one in Philippines (2) . Analysis of the articles' content allowed to group the needs of caregivers into five categories: needs related to the transition into the role of caregiver; caregivers' self-care needs; health needs; economic needs; and social and community needs.…”

“…There is a consensus among researchers regarding the introduction of instruments that assess caregivers' needs (5)(6) , to individualize the intervention proposed to people that provide care to dependent older people (6) . However, the literature indicates that the objective of interventions oriented toward caregivers is training them or relieving the emotional overload they experience, so they can replace or help dependent older people in the execution of activities of daily living and manage the therapeutic regimen, especially the adequate and safe medication administration (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) .…”

The cost-effectiveness of a telephone-based intervention to support caregivers of older people discharged from hospital

“…The intervention, the Further Enabling Care at Home program, is described in detail elsewhere [8,13]. The central component of the program is the nurse's inclusion of the caregiver in a caregiver-led conversation using the Caregiver Support Needs Assessment Tool (CSNAT) [18][19][20]. This tool is provided to the caregiver a few days before the phone conversation to facilitate reflection upon the questions, which are about the needs for support to (a) enable the caregiver to care for the patient and (b) address caregivers' needs to look after themselves [19].…”

“…Designated data collection time points for outcome measures were as follows: Time 1, within four days of discharge; Time 2, 15-21 days after discharge; and Time 3, six weeks after discharge [20]. Demographic data for patients and information about the patients' health conditions and the caregiving situation were obtained from the caregivers at Time 1 [8,13].…”