Participation of informal caregivers in the hospital care of elderly patients and their evaluations of the care given: pilot study in three different hospitals

Abstract

This action research is an ongoing study which will last from 1991 to 1993. The main purpose of the study is to increase the participation of informal caregivers in the hospital care of elderly patients without decreasing the quality of care. The data reported here are from a pilot study. This study had three aims: (a) to test reliability and validity of the measure used, (b) to investigate the current participation of informal caregivers in the hospital care of elderly patients (aged over 75), and (c) to evaluate and compare the quality of care from both the patients' and the informal caregivers' point of view in three different hospitals. The measure of quality of care was developed on the basis of need theories, mainly those of Maslow and Alderfer. Patients and caregivers were also asked to rate the participation of the caregivers in the hospital care of elderly patients. Participation consisted of 18 activities of daily living. The pilot test with 18 elderly hospital patients and seven family members or significant others showed differences between the two groups in perception of care received. Statistically significant differences (P < 0.001) were found in the following categories: mainly social needs, psychic and spiritual needs and totals. The results supported earlier findings that elderly patients are satisfied with and do not criticize their care. The younger generation (i.e. their children) is more demanding and has precise perceptions about the care given. Relatives could be used more in planning, evaluation and even implementation of care; however, their current participation in patient hospital care is minimal.

Family member as a hospital patient: Sentiments and functioning of the family

“…20,23,25 In this study, however, 80% of statements about 'help' dealt with participation in concrete nursing care and only 20% with emotional support. In earlier studies, family members had participated little in care and the primary form of participation in care had been emotional support for the patient.…”

“…9,25 Hospital patients look forward with enthusiasm to the visits of their family. 9,25 Hospital patients look forward with enthusiasm to the visits of their family.…”

“…Helping the patient in daily tasks increases the family members' sense of wellbeing because they feel a need to be of help. 20,23,25 Family members' participation in care has involved different concrete treatments, such as helping the patient eat or go to the toilet, walking the patient or aiding their movement, and skin care and shaving. 27 Family members' participation in care may, however, also produce difficulties if the family member is overly solicitous, helpless or easily frightened.…”

“…16 Participation in care has also been linked to diminishing family members' feelings of helplessness and guilt. 23,25 However, the most important method of help in several studies has been the provision of emotional support. A number of studies indicate that families want to participate in the care of a hospitalized family member; 9,19,23,28 however, study results concerning the participation of family members are contradictory.…”

“…27 Family members' participation in care may, however, also produce difficulties if the family member is overly solicitous, helpless or easily frightened. 9,23,25 In addition, participation in care includes participation in decisions concerning care of the patient. According to some studies, family members participate extensively in the care, 5 while according to others, there has been little participation.…”