Missed Care in Family Caregiving for Alzheimer's Disease and Related Dementias

阿尔茨海默病和相关痴呆症的家庭护理中的缺失

基本信息

批准号：
10407620
负责人：
Carolyn E Ziminski Pickering
金额：
$ 54.28万
依托单位：
UNIVERSITY OF ALABAMA AT BIRMINGHAM
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-06-01 至 2026-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10407620
关键词：
Activities of Daily Living Alzheimer&apos s disease related dementia Care given by nurses Caregivers Caring Data Decision Making Development Discipline of Nursing Elder Abuse Enrollment Equation Event Failure Family Caregiver Family member Formal caregiver Future Guidelines Health Services Health Services Research Health system Intervention Interview Knowledge Left Life Light Measures Methods Modeling Nurses Outcome Participant Patient Self-Report Perception Persons Physiological Policies Process Quality of Care Research Resources Sampling Self Care Stress Surveys Testing Theoretical model Time Work care outcomes care recipients caregiving caregiving outcomes contextual factors data-driven model design diaries driving force experience falls family caregiving improved innovation insight instrumental activity of daily living longitudinal design neglect novel psychologic recruit theories

Activities of Daily Living Alzheimer&apos s disease related dementia Care given by nurses Caregivers Caring Data Decision Making Development Discipline of Nursing Elder Abuse Enrollment Equation Event Failure Family Caregiver Family member Formal caregiver Future Guidelines Health Services Health Services Research Health system Intervention Interview Knowledge Left Life Light Measures Methods Modeling Nurses Outcome Participant Patient Self-Report Perception Persons Physiological Policies Process Quality of Care Research Resources Sampling Self Care Stress Surveys Testing Theoretical model Time Work care outcomes care recipients caregiving caregiving outcomes contextual factors data-driven model design diaries driving force experience falls family caregiving improved innovation insight instrumental activity of daily living longitudinal design neglect novel psychologic recruit theories

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项目摘要

Abstract Most caregiving responsibilities for persons with Alzheimer’s disease and related dementias (ADRD) fall on their family members. While we know types of tasks caregivers are responsible for, and have described styles of caregiving, it remains unclear how processes used by caregivers impact outcomes for their care recipient. Missed care is a term from health services which describes care that is left undone because of a decision made in light of other factors. Our preliminary data suggest that missed care is a frequent and daily experience in ADRD family caregiving. Therefore, using a concurrent mixed-methods triangulation design, we aim to more clearly understand processes that contribute to missed care within ADRD family caregiving. The well-established missed care model contextualizes the decision to skip care and points to situational antecedents (e.g., time demands, resource scarcity) and internal processes (i.e., values) that impact nurses' decision-making on how to prioritize care, including decisions to skip needed care. Our underlying hypothesis is that similar decision- making processes can be identified within ADRD family caregiving. In Aim 1, we will enroll a sample of ADRD family caregivers recruited from the local health system (N=225) to complete daily diary surveys characterizing their day. Data will be analyzed using multi-level structural equation modeling to evaluate our application of the Missed Nursing Care Model to family caregiving. In Aim 2, we will use a grounded theory design with in-depth interview data collected from a subset of participants (N=35) to produce a theoretical description of decision- making related to care provision and prioritization. In Aim 3, we will triangulate the data to create a data-driven model to explain multi-factorial daily decision-making that leads to missed care in ADRD family caregiving. Distinguishing the process of decision-making (Aim 2) from its underlying contextual factors (Aim 1) will identify the underlying processes contributing to missed care. This body of data will inform a novel data-driven theoretical model describing mechanisms leading to missed care events in ADRD family caregiving. This model will serve as an intervention framework, highlighting actionable intervention targets. Our results have the potential to significantly impact the family caregiving field by advancing its conceptual paradigm – moving from merely defining the tasks for which family caregivers are responsible, to illuminating the decision-making process that determines how they provide care in real-life contexts. This will permit a better alignment of future policies and interventions with caregiver needs. An innovation of this work is its combination of micro-longitudinal data with grounded theory analysis, which we surmise will lead to a more ecologically valid reflection of key processes in day-to-day caregiving.

抽象的大多数对阿尔茨海默氏病和相关痴呆症患者（ADRD）的护理责任属于家庭成员。虽然我们知道任务类型是负责的，并且已经描述了护理，目前尚不清楚看护人使用的过程如何影响其护理人员的结果。错过护理是卫生服务的一个术语，该术语描述了由于持续的决定而被取消的护理其他因素。我们的初步数据表明，错过的护理是ADRD家庭的经常和日常体验照料。因此，使用并发的混合方法三角剖分设计，我们的目标是更清楚了解在Adrd家庭护理中导致错过护理的过程。良好的错过的护理模型将跳过护理和指向情境前因的决定背景下（例如，时间）需求，资源稀缺）和内部流程（即价值）影响护士对如何做出的决策优先考虑护理，包括跳过需要护理的决定。我们的基本假设是类似的决定 - 可以在ADRD家庭护理中确定制作过程。在AIM 1中，我们将注册ADRD样本从当地卫生系统（n = 225）招募的家庭护理人员完成每日日记调查的特征他们的一天。将使用多级结构方程建模来分析数据，以评估我们的应用错过了家庭护理的护理模式。在AIM 2中，我们将使用深入的理论设计从参与者子集收集的访谈数据（n = 35），以产生决策的理论描述 - 与护理条款和优先级相关。在AIM 3中，我们将对数据进行三角测量以创建数据驱动解释多因素每日决策的模型，导致在ADRD家庭护理中错过护理。区分决策过程（AIM 2）与其潜在的上下文因素（AIM 1）将确定导致缺席护理的基础过程。这一数据将为数据驱动的新型理论提供信息描述导致ADRD家庭护理中错过护理事件的机制的模型。该模型将服务作为一个干预框架，突出了可行的干预目标。我们的结果有可能通过推进其概念范式来显着影响家庭护理领域 - 仅从定义家庭护理人员负责的任务，以阐明决策过程确定它们如何在现实生活中提供护理。这将使未来政策更好地结合护理人员需求的干预措施。这项工作的创新是它的微观数据与扎根的理论分析，我们浏览将导致对关键过程的生态有效反映更有效日常护理。