Caregiver Training Courses

Caregiver Training Ebooks

The caregiver training e-book gives a training course on how to provideassistance to another person who is ill, disabled or needs help with daily activities. It can also serve as a useful guide to the individuals in the need of help. The product deals in physical, mental, social, and psychological needs and well-being of both the caregivers and the elderly person requiring care. Everyone needs a little help from time to time and while many seniors lean on the friends and family members for support, there may be some instances in which it's necessary to seek additional assistance or long-term care which was why this product was created by the author. This caregiver product is a practical guide created by the author who is an expert in the field. This product embeds in it several training sections in which each section gives detailed information on how to provide assistance to people who are ill, disabled, or aged. This product is a trusted and 100% guarantee to provide the necessary details needed in caring for the physically challenged, aged and ill individuals. The product is also an essential overview of issues from Alzheimer's to diabetes to strokes. Continue reading...

Caregiver Training Ebooks Summary


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Highly Recommended

It is pricier than all the other ebooks out there, but it is produced by a true expert and includes a bundle of useful tools.

Overall my first impression of this book is good. I think it was sincerely written and looks to be very helpful.

Types Of Caregiving Responsibilities

The focus of this article is on informal, family care-givers who are providing assistance with both ADLS and IADLS in older adults with a dementia. Concern about the mental health needs of such family caregivers of impaired older adults continues to be high. This interest exists for good reasons most older adults live in noninstitutional settings, and families remain the most common source of assistance for community-dwelling older adults who have some functional impairment. Ory, Yee, Tennstedt, and Schulz (1999) provide a review of definitions and prevalence of family caregiving, caregiver characteristics, and health effects. According to their review, family caregivers provide assistance with a wide variety of tasks, ranging from light assistance with independent activities of daily living (e.g., accompanying on medical visits, shopping, transportation) to intensive in-home care. The majority of caregivers are either spouses or adult children of the impaired individual. Although...

Cognitive And Behavioral Interventions For Dementia Family Caregivers

Most community-based interventions for family care-givers, whether they involve educational programs, support groups, respite services, or case management, share an interest in multiple outcomes. That is, many programs aim to improve caregivers' problem-solving abilities, reduce their emotional distress, and improve their management of patient care. Some programs also seek to improve interpersonal family relationships or to delay institutionalization of the patient. Behavioral and cognitive treatments are distinguished from others, not necessarily by the expected outcomes, but by the conceptualization of the problem(s) and proposed mechanisms of the intervention. The following limited summary is by no means an exhaustive review of cognitive-behavioral interventions for family caregivers of cognitively impaired older adults. Rather, this section describes several exemplars that demonstrate the usefulness of individual and group-based cognitive and behavioral interventions for this...

Caregiverchild Interactions

Although all of the factors we have discussed so far are important to the child's development, they are distal influences. These factors impact the child's development through the interactions that take place within these environments these are the proximal influences. We now know a great deal about the outcomes of a variety of interactions at least within our own culture. We are relatively ignorant about these interactions and their effects within other cultures, so the approach described here to assessment of caregiver-child interactions must be viewed within the constraints of the culture within which it was developed, and we must be very careful about generalizations. Early childhood is a time of particular sensitivity to the effects of caregiver-child interactions (Pianta, 1997). As I discuss in Chapter 9, early childhood is a time of rapid development of executive functions, and caregiver-child interactions impact the development of these functions, with important consequences...

Overview Of The Caregiving Literature

Historically, the study of caregiving has developed within the context of caring for persons with schizophrenia or dementia. Thus, until the rise in focus on clinical health psychology and behavioral medicine, little attention had been given to caregivers of medically ill persons, or differences between various caregiving populations. More recently, variables affecting the well-being of caregivers of patients with medical illnesses such as cancer, HIV AIDS, traumatic brain injury, spinal cord injury, and ALS have been examined independently and in comparison to other caregiver groups. Although limited, research findings suggest that the experiences of individuals caring for family members with different medical and care needs may differ significantly. Differences may occur due to patients' rate of disease progression, functional abilities, or palliative care requirements, for example. Also, caregiver variables such as age, coping abilities, relationship variables, and other factors...

Interventions With Family Caregivers

A variety of interventions with family caregivers have been developed to relieve stress and improve management of dementia-related problems. From a theoretical perspective, negative outcomes of caregiving such as depression and poor health are the result of primary stressors that are associated with primary care, secondary stressors that represent the spillover of care tasks into other areas of the person's life, as well as resources that limit or buffer the effects of stressors (Aneshensel, Pearlin, Mullan, Zarit, & Whitlatch, 1995). Among the resources that affect the impact of stressors on outcomes are how caregivers appraise stressors, how they cope with or manage stressors, and how much help or support they receive. In varying degrees, many different treatments have been developed that target these resources. Protocols involving 6 to 10 sessions with the primary caregiver and one or more meetings with other family members have been found to be particularly effective in relieving...

Childrens Companionship Age Gender and Kinship

Children's age has a strong influence on their choice of companions, much more so than does their gender in the early years. Age-related changes in children's physical, social, and intellectual capacities are necessarily related to changes in their social settings and their companions. For example, infants and toddlers require constant supervision and show dependency behaviors such as seeking comfort, protection, and food from the primary caregiver or designated guardians. They are more likely to be in the company of mothers or other female adults (grandmothers, aunts, or hired caregivers) rather than male adults in almost all cultural communities.

Joanne Zurlo And Alan M Goldberg Refinement Alternatives

Assessing the quality of life for the animal requires some understanding of the animal's point of view of its world. The discipline of animal behavior provides tools to evaluate an animal's well-being. With the awareness of the importance of the human caregiver and the potential stress of various restraining techniques that limit movement, animals can be trained, by positive reinforcement, to cooperate with medical examination procedures so that restraint is not required. Alternatives to Animal Experiments (Refinement Alternatives) Animal caregivers in this laboratory conducted systematic observations of rabbits and concluded they preferred social housing, as seen here. Photo by Lynette A. Hart.

Similarities and Differences in Fathers and Mothers Interactions with Offspring

Much of the research into parent-child relations has been informed by the belief that mothers influence children's physical, emotional, psychological, and social well-being through expressive and affective behaviors, including warmth and nurturance (Bowlby, 1969 Hojat, 1999 Mahler & Furer, 1968 Phares, 1992 Stern, 1995), whereas fathers have often been viewed as influencing children's development through the instrumental roles of provider and protector, and as role models for social, cognitive, psychological, and gender-identity development (Bronstein, 1988 Gilmore, 1990 Lamb & Oppenheim, 1989 Mackey, 1996 Parsons & Bales, 1955 Radin, 1981b). However, contemporary research suggests that maternal behavior is not situated exclusively in the expressive sphere any more than paternal behavior is situated exclusively in the instrumental one. Indeed, multivariate research in the 1990s demonstrated the importance of paternal expressive and affective behaviors despite the fact that mothers are...

Youths Age and Gender

According to Collins and Russell (1991), research in Western societies shows that fathers and mothers interact differently with their middle childhood (i.e., preteens) to adolescent children than with younger children. For example, fathers generally interact with their adolescents through focusing on instrumental goals (e.g., school and athletic achievement, future plans) and objective issues such as political discussions. Mothers' interactions with adolescents, on the other hand, tend to be marked more by discussions of personal issues. More specifically, in their review of the literature on U.S. families, Collins and Russell (1991) reported that 15- to 16-year-old U.S. adolescents spent twice as much time alone with their mothers as with their fathers. Collins and Russell also reported that 14- to 18-year-olds, more than 12- to 13-year-olds, spent more time alone with their mothers than with their fathers. As for middle childhood, Collins and Russell (1991) found that mothers tend...

Hypothalamic Regulation Of Aggression

Clinical observations in humans suggest a broadly similar role for the hypothalamus in human aggression. Neoplasms that destroy the ventromedial hypo-thalamic area bilaterally are associated with attacks on caregivers reminiscent of animal aggression following ventromedial lesions. In the classic report of Reeves and Plum, a 20-year-old woman developed bulimia and obesity, amenorrhea, diabetes insipidus, and profound behavioral change. Over a 2-year period, she displayed outbursts of aggression characterized by indiscriminately scratching, hitting, or biting examiners who approached. She denied experiencing angry or vindictive internal feelings toward these individuals and expressed surprise and regret regarding her attacks. The outbursts tended to occur more frequently when she had not eaten for several hours, suggesting the emergence of predatory-like aggression. Postmortem examination revealed a hamartoma destroying the ventromedial hypothalamus. In another case report, a patient...

Changing Attitudes on Child Abuse

Whether moral principles, such as those designed to guide the care of children, have changed over time or whether people have gradually become more or less virtuous in the treatment of children will be debated elsewhere in this work. Currently, attempts to formulate standards for appropriate ethical and legal responses to child abuse can be seen as efforts to craft social and legal policies that reflect our views of how children should be cared for and reared. But parents and other caregivers receive conflicting messages from current social policies whereas our society restricts child abuse, its institutions and laws condone other activities such as sexual activity during early teenage years and exposure to violence in television, films, and daily life that would have been regarded as morally problematic in societies of previous eras and are so regarded in non U.S. societies in the early twenty-first century. From one perspective, these conflicting efforts can be seen as experiments...

Gender and Socialization

Caregivers in all societies share the dilemma of how to talk to humans who have not yet mastered language. The ways caregivers solve these dilemmas reflect distinctive cultural attitudes towards children, adults, and parenting. Ochs (1992) argues that the use of different child-rearing strategies shapes, in considerable part, some of the differences in how the social positions of women are understood. Some caregivers accommodate to children (child-centered cultures) others ask children to accommodate to them (adult- or situation-centered cultures). For example, European American middle-class North American caregivers simplify their talk when speaking to young children. They use a smaller vocabulary, shorter sentences, exaggerated intonation, talk more slowly, and repeat themselves often. Before children are able to talk, they may even construct elaborate dialogs in which they take the part of both interlocutors ( You see that squirrel outside Yes, you do You like the squirrel don't...

Overview and Fundamental Characteristics

Behavioral consultation is a treatment modality that involves at least three individuals the client, the consultee, and the consultant. The client is typically a child who is exhibiting some sort of behavior problem and needs psychological services. The consultee is typically a caregiver for the client, usually a parent or teacher, but it could be a peer. The consultant is a mental health professional, trained in a variety of treatment practices and techniques. Through the consultation process, the consultant and consultee work together to address the challenging behaviors displayed by the client. The consultation process also can be used to increase the skills and social competencies of the client.

Applications And Exclusions

There are also considerable advantages to treatment by having the consultee act as the primary treatment agent. Because the consultee is typically a caregiver for the client, the consultee usually spends substantial periods of time with the client on most days. Thus, the client can receive continuous and ongoing treatment. In addition, the treatment usually takes place in the natural setting, where the problem behavior actually occurs. This context permits immediate, on-the-spot application of the strategies developed in the treatment plan. Finally, because the consultee can readily observe the client's behavior in the natural setting, the consultee can collect extensive data on client behavior, which permits thorough evaluation of plan effectiveness.

Future Directions

Given the current status of the literature, a possible future direction for research could be guided by acknowledgment of the heterogeneity of caregiving experiences. As opposed to directing efforts toward discovering features of caregiving that are common to all diseases and illnesses and developing generalized, global interventions, it may be more beneficial to develop an understanding of illness-specific caregiving stressors and demands. Clinicians and researchers are challenged to develop new ways to apply cognitive and behavioral interventions and prevention services to populations who are not usual consumers of psychological services, or who may not have the time or ability to attend traditional outpatient treatments.

Parental and Other Caretaker Roles

For the first few years of a child's life, the mother and other close female relatives are the primary caretakers. Fathers may be very loving with their small children and play with toddlers of both genders, but their time with them is limited. Abelam of both genders are generally very affectionate with their children and very indulgent of them. Disciplining small children with physical punishment is very unusual in Abelam society (Scaglion, 1999a). When discipline becomes necessary, scolding or withholding food are more common punishments, and, as the primary caregivers, females are usually the disciplinarians. After the first several years, men take a more active hand in parenting boys, while women continue their primary role in socializing girls. When young girls are of an age to be sexually active, men again take a strong interest in their socialization. Abelam believe that sexual activity may be harmful to yam growth (Scaglion, 1998), and fathers and brothers are accountable for...

Stephanie H Felgoise and Krista Olex

Keywords medical illness, caregivers, chronic illness Changes in the philosophy underlying the provision of health care and medical technology have extended the lives of patients with chronic illnesses and have resulted in increased numbers of patients requiring in-home medical care. Often, the responsibility of providing such care lies with family members, also termed caregivers. Informal or lay caregivers is operationally defined as those unpaid carers who provide physical, practical, and emotional care and support for a loved one with a chronic or terminal illness (Harding & Higginson, 2003). Duties that had previously been the responsibility of formally trained health care professionals are now performed by lay caregivers, essentially rendering them members of the patient's health care treatment team. Fairly recent estimates have indicated there are over 52 million lay caregivers in the United States (Health and Human Services, 1998). As such, caregivers have and will continue to...

Supplementation with Micronutrients

ORT reduces mortality from dehydrating diarrhea, but it does not decrease the duration of episodes or their consequences, such as malnutrition. In addition, adherence to recommendations regarding ORT in children is poor because caregivers want to reduce the duration of illness. This often leads to use of antibiotics and other treatment of no proven value. In addition, there are indications that knowledge and use of appropriate home therapies, including ORT, to manage diarrhea successfully may be declining in some countries. The limitations of ORT and continued high diarrhoeal morbidity, mortality, and associated malnutrition led to a search for adjunct therapies. Zinc and vitamin A are essential to repair the intestinal mucosa and boost

The Obligations of Emergency Health Workers

A feature of the healthcare workers' morality that should, in principle, set them apart from the rest of society is that their circle of concern knows no distance. Yet it is worth asking if this presumption of universal concern, of impartiality, is always sound when it competes with more local concerns about one's own family, friends, and colleagues. Further, partiality is not a vice if it is conceived as one way in which human beings express their individuality through the uniqueness of their relationships (Eckenwiler). Healthcare professionals functioning in emergencies may not be expected and should not be required to subvert justifiable tendencies to place primary value on personal relationships when forced to allocate their caregiving under extreme conditions.

Ferber Techniqueeffect

The Ferber technique effect requires that the care-giver place the infant in its crib, then leave the room and ignore the infant's crying for at least 20 minutes. Subsequently, the care-giver returns to the crib, pats the infant on the back, but doesn't pick it up, and then leaves the room quickly. This procedure is repeated every night, increasing the waiting period by five minutes per night before responding to the infant's crying with patting. This often controversial child-care practice is similar, theoretically, to a modification of the operant behavioral conditioning procedure called fading used in stimulus control and errorless discrimination learning situations (where discriminative stimuli are faded out gradually) but, in this case, fading occurs by slowly extending (fading out) the waiting time period before the reinforcing stimulus (pat or attention given by the care-giver) is administered. The Ferber technique effect seems to work for some infants, but not for...

Impact on Health and Quality of Life

Cognition, and motor deficits are perceived as severe deficits, greatly reducing quality of life. Initial stroke symptoms include weakness in 88 of stroke survivors, sensory deficits in 50 , and visual, cognitive, or speech impairments in 30-48 . Depression affects almost one-third of patients with stroke and half of those with left frontal lobe stroke. Caregivers are susceptible to anxiety (58 ), depression (50 ), fear, frustration, impatience, and resentment. Functional impairments following stroke may become the responsibility of these caregivers if other sources of social support are not sufficient, and such caregivers may be forced to leave the workforce temporarily or permanently. These intangible and indirect costs of stroke are among the most devastating to the family and the most difficult to measure. Thus, stroke substantially diminishes caregiver quality of life, and only recently have quality of life assessments begun to reveal the true impact of cerebrovascular disease.

Organizing the Estate Plan to Ensure the Continued Care of the Child

Selecting a New Primary Caregiver No one is in a better position to understand the day-to-day obligations a primary caregiver faces than the parents of a child with a disability. One of the first items parents should consider is who will assume their role when they are gone. The parents must consider what their everyday role is and weigh who or what organization can fulfill the physical and emotional needs of the child. A carefully structured trust may provide the child with the disability with security while allowing the child to qualify for government benefits. This plan provides the family with maximum flexibility, which allows the new primary caregivers to take those actions necessary for the child with a disability's social, emotional, physical, and financial needs. What is different in the special needs trust Special needs language and discretionary distribution language is placed in the trust. The trustee is given absolute and sole uncontestable discretion as to whether the...

Implementation of EHealth Records

Interface the different tools available for making EHRs useful, such as decision support, analytical tools, and learning tools and a security layer to ensure the protection of the electronic health records. The e-stakeholders consist of e-patients or e-consumers the general public e-health professionals, including e-health administrators and e-caregivers e-health policymakers and researchers and third-party e-payers, including employers and e-health insurers. Because of its implications for all of the functions just described, it is evident that the effective design of the technology infrastructure for EHRs must involve all e-stakeholders, including e-health care providers, e-payers, e-vendors, and e-consumers sharing ideas among all parties involved will determine what information is needed from the system, in what standardized format, and in what manner the information will be used (Tan with Sheps, 1998). As has been noted time and again, e-stakeholder endorsement and support is of...

Caring in Nursing Theory Philosophy and Ethics

Nursing theorists, educators, and philosophers explored and applied a more extensive theory and ethic of care prior to 1982 than any other single group had. Their contributions differed considerably from those of physician-writers The nursing theorists paid much more attention to the meaning and theories of nursing, examined the structures and functions of care, turned occasionally to philosophers who had explained the meaning of care (such as Martin Heidegger and Milton Mayeroff), developed the implications of care for nursing practices and skills, considered the status of caregivers, showed an interest in the historical links between nursing and maternal care, and proposed educational improvements to foster professional care. ingredient in the curative process, because caring acts and decisions make the crucial difference in effective curing consequences (Carper, p. 14, quoting Leininger, 1977, p. 2). Anne J. Davis stimulated reflection on the relationship between caring and ethical...

Communicate with the Family

Assess and treat the child in the context of his or her family, avoiding separation whenever possible. Emergency department policy should encourage parental accompaniment of children to the clinical area. It is optimal to consider that there are two patients, child and parent(s), each with expectations that must be addressed. Caregivers have essential historical information and, in the case of infants and toddlers, are physically necessary to the performance of a meaningful physical assessment. At all ages, children watch their parents for cues with respect to how to respond to the medical staff. Parents who understand and accept the sequence of events involved in emergency care become allies in enlisting their child's cooperation. Whenever possible, parents should be encouraged to remain present during procedures, maintaining visual and physical contact from a sitting position. Appropriate exceptions include parental discomfort and critical illness. Finally, because parents are...

Primary Health Care and EHealth Records Cases

Greater harnessing of information and knowledge within a team means that vastly greater amounts of sensitive medical data and information are available to many more people than were available a relatively short time ago. Thus, security and confidentiality are no longer as easy as remembering to lock the filing cabinet and keeping the key safe. E-technologies allow greater and more effective use but also potential for misuse of information, leading to the need for further technological aids to address information security and integrity requirements. The importance of continuing education both in monitoring and in improving skills and knowledge in the primary health care profession is well known. However, in some contexts, such as rural settings, literature is scarce and access to primary care may be difficult to come by. In these situations, caregivers rely even more on e-systems for access to up-to-date information (Murray, 1995). E-decision support systems, e-medicine, and e-home...

Alternatives to Rights

Given children's vulnerability to abuse and neglect by immediate caregivers and by society at large, what ethical bases other than rights might serve to enhance children's welfare Philosopher Onora O'Neill (1989) suggests that Immanuel Kant's notion of imperfect duty provides such a basis. An imperfect duty the duty to contribute to charity is an illustration differs from a perfect duty in the latitude allowed for fulfillment toward whom and how much the duty requires is not specified. Thus, although we all have an obligation to help the next generation not only to survive but also to develop its capacities, we may meet this obligation in different ways some as parents, some as professional caregivers, some as taxpaying citizens. The idea is attractive philosophically, but it admittedly lacks the Unlike the children's rights approach, which may pit parents against children, this approach does not put parents on the defensive. But virtue ethics also has theoretical difficulties, chief...

Serious Illness And Other Unanticipated Absences

Both therapists and clients tend to find comforting the myth that the therapist is immortal and invulnerable (Pope, Sonne, & Greene, 2006). Therapists may enjoy the feeling of strength and of being a perfect care-giver that such a fantasy, which sometimes occurs on an unconscious level, provides. Clients may soothe themselves (and avoid confronting some personal issues) with the fantasy that they are being cared for by an omnipotent, immortal parental figure.

Therapeutic Aspects of Community Relations

Shamanistic healing typically occurs in a community context. Community participation facilitates therapeutic effects derived from psychosocial influences (positive expectation and social support). These collective rituals strengthen group identity and commitment, enhancing community cohesion by reintegrating patients into the group. Communal healing practices reinforce attachment needs in the mammalian biosocial system (Kirkpatrick, 1997). Attachments and affectional bonds that evolved to maintain proximity between infants and care-givers provide a secure basis for the self, feelings of comfort, and protection from powerful figures (e.g., shamans, spirit allies).

The Family As A System

The first question we must address when a child is referred is, Who is the family As in any clinical work, we must carefully avoid preconceptions, withhold our own attitudes and beliefs, and merely ask the question without reacting to the response. We need to know both who the legal guardians of the child are and who the primary caregivers are. We need to know other potential sources of influence on the child's development. In other words, we need a map of the child's family system. This map may be verbal and conceptual, or it may be an actual diagram of relationships. Bailey and Simeonsson (1988) described two approaches to visual portrayal of

N Psychosocial Aspects of Aphasia

The psychological reactions to aphasia are believed to be influenced to some degree by premorbid personality, level of achievement, and values. As a result of its negative effect on interpersonal activity and quality of life, aphasia is frequently referred to as a social disability. By far the most commonly mentioned psychological reaction is depression. Difficulty in coping with being socially different, feelings of loss, grief, and lowered self-esteem are also pervasive. Family members also suffer from the effects of role changes, caregiving, the impact on the family's sources of gratification, and difficulties in communication.

Prevalence Of Psychosocial Distress

Although there is a great deal of variability in individuals' responses to the challenges of providing care, family caregiving is associated with higher rates of psychosocial distress and mental health problems. This is especially true for family caregivers of individuals with dementia. Studies of dementia family caregivers have found elevated rates of depressed, irritated, and anxious mood, clinical depression, and generalized anxiety disorder among this population. In addition, dementia family caregivers tend to report poorer perceived sleep and general health, and an increased use of psychotropic medications (Ory et al., 2000). These declines in psychosocial functioning not only affect the caregivers' general well-being and quality of life, they also can affect their ability to provide care. Thus, interventions that aim to reduce caregiver psychosocial distress are extremely important. Before we begin our review of such interventions, however, we want to highlight that levels of...

Challenges To Mental Health Professionals

The literature on caregiving suggests that family care-givers often place their own mental and physical health needs secondary to those of their impaired family member. When they recognize that emotional distress is adversely impacting their functioning, family caregivers are more likely to select pharmacologic (i.e., antidepressants and or anxiolytics prescribed by their general practitioner) and community-based programs (e.g., support groups and educational programs) for themselves, compared to traditional mental health services. This tendency has important implications for how interventions are packaged and delivered, which has led many cognitive and behavioral interventionists to appropriately label their programs as educational classes, or coping workshops, rather than individual or group therapy (i.e., use of the terms therapy and psychotherapy is not common in these interventions). Most of the individual-based approaches cited were either entirely home-based, or included a...

Development and Evaluation of Mechanisms to Individualize Treatment

Behavioral and cognitive treatments generally include close attention to initial and ongoing assessments of target problems. Interventions using these theoretical orientations also emphasize a strong collaborative relationship between service recipient and clinician, as well as careful selection of which problem areas to begin to work on. Even highly structured and manualized treatments involve a focus on helping the caregiver apply the intervention strategies to his or her specific life situation. For that reason, one of our first recom-men-dations fits well with the majority of these treatment approaches Interventions for family caregivers should include mechanisms for tailoring the intervention to the specific needs of the participants. This recommendation is based on the heterogeneity of caregiving situations and the dynamic nature of providing care. We have not identified any research that directly compares more versus less flexible treatments. However, the tremendous variability...

Use of Behavioral and Cognitive Strategies to Assess and Intervene with Barriers to Treatment

There is a general recognition in the caregiving literature that most family caregivers either underutilize available services, or delay utilization until a specific service is no longer appropriate. Examples of this include enrolling an older adult in a home-delivered meals program when the family member actually needs daily supervision, or considering use of an adult day care center when the level of need is for residential care. These behaviors are often labeled as denial by service providers and are hypothesized to represent an emotionally driven failure by the family to recognize the older adult's true level of chronic impairment. Such occasions of denial, however, have not been studied in detail using cognitive and or behavioral perspectives. Consequently, it is not always clear exactly what denial means, how it functions throughout the caregiving career, and what might be appropriate intervention strategies. This area is ripe for assessment and interventions targeting the...

Recommended Readings

W., Gallagher-Thompson, D., & Thompson, L. W. (2002). Interventions for family caregivers. New York Springer. Coon, D. W., & Thompson, L. W. (2002). Family caregiving for older adults Ongoing and emergent themes for the behavior therapist. Behavior Therapist, 25, 17-20. Olshevski, J. L., Katz, A. D., & Knight, B. G. (1999). Stress reduction for caregivers. Philadelphia Taylor & Francis. Yeo, G., & Gallagher-Thompson, D. (2000). Ethnicity and the dementias. Washington, DC

Conducting A Family Interview

We also need to know the family's goals and priorities, and E. W Lynch (1998) adds the need to gather information about the family's structure and arrangements for caregiving knowledge of the family's child-rearing practices, including family sleeping patterns and the family's perceptions about disability, health and healing, and help seeking and intervention. This type of information helps with the development of appropriate planning for services to the child and family. The sources of data for these domains come from tests, observations, interviews, and rating forms. The Bailey and Simeonsson (1988) book has a useful form for eliciting family needs. Their child observation form covers developmentally referenced assessment and has a section for family supports and needs, and this chapter offers my own procedure for assessment of caregiver-child interactions. Readers may also find the Parenting Stress Index (Abidin, 1995) a useful instrument, and Trivette, Dunst, Deal, Hamer, and...

Epidemiology of breathlessness in paediatric palliative care

A chart review of the end-of-life care of children with cystic fibrosis showed that almost half were reported to have both dyspnea and chest pain and most received opioids from between one hour to more than one month before death.8 There remains a dearth of literature on the prevalence and severity of dyspnea in children dying from illnesses other than cancer. From the data that exists to date it appears that dyspnea is both a common and very significant symptom for both the affected children as well as for their caregivers.

Tele Rehab at Integris Jim Thorpe Rehabilitation Center

IJTRC program was a core group of clinicians and therapists who were able to focus on patient needs, putting aside uncertainties and barriers in order to address a growing underserved population. This driving purpose led them to devise safe and effective alternatives to traditional modes of delivery. A physical therapist, for example, might use a caregiver in a home situation as an assistant to lower the probability of patient falls, provide patient props, reinforce therapist instruction through cueing, and promote compliance with an in-home exercise regimen. A speech language pathologist might use toys such as an automated reader for joint play with the client in order to sequence language exercises to assist with reading skills. A psychotherapist could address adjustment to disability for the caregiver as well as the patient in the safety and anonymity of their home setting. This program has been developed over a period of three years. To date, a total of 3,711 consults have been...

Borderline Personality Disorder

Historically, the term borderline marked a boundary between psychotic and neurotic personality types, but it has increasingly come into usage as a noun, carrying a pejorative meaning. This can be seen in language used to describe the treatment of such patients. They are considered difficult to treat because of the intensity of their engagement with caregivers, the sometimes overwhelming nature of their demands for care, and the strong emotions and conflicts that they provoke in others (Herman et al. 1989 1). Put less delicately, one researcher claims to distinguish BPD patients from depressed or schizophrenic ones by their angry, demanding, and entitled presentation, (Solof 1981 quoted in Mitton and Huxley 1988 341) and another warns that any interviewer, whether with a clinical or research purpose, will be exposed to devaluation, manipulation, angry outbursts, clinging or appeal (Mitton and Huxley 1988 341). Most bluntly, borderliners are the patients you think of as PIAs pains in...

Management of breathlessness in children

In the management of breathlessness in children with advanced disease it is first and foremost necessary to clearly identify the goals of treatment. The goal of the treatment of dyspnea is to reduce the child's perceived unpleasant or painful sensation of breathlessness or air hunger. Treatment may not diminish the outward manifestations of respiratory distress (i.e. tachypnea may persist) but aims instead to eliminate the child's inner feeling sensation of dyspnea. This may be important to articulate to both parents and professional caregivers who may not be aware that a child who appears relaxed but tachypneic is not necessarily experiencing breathlessness as a perceived sensation. In fact, the effects of drugs in the benzodiazepine and opioid class are often to decrease the sensation of dyspnea without necessarily altering the respiratory pattern.

The Culture of Biomedicine and Biomedical Death Reflect Features of US Society

National efforts to improve end-of-life care often include the notion that cultural change or promotion of cultural readiness is essential for reform efforts to be successful (Moskowitz and Nelson). Yet, what this cultural change would look like and what barriers to such change exist are rarely itemized. National public awareness campaigns such as Last Acts have used a variety of strategies to change the culture of dying in America, including working with the media. For example, one strategy has been to sponsor scriptwriting conferences to encourage widely viewed television programs, such as ER, to include realistic stories about patients near the end of life. In fact, one episode focused on end-stage cystic fibrosis. Narratives created for television might convey the idea that a comfortable, pain-free death is possible and should be demanded by patients and families as an essential feature of a comprehensive healthcare system. The stories might convey the important lesson that...

Appendix Information on Recommended Measures Child Health Questionnaire

The FIQL scale is a symptom-specific measure of QoL developed from input from both patients and caregivers 108 . It is composed of 29 items that form four scales lifestyle (10), coping behavior (9), depression self-perception (7), and embarrassment (3). Each item has four to six response categories. Scale scores are the mean response to all items in a scale. A total score was not calculated by the developer, but one has been used by Jess and colleagues 52 .

Euthanasia Of Newborns With Impairments

Because newborn infants cannot make informed decisions about whether to end their lives, those who grant that some euthanasia is legitimate usually argue that such decisions should be made for newborns on the basis of whether a child's life will be of value to the child. The witholding of life-prolonging treatment is treated in the same way because there is no possibility in this case of informed refusal of treatment by the patient. According to the minority group model, infants born with incurable impairments may be wrongly killed because caregivers and parents assume that their lives would be entirely unrewarding even though many people with similar disabilities lead satisfying lives.

Withholding Food and Water The Patient Experience

Robert McCann reported an experience with thirty-two dying cancer patients in a hospice-like setting. These patients were sufficiently aware to judge hunger and thirst, and were offered food and water as desired. Nearly two-thirds experienced neither hunger nor thirst one-third had hunger only initially. Oral feeding as desired and or mouth lubrication effectively met needs when they occurred and caregivers could focus on patient comfort.

Type of Nutritional Support

Products can be used to augment a patient's dietary intake. They are available in the form of milk, sweet and savoury drinks, fortified fruit juices, milkshake powder, glucose polymer powders and liquids, and puddings. Patients and caregivers need to be given complete instructions regarding their use to optimise this form of nutritional supplementation. Unfortunately, many studies found that in COPD the use of these supplements led to a reduction in usual energy intake and caused symptoms such as bloating, nausea, and early satiety. Oral supplements are probably less effective in older patients with a systematic inflammatory response.

Chemoaffinity Hypothesis

The data of language acquisition, a third perspective emphasizes the personal interaction between infant and caregiver, between one person and another, and between the person and the environment as the heart of language learning (cf., neurolinguistic theory - study of language via analyses of deficits and impairments of language function resulting from neurological damage and semiotic theory - study of patterned human communication in all its forms, including spoken and written signs and symbols, touch, gestures, and facial expression). Chomsky's notions concerning transformational grammar, although they revolutionized the field of linguistics, do not provide all the answers to the many problems of language acquisition. Psychologists, while retaining many of Chomsky's ideas, have moved on to new research regarding language behavior. See also GREEN-SPOON EFFECT LAN-GUAGE ORIGINS, THEORIES OF NATURE VERSUS NURTURE THEORIES SKINNER'S DESCRIPTIVE BEHAVIOR AND OPERANT CONDITIONING THE-ORY...

Norman Andrew Clemens

The health care record has multiple purposes and many potential readers, intended and unintended. For the clinician and the patient or client, it is a record of diagnosis and treatment that serves continuity of care both by the treating clinician and any succeeding care-giver. In an organized setting such as a hospital or clinic, it may facilitate knowledgeable treatment by circulating information among a number of caregivers. The record may also benefit future patients by contributing data to research. Medical information is often requested by third-party payers to assess the validity of health care insurance claims. In the era of managed

Introduction And Definition Of Issues

Costs to individuals households1 Human illness costs Medical costs Physician visits Laboratory costs Hospitalization or nursing home Drugs and other medications Ambulance or other travel costs Income or productivity loss for 111 person or dying person Caregiver for ill person Other illness costs Travel costs to visit ill person Home modifications Vocational physical rehabilitation Child care costs Special educational programs Institutional care Lost leisure time Psychological costs

Dilemmas And Controversies

There is a wide variation in the way psychotherapists handle this dilemma, depending on the locus of treatment, the therapist's technical and theoretical orientation, the nature of payment, and the potential risks of invasion of the record. Many therapists, especially in solo private practice, keep minimal records. Some keep none, which forestalls access to any written psychotherapy information by third parties for any reason (although it does not preclude a subpoena of the therapist for testimony). However, it also exposes the therapist to serious legal risks and may detract from the continuity and coordination of care. In hospitals or multidisciplinary, ambulatory settings a detailed record may be required by institutional standards and the exigencies of coordinating care by a variety of care-givers. In training situations detailed notes may be essential for supervision or consultation with more experienced clinicians.

Artificial Nutrition Support Home Parenteral Nutrition and Home Enteral Tube Feeding

Patients suffering from chronic conditions often prefer to be treated in the familiar surroundings of their home rather than in hospital. When the treatment involves sophisticated techniques, it is essential that either the patient or the caregiver is adequately trained to distinguish between problems that can be easily remedied at home and those that need

Costeffective Treatment Options For Generalized Dystonia

In a treatment setting limited by financial concerns, the potential or confirmatory blood or imaging studies is likely unavailable. In this arena, evaluation and treatment of generalized dystonia relies heavily on careful history and physical examination. Since phenotypic expression of ITD is highly varied in this population, extreme care should be taken in recording family data with particular attention to consanguinity or Jewish ancestry. Given that an early onset of symptoms is predictive of ITD, this information is important for families to assist in planning for longer-term medical and care-giver support. Initial area(s) of involvement and pattern and rate of spread to other areas in an affected child also will assist parents and families in determining long-term care issues. Treatment of generalized dystonia in a setting in which the use of botulinum toxin, a baclofen pump, or surgical intervention are not options will rely heavily on assistive devices and oral medications....

Home Parenteral Nutrition

Many patients are able to receive PN in the home setting. If the patient's medical condition is stable and careful patient selection has been employed, home parenteral nutrition (HPN) can be considered. The patient and caregiver must be able to be taught to use an infusion device, administer PN safely, and search for signs of infection, fluid issues, or other complications. Appropriate education should begin in the hospital and continue in the home setting. Psychosocial and socioeconomic issues, such as family support, private or government payer status, and patient emotional status, are important to consider when assessing the appropriateness of HPN.

Suggested Guidelines For Observing Play

For this procedure the assessor needs to assemble a standard toy set and select one toy that is familiar and one that is unfamiliar to the child. These selections can be from within the toy set, or the caregiver can be asked to bring one of the child's favorite toys from home however, it is necessary that this toy be able to elicit a variety of interactions and not be just a transitional, hug -type toy. A typical standard toy set might include play dough, a construction toy, miniature family figurines, crayons and paper, a puzzle, a book, a bang or hit type of toy, and another that inspires search and exploring kinds of behaviors. The assessor would proceed in the following sequence This procedure is a guide to observations of young children's play under conditions of independent and facilitated interactions with materials, as well as comparisons of the child's interactions with both familiar and unfamiliar toys. Determination of familiarity is best derived from consultation with the...

Clinical Features

Delirium, or acute confusional state, is acute in the sense that it is present over days to weeks by definition less than 1 month, although rapid onset may be noted. Attention and the cognitive functions of perception, thinking, and memory are all distorted to varying degrees. Alertness (but not necessarily consciousness) is reduced. The patient may appear quite awake but attention is impaired. Activity levels may be increased with agitation or decreased in a quiet delirium. Three variants are described a hypoalert-hypoactive type, a hyperalert-hyperactive type, and a mixed type. The patient with the mixed variety may fluctuate rapidly between hypoactive and hyperactive states. Symptoms may be intermittent, and it is not unusual for different caregivers to witness completely different behaviors within a brief time span.3 The sleep-wake cycles are often disrupted with increased somnolence during the day and agitation at night. The increased nocturnal agitation is commonly referred to...

Gender over the Life Cycle

The birth of a boy, who continues a father's patriline, is more celebrated than that of a girl, who is given away in marriage. Otherwise, there is little overt difference by gender in the treatment of young children (Rohner & Chaki-Sircar, 1988 Seymour, 1999). For upper-caste males, however, there is an idealized four-stage life cycle (the dharmasastras) outlined in Hindu ethical-legal texts (1) celibate student, (2) married householder, (3) disengaged forest dweller, and (4) wandering mendicant (sannyasi) preparing for death and potential release (moksha) from the cycle of rebirth. Women and lower-caste males have less well-defined life stages. For upper-status females the onset of menarche marks the beginning of restrictions on behavior and change of dress. Marriage overtly defines the transition from childhood to adulthood, and old age is marked by a reduction in work and the receipt of care from others. Throughout life, regardless of gender, one is either a caregiver or a...

Nutritional Assessment Tools

Arrays of nutritional screening tools have been developed to facilitate the identification of older persons at risk for undernutrition. The Nutrition Screening Initiative (NSI) in the US stemmed from a collaborative effort between family physicians, dietitians, and the National Council of Aging. This is a three-tiered tool formulated to assist in the detection of older persons at risk for nutritional compromise and subsequent direction of such persons toward the appropriate level of care. The first level of screening is designed to be initiated by the patient or primary care giver. Persons identified to have an increased risk of undernutrition are then referred for evaluation by healthcare or social services personnel. This constitutes the second level of screening. The identification of factors that may warrant medical intervention will prompt referral to a physician for further evaluation. The NSI is of proven value as an epidemiological tool and serves to increase the awareness of...

Managing Undernutrition in the Community Setting

With increasing emphasis on home healthcare, the number of community-dwelling persons requiring alternative modes of feeding has increased. Special consideration and appropriate modification of therapeutic regimens may be required in such cases to ease the care giver or personal burden. If enteral tube feeding is provided at home, continuous infusion may limit the patient's mobility and functional independence. This method also has the disadvantage of requiring immediate access to technical support, in the event of mechanical failure of the infusion pump. Thus, care givers and patients may find intermittent bolus feeding a more convenient and less daunting task. To minimize the aspiration risk, intermittent bolus feeds should be administered, where possible, with the patient in a seated position. Patients should also be encouraged to remain seated for at least 1 h after feeds. Some active older people resent the social inconvenience and embarrassment of tube feeding during daytime...

Positive Pressure Technique

The successful use of this method is well documented.9,1 and H It can be performed in both cooperative and uncooperative patients, and it is less invasive. After vasoconstrictors, positive pressure can be applied by the patient, if cooperative, or the caregiver. The caregiver is instructed to give a puff of air to the mouth of the child while occluding the unobstructed nare with a finger. The foreign body is usually expressed from the nose onto the cheek of the caregiver. Repeated attempts

Developmentbased Testing

Examples of procedures that are both development- and curriculum-based include the Learning Accomplishment Profile-Diagnostic Standardized Assessment 1992 Revision and Standardization (LAP-D Sanford & Zelman, 1981) and the Hawaii Early Learning Profile (HELP) for Preschoolers (VORT, 1995). The Developmental Observation Checklist System (Hresko, Miguel, Sherbenou, & Burton, 1994) is an example of one of the better assessment tools that can be used for multiple purposes to screen children between the ages of birth to 6 years to determine risk for developmental problems, to target areas of need for intervention, and to monitor the children's response to intervention. This is a standardized, normed procedure that depends on ratings by caregivers. There are three components a developmental checklist, a behavior adjustment checklist, and a parent stress and support checklist. The items on these scales represent a more updated review of the research literature than is available from most...

Hospitals and Physicians Offices

Faced with increasing pressure to reduce expenses, along with changing health care consumer expectations for greater accountability and higher-quality care and services, hospitals as well as physicians' offices nowadays are trying to cut costs while maintaining quality of services. To manage their day-to-day business activities more efficiently and effectively, both groups are turning to emerging technologies for new and innovative ways of doing business. Strategic uses of e-technologies can help achieve the goals of reduced costs and more time for patient care. To this end, e-technologies such as intranets and extranets can prove to be effective. For example, e-technologies can be used for marketing, for providing on-line scheduling information to patients, and for the exchange of information between e-caregivers and e-patients and between users and insurance companies.

American Health Care in the 1930s The Robin Hood Model of Economics

This decade in history is known as the Great Depression, characterized by hunger, high unemployment, and economic stagnation. It was also the decade when medicine ascended fully to the stature of a profession, having established A and B grade medical schools, replacing the apprenticeships by which characteristically one became a physician in the 1910s and 1920s. Soon all but A grade medical schools were closed, upgrading the profession even more. The physician of the 1930s was proud, altruistic, well-educated, and dedicated. The Hippocratic Oath was taken seriously, and in spite of a shortage, the physicians saw everyone who wanted to see them, even if it meant a consistently 16-hour work day. A request for a house call was never denied. It was unthinkable to press a bill for payment, and no physician would even consider using a collection agency. Patients were seen and house calls were made even when a patient had not paid the accumulated bill for 3 or 4 years. Physicians knew people...

Language Origins Theories Of

- holds that the interaction between the infant and caregiver, or between one person and another, is at the heart of language acquisition and development. Another speculation is that language origination acquisition development is analogous to the ethologist's imprinting phenomenon (cf., Hess, 1959 Lorenz, 197071) - that is, a form of rapid learn-ing (via innate ability) that takes place during a critical period of development, where the environment provides the requisite stimulation to release or trigger the behavior cf., the waggle dance of bees, described by the Austrian zoologist Karl von Frisch (1886-1982), that comes closer to being a language than any other nonhuman communication system and Yerkish - named after the American psychologist Robert Yerkes (1876-1956) who experimented with primates - refers to an artificial language using a computer console with keys containing geometrical symbols for words in the effort to communicate with, and study language development in,...

Medications for the relief of dyspnoea at the end of life

In considering the evidence for use of pharmacotherapy for symptomatic breathlessness, it is important to consider the quality of the evidence (validity) and the population studied (generalizability). The palliative population is heterogeneous and each person has varying contributions to their breathless-ness from the disease (primary life-limiting illness and comorbid causes), the interpretation of their situation (cortical input) and their response (what health professionals and caregivers family see). None of this happens in isolation of the non-pharmacological approaches to people with dyspnoea in the face of advanced disease.

Harm and Harm Referring Duties in Bioethics

Assessing harm and distinguishing it from offenses, minor hurts, or non-harmful instances of lacking benefit requires an analysis of harm's nature and of how to determine its significance. Particularly in the context of healthcare, many instances of harm and potential harm to patients are widely uncontested, namely severe lack of functioning resulting from bodily or mental disease, enduring pain, substantial suffering, gross disfigurement, or premature death. Another, easily neglected category of possible harm in the context of medical practice is of a psychosocial nature for example, patients may experience absorbing anxiety, mistrust, alienation, helplessness, loss of self-control, loneliness, or annoyance due to structural and human deficits. In particular, the work of feminist ethicists (e.g., Noddings Warren) and physician-ethicists (e.g., Cassell Pellegrino and Thomasma) has created a new awareness of widely neglected kinds of harm to patients that occur in daily medical...

Ethnomedical Care and Treatment

The efforts of caregivers to focus on decreasing the output of diarrhea sometimes results in withholding of foods and fluids. There is the danger that a resulting diminished flow of diarrhea is due to dehydration rather than lessening of the disease. This can have serious to fatal results. Purging is a rather common practice for the treatment of diarrhea and carries the potential risk of hastening dehydration. There is always the possibility that folk treatments can have harmful effects, just as biomedical practices are sometimes found to require re-thinking and modification. There is also some risk that traditional therapies may be pursued to the extent that life-saving measures of medical intervention are applied too late or not at all.

Classification Epidemiology of Hip Fractures

The possibility of elder abuse should be considered in all elderly patients with falls and fractures. Evidence of physical abuse such as bruises and burns, especially if they are unexplained, and of various ages and certain patterns should raise the physician's clinical suspicion of abuse. Patterns or well-defined shapes, such as an emersion pattern or rope or restraint marks on the wrists or ankles, should also raise suspicion. Signs of neglect, such as dehydration, malnutrition, poor hygiene, extensive bed sores, urine burns or excoriations, and fecal impactions, should also increase suspicion for elder neglect. Interactions between family or caregivers and the patient should be observed and Social Services should be consulted and abuse reported as required by law when appropriate. 28

Mobile Health Clinical Applications

Not only is wireless computing changing the lives of e-health stakeholders, but its effects are also becoming evident on a global and extraterrestrial scale. News articles about medical breakthroughs describe how e-medicine can be transmitted to the North and South Poles and even to outer space, providing e-care services to astronauts on the space shuttle. When one begins to fathom the countless possibilities that mobile computing technology opens up, the result is a growing stream of future applications and opportunities for scientific advances in almost every imaginable occupation. With regard to future-oriented e-patient care, the following list of ideas is only a sampling of the ways in which handheld technology can transform patient-caregiver interactions and provide instantaneous improvements. E-patient monitoring and tracking recording information such as vital signs, medical history, prescriptions, allergies, and patient laboratory data at the point of care and updating...

Bioethical Implications

The illness experience has implications not only for clinical practice but for the field of bioethics. Bioethical reflections need not be top-down starting from overarching theories and principles that then are applied to cases. They can be bottom-up commencing with the concrete situation of the ill and drawing out the needs and moral claims that follow. Indeed, some suggest that bioethics is undergoing a paradigm shift, with a new openness toward methodologies that pay close attention to the experiences of illness and caregiving (DuBose et al. Welie). Several consequences might ensue for the field. An experience-based bioethics would also look at the burden placed upon the individual practitioner by the special situation of the ill. This is not just a matter of What action do I take (the focus of deontological and utilitarian ethics), but of What kind of person should I, the caregiver, be (the focus of virtue ethics). The isolation and incapacity of the ill underscore the importance...

Personality Differences by Gender

Caribbean cultural stereotypes of proper women as dependent on men, natural nurturing caregivers, and bound to the home have been contested in the Caribbean and are displaced in the United States because women have greater success in the U.S. labor force, are often heads of households, and sometimes support legal and common-law husbands back home. These practices in turn disrupt cultural constructions of West Indian men as dominant independent breadwinners.

The Fundamental Moral Question Do People with Dementia Count

Despite the seriousness of dementia and the responsibilities it creates for caregivers, it is ethically important that the person with dementia not be judged by hypercognitive values (Post, 1995, 2000a). The self is not cognition alone, but is rather a complex entity with emotional and relational aspects that should be deemed morally significant and worthy of affirmation (Sabat). A bias against the deeply forgetful is especially pronounced in personhood theories of moral status in which persons are defined by the presence of a set of cognitive abilities (Kitwood). After discussion of the disparities in bioethical thinking about what constitutes a person, Stanley Rudman concludes, It is clear that the emphasis on rationality easily leads to diminished concern for certain human beings such as infants, and the senile, groups of people who have, under the influence of both Christian and humanistic considerations, been given special considerations (Rudman, p. 47). Often, the personhood...

Comportment Insight and Judgment

A neuropsychologist can assess these functions informally through naturalistic observation, reports from individuals familiar with the patient, and by inquiring about any accidents or legal infractions involving the patient. Formal measures of these functions exist primarily in the form of questionnaires that quantify the degree to which the patient manifests disturbances in these general areas. The Frontal Lobe Personality Scale (FLOPS) comprises 46 descriptions of various behaviors that are characteristic of patients with frontal lobe damage. Each behavior is assigned a severity rating by the patient and by a family member, and the overall severity rating is thought to reflect the degree of behavioral disturbance present. The Neu-ropsychiatric Inventory (NPI) is another self-report rating scale that is completed by a family member or caregiver. Both the extent of the patient's behavior and the degree of subsequent familial distress are rated.

Social And Environmental Etiologic Factors

While in general elderly victims are socially isolated from family and friends, many of them live with their abuser. When abuse occurs, it has been found that the abuser is often dependent upon the victim for housing, and financial and emotional support. Caretakers usually attempt to provide acceptable and appropriate care. However, when the caregiver is overwhelmed, frustrated, or resentful of the responsibilities involved in the task of caring for a less than fully independent elder, abuse and or neglect may occur.

Collateral Informants

The evaluation of developmentally disabled patient usually requires collateral information from others, including parents or other family members, group home staff, or social service agency staff. The extent and importance of such information increases as the developmentally disabled patient's ability to communicate decreases. Unfortunately, the person with the patient may have relatively little information about the patient's current problems and or past history. For example, 55 percent of caregivers in a community setting could not supply basic medical information about the patient. It is important to ask the collateral source explicitly how much information they have and whether there are others who can be contacted by phone who can provide additional information. It is also important to ask if they brought any written information with them. Frequently, lower functioning individuals will be living in group settings where a medical chart with a complete medical history, current...

Chronic Stress and Depression 1 Animal Research

The results of studies examining immune consequences of chronic stress in humans largely parallel the findings in animals. Research across a range of chronic stress situations, including bereavement, caregiving for a relative with dementia, unemployment, and diagnosis with a life-threatening illness, reveals that stressed individuals have altered immune function in comparison with controls. In contrast to the acute stress literature, chronic stress is typically, although not always, associated with lower numbers of immune cells and weaker immune functioning. In particular, chronic stress associated with the loss or disruption of personal relationships has been shown to reliably alter immune activity. For instance, women who have been separated or divorced for less than 1 year have demonstrated poorer immune function than married women, and both men and women who reported poor marital quality had lower immune function than more happily married individuals. Research has also suggested...

Esther Deblinger and Melissa K Runyon

These alarming statistics are most likely an underestimate given that these numbers are based on narrow definitions of abuse and only on those children who are abused by a caretaker. Other surveys, such as the National Incidence Study-3 (NIS-3 Sedlak & Broadhurst, 1996), have categorized CSA more broadly as the exploitation, involvement, or exposure of children, to age-inappropriate sexual behavior by older or more powerful peers or adults, for purposes of sexual gratification. CPA has also been more broadly defined as physical punishment administered by caregivers if either the Harm (sustained injury) or Endangerment standard (at-risk for injury) were met as a result of being hit by a hand or object, kicked, thrown, shaken, burned, stabbed, or choked. Indeed, studies utilizing these broader definitions have yielded higher rates of child sexual and physical abuse (see Finkelhor, 1994 Finkelhor & Dziuba-Leatherman, 1994). For example, the NIS-3 study reported incidence rates of 9 and...

The Evolution of Disease

Similar analyses have been applied to infant colic, a mysterious condition of prolonged crying that seems to peak at two months and then gradually dissipates. In an evolutionary sense, crying represents an infant's communication to elicit feeding and care. Because care-givers and infants are often spatially separated in contemporary households, infant crying may be prolonged and fretful because of the difficulty of securing feeding and comfort. Rather than treating the infant, the implications of this perspective is that parental care-giving patterns could be modified (Barr, 1999).

Enhancing Quality of Life

A sense of purpose or meaning on the part of caregivers can enhance quality of life for the person with dementia. In an important study by Peter V. Rabinsand and his colleagues, thirty-two family caregivers of persons with AD and thirty caregivers of persons with cancer were compared cross-sectionally to determine whether the type of illness cared for affected the emotional state of the caregiver and to identity correlates of both undesirable and desirable emotional outcomes. While no prominent differences in negative or positive states were found between the two groups, correlates of negative and positive emotional status were identified. These include caregiver personality variables, number of social supports, and the feeling that one is supported by one's religious faith. Specifically, emotional distress was predicted by self-reported low or absent religious faith (Rabins et al., p. 335). Moreover, spirituality predicted positive emotional states in caregiving. Interestingly, the...

Home Care Applications

The concept of e-disease management is defined by the utilization of ICT such as the Internet to allow patients with chronic conditions to stay at home and be involved in the care delivery process. Such e-technologies can help co-ordinate e-home care with hospital and ambulatory care and facilitate information exchange and communications between and among patients, family members, and care providers. If an e-patient has to be attended by specialists, for example, in the case of a cardiac arrest, linking e-home care with hospital and ambulatory care would prove more efficient and beneficial in the treatment of the e-patient. E-patient education is an essential component of e-disease management and can be easily supported by the transmission of tailored health information or automated reminders to patients or their caregivers. The integration of commercially available household items such as television sets, mobile phones, videophones, medication dispensing machines, and handheld...

Objections to an Ethic of Care

A second family of concerns about a feminine ethic of care relates to the belief that caring for others can lead to neglect of self. The phenomenon of burnout, for example, refers to the situation of parents, nurses, family caregivers, or other individuals who become utterly exhausted by the physical and emotional demands associated with giving care. Especially when care is conceived to be an ethic that is sufficient unto itself, the tendency may be to continue caring at any cost. Attention to other values, such as respect for the rights of the one caring, may be necessary in order to preserve the integrity of the caregiver Arguing along these lines, Nancy Jecker notes that if women are seen as having the same possibility men have to create a plan of life that places central importance in activities other than caregiving , then a duty to care can potentially stand in the way ofwhat a woman wants to do (2002, p. 128). The idea here is that individuals presumably prefer to protect, as...

Cognitive Restructuring

Negative or maladaptive thoughts can be generated by caregivers in response to the challenges and stressors they face, thereby contributing to negative affective and emotional states. For example, in a qualitative study investigating the psychological effects of lay caregiving in a sample of 68 caregivers, Ruppert (1996) noted that guilt was a common emotion experienced and expressed by the caregivers in her sample. Ruppert cited examples of thoughts beginning with phrases such as I should have , Why didn't I , or If only I had as being commonly expressed by these caregivers. Ruppert also noted that the caregivers made these statements despite being responsible, conscientious, and fully involved in the care of their loved ones. The cognitions that underlie feelings of guilt are particularly amenable to cognitive restructuring. Other mal-adaptive cognitions expressed by caregivers may contribute to feelings of hopelessness, powerlessness, and depression. Thus, cognitive restructuring...

Referral for Services

Caregivers' Names Relationship Have you discussed this with the child's caregivers 3. Collaboration working and sharing particularly with caregivers In the olden days, when I was trained, it was automatic to see children of all ages without their parents. Part of the description of the child in the report addressed the ease or difficulty of this separation. Somewhere along the line of my professional practice, I asked myself why and decided that there was not sufficient justification to sustain this practice, particularly if we keep in mind the issue of optimizing the child's performance. Once we have determined that the child will scream uncontrollably when separated from his parents, what do we accomplish by spending the next hour trying to calm him or her down And what can we conclude from this reaction in any case I now most often see very young children in the company of their care-givers and use the caregiver as a collaborator-informant to help me understand the child. This is...

Criticisms Of Cbt With Children

The combination of cognitive and behavioral strategies has consistently been shown effective in treating childhood anxiety. Yet some CBT approaches have been paired with superior and more sustainable change than others. In recognizing the social elements that influence children's behavior (e.g., relationships with family members, peers, teachers), the efficacy of GCBT and FAM has received considerable attention in recent years. Because sociocultural support styles and family dynamics differ between cultural groups, the efficacy of these intervention formats requires closer scrutiny. It may be argued that diverse types of family closeness (i.e., closeness-caregiving and closeness-intrusiveness Green & Werner, 1996) can dramatically impact therapeutic outcomes. Whereas caregiving serves to support child development, intrusiveness is characteristic of psychological coercive control and may even promote specific fears (Elbedour, Shulman, & Kedem, 1997). As multicultural populations...

Presentation Formats 1 Visual Imagery

Target behaviors can be identified in a number of ways (1) self-report from either the client or in the case of children, legal guardians or caregivers (2) paper-and-pencil surveys or (3) natural observations. Establishing a baseline, which is taken prior to beginning any formal intervention, involves data collection to gather information about frequency, duration, and the topography of the behavior. The baseline data are then used to measure effectiveness of the procedure. It is also useful during the course of treatment. If there is not a positive change in the data or the trend line, modifications can be made to the scenes to incorporate new information and alter the scripts to reflect this new information.

Veracity and Truthtelling in Genetic Counseling

The latter two cases, in which information is withheld from third parties, raise the question of the counselor's obligation or duty to warn others who might be affected by the presence of the genetic condition in a spouse or significant other. For some counselors, the right to know or the duty to warn provides strong justification for telling the whole truth at all times during the counseling process, regardless of the potential consequences. At the same time, a minority of counselees feel they have a right not to know. These people would rather not be told about a serious genetic condition of late onset, especially if there is no effective therapy or other maneuver that will forestall its onset or significantly reduce its symptoms. If counselees do not wish to know about their incurable condition, the information may nevertheless have to be placed in the medical record so that future health-care givers will be alert to the counselee's status. The information can also be provided if...

Noninvasive ventilation

For late onset secretions in the terminal phase of illness the sounds made by the child (so-called 'death rattle') maybe more disturbing for onlookers and caregivers rather than for the child themself. In this case carefully explaining that the child is not bothered by the sounds may help to alleviate caregiver distress. At times scopolamine maybe also be used to help dry excessive secretions. Terminal breathing patterns may include gasping, rapid shallow or agonal ataxic breathing, or Cheyne-Stokes respiration. At these times careful reassurance and explanation of what the dying process involves is often helpful in alleviating caregiver distress. Listening to caregivers' concerns, carefully reassessing for possible dyspnoea, and selectively adding both drug and non-drug treatments that seek to improve comfort at the end of life together make up one of the cornerstones of the practice of paediatric palliative care.

Parenting A Child With Special Needs

Children may not come with instructions, but most parents have experiences with their own parents or caregivers to provide some model for how to raise their children. Few parents who have a child with a disability have such models. Parents certainly did not plan for such a child (with the exception of those who knowingly adopt a child with special needs), and they most likely did not include the challenges of raising such a child in their fantasies of parenting. Therefore, when parents are informed or discover that their child has a disability, they need to process this information and adjust their perceptions, expectations, and attitudes. How this is done is very much related to cultural background, the nature and extent of the disabling condition, and the personality characteristics of the parents (Davis, Stroud, & Green, 1988 Seligman & Darling, 1989), but each individual must find her or his own way to deal with this situation. Seligman and Darling pointed out the controversy...

Background and Significance

Existing screening proposals were predominantly centered on the detection of cancer, not polyps. Further, it was in general believed that most cancers (over 75 ) arose in the distal colon within reach of the sigmoidoscope. Initially, screening consisted of a digital rectal examination and, possibly, a rigid sigmoidoscopy or stool testing for occult blood. Even the latter was performed inappropriately, being performed at the time of rectal examination rather than the current more systematic and rigorous process. With the addition of flexible sigmoidoscopy, the focus was predominantly on the left side of the colon. However, over the next 15 to 20 years a number of studies indicated that colorectal cancers (and adenomas) were more uniformly distributed throughout the colon. Even these relatively limited screening strategies were not widely adopted. A lack of appreciation and acceptance of the magnitude of an individual's risk and lack of confidence in the effectiveness of screening tests...

Care in the Community

Most people with Down's syndrome live in the community some live with parents or caregivers, but adults often live independently or semi-independently. Many people with Down's syndrome can learn about healthy eating and manage their own diets. A dietitian's role in a community learning disability support team is likely to encompass not only individual assessment but also teaching and educating people with Down's syndrome as well as parents, caregivers, and other professionals.

Decubitus Ulcers Pressure Sores

Fascia Rosacea

Any individual who is confined to bed can develop a decubitus ulcer. Poor nutrition, vascular insufficiency (e.g., diabetes mellitus), accumulation of urine and feces due to incontinence, and friction arising from the actions of caregivers (e.g., repositioning patient on the bed) are contributing factors (69,71-75,77). Rubbing of the skin likely removes an already devitalized epidermis (78). The area of pressure first shows erythema (stage 1), then proceeds to a blister or superficial ulcer (stage 2), full thickness cutaneous necrosis with extension into the subcutaneum and fascia (stage 3), and eventual involvement of underlying muscle and supporting structures (bone, tendon, joint capsule stage 4 69,71,73-75 ).

Risk Factors and Characteristics

Likely than the comparison group of caregivers to have mental, emotional, and or alcohol problems and to be dependent on the victims. Conversely, the abused elders were less functionally dependent than the control group in carrying out their activities of daily living. The families in which abuse occurred also tended to have fewer outside contacts and were less satisfied with them than were their nonabuse counterparts. Similar results have been reported by other researchers (Phillips, 1988 Bristowe and Collins Anetzberger Lachs et al., 1997).

Consequences of Child Abuse and Neglect

Child abuse and neglect has been associated with increased risk of adverse outcomes. Not all abused and neglected children suffer immediate or lasting consequences beyond their immediate injuries. Nevertheless, abused and neglected children are at increased risk for a range of physical, mental emotional, and social behavioral difficulties. The pathways to these outcomes are currently unclear, but involve a combination of compromised brain development and long-term psychological and emotional sequelae associated with their abuse and neglect. Abused and neglected children are at increased risk of school-related difficulties resulting from cognitive and learning difficulties or from emotional adjustment problems. Abused and neglected children are at increased risk of relationship problems stemming from low-self esteem or aggressive tendencies. Abused children are also at increased risk of juvenile delinquency. Girls who have been sexually abused are at increased risk for violence in...

Management Of Bipolar Disorder In The Youth

Conceptualizing the child's treatment and needs as moving targets is a good way to plan the treatment of this complicated illness. Generally, management of a bipolar child requires pharmacological treatment of manic symptoms and other comorbid psychiatric symptoms. Also, management of suicidal and other emergency behaviours, management of school functioning, management of family stress and caregiver burden, and mental health treatment of other family members is necessary. Hospitalization of the child may be needed during a full-blown manic episode to ensure patient and family safety. Suicidal threats and gestures need to be taken seriously. The family should develop a crisis plan with the members of the treatment team so that in an emergency the parents know how to access the appropriate services efficiently. In acute manic state, clinicians must avoid getting into any arguments or questions regarding the delusional system of

Dietary Management Dietary Guidelines

The antioxidant defence system has a particularly important role in Down's syndrome, and parents and caregivers can be advised on providing a diet rich in antioxidants. Dietary intakes need to be considered for the sulfur amino acids (which are needed for glutathione synthesis) fat-soluble vitamins A, C, and E water-soluble vitamins B6, B12, and folic acid and the minerals selenium and zinc. In latitudes where no vitamin D is synthesized in the winter months, it is particularly important to ensure exposure to sunlight during summer months to maintain adequate stores of the vitamin throughout the year because studies indicate an increase in the incidence of osteoporosis in Down's syndrome.

Cognitive Neuroscience and Consciousness

The problem of consciousness involves many difficult and overlapping issues (Block, 1995 Posner, 1994). Perhaps the most frequently discussed role of consciousness involves awareness of our sensory world but another equally important aspect of consciousness is the fact or illusion of voluntary control. In the course of development, a central issue is the awareness of one's self, and the form of voluntary control involved in self regulation. These functions develop within the dyad involving the child and the caregiver as a carrier of the culture's socialization process. It is possible, even likely, that brain mechanisms subserving these various forms of consciousness may cut across definitions in ways that defy the usual logical and philosophical distinctions.

Commercial Airline InFlight Emergencies

The airplane environment presents several unique aspects of medical emergencies and their treatment. Following discovery of a medical incident, the response time to on-board care is minimal. Care givers' access to victims is compromised by their seated position in a setting similar to that in a crowded stadium. The victim's safe, timely extraction to a secured space allowing the supine (left lateral decubitus for pregnant patients) position is a foremost priority but is a great challenge in such a confined environment not dedicated to even provisional medical care. Oxygen sources are plentiful, but their location is not configured for optimal care of patients. At cruising altitude, despite cabin pressurization, ambient air oxygen availability is below that at sea level (P o2 118 mmHg in flight versus 159 mmHg at sea level) and has the potential of causing respiratory problems in the marginally compensated. Flight attendants receive basic first aid training to a degree that varies among

Assessing breathlessness in children

For the many children in paediatric palliative care who are not able to talk either by virtue of their young age or advanced illness, self-report of dyspnea is impossible. For these children the frequency and intensity of their breath-lessness will need to be assessed by others, most often their parents and the professional caregivers who know them best. Although this dependence on the subjective judgement of someone other than the patient to define dyspnea makes research into dyspnea at the end-of-life fraught with difficulty, these limitations are thankfully less important in day-to-day practice. It may be difficult to standardize, but the subjective assessment of breathless-ness made by looking at the non-verbal language of the child (facial expression and posture) often is a sensitive measure of the respiratory distress of children. By their nature parents are always and continually responding to the non-verbal needs of their children and the facial expression of someone with...

Interventions With Patients With Dementia

Medications are now available for Alzheimer's disease and other dementias that sometimes slow the progression of symptoms, but do not reverse the overall course of the disorder (Mendez & Cummings, 2003). Psychological interventions have focused on the early stages of the illness when people still have an awareness of their problems, and can actively participate in treatment. Early stage support groups for patients and their families have been very popular and can now be found in many communities (e.g., Yale, 1989, 1999). Examples of counseling with the person with dementia or with the person and his her caregiver have also been reported (Zarit & Zarit, 1998). Many different treatment strategies have been described, including improving communication between the person with the illness and his her spouse or other family caregiver, learning strategies for managing memory loss, exploring how to talk about the disease with family and friends, finding ways for the person with dementia to...

Cognitivebehavioral Interventions

Cognitive-behavioral interventions have been used with caregivers to improve time management, coping, problem-solving skills, assertiveness, relaxation, positive experiences, and self-care, and to decrease distorted thought processes regarding the caregiving experience. Regardless of the specific technique or modality utilized, the fundamental goal of these interventions is to decrease distress and to improve the caregiver's ability to cope with the multifac-eted caregiving challenges and role changes, improve their sense of control, and overall quality of life. Many of these interventions can be offered in individual, group, or family modalities, and with or without the care recipient present, depending on the nature of individual concerns. Problem-Solving Training for Caregivers The construct of social problem-solving has long been of interest to researchers and clinicians, but has only been specifically applied to the caregiver population within the past decade. Problem-solving has...

Summary And Conclusion

The stressors and demands associated with providing care to a loved one with a debilitating or terminal illness have been well-documented throughout the literature. There is no question that the role of caregiver is one that can be extremely challenging and can contribute to considerable psychological distress on the part of the caregiver. Given that there are over 52 million lay caregivers in the United States (Health and Human Services, 1998), and that depression, anxiety, powerlessness, role strain, guilt, and grief are common feelings experienced by caregivers, the need for intervention is clear. While supportive and educational group interventions have long been utilized with this population, caregivers are likely to have needs that are not sufficiently addressed by these types of interventions alone. Thus, the need for more active, directive, goal-driven interventions has been recognized. As discussed in this article, cognitive-behavioral interventions have been increasingly...

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