• Caregiving Context:
  • Caregiver relationship to care recipient (spouse, non-spouse) (Gitlin et al., 2003; Sorensen, Pinquart, & Duberstein, 2002 [both Level I])
  • Caregiver roles and responsibilities
    • Duration of caregiving (Sorensen, Pinquart, & Duberstein, 2002 [Level I])
    • Employment status (i.e., work, home, volunteer) (Pinquart & Sorensen, 2006 [Level I])
    • Household status (e.g., number in home) (Pinquart & Sorensen, 2006 [Level I])
    • Existence and involvement of extended family and social support (Pinquart & Sorensen, 2006 [Level I])
  • Physical environment (i.e., home, facility) (Vitaliano, Zhang, & Scanlan, 2003 [Level I])
  • Financial status (Vitaliano, Zhang, & Scanlan, 2003 [Level I])
  • Potential resources that caregiver could choose to use—list (Pinquart & Sorensen, 2006 [Level I])
  • Family's cultural background (Dilworth-Andersen, Williams, & Gibson, 2002 [Level I])
• Caregiver's perception of health and functional status of care recipient:
  • List activities care receiver needs help with; include both activities of daily living (ADLs) and instrumental ADLs (IADLs) (Pinquart & Sorensen, 2003, 2006 [both Level I]).
  • Presence of cognitive impairment—if yes, any behavioral problems? (Gitlin et al., 2003 [Level I]; Sorensen, Pinquart, & Duberstein, 2002 [Level I]).
  • Presence of mobility problems—assess with single question (Archbold et al., 1990 [Level II]).
• Caregiver preparedness for caregiving:
  • Does caregiver have the skills, abilities, knowledge to provide care recipient with needed care? (see Preparedness for Caregiving Scale at http://www.hartfordign.org/publications/trythis/issue14.pdf, Family Caregiving topic).
• Quality of family relationships:
  • The caregiver's perception of the quality of the relationship with the care receiver (Archbold et al., 1990 [Level II]) (see Mutuality Scale at www.ConsultGeriRN.org, Family Caregiving topic).
• Indicators of problems with quality of care:
  • Unhealthy environment
  • Inappropriate management of finances
  • Lack of respect for older adult (see Elder Assessment Instrument [EAI]) at http://www.hartfordign.org/publications/trythis/issue15.pdf).
• Caregiver's physical and mental-health status:
  • Self-rated health: single item—asks what is caregivers' perception of their health (Pinquart & Sorensen, 2006 [Level I]).
  • Health conditions and symptoms
    • Depression or other emotional distress (e.g., anxiety) (Pinquart & Sorensen, 2006, 2003; Sorensen, Pinquart, & Duberstein, 2002 [all Level I]). (See CES-D in the original guideline document).
    • Reports of burden or strain (Schultz & Beach, 1999 [Level II]; Vitaliano, Zhang, & Scanlan, 2003 [Level I]). (See Caregiver Strain Index at http://www.consultgerirn.org, Family Caregiving topic)
  • Rewards of caregiving:
    • List of perceived benefits of caregiving (Archbold et al., 1995 [Level II])
    • Satisfaction of helping family member
    • Developing new skills and competencies
    • Improved family relationships
  • Self-care activities for caregiver

Nursing Care Strategies

• Identify content and skills needed to increase preparedness for caregiving (Acton & Winter, 2002 [Level I]; Gitlin et al., 2003 [Level I]; Farran et al., 2003 [Level IV]; Farran et al., 2004 [Level II]; Sorensen, Pinquart, & Duberstein, 2002 [Level I]).
• Form a partnership with the caregiver prior to generating strategies to address issues and concerns (Brodaty, Green, & Koschera., 2003 [Level I]; Gitlin et al., 2003 [Level I]; Harvath et al., 1994 [Level V]).
• Identify the caregiving issues and concerns on which the caregiver wants to work and generate strategies (Acton & Winter, 2002 [Level I]; Gitlin et al., 2003 [Level I]; Sorensen, Pinquart, & Duberstein, 2002 [Level I]; several Level II studies [see Table 8.1] in the original guideline document).
• Assist the caregiver in identifying strengths in the caregiving situation (Archbold, et al., 1995 [Level II]).
• Assist the caregiver in finding and using resources (Archbold et al., 1995 [Level II]; Farran et al., 2004 [Level II]; Schumacher et al., 2002 [Level IV]).
• Help caregivers identify and manage their physical and emotional responses to caregiving (Schulz & Beach, 1999 [Level II]).
• Use an interdisciplinary approach when working with family caregivers (Acton & Winter, 2002 [Level I]; Gitlin et al., 2003 [Level I]; Farran et al., 2003 [Level IV]; Farran et al., 2004 [Level II]; Sorensen, Pinquart, & Duberstein, 2002 [Level I]; several Level II studies [see Table 8.1] in the original guideline document).

Definitions:

Levels of Evidence

Level I: Systematic reviews (integrative/meta-analyses/clinical practice guidelines based on systematic reviews)

Level II: Single experimental study (randomized controlled trials [RCTs])

Level III: Quasi-experimental studies

Level IV: Non-experimental studies

Level V: Care report/program evaluation/narrative literature reviews

Level VI: Opinions of respected authorities/Consensus panels

Reprinted with permission from Springer Publishing Company: Capezuti, E., Zwicker, D., Mezey, M. & Fulmer, T. (Eds). (2008) Evidence Based Geriatric Nursing Protocols for Best Practice, (3^rd ed). New York: Springer Publishing Company.

References open in a new window

Electronic copies: Available from the Hartford Institute for Geriatric Nursing Web site.

Copies of the book Geriatric Nursing Protocols for Best Practice, 3rd edition: Available from Springer Publishing Company, 536 Broadway, New York, NY 10012; Phone: (212) 431-4370; Fax: (212) 941-7842; Web: www.springerpub.com.

• The Modified Caregiver Strain Index (CSI). Try this: Best practices in nursing care to older adults. 2007. Electronic copies available from the Hartford Institute for Geriatric Nursing Web site.

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