...examined experience of caring during the first 12 months after stroke. Caregivers were randomized to an online intervention of support and education (n = 36 Web users) or a control group (n = 37 non-Web users). A secondary analysis of data collected during telephone interviews at baseline, 3, 6, and 12 months after stroke was performed. No significant mean differences were found between Web and non-Web users in the above variables at these points in time. Consequently, the caregivers were merged into one group, and the relationships among the variables at the different points in time were analyzed. Significant, moderately positive relationships were found between emotional support and physical help at baseline, 3, and 12 months. There were also significant, moderately positive relationships between emotional support and caregiver health at 6 and 12 months. Results highlight the importance of caregivers (dependent care agents in Orem's terms) establishing an adequate self-care system that provides emotional support and physical help. Findings also denote the need for nurses (as caring agents) to assess caregiver health later in the caring process and be aware of its relationship to emotional support.

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An estimated 750,000 Americans suffer a new or recurrent stroke each year. Currently, there are more than 5 million stroke survivors alive, with as many as 30% of them being permanently disabled as a result of the stroke. It was estimated that Americans would pay $62.7 billion in 2007 for stroke-related medical costs and disability (American Heart Association, & American Stroke Association, 2007). Most of these stroke survivors are cared for in the home by family members (Dorsey & Vaca, 1998; Singh & Cameron, 2005; Ski & O'Connell, 2005).

Due to the acute nature of the disease, many caregivers of stroke survivors enter the caring role abruptly and have little time to adapt (Kerr & Smith, 2001; Tooth, McKenna, Barnett, Prescott, & Murphy, 2005). Many caregivers feel inadequately prepared to face the emotional and physical challenges of caring for someone with a disability (Bakas, Austin, Okonkwo, Lewis, & Chadwick, 2002; Kerr & Smith), suggesting that the early weeks and months after discharge are an uncertain and vulnerable time for caregivers (Grant, Glandon, Elliot, Giger, & Weaver, 2004). Despite these findings, few studies have specifically addressed the needs and experiences of first-time caregivers of people with stroke during the initial phase of caring (Bakas et al.; Grant et al., 2004; Pierce et al., 2004) and how these needs and experiences change over time.

The purpose of this descriptive, comparative study was to examine the emotional support, physical help, and health of caregivers of stroke survivors during the first 12 months of caring and whether these variables were affected by an online intervention of support and education. The research question was:

* Is there a difference in emotional support, physical help, and health of caregivers of stroke survivors who receive an online intervention versus those who do not at four points in time over the course of 1 year?

This study was guided by Orem's (2001) self-care deficit nursing theory, which is based on the concept of self-care, where individuals perform specific learned activities to maintain health and well-being. A self-care deficit occurs if total self-care actions do not meet needs. Nurses have specialized abilities, known as nursing agency, to help people with self-care deficits. Orem's theory was chosen for this study because caregivers, as dependent care agents, have a dual role of caring for themselves (self-care agency) and for another person whose self-care demands cannot be independently met (dependent care agency).

Relevant Literature Review

Caregivers and Emotional Support

The need for emotional support is evidenced in the literature. Dorsey and Vaca (1998) stated, "Caregivers, no matter what personality, need support and respite from care to be successful in their efforts" (p. 64). Qualitative studies involving 22 caregivers of stroke survivors by Kerr and Smith (2001) and 14 caregivers by Bakas and colleagues (2002) identified emotional support as a significant caregiver need. Informally provided emotional support is critical because many caregivers of stroke survivors are apprehensive to use formal support because of concerns such as the finances needed, quality of care provided, or time spent away from the care recipient (Winslow, 2003).

Caregivers and Physical Help

Several studies highlight concerns that caregivers of stroke survivors have regarding the physical aspects of care, such as enhancing mobility, preventing falls, and assisting with bathing and toileting (Bakas et al., 2002; Kerr & Smith, 2001). Strain caused by the frequent bending, lifting, and moving required at high levels of care can be especially difficult for older caregivers (Fultner & Raudonis, 2000; McGarry & Arthur, 2001). The majority of emotional support and physical help is provided informally (Dorsey & Vaca, 1998; Singh & Cameron,...

NOTE: All illustrations and photos have been removed from this article.



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