Biomedical subjects

A Neufeld

Publications and source records attributed to A Neufeld.

At least 19 recordsLinked to original sources

PubMed2006

Immigrant women family caregivers in Canada: implications for policies and programmes in health and social sectors.

Migration has become a profound global phenomenon in this century. In Canada, uncoordinated policies, including those related to immigration, resettlement, employment, and government funding for health and social services, present barriers to immigrant women caregivers. The purpose of this paper is to share relevant insights from individual and group interviews with immigrant women family caregivers, service providers and policy influencers, and discuss these in relation to immigration, health and social policy, and programme trends in Canada. The present authors conducted individual interviews with immigrant women family caregivers (n = 29) in phase 1, followed by two group interviews with women family caregivers (n = 7), and two group interviews with service providers and policy-makers (n = 15) in phase 2. Using an inductive approach, the authors employed thematic content data analysis. Immigrant women experienced barriers to health and social services similar to Canadian-born family caregivers, particularly those who have low incomes, jobs with limited flexibility and heavy caregiving demands. These immigrant women family caregivers avoided certain formal services for a variety of reasons, including lack of cultural sensitivity. However, their challenges were compounded by language, immigration and separation from family in the home country. The identified barriers to support reinforce the importance of modifying and expanding policies and programmes affecting immigrant women's ability to care for family members with illnesses or disabilities within the context of Canadian society. Participants recommended changes to policies and programmes to deal with information, transportation, language, attitudinal and network barriers. The various barriers to services and programmes which were experienced by immigrant women caregivers underscore the importance of reviewing policies affecting immigration, caregiving, and access to health and social services. Intersectoral collaboration among agencies is essential to reduce the barriers identified in the present study, and to establish services which are linguistically and culturally appropriate.

Asian People↗

PubMed2003

Unfulfilled expectations and negative interactions: nonsupport in the relationships of women caregivers.

BACKGROUND: Most research has viewed social support as unconditionally positive, but negative interactions such as conflict and dissatisfaction with support are present in caregivers' relationships and have a negative impact on their health. PURPOSE: The purpose of this study was to describe women's experience of nonsupport and identify the types of nonsupport present in their relationships with family and friends while caring for a family member with dementia. ETHICS: The study received ethical clearance from the university ethics review committee. METHODS: The theoretical perspective of symbolic interaction guided this longitudinal qualitative research. Included in the study were 25 in-depth interviews with a group of eight women selected from a larger study of family caregiving because they described nonsupport in their relationships with family and friends. FINDINGS: The women experienced two types of problems in realizing support. Unmet expectations for support was the most pervasive difficulty and included unfulfilled or missing offers of assistance, unmet expectations for social interaction, mismatched aid, or incompetence on the part of the potential helper. Negative interactions, particularly with kin, took several forms: disparaging comments that belittled a caregiver's experience, conflict between the caregiver and others in their appraisal of the care recipient's health status, criticism of the caregiver's decisions in caring for the care recipient, and spillover from longstanding conflict and issues in the family history. LIMITATIONS: This study was limited to women caring for an adult relative with dementia and included a relatively homogeneous sample of English speaking, North American women of European descent. CONCLUSIONS: This study highlighted the utility of identity theory to explain the impact of unmet expectations for support and recognized disparaging comments as a form of nonsupportive interactions.

Aged↗

PubMed2001

Service system finance: implications for children with depression and manic depression.

An estimated 6.2% of children in the United States satisfy the criteria for a depression diagnosis, but approximately half of this group do not receive necessary treatment. Thus it is important to consider potential barriers to use through service system finance. This article reviews three major types of changes affecting access: parity legislation, managed care, and public contracting. How these developments will affect children with depression and manic depression (DMD) is unclear. To better understand the potential effects on children with DMD, this review uses new data from the Medical Expenditure Panel Survey to describe the service use patterns of this population. These children have higher levels of expenditures, higher rates of inpatient use, and higher rates of Medicaid payment than do other children with mental health diagnoses; they also are overrepresented among the costliest cases of mental illness in children. Children with DMD pay a relatively low out-of-pocket share, suggesting that parity efforts focusing only on copayments and deductibles will have little effect on the absolute out-of-pocket burden for these children. Because children with DMD are overrepresented among high utilizers of health services, health care rationing arrangements or techniques, such as utilization review and capitation, may place this population at particular risk.

Bipolar Disorder↗

PubMed2001

Participation of immigrant women family caregivers in qualitative research.

The recruitment of articulate, expressive participants is an essential part of methodology in qualitative research. This article presents the authors' experience in the recruitment of immigrant women of Chinese and South Asian origin in an ethnographic study. The study included women caring for an adult or child family member who had a chronic health problem. Knowledge of women family caregivers' health is restricted by the failure to include diverse groups of women in research. In this article, the authors discuss issues related to recruitment and participation of immigrant women in research, including establishing access to diverse groups of women, benefits for immigrant women, and placing the researcher and research process on the same level. Practical research strategies to address these issues and engage the women in research that portrays their perspectives are presented. The authors' discussion concludes with reflection on their experience and that of other researchers.

Adult↗

PubMed2000

A review of the research on the health of low-income Canadian women.

Reducing health inequities associated with poverty is an important public health nursing role. This article describes the scope of research on the health of low-income Canadian women. The research included was published in English-language peer-reviewed journals between 1990 and 1997. The 26 articles retrieved are summarized according to the focus of the study and the composition of the sample. Most addressed personal health practices and health status. Only one intervention study was identified. The studies and the findings of this analysis are discussed in relation to three recommendations for research on women's health: an emphasis on social context, including the structural conditions affecting women's health; active participation of women in the research process; and recognition of diversity among low-income women. Suggested priority areas for future research are: intervention studies; studies addressing the structural context of the lives of low-income women; research strategies that enhance the participation of women in the research process; and increased involvement of diverse groups of women such as homeless women and women of varied ethnic backgrounds, including First Nations women.

Canada↗

PubMed1999

Male caregivers' use of formal support.

The purpose of this study was to explore male caregivers' perceptions of formal support. The men were caregivers of adults with cognitive impairment. The study involved secondary analysis of interview data on perceptions of support that had not been previously analyzed from the perspective of formal support. Techniques of data analysis used in grounded theory were applied to 62 guided interactive interviews conducted with 24 male caregivers during a period of 18 months. The men experienced a process of making concessions for care in the following four sequential stages: resisting, giving in, opening the door, and making the match. Personal barriers deterred the caregivers from seeking help, and once the caregivers engaged formal help the influence of characteristics of the health care system and individual staff members had both enabling and disabling effects. For caregivers whose use of formal support involved admitting their relative to a long-term care facility, the phase of making the match was followed by redesigning their caregiver role.

Adaptation, Psychological↗

PubMed1998

Men as caregivers: reciprocal relationships or obligation?

This study explored reciprocity in the relationships of men caregivers of cognitively impaired older adults. Reciprocity is a dimension of social support that is important in caregivers' ability to sustain supportive relationships. Equity theory predicts that inequitable (non-reciprocal) exchanges will result in termination of relationships. The objective of the study was to identify the context in which reciprocity was present or absent, the characteristics of reciprocity in caregivers' relationships with the care recipient, family and friends, and the men's feelings about reciprocal social support during caregiving. Twenty-two men caregivers were interviewed three times over 18 months. Study findings were confirmed in a focus group discussion with seven caregivers. Three variations in reciprocity in the men's relationship with the care recipient were identified: waived reciprocity, generalized reciprocity and constructed reciprocity. Those experiencing constructed or generalized reciprocity described positive feelings, whereas men identifying waived reciprocity described either positive or negative feelings. When reciprocity was absent the men described giving care on the basis of obligation with either mixed or negative feelings. Reciprocity in relationships with friends and family is also described. The study findings support the assumptions of equity theory about reciprocity; however, perceptions of obligation may be better understood in the context of the principles of justice and caring.

Adult↗

PubMed1998

Nursing research on the health of low-income women.

The purpose of this paper is to describe the scope of published nursing research on the health of low-income women. Williams' (1990) model of the relationship between socioeconomic status and health was used as a framework for the analysis. This model includes three major components: Medical Care, Psychosocial Factors, and Health Outcomes. There is a body of published nursing research that addresses a range of health issues of low-income women. Our search of English language literature published between 1989 and 1995 retrieved 49 articles that met the inclusion criteria. Most of the nursing studies examined a portion of Williams' model but did not address multiple components. The most frequently addressed component was Psychosocial Factors, particularly health practices, stress and coping, and social ties. Williams' model was an effective framework to classify nursing research. Results of our analysis suggest that further research is needed on the pathways by which low income influences health and on the effectiveness of nursing interventions.

Adolescent↗

PubMed1997

Social networks of women caregivers.

Social networks and the support that network members provide are important resources for family caregivers in sustaining their caregiving role. Caregivers' perceptions of support from family and friends have been linked to their health status (R. Kahn & T. Antonucci, 1980; I. Sandler & M. Barrera, 1984). The purpose of this study was to explore the social networks and types of perceived support described by women who are caregivers of cognitively impaired older adults. Content analysis was used to examine interview data from a longitudinal qualitative study of 20 women caregivers of cognitively impaired older persons. An important finding of this study was the identification of a typology of social networks of the women caregivers. The caregivers' perceptions of satisfaction with support received and experience of conflict with network members varied according to the characteristics of their social network. Those caregivers who belonged to diverse social networks reported high satisfaction with the support that they received and little or no conflict. Those caregivers with kin-dominated social networks reported little satisfaction with support received and a high degree of conflict.

Adult↗

PubMed1997

Strategies to address the methodological challenges of client-satisfaction research in home care.

While there is an abundance of recent client satisfaction research, methodological difficulties continue. This paper addresses common methodological challenges in securing useful feedback from elderly clients receiving home-care services. The methodological challenges include socially desirable response sets (SDRS), fear of reprisal, acquiescent response sets (ARS), and negative or positive wording of items. These contribute to an inability to capture salient dimensions of satisfaction and dissatisfaction important to home-care clients. Several data-collection strategies are proposed: guided interactive interviews, story-telling, scenarios, and rating of the importance of the dimensions of satisfaction and dissatisfaction identified from interview data. Each strategy is discussed using illustrations from a study on elderly clients' satisfaction with home-care services. Nurses and other health-care providers require credible feedback about client satisfaction in order to develop policy and to provide more appropriate and effective services to home-care clients.

Home Care Services↗

PubMed1996

Educational issues in preparing community health nurses to use nursing diagnosis with population groups.

Recently there has been increased interest in the use of nursing diagnosis by community health nurses who work with population groups in community settings. The purpose of this article is to discuss educational issues important in the preparation of undergraduate students and practising community health nurses in the use of nursing diagnosis with population groups. The educational issues discussed emerged from the findings of a preliminary survey of undergraduate students and community health nurses and were related to: differences in the learning requirements of novice and expert practitioners; common errors in the use of nursing diagnosis; and the perceived benefits and barriers in using nursing diagnosis. There is a need to develop an educational strategy to address these concerns for both undergraduate students and community health nurses.

Clinical Competence↗

PubMed1996

Early postoperative intraocular pressure pattern in glaucomatous and nonglaucomatous patients.

PURPOSE: To evaluate intraocular pressure (IOP) changes in the 24 hours following cataract extraction in glaucomatous and nonglaucomatous patients. SETTING: General Eye Service and Glaucoma Service of the Goldschleger Eye Institute, Tel Hashomer, Israel. METHODS: Twenty-six nonglaucomatous patients and 13 glaucomatous patients scheduled for routine cataract extraction and intraocular lens implantation were evaluated. In each patient, IOP was measured before cataract surgery and every 4 hours for 24 hours postoperatively. Thirteen of the nonglaucomatous patients were randomly treated with one drop of timolol maleate at the end of surgery (NG-T group). The other 13 nonglaucomatous patients (NG group) and all glaucoma patients (G group) were not treated. RESULTS: In the NG group, mean preoperative IOP was 13.9 mm Hg. Following surgery, IOP rose steadily to 22.2 mm Hg at 12 hours; it returned to almost presurgical levels at 24 hours. The IOP exceeded 35 mm Hg in only one patient. In the NG-T group, mean preoperative IOP was 16.5 mm Hg and increased to 21.2 mm Hg at 12 hours. The IOP returned to almost presurgical levels at 24 hours. In the G group, mean IOP was 18.8 mm Hg preoperatively and rose to 29.9 mm Hg at 8 hours after surgery. In seven eyes the IOP exceeded 35 mm Hg. COMMENTS: Our findings of elevated IOP emphasize the need for prophylactic treatment (medical or combined cataract and glaucoma surgery) to prevent IOP spikes in high-risk patients.

Acetazolamide↗

PubMed1996

Gender differences in the support networks of caregivers.

Nurses in home care and long-term care settings play an important role in assisting family caregivers of elders who are cognitively impaired to sustain personal support while caregiving. Research has shown that such support is associated with positive health status. The characteristics of the caregiver's social network provide information about the potential for support. The purpose of this study was to describe and compare the social networks of men and women caregivers in terms of the composition of the social network and the size of the available, utilized and conflicted social networks. The possible relationship between the demographic characteristics of caregivers and the size and composition of their social networks was also examined. In comparison to men, the conflicted social networks of women were larger and comprised of more family members. For women, age, years of caregiving and socioeconomic status were not significantly related to the size of their social network. However, younger men and men of higher socioeconomic status reported significantly larger available social networks than other men. Knowledge of the gender differences in network size and composition that were identified in this study contributes to nurses' ability to identify caregivers who may be at risk for inadequate social support. In conjunction with the findings from related studies these results have implications for nursing assessment and intervention in home care and long-term care settings.

Adult↗

PubMed1995

Women in transition: access and barriers to social support.

As little is known about how support assists individuals during a normative life transition, this qualitative, prospective study explored how women chose sources of informal support. Women having their first child, returning to work after an extended absence or recently retired from full-time employment were interviewed. Support during a life transition was described as having someone who would listen while the woman problem-solved. Women preferred to get their support from close family members or others experiencing a similar life transition. A number of barriers to the use of support were identified: perception that the use of support would be a burden on others, lack of reciprocity, reluctance to ask for support, and nonsupportive messages included within supportive actions. The transition often took more than 2 years to complete and, for a subgroup of women, involved major changes in their self-expectations and ability to access support. The findings identify areas that nurses should consider in health promotion activities with women who are experiencing these life transitions.

Adult↗

PubMed1995

Using critical feminist principles to analyze programs for low-income urban women.

Public health nurses are committed to promoting the health of vulnerable populations, including the economically disadvantaged. One of the perspectives that can be used to work with low-income women is feminist theory. In this paper, we analyze program descriptions from 45 community agencies whose services are accessed by urban low-income women. The purpose of the analysis is to identify congruence between agency programs and selected feminist principles. As a result of the content analysis, empirical referents and examples were identified for each principle. Public health nursing programs can incorporate feminist principles by responding to the perspectives of the vulnerable and facilitating their efforts to change the conditions that led to their vulnerability. Questions are presented that could guide public health nurses in stimulating reflection and in facilitating dialogue in the process of developing programs for low-income women.

Alberta↗

PubMed1992

Issues in the evaluation of small-scale adult day care programs.

Evaluation of health care programs is a complex process which presents many challenges. A case study of a small-scale adult day care program evaluation is presented to illustrate these issues. The rationale for developing the program and the findings from the evaluation study are discussed. Several evaluation issues including the use of multiple methods, levels of analysis, characteristics of the sponsoring agency, political influences, methodological issues and influences on utilization of findings are addressed.

Adult↗

PubMed1990

The development of nursing diagnoses for aggregates and groups.

A focus on aggregates, groups, or communities as clients is an important characteristic of community health nursing practice. Community health nurse practitioners have identified population groups as one of five functional components in a typology of community health nursing practice. Questions have been raised, however, as to whether such groups need different forms of nursing diagnoses than those used for individuals. We attempted to use nursing diagnoses in a senior community health nursing course with undergraduate students that included experience working with aggregates or groups. Issues were identified in relation to the scope of the role of nurses in the community, the selection of the client, and the use of a taxonomy.

Clinical Nursing Research↗

PubMed1990

Adult day care programs: a source for respite.

Respite care can be considered an illness prevention and health promotion intervention for both caregivers and the older people dependent on them. By maintaining clients' level of functioning, the process of deterioration is delayed and a degree of health promotion is achieved. Similarly, the relief of caregivers' burden, although minimal, sustains them in their role. A community-based mode of providing adult day care is supported in the literature. It seems logical to combine the services of a community-based organization and a long-term care institutional setting whenever possible.

Aged↗