Family caregiving that precipitously arises when stroke occurs in another family member presents an enormous challenge for nursing practice. Thrust abruptly into what amounts to an unexpected career change, individuals who assume the role of family caregiver must rapidly assimilate a tremendous amount of new information and acquire new skills. They need to master dual competencies which require meeting the stroke survivor's needs (caregiving competence) while adhering to health habits that preserve their own health and well-being (self-preservation). With shorter hospitalizations severely reducing the opportunity for in-hospital preparation for the role, family caregivers often view themselves as lacking requisite knowledge, skill, and support to handle the problems related to caregiving that intrude upon their lives. Limited improvement in caregiver outcomes has been obtained through group educational programs; telephone counseling; computerized informational, communication, and decision support; and persuasive communication techniques. Using stroke as a prototype condition that results in sudden-onset family caregiving, we plan to join elements of these approaches into an intervention that is guided by cognitive-behavioral and persuasion theories and capitalizes on emerging technologies. In conjunction with relevant career training, we plan to develop (Phase I) and test (Phase II) a telecommunications-based intervention with family caregivers of first-time stroke survivors. Specifically, Phase 11 will involve a three-group, randomized, controlled, experimental study (N=75) to determine the effect of a nurse-delivered intensive intervention post-hospital discharge on caregiving competence and self-preservation. The intervention will involve: 1) regular telephone contact for stroke care information, problem focused counseling regarding the needs of the caregiving dyad, and persuasive communication aimed at preserving or improving the family caregiver's preventive health practices; 2) in-home access to peer and professional electronic mail communication, and 3) linkage to community and Internet informational and support resources. Caregiving competence (stroke care knowledge and caregiving preparedness) and self-preservation (caregiving appraisal, adherence to preventive health practices, depressive symptomatology, anxiety, and health resource utilization) will be measured using on-line data collection methods at 2 weeks, 6 months, and 12 months post-hospital discharge. Two cognitive strategies (need for cognition and problem solving ability) will be evaluated for their potential modifying effect. Longitudinal data analytic techniques, descriptive statistics, and content analytic methods will be employed.
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