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| Family caregivers’ needs | Themes of sessions | Performance targets | Middle-range theories/selected empirical studies | Content and sample of exercises |
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| To understand the relative’s illness | 1st session
Learning to live with certainties and uncertainties related to Alzheimer’s disease and sharing concerns | Enable caregiver to
(i) gain awareness of own beliefs regarding Alzheimer’s disease, caregiver role, and role of health professionals
(ii) reevaluate own constraining beliefs
(iii) identify own main questions and immediate concerns | (i) Illness beliefs model [34]
(ii) Empirical work of Wright et al. [34] and Keady and Nolan [19] | Content
(i) Exploring caregiver beliefs regarding diagnosis, causes of illness, treatments, and course of illness
(ii) Discussing what is known about Alzheimer’s disease, what is currently unsure, and importance of progressively integrating uncertainty in order to remain proactive
(iii) Clarifying expectations and presenting program themes |
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(i) To develop new skills adapted to relative’s present situation
(ii) To find balance in life | 2nd session
Dealing with problems and averting psychological distress | Enable caregiver to
(i) identify own main problems related to caregiver role and effects on own well-being and QoL
(ii) utilize effective strategies to deal with problems and to maintain social relations
(iii) try out new strategies suited to own main concerns | (i) Coping process [44]; [67]
(ii) Empirical work of Ducharme et al. [56] | Content
(i) Identifying sources of difficulty or stress and strategies to use
(ii) Presenting coping strategies (reframing, problem solving, and stress management)
(iii) Discussing fit between strategies and nature of situations
Exercise
Analyzing the problem bothering me |
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| To develop communication skills to interact with relative | 3rd session
Communicating effectively and enjoying pleasant moments with relative | Enable caregiver to
(i) understand impact of illness on relative’s behaviour and mood
(ii) develop self-efficacy regarding own capacity to interact with relative and to feel good | (i) Concept of personhood [68]
(ii) Empirical works of Clark et al. [29], West [30], and Gauvreau and Gendron [69] | Content
(i) Interpreting changes, attributing difficulties to relative’s illness rather than ill intent
(ii) Key elements for communicating with relative with Alzheimer’s disease
(iii) Means to facilitate effective communication with relative (e.g., behaviours express emotions, affective memory) and render exchanges pleasant (e.g., words giving a valorizing sense to relative’s life)
Exercises
Interpreting changes in my relative; render an activity more enjoyable |
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| To receive reassurance about caregiving capacity and attribute a meaning to caregiver role | 4th session
Using own strengths and life experiences to care for relative | Enable caregiver to
(i) develop self-competence and self-efficacy regarding caregiver role
(ii) improve skills for taking care of relative
(iii) understand motivation in taking care of relative | (i) Cognitive Social Theory [35, 36]
(ii) Empirical work of Schumacher et al. [70] | Content
(i) Aspects of care provided successfully and those more difficult to provide
(ii) Questions and concerns about caregiver role
(iii) Ways to improve skills to care for relative (e.g., avoid being overprotective, ask relative to participate in duties he/she enjoys and within limits of capacity)
Exercise
Identifying obstacles that recur most often in course of exchanges with relative |
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| To discuss responsibility for care among family members | 5th session
Seeking help from family and friends | Enable caregiver to
(i) increase ability to call upon informal social support network in order to meet own needs for help, assistance, support, and comforting
(ii) acquire means to be able to prevent and manage family conflicts | Empirical works of Carpentier and Ducharme [71] and Trelaun [72] | Content
(i) Structural and functional dimensions of network
(ii) Changes in support network
(iii) Reluctance to seek help
(iv) Managing divergent opinions between caregiver and network
(v) Process for seeking help
Exercises
(i) Establishing ecological map
(ii) Seeking help from a network member |
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(i) To become familiar with available services and to establish ties with health professionals
(ii) To know what to expect regarding ill relative and themselves and to plan for what lies ahead | 6th session
Knowing available resources, making use of them, and planning for future | Enable caregiver to
(i) identify current and future help needs
(ii) call upon formal support network (services) in order to meet own needs
(iii) look to challenges lying ahead with confidence (including eventually placing relative in a facility) | (i) Support seeking [67] and social network analysis
(ii) Empirical work of Carpentier and Ducharme [71] | Content
(i) Discussing current and future needs for help
(ii) Presenting resources that offer services to caregivers
(iii) Prioritizing needs for help and identifying resources
(iv) Discussing how to proceed to request formal services and ways of increasing likelihood of success
Exercises
(i) Drawing the ecological map of regional resources
(ii) Planning a service request |
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| Not applicable to final session | 7th session
What has been learned and accomplished | Allow caregiver to
(i) Review what was learned and accomplished during six previous sessions
(ii) gauge sense of self-efficacy in pursuing caregiver role
(iii) discuss importance of transferring acquired competencies and skills to other situations
(iv) prepare for end of relationship with practitioner | Not applicable as no new content is covered in last session | Content
(i) Asking caregiver for examples of changes in behaviour or attitude following participation in program
(ii) Underlining caregiver’s strengths and competencies and giving caregiver credit for change
(iii) Underscoring processes underlying ways of taking action during program by making connection between approaches followed, strategies implemented,and results
(iv) Underlining how skills learned can be used to deal with other difficulties |
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