Resourcefulness Intervention to Promote Self-Management in Parents of Technology-Dependent Children

智谋干预促进技术依赖儿童家长的自我管理

• 批准号: 10064030
• 负责人: Valerie Annette Toly
• 金额: $ 55.75万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-12-28 至 2022-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10064030
• 关键词: Acute; Affect; Alzheimer' s disease caregiver; Alzheimer' s disease patient; Behavior; Behavioral; Blood Pressure; Caregivers; Caring; Child; Child Care; Child health care; Chronic; Chronic stress; Cognitive; Cognitive Therapy; Control Groups; Deterioration; Educational Intervention; Educational process of instructing; Emergency department visit; Enrollment; Enteral Feeding; Ethnic Origin; Family; Fathers; Gender; Goals; Hair; Health; Health Promotion; Healthcare; Home; Hospitalization; Hospitals; Hour; Household; Hydrocortisone; Income; Internet; Intervention; Journals; Length of Stay; Life; Locales; Mechanical ventilation; Mediating; Mediator of activation protein; Mental Health; Mothers; Outcome; Parents; Population; Psychological reinforcement; Race; Randomized Controlled Trials; Reporting; Sampling; Savings; Science; Self Management; Sleep; Societies; Stress; Structure; Technology; Telephone; Testing; Time; Training; Translations; United States; Work; Writing; adverse outcome; attentional control; base; care recipients; caregiver interventions; caregiving; complex chronic conditions; depressive cognitions; depressive symptoms; effectiveness testing; experience; functional status; group intervention; health related quality of life; help-seeking behavior; improved; mortality risk; neglect; nursing intervention; physical conditioning; post intervention; psychoeducational intervention; psychologic; randomized trial; self help; skill acquisition; skills; sleep pattern; social; stress management; theories; therapy design; treatment as usual; vigilance

Project Summary/Abstract Parent caregivers of children who require life-saving technology such as mechanical ventilation or feeding tubes must maintain a high level of vigilance 24 hours a day, 7 days a week. They report greater levels of stress, compromised self-management behaviors and poorer psychological and physical health than other caregiver groups which dramatically increases their mortality risk. Technology-dependent children (approximately 600,000) are among the sickest and most vulnerable subset of children with complex chronic conditions in the United States. They comprise 20% of all children discharged from the hospital to home, yet account for 61% of healthcare spending for children, up to $110 billion annually. Despite the adverse consequences for caregivers, there are no interventions to meet their specific needs. Resourcefulness Training, (cognitive-behavioral self-management intervention) has been shown to improve psychological and physical outcomes, mediate the effects of stress, and enhance the care provided to care-recipients. A Resourcefulness Training Intervention (RTI) will be tested in a randomized trial against an attention control group. The RTI includes face-to-face session for teaching social (help-seeking) and personal (self-help) resourcefulness skills, ongoing web access to the RTI video and video vignettes of caregivers of technology- dependent children describing resourcefulness skill application in daily life, 4 weeks of skills' reinforcement using daily journal writing, weekly phone calls for the first 4 weeks, and booster sessions at 2 and 4 months post enrollment. The Attention Control group will receive weekly phone calls for the first 4 weeks and at 2 and 4 months post enrollment plus any usual care. The aims of the study are to: 1) Determine whether the RTI versus Attention Control improves psychological (mental HRQoL depressive cognitions, depressive symptoms, appraised stress, burden) and physical outcomes (physical HRQoL, chronic stress [hair cortisol]) over 9 months in parents of technology-dependent children, after controlling for covariates (parent race/ethnicity and gender, family income, and children's functional status, type of technology). 2) Determine whether changes in psychological and physical outcomes are mediated by changes in parents' levels of resourcefulness based on intervention condition. 3) Compare self-management behavior (sleep, positive health practices) over 9 months in parents who received RTI versus Attention Control. 4) Explore whether resourcefulness is a mediator between intervention condition and self-management behaviors controlling for baseline self-management behavior over 9 months. 5) Explore the relationship between self-management behavior and parent psychological and physical outcomes based on intervention condition. Our study will be the first to test a cognitive-behavioral RTI for this caregiver population. 6) Compare target children's ER visits, hospital days over 9 months based on parent intervention condition. If shown to be efficacious, it can be replicated with other caregivers of children with complex chronic conditions with strong potential for translation into practice.

项目概要/摘要 需要机械通气或喂养等救生技术的儿童的家长照顾者 管子必须每周 7 天、每天 24 小时保持高度警惕。他们报告说， 压力、自我管理行为受损以及心理和身体健康状况比其他人差 护理人员群体，这大大增加了他们的死亡风险。技术依赖型儿童 （约 600,000）是患有复杂慢性病的儿童中病情最严重、最脆弱的群体之一 美国的条件。他们占所有出院回家儿童的 20%，但 占儿童医疗保健支出的 61%，每年高达 1100 亿美元。尽管不利 对于护理人员来说，没有任何干预措施可以满足他们的特定需求。足智多谋 培训（认知行为自我管理干预）已被证明可以改善心理和 身体结果，调解压力的影响，并加强为护理接受者提供的护理。一个 足智多谋训练干预（RTI）将在一项随机试验中针对注意力控制进行测试 团体。 RTI 包括教授社交（寻求帮助）和个人（自助）的面对面课程 足智多谋的技能，持续通过网络访问 RTI 视频和技术护理人员的视频片段 - 受抚养儿童描述日常生活中的足智多谋技能应用，4周的技能强化 每天写日记，前 4 周每周打电话，第 2 个月和第 4 个月加强课程 注册后。注意力控制组在前 4 周每周都会接到电话，并在下午 2 点和 注册后 4 个月加上任何常规护理。本研究的目的是： 1) 确定 RTI 是否 与注意力控制相比，改善心理（精神 HRQoL 抑郁认知、抑郁症状、 评估压力、负担）和身体结果（身体 HRQoL、慢性压力 [头发皮质醇]）超过 9 在控制协变量（父母种族/民族和 性别、家庭收入、儿童的功能状况、技术类型）。 2）判断是否发生变化 心理和身体结果是由父母足智多谋水平的变化所调节的 干预条件。 3) 比较 9 个月内的自我管理行为（睡眠、积极的健康习惯） 接受 RTI 与注意力控制的父母。 4）探索足智多谋是否是中介因素 干预条件和自我管理行为之间控制基线自我管理 超过 9 个月的行为。 5）探索自我管理行为与父母的关系 基于干预条件的心理和身体结果。我们的研究将是第一个测试 针对该照顾者人群的认知行为 RTI。 6) 比较目标儿童的急诊就诊次数、住院天数 根据家长干预情况超过 9 个月。如果证明有效，可以用其他方法复制 患有复杂慢性病的儿童的护理人员，具有很强的转化为实践的潜力。