Stressors, mediators, and health care outcomes of home enteral nutrition in family caregivers and their older adult care recipients

Family caregivers manage home enteral nutrition (HEN) for over 77% of an estimated 1 of every 400 Medicare recipients. Increasing usage of HEN in older adults combined with reliance on family caregivers raises concerns for the quality, outcomes, and costs of care. These concerns are relevant in light of Medicare limitations on nursing assistance and non-reimbursement for nutrition services, despite annual costs of over $600 million. This study applied stress process theories to assess stressor, mediator, and outcome variables salient to HEN and caregiving. In-home structured interviews occurred with a multi-ethnic sample of 30 caregiving dyads at 1–3 months after discharge on HEN. Care recipients were aged ≥60 (M = 68.4 years) and did not have dementia. Caregivers were aged ≥21, unpaid, and lived within 45 minutes of care recipients. Caregivers performed an average of 19.7 tasks daily for 61.9 hours weekly. Training needs were identified for 33 functional, care management, technical, and nutritional tasks. Preparedness scores were low (M = 1.73/4.0), and positively correlated with competence, self-rated quality of care and positive feelings, and negatively with overload, role captivity, and negative feelings (Ps < .05). Caregivers had multiple changes in lifestyle and dietary behaviors. Lifestyle changes positively correlated with overload, and negatively with preparedness and positive feelings. Dietary changes positively correlated with number of tasks, overload, role captivity and negative feelings, and negatively with preparedness (Ps < .01). Fifty-seven percent of caregivers aged >50 were at nutrition risk. Care recipients fared worse. Average weight change was −4.35 pounds (P < .001). Physical complications interrupted daily enteral infusions. Water intake was half of fluid need and associated with signs of dehydration (P < .001). Physical and social function was poor, with older subjects more impaired ( P < .04). Those with better prepared or less overloaded caregivers had higher functionality and QOL (P < .002). Complications, type of feeding tube, and caregiver preparedness correlated with frequency of health care utilization (Ps < .05). Efficacy of HEN in older adults requires specialized caregiver training, attention to caregivers' needs, and frequent monitoring from a highly skilled multidisciplinary team including dietitians. ^

Taiwanese faculty and administrators' perceptions and preferences toward shared governance

This study investigated the perceptions, attitudes, preferences, and actual reported degree of faculty participation in decision-making in Taiwanese universities. It was aimed at exploring possible agreements and disagreements between the faculty and administrators concerning these perceptions, and between the actual and preferred degree of faculty participation in both groups. ^ Seven questions were addressed in this study: (a) What are the most and the least reported areas of faculty involvement in decision making? (b) What are the most and the least preferred areas of faculty involvement in decision-making? (c) Is there a difference between faculty and administrators' reports of faculty involvement in decision-making? (d) Is there a difference between faculty and administrators in their preference for faculty involvement in decision-making? (e) Among the faculty, is reported involvement different from preferred involvement in decision-making? (f) Among the administrators, is their reported faculty involvement different from their preferred faculty involvement? and (g) Do faculty and administrators hold different attitudes toward faculty participation in decision-making? ^ The results indicated that: (a) Faculty had the highest level of involvement in academic decisions, and had the lowest level of involvement in developing general policies. (b) Both faculty and administrators had the highest preference for faculty involvement in academic decisions, and both of them had the lowest preference for faculty involvement in general policies. (c) Administrators reported a level of involvement for the faculty that was higher than the level that the faculty themselves reported. (d) Faculty desired a higher level of involvement than they currently have, and administrators also agreed that faculty should have greater involvement. ^ The interview results indicated that the presidents believed that faculty should participate in decision-making, but they also had negative feelings towards faculty who were enthusiastic about participating. The presidents showed their support of faculty participation in academic decisions, but not in other areas. ^ The results reflected the traditional Taiwanese social expectations of the role of faculty. When the range of decisions was narrowed to the academic context, the disagreements between the faculty, administrators, and university presidents disappeared. However, when the range of decisions was expanded, the agreement declined. ^