Web-Based Educational Intervention for Caregivers

Web-based interventions are an important tool that nurses can use to improve the quality of life in their patients (Fredericks, Martorella, & Catallo, 2014; Yin, Goldsmith, & Gambardella, 2015). In order to do so, nurses can target patients and their caregivers. Web-based education (WBE) for caregivers can achieve multiple aims, including the improvement of the intent to care, quality of care, and pertinent knowledge (Cristancho-Lacroix et al., 2015; Hattink et al., 2015). Moreover, other outcomes can include the reduction of stress levels and burn-out and, possibly, the enhancement of the quality of life of caregivers (Barbabella et al., 2016; Cristancho-Lacroix et al., 2015). It is apparent that WBE for caregivers can be exceptionally important in multiple cases, including that of dementia.

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In the present paper, a proposal for a WBE for the family caregivers of patients with dementia is going to be considered. Such interventions are currently being studied, and they can be used by a Doctor of Nursing Practice (DNP) in multiple healthcare settings in the cases when a patient with dementia receives or is going to receive care from a family member.

The interventions should be employed to improve the quality of life of both patients and caregivers; apart from that, they are expected to advance and transform healthcare by addressing the problem of undertrained caregivers through innovative methods. The following PICOT question can be used for this proposal: in family caregivers of people with dementia, how does a WBE intervention affect their self-perceived efficacy, quality of life, and actual knowledge immediately after taking the course and six months later as compared to the pre-intervention perceptions?

Description of PICOT Elements Necessary for the Proposed Online Intervention

The present section will consider the elements of the PICOT question in detail. First, the population selection is well-justified. Family caregivers are not an unusual choice of care for people with chronic diseases, especially older ones, and dementia disproportionately affects older people (Boots, de Vugt, Withagen, Kempen, & Verhey, 2016). The education of caregivers is important both for the patients who have dementia and the caregivers themselves.

Family caregivers are not professionals, which limits their effectiveness in their new role (Hattink et al., 2015). Apart from that, it is well-established in modern literature that caring can be associated with multiple costs, including emotional and social ones (Kaltenbaugh et al., 2015). Mental health issues can result from the role of caregiving; they range from stress and anxiety to depression (Ploeg et al., 2017). Consequently, DNP-prepared nurses can indeed propose the interventions in multiple healthcare settings and different situations: for example, when they devise a plan of caring for a patient with dementia or when they are approached by a caregiver struggling with their role.

The intervention of the study is a WBE course for caregivers; in particular, the STAR initiative is proposed for evaluation. Its detailed description can be found in the article by Hattink et al. (2015). The European Skills Training and Reskilling (STAR) is a multidimensional project that focuses on dementia care and involves the development and testing of relevant interventions in several European countries. According to Hattink et al. (2015), the STAR e-learning course for dementia caregivers appears to have only been tested in two European countries. Consequently, the proposed project could contribute by diversifying the settings to include the US and offering more data to indicate the course’s effectiveness.

The course itself was developed over several years based on available research. It consists of the modules devoted to knowledge on dementia and its consequences for the daily life of the affected, as well as the specifics of caring for a person with dementia (for example, models for coping with stress and adaptation). According to Hattink et al. (2015), the current evaluation suggests that STAR improves the attitudes of caregivers towards dementia and care (in particular, promoting the concept of person-centered care) and assists in stress-coping abilities development, but it may also decrease the perceived idea of competence. Still, the described evaluation included only 142 people, which means that additional information would be helpful.

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It should be pointed out that nowadays, WBE interventions for caregivers, including those working with patients with dementia, are shown to be capable of having positive effects on their users. In particular, they are evidenced to be effective in improving their knowledge and supporting them (Barbabella et al., 2016; Boots et al., 2016; Cristancho-Lacroix et al., 2015; Kaltenbaugh et al., 2015; Ploeg et al., 2017). In other words, the concept of WBE for caregivers is proven to be an effective method of education, but specific programs require individual attention and testing.

The STAR intervention is already implemented in Europe; the permission to test it can be acquired by emphasizing the importance of producing more evidence on its effectiveness. As shown by the example of STAR (Hattink et al., 2015), the implementation of a similar or the same intervention in the US would require some financial assistance from the government or major healthcare associations, including, for instance, the Alzheimer’s Foundation of America (n.d.).

The support would be needed to establish the website for the program, acquire and manage the required content, and ensure the continuous monitoring of its effectiveness. Also, the dissemination of the information about the intervention should be carried out, in which dementia-concerned organizations can also be very helpful. However, before disseminating the information about the course, it is necessary to test its effectiveness to a greater extent, which the proposed project would do.

The choice of the comparison (the pre-test and post-test study design) is explained predominantly by the need to track the outcomes of using the intervention for a specific population. This approach is not uncommon for WBE testing, as shown by the example of the study by Liaw et al. (2015). Randomized controlled trials are also an option; after all, there exist several WBE interventions for the caregivers of persons with dementia (Boots et al., 2016; Hattink et al., 2015). However, for the time being, it appears more important to generate data specifically covering the intervention since it (as well as other WBE courses that have been discovered during the preparation of this project) remains understudied. Consequently, exploratory research like the proposed one seems to be a requirement.

The outcomes that are going to be considered are connected to the outcomes that the proposed intervention intends to achieve (Hattink et al., 2015). They are also the ones that are typically targeted by WBE interventions for family caregivers, especially when dementia is concerned (Barbabella et al., 2016; Boots et al., 2016; Cristancho-Lacroix et al., 2015; Ploeg et al., 2017). They include the actual knowledge and attitudes towards dementia, ability to manage stress, perceived self-efficacy, and quality of life. These outcomes define the effectiveness of the intervention in preparing caregivers for their role and supporting them. The specific tools that can be employed to measure the outcomes should follow the methodology of Hattink et al. (2015); in that case, the two evaluations will be compatible, and their results will be easier to meta-analyze.

The chosen timeframe follows the methodology of Hattink et al. (2015) and attempts to determine both short-term and long-term outcomes of the project. Indeed, while short-term results can yield some information about the effectiveness of the intervention, it is the long-term outcomes that are likely to define the quality of care and life of caregivers. Consequently, the project suggests tracking the results immediately after the intervention and six months after it. Thus, the proposed PICOT question is justified by the needs of the study and evidence on the topic.

Reflection on the Application from a Health Information Technology Perspective

From the Health Information Technology (HIT) perspective, the proposed project is another element of HIT-based interventions that are meant to improve the quality of care and life and facilitate healthcare procedures. Such initiatives include telehealth, computer-based education, self-care tools, and many other options that have the primary rationale of using modern technology to the benefit of patients (Portz, Miller, Foster, & Laudeman, 2016).

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The WBE intervention for family caregivers is especially important since it addresses the issue of unprofessional caregivers who are still an essential source of care for people with dementia (Barbabella et al., 2016; Cristancho-Lacroix et al., 2015). The practice examples of this contribution include the improvement of knowledge about dementia and the reduction of stress-related to the caregiver role. In other words, the proposed project has the potential for quality improvement achieved with the help of modern technologies.

Moreover, the project can also be viewed as another transformative element that increasingly introduces informatics into healthcare, expanding the educational options available for caregivers. HIT is a new field that requires additional investigation (Portz et al., 2016). The proposed project makes a contribution to it by testing one of the WBE interventions for caregivers and producing information about its effectiveness that might have some value for other similar tools. For example, the process of intervention implementation tends to yield evidence about barriers and facilitators pertinent to the process. Thus, from the perspective of HIT, the proposed project is justified as another step towards the improvement, expansion, and transformation of healthcare services.

Conclusion

The present paper discusses a project proposal devoted to WBE for the family caregivers who support people with dementia. The project offers to choose the population of caregivers due to their importance for the quality of life of people with dementia and emphasizes their specific educational and emotional needs. Also, the proposal suggests testing the STAR intervention, demonstrating that it needs additional research.

By analyzing prior literature, the paper indicates that pre-test and post-test research design is appropriate for exploring WBE and suggests using the outcomes and timeframes that have already been employed for testing the intervention to enable the pooling of data. The fact that STAR has already been implemented facilitates the achievement of the goals of the proposed project. The WBE initiative is going to be beneficial for the improvement of healthcare since it targets an important but largely under-trained and even untrained part of the caregiving population. Apart from that, the project is transformative and reflects the modern trend of using technology for healthcare purposes. Thus, it is justified from the HIT perspective.

References

Alzheimer’s Foundation of America. (n.d.). About us. Web.

Barbabella, F., Poli, A., Andréasson, F., Salzmann, B., Papa, R., Hanson, E.,… Lamura, G. (2016). A web-based psychosocial intervention for family caregivers of older people: Results from a mixed-methods study in three European countries. JMIR Research Protocols, 5(4), e196. Web.

Boots, L., de Vugt, M., Withagen, H., Kempen, G., & Verhey, F. (2016). Development and initial evaluation of the web-based self-management program “Partner in Balance” for family caregivers of people with early stage dementia: An exploratory mixed-methods study. JMIR Research Protocols, 5(1), e33. Web.

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Cristancho-Lacroix, V., Wrobel, J., Cantegreil-Kallen, I., Dub, T., Rouquette, A., & Rigaud, A. (2015). A web-based psychoeducational program for informal caregivers of patients with Alzheimer’s disease: A pilot randomized controlled trial. Journal of Medical Internet Research, 17(5), e117. Web.

Fredericks, S., Martorella, G., & Catallo, C. (2014). A systematic review of web-based educational interventions. Clinical Nursing Research, 24(1), 91-113. Web.

Hattink, B., Meiland, F., van der Roest, H., Kevern, P., Abiuso, F., Bengtsson, J.,… Nugent, C. (2015). Web-based STAR e-learning course increases empathy and understanding in dementia caregivers: Results from a randomized controlled trial in the Netherlands and the United Kingdom. Journal of Medical Internet Research, 17(10), e241. Web.

Kaltenbaugh, D., Klem, M., Hu, L., Turi, E., Haines, A., & Hagerty Lingler, J. (2015). Using web-based interventions to support caregivers of patients with cancer: A systematic review. Oncology Nursing Forum, 42(2), 156-164. Web.

Ploeg, J., Markle-Reid, M., Valaitis, R., McAiney, C., Duggleby, W., Bartholomew, A., & Sherifali, D. (2017). Web-based interventions to improve mental health, general caregiving outcomes, and general health for informal caregivers of adults with chronic conditions living in the community: Rapid evidence review. Journal of Medical Internet Research, 19(7), e263. Web.

Portz, J., Miller, A., Foster, B., & Laudeman, L. (2016). Persuasive features in health information technology interventions for older adults with chronic diseases: A systematic review. Health and Technology, 6(2), 89-99. Web.

Yin, B., Goldsmith, L., & Gambardella, R. (2015). Web-based education prior to knee arthroscopy enhances informed consent and patient knowledge recall. The Journal of Bone and Joint Surgery-American Volume, 97(12), 964-971. Web.

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