Caregiver Training Courses

Caregiver Training Ebooks

The caregiver training e-book gives a training course on how to provideassistance to another person who is ill, disabled or needs help with daily activities. It can also serve as a useful guide to the individuals in the need of help. The product deals in physical, mental, social, and psychological needs and well-being of both the caregivers and the elderly person requiring care. Everyone needs a little help from time to time and while many seniors lean on the friends and family members for support, there may be some instances in which it's necessary to seek additional assistance or long-term care which was why this product was created by the author. This caregiver product is a practical guide created by the author who is an expert in the field. This product embeds in it several training sections in which each section gives detailed information on how to provide assistance to people who are ill, disabled, or aged. This product is a trusted and 100% guarantee to provide the necessary details needed in caring for the physically challenged, aged and ill individuals. The product is also an essential overview of issues from Alzheimer's to diabetes to strokes. Read more...

Caregiver Training Ebooks Summary


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Contents: Ebooks
Author: Kenneth Watts
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My Caregiver Training Ebooks Review

Highly Recommended

Of all books related to the topic, I love reading this e-book because of its well-planned flow of content. Even a beginner like me can easily gain huge amount of knowledge in a short period.

In addition to being effective and its great ease of use, this eBook makes worth every penny of its price.

Health Issues For Caregivers

The health of family members who often provide extensive home care services (care-givers) is extremely important, but often neglected in the discussion of MS needs and supports. It may be neglected by the person with MS, who sees all others as healthy, in comparison it may be neglected by the physician, who concentrates on the more obvious needs of the person with MS and, more importantly, it is often neglected by the caregivers themselves, as they believe their problems and needs are minor compared with those of their loved one with MS. Many studies have shown that caregivers neglect their own health. They do not get regular checkups, do not have their blood pressure taken regularly, and are not being treated for important problems and risk factors when they are present. It is interesting that this is different for women and men in many cases, as women more naturally move into the caregiver role and pay less attention to themselves in view of the new responsibilities, whereas men...

Family And Caregiver Burden

Burdens on family members and caregivers for individuals with bipolar disorder are extensive (over 90 of caregivers report moderate or greater distress 77 ) and may be more profound than occurs with either major depression alone 78 or schizophrenia 79 . Clinicians also have been shown to demonstrate a keener appreciation for the burden experienced by relatives of patients with schizophrenia than with bipolar disorder particularly with regard to patients being delusional or displaying other positive symptoms, or showing lack of insight into the nature of their condition 79 . Demographically, among families of severely mentally ill individuals in general, African American caregivers tend to report less subjective burden than do white family caregivers, independent of religious or other social factors 81 . The degree of caregiver burden perceived by the well siblings of severely mentally ill individuals appears directly linked to symptoms experienced by an affected sibling, and may also...

Problem Solving for Caregivers of Cancer Patients

Family members who are responsible for the day-to-day care of cancer patients can also experience high levels of distress and frequent problems. As such, we have also hypothesized that training such individuals themselves in problem-solving skills may be a particularly useful approach in helping family caregivers to cope more effectively in this role.55,56The Prepared Family Caregiver Course adapted the D'Zurilla and Nezu57 PST model as a means of providing the following types of information to family caregivers of cancer patients (a) understanding the problem (b) when to get professional help (c) what can be done to deal with, as well as prevent, a problem (d) identifying obstacles when they arise and planning to overcome them and (e) carrying out and adjusting the plan. Manuals have been developed that contain guided problem-solving plans across a variety of physical (e.g., fatigue, hair loss, appetite difficulties) and psychosocial (e.g., depression, anxiety) problems that cancer...

As a caregiver how can I cope with my partners PD

Balance of your relationship is shifting you will be challenged emotionally, spiritually, and physically. A partner who mowed the lawn and kept the garden may no longer be able to perform these tasks. A partner who shopped and cooked and cleaned the house may have to share those tasks with his or her mate. At times, the responsibility for the home combined with caregiving for the ill partner can become so burdensome that you feel pushed beyond your abilities to cope. As a caregiver you must take care of yourself physically by eating a balanced diet and getting enough sleep and regular exercise. Exercise is a great way to relieve stress while strengthening you for the physical challenges of caregiving. Take care of yourself emotionally by learning to channel your emotions and feelings into constructive outlets. Find a support group for caregivers. Talk about your feelings with friends and family. Learn as much about PD as possible so that the next challenge won't come as such a...

Caregiver Differences

A number of researchers have conceptualized emotion regulation as developing within the context of the parent-child relationship (e.g., Gianino & Tronick, 1988). Parent-child interaction involves mutual regulation in which caregiver and child each modulate the affect of the other (e.g., Tronick, 1989). The parent-child context may be characterized as more unresponsive and poorly coordinated in which case, the parent fails to recognize the child's emotional needs or ignores the child's existing capabilities or smoothly coordinated with matching of parent and child affect (Field, 1994). Greenspan (1981) similarly discussed the growth-promoting early environment as one that balances the child's need for stimulation with his or her need to experience homeostasis or self-regulation. According to his view, the parent initially provides soothing or comforting to supplement the child's emerging capacities. As the child becomes older, the parent helps the child integrate affective polarities...

Family Caregivers

Finally, living with advanced cancer impacts on social relationships so this last section will discuss the implication for families and informal carers who are in close contact with cancer survivors with advanced disease. A number of reviews of the literature from Australia,64 the UK,65,66 and Canada67 have consistently highlighted the problems and challenges faced by family caregivers. The following section offers a summary of the main factors identified. Until relatively recently there was little acknowledgment of the needs of family caregivers.66 It is only recently that patients and caregivers in the UK have been invited to contribute directly to national debates on health and social care or become involved in the planning and delivery of services and contribute to the design and conduct of research in health care.68,69 Even within these new user involvement policies, carers in palliative care tend to be regarded as proxies for patients who are too ill or otherwise unable to...

How this book is organized

To meet some of the children you will read about in this book, and to give you more places to find help for your cancer journey, I have included four appendixes for reference a photo gallery of children during and after treatment, blood counts and what they mean, resource organizations, and books and online sites. In addition, bound in the book is an indispensable health record to be filled out at the end of treatment and copied and given to each subsequent caregiver for the rest of your child's life. This personal long-term follow-up guide educates healthcare providers about the types of treatment given and the follow-up schedule necessary to maintain optimum health.

Developmental and Social Impact on the Child

Children younger than two years of age are unable to grasp the concept of being diagnosed with a life-threatening disease. As a result, the psychological impact of the diagnosis falls mainly on the child's caregiver ). Parents may feel horrified at the idea of losing their child to a disease that they essentially gave to their children. They may benefit from psychological services that offer support and guidance for coping with these feelings of fear and guilt. Infants and toddlers, on the other hand, are most concerned with immediate events, such as painful procedures and separation from their parents. Psychologists can help parents prepare their child for medical procedures through role-playing, medical play, and coloring books that illustrate the procedure.

Stability of Temperament2

My choice of evidence to address the first area listed above is based on methodological considerations. As Crockenberg (1986) has noted, in studies that concurrently measure temperament and context it often is difficult to establish whether it is the child's temperament influencing their caregiver's rearing style, or the caregiver's rearing style that is influencing the child's level of temperament. Given this potential confound my conclusions on temperament and context will be based on (a) longitudinal investigations in which the measurement of temperament precedes the measurement of context or vice versa (b) studies assessing nonparental aspects of the environment that are less likely to be influenced by the child's temperament, thus allowing inferences to be made about directionality when relations between temperament and environment are found and (c) intervention studies that allow causal inferences to be made. Obviously, there still will be interpretive problems, even with these...

Summary Influence of Context Upon Temperament

While there is little direct evidence for the position taken by Kagan et al. (1993), some evidence does exist for the operation of a reverse process namely, that the meaning, expression, and consequences of temperament can be moderated by cultural characteristics. Perhaps the most dramatic example of this phenomena is seen in evidence indicating that fussy difficult infants living in developing countries are more likely to survive during drought conditions (DeVries, 1984), or where there are high levels of infant mortality (Scheper-Hughes, 1987). Differential survival rates appear to be based, in part, on culturally driven beliefs about the desirability of certain infant characteristics. Less dramatic but equally valid, Thomas and Chess (1986) have noted how concepts like difficult temperament may have very different meanings in different cultural contexts. Characteristics that are viewed as difficult in one culture may not be viewed in the same way in other cultures. For example, in...

History of Attachment Theory

World Wars I and II alerted mental health professionals and the general public alike to the importance of close interpersonal relationships in development. Particularly in Europe, where casualty rates were highest, psychological trauma due to the loss of loved ones was common. Therapists, in fact, reported that death of family members was a frequent reason for individuals to seek therapy during the postwar years. In this context, British psychiatrist John Bowlby, while working with children and adolescents in London orphanages, discovered that the most disturbed children were those who had experienced separations from their caregivers, particularly their mothers. Consider, for example, his account of a seven-year-old girl Bowlby also noted that children who developed behavioral and emotional problems often experienced parenting that was characterized by displays of ambivalence or outright rejection. Based on these observations, he hypothesized that a caregiver's emotional attitude...

Stability of Attachment and Later Relationship Functioning

Strange Situation classifications in infancy are also predictive of later relationship functioning. Infants classified as secure show more positive emotions toward their parents at two years of age and have better communication with their parents during middle childhood than infants classified as insecure. Patterns of attachment in infancy are also predictive of the quality of relationships with people other than parents. For example, children who are securely attached to their caregivers have better relationships with teachers, peers, and close friends.

Who should tell your child

We've really marveled as we watch Joseph go through the stages of coping with all of this just as an adult might. First of all, when he was diagnosed in April, he was terrified. Then in May and June he was alternately angry and depressed. When we talked to him seriously during that time about the need to work with the doctors and nurses against the cancer no matter how scary the things were that they asked him to do, he looked us right in the eye and screamed, I'm on the cancer's side Then over the course of a few weeks he seemed to calm down and made the decision to fight it, to cooperate with all the caregivers as well as he possibly could and to live as normal a life as he could. It's hard to believe that someone could do that at 4 years old, but he did it. By his fifth birthday on July 26th, he'd made the transition to where he is now hopeful and committed to killing the cancer

Stages in the Development of Pre Speech Vocalizations

In the third stage (at four to six months), vocal play or expansion, syllable-like productions with long vowels appear. Squeals, growls, yells, bilabial or labiodental trills, and friction noises demonstrate infants' playful exploration of their vocal tract capabilities during this stage.

Pre Speech Productions and First Words or Signs

Early words are produced by the child in expected contexts, and hence are recognized by familiar listeners as linguistic units conveying meanings. In 1999 Esther Dromi distinguished between comprehensible and meaningful words. Comprehensible words are phonetically consistent forms resembling adult words that caregivers understand, but that do not yet convey referential meanings. Meaningful words are symbolic, arbitrary, and agreed-upon terms of reference. Considerable variation exists in both the age of speech onset and the rate of early lexical development. Large-scale questionnaire data reported in 1994 by Fenson and his colleagues for English-speaking typically developing children, cited the range of vocabulary size for twelve- to thirteen-month-olds at 0 to 67 different words, and for eighteen- to nineteen-month-olds at 13 to 471 different words. In 2000 Maital and her colleagues reported very similar figures for Hebrew.

Psychosocial Concerns

Cancer survivors with preexisting anxiety or affective disorders appear to be at greatest risk for ongoing distress.25 Changes to body image from cancer therapy, such as that resulting from mastectomy or colostomy, can be a source of problems with psychological adjustment.72 Distress appears to dissipate with time, however. There are a small proportion of patients who experience ongoing effects characteristic of posttraumatic stress disorder.73 Having a spouse or partner decreases the risk of psychological sequelae,74 although these caregivers may also themselves be adversely

Laying Out a Lifeline

Questions About Mother (or other caregiver) Questions About Father (or other important caregiver) 1. What was my father's personality like Start by reflecting on your childhood. You may jump-start your memory by talking with relatives or by looking through old photo albums. Then move on to answer the questions about your parents or caregivers as well as the questions about your childhood and adolescence. Don't worry about getting all the details right just do the best you can. Memories aren't always completely accurate, but, in a powerful way, they impact the way you feel today.

Within Task Learning versus Previously Acquired Knowledge Revisited

Given that the evidence did not support sensory explanations for the female face preference displayed by young infants, a cognitive explanation for the preference was investigated. This explanation rests on the idea that infants might prefer female over male faces because of greater familiarity with female faces. It is known that familiarity preferences can be observed in face comparisons as is evidenced by the finding that young infants will display a spontaneous preference for mother's face over a strange female face, even in the absence of external hair cues (Bartrip, Morton, & de Schonen, 2001). In addition, a majority of infants in the first 3 months of life are reared with female primary caregivers, and this was true for all the infants thus far described for the experiments of Quinn et al. (2002). These observations led to the hypothesis that infants might generalize their experiences with primary caregivers who are female to female faces more generally (at least when compared...

Substance Abuse And Cancer Treatment

On the other hand, preexisting abuse of these same substances complicates cancer treatment. A history of substance abuse may shorten a cancer patient s life expectancy and undermine the effectiveness of palliative care. Ongoing substance abuse disrupts the patient s relationships with physicians and other caregivers. As of 2000, the National Cancer Institute has issued guidelines for the clinical management of cancer patients with substance abuse histories. These guidelines include evaluation and treatment of comorbid psychiatric disorders, evaluation of the patient's tolerance of drugs, and monitoring of hospital inpatients.

Brazelton Neonatal Assessment Scale

The scale enables parents, health care professionals, and researchers to understand a newborn's language, as well as individual strengths and needs in depth. The BNAS assesses various behaviors of infants until two months of age and takes about thirty minutes to administer. This assessment evaluates four main areas, including the infants' ability to monitor their own breathing, temperature, and other bodily systems control their motor movements maintain an appropriate level of consciousness, which ranges from quiet sleep to a full cry and interact socially with parents and other caregivers. The purpose of the BNAS is to help professionals assess the infant's pattern of response to the environment and then assist parents with strategies to build a positive relationship with their infant.

From the bench to the bedside

With the advances in sequencing and bioinformatics, gene discovery in CHD is escalating. This advance in research is directly translated to clinical testing to provide genetic counseling for adult patients with CHD who plan to have children. From a technical aspect, our capability to identify genetic variants in CHD genes has magnified. Nonetheless, making functional significance and even clinical sense of the large number of gene mutations remains a big challenge. Given the complexity of CHD, definite gene mutations remain uncommon. At this time when the genetic inflow of information is very fast, physician-scientists must be very careful in communicating genetic information that is not validated to patients, in order to avoid psychological and emotional harm. On a different angle, with sequencing of the exome or genome, the chances of detecting incidental findings that indicate disease risk or prognosis becomes very high. All such unintentionally detected serious genetic findings...

Management View of the Care Relationship

Thinking in triads becomes especially important whenever relationships are characterised by asymmetries and dependencies, as is the case in care relationships. Following Jochimsen (2003), it is meaningful to distinguish between types of caring activities. Care may occur between persons, who could in principle help each other (e.g. between friends). Both partners, in this case, will have the capacities and resources to be in the role of the care giver, or will be able to reciprocate on another occasions. Both partners can also be conceived of as having the capacities for self-help. Although these situations have their own importance in the conceptualisation of a general theory of help and caring, the classical cases are the care for children, for the underprivileged, sick or impaired or for frail older persons who have some kind of dependency on care or help. These persons are vulnerable in the sense that not receiving care will bring them to some kind of precarious situation, because...

Directions For The Future

In terms of interventions, there are several areas with potential. First, given the relative scarcity of psychologists and psychiatrists in community oncology settings, interventions utilizing oncology nurses to identify and treat depression have shown promise.77 Second, caregiver depression has recently become a focus,78 and a number of emerging programs have proposed to treat caregiver depression in the hopes of improving quality of life for the entire cancer-affected family. Third, prospective trials continue to explore the role of support groups in mediating depression, and the functional components of these groups (see Goodwin,79 for a review). Finally, the role of exercise in remediating depression has shown notable promise,80 although some studies have found no beneficial psychological impact of exercise.81Coping style continues to be an active area of research interest in cancer survivors. It is clear that coping style and dispositional traits may play a large role in risk of...

What Is Successful Adaptation To Advanced Cancer

The extant literature on patients with metastatic cancer focuses almost exclusively on two indicators of psychological adjustment depression distress and QOL. Reports of the prevalence of emotional distress among individuals living with AC vary depending on the method of assessment and the nature of the sample.29 Several large studies and literature reviews estimate the prevalence of depression in AC to be approximately one-quarter to one-third of patients.29-35 Studies using self-report instruments generally report higher prevalence rates than those using structured psychiatric interviews to diagnose depression,29 and rates may be inflated if measures include somatic symptoms of depression (e.g., fatigue, insomnia).36 Estimates based on the perceptions of caregivers or physicians may also inflate the prevalence of distress, as one study based on palliative care social workers' assessments of patient functioning found that 63 of patients were anxious and 54 were depressed.28 In...

Are there any MS groups that I can look into for additional help

The people at the meetings by and large are there for positive reasons. They are generally well informed and well meaning. Additionally, there are the usual characters the newly diagnosed person in denial who is sure it was a misdiagnosis and expects never to be at another meeting the recently diagnosed person who expressed the same denial at a prior meeting the person who is certain of and has all of the answers the bee sting aficionado the lonely soul who has no other social contact the nervous caregiver who eats cookies nonstop and me. All of these people come together with stories that are unique, unnerving, empowering, irritating, enlightening, heartbreaking, tiring, and fascinating.

Components Of The Intervention

Her reply was a scornful Well, yeah but it did force her to speak to me and I could now keep working at giving her something to think about. (This is a version of directing aggression toward the leader that others in this book have noted, but begins with affect rather than content.) Once I had Jane's attention, I could move on to saying I think you are angry at Sara for her mother's interest because you're angry at Francis for bringing me into the group and paying no attention to your wishes. It is less relevant that this be insightful and accurate it should carry the kind of emotional tension the member is expressing. Engaging and getting the patient's attention are the more basic objectives accuracy will come later, when dialogue can be established. So, when Sara replied That's stupid I did not take her retaliation personally but was ready to keep her mind engaged by saying She not only left you and brought me in to cover for her, but she also brought a little sister into the...

Third Party Informants

For clients who were unable to provide responses to the self-report questionnaires, the views of a key informant were elicited. Two instruments were used (see Chapter 2, this volume). The QUALID-instrument (Weiner et al., 2000) is answered by an informant who may be either a family member or professional caregiver in regular contact with the client. QUALID uses five

Nutritional Assessment Tools

Arrays of nutritional screening tools have been developed to facilitate the identification of older persons at risk for undernutrition. The Nutrition Screening Initiative (NSI) in the US stemmed from a collaborative effort between family physicians, dietitians, and the National Council of Aging. This is a three-tiered tool formulated to assist in the detection of older persons at risk for nutritional compromise and subsequent direction of such persons toward the appropriate level of care. The first level of screening is designed to be initiated by the patient or primary care giver. Persons identified to have an increased risk of undernutrition are then referred for evaluation by healthcare or social services personnel. This constitutes the second level of screening. The identification of factors that may warrant medical intervention will prompt referral to a physician for further evaluation. The NSI is of proven value as an epidemiological tool and serves to increase the awareness of...

The Social Context Of Pain In Cancer Survivors

Mechanic and his colleagues92,93 discussed the change in role expectancies that accompanies the onset of illness. According to Mechanic,92 during periods of active disease and treatment, individuals are relieved of a variety of life responsibilities such as domestic and occupational duties. The patient is expected to follow directives of treating professionals in order to maximize the probability of successful recovery. The social environment is expected to adopt a supportive and caregiving role in order to promote the recovery of the patient. In other words, there are implicit guidelines for the responsibilities of the patient and the caregiver. Following recovery, there is the expectation that the patient will begin to resume pre-illness responsibilities and the social environment will be absolved of further caregiving activities.

Infancy and Preschool An Emphasis on Biology and Parenting

Although it is clear that genetic makeup plays a crucial role in social development, it is less certain exactly what biological mechanisms account for this influence. Certainly, many innate factors affecting social behavior are common to nearly all infants. For instance, infants will cry when distressed, and they actively attend to and seek attention from caregivers. Infants have differences, however, in their genetic makeups, and researchers have searched for ways in which these differences are expressed. Perhaps the most widely studied aspect is temperament, which consists of several components related to emotional reactivity and regulation. Infants described as having ''difficult temperament'' are those who are fussy, become upset easily, and are not easily soothed. Other infants are considered inhibited they are timid and fearful, become easily upset by intense stimuli, and are also not easily soothed. Infants with ''easy temperaments'' are outgoing and respond positively to...

Economic And Occupational Illness Burden

Costs (totaling approximately 7.6 billion year, or 17 of total costs) and indirect expenses (about 83 of total costs, reflecting expenses due to worker absenteeism and diminished work productivity or lost wages, institutional costs, premature death, and family caregiver burden). Direct expenses linked to affective disorders include nursing home (33 ) and inpatient (26 ) costs, crime (25 ), substance abuse (8 ), suicide (2 ), medications (1 ), shelters (1 ), and research training programme costs A different morbidity cost estimate for affective disorders, using a timing model with regression analysis based on data from 1985, determined that affective disorders comprised 21 of costs related to all forms of mental illness a majority of expenses were accounted for by direct treatment costs (58.4 ), while morbidity comprised 8.1 of costs and mortality constituted 28.9 costs due to crime, diminished work productivity and caregiver services comprised 4.6 of costs 10 .

Adaptive Equipment and Environmental Changes

Occupational therapists can often recommend adaptive equipment to make activities of daily living easier, such as modified eating utensils, reaching aids, and dressing aids to facilitate ease of performance. Both PT and OT therapists can assist and educate the patient and caregiver on changing the environment of their home to make it easier to maneuver in the home and to enhance safety and reduce falls. As the patient's function warrants, grab bars may need to be installed to assist with sit-to-stand transfers from the toilet and other low surfaces. Other equipment to consider includes high-rise toilets and shower chairs. A home visit can be helpful to identify risks for falls and recommendations to eliminate throw rugs and clutter on the floor, and placement of nightlights.

Session 10 Family Communication

This module, which involves both the teenager and the caregivers, is used when the therapist becomes aware of negative communication in the family, or when there are high levels of expressed emotion. We began with a discussion of common patterns of communication that can contribute to con

The psychological effects of exercise

Cancer diagnosis, treatment, and uncertainty of reoccurrence is a chronic and dynamic process that exerts a great deal of emotional stress on individuals with cancer. Depression may be a co-morbid and disabling syndrome that elicits anxiety, sadness, and fatigue. It is difficult to differentiate whether fatigue causes depression or vice versa. Both fatigue and depression are strong predictors of quality of life in cancer patients (Hopwood and Stephens 2000) and depression is more likely than fatigue to cause emotional distress in family caregivers. Thus, it is important to manage depression not only for the comfort of the patient, but also in order to reduce distress in the family.

Perspectives on Personality Development

Many personality theorists and researchers emphasize the importance to early personality development of the quality of attachment between infant and primary caregiver. Attachment is considered the enduring emotional tie that an infant forms with his caregiver, which helps to ensure a relationship style between caregiver and infant that fosters infant survival. Several models characterize the developmental progression of attachment formation. These models emphasize the universal, biologically based process of attachment as it unfolds across infancy and childhood. Significant individual differences are not thought to occur in the actual process of attachment formation itself, but individual differences do occur in the quality or style of attachment. See Table 1 for a listing of the commonly agreed upon infant and childhood attachment patterns and their characteristic behaviors. These patterns of behavior have been identified through a laboratory procedure called the Strange Situation,...

BOX 62 Kids Off the Couch

Kids Off the Couch is a community collaborative pilot project in Modesto, California, that works with parents and caregivers to prevent obesity in children up to 5 years of age. The project's goal is to influence behavioral changes in food selection and physical activity among parents and primary caregivers. The program provides parents and caregivers with

Case Conceptualization Of Comorbidity Of Gad Ocd And Ptsd

The case formulation also includes a postulation of how early childhood-adulthood experiences may have contributed to a psychological vulnerability that, when activated by life stressors, led to the emergence of each condition. Early experiences of uncontrollability may represent the psychological vulnerability for anxiety disorders, particularly for GAD (Barlow, 1991). Borkovec (1994) has suggested that childhood histories of psychosocial trauma (e.g., death of a parent, physical sexual abuse) and insecure attachment to primary caregivers may be childhood origins that lead to the development of a psychological vulnerability for GAD. For PTSD, prior negative experiences and traumas may exert influence and give additional negative meaning to the traumatic event (Ehlers & Clark, 2000). Clinicians should

Infant Parent Attachment A Critical Sensitive Period for Social Development

Attachment is the strong emotional ties between the infant and the caregiver. This reciprocal relationship develops over the first year of the child's life, and especially during the second six months of the first year. During this time, the infant's social behavior becomes increasingly organized around the principal caregiver. Bowlby suggested that there was a sensitive period for the formation of the attachment relationship. This period is from approximately six months to twenty-four months of age and coincides with the infant's increasing tendency to approach familiar care-givers and to be wary of unfamiliar adults. In addition, according to Bowlby and his colleague Mary Ainsworth, the quality of this attachment relationship is strongly influenced by experiences and repeated interactions between the infant and the caregiver. In particular, Ainsworth's research, that was first published in the late 1960s, demonstrated that a secure attachment relationship is associated with the...

Developmental Perspectives of Child Maltreatment

Infants are at the greatest risk for all types of maltreatment, including fatal maltreatment. This is relatively easy to understand from a developmental standpoint. Child neglect occurs commonly as infants are the most dependent on their caregivers to provide the basic necessities of life in a stable, secure environment. Parents who are overwhelmed by life stressors and have personal limitations, or have certain cognitive or medical conditions (such as mental retardation or depression) may become caregivers who cannot pick up on infant cues. In these situations there is a risk of poor attachment and emotional neglect. Parents can also be easily frustrated by an infant whose crying or temperament makes them difficult to handle, leading to the potential for physical abuse. This risk is dangerously high given that infants are already at higher risk for physical abuse because of their physical attributes, such as softer bones, small size, and the inability to resist physical harm or...

The Functions of Friendships Between Very Young Children

Attachment theory, once expanded beyond the study of early parent-child relationships, also is likely to continue be a powerful influence on the study of peer relationships. This work has suggested that attachments with alternative caregivers are influential to peer relations. Furthermore, descriptive studies have established that relationships between young children are stable affective bonds. These findings may lead researchers to move beyond the description of friendships towards the study of internal representations of friendships. The question of what internal representations are derived from early peer affective relationships and how these representations shape children's working models of relationships is far from answered. In this context, it is important that the earliest friendships appear to be based on some chemistry that leads toddlers to prefer each other rather than on matches between children of similar gender and ethnicity. As classrooms become filled with children...

Emotion Regulation and Later Adaptation

Attention deployment strategies more able to use cognitive strategies as they become older What sorts of caregiver influences impact on individual differences in the use of coping strategies When does the use of less autonomous strategies become emotional dysregulation What roles do temperament and caregiver styles play in extreme forms of dysregulation How early are these difficulties evident In addressing these and other questions, the study of emotion regulation promises to provide important insight into the development of problem behaviors and clinical disorders.

Emotional Self Regulation in Infancy and Toddlerhood

In this chapter, we present a theory of the development of emotional self-regulation, focusing in particular on the toddler and early preschool years. We begin by describing the functionalist approach to emotions which underlies our work. We then tie this view of emotions to the concept of emotion regulation. Next, we describe self-determination theory, the lens through which we view the development of emotional self-regulation. Given the varied use of terminology in the literature, we include a section on key distinctions such as those between emotion control and emotion regulation and emotion management versus emotional integration. Following this, we provide an in-depth discussion of our framework for understanding the development of emotional self-regulation that includes a review of empirical support for our theory. Drawing on our own work and that of others (e.g., Calkins, 1994 Kopp, 1989), we also present a model of factors that contribute to emotional self-regulation,...

Healthy Home Environment

Parents (defined broadly to include primary caregivers) have a profound influence on their children by fostering certain values and attitudes, by rewarding or reinforcing specific behaviors, and by serving as role models. A child's health and well-being are thus enhanced by a home environment with engaged and skillful parenting that models, values, and encourages healthful eating habits and a physically active lifestyle. Economic and time constraints, as well as the stresses and challenges of daily living, may make healthful eating and increased physical activity a difficult reality on a day-to-day basis for many families.

Clare Stevinson Kristin L Campbell Christopher M Sellar and Kerry S Courneya

Cancer-related fatigue has been identified as one of the most common and distressing symptoms reported by patients, and also one of the most difficult to treat.10 An overemphasis on rest carries the likelihood of causing increased fatigue, due to individuals becoming caught in a vicious cycle of inactivity that leads to further de-conditioning, hence greater fatigue upon even minimal exertion. Some trials have reported reductions in fatigue in participants exercising during treatment,42,76,77 and those who have completed treatment.40,79 However, not all trials have demonstrated this effect, and the results of meta-analyses are conflicting on this outcome, with no significant change in fatigue found in three reviews,54,67,70 but a small significant reduction in another.62 It is important to note that there is little evidence of increased fatigue from exercise. This is a highly positive finding with respect to the understandable concerns of patients and caregivers that exercise may...

L Oriana Linares Nicole A Morin

Based on the community violence studies of the early 1990s, between 44-82 of school-aged children and youth are exposed to community violence, depending on definitional criteria, methodology, and sample characteristics (Overstreet, 2000 Stein, Jaycox, Kataoka, Rhodes, & Vestal, 2003). According to the early studies, by the end of elementary school, almost all children residing in high crime innercity areas of Washington and New Orleans had heard (98 ) or witnessed (90 ) moderate to severe levels of violent occurrences (Richters & Martinez, 1993 Osofsky, Wewers, Hann, & Fick, 1993). School-aged children exposed to community violence are at risk for an array of problematic behavior including lower self-competence (Farver, Ghosh, & Garcia, 2000), high levels of distress (Martinez & Richters, 1993), depression (Durant, Getts, Cadenhead, Emans, & Woods, 1995), post-traumatic stress disorder (Fitzpatrick & Boldizar, 1993 Jaycox, Stein, Kataoka, Wong, Fink, Escudero, & Zaragoza, 2002),...

Psychosocial Influences On Painrelated Limitations In Cancer Survivors

Keefe et al.153 described a three-session cognitive-behavioral, partner-assisted, pain-management intervention for terminally ill cancer patients. The program of intervention was developed on the basis of research with osteoarthritis patients showing that partner-assisted pain management improved the physical and emotional function of the pain patient as well as the emotional functioning of the spouse or caregiver.153 The three-session program included (1) education about the nature of pain experience and different options for pain control, (2) instruction in the use of pain coping strategies, and (3) instruction in activity pacing. The intervention program was delivered by nurse educators. Patient and partner outcomes following participation in the partner-assisted intervention were compared to a usual care control group. Although there were no significant differences between groups on patient outcomes, there was a trend toward reduced pain and increased quality of life. The partners...

Robert H Bradley Robert F Corwyn

This piquant passage is from Anil's Ghost by Michael Ondaatje. The story is set in war-ravaged Sri Lanka, a near armageddon of ethnic cleansing, brutal subjugation, and political intrigue. The passage conveys two basic beliefs about parenting. First, there is something elemental about parental caregiving, with near universal agreement as to its significance in children's lives. Second, the context in which parenting occurs shapes both its goals and its tactics. As a result, what children experience as part of their home life is enormously varied despite the fact that all children share many common needs for parental care.

James F Maddux David P Desmond

Same time, the old three-rank system of health-care givers, in which physicians treated the well-to-do while surgeons and apothecaries met the health needs of those of more modest means, was giving way. Surgeons and physicians joined a unified healing profession, whereas pharmacists prepared and sold drugs without providing diagnostic or therapeutic advice. As physicians worked to increase their professional authority, they sought to gain control over the use of drugs, defining them as medicines that only the medically trained could use or prescribe with safety. Toward the middle of the nineteenth century, a few physicians expressed concern about opium use for its stimulant effects. These voices foreshadowed an alarm about nonmedical use of opiates that would transform how this behavior was viewed. In the meantime, the 1868 Pharmacy Act called for precise labeling of any preparation containing opium.

Norwalk agent virus infection 371

Parents and the school should not underestimate the gravity of this disability. The main problem in the painstaking approach to teaching the child is the caregiver's faulty impression that the child is much more adept than he is. Everyone tends to overestimate the intelligence of NLD adolescents. The child should be shielded from teasing, persecution, and other sources of anxiety.

Conclusion and Future Directions

In this chapter, we have presented a model of the development of emotional self-regulation in infancy and toddlerhood that is organized around the construct of autonomy. In our framework, we focus on children's emotional responsiveness as well as the strategies children use to modulate that responsiveness. We argue that movement along a continuum of autonomy toward more active, flexible strategies for regulating affect is a natural phenomenon fueled by children's innate propensities to master their environments and to take on or internalize regulatory structures provided by caregivers. We provide evidence that emotional self-regulation is a developmental phenomenon, with more autonomous strategies evident with increasing age, as well as an individual difference phenomenon, influenced by both temperamental characteristics and caregiver influences. The complex nature of emotional self-regulation is illustrated by the contextual and situational nature of adaptive strategies, specificity...

Ainsworth Mary Dinsmore Salter 19131999

Mary Dinsmore Ainsworth

Mary Dinsmore Salter Ainsworth's conceptual contributions and empirical findings revolutionized how psychologists think about infant-caregiver attachment. (R. S. Marvin) Mary Dinsmore Salter Ainsworth's conceptual contributions and empirical findings revolutionized how psychologists think about infant-caregiver attachment. (R. S. Marvin) When Ainsworth accepted a position at the University of Virginia in 1974, her work was becoming increasingly influential, stimulating longitudinal studies of attachment in the United States and other countries that are still ongoing. In the late 1970s she was elected president of the Society for Research in Child Development. At the same time, many graduate students interested in attachment continued to flock to her (among them Jude Cassidy, Deborah Cohn, Virginia Colin, Patricia Crittenden, Carolyn Eichberg, Rogers Kobak, and Ulrike Wartner). After reluctantly retiring as Professor Emerita in 1984 at the required age of seventy, Ainsworth remained...

Addressing Narcissistic Vulnerability

Narcissistic vulnerability is thought to arise in early experiences of helplessness, loss, or rejection. The sadness connected to these experiences is interpreted by children as a sign of personal damage or weakness, of being inadequate or unloved. They may even interpret their sadness somat-ically, as something physically wrong in the body, with the development of unconscious fantasies concerning bodily damage. If children envy others' strengths in contrast to the damage they imagine because of the sad and vulnerable feeling states, this envy may provide a further source of concern. They may feel even more unlovable, as they have aggressive feelings that seem toxic. Similarly, feelings of neediness may alarm children, who sense the burdens they place on the parent. The neediness is seen as something hard to manage or control, which will only distance needed caregivers. A sense of frustration and hopelessness becomes connected with the idea of actively seeking love and caring (Figure...

Stability of Temperament during Infancy

Researcher Mary Rothbart (1981, 1986) studied a group of infants at dif ferent ages, starting at 3 months of age. She examined six factors of temperament, using a measure completed by the infants' caregivers The caregivers, mostly mothers, completed observer -based scales designed to measure these six aspects of temperament. T able 5.1 shows the cross-time correlations over different time intervals. If you scan the correlations in the table, you will notice first that they are all positive. This means that infants who tend to score high at one time period on activity level, smiling and laughter , and the other personality traits, also tend to score high on these traits at later time periods. Like all studies, this one has limitations. Perhaps most important, the infants' caregivers may have developed certain conceptions of their infants, and it may be their conceptions rather than the infants' behaviors that show stability over time. After all, the correlations are based on ratings...

Moral concepts Emotions in Moral Cognition

Further evidence for this conclusion comes from the literature on moral development (see Eisenberg, 2000, for review). The most effective means of training children to be moral are parental love withdrawal, power assertion, and the induction of sympathy through drawing attention to the consequences of action (Hoffman, 2000). All of these methods affect a child's emotional state. Love withdrawal is especially effective. It induces sadness in children by convincing them that they may lose the affection and support of their caregivers. Elsewhere I have argued that this becomes the foundation for guilt (Prinz, 2003). Guilt is a species of sadness directed at one's own transgressions. Eventually the sadness induced by love withdrawal is transferred to the action, and we become sad about what we have done, rather than being sad about the consequences. This transfer can be driven in part by mechanisms as simple as classical conditioning. Other moral emotions may be learned by emulating...

Family Income and Early Child Care

Child-care quality usually encompasses (1) the child-provider relationship and child experiences (e.g., amount of verbal and cognitive stimulation, responsiveness, stability) (2) structural and caregiver characteristics (e.g., ratios, group size, caregiver education, physical environment materials) and, (3) health and safety provisions (Lamb, 1997 Phillips, 1995). High quality care may serve as a protective factor for low-income children, and low quality care may compound other risk factors (Shonkoff & Phillips, 2000). Information about the number of hours, stability, and type of child care was collected from parents by telephone every 3 or 4 months. Children who were in nonmaternal care for more than 10 hours a week were observed in whatever child-care setting their parents used at each of the major assessment periods (6, 15, 24, 36, 54 months). Both structural features (e.g., adult-child ratio, group size, caregiver training) and processes were assessed during an observation...

Substance Abuse And Family Life

Substance abuse and child abuse may co-occur under similar family conditions and dynamics, or substance abuse can lead to child abuse (Kelley, 1992). Mediating factors, such as social support and education, income, alternative sources of nurturing, and parents' own histories of familial substance abuse and histories of neglect and abuse are important. It is likely, however, that when mothers who use drugs or alcohol are primary caregivers, they will be unable to fulfill some aspects of their children's emotional or physical needs (Tracy & Farkas, 1994).

Conceptualization Of Depression In Older Adults

Late Life Depression Elderly

Depression in older adults can vary considerably across persons in terms of presentation and etiology. Between 1 and 4 of older adults experience major depression (Waraich, Goldner, Somers, & Hsu, 2004), with 40 of depression in older adults representing a recurrent episode, with the first episode having occurred in young adulthood, and 30 being the very first episode of depression ever (late-onset depression Blazer, 2003). For many years, researchers felt that depression was an understandable consequence of aging, because older adults are exposed to so many risk factors associated with the onset of depression. It is not uncommon for older adults to complain about sadness related to bereavement, social isolation, caregiver strain, and financial problems all salient psychosocial risk factors for depression

Summary And Evaluation

Object relations theory is another major new development in this area, having been called the most important theoretical development in psychoanalysis since Freud's death. The term object relations is used to refer to enduring patterns of behavior in relationships with intimate others, as well as to the emotional, cognitive, and motivational processes that generate those patterns of behavior . The theory is about how relationship behaviors are determined by mental representations laid down in childhood through experiences with caregivers. This theory began with studies of attachment between children and primary caregivers typically , mothers. This bond may set a pattern that continues into adulthood. Also important are the experiences the growing child has with the relationship he or she observes between the parents. This is also internalized in the form of a mental representation for how people get along and what is appropriate behavior in a relationship.

Early Childhood Attachment

Work on early childhood attachment has drawn on a couple of lines of research in developmental psychology. The first line of research was the work by Harry Harlo and others on infant monkeys. Harlow' s well-known experiments involved taking infant monkeys away from their real mothers and raising them with models of mother monkeys made of wire or cloth. These fake mothers did not provide the grooming, cuddling, holding, or social contact of the real mothers. The infant monkeys raised with the fake mothers developed problems in adolescence and adulthood, growing into adults that were socially insecure, that were generally anxious, and that did not develop normal sexual relations as adults (Harlow , 1958 Harlow & Suomi, 1971 Harlow & Zimmerman, 1959). Moreover , the infant monkeys preferred their real mothers to the fake mothers, and they preferred the cloth mother to the wire mother when given the choice. Harlow concluded that attachment between infant and primary caregiver required...

Alzheimers Disease AD

Although these drugs have limited effectiveness, their sales were about 1.4 million per year in the Untied States alone in 2006. Todd Golde of the Mayo Clinic has said, It's scary if you look at the trials that got these drugs approved. The change in mental status was so small. The average caregiver of a patient would have no way of knowing whether there was any difference. The changes can be as minor as a better ability to dress oneself or take out the trash. With the high failure rate in developing drugs, it is unlikely that many of the drugs under development will make it to widespread clinical use.

Growth Standards for Preterm Infants

One advantage of postnatal growth standards is that they allow the weight to be plotted daily 11 and encourage caregivers to focus on growth as an integral part of daily management. However, a baby that is consistently growing along a postnatal chart centile line is no cause for celebration in the absence of evidence of catch-up growth towards their birth centile, the baby is extremely likely to leave hospital weighing less than the 10th centile.

Types of Day Care and Demographic Information

Census Bureau, in 1995, 75 percent of the 19.3 million children under age five were in some form of regular day-care arrangement. Multiple care arrangements were common 44 percent regularly spent time in more than one arrangement per week (the average was two). Many types of day care were used. Whereas 50 percent of these children were cared for by relatives (such as a grandparent at 30 or the other parent at 18 ), 49 percent were cared for by nonrelatives. Some children were cared for in their homes by a nonrelative such as a babysitter, nanny, or au pair (9 ), while others were left with a nonrelative such as a friend or neighbor in the caregiver's home (9 ). Other types of nonrelative care include day-care centers (15 ) and family day care (13 ). A day-care center is an organized facility that is licensed to provide care for many children. Caregivers in centers can change often, and high turnover is frequently a problem. Family day cares are operated in a home...

Correlates Of Adjustment

A patient's social context may be associated with their ability to adjust to AC, and investigators have examined different aspects of social support. For example, one study demonstrated that greater perceived social support was related to lower distress, even after controlling for physical health status.3 In another study, having more people in one's social support system was correlated with less mood disturbance, but only among patients who had undergone high levels of previous life stress.52 Perhaps quantity of social support is less important than the perceived quality of support, such that the number of people in one's network is less predictive than whether a patient perceives that support is available when needed. Marital status and quality have also been examined, and a study of metastatic breast cancer patients revealed that partnered women did not differ from single women in the amount of mood disturbance reported once household income was statistically controlled.53 This is...

Selecting the Instrumentation to Evaluate the QoL in Clients with Dementia

Ultimately, the instruments chosen were the QUALID and the Cornell Scale for Depression in Dementia. QUALID was developed in the Department of Psychiatry at the University of Texas Southwestern Medical Center to assess the effects of treatment on QoL in people with severe dementia. It consists of 11 observable behaviours rated for the previous week on a five-point Likert scale by interview with a caregiver. It also includes two questions for the interviewer to rate the quality of the information. A sum score of responses indicates relative well-being in a range 11-55, with lower scores representing higher QoL. Although relatively new and untested, the scale was appropriate for our use and was well received during the pilot testing. The Cornell Scale for Depression in Dementia is completed by an interviewer and includes both the responses of the client and a relative or care person who knows the client well, and based on the week prior to interview. Responses use a three-point scale...

Artificial Nutrition Support Home Parenteral Nutrition and Home Enteral Tube Feeding

Patients suffering from chronic conditions often prefer to be treated in the familiar surroundings of their home rather than in hospital. When the treatment involves sophisticated techniques, it is essential that either the patient or the caregiver is adequately trained to distinguish between problems that can be easily remedied at home and those that need

Detection and Assessment

In a clinic-based study, the detection of depressive symptomatology in patients with PD more than doubled (21-44 ) when patients were screened using the Beck Depression Inventory (BDI) (15). The assessment and recognition of depression has been ranked highly as an indicator for improving care of PD patients (103). All PD patients should be screened periodically to detect clinically significant depressive symptomatology. If self-reported disability is out of proportion to findings on the neurologic exam, depression should be suspected (73). Caregivers or family members are often valuable sources of information about the patient's psychological well-being, especially when self-report may be unreliable (104).

Separation Anxiety Disorder

Children with separation anxiety disorder have intense anxiety about being away from home or caregivers to the point where social or school functioning is affected. Such children have a great need to stay at home or close to their parents. When they are apart, these children may worry excessively about their parents, and when they are together, the children may cling to parents, refuse to go to school, or be afraid to go to sleep. Repeated nightmares about separation and physical symptoms such as stomachaches and headaches are also common.

HOME and Socio Emotional Development

Concerns about parental investment in children span many decades and many disciplines, from evolutionary biology (Trivers, 1972) to economics (Becker, 1991) to psychology (Hertwig, Davis, & Sulloway, 2002). Each decade and each discipline has put its own stamp on the issue, but there is consensus on one belief investing in children entails costs. As the trend toward disinvestment in family and child rearing has accelerated (Popenoe, 1993), our research has focused more intensively on parental involvement in the lives of children. We constructed a measure called Parents' Socioemotional Investment in Children (PIC Bradley, Whiteside-Mansell, Brisby, & Caldwell, 1997). The PIC assesses four components of investment acceptance of the parenting role, delight in the child, knowledge sensitivity, and separation anxiety. A study done on 137 mothers of 15-month-old children revealed that PIC was related to the quality of caregiving, maternal depression, neuroticism, agreeableness, social...

Conceptual and Methodological Issues

Another set of challenges concerns the generality versus specificity of the adaptiveness of emotion regulation processes. As discussed above, the adaptiveness of various strategies depends on the context within which they are occurring. For example, the functionality of the use of caregivers depends on their availability and other situational constraints. If this is so, a taxonomy of adaptive strategies and developmentally appropriate emotion regulation is highly dependent on the situation. This issue is paralleled in the coping literature in which researchers stress that the same coping strategy may be adaptive or nonadaptive, depending on the situation (Lazarus & Folkman, 1984). For example, denial and avoidance-like processes may be constructive in situations in which no direct action can overcome the harm or threat. Conversely, problem-focused strategies are presumed to be more useful with potentially controllable stressors (Lazarus & Folkman, 1984).

Jamie S Ostroff and Lara K Dhingra

Cancer survivorship is a relatively new phase in the continuum of cancer care. Established by the National Cancer Institute (NCI) in 1996, the Office of Cancer Survivorship has adopted the National Coalition of Cancer Survivors (NCCS) definition of a cancer survivor23 which specifies that an individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life. Family members, friends and caregivers are also impacted by the survivorship experience and are therefore included in this definition. Providing useful guideposts for cancer survivorship, Fitzhugh Mullan24 outlined three seasons of survival each with unique sets of issues and concerns. Acute survival begins with the diagnosis of the cancer and is dominated by diagnostic and therapeutic efforts. Extended survival is a period during which a patient goes into remission or has terminated the active treatment and enters a phase of medical surveillance or watchful waiting with periodic...

Internationalcultural Perspectives On Quality Of Life

What is meaningful survivorship in one culture may be very different in another, often defined as the cultural consensus on what quality of life means. For example, Chaturvedi found in a sample of Indian cancer patients, family members, and their caregivers the 10 most important factors related to quality of life.30 In this culture, she found that the level of individual functioning was not nearly as meaningful to them as was having peace of mind, spiritual satisfaction, satisfaction with religious acts, and happiness with family. These results contrast the values that most North Americans and Europeans have regarding the importance of the independence of the individual.

Adherence to Pharmacological Therapies

Two retrospective studies using serum assays found that 45 of children and adolescents with JRA were non-adherent with medication (23,24). In three case-report studies including 5 patients in total, baseline adherence as assessed by parental observation or pill counts ranged from 38 to 59 (25-27). Parent-reported adherence to medication was 84.9 in a study of Feldman et al. (28). In this study in 118 patients, adherence was evaluated as caregiver's response on a 100-mm visual analogue scale to the question of how often they followed treatment recommendations as prescribed by the health care provider (28). Studies using patient self-report demonstrated that adherence with pharmacological treatment is less than optimal with prevalence ranging from 4 to 89 (1,27,29,30).

Factors affecting carers perceptions of fatigue

The relief of debilitating and distressing symptoms is described as an essential feature of quality cancer and palliative care, and has been shown to be crucial to an individual's ability to cope with the challenges of a caregiving role (Stetz and Hanson 1992). Unrelieved symptoms are not only known to induce patient reports of reduced quality of life, but are also increasingly recognized as having profound effects on the psychological well-being of carers (Payne et al. 1999). When symptoms are regarded as being poorly defined and understood, as is the case with cancer-related fatigue (see Chapter 4), attempts at minimizing the functional and emotional impact is further complicated. The repercussions for those observing the effects of unresolved symptoms on the lives of patients may be especially stressful, particularly if they are also attempting to take on the tasks and roles that their relative is no longer able to undertake. The extent to which the resultant distress may affect...

Supplementation with Micronutrients

ORT reduces mortality from dehydrating diarrhea, but it does not decrease the duration of episodes or their consequences, such as malnutrition. In addition, adherence to recommendations regarding ORT in children is poor because caregivers want to reduce the duration of illness. This often leads to use of antibiotics and other treatment of no proven value. In addition, there are indications that knowledge and use of appropriate home therapies, including ORT, to manage diarrhea successfully may be declining in some countries. The limitations of ORT and continued high diarrhoeal morbidity, mortality, and associated malnutrition led to a search for adjunct therapies. Zinc and vitamin A are essential to repair the intestinal mucosa and boost

Managing Undernutrition in the Community Setting

With increasing emphasis on home healthcare, the number of community-dwelling persons requiring alternative modes of feeding has increased. Special consideration and appropriate modification of therapeutic regimens may be required in such cases to ease the care giver or personal burden. If enteral tube feeding is provided at home, continuous infusion may limit the patient's mobility and functional independence. This method also has the disadvantage of requiring immediate access to technical support, in the event of mechanical failure of the infusion pump. Thus, care givers and patients may find intermittent bolus feeding a more convenient and less daunting task. To minimize the aspiration risk, intermittent bolus feeds should be administered, where possible, with the patient in a seated position. Patients should also be encouraged to remain seated for at least 1 h after feeds. Some active older people resent the social inconvenience and embarrassment of tube feeding during daytime...

Home Parenteral Nutrition

Many patients are able to receive PN in the home setting. If the patient's medical condition is stable and careful patient selection has been employed, home parenteral nutrition (HPN) can be considered. The patient and caregiver must be able to be taught to use an infusion device, administer PN safely, and search for signs of infection, fluid issues, or other complications. Appropriate education should begin in the hospital and continue in the home setting. Psychosocial and socioeconomic issues, such as family support, private or government payer status, and patient emotional status, are important to consider when assessing the appropriateness of HPN.

Transitioning from active treatment

For children who have had a series of relapses, medical caregivers and parents need to decide when to end active treatment and begin to work toward making the child comfortable for his remaining days. This is an intensely personal decision. Some families want to try every available treatment and exhaust all possible remedies. Others reach a point where they feel they have done all they can, and they simply do not want their

Ethical Considerations for Care

It is strongly advised that those suspected with or diagnosed with HIV infection seek professional attention from a qualified physician and a registered dietician. For these caregivers, the development of new antiviral drugs, changes in methods of administration of existing drugs, and new information regarding nutrition require diligent and regular review. It is important for health care workers to keep an open dialogue with the patient, so that they stay aware of the patient's health status and treatment measures. Many issues regarding the amount (drugs and nutrition) and length of care for AIDS patients remain controversial and should be negotiated with the patient.

Positional plagiocephaly 409

Ommended that caregivers change a child often and make frequent trips to the toilet. Swim diapers or pants are not a substitute for frequent diaper changing. Caregivers should wash child thoroughly (especially the anal area) with soap and water before swimming. invisible amounts of fecal matter in the anal area can end up in the pool. (See also

Measuring Sleep Disorders

The first bedside scale for a comprehensive assessment of sleep problems was validated and published in 2002 and is the PDSS, which has now been translated globally and used across the world for a bedside assessment of clinical aspects of sleep disabilities of PD (65,66). The PDSS is a 15-question visual analog scale, which can be easily administered at the bedside and has also undergone formal linguistic validation in Italy, Spain, and Japan (66,77). The PDSS has robust test-retest reliability and good discriminatory power between patients with PD and healthy controls. Patients and caregivers respond to individual questions on the basis of their experiences in the past week, and scores for each item range from 0 (symptom severe and always experienced) to 10 (symptom free). The maximum cumulative score for the PDSS is 150 (patient is free of all symptoms). The PDSS aims to distinguish between sleep onset and sleep maintenance insomnia (questions 2 and 3) nocturnal motor symptoms...

Social Emotional Milestones

They are separated from their caregivers. By the preschool years, children are able to identify emotions in others and can seemingly empathize with the feelings of others, as reflected, for instance, by a three-year-old bringing his tearful mother his teddy bear to comfort her. Although toddlers are interested in other children, friends typically do not become important until the early school years, at which time children enter the peer group and establish dominance hierarchies, often based on physical strength, especially among boys. Typically during this time, boys and girls segregate themselves into same-sex play groups. In adolescence, the peer group becomes increasingly important (although the family rarely loses its influence), and, coupled with the onset of puberty, heterosexual interests and behavior commence.

Treatment Of Depression Among Adolescents Adaptations of Standard Cognitive Therapy

The most significant modification made in adapting Beck's CT for work with adolescents, however, centers on the role ofthe family. A major emphasis is placed on psychoeducation and on including parents in the treatment process. Brent and Poling (1997) recommended providing caregivers with information about the nature of depression and the process of CT. An objective of psychoeducation is to help parents to understand that depression is an illness, and to counter potentially maladaptive parental beliefs such as My child is doing this on purpose, or that he she could snap out of it.

Friendship As Affective Relationships

Furthermore, the processes of relationship formation embedded in Bowlby's (1969, 1982) attachment theory began to be understood as also applicable to relationships other than the child-mother attachment (Howes, 1996). According to this reinterpretation of attachment theory, relationships (whether attachment or playmate relationships) develop through multiple and recursive interactive experiences. Recursive interactions are well-scripted social exchanges which are repeated many times with only slight variation (Bretherton, 1985). Examples include infant caregiver interaction around bedtime or repeated toddler-age peer run-and-chase games. From these experiences, the infant or young child internalizes a set of fundamental social expectations about the behavioral dispositions of the partner (Bowlby, 1969 1982). These expectations form the basis for an internal working model of relationships. Therefore, through repeated experiences of social and social pretend play with a particular peer,...

Disentangling Concepts Emotional Control Versus Regulation

Others, theorists, notably Kopp (1982) and Block and Block (1980), have made distinctions between emotion control and emotion regulation. Kopp (1982), for example, discussed self-control and self-regulation as stages in the child's development of behavior regulation. In the stage of self-control, the child has the ability to comply with the caregiver's demands and directives in the absence of the caregiver. Though emitted by the child, the behavior is rigid, conforming to the original directive. In contrast, the stage of self-regulation involves the flexible guiding of behavior. The child's behavior at this point is actively and flexibly adjusted to meet the demands of new situations. We concur with this distinction between control and regulation however, we do not see these as developmental stages but, rather, as a continuum of regulation which is a function both of development and individual differences among children. While for Kopp (1982) the stage of self-control is not...

Mary Dinsmore Salter Ainsworth and the Strange Situation

Ainsworth conducted the first observational studies of mothers and children that were rooted in attachment theory, first in Uganda and later in Baltimore, Maryland. Through her careful field notes, she noticed important individual differences among infants. Most appeared soothed by their mothers, while others were not, and still others displayed little emotion to their mothers' presence or absence. Ainsworth moved her work to the laboratory in order to assess the effect of maternal absence on infant exploratory behaviors. Her paradigm, called the Strange Situation, is a thirty-minute procedure that consists of a series of separations and reunions among a caregiver, a child, and a stranger.

Environmental Factors

Thomas and Chess argued that children's temperament characteristics interact with parenting to produce children's positive or negative adjustment. Their concept of the goodness-of-fit between the parent and the child is similar to the notion of attachment developed by John Bowlby. Attachment is the dynamic relationship between the child and the care-giver. Human infants are born vulnerable and need the security of a consistent, attentive, warm caregiver in order to feel safe enough to explore the world. Car-egivers give children verbal and nonverbal clues about the nature of the environment and provide them with a secure base to return to when they feel anxious or threatened. Mary Ainsworth advanced the attachment literature by creating a laboratory measure of attachment called the Strange Situation. During this procedure, the child and caregiver are separated and reunited several times in a laboratory playroom. During the separation episodes, the child is left alone with a strange...

Basic ethical principles

The principle of respect for persons requires that scientists recognize the individual worth and dignity of all potential human subjects and it encompasses two important concepts. First, respect for persons requires that scientists and caregivers honor the right of self-determination, or autonomy , for persons in relation to both medical care and participation in research. That means that individuals who are competent to make medical decisions generally have the right to freely choose whether or not to participate in biomedical or behavioral research. Second, those individuals who are not able to make decisions for themselves, are non-autonomous, deserve additional protection.

The Early Onset Persistent Pattern

Experts have turned to emotion regulation processes to explain why early parenting factors are associated with EOP delinquent behavior. They have observed that, starting in the first year of life, children depend exclusively on caregivers to help them regulate their emotions and to stay organized in the face of arousing situations. In optimal caregiving contexts, children are free to explore their environments and to experience a wide range of emotions because they are confident that their caregivers will be available in times of distress. When parents experience high levels of life stress, mental health problems such as depression, and low amounts of social support, they have fewer resources to devote to their parenting. Without adequate parental support, children in such environments are likely to develop maladaptive coping skills for dealing with disorganizing emotions (such as anger and sadness) and are likely to behave aggressively and impulsively instead. This is especially true...

Dietary Management Dietary Guidelines

The antioxidant defence system has a particularly important role in Down's syndrome, and parents and caregivers can be advised on providing a diet rich in antioxidants. Dietary intakes need to be considered for the sulfur amino acids (which are needed for glutathione synthesis) fat-soluble vitamins A, C, and E water-soluble vitamins B6, B12, and folic acid and the minerals selenium and zinc. In latitudes where no vitamin D is synthesized in the winter months, it is particularly important to ensure exposure to sunlight during summer months to maintain adequate stores of the vitamin throughout the year because studies indicate an increase in the incidence of osteoporosis in Down's syndrome.

Fatigue a complex symptom with widereaching effects

Fatigue is associated with increased distress due to some other symptoms, including pain. It often clusters with cachexia and anorexia, and is difficult to distinguish between them (see Chapter 5). It has profound effects on everyday functioning and, perhaps consequently, service use. It reduces quality of life and increases suffering. Fatigue has been associated with hospital admission and increased stress to caregivers (Hinton 1994 Robinson and Posner 1992). The needs of lay caregivers in this context are often overlooked (see Chapter 9). A deeper comprehension of these factors is important in assessing patients, planning care, and in designing and testing future treatments for fatigue.

The emotional effects of a Caesarean birth

Almost one out of four women give birth by Caesarean today, and the most important product of your pregnancy is a healthy baby. If you find yourself struggling with uncomfortable feelings, discuss them with your health care provider. Postpartum depression is a common disorder and a serious one. In addition, talk it over with friends, family and your caregiving team. It can help to know what happened and to understand fully the circumstances of your baby's birth. There are many resources to help work through postpartum concerns, so make your concerns known.

The Effect of Experience on Brain Development

Development of the ability to keep things in mind even when they are not observable may be related to the emergence of infants' objection to separation from the caregiver that often occurs around age seven to nine months. Thus, areas of the cortex that appear to develop late may be functioning in simpler ways earlier in life rather than remaining completely silent.

Antecedents of Father Involvement

A father's economic status clearly affects his ability to provide adequate child support and may ultimately affect his relationship with both his partner and child. More-educated fathers play with and teach their children more than do less-educated fathers, and fathers' academic achievement is associated with the amount of time spent as primary caregivers. A father's job loss is associated with negative outcomes for the child, and fathers in poor and welfare families, particularly those facing chronic poverty, are less involved in their adolescent children's lives.

Strategy 2 Exercise to Reduce Stress

The two forms of exercise offered in the Fat-Burning Metabolic Fitness Exercise Plan are specifically designed to deal with stress. If you must navigate a series of several stressful events daily, then the steady-state exercises on days 1,3, and 5 will help to create greater emotional homeostasis so that you can cope better. If you are experiencing continuous stress, such as having to be the caregiver for someone in the family who is seriously ill, the core and interval exercises on days 2,4, and 6 will enable you to achieve greater emotional and physical equilibrium.

Cross Cultural Research

Because attachment theory is grounded in evolutionary biology, one of its core assumptions is that infant-caregiver attachment is a universal phenomenon. This assumption is controversial. At the very least, however, research from around the world supports the claim that all infants develop attachment relationships, secure or insecure, with their primary caregivers. Beyond this, there is considerable evidence that the number of children who develop a secure pattern of attachment is proportionately similar across cultures. In African, Chinese, Israeli, Japanese, Western European, and American cultures alike, most children, about two-thirds, are securely attached to their caregivers. The proportion of children who are insecure-avoidant or insecure-ambivalent, however, varies across cultures. Consider that in Japan a higher proportion of children are classified as ambivalent and a lower proportion of children are classified as avoidant than in Western European and American cultures....

Definitions of Child Maltreatment

The phrase ''child abuse'' often immediately brings to mind the image of a child beaten black and blue by an angry parent or caregiver. This is merely one scenario and perhaps the easiest to contrive because one can see what has been done to the child. It ''Child maltreatment'' is a term designed to draw attention away from the purely abuse-related acts or injuries that children suffer. It is an all-inclusive term to describe, in essence, when a caregiver does something or fails to do something that has harmed or threatens to harm a child in his or her care. Child abuse refers to acts of commission, which are done to a child and cause harm (or the threat of harm), whereas child neglect refers to acts of omission, acts that are not done to or for a child, which result in harm (or the threat of harm). In using the separate categories of child abuse and child neglect there are further distinctions that can be made. Abuse is often categorized into physical, sexual, psychological, and...

Trisha M Karr Heather Simonich and Stephen A Wonderlich

Childhood physical abuse is the second most common form of child maltreatment and legal definitions vary from state to state, but broadly defined CPA is any physical act by a caregiver that results in a child being injured. CPA is the only type of abuse reported more often by males than females (30 per cent vs. 20 per cent, respectively) in the general population (MacMillan et al. 1997). CPA has been linked to a variety of negative mental health outcomes in adulthood, such as post-traumatic stress disorder (PTSD), aggressive behavior, substance dependence, depression, poor communication skills, and lack of empathy toward others (Gershoff 2008). Importantly, childhood physical abuse is also associated with violent or criminal behavior as well as abusive behaviors in intimate relationships (Grogan-Kaylor 2004). It is crucial to consider the effects of experiencing multiple forms of child maltreatment given that many children who experience one type of maltreatment will also be exposed...

Nonparental Contextual Characteristics

In distinguishing contextual influences on child temperament from influences of child temperament on context, one approach would be to look at aspects of the environment which are potentially less sensitive to the influence of child temperament. One such aspect is the physical environment the stage or setting on which social transactions between child and caregiver take place (Wohlwill & Heft, 1987). The extent to which a child's temperamental characteristics can act to influence dimensions of the physical environment, such as number of wall decorations or rooms to people ratio, is both less likely and less intuitively obvious. Rather, it is more likely that specified dimensions of the physical environment can act to influence child temperament characteristics. One such dimension is environmental chaos, which involves factors such as crowding (e.g., rooms to people ratio), and levels of nonhuman noise in the home. Several studies provide converging evidence of the importance of...

Emotional Development in Infancy and Toddlerhood

By six months, smiling is more sophisticated and social. It increasingly results from the interactions between infants and their care-givers. Crying is another powerful emotional behavior that is present in early development and is an effective tool for communicating with the social world. Children cry more during infancy than at any other period and their cries differ in their patterns depending on whether they are in pain, hungry, or angry. It is clear that parents play an important role in children's emotional development. Through relationships with caregivers, children develop a sense of themselves and of others, and get clues about the way that the world works. For example, an infant who has fallen down and is unsure of whether he is hurt may look to his parent for information. Social referencing provides an infant with an opportunity to get feedback from a caregiver about how to feel in an uncertain situation.

Acknowledging Different Perspectives

The different perspectives of the adolescent and their parent(s) caregiver(s) need to be considered by health professionals involved in the triadic consultations of child-centered health services. Within the generic literature, the most comprehensive study of parents as proxies of adolescents has been conducted by Waters et al. who examined the relationship between 2096 Australian adolescents (aged 12-18 years) and their parents using the Childhood Health Questionnaire (12). This study demonstrated strong overall agreement for physical health. However, adolescents were less optimistic than their parents with respect to their mental health, well-being, general health, and impact of health on family activities. Moreover, these discrepancies increased when the adolescent had an illness.

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