Family caregivers’ preparedness to support the physical activity of patients at risk for hospital readmission in rural communities: an interpretive descriptive study

Abstract

Background Physical activity in the post-discharge period is important to maximize patient recovery and prevent hospital readmission. Healthcare providers have identified family caregivers as potential facilitators of patients’ engagement in physical activity. Yet, there is very little research on family caregivers’ perspectives on their preparedness to support the physical activity of patients, particularly those at risk for hospital readmission in rural communities. Accordingly, this study explored the challenges related to family caregivers’ preparedness to support the physical activity of a recently discharged, rural-dwelling relative at risk for hospital readmission. Methods In this interpretive descriptive study, semi-structured interviews were conducted by telephone with 16 family caregivers. Interview transcripts were analyzed using thematic analysis. Results Participants were predominantly women (n = 14; 87.5%) with an average age of 49 years (range 26–67) who were the primary caregivers of a relative who had been hospitalized for a medical illness (n = 12; 75%) and was at high risk for hospital readmission. Four themes were identified: 1) family caregivers generally felt unprepared to support their relative’s physical activity, 2) some family caregivers believed that rest was more important than physical activity to their relative’s recovery, 3) insufficient physical activity preparation led to family caregiver-relative conflicts, and 4) to defuse these conflicts, some family caregivers wanted healthcare providers to be responsible for promoting physical activity. Conclusions Despite assertions that family caregivers are a potential source of support for patient physical activity, our findings indicate that family caregivers are largely unprepared to assume that role and that more work needs to be done to ensure they can do so effectively. We suggest that healthcare providers be conscious of the potential for family caregiver-patient conflict surrounding physical activity, assess family caregivers’ ability and willingness to support physical activity, educate them on the hazards of inactivity, and provide physical activity instructions to family caregivers and patients conjointly. Preparing family caregivers to support their relative’s physical activity is particularly important given the current emphasis on early discharge in many jurisdictions, and the limited formal healthcare services available in rural communities.

Caregivers’ Role in In-Home Video Telehealth: National Survey of Occupational Therapy Practitioners

“…The most frequent barrier was poor connectivity, which aligns with evidence of difficulty with Wi-Fi and internet access in rural areas [68,69]. In addition, it is important to note that challenges integrating caregivers into patient care present in brick-and-mortar settings, such as caregivers' difficulty assisting patients with implementing care plans [70,71] or lack of knowledge about patient health conditions [72], may also be present in video visits.…”

Healthcare providers’ perceived acceptability of a warning signs intervention for rural hospital-to-home transitional care: A cross-sectional study

“…troubling that the results indicated low frequency of current use of the intervention. Since rural dwellers have high expectations for their preparedness to detect and respond to signs of worsening health conditions because of their limited access to HCPs and travel distances to hospitals [6,8], a greater emphasis on such preparation appears to be much needed.…”

“…Furthermore, the transition from hospital to home constitutes a marked shift from provider-driven to self-managed care for rural patients. After hospital discharge, many patients and their families find themselves managing care previously provided by nurses in hospital (e.g., watching for worsening health conditions), typically with minimal training and professional guidance [6][7][8].…”

“…In our prior research, older rural medical patients at risk for hospital readmission and their families indicated that their most pressing unmet TC need was knowing how to recognize and address the signs of worsening health conditions [6][7][8]. Evidence indicates that patients typically receive little preparation in this regard and require more education prior to discharge on whether a sign or symptom necessitates professional intervention [9].…”

The effect of family centered care on unplanned emergency room visit, hospital readmissions and intensive care admissions after abdominal surgery: a root cause analysis

“…Speci cally, family engagement in healthcare is a core component that is effective in reducing hospital readmissions (8), and its signi cance increases when family caregivers are more actively engaged in healthcare (8) because family caregivers provide continuity during care transitions. To safely engage family caregivers in healthcare, conscientiously educating and training them during in-hospital healthcare is essential (10)(11)(12)(13). Therefore, an academic hospital developed and implemented a theoretically grounded family involvement programme (FIP) (14,15); these types of programmes and other TCIs are being developed to provide healthcare professionals with tools to improve patient outcomes by re ning transitional care.…”