Background. While researchers have identified negative outcomes for family caregivers caused by providing care, less is known about positive aspects of family care for both members of a family dyad. Understanding family care relationships is important to nurses because family participation in the care of chronically ill elders is necessary to achieve optimal outcomes from nursing interventions. A previous naturalistic inquiry identified a new construct, Shared Care, which was used to describe a family care interaction that contributed to positive care outcomes.

Methods. A literature review was carried out using the databases Medline, CINAHL, and Psych-info and the keywords home care, care receiver, disability, family, communication, decision-making and reciprocity. The results of the review were integrated to suggest how Shared Care could be used to study care difficulties and guide interventions.

Results. The literature confirmed the importance of dyad relationships in family care. Shared Care extended previous conceptualizations of family care by capturing three critical components: communication, decision-making, and reciprocity. Shared Care provides a structure to expand the conceptualization of family care to include both members of a care dyad and account for positive and negative aspects of care.

Conclusions. The extended view provided by the construct of Shared Care offers practitioners and scholars tools to use in the context of our ageing population to improve the effectiveness of family care relationships.

Methods: Nurses using TEP augmented the usual care with a web-based resource (HeartCareII) that provided patients with self-management information, self-monitoring tools, and messaging services.

Results: Patients exposed to TEP demonstrated better quality of life and self-management of chronic heart disease during the first 4 weeks, and were no more likely than patients in usual care to make unplanned visits to a clinician or hospital. Both groups demonstrated the same long-term symptom management and achievements in health status.

Conclusion: This project provides new evidence that the purposeful creation of patient-tailored web resources within a hospital portal is possible; that nurses have difficulty with modifying their practice routines, even with a highly-tailored web resource; and that the benefits of this intervention are more discernable in the early postdischarge stages of care.

Methods and Results: Psychometric testing was done using data from 760 HF patients (age 70.36 ± 12.3 years, 51% male) from 7 sites in the United States. Reliability of the SCHFI (alpha .76) was adequate. Reliability of the Self-Care Maintenance subscale was lower than desired (alpha .56) but the reliability of the other subscales was adequate: Self-Care Management (alpha .70) and Self-Care Self-Confidence (alpha .82). Construct validity was supported with satisfactory model fit on confirmatory factor analysis (NFI = .69, CFI .73). Construct validity was supported further with significant total and subscale (all P < .05) differences between patients experienced with HF and those newly diagnosed, consistent with the underlying theory.

Conclusion: Low reliability of the Self-Care Maintenance subscale was expected because the items reflect behaviors known to vary in individuals. The reliability and validity of the SCHFI are sufficient to support its use in clinical research.

The purpose of this study was to explore background characteristics associated with supportive relationships, and the contribution of supportive relationships to HF self-care. The construct of shared care was used to operationalize supportive relationships. Shared care refers to a system of interpersonal processes (communication, decision making, and reciprocity) used in close relationships to exchange support. A cross sectional design was employed recruiting 75 HF dyads.

Older patients who perceived their health as better reported better shared care communication. Spouse dyads perceived more reciprocity in their relationship than non-spouse dyads. The process of patient shared care decision making was related to HF self-care maintenance (r=0.65) and self-care confidence (r=0.52). Patient communication (r=0.24) and reciprocity (r=0.41) were related to self-care confidence. Caregiver decision making (r=0.29) contributed to self-care maintenance; and caregiver decision making (r=0.37) and reciprocity (r=0.35) contributed to self-care confidence.

These findings suggest that augmenting the processes of shared care may be a valuable focus for future intervention research.