Family Involvement in Care Study

Protocols Used in the Study

The Family Involvement in Care (FIC) intervention is a protocol for negotiating and establishing a partnership (cooperative role behaviors) of identified Family Member/Friend Caregivers of residents with Alzheimer's disease and institutional staff in the therapeutic activities and personal care of the residents. The essence of the FIC intervention is the family-staff caregiving partnership, a negotiated role for the family caregiver.

The purpose of the protocol is fourfold:

(1) to decrease Family Member/Friend Caregivers' and staffs' stress and dissatisfaction with caregiving roles and role relationships,

(2) to increase Family Member/Friend Caregiver's satisfaction with care of their relatives with Alzheimer's disease,

(3) to increase staff job satisfaction and positive attitudes about families, and

(4) to maximize cognitive and functional abilities and lessen agitation and social inaccessibility of residents with Alzheimer's disease.

Two sub-protocols are required for the implementation of the Family Involvement in Care protocol: (1) FAMILY PROTOCOL, and (2) STAFF PROTOCOL.

Basic Protocol Information
The principal operations for conflict resolution, role negotiation, role transition (family & staff), and family/staff partnerships are:

(1) the negotiation of an "agreement" for family involvement in care (FIC Family/Staff Agreement) between family and staff;

(2) education of family and staff (FIC Resource Manual, Staff Education Program);

(3) enactment of the partnership agreement with renegotiation at least monthly; and

(4) documentation of the agreement with monthly ratings (by family member and primary nurse) of the extent the agreement is carried out (FIC Family-Staff Agreement Documentation).

Dosage of the FIC Intervention
The concepts that define the variable dosage of the FIC Intervention are:

(1) number of care involvement activities (Group, 1:1 Physical, 1:1 Psychosocial),

(2) intensity of participation,

(3) length of involvement per contact, and

(4) frequency of contact (FIC Family-Staff Agreement).

The number of care activities can range from 1 to more than 20, but are expected to average 5 or less based on the pilot study, which was undertaken at the Iowa Veteran's Home in Marshalltown. Intensity of participation ranges from '1=provides information for care plan' to '3=participates in/leads caregiving.' Contact length ranges from '1=10 minutes' to '7=>6 hours.' Contact frequency ranges from '1=monthly' to '5=daily.'

The minimum therapeutic dose of the FIC intervention is defined as participation in at least one care activity at the level 1 intensity (provides information for care plan), for at least 10 for each contact, and at least monthly. The quantification of the dosage of the FIC intervention is equal to the sum of values for participation, contact length, and frequency for each activity to achieve a total FIC dose. Thus, the dose prescribed is computed from the negotiated agreement (initial and at least monthly) for family involvement documented on the FIC Family-Staff Agreement and Documentation Forms. The actual dose administered will be calculated by family member and primary nurse/social worker congruent ratings of family member involvement (the sum of congruent values for participation, contact length, and frequency for each activity in the Family/Staff Agreement) documented on the Family-Staff Agreement Rating form.

Ratings by the Family Member/Friend Caregiver and the primary nurse/social worker of the FIC dose administered will be done each month on the Family/Staff Agreement Rating Form prior to renegotiation of the agreement. Family member and primary nurse/social worker perceptions of the FIC dose administered will also be able to be analyzed separately. Family Member/Friend Caregivers who do not fulfill the agreement for the minimum therapeutic dose will be analyzed separately to assess the validity of the minimum therapeutic dose.