Assessing and Supporting Family Caregivers

Family Focus Each family is unique. Nurses must be aware and sensitive to the varied communication styles and characteristics of families. What are some of the characteristics of your family that would be helpful for a nurse to know?

Family Caregiving Scenario Mrs. Sather, age 75, has lived in her own home for 25 years. She has three adult children, two daughters and a son, who provide assistance with transportation, bathing, and medication management.They have been doing this successfully together for the past 3 years. To date, Mrs. Sather’s children have felt able to handle most situations and were able to obtain the resources needed to continue to manage their own lives and help their mother.

Caregiver Competence Research shows: Higher level of skill in providing care for a family member is associated with lower caregiver role strain. Definition: The competence and skill of the caregiver(s) and the family in providing care to a family member or loved one. Assessment: From the scenario, would you assess the caregiver competence of Mrs. Sather’s family as high or low?

The Scenario: Relationships Mrs. Sather’s older daughter has had a close relationship with her mother. They both enjoy knitting and listening to big band music together. The other two children enjoy playing card games, especially canasta, with their mother. Mrs. Sather looks forward to their frequent visits.

Relationships and Rewards Research shows: A higher quality relationship between a caregiver and a care recipient is associated with lower caregiver strain. Definition: Interactions between the caregiver and the care recipient based on love, shared activities, and shared values. Assessment: From the scenario, what is your assessment of relationships and rewards?

The Scenario: Role Strain The older daughter feels that, despite some help from her brother and sister, most of the burden of organizing her mother’s care falls to her. She has gladly accepted this responsibility in the past. However, she now has two children in college and two teenagers at home. As a result, she has had to go to full-time status at work. Her stress level continues to increase and she is beginning to resent her mother’s needs.

What is Caregiver Role Strain? Caregiver role strain is defined as the felt difficulties in performing the caregiver role. Caregiver role strain can come from:  Providing direct care  Tension and worry  Economic burden  Communication problems  Lack of support or resources In the scenario, what factors are contributing to role strain?

How Nurses can Support Family Caregivers Be family focused. Provide systematic assessment. Individualize family strategies. Help the family recognize health problems and problematic transitions early. Work together with the caregiver to blend family and nursing knowledge.

Systematic Assessment Help identify family strengths and family care issues by:  Listening to the family caregiver and care recipient.  Asking the family caregiver what his/her concerns are.  Sharing nursing knowledge and skill in building the caregiver’s competence in caregiving.  Supporting the family in enjoyable activities or discovering new ways of relationship building.  Providing information and support through caregiving transitions.  Encouraging the caregiver to take care of his/her own health.

Individualized Family Strategies Strategies should be individualized with consideration of:  Family preferences.  What family has tried or not tried before.  Educational level.  Culture and ethnicity.  Health care provider or health care system support. Family Strategies do not come in “one size fits all”.

Identifying Health Problems and Problematic Transitions Early Transitions can occur for many reasons:  Changes in health condition of care recipient or caregiver  Relocation  Death  Family relationships  Change in health care system or provider Nursing support of the family during transitions may need to be redefined to meet the family’s changing needs.

Caregiving Scenario: Transition One day, when Mrs. Sather was home alone, she had a severe CVA. Suddenly, she needed total care. Her three children now had new concerns, each from his/her own perspective. The situation was changing rapidly. The patterns of support that they had established for their mother were no longer adequate. Even their communication patterns were disrupted, due to Mrs. Sather’s aphasia.

Predictability and Stability Research shows: Higher levels of predictability in unstable family care situations are associated with lower caregiver role strain. Definition: The perception by the caregiver of regularity and consistency in the family care situation, especially through times of transition. Assessment: From the scenario, would you assess the predictability and stability as high or low at present?

Systematic Assessment of Family Important features of the care situation in the scenario:  Care recipient could no longer speak for herself.  Discharge was dependent on provision of 24-hour care.  Family members had different educational levels and learning styles.  Conflict existed between two family members.  Financial concerns existed in the family about cost of care.  Family was grieving and upset by Mrs. Sather’s serious condition.

Working Together to Blend Family and Nursing Knowledge Working on family care concerns is facilitated by families and nurses listening to each other and putting their knowledge and skill together to:  define what the caregiving issues are.  generate strategies that can be tried to improve or solve issues of concern.

Caregiving Scenario: Support Need Mrs. Sather’s three adult children identified that the support they needed was:  More information about Mrs. Sather’s health condition and her long-term prognosis.  Ideas on how they might care for her once she came home from the hospital. They were unsure if they could, because their mother now required total care.  To know if resources were available to help them care for her, as they all worked full-time.

This family was supported through these individualized strategies: Educational materials about stroke were provided. These included written materials and a video tape, which accommodated their different learning styles. A family care conference was scheduled at the hospital. It was facilitated by a MSW, so entire family could ask questions and discuss individual concerns. Family members were encouraged to prepare questions for the physician and different members of the health care team. Resource materials about long-term care options, in- home care, and cost were provided.

These family-focused nursing interventions helped this family to devise ways to be involved in the caregiving of Mrs. Sather and establish resources that would support them in the future.

Family Assessment and Support Goals: – Increase family and caregiver competency in providing care. – Strengthen relationships and the rewards of caregiver. – Increase predictability and stability in family care situations.

Research Cited: Archbold, P.G., Stewart, B.J., Greenlick, M.R., et al. (1990). Mutuality and preparedness as predictors of caregiver role strain. Research in Nursing and Health, 13, Archbold, P.G., Stewart, B.J., Miller, L.L., et al. (1995). The PREP system of nursing interventions: A pilot test with families caring for older members. Research in Nursing and Health, 18, 3-16.

Assessing and Supporting Family Caregivers was prepared by Carla Hagen, M.P.H., R.N. for the Older Adult Focus Project, OHSU School of Nursing.