Nurse As Caregiver

Nurse Role as Caregiver

Who Is Caregiver,Potentials Of Care Givers,Problem Solving Capacity Of Caregiver,Caregivers In Clinical Settings ,Caregivers Strategies ,History Of Nursing As Caregivers.

Who Is Caregiver

     The term caregiver is defined as an individual who assists ill person(s), helps with a patient's physical care, typically lives with the patient, and does not receive monetary compensation for the help. 

    A more descriptive definition of a caregiver is a person who not only performs common caregiver responsibilities (ie, providing physical, social, spiritual, financial management, and technical care) but also advocates for the ill person within health care systems and society as a whole. 

    The caregiver role is often anticipated in relationship to ciders, yet rarely is their preparation for care-giving to one's child or one's spouse.

Potentials Of Care Givers

    Delineating the role of the caregiver reveals potential problems they experience. Direct patient care encompasses much more than physical care; it also necessitates learning an extensive amount of information about illness, symptoms, medications, technological treatments, and how to relate to health care professionals (Smith, 1995). 

    Caregivers also must be prepared for emergencies and be capable of responding. Usually, the caregiver must also maintain their personal responsibilities, whether as breadwinner, housekeeper, or both. 

    The caregiver's relationship with the patient, the caregiver's age and life developmental stage, the patient's illness severity, and the suddenness and amount of the change in the patient's need for caregiving have been predictive of caregiver burnout in various illness populations such as cancer care with home chemotherapy, cardiac rehabilitation, muscle deterioration, and dementia victims ( Biegel , Sales, & Schultz,1991). 

    The indirect familial caregiver tasks include designating others to assist with patient care, exchanging information, and maintaining decision making among appropriate persons. 

    Caregivers also have numerous expectations for themselves and from others around them to perform various psychosocial tasks such as coping with changes in role. grieving the loss of the health and personality of their loved one, releasing tension, resolving uncertainty or guilt, and providing positive regard for those with whom they interact. 

    Because the caregiver by definition is loaded with tasks and expectations, it is no wonder that the major area of research has been caregiver burden and negative outcomes on caregivers' physical, mental, and financial health. 

    The majority of burden studies have been descriptive and correlational and have resulted in identification of multiple factors recognized as being significant for burden: characteristics of the care needed by the patient that are often measured as illness demands. 

    Numerous variables (eg, demographic information, developmental stage, social support) that have been studied in relation to caregiver experience are influential yet not universally predictive of caregiver burden. ( Biegel et al., 1991). 

    Research across disciplines identifies significant negative health outcomes of caregiving (reduced physical function, immune status, wound healing. greater fatigue, mortality, and cardiovascular disease) (Beach, Schultz, Yee, & Jackson, 2000; Federal Interagency Forum on Aging. 2000; Given & Given, 1998; Schultz & Beach, 1999; Silver & Wellman, 2002). 

    The majority of caregivers experience depression, social isolation, financial strain, sleep deprivation with daytime sleepiness, and inefficient use of family resources (Fitzgerald, 2003; Smith, 1996).These caregiver problems directly influence patient outcomes, resulting in complications and high health service use (Smith, Pace, et al., 2002), Smith's (1994).

    Research indicated caregivers' motives for helping consistently explain variance in their depression, coping, and quality of life (Smith, Kleinbeck, Boyle, Kochinda , & Parker , 2002).

Problem Solving Capacity Of Caregiver

    Problem solving ability is lauded as essential and caregivers' ability to solve problems can avert patient problems (National Family Caregivers Association, 2002; Schultz, 2000), yet only a handful of studies on problem solving in caregiving were found and not all had positive outcomes (Roberts et al. 1995). 

Unique research on the positive aspects of caregiving is being conducted by Smith under the concept of caregiving effectiveness. 

    Effective caregiving is defined as family provision of technical, physical, and emotional care that results in optimal patient health and quality of life and minimal technological side effects ( eg , catheter infections) while maintaining the caregiver's health and quality of life. 

    Nursing interventions have been found effective for caregiver problems of depression, sleep deprivation, social isolation, and lack of access to evidence-based information, caregiving and complex technology problem solving. 

    These interventions include counseling, peer support, high-quality internet information, and contacts with experts. For example, there is a dearth of research on caregiving with lifelong technology dependence that begins unexpectedly.

    In middle life (when teenagers and elder family members also need assistance) and continues on a trajectory of intermittent disease exacerbations and slow, progressive decline (Collins, Stommel, Wang, & Given, 1994; Di-Martini et al., 1998; Howard & Malone, 1996).

Caregivers In Clinical Settings 

    The most widely recommended clinical yet unverified approach is to provide guidelines to manage specific caregiving problems (Schultz, Lustig, Handler, & Martires, 2002). A step-by-step approach is an essential care-giving skill. 

    Step-by-step guidelines on computer algorithms can guide systematic thinking and develop skills for solving stressful problems (Smith et al., 2003; Wilkinson & Mynors -Wallis, 1994). 

    The state of the science report on computer-based algorithms that aid patients to make step-by-step decisions about treatment options concluded that improved knowledge, attitudes, and lower health services used resulted from patients' use of algorithms (Agency for Health Care Policy and Research (AHCPR), 1998). 

    The Cochrane review and randomized trial results concur, adding that patients with step-by-step decision aids had realistic treatment expectations, satisfaction with care, and lowered anxiety (O'Connor et al., 2002). 

    The more successful problem-solving algorithms included logical, easily-remembered steps, multi-perspective (psychological and physical) information, long-term access, and booster repetition, all tailored to a specific group with common problems (Shaw, McTavish, Hawkins, Gustafson, & Pingree, 2000).

Caregivers Strategies 

    Research should continue on the culturally-related aspects of caregiving strategies used in various ethnic groups (Picot, 1995). 

    Another contemporary focus in caregiving research should be the caregiving family, as research has clearly indicated that multiple members of families are involved in providing direct and indirect care, both to the patient and in support of the primary caregiver (Smith CE, 1996) . 

    In addition to the caregiving family, the caregiving neighborhood or parish should be a focus of study. In some countries giving care is a way of life that extends to friends, neighbors, and society. In the Netherlands the term mantle Zork is used to define caregiving. 

    This term is translated as the "care cloak," protecting not only the patient but also the caregiver. In the US, Share the Care, a program designed for the care of people with cancer, is an example of mantle Zork (Lackey, Singh, Warnock, Elliott, & Rajotte, 1995).

History Of Nursing As Caregivers 

    Historically, research on the topic of caregivers has come from the literature on aging in which burden and supportive interventions have been studied. 

    Interventions tested include teaching mastery of caregiving tasks, social interventions such as support groups or telephone contacts, and direct clinical services such as counseling and respite care. Out comes of many of these intervention studies indicated that in the short term, the interventions may reduce caregiver stress in a limited way but the burden returns when the interventions cease. 

    Research with midlife caregivers reveals the need for interventions on resource management (Smith, 1993b) and motivation to help (Smith, 1994a). Further research is needed to test more interventions and match the timing of the intervention with the developmental life stage of the caregiver.