NCP Nursing Diagnosis: Caregiver Role Strain

Nursing Diagnosis: Caregiver Role Strain
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels

* Caregiver Well-Being
* Caregiver-Patient Relationship

NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels

* Caregiver Support

NANDA Definition: Difficulty in performing the caregiver role

The focus of this care plan is on the supportive care rendered by family, significant others, or caregivers responsible for meeting the physical and/or emotional needs of the patient. With limited access to health care for many people, most diseases diagnosed and managed in the outpatient setting, and rapid hospital discharges for even the most complex health problems, the care of acute and chronic illnesses are essentially managed in the home environment. Today’s health care environment places high expectations on the designated caregiver, whether a family member or someone for hire. For many elderly patients, the only caregiver is a fragile spouse overwhelmed by his or her own health problems. Even in cultures where care of the ill is the anticipated responsibility of family members, the complexities of today’s medical regimens, the chronicity of some disease processes, and the burdens of the caregiver’s own family or environmental milieu provide an overwhelming challenge. Caregivers have special needs for knowledge and skills in managing the required activities, access to affordable community resources, and recognition that the care they are providing is important and appreciated. Nurses can assist caregivers by providing the requisite education and skill training and offering support through home visits; special clinic sessions; telephone access for questions and comfort; innovative strategies such as telephone or computer support, or "chat groups"; and opportunities for respite care.

* Defining Characteristics: Illness severity of care receiver
* Unpredictable or unstable illness course
* Discharge of family member with significant home care needs
* Caregiver has health problems
* Caregiver has knowledge deficit regarding management of care
* Caregiver’s personal and social life is disrupted by demands of caregiving
* Caregiver has multiple competing roles
* Caregiver’s time and freedom is restricted because of caregiving
* Past history of poor relationship between caregiver and care recipient
* Caregiver feels care is not appreciated
* Social isolation of family/caregiver
* Caregiver has no respite from caregiving demands
* Caregiver is unaware or reluctant to use available community resources
* Community resources are not available or not affordable

* Related Factors: Caregiver expresses difficulty in performing patient care
* Caregiver verbalizes anger with responsibility of patient care
* Caregiver worries that own health will suffer because of caregiving
* Caregiver states that formal and informal support systems are inadequate
* Caregiver regrets that caregiving responsibility does not allow time for other activities
* Caregiver expresses problems in coping with patient’s behavior
* Caregiver expresses negative feeling about patient or relationship
* Caregiver neglects patient care
* Caregiver abuses patient

* Expected Outcomes Caregiver demonstrates competence and confidence in performing the caregiver role by meeting care recipient’s physical and psychosocial needs.
* Caregiver expresses satisfaction with caregiver role.
* Caregiver verbalizes positive feelings about care recipient and their relationship.
* Caregiver reports that formal and informal support systems are adequate and helpful.
* Caregiver uses strengths and resources to withstand stress of caregiving.
* Caregiver demonstrates flexibility in dealing with problem behavior of care recipient.

Ongoing Assessment

* Establish relationship with caregiver and care recipient. This facilitates assessment and intervention.
* Assess caregiver-care recipient relationship. Dysfunctional relationships can result in ineffective, fragmented care or even lead to neglect or abuse.
* Assess family communication pattern. Open communication in the family creates a positive environment, whereas concealing feelings creates problems for caregiver and care recipient.
* Assess family resources and support systems. Family and social support is related positively to coping effectiveness. Some cultures are more accepting of this responsibility. However, factors such as blended family units, aging parents, geographical distances between family members, and limited financial resources may hamper coping effectiveness.
* Assess caregiver’s appraisal of caregiving situation, level of understanding, and willingness to assume caregiver role. Individual responses to potentially stressful situations are mediated by an appraisal of the personal meaning of the situation. For some, caregiving is viewed as "a duty"; for others it may be an act of love.
* Assess for neglect and abuse of care recipient and take necessary steps to prevent injury to care recipient and strain on caregiver. Safe and appropriate care are priority nursing concerns. The nurse must remain a patient advocate.
* Assess caregiver health. Even though strongly motivated to perform the role of caregiver, the person may have physical impairments (e.g., vision problems, musculoskeletal weakness, limited upper body strength) or cognitive impairments that affect the quality of the caregiving activities.

Therapeutic Interventions

* Encourage caregiver to identify available family and friends who can assist with caregiving. Successful caregiving should not be the sole responsibility of one person. In some situations there may be no readily available resources; however, often family members hesitate to notify other family members or significant others because of unresolved conflicts in the past.
* Encourage involvement of other family members to relieve pressure on primary caregiver. Caring for a family member can be mutually rewarding and satisfying family experience.
* Suggest that caregiver use available community resources such as respite, home health care, adult day care, geriatric care, housekeeping services, Home Health Sides, Meals-on-Wheels, Companion Services, and others as appropriate.
* Encourage caregiver to set aside time for self. This could be as simple as a relaxing bath, a time to read a book, or going out with friends.
* Teach caregiver stress-reducing techniques.
* Encourage caregiver in support group participation. Groups that come together for mutual support can be quite beneficial in providing education and anticipatory guidance. Groups can meet in the home, social setting, by telephone, or even through computer access.
* Acknowledge to caregiver the role he or she is carrying out and its value. Caregivers have identified how important it is to feel appreciated for their efforts.
* Encourage care recipient to thank caregiver for care given. Feeling appreciated decreases feeling of strain.
* Provide time for caregiver to discuss problems, concerns, and feelings. Ask caregiver how he or she is managing. As a caregiver, the nurse is in an excellent position to provide emotional support.
* Inquire about caregiver’s health. Offer to check blood pressure and perform other health checks. Provide suggestions for ways to adjust the daily routines to meet the physical limitations of the caregiver.
* Encourage family to become involved in community effort, political process, and policy making to effect legislation that supports caregivers (e.g., family leave policy, availability of affordable community resources).

Education/Continuity of Care

* Provide information on disease process and management strategies. Accurate information increases understanding of care recipient’s condition and behavior. Caregivers may have an unrealistic picture of the extent of care required at the present time. Home care therapies are becoming increasingly complex (e.g., home dialysis, ventilator care, terminal care, and Alzheimer’s care) and require careful attention to the educational process.
* Instruct caregiver in management of care recipient’s nursing diagnoses. Demonstrate necessary caregiving skills and allow sufficient time for learning before return demonstration. Increased knowledge and skills increase caregiver’s confidence and decrease strain.
* Refer for family counseling if family is amenable.
* Refer to social worker for referral for community resources and/or financial aid, if needed.