Abstract
This paper gives deep insight on caregivers’ burden with the bias on the clinical aspects of it. the paper has looked into various literature and the most outstanding point about caregivers’ burden is that it can be reduced when they receive support both from the healthcare professionals as well as their families. The majority of the burden that caregivers face is often psychological as it is cumbersome for them to strike a balance between their roles as caregivers and also their position in the family and at the workplace.
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Introduction
The majority of the patients have family members that are offering some degree of care as well as support when it comes to individuals of different ages suffering from chronic illness or some sort of disabilities. This care which can be seen as informal to some extent can be considered in scope, duration as well as intensity. According to Abdollahpour et al (2014), caregiving in the family raises safety concerns in two ways that are supposed to be a concern for the nurses no matter the setting. To begin with, caregivers are now and then referred to as ‘secondary patients’, who deserve as well as need guidance and protection. The study that supports caregivers-as-client view protecting put more weight on protecting family caregivers’ health as well as safety because there demands caregiving put them at a higher risk for injuries together with unfavorable events. Secondly, the family caregivers are usually voluntary providers who usually need more support to enable them to become more proficient, a safe volunteer worker with the focus on protecting their family from harm in a better way.
Description of the clinical analysis of caregiver burden
As a community nurse, I came across a caregiver who was taking care of patients with a series of conditions. The caregiver herself opened up to me on the series of responsibilities that she has, first was to maintain the residence. Surviving on a limited financial budget as well as managing a series of health conditions her own. Falling short of physical presence required for a support system, she had to bear the entire burden of her husband’s short but extreme outpatient care which entailed: driving, preparation of meals, cleaning, organizing the medicine and oxygen as well as other related activities by herself lacking. With all this, she is still hoping the transplant turns out to be successful while being faced with multiple uncertainties the major one being the one on her husband’s survival. While asked she slightly complained but her face showed severe emotional distress, considerable fatigue, sleep deficiency as well as challenges in maintaining her focus and energy in the entire process of transplant.
I noticed the caregiver had failed to follow the dosage of drugs as prescribed citing the pressure that the task entails. This hurt the health of patients as though there was an improvement but it was noted to be extremely gradual. Psychologically the caregiver was vulnerable with a high likelihood of causing harm to the patient. Her level of aggressiveness was a concern together with the way she was easily irritable.
Step 3 – Relevance of Topic/ Situation to You Personally and Professionally
This topic highlights the plight that the caregivers go through, to the caregivers the common assumptions are that though it’s a hard task one gets used to it. But this topic has highlighted and given insights on how entailing the role of caregiver is and it also highlights the challenges they are likely to face or the ones that they should anticipate in the future.
The paper also provides the better side of the healthcare workers as they tend to offer support to the caregivers and reduce the level of stress that they might be going through. Most of the issues that caregivers face are psychological, therefore the topic tries to link the psychological issues as part of the burden that caregivers take as the topic goes hand in hand.
Identification, Discussion, and Analysis of 3 Issues of the Concept Within the Clinical Situation
The threat of elder abuse
The existence of cognitive-behavioral problems and dementia puts the recipient of care in danger for abusive behaviors towards the caregiver. Abandonment may also take place, including urinary incontinence, nutritional neglect together with access to food, falls, and unmanaged pain. Neglect of the caregiver may also occur because the dementia patient is not able to converse and the caregiver is also not capable of comprehending or know how to handle nutritional intake as well as pain management (Reinhard, n.d). Chappell, Dujela, and Smith (2015) discovered that counseling, as well as support for caregivers that face disrupting behavior from their family members due to illness, will decrease the degree of stress over their multiyear caregiving responsibility.
Caregiver spends considerable time engaging with the recipient of care, and at the same time offering care in a vast range of activities. The interaction of the healthcare professional with the patient is usually limited while caregiving can last from the shortest period of time, mostly after the hospitalization of the patient to more than forty years of constant care to a patient with a chronic illness. The devotion needed to deal with a recipient who has a chronic illness can be daunting to the mind. This has got serious psychological effects on both the caregiver and the recipient of care which might end up damaging both of them psychologically.
Medication errors
Regarding the skills together with the familiarity of the caregiver, an essential case in point of the probable to hurt patient is the administration of medications by the caregivers. A considerable number of community-based elders rarely recollect receiving any directives on how they are supposed to use their medications. They usually depend on the members of their families for help in taking the drugs (Reinhard, n.d).
According to the study conducted by Travis and colleagues, it was discovered that caregivers only manage one to 14 medication daily have the complexity of keeping track of many prescriptions, and due to the nature of their tight schedule, they are prone to miss doses (Chappell, Dujela, & Smith, 2015). Their roles of monitoring for the toxic or severe effects within the members of the families who are incapable of reporting like diarrhea, vomiting, dehydration, and any situations they see an emergency. Caregivers need to have significant knowledge to be able to identify both atypical and classical severe effects of the drugs they may see as the condition of their family members’ changes and also help in creating critical thinking abilities that would enhance them to administer possible problems (Reinhard, n.d).
Having the required skills to manage the condition of the patient will also minimize the emergencies as the skilled caregiver will be able to identify when the condition gets worse and when to give the emergency drugs to the patient when need be. The problem comes when the illness is prolonged as fatigue and normalization of condition may make the caregiver miss essential aspects or assume some of the required symptoms for proper diagnosis. Proper training about the condition and also being able to keenly follow up on the patient’s progress would tackle this concern as the caregiver would easily identify an emergency and offer the patient the drugs as advised.
The perspective of harm
The family members of the caregivers can be exposed to two categories of risk; situational and preventable risks, to begin with, even though they usually have good intentions in addition to hard work, if caregivers lack essential skills as well as knowledge to execute their work, they may end up harming their loved ones unintentionally. Such injuries are normally related directly to shortage or deficiency of skills as well as competence which can be enhanced by providing the caregiver with necessary education together with support. For instance, according to a recent study which established that patients had numerous unfavorable outcomes when they are managed by untrained caregivers whom they depend on in terms of enteral nutrition or tube feeding the challenges that they experience include the displacement of tube, the clogging of the tube, dehydration as well as an infection. This leads to a strainful caregiving situation as well as a readmission in the hospital.
The second fear is that the fact that the work of a caregiver is extremely demanding, this can put them at risk of engaging in behaviors that may be harmful towards the receiver of the care, especially among the individuals with cognitive impairment. Caregivers who are depressed have a higher probability of harming their spouses, caregivers who are more likely to be depressed in the course of caring for their spouses with physical impairment or considerable cognitive are more probable to engage in abusive or neglect behaviors like yelling and screaming, use of physical force or threatening to abandon, withholding meals, or even handling the patient roughly.
In an overview, family members may be defied to find the ability or capacity to provide care, nonetheless, Fulmer discovered those caregivers with poor health or whose incomes are a loan or the ones with the dysfunctional situation are the ones more likely to have limited ability to offer the needed care. They might also not be able to understand the standard for quality and might not offer the level of care that is required
Review the literature
According to Allred (2013), healthcare professional lack of unambiguous concentration to caregivers is a huge gap in healthcare and it’s even more embarrassing considering it’s been more than two decades with documented potential risks of family caregiving. As it currently stands caregivers happen o be secreted patient themselves, due to the adverse mental and physical health consequences from the nature of their work is both emotionally and physically demanding as most of them tend to pay little attention to their own health and healthcare at large (Hsiao & Tsai, 2015).
Declines in both physical health as well as premature death amongst the caregivers in totality have been reported. Reinhard (n.d) discovered that family caregivers face a considerable negative physical cost as the illness of the patient progresses, the caregiver who was elderly particularly the elderly spouses with the experience of caregiving which is stressful have a higher mortality rate at 63% in comparison to the non-caregiver who are at the same age group. The most current, study indicated that elderly husbands, as well as wives who take care of their spouses, have ended up being hospitalized for severe illness and they end up having increased chances of them dying ahead of time.
The deterioration in caregivers’ health can be specifically linked with caregivers who see themselves as laden. Caregiver burden, as well as caregiver strain, can be easily connected to caregiver’s individual poor health status, amplified health-risk behaviors (for instance smoking), and an elevated abuse of drugs which have been prescribed to them (Reinhard (n.d), Many scholars have highlighted the fact that caregivers are often at risk of fatigue as well as sleep interruptions, reduced immune functioning, increased in the level of insulin and pressure, modified influenza shots, altered lipid profile, wound taking time to heal as well as a higher risk for cardiovascular disease.
Burton and colleagues investigated the relationship between the provision of care by members of the family and their health maintenance and behavior. These scholars discovered the fact that, with an increased height of caregiving activities, and the likelihood of caregiver neither having rest, nor have enough time for exercise, and in fact not recovering from illness were also so high (Reinhard, n.d),. Furthermore, caregivers had a higher probability of forgetting their prescriptions for their individual chronic conditions. Offering care creates a danger to the general health of the caregivers, which can interfere with their capability to maintain to be caregivers. If it’s inevitable for caregivers to continue providing care, a reprieve from the distress as well as the burden of maintaining the necessary care ought to be measured.
Both exceedingly negative and positive outcomes of offering care may be present concurrently. It is reasonable that the positive consequences, like rewards together with approval, may caution the pessimistic effects of caregiving. The positive facets of caregiving are vital some scholars are now using a caregiver rewards scale to better have a comprehensive insight into the experiences of caregivers. On the other hand, other scholars are surveying the positive aspects of care as the affinity between the patient and caregiver grows. Whitmore, Crooks, & Snyder (2017), established that preparedness and mutuality did not minimize some of the tension on the caregiver. Picot and colleagues worked basically with the caregivers who were of African American descent and discovered that rewards seen professed by caregivers were more vital than coping.
A caregiver who tries to strike a balance between caregiving and other activities, for instance, family, work, and relaxation may find it cumbersome to keep the attention on the positive portion of caregiving and usually experience more negative responses, like an amplified sense of burden (Roper et al, 2014). Despite the amount of care offered, caregivers may happen to be progressively more distressed if they are not able to contribute to more valued interests as well as activities. More than half of adult children that offer parent care are underemployment. Hence caregiving functions can hurt work functions as caregivers acclimatize the obligation of employment to manage as well as meet the demands of care. Employed caregivers record missed days, as well as interruptions at work, which has an overall negative effect on their productivity at work. They have a problem when it comes to maintaining work functions and at the same time providing support to family members (Ruiz & Ortega, 2019).
According to Reinhard (n.d), Low household and personal incomes, as well as restricted financial resources, can have an increased chance of a caregiver risk for negative results, specifically if there are considerable out-of-pocket costs for care recipient desires. The unemployed caregivers or the ones with low income may face more distress because they have limited resources to meet the demands for care. According to Allred (2013), generally, financial concerns predominantly distress for caregivers during the treatment periods which appear to belong and the limited resources become washed-out as those with restricted resources.
The caregiver burden, as well as symptoms depressive, is the major common negative result of offering care for the elderly as well as chronically ill. Caregiver burden can be described as a negative response to the impact of offering care on the caregiver’s occupational, social as well as personal roles and attempt to be a predecessor to depressive symptoms (Reinhard, n.d). Whether a negative outcome is developed by the caregiver appears to be directly linked to the care recipient’s incapacity to execute ADLs, either because of the physical limitation or cognitive status. If the recipient of the care wanders (linked with Alzheimer’s disease) or portrays the behavior which is considered to be unsafe, the caregiver has to be at attention and on-call for supervision 24 hours every day. The regular concern for managing disruptive behaviors (including walking in the street, abusing pills by taking it in excess, cursing and yelling, and many more) also negatively influences the caregivers (Juntunen et al, 2018).
Care recipient’s cognitive, functional, and emotional status envisages caregiver burden as well as depression. This may be apparent in feelings of isolation as well as loneliness, fearfulness as well as being simply worried, as the demands of caregiving restrict their individual time. Care recipient behavior like yelling, screaming and swearing are connected with augmented caregiver clinical depression. The depression of the caregiver may also have a somatic module, like fatigue, insomnia, anorexia, and exhaustion (Thompson, 2015).
According to Thompson (2015), Caregivers could suffer serious vacillation in sleep patterns over time, which may impact depression and aggravate symptoms of chronic illness. Management of pain is an obstinate problem for caregivers that result in considerable caregiver distress, as caregivers help with both pharmacologic and nonpharmacologic pain management policies.
Caregivers are approximated to be around 15 million people and they offer around $202 billion of free care to the older adults who suffer from cognitive impairment because of neurodegenerative diseases, progressive chronic conditions that can lead to disturbance in behavior, memory, and orientation. Approximately 80 percent of the caretakers are family members (Allred, 2013). These caregivers are usually overwhelmed caring for older people who are suffering from several chronic conditions that happen to be complicated by cognitive impairment. Older adults with cognitive impairment that originated from dementia have higher occasions of hospitalization as compared to older adults without a dementia diagnosis.
The efficiency of managing the symptoms linked to cognitive impairment has been linked to the lower caregiver burden. According to Abdollahpour et al, (2014), the healthcare professionals have been on hand in getting involved to ensure a smooth transition of the patient to the subsequent setting of care and could use self-efficacy evaluation tool together with other clinical assessment to further focus on offering post-hospitalization transformation or transition plan to the patient needs as well as the caregivers.
Caregivers are also linked to the existence of delirium amongst patients with cognitive impairment during the hospitalization period after alteration for multiple other vital clinical factors. Nevertheless, the use of pharmacological as well as non-pharmacological interventions in the course of hospitalization has been discovered to reduce delirium, particularly amongst high-risk patients like the ones with cognitive impairment.
Discussion/ Analysis of How Your Future Practice Maybe influenced
Considering the majority of the study on caregiving remains to be expressive, there still exist numerous gaps that are evidence-based research to endorse patient quality care and safety as secondary as well as caregivers as providers to susceptible policies for future study
By caregiving being a day out a function that varies as the needs of the care receiver change, it is not well comprehended through cross-sectional research designs. It is important to note that longitudinal and descriptive designs are employed to follow the necessary care requirements over the line of illness course. The longitudinal study currently has matched intervals between observations like 3, 6, 9, or 12 months, devoid of concerns for the protocol of treatment or phase of disease or the demands of care. Future research should take notice of the time points that may be better portray the trajectory of the disease like a time of original diagnosis, protocols alterations, as well as points of disease exacerbation or in other words, decline. An extraordinary focus on safety, the risk for negative results as well as severe effects for both the care recipient and caregiver should be acknowledged.
The key variable that needs to be included in the future includes the type and the phase of the disease as well as the treatments because they will relate to the kinds of continuing therapy. This range of therapies will be linked to the requirements of the patients as well as the assistance with self-care in addition to the ability of the patient to execute other usual daily activities. Are the demands bestowed upon the caregiver too much in a way that it could put at risk his or her health?
A study that uses cautiously selected beginning associates is required so that disparity in care demands can be well comprehended. It will put as in a far better position to depict how the course of the disease and linked treatment as well as happenings through care that is palliative in nature. Undesirable patient care, as well as caregiver situations like medication errors, subsequent hospitalization, and falls, can be noticed over a given time
Conclusion or Summary
Caregivers in the family are signs with significant partners in the plan of care for patients mostly the ones suffering from chronic illness. Healthcare personnel should b worried about various issues that affect patients’ quality of care as well as safety as a family has over-relied on caregivers. progress can be attained through communication as well as caregiver support to fortify the competence of the caregiver in addition to teaching them new skills that will improve the safety of the patient. Preceding interventions and research have indicated the fact that the outcome of the caregiver is more improved when the healthcare practitioners are involved though more research is needed to be conducted on the area. Nurses play a core role in helping family caregivers to be more confident as well as competent as they enter the route of the healthcare process.
References
Abdollahpour, I., Nedjat, S., Noroozian, M., Salimi, Y., & Majdzadeh, R. (2014). Caregiver Burden. (Journal of geriatric psychiatry and neurology.)
Allred, D. (2013). Caregiver burden and sibling relationships in families raising children with disabilities.
Bevans, M., & Sternberg, E. M. (2012, January 25). Caregiving burden, stress, and health effects among family caregivers of adult cancer patients. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3304539/
Chappell, N. L., Dujela, C., & Smith, A. (January 01, 2015). Caregiver Well-Being: Intersections of Relationship and Gender. Research on Aging, 37, 6, 623-45.
Hsiao, C.-Y., & Tsai, Y.-F. (June 01, 2015). Factors of caregiver burden and family functioning among Taiwanese family caregivers living with schizophrenia. Journal of Clinical Nursing, 24, 1546-1556.
Juntunen, K., Salminen, A.-L., Törmäkangas, T., Tillman, P., Leinonen, K., & Nikander, R. (October 01, 2018). Perceived burden among spouse, adult child, and parent caregivers. Journal of Advanced Nursing, 74, 10, 2340-2350.
Reinhard, S. C. (n.d.). Supporting Family Caregivers in Providing Care. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK2665/
Roper, S. O., Allred, D. W., Mandleco, B., Freeborn, D., & Dyches, T. (January 01, 2014). Caregiver burden and sibling relationships in families raising children with disabilities and typically developing children. Families, Systems and Health, 32, 2, 241-246.
Ruiz, F. M. D., & Ortega, G. A. M. (January 01, 2019). Evaluation of the perceived health of caregivers of patients in mild-to-moderate stage Alzheimer’s disease. Perspectives in Psychiatric Care, 55, 1, 87-94
Thompson, K. (2015). Paid formal caregivers and caregiver burden: A quantitative study.
Whitmore, R., Crooks, V. A., & Snyder, J. (January 01, 2017). A qualitative exploration of how Canadian informal caregivers in medical tourism use experiential resources to cope with providing transnational care. Health & Social Care in the Community, 25, 1, 266-274.
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