Caregiver Role Strain
Kathleen M. Perry, RN,
Meg Gulanick, RN, PhD
NANDA: A caregiver's felt difficulty in performing the family
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.
- 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
- Caregiver has multiple competing roles.
- Caregiver's time and freedom is restricted because of
- Past history of poor relationship between caregiver and care
- 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
- Community resources are not available or not affordable.
- Caregiver expresses difficulty in performing patient care.
- Caregiver verbalizes anger with responsibility of patient care.
- Caregiver worried that own health will suffer because of
- Caregiver states that formal and informal support systems are
- 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
- Caregiver neglects patient care.
- Caregiver abuses patient.
- 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
- Caregiver reports that formal and informal support systems are
adequate and helpful.
- Caregiver uses strengths and resources to withstand stress of
- Caregiver demonstrates flexibility in dealing with problem
behavior of care recipient.
- (i) independent
- (i) Establish relationship with caregiver and
- To facilitate assessment and intervention.
- (i) Assess caregiver-care recipient
- Dysfunctional relationships can result in ineffective,
fragmented care or even lead to neglect or abuse.
- (i) Assess family communication
- Open communication in the family creates a positive
environment whereas concealing feelings creates problems for caregiver and care
- (i) Assess family resources and support
- 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, geographic
distances between family members, and limited financial resources may prove to
- (i) Assess caregiver's appraisal of
caregiving situation, level of understanding, and willingness to assume
- 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
- (i) 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.
- (i) 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.
- (i) independent
- (i) 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.
- (i) Encourage involvement of other family
members to relieve pressure on primary caregiver.
- Caring for a family member can be a mutually rewarding and
satisfying family experience.
- (i) 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,
Companios Services, and others, as appropriate.
- (i) Encourage caregiver to set aside time
- This could be as simple as a relaxing bath, a time to read
a book, or going out with friends.
- (i) Teach caregiver stress-reducing
- (i) Encourage caregiver in support group
- 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
- (i) 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.
- (i) Encourage care recipient to thank
caregiver for care given.
- Feeling appreciated decreases feeling of strain.
- (i) Provide time for caregiver to discuss
problems, concerns, and feelings. Ask caregiver how he or she is managing.
- A nurse as a caregiver is in an excellent position to
provide emotional support.
- (i) 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.
- (i) Encourage family to become involved in
community effort, political process, and policymaking to effect legislation
that supports caregivers (i.e., family leave policy, availability of affordable
Education/Continuity of Care
- (i) independent
- (i) Provide information on disease process and
- 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. However, home care
therapies are becoming increasingly complex (home dialysis, ventilator care,
terminal care, Alzheimer's care, and others) and require careful attention to
the educational process.
- (i) 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 skill increases caregiver's
confidence and decreases strain.
- (c) Refer for family counseling if family
- (c) Refer to social worker for referral
for community resources and/or financial aid, if needed.
~ Care Plan Index ~
Outcomes Index ~
~ Care Plan Constructor Home ~