The Experience Of Being A Nurse And Caregiver
During my time as a nurse, I saw many patients become less independent due to aging and disease. I was able to see through family members and coworkers that it is our responsibility to advocate for these patients. After interviewing a caregiver, I was able to see how a family member can participate in this process. I will address in my paper the research about how the caregiver takes care of the family member. The caregiver describes their emotions, effort, and time they take to care for their family member. The family member suffered a stroke about three months ago, effecting their ability to perform activities of daily living. I will also include how the caregiver was being an advocate to their family member and how I as a nurse can advocate for the caregiver. Resources were referred to the patient were addressed in this paper. Three months ago, a family member of mine was taken to the emergency room after a possible stroke. After a few hours, my family member was diagnosed with a stroke. Upon release of the family member, their son took upon himself the responsibility of becoming the primary caregiver. The caregiver was not married and lived alone, therefore he did not have an issue of becoming the primary care provider. The caregiver currently had a job, working full-time manufacturing airplane parts. His current job took up most of his day, causing him to sacrifice several working hours in order to provide care for the family member. The caregiver had the responsibility of taking care of the family member’s yard and doing house chores.
The interview was with the family member’s son in the home of the family member. The caregiver was nervous to leave the family member alone by herself, so he asked if we could conduct the interview in the family member’s house. He wanted to keep an eye on her while he was participating in the interview. The caregiver asked to conduct the interview in the afternoon, after he helped feed her lunch, so she could be comfortable. The interview took place in the family member’s family room, while the family member was in another room watching television. The interview lasted for about one hour due to the caregiver having other tasks that needed to be done while the family member was occupied. During the interview, there were many emotions that could be felt. The caregiver was showing he was stressed and was trying to rush the interview to accomplish the other tasks needed to be done that day. The caregiver seemed tired from trying to balance the care of his family member, work, and other chores. There was a feeling of sadness and depression as I was talking with the caregiver while he explained to me how he felt isolated. The family member suffered from a stroke about three months ago. A stroke is defined as, “the sudden onset of loss of focal neurological function due to infarction or hemorrhage in the relevant part of the brain, retina, or spinal cord” (Hankey, 2017). A stroke can either be defined as a hemorrhagic or ischemic stroke. A hemorrhagic stroke occurs when a blood vessel in the brain bursts from a weakened blood vessel and bleeds into the brain. An ischemic stroke is defined as a block in a blood vessel in your brain caused by a blood clot (Hankey, 2017). Treatment for a stroke has to be very prompt in order to prevent increased risk of disability. Treatment of a hemorrhagic stroke is different from an ischemic stroke. Hemorrhagic stroke treatment includes administration of warfarin, reducing the blood pressure lower than 160 mmHg for systolic and reversing INR to lower than 1-3 within the first 4 hours of symptoms.
Constant monitoring of a patient’s INR is implemented because of the therapeutic range. Ischemic strokes are treated with a recombinant tissue plasminogen activator, which is thrombolytic therapy to break up the clot. This must be administered within the first 4 hours of symptoms (Munshi & Sharma, 2015). As for prognosis, some patients never fully recover, others may take months or years to recover from a stroke. Negative outcomes may occur after a stroke and can be temporary or permanent. According to Lui and Nguyen (2018), “Motor impairment is the most common deficit after stroke” (p. 1). Patients are at increased risk of falls. Control of bowel and bladder function may be affected with increased risk for urinary tract infections. Skin breakdown can occur if patients are incontinent due to sitting in stool or urine for a long time. Increased risk of cognitive impairment has been associated with pain, fatigue, and depression. Although these complications aren’t specific to every patient, educating both the caregiver and patient can help prepare the patient for the care that may be needed (Lui & Nguyen, 2018). A caregiver can be defined as a person who assists in meeting both physical and psychological needs of an ill or dependent person. Usually, caregivers are members of the family and are not paid to perform cares (Frey et al., 2015). Just as the dependent patient must have their needs met, a caregiver also has needs that must be met. Being a caregiver brings a lot of responsibilities to the table, which can overwhelm the caregiver. Oftentimes, caregivers tend to have physical, psychological, emotional, social, and financial burdens. This can cause an effect on the caregiver’s health and quality of life. Caregivers often feel isolated from family and friends. Most of the time, caregivers have the additional responsibility to take care of children (Sullivan, 2015). The caregiver identified during the interview that he was feeling isolated. His day consisted of helping his family member in the morning to shower, eat, use the bathroom, etc. then he would have to leave for work for the afternoon, come home and help get the family member ready for bed. He stated he hasn’t had time to relax or go out with friends, and that is making him depressed.
The caregiver stated his health has declined since he hasn’t had time to take care of himself through exercise. He used to exercise every morning, but now has to care for his family member instead. Grief was stated by the caregiver as an overall feeling since taking care of the family member. Caregivers often need coping mechanism to help with the transition of having to care for a family member. According to Hawken et al. (2018), the use of these problem-focused coping strategies found positive outcomes for caregiver role strain (p. 4). Coping mechanisms that are commonly used by caregivers include, reducing the number of work hours, utilizing resources, acceptance of financial instability, integrating care into family culture, utilizing social support and religion, and planning activities related to self-care (Hawken et al., 2018). During the interview, the caregiver stated the coping mechanisms he was currently using included, attending his religious services, decreasing the number of hours at work, and utilizing family members to take turns caring for this family member. Being a caregiver means advocating for that family member. As seen in this scenario, the son of the family member is advocating for his mother during this time of rehabilitation. An advocate means supporting and protecting the rights and privileges of others. Defending the rights of a patient, contributing to the making decisions, and being a voice for the patient are all example of being an advocate (Isaacs, 2015). A few examples of how the caregiver is an advocate includes bathing, toileting, eating, dressing, etc. The caregiver is supporting the family member by allowing her to live at home while he takes care of her instead of putting her into an assisted living. The caregiver also performs weekly tasks including, shopping for groceries, cleaning the house/dishes, cooking for the family member, driving the family member to appointments, etc. Caregivers of stroke patients need resources to provide education about strokes, the family member’s needs, and how to care for themselves. Usual resources that are useful include community services and social support groups.
Brochures, guides and online education can be used for education purposes. Counseling, respite, informal, home and hospice care are other resources that can be used for the caregiver. Employee assistance programs can be offered to people who are caregivers (Adelman et al., 2014). The caregiver stated the resources he was using currently were brochures and guides he received from the hospital staff after the family member was discharged. Another resource was social support, where his friends would come over to visit with him and his family member. When his friends would come over he said it would help him feel a bit better, but he still felt isolated and depressed. The new resources that can be referred to the caregiver are support groups for individuals who are caring for stroke patients, the use of counseling, and available respite, home health, or informal care. The online support group I referred came from the American Heart Association webpage. The caregiver was able to search on the website where support groups were located. These services provided a time, date and location where this occurs along with contact information for questions. These support groups were free of charge and were within close proximity to where the caregiver was living. Individuals who are caring for stroke patients come together at night and discuss feelings, experiences, treatment options to prevent the feeling of loneliness (“Support groups,” n.d.). Another resource the caregiver was offered was counseling. The American Heart Association offers Careliving Community, an online network for caregivers caring for stroke family members. The services they provide includes sharing stories, discussing issues, and supporting one another. Online healthcare workers offer advice to caregivers who are struggling with depression and anger. The service is free of charge (“Carelivng community,” n.d.). The last resource referred to the caregiver was respite care. Home Helpers is a care service provided in Utah for caregivers taking care of adults with physical and cognitive impairments. The services they provide include, in-home assistance, short-term stay in an assisted living or nursing home, or adult day services.
Home Helpers provides a phone number for questions or an application to fill out for a free in-home consultation (“Respite care in-home care services,” n.d.). The caregiver responded well to these resources. He stated he would like to research more about these options and use them during his time as a caregiver. As a registered nurse, I am able to advocate for both the caregiver and the family member by allowing the caregiver to relax and take a break. During the interview, the family member asked to be taken to the bathroom wanted a glass of water. Instead of letting the caregiver do it, I advocated for him by performing those tasks myself. After the interview, I visited with the family member for a while as the caregiver ran errands. I educated the caregiver regarding the importance of health and wellness. I encouraged him to schedule time for himself by asking family members or community members to help take care of the family member. Spending time with friends will also improve both his physical and emotional wellbeing. Eating healthy and exercising was the advice I provided to the patient to help prevent him from getting sick. As a nurse, it is important to advocate for both patients and family members. Being a caregiver means supporting and caring for a person who is unable to care for themselves. The son became a caregiver to his mother after she suffered a stroke. Having to take on the responsibility of being a caregiver was a difficult task. The caregiver understood that taking care of his health and wellness would be best for his safety. Also, educating caregivers about the recourses available can help ease the burden. As nurses, we need to learn that it is important to advocate for both the patient and family member because the family member may experience burnout. From this experience, I have gained a new perspective about how important care is for both the patient and caregiver.
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