Susceptible to difficulty in fulfilling care responsibilities, expectations, and/or behaviors for family or significant others, which may compromise health

Pathophysiologic

Related to unrelenting or complex care requirements secondary to:

Addiction

Chronic mental illness

Cognitive problems

Debilitating conditions (acute, progressive)

Disability

Progressive dementia

Unpredictability of illness course

Situational (Personal, Environmental) NANDA-I

Caregiver Factors

Related to:

Competing role commitments

Depressive symptoms

Inadequate fulfillment of others' expectations

Inadequate fulfillment of self-expectations

Inadequate knowledge about community resources

Inadequate psychological resilience

Inadequate recreation

Ineffective coping strategies

Inexperience with caregiving

Insufficient physical endurance

Insufficient privacy

Not developmentally ready for caregiver role

Physical conditions

Stressors

Substance misuse

Unrealistic self-expectations

Unstable health status

Care Receiver Factors

Related to:

Discharged home with significant needs

Increased care needs

Loss of independence

Problematic behavior

Substance misuse

Unpredictability of illness trajectory

Unstable health condition

Caregiver-Care Receiver Relationship

Related to:

Abusive interpersonal relations

Codependency

Inadequate interpersonal relations

Unaddressed abuse

Unrealistic care receiver expectations

Violent interpersonal relations

Caregiving Activities

Related to:

Altered nature of care activities

Around-the-clock care responsibilities

Complexity of care activities

Excessive caregiving activities

Extended duration of caregiving required

Inadequate assistance

Inadequate equipment for providing care

Inadequate physical environment for providing care

Inadequate respite for caregiver

Insufficient time

Unpredictability of care situation

Family Processes

Related to:

Family isolation

Ineffective family adaptation

Pattern of family dysfunction

Pattern of family dysfunction prior to the caregiving situation

Pattern of ineffective family coping

Socioeconomic

Difficulty accessing assistance

Difficulty accessing community resources

Difficulty accessing support

Inadequate community resources

Inadequate social support

Inadequate transportation

Social alienation

Social Isolation

Care receiver with developmental disabilities

Care receiver's condition inhibits conversation

Caregiver delivering care to partner

Caregiver with developmental disabilities

Female caregiver

Individuals delivering care to infants born prematurely

Individuals experiencing financial crisis

Caregiver Factors

Impaired health status

Psychological disorder

Care Receiver Factors

Chronic disease

Cognitive dysfunction

Congenital disorders

Illness severity

Mental disorders

AUTHOR'S NOTE

Refer to Caregiver Role Strain.

Assess for Related Factors

History of Relationship with Caregiver

Problematic behaviors (*Pearlin et al., 1990)

Wanders, threatens

Uses foul language

Incontinence

Suspicious

Sexually inappropriate

Cries easily

Repeats questions and requests

Clings

Depressed

Insomnia

Substance abuse

Who is in your support system? (family, friends, clergy, agency, group)

What? (visits, respite, chores, empathy)

How often? What have you lost because of your caregiver responsibilities?

The caregiver will report a plan to decrease the caregiver's burden:

• Share frustrations regarding caregiving responsibilities.
• Identify one source of support.
• Identify 2 changes that would improve daily life if implemented.

The family will establish a plan for weekly support or help.

• Relate 2 strategies to increase support.
• Convey empathy to caregiver regarding daily responsibilities.

The individual will relate a plan for how to continue social activities despite caregiving responsibilities.

• Identify activities that are important for self.
• Relate intent to enlist the help of at least 2 people weekly.

Level 2 Extended Interventions (all settings)

Explore with the Caregivers the History and Quality of Their Relationship with Their Family Members and How They Feel About Being a Caregiver (Smith & Segal, 2015)

• Anxiety about their ability, fears related to the future
• Anger toward the person and other family members about not receiving help with daily responsibilities.
• Guilt for not doing more, not being a "better" caregiver or having more patience, or in the case of long-distance caregiving, not being available more often.
• Grief for the "many losses that can come with caregiving (the healthy future you envisioned with your spouse or child; the goals and dreams you've had to set aside)."
  • In addition, if your loved one is terminally ill, grieving is present.

Explain the Risk Factors for Caregiver Role Strain

Refer to Related Factors for Caregiver Role Strain.

Teach Caregiver and Significant Others to Be Alert for Danger Signals (*Murray, Zentner, & Yakimo, 2009)

• No matter what you do, it is never enough.
• You believe you are the only individual in the world doing this.
• You have no time or place to be alone for a brief respite.
• Family relationships are breaking down because of the caregiving pressures.
• Your caregiving duties are interfering with your work and social life.
• You are in a "no-win situation" and will not admit difficulty.
• You are alone because you have alienated everyone who could help.
• You are overeating, undereating, abusing drugs or alcohol, or being harsh and abusive with others.
• There are no more happy times. Love and care have given way to exhaustion and resentment.
• You no longer feel good about yourself or take pride in what you are doing.

R: "Quality of life is affected by 4 major characteristics of a caregiving situation: (1) high caregiving demands, (2) loss of physical health for the caregiver, (3) psychological distress, and (4) interference with life roles" (Yarbro, Wujcik, & Gobel, 2018). Danger signals must be addressed to preserve health and relationships and to prevent abuse.

Explain the 4 Types of Social Support to All Involved:

• Emotional (e.g., concern, trust)
• Appraisal (e.g., affirms self-worth)
• Informational (e.g., useful advice, information for problem-solving)
• Instrumental assistance (e.g., caregiving) or tangible assistance (e.g., money, help with chores)

R:Identifying the various sources of social support can help the caregiver with coping.

Stress the Importance of Daily Health Promotion Activities

• Rest-exercise balance
• Effective stress management
• Low-fat, high-complex-carbohydrate diet
• Supportive social networks
• Appropriate screening practices for age
• Maintain a good sense of humor; associate with others who laugh.
• Advise caregivers to initiate phone contacts or visits with friends or relatives rather than waiting for others to do it.

R:Caregivers must maintain their own health in order to be successful with coping with caregiving responsibilities.

Initiate Health Teaching and Referrals, if Indicated

Refer to Caregiver Role Strain.