Overwhelming multidimensional strain when caring for a significant other

• Difficulty accessing community resources
• Difficulty accessing support
• Difficulty navigating complex health care systems
• Difficulty prioritizing competing role commitments
• Impaired family process
• Impaired resilience
• Inadequate equipment for providing care
• Inadequate knowledge about community resources
• Inadequate physical environment for providing care
• Inadequate privacy
• Inadequate use of prescribed medication
• Ineffective use of coping strategies
• Unaddressed abuse from care receiver

• Mental disorders

• Caregiver's age, sex, level of education, occupation, and marital status
• Caregiver's physical and mental status, including chronic health problems, self-care abilities, mobility limitations, and level of cognitive function
• Care recipient's physical and mental status, including illness, self-care limitations, mobility limitations, and level of cognitive function
• Patient's physical and mental status, including history of psychiatric illness, self-care limitations, and level of cognitive function
• Support systems, including financial resources, family members and friends, community services, health-related services such as geriatric day care, and home health aides
• Home environment, including layout, structural barriers, need for equipment or assistive devices, and availability of transportation
• Cultural, ethnic, and religious background
• Perceived and actual obligations of caregiver
• Caregiver's personal strengths, including coping and problem-solving abilities and participation in diversional activities or hobbies
• Family roles, coping patterns, family alliances, goals, and values

• Caregiver will fulfill role responsibilities/activities/behaviors to best of ability.
• Caregiver will describe current stressors.
• Caregiver will discuss how patient's illness has altered established roles and responsibilities within family.
• Caregiver will identify which stressors can and can't be controlled.
• Caregiver will refrain from using destructive coping mechanisms, such as substance abuse and physical or mental abuse of care recipient.
• Caregiver will identify formal and informal sources of support.
• Caregiver will show evidence of using support systems.
• Caregiver will report increased ability to cope with stress.

Suggested NOC Outcomes

• Help caregiver to identify current stressors in order to evaluate the causes of role strain.
• Assist caregiver to clarify needs, set individual goals, and develop plans to meet them. This will instill in each person a sense of empowerment and control over life.
• Using a nonjudgmental approach, help caregiver evaluate which stressors are controllable and which aren't to begin to develop strategies to reduce stress.
• Encourage caregiver to discuss coping skills used to overcome similar stressful situations in the past to build confidence for managing the current situation.
• Encourage caregiver to participate in a support group. Provide information on organizations such as Alzheimer's Association, Children of Aging Parents, Al-Anon, the referral service of the community AIDS task force, etc., to foster mutual support and provide an opportunity for caregiver to discuss personal feelings with empathetic listeners.
• Encourage discussion among family members about role changes and added responsibilities that have occurred as a result of the patient's health status to establish open and honest communication among family members.
• Encourage discussion of family's past experience with crises, comparing them with the present situation to help family see they have survived difficulties together and encourage them to seek viable solutions.
• Encourage family members to retain involvement with social and religious networks to avoid feelings of isolation and abandonment.
• Help caregiver identify informal sources of support, such as family members, friends, church groups, and community volunteers, to provide resources for obtaining an occasional or regularly scheduled respite.
• Help caregiver identify available formal support services, such as home health agencies, municipal or county social services, hospital social workers, physicians, clinics, and day care centers, to enhance coping by providing a reliable structure for support.
• If caregiver seems overly anxious or distraught, gently point out facts about care recipient's mental and physical condition. Many times, especially when care recipient is a family member, caregiver's perspective is clouded by a long history of emotional involvement. Your input may help caregiver view the situation more objectively.
• If you believe that excessive emotional involvement is hindering caregiver's ability to function, consider recommending Codependents Anonymous, a support group for people whose preoccupation with a relationship leads to chronic suffering and diminished effectiveness, to provide support.
• Refer family to appropriate professional services to ensure their needs are being met. Caregiver support groups may provide the family with helpful strategies that have worked for others facing the same problems.

Suggested NIC Interventions

• Caregiver identifies and develops a realistic appraisal of each stressful situation.
• Caregiver adjusts to changes in roles and responsibilities.
• Caregiver doesn't exhibit signs of stress.
• Caregiver uses community resources, as needed.
• Caregiver describes emotional response to each stressful situation.
• Caregiver identifies sources of support.
• Caregiver uses available support systems.
• Caregiver uses appropriate coping skills for each stressful situation.
• Caregiver attends support groups or seeks other forms of professional assistance.

• Stressors (perceived and actual) identified by caregiver
• Role adjustment and flexibility of family members
• Coping patterns
• Observations of caregiver's response to stressful situations
• Referrals provided
• Caregiver's use of informal and formal support systems
• Coping strategies identified by caregiver and nurse
• Evidence of improvement in caregiver's ability to cope
• Response to nursing interventions
• Evaluations for expected outcomes

• Besser, L. M., & Galvin, J. E. (2018). Perceived burden among caregivers of patients with frontotemporal degeneration in the United States. International Psychogeriatrics. doi:10.1017/S104161021800159X
• Kajiwara, K., Noto, H., & Yamanaka, M. (2018). Changes in caregiving appraisal among family caregivers of persons with dementia: A longitudinal study over 12 months. Psychogeriatrics, 18(6), 460-467. doi:10.1111/psyg.12360
• Leonidou, C., & Giannousi, Z. (2018). Experiences of caregivers of patients with metastatic cancer: What can we learn from them to better support them? European Journal of Oncology Nursing, 32, 25-32. doi:10.1016/j.ejon.2017.11.002
• Liu, H., Yang, C., Wang, Y., Hsu, W., Huang, T., Lin, Y., … Shyu, Y. L. (2017). Balancing competing needs mediates the association of caregiving demand with caregiver role strain and depressive symptoms of dementia caregivers: A cross-sectional study. Journal of Advanced Nursing, 73(12), 2962-2972. doi:10.1111/jan.13379