Susceptible to 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, gender, and general health
• 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
• Family status, including role performance and perception of role within family
• Support systems, including financial resources, family members and friends, community services, and 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 usual coping and problem-solving abilities and participation in diversional activities or hobbies

• Caregiver will report reduced stress related to caregiver duties.
• Caregiver will identify current stressors.
• Caregiver will realistically describe current obligations and challenges that lie ahead.
• Caregiver will distinguish obligations that must be fulfilled from those that can be controlled or limited.
• Caregiver will identify appropriate coping strategies and will state plans to incorporate strategies into daily routine.
• Caregiver will state intention to contact formal and informal sources of support.
• Caregiver will contact sources of support to help provide care.
• Caregiver will allot time each day for respite, recreation, and personal developmental activities.
• Caregiver will report satisfaction with ability to cope with stress caused by caregiving responsibilities.

Suggested NOC Outcomes

• Help caregiver identify current stressors. Ask whether stress is likely to increase or decrease in the future to evaluate the risk of caregiver role strain.
• Encourage caregiver to discuss coping skills used to overcome similar stressful situations in the past to bolster caregiver's confidence in ability to manage current situation and explore ways to apply coping strategies before caregiver becomes overwhelmed.
• Help caregiver identify informal sources of support, such as family members, friends, church groups, and community volunteers, to plan for 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 help lessen risk of strain on caregiver.
• Encourage caregiver to discuss hobbies or diversional activities. Incorporating enjoyable activities into the daily or weekly schedule will discipline caregiver to take needed breaks from caregiving responsibilities and thereby diminish stress.
• Encourage caregiver to participate in a support group. Provide information on organizations such as Alzheimer's Association, Children of Aging Parents, Al-Anon, or the referral service of the community task force for AIDS, etc., to foster mutual support and provide an outlet for expressing feelings before frustration becomes overwhelming.
• 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.

Suggested NIC Interventions

• Caregiver identifies and develops a realistic appraisal of each stressful situation.
• Caregiver describes coping strategies used in stressful situations.
• Caregiver develops realistic assessment of situation.
• Caregiver distinguishes obligations that must be fulfilled from those the caregiver can control or limit.
• Caregiver identifies and uses adaptive coping strategies.
• Caregiver uses available support systems.
• Caregiver incorporates recreational activities into daily routine.
• Caregiver reports satisfaction in coping with stress.

• Current stressors identified by caregiver
• Risk factors (developmental, physiologic, psychological, and situational) for caregiver role strain identified by nurse
• Caregiver's statements indicating intention to take action to minimize stress, such as seeking help from support services, participating in a caregiver support group, and scheduling time for recreational activities
• Coping strategies identified by caregiver and nurse
• Observations of caregiver's response to stressful situations
• Referrals provided
• Evaluations for expected outcomes

• Ariza-Vega, P., Ortiz-Piña, M., Kristensen, M. T., Castellote-Caballero, Y., & Jiménez-Moleón, J. J. (2019). High perceived caregiver burden for relatives of patients following hip fracture surgery. Disability & Rehabilitation, 41(3), 311-318. doi:10.1080/09638288.2017.1390612
• 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
• Paúl, C., Teixeira, L., Duarte, N., Pires, C. L., & Ribeiro, O. (2019). Effects of a community intervention program for dementia on mental health: The importance of secondary caregivers in promoting positive aspects and reducing strain. Community Mental Health Journal, 55(2), 296-303. doi:10.1007/s10597-018-0345-6
• Wang, T., & Anderson, J. A. (2018). Predicting caregiver strain to improve supports for the caregivers of children with emotional and behavioral disorders. Journal of Family Issues, 39(4), 896-916. doi:10.1177/0192513X16683986