Risk for caregiver role strain

Domain 7. Role relationship
Class 1. Caregiving roles
Diagnostic Code: 00062
Nanda label: Risk for caregiver role strain
Diagnostic focus: Role strain

Caring for an individual with a chronic illness can be challenging. For example, a person with a long-term disability or terminal illness, may require around the clock care and support. This could lead to caregiver role strain, and create a lot of stress on the caregiver or primary carer. The purpose of this article is to discuss nursing diagnosis risk for caregiver role strain and what preventive steps should be taken to avoid it.

NANDA Nursing Diagnosis Definition

NANDA International defines nursing diagnosis as “a clinical judgment about individual, family, or community responses to actual or potential health problems/ life processes” (nanda.org, 2014). According to NANDA International, caregiver role strain is defined as “a state in which an individual experiences physical, psychological, and social imbalance caused by the conflicting demands of providing care while managing his/her personal or professional activities.”

Risk Factors

There are many factors that can increase the risk of caregiver role strain and these can include:

• Age: Older caregivers may find it more difficult to balance their caregiving responsibilities with their own health and personal needs.
• Family history: Caregivers whose family members have previously faced similar caregiving roles are more likely to be at risk for strain due to their improved understanding of the circumstance.
• Unfamiliarity with medical terms and treatments: Knowing what to do and how to manage care for an individual with chronic illness can be very challenging for someone without in-depth knowledge about the medical terminology and treatment necessary for the care.
• Unrealistic expectations: Having unrealistic expectations from oneself or from the person needing care can increase caregiver role strain.
• Lack of support: If the caregiver lacks emotional, practical and financial help needed to manage responsibilities, then the caregiver becomes vulnerable to role strain.

At Risk Population

• Family caregivers: This includes family members such as parents, spouses, siblings, and adult children who provide unpaid care and support to individuals with chronic illness or disability.
• Professional caregivers: This includes healthcare workers and medical personnel who provide medical care and assistance to patients with chronic illness or disabilities.
• Foster carers: Foster carers commonly provide care and support for children and vulnerable adults in the UK.

Associated Conditions

Caregiver role strain can lead to several physical and emotional ailments. These can include feelings of guilt, decreased self-esteem, sadness, irritability, increased anxiety, depression, exhaustion and poor physical health conditions.

Suggestions for Use

To reduce the risk of caregiver role strain, caregivers should take the following steps.

• Create a plan: Caregivers should draw up a plan to manage routine daily tasks and medical care in order to keep on top of their responsibilities.
• Seek emotional and practical support from family and friends: Reaching out to family and friends for emotional and practical support can relieve stress for the caregiver.
• Set realistic goals: Caregivers should set achievable goals that accomplish what needs to be done. Unrealistic goals will only lead to increased stress.
• Take breaks and have some “me” time: Caregiver exhaustion is common, so it is important to schedule regular breaks and “me” time to rest and relax.
• Make time for leisure activities: Making time for meaningful leisure activities such as attending social events, going on small day trips to places of interest, or simply engaging in hobbies is important. Such activities allow the caregiver to focus on something other than care giving.
• Know when to delegate: If possible, delegate some of the tasks to other family members, friends and professionals. This can scatter the burden, allowing the caregiver more time to relax and take necessary breaks.
• Attend caregiver workshops: Attending caregiver workshops can be beneficial for discovering more information about taking care of a loved one, and allows the caregiver to receive emotional and practical support from those in the same situation.

Suggested Alternative Nursing Diagnoses

The following are alternative nursing diagnoses which could replace ‘caregiver role strain’ depending on the individual’s circumstances:

• Activity intolerance: A reduced ability to perform or complete activities of daily living.
• Ineffective coping: An inability to cope effectively with stressors.
• Social isolation: A feeling of being alone and disconnected from others.
• Pain: An unpleasant sensation or emotional experience caused by injury, disease or dysfunction.
• Acute confusion: A temporary state of disorientation.
• Chronic pain: An ongoing, often long-term, pain experience associated with an illness.

Usage Tips

When trying to assess and measure caregiver role strain, it is important to consider following points:

• How long has the caregiving responsibility been in place?
• What type of care is required? How complex or intensive is the care required?
• Are there adequate supports available in terms of social contact, familial support, respite care, and financial support?
• What is the caregiver’s perception of the role strain?
• Is there evidence that the caregiver is experiencing exhaustion, burnout, change in sleeping habits, or significant weight gain or loss?

NOC Outcomes

The following list outlines the outcomes related to caregiver role strain:

1. Risk Control: The ability to identify and practice appropriate strategies to reduce the likelihood of an accident or illness occurring.
2. Family Coping: The ability of individuals within a family to successfully manage stressful events.
3. Social Interaction: The ability to interact positively with others in order to build and maintain relationships.
4. Individual Resilience: The ability to adapt to and recover from adverse or challenging events.
5. Healthy Coping: The ability to adopt constructive behaviors to manage and cope with stress.

Evaluation Objectives and Criteria

When assessing and measuring the effectiveness of interventions aimed at reducing caregiver role strain, the following objectives and criteria should be considered;

• Objective: Reduce its caregiver role strain for the patient and their family.
• Criteria: Decreased incidence and severity of caregiver role strain indicators, decreased health complications related to the condition, better quality of life for the family, improved social connectedness, and strengthened family resilience.

NIC Interventions

The following list outlines the interventions related to caregiver role strain:

1. Caregiver Support Strategies: Development of coping strategies to support the caregiver, ways to reduce role conflict, and ways to encourage family/carer involvement.
2. Communication Skills Training: Teach the caregiver how to communicate their symptoms and experiences more effectively, how to ask for help, and how to resolve conflicts with others.
3. Education Interventions: Provide resources and education about medical care, management of illness, safe care techniques, symptom management, and palliative care.

Nursing Activities

Activities that a nurse might use to support carers and reduce caregiver role strain include;

• Assessing the needs of the patient, carer, and family
• Encouraging family/carer participation in the care planning process
• Educating the carer on the illness and care regime so they can act independently
• Referring the carer to counseling services
• Referring the carer to support groups and organizations
• Signposting the carer to relevant books, online resources and publications
• Encouraging the carer to take regular breaks from caregiving and participate in leisure activities

Conclusion

Caring for an individual with a long-term illness or disability can be emotionally, physically, and mentally draining. Caregiver role strain can have serious implications for the caregiver, with physical and emotional ailments such as depression, anxiety, guilt, and exhaustion. Therefore, it is important to take the necessary preventive steps and supportive measures to ensure the health and wellbeing of the primary carer.

FAQs

• What is caregiver role strain? Caregiver role strain is a state of physical, psychological and social imbalance caused by the conflicting demands of providing care for an individual with a chronic illness or disability and managing personal or professional activities.
• Who is at risk for caregiver role strain? Family caregivers, professional caregivers, and foster carers are all at risk for caregiver role strain.
• What are the symptoms of caregiver role strain? Common symptoms of caregiver role strain include feelings of guilt, decreased self-esteem, irritability, increased anxiety, depression, exhaustion and poor physical health.
• What steps can caregivers take to reduce the risk of role strain? Caregivers should create a plan, seek support from family and friends, set realistic goals, take breaks and have some “me” time, make time for leisure activities, delegate tasks where possible and attend caregiver workshops.
• What activities can a nurse do to provide support and reduce caregiver strain? A nurse can assess the needs of the patient, carer and family, encourage family/carer participation, educate the carers on the illness and care regime, refer the carers to counseling services, signpost the carers to relevant books, online resources, and publications, and encourage them to take regular breaks from caregiving.