As a nurse or future nurse, you will interact and engage both with patients and their loved ones. Sometimes that loved one plays a major role in your patient’s well-being, in the form of a caregiver.
Caregivers tend to be the most unrecognized individuals in healthcare. They are sometimes referred to as the “invisible workforce” of care. Taking on this role requires extraordinary personal sacrifice. A family caregiver is responsible for a patient who requires continuous care between office visits and treatments. The caregiver devotes extensive time and effort to assisting, protecting, and nourishing an ill, elderly, or disabled loved one, and they deserve our highest esteem.
Most caregivers—sometimes called “informal caregivers”—are unpaid. With an average age of 70, many caregivers are elders themselves. Most have little, if any, professional training and a strong emotional investment in an ailing, aging, or disabled loved one. These loving, generous people deserve appreciation, but beyond that, they desperately need support.
A caregiver’s physical and mental health has been shown to have concurrent impact on the health of the patient. It is therefore incumbent upon healthcare professionals to be cognizant of the physical and psychological health of their patient’s caregiver.
In this post, we’ll explore how you as a nurse can provide essential support to the informal caregiver. Beyond the partnership you develop, how can you ensure that this individual is receiving the information, guidance, and even emotional support they need to fulfill their important role in their loved one’s health?
The first step in understanding how to support caregivers is to understand their situation, which brings us to…
Beyond the emotional toll of caring for an aging parent or disabled family member, caregivers are subject to physical and psychological strain that can affect their health. Of the many contributing factors to caregiver stress, physical strain is the most prevalent. This is unsurprising since caregivers are often caring for patients with limited mobility, which requires frequent lifting and moving of the patient. Commitment to someone else’s care can significantly impact one’s own lifestyle and health. Common stressors and risks for caregivers include:
- Difficulty sleeping
- Weight fluctuation
- Headaches or body pain
- Irritability or depressed mood
- Alcohol or substance abuse
These risk factors compound with other lifestyle challenges like maintaining a healthy diet, regular physical activity, and a social life. Other common factors that add to caregiver stress include patient behavioral issues, and in many cases, financial hardship. Caregivers may or may not have financial stability or a family support system. It’s a lot to deal with.
While you as a nurse cannot mitigate many of these factors, there are a number of things you can do to support a caregiver so they are equipped to give the best possible care to the patient while finding some life balance and self-care of their own.
As a nurse, your contact with a caregiver may be limited to a single office visit or a repeated touchpoints during ongoing care. Either way, you enter into a partnership of sorts with the individual who is looking after the patient. You are both responsible for the health and well-being of that patient.
You may meet a caregiver while they’re figuring out how to access healthcare services for the patient, during end-of-life decision-making, or at any point in between. In each of these scenarios, the relationship is strongest when there is a consistent flow of information between nurse and caregiver.
In the midst of care, this means actively dispensing any information to the caregiver on each discharge, as well as requesting any updates from them. Creating a communication-rich relationship where a caregiver feels invited to ask questions helps remove the weight of uncertainty and powerlessness. Remember that some people are intimidated by a healthcare environment and may need to be encouraged to communicate freely.
End-of-life decision-making can be very stressful on a caregiver, and they may lean on the patient’s healthcare team for clinical guidance necessary to decide “when it’s time.” This should be appropriately handled with the patient’s primary healthcare provider, but you may be a part of this conversation as well.
During all of these phases of the nurse-caregiver relationship, you should actively and freely encourage the caregiver to pursue support outside of the healthcare facility. There are abundant resources available from which they can benefit, particularly when there isn’t a strong family support system in place. These types of external support may include:
- Informational resources: There are numerous resources available for those who know where to look. The U.S. Department of Health & Human Services lists many helpful organizations and websites, and it’s a great place to start.
- Positive activities: This can be any wellness or self-care activity. Caregivers need to make time for organized exercise, hobbies, or pastimes as simple as quiet reading or a nature walk.
- Social support: Beyond caregiver support groups, which can be found online or locally, caregivers should make time for friends and family, and ask for encouragement and help when they need it.
Many resources are accessible at the local level and should be relatively easy to find through online searches, but you may want to educate yourself on some of the more reputable nearby organizations so you can point a caregiver in the right direction. Remember that you should never endorse a service unless it’s a pre-approved affiliate, but you can provide guidance and a starting point for someone to find the right kind of help.
Many caregivers are thrown into a job they weren’t trained for. They may lack preparation or appropriate expectations for what the work will require. You probably know more than they do about what they need to succeed. A little knowledge can empower a caregiver to care more effectively for their loved one, and also avoid some of the negative personal outcomes that can accompany taking on this role.
When you meet a caregiver, don’t assume they know basic options. If they are struggling, you might offer some education on the following:
- In-home respite care: This is bringing a professional nurse or caregiver into the home temporarily to provide relief to the family caregiver.
- Short-term nursing homes: Some residential care facilities will accept patients for briefer stays, like when a caregiver has a vacation planned or needs a break.
- Adult care centers: Many communities have facilities available where trained professionals can take over care for the day, and the patient also gets a chance to socialize.
Another educational opportunity is speaking with a caregiver about in-home equipment and assistive technology. While the patient may already be using a cane or walker, there are many products available to help with mobility and hygiene. Some are small investments that may make a big difference; others like adjustable hospital beds can be rented and may be covered by insurance or Medicaid. Here are just a few examples of products a caregiver might be unfamiliar with:
- Transfer sling gait belt: This is a strappy device that is designed to help move a patient with limited mobility in and out of bed, and provides a caregiver with a more ergonomic, safe way to transfer their patent.
- Reusable waterproof underpads: For patients with incontinence, there are mattress-protecting pads that can go above or below sheets, are absorbent to prevent wetness and discomfort, and easy to just wash with sheets.
- Toilet risers: Add a riser to the home toilet with or without handles can make bathroom trips easier for both patient and caregiver, and they are a relatively inexpensive retrofit.
There are a host of other products and devices that can help a caregiver streamline and organize home care, from medication timers to reaching tools.
While it’s in your patient’s best interest that you engage with and educate their caregiver, it’s never your job to act as a caregiver’s therapist or absorb any of their responsibilities. It’s important that a caregiver doesn’t come to depend on you, emotionally or otherwise. The National Council of State Boards of Nursing (NCSBN) considers it to be boundary-crossing when a nurse-patient relationship gets confused and the nurse’s needs supersede those of the patient, even momentarily or inadvertently.
Boundary-crossing is also something to look out for in the nurse-caregiver-patient relationship. You’re there to nurse a patient, and if the caregiver’s therapeutic needs are superseding those of the patient, you should reevaluate your boundaries. Setting firm boundaries doesn’t mean you don’t care, and getting too close to a caregiver can create problems for you both.
Protecting professional boundaries requires maintenance and discipline. Nurses are compassionate by both nature and trade, and eager to help someone who is struggling. The blurring of lines can start small. If a caregiver makes a minor personal request, even seemingly in the interest of the patient, it sets a precedent that you are available for off-menu support. Instead of taking on the emotional or physical burden of the caregiver, empower them to pursue the resources they need to stay healthy and energized so they can properly care for the patient.
A good response to an inappropriate ask or interaction with a caregiver is to redirect them to a more appropriate source of aid. If, for example, a caregiver is coming to you to talk about depression or anxiety, you might suggest a support group or therapist. If they are having financial difficulties, you might encourage them to look into any state or federal programs for which they could be eligible.
Don’t be a hero. These kinds of issues are neither your responsibility nor your purview, and they should be left to their respective experts.
Showing Appreciation on National Caregivers Day
Beyond the clinical and educational support you provide your patients’ caregivers, don’t hesitate to voice appreciation and acknowledgement. Remember that in many cases, a caregiver isn’t receiving thanks for their work.
Tell a caregiver how important they are, what a great job they’re doing, and how meaningful their efforts are to the patient. Simply acknowledging someone’s sacrifice and hard work can have an enormous emotional impact.
And remember to wish them a happy National Caregivers Day every third Friday in February!
WCU provides career guidance and assistance but cannot guarantee employment. The views and opinions expressed are those of the individuals and do not necessarily reflect the beliefs or position of the school or of any instructor or student.