Today 40+ million family caregivers in the United States perform home healthcare for their loved ones. The burden on family caregivers has become increasingly heavy over the years, with many taking on complex medical responsibilities.
Nurses are often on the front lines together with family caregivers. They’ve seen firsthand how the role of family caregivers has grown without the proper instruction or support to accompany them. Though done out of love and necessity, informal caregiving can also be dangerous—for example, in the case of medication errors.
Family caregivers also suffer from the stress of daily caregiving without support and task-specific training. Uninformed caregiving can quickly lead to frustration, distress, isolation, and burnout, as well as depression and poor health in the caregiver.
With this context in mind, nurses are uniquely positioned to work together with family caregivers to help them provide informed, safe, and well-supported home care. Let’s go over the critical family caregiver situation today, as well as what nurses can do to better support patients through a robust caregiver-nurse relationship.
The critical family caregiver situation
Family caregivers have often helped with the personal care and social support of their loved one at home. In the past, their job description was limited to helping their loved one perform necessary daily activities, such as bathing, dressing, toileting, eating meals, and staying mobile at home. Caregivers also planned enriching activities, such as walks, games, or social visits, to keep their loved one engaged.
However, half of family caregivers nowadays are performing nursing tasks as well. This may include administering medications and injections, providing wound care, managing colostomies, inserting catheters, giving tube feedings, performing ostomy care, managing incontinence, and more. In other words, caregivers are now responsible for some tasks that registered nurses typically perform.
This new, expanded vision of caretaking has put a lot of stress on caregivers, who often don’t have the same credentials and experience as nurses.
Potential dangers of uninformed family caregiving
The vast majority of family caregivers don’t intend to harm their loved one. But a lack of competence can lead to a risk of patients suffering injury, neglect, or abuse. Some potential dangers of uninformed family caregiving include:
- Accidental injury
- Medication errors
- Risk of neglect or abuse, such as yelling, using physical force, withholding food, manipulating psychologically, etc.
Without the right knowledge and skills, caregivers may not understand how to handle certain medical situations or difficult behaviors. In addition to incompetence or lack of experience, caregivers may not be able to calmly handle scenarios due to frustration or burnout.
These negative reactions can become worse over time, leading to elder abuse. While there are no excuses for neglect or abuse, uninformed family caregivers may be at greater risk of these behaviors.
How to build a robust caregiver-nurse relationship
Nurses can play a key role in supporting family caregivers. Given their extensive experience, nurses can identify potential skill gaps and address lack of caregiver resources. Nurses also have the unique professional perspective to better coordinate care and ensure the patient’s safety during off-hours, especially since they have working relationships with both the patient and caregiver. Here are five essential steps toward building a robust caregiver-nurse relationship for the benefit of the patient.
1. Consider the family caregiver as a “secondary patient”
Caregivers are much more than family members. They’re involved in the 24/7 home care of the patient and often make critical decisions. Their ability to care is essential to the patient’s well-being.
In many ways, this means that the family caregiver is like a “secondary patient” who also needs the nurse’s attention and support. If the caregiver is unable to provide quality care—due to incompetence, burnout, depression, or other reasons—this directly impacts the patient.
By shifting their mindset to include the caregiver as a part of the care plan, nurses may see more positive patient outcomes.
2. Connect the family caregiver with support resources
Family caregivers aren’t usually given the information or resources they need. In fact, when patients are discharged from the hospital, 33% of caregivers don’t receive information about home health. Caregivers often feel alone, unprepared, and confused about next steps.
Nurses can help bridge this gap by providing professional guidance, including information about:
- Community services, such as adult day care, respite programs, and senior transit
- Recommended home healthcare services
- Caregiver support groups
- Caregiver self-care and stress-relief products
- Caregiver apps and online information centers
Often basic guidance like this can help caregivers build a foundation for informed care and feel confident in looking up and using resources.
3. Coordinate caregiver skills training
Information centers aren’t enough for many caregivers who are performing nursing tasks. Sometimes skills training may be necessary to ensure the patient’s safety during care. Skill training can also boost their confidence and allow caregivers to better solve patient problems during the day. This type of training may look different depending on the patient scenario, such as:
- Nurse coordination to identify skill gaps
- Interventions to train on tasks such as medication administration
- 24-hour nurse telephone service
- Clear care protocols in case of emergency
Skills training and nursing support like this can make a huge difference in caregiver ability and confidence. In turn, this can positively influence the caregiver-patient relationship.
4. Provide partnership and psychosocial support
Family caregivers often feel invisible to professional healthcare providers. Nurses can redefine this relationship through simple actions of partnership. When a caregiver feels listened to and respected, it can bring about meaningful change.
Nurses can work to create mutual respect, share key care planning, and work together in the best interests of the patient. Building this relationship of respect also allows the caregiver to feel supported and have a more positive outlook.
As part of this partnership, nurses might also identify caregivers who need extra psychosocial support. Caregiver counseling is a simple but effective way to support caregivers when things get tough.
5. Address family caregiver health
The caregiver burden often leads to poor health, including a higher risk for smoking, drinking, and using prescription drugs. According to studies, caregivers are more likely to feel fatigued, have weaker immune systems, suffer higher blood pressure, and be at risk for certain diseases.
Without a healthy caregiver, the daily task of caregiving can become difficult. Nurses can support their patients by paying attention to caregiver health and suggesting interventions as needed.
Often access to the resources listed above (caregiver self-care, respite care, etc.) can go a long way to improving caregiver health as a whole.
How COVID has impacted caregiver-nurse relationships
The COVID pandemic has made caregiving and nursing even more difficult. During the pandemic, caregivers may have become frustrated by suspended services, isolated from their usual support system, and stressed by financial hardship.
Nurses have also experienced high stress due to the pandemic, especially in clinics and hospitals overwhelmed by patients. These are all valid challenges during COVID that have made seamless caregiving difficult.
In particular, caregivers may feel like they don’t have the same access to medical staff and are limited to telehealth nursing. Nurses can help mitigate this lack of support by focusing on caregiver communication and telehealth care, wherever possible.
With these five steps, nurses can work together with caregivers to get great patient outcomes. By refocusing attention on the caregiver-nurse relationship, healthcare providers can better support caregivers—and patients, too.
Through resources, skills training, and partnership, caregivers can provide informed, safe, and well-supported home care. Now that’s something we can all care about!
Supporting Family Caregivers in Providing Care, NCBI, https://www.ncbi.nlm.nih.gov
Nurses Leading the Way to Better Support Family Caregivers, OJIN, https://ojin.nursingworld.org
Nurses Supporting Family Caregivers, AJN, https://journals.lww.com
Supporting Family Caregivers in the Time of COVID-19, CHCS, https://www.chcs.org
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