Evaluating Caregiver Strain

A caregiver is someone who provides the primary needs of one individual who is unable to provide the care themselves. A large number of caregivers are caring for elderly patients, and this number continues to increase as the elderly population is rapidly growing. It is vital to assess the caregiver strain of these caregivers, as their job is demanding and can negatively impact their health. In the article, “Helping Those Who Help Others: The Modified Caregivera Strain Index”, Onega (2008) identifies strain as, “a combination of stress and burden that has consequences on a caregivers’ overall health” (Onega, 2008, p.63). The Caregiver Strain Index is a tool designed to specifically identify strain of caregivers caring for disables elderly adults.

The index asks 13 questions to assess the caregivers physical, financial, employment, time, and social strains. When the index is administered, each question is asked and the caregiver replies with “Yes, on a regular basis”, “Yes, sometimes”, or “No”. Each of these answers corresponds with a numerical value being either 2, 1, or 0 respectively. The total score is added up, with the highest possible score being 26. The higher the score, the more strain the caregiver has. When the caregiver strain has been identified, a nurse can formulate interventions specific to that individual to help alleviate the strain in each of the targeted areas. I had the opportunity to evaluate the caregiver strain of S.W., a women who cares for her elderly mother, and provide some interventions to help relieve some of her caregiver strain. Background on the Caregiver S.W. S.W. has been caring for her elderly mother for the past 11 months. Her mother has a history of Alzheimer’s, COPD, and asthma. S.W. is a former clinical nurse, so her understanding of her mother’s chronic illnesses is proficient. However, she has a better understanding of the pathology of COPD and asthma rather than Alzheimer’s. She explained to me that her mother has always been very independent, but over the past 5 years, things have deteriorated quickly. S.W.’s father died 7 years ago, and she believes that contributed to the progression of her mother’s chronic illnesses. She explained that her overall health is fair, but her mental capacity has vastly changed. S.W’s family is Caucasian, originally from rule Nebraska on farmland. They identify their culture to be American with traditional values.

Their religion is Christian, and their denomination is Church of Christ. They place their value on family and faith. These factors greatly influence their caregiving because they believe they have a responsibility to care for their family members and to provide them with respect and integrity in their care. I was able to administer the Caregiver Strain Index tool to S.W. on January 28th, and her overall score was 19. This identified that S.W. has significant strain and I identified interventions regarding coping techniques, community resources, and further education over the disease processes would benefit S.W. the most and help alleviate her strain. Evaluating Sub-Scores of Strain and Providing Nursing Interventions The first sub-score The Caregiver Strain Index evaluates is sleep. I asked S.W if her sleep is ever disturbed when caring for her mother, and she replied, “No, she doesn’t roam at night and never wakes me up”. So, I gave a score of 0 for the first sub score. This did not require any nursing interventions. The second sub-score from the index assesses the inconvenience of caregiving. S.W. answered with, “Yes, it is always inconvenient. It takes a lot of time and patience”. The score for this sub-score was 3.

When providing nursing interventions for this sub-score strain, I considered S.W.’s family. She has a husband and a 22-year-old daughter who just graduated college living with her. My first intervention is to have another household family member assume the primary caregiver role for a few hours each day to give S.W. a time off. Another intervention is to make a schedule for daily activities to ensure that vital actions, such as medication administration and bathing, take place in a timely manner each day. This organization can help with daily stress because S.W. will have a schedule to follow. A third intervention I provided is to incorporate some specific Alzheimer’s care techniques into S.W.’s household to help her mother maneuver and improve independence.

These care techniques can include labeling drawers in large letters and minimizing hazards in the household. The third sub-score addresses if caregiving was a physical strain. Since her mother is still physically able to stand, walk, and follow commands so S.W. said she did not consider caregiving to be a physical strain. No nursing interventions were required for this sub-score of 0. For the fourth sub-score of the index, I asked S.W. if caregiving was confining. She definitely said caregiving is confining and illustrated an example that she cannot even go to the grocery store in peace. This gave S.W. a sub-score of 2. Nursing interventions I created centered around focusing on S.W.’s self-care. I encourage her to practice self-care, such as ensuring she eats healthy meals and taking time to do fun things for herself. I also encourage her to identify her support team, and not be afraid to lean on them. Lastly, a more structured form of self-care would be forming an organized schedule of doctors appointments and health care records to relieve the stress of not knowing what’s coming next. The fifth sub-score addresses family adjustments. S.W. confirmed there is a continual family adjustment with incorporating her mother into her families daily life. Her sub-score for this section is 2. The interventions I created centered around communication and openness.

The first intervention is to facilitate a family discussion between the members of the family that live in the house; this conversation would be focused on explaining their frustrations and opening a conversation on how to overcome their frustrations. The second intervention would be finding a family counselor for the family to see, so they can talk through their feelings with a professional. North Texas Christian Counseling provides family counseling that aligns with S.W’s family values (North Texas Christian Counseling). The last intervention for helping family adjustments is helping the family form new routines and establish new boundaries regarding the role S.W. has. The other family members can help alleviate some of S.W.’s caregiver strain by helping with household activities S.W. usually does, such as laundry. The sixth sub-score addresses changes in personal plans, and S.W said she has to change plans often in order to care for her mother. She gave me an example that she was supposed to go visit her son at college during his fall break, but she was unable to because she had to stay home to care for her mom.

The gave her another score of 2. My nursing intervention for this is to provide coping techniques such as allowing herself to express her frustrations and not feel guilty about feeling this way. Another intervention is to encourage S.W. to stay flexible and understanding of the situation and to allow herself to look at the bigger picture. The last nursing intervention is to facilitate other extended family members to help take care of the mother whenever S.W. and her family want to go out of town. S.W. has two sisters and one brother that she said she could ask for help more often. The seventh sub-score assesses if caregiving has placed other demands on S.W.’s time. She said she feels like there is always other demands on her time, with other family members calling to check on her mother, her own family members wanting attention from her, and her inability to get her errands done because she is caring for her mother. Her sub-score for this section is 2. The nursing interventions center around community resources. After researching, I found Encore Memory Care Center, a place near S.W.’s house that provides resources to families caring for elderly adults with Dementia and Alzheimer’s. This can provide care for S.W.’s mother during the day, and this location is equipped with medical staff and personal care activities (Services Overview, Encore Memory Care).

The second intervention is to discuss these time demands with members of the family and develop ways to help with scheduling. The last intervention is to develop times each week for S.W.’s mother to call extended family members so S.W. can know when the calls are coming and provide better communication to extended family members. The eighth sub-score addresses emotional adjustments. When asked if this has been an emotional adjustment when caring for her mom, S.W. said “100% yes”, so her sub-score is 2. The first intervention I created for S.W. was to allow herself to set a little time aside each day for herself. This allows her to have time to cope and process and practice self-care. The next intervention is finding a support group with individuals dealing with the same caregiver strains. Alzheimer’s Association has a support group that meets at a church near S.W.’s house that could provide S.W. and her family with a community (Alzheimer’s Support Group, FBC Lewisville). A third intervention to deal with emotional adjustments is practicing stress relieving methods, such as deep breathing techniques. The ninth question in the index addresses the behavior of the individual. When I asked if the behavior of her mother is upsetting, S.W. immediately said yes. Her sub-score is a 2. My first nursing intervention ties into the intervention listed above, the Alzheimer’s caregiver support group (Alzheimer’s Support Group, FBC Lewisville).

The emotional support from this group can provide comfort to S.W. because these individuals know exactly what she is going through and can relate to her experiences. The second intervention is providing education on Alzheimer’s disease process. Even through S.W. has some understanding of the disease, it will benefit her to learn more about the disease process to cope with the behavior changes. The Alzheimer’s Association website has excellent educational materials that help individuals understand the disease. The last intervention is to provide coping techniques, such as exercising, to help S.W. deal with upsetting behaviors. The tenth sub-score addresses the upsetting changes in the person the caregiver cares for. I asked S.W. if it was upsetting to see that her mother has changed from her former self. S.W. said definitely. She said, “Yes, that woman is not the woman I remember as my mother”. Her sub-score is a 2. My nursing interventions centered around validating S.W.’s feelings and encouraging her to realize this disease is tough to deal with, but she has support. The first intervention is encouraging S.W. to express her feelings and talk to her support group. The second intervention is to reinforce the education on Alzheimer’s disease process, as this shows that the changed personality is all from the disease. The third intervention is to encourage S.W. to love her mom as she is now, and to enjoy the time she has with her. The eleventh sub-score evaluates how the caregiver has strain regarding their employment. S.W. confirmed there have been work adjustments, and this makes her sub-score a 2. S.W. works from home, so my nursing interventions center around balancing work and care. My first intervention is to develop a schedule to provide care during work breaks. The second intervention is to make sure S.W. is using technologies, such mute and speakerphone, to be able to care for her mother while she is working (for example, listening to a conference call while making lunch for her mother).

The last intervention is to establish an office space that S.W. can find privacy and boundaries for more serious work matters. The twelfth sub-score addresses the financial strain of caregiving. When I asked S.W. about the financial situation, she said money has not been a problem because her mother has savings and excellent insurance. So her sub-score is 0, and no nursing interventions are required. The final thirteenth sub-score addresses the overall strain of caregiving. S.W. said she frequently feels completely overwhelmed while caregiving. The first nursing intervention I created was to listen and allow S.W. to share her feelings. The second nursing intervention is to provide comfort and reassurance to her. My goal is to encourage S.W. to have pride in her caregiving, as it is not an easy job.

My final nursing intervention is to encourage S.W. to stay positive and continue to utilize their support system. Conclusion Overall, caregiver strain needs to be evaluated in individuals caring for elders with chronic illnesses because caregiver strain can lead to fatigue, depression, and other physical health problems (Onega, 2008). Using the specifically designed tool, the Modified Caregiver Index, it is simple to identify caregiver strain. Then, once strain is identified, a nurse can develop individualized interventions to help with the strain. The nurse must consider the culture, background, and religion of the family in order to develop effective interventions. Through my interview utilizing the Modified Caregiver Index, the results displayed that S.W. has significant caregiver strain at 19 points. Through my provided nursing interventions, my goal is to alleviate her strain. These interventions focus on coping techniques, community and support resources, and education. I took the family’s culture and religion into consideration when choosing community resources, and I believe this will make my interventions more effective. I believe these interventions can help S.W.’s stress level and overall caregiver strain.