Common Caregiver Issues and Nursing Interventions After a Stroke
J. S. Grant, C. W. Hunt, L. Steadman
2014
Stroke
A fter rehabilitation, most stroke survivors return to the community and continue with their daily lives, despite stroke-related functional, cognitive, and behavioral changes. 1 Caregivers are the primary support system for these survivors after discharge and an integral part of the healthcare team that contributes to survivors' rehabilitation and recovery. 2,3 However, caregiving is stressful, and caregivers often experience a variety of interrelated individual, interpersonal, and
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... l issues in managing stroke-related deficits. These issues and potential nursing interventions for addressing them will be discussed in this article. Individual Issues and Nursing Interventions Individual caregiver issues commonly relate to insufficient knowledge and skills to understand and manage stroke survivors' physical, cognitive, emotional, and behavioral problems. 4 Initially, caregivers request information about the stroke diagnosis, prognosis, complications, and predicted recovery. 5 As stroke survivors begin the transition to home care, caregivers require information about assuring their safety, including fall prevention, medications, and prescriptions; adequate nutrition; and management of physical, instrumental, psychological, and behavioral problems. 3 Empirical data support caregivers who also require information and support about how to manage complex feelings and interactions with stroke survivors who experience memory problems, depression, anxiety, frustration, withdrawal, and are argumentative. [6] [7] [8] Empirical literature also indicates that caregivers feel uncertain and unprepared in the caregiving role. 9 Caregivers need open and honest communication about their role and stroke survivors' abilities, 3,10 while also offering hope. Conducting a comprehensive predischarge nursing assessment of caregiver physical and psychological health and social, financial, and spiritual needs initially and during follow-up is essential. 11 This assessment is vital to understand how caregivers' skills, abilities, and resources match stroke survivors' needs for follow-up care better. On the basis of this assessment, nurses should develop a highly individualized case management plan to help caregivers attain skills and services necessary to facilitate success and seamless postdischarge transition. 2 Although nurses provide important information, stroke-and caregiving-related information commonly is not remembered by overwhelmed caregivers. Therefore, basic information should be provided throughout acute and chronic care in both oral and written formats, with frequent reinforcement of specific information in the caregiving trajectory. 12 Caregivers also request that more extensive services be offered during rehabilitation, especially on weekends 13 because competing work and other responsibilities (family, home, and church) make attending rehabilitation therapy difficult during the week. 4 Furthermore, although guidelines exist, some resources suggest there is no consensus about what caregivers need in rehabilitation and the guidelines are not consistently applied in practice. 10 Although caregivers report being invited to observe rehabilitation therapy and care, fewer opportunities may be available to practice these important caregiving skills adequately. 4 Household environments also differ from rehabilitation settings (eg, logistics of bathrooms and hallways), making it difficult to transfer these skills to home settings. These findings suggest that caregivers need tailored nursing interventions that develop and reinforce requisite information and skills (including handling techniques and assisting with activities of daily living), while being attentive to caregiver responses during teaching and allowing time for return demonstration of skills and care. 8,10 More comprehensive services offered on weekends and during all phases of recovery (eg, acute care, rehabilitation, and after rehabilitation) is important. Realistic simulated environments that better mimic caregivers' homes during rehabilitation also may be valuable in transferring skills to the home setting. Multicomponent nursing interventions that provide caregivers skills to cope and manage physical, cognitive, emotional, and behavioral stroke-related problems are essential beginning with initial treatment and continuing throughout stroke recovery. 3 Furthermore, caregivers may question how they will manage caregiving long term and report feelings of physical and emotional strain, being worried about themselves and care recipients, extreme tiredness, and losing self to caregiving. 14 Telephone follow-up by nurses to monitor how caregivers are coping with physical and emotional aspects of caregiving is important. 3 Furthermore, caregivers need suggestions for setting realistic goals to improve their physical (time to exercise, eating a heart healthy diet) and psychological (time alone
doi:10.1161/strokeaha.114.005094
pmid:24947288
fatcat:jkx4dwvz2bhspdhicsc2khzlzu