Assessing and Supporting
Family Caregivers
Family Focus
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Each family is unique.
Nurses must be aware and
sensitive to the varied
communication styles and
characteristics of families.
What are some of the
characteristics of your family
that would be helpful for a
nurse to know?
Family Caregiving Scenario
Mrs. Sather, age 75, has lived in her own home
for 25 years. She has three adult children, two
daughters and a son, who provide assistance
with transportation, bathing, and medication
management.They have been doing this
successfully together for the past 3 years.
To date, Mrs. Sather’s children have felt able to
handle most situations and were able to obtain
the resources needed to continue to manage
their own lives and help their mother.
Caregiver Competence
Definition:
The competence and
skill of the caregiver(s)
and the family in
providing care to a family
member or loved one.
Research shows:
Assessment: From the scenario, would you
assess the caregiver competence of Mrs.
Sather’s family as high or low?
Higher level of skill in providing care for a family member is
associated with lower caregiver role strain.
The Scenario: Relationships
Mrs. Sather’s older daughter has had a close
relationship with her mother. They both enjoy
knitting and listening to big band music
together.
The other two children enjoy playing card games,
especially canasta, with their mother. Mrs.
Sather looks forward to their frequent visits.
Relationships and Rewards
Definition:
Interactions between
the caregiver and the
care recipient based
on love, shared
activities, and shared
values.
Research shows:
Assessment: From the scenario, what
is your assessment of relationships and
rewards?
A higher quality relationship between a caregiver and a care recipient
is associated with lower caregiver strain.
The Scenario: Role Strain
The older daughter feels that, despite some help from her
brother and sister, most of the burden of organizing her
mother’s care falls to her. She has gladly accepted this
responsibility in the past.
However, she now has two children in college and two
teenagers at home. As a result, she has had to go to
full-time status at work. Her stress level continues to
increase and she is beginning to resent her mother’s
needs.
What is Caregiver Role Strain?
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Caregiver role strain is defined as
the felt difficulties in performing the
caregiver role.
Caregiver role strain can come from:
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Providing direct care
Tension and worry
Economic burden
Communication problems
Lack of support or resources
In the scenario, what factors are contributing to role strain?
How Nurses can Support
Family Caregivers
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Be family focused.
Provide systematic
assessment.
Individualize family strategies.
Help the family recognize
health problems and
problematic transitions early.
Work together with the
caregiver to blend family and
nursing knowledge.
Systematic Assessment
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Help identify family strengths and family care issues
by:
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Listening to the family caregiver and care recipient.
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Asking the family caregiver what his/her concerns are.
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Sharing nursing knowledge and skill in building the caregiver’s
competence in caregiving.
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Supporting the family in enjoyable activities or discovering new ways
of relationship building.
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Providing information and support through caregiving transitions.
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Encouraging the caregiver to take care of his/her own health.
Individualized Family Strategies
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Strategies should be
individualized with
consideration of:
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Family Strategies do not
come in “one size fits all”.
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Family preferences.
What family has tried or not
tried before.
Educational level.
Culture and ethnicity.
Health care provider or health
care system support.
Identifying Health Problems and
Problematic Transitions Early
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Transitions can occur for
many reasons:
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Changes in health condition of
care recipient or caregiver
Relocation
Death
Family relationships
Change in health care system
or provider
Nursing support of the family during transitions may need
to be redefined to meet the family’s changing needs.
Caregiving Scenario: Transition
One day, when Mrs. Sather was home alone, she had a
severe CVA. Suddenly, she needed total care.
Her three children now had new concerns, each from
his/her own perspective. The situation was changing
rapidly. The patterns of support that they had
established for their mother were no longer
adequate. Even their communication patterns were
disrupted, due to Mrs. Sather’s aphasia.
Predictability and Stability
Definition: The perception
by the caregiver of regularity
and consistency in the family
care situation, especially
through times of transition.
Research shows:
Assessment: From the scenario,
would you assess the predictability
and stability as high or low at
present?
Higher levels of predictability in unstable family care situations are
associated with lower caregiver role strain.
Systematic Assessment of Family
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Important features of the care situation in the scenario:
 Care recipient could no longer speak for herself.
 Discharge was dependent on provision of 24-hour care.
 Family members had different educational levels and learning
styles.
 Conflict existed between two family members.
 Financial concerns existed in the family about cost of care.
 Family was grieving and upset by Mrs. Sather’s serious condition.
Working Together to Blend Family
and Nursing Knowledge
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Working on family care concerns is
facilitated by families and nurses
listening to each other and putting their
knowledge and skill together to:
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define what the caregiving issues are.
generate strategies that can be tried to
improve or solve issues of concern.
Caregiving Scenario: Support Need
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Mrs. Sather’s three adult children identified that the
support they needed was:
More information about Mrs. Sather’s health
condition and her long-term prognosis.
 Ideas on how they might care for her once she
came home from the hospital. They were unsure
if they could, because their mother now required
total care.
 To know if resources were available to help
them care for her, as they all worked full-time.
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This family was supported through
these individualized strategies:
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Educational materials about stroke were provided.
These included written materials and a video tape,
which accommodated their different learning styles.
A family care conference was scheduled at the
hospital. It was facilitated by a MSW, so entire family
could ask questions and discuss individual concerns.
Family members were encouraged to prepare
questions for the physician and different members of
the health care team.
Resource materials about long-term care options, inhome care, and cost were provided.
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These family-focused nursing interventions
helped this family to devise ways to be
involved in the caregiving of Mrs. Sather and
establish resources that would support them
in the future.
Family Assessment and Support
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Goals:
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Increase family and caregiver competency in
providing care.
Strengthen relationships and the rewards of
caregiver.
Increase predictability and stability in family
care situations.
Research Cited:
Archbold, P.G., Stewart, B.J., Greenlick, M.R., et al. (1990). Mutuality and
preparedness as predictors of caregiver role strain. Research in
Nursing and Health, 13, 375-384.
Archbold, P.G., Stewart, B.J., Miller, L.L., et al. (1995). The PREP system
of nursing interventions: A pilot test with families caring for older
members. Research in Nursing and Health, 18, 3-16.
Assessing and Supporting Family
Caregivers was prepared by Carla Hagen,
M.P.H., R.N. for the Older Adult Focus
Project, OHSU School of Nursing.