RESULTS AND DISCUSSION
FUTURE IMPLICATIONS IN NURSING RESEARCH
Objective:Caregiver burden is regularly used in nursing literature. However, it has not been yet clearly defined because there are various opinions regarding the concept. This document provides clarity surrounding the concept of caregiver burden and outcomes associated with it.
Research problem:Caregiver burnout can harm the health of the caregiver and has been linked to increased stress, depression, and decline in physical health.
Problem statement: Caregiver burnout is correlated with the profession of nursing and common in caregivers caring for chronically ill family members. Knowing and identifying the signs and symptoms associated with caregiver burden can decrease adverse events for both the caregiver and the patient.
Hypothesis:caregiver burnout is associated with decreased quality of life and adverse outcomes for both the caregiver and the patient. Caregiver burnout can have physical and psychological effects on the caregiver. Appropriate interventions are needed to alleviate the stress and promote a better quality of life for themselves and their patient.
Methods: I did my research from the following databases; CINAHL, MEDLINE, Health Source Nursing, COCHRANE, and Academic Search Complete (ASC) of EBSCO. The paper adopted the framework by Walker and Avant. The antecedents, attributes, consequences, and uses of the concept were identified.
Results:The three attributes of caregiver burden were identified as multifaceted strain, self-perception, and over time. The antecedents included lack of social activities, insufficient financial resources, and multiple responsibility conflict. The consequences of caregiver burden resulted in negative change which includes; a decrease in quality of life, decreased care provision, physical and psychological health deterioration. Generations and Gender Programme (GGP) data from France, Georgia, Bulgaria, Russia, and Romania were researched and depression score is the outcome variable.
Conclusion:A definition of caregiver burden was developed. Tools to measure caregiver burden were identified. The findings from this research can be used in nursing practice, nursing education, research, and administration. Providing parent care is stressful and these stresses are associated with adverse mental health outcomes.
Keywords:Burden. Quality of life. Mental health. Caregivers. Home nursing. Cost of illness. Informal care. Parent care.
Caregiver burnout is caused by too much long-term stress. It happens when the caregiver is overwhelmed and fails to meet constant demands. The interest that led someone to take on an active certain role diminishes as the stress grows. Psychological and emotional health affects physical health. Many caregivers fail to take care of themselves and begin to show caregiver burnout symptoms. Health body, spirit, and mind benefit the caregiver and as well as the loved ones. It is wise for the caregiver to learn the burnout symptoms and seek help when necessary. Such signs are; excessive use of alcohol, or sleeping pills, neglect or rough treatment of the person for whom you’re caring, change in appetite or weight, losing control emotionally or physically, sleeping too much or too little, difficulty concentrating, missing appointments, depression, hopelessness, feelings of alienation, and lack of energy to do new things.
To avoid burnout, become more active, set aside time for yourself, join a caregiver support group, avoid the use of tobacco, share with a professional the challenges faced and how to manage stress, and choose good nutrition. Healthcare organizations have remarkable roles in improving the support structures for caregivers. This will heal the heart and strengthen the mind. Family members play a significant role in care provision to the elderly especially in countries that maintain a strong social-care sector (Haberkern and Szydlik, 2010). This informal care is beneficial to those who receive it and may have wider social benefits by easing the demands on publicly funded services. Caregivers are instrumental in caring for loved ones and family members. They experience burden when doing the work of caregiving. Many interpretations of caregiver burden are found in the literature. There is a hypothesis that, caregiving has negative implications for the well-being of the caregivers themselves. Stresses of providing parental care are related to adverse mental and physiological outcomes. However, some studies suggest that having a parent who has major care needs, while not being an active caregiver may be the cause of stress. These discoveries rest on an expanded model of the consequences of family caregiving. It requires data that allows separate controls for parental care needs and provision of parent care by adult offspring. The Generations and Gender Programme (GGP) survey measures the care related to regular help with personal care like getting up, eating, dressing, bathing, and using toilets among others. These types of care are characterized as burdensome and stressful in practice and public arenas.
The GGP’s Wave One questionnaire for the aforementioned five countries estimates the model of depression, contrasting caregivers and non-caregivers to a group whose parents are alive but without reported care needs. Healthcare is shifting from hospital to community and family due to the aging population that is growing and increasing number of people living with chronic diseases. Family caregivers experience a notable burden when providing care for patients suffering from dementia, terminal cancer, Parkinson's disease, and mental health illnesses. The concept of caregiver is regularly used interchangeably with terms like "stress, problem, and negative effects" (Pinquart and Sorensen 2003) which leads to a lack of apprehension of the concept. This document aims to clarify the caregiver burden concept and mental health outcomes. Walker and Avant's framework guides the document.
Walker and Avant state framework was used to conducting the research. The framework provides a user-friendly guide and a step-by-step approach. It is used regularly in nursing. It covers eight steps which include; selecting the concept, determining the aim of analysis, identifying all the uses of the concept, identifying the defining attributes, constructing a model case, constructing borderline, related and contrary cases, identifying antecedents and consequences, and lastly determining the empirical references. The stress process model distinguishes primary stressors, secondary stressors, mediators, and outcomes like depression, anxiety, and adverse physical health.
The caregiver burden concept is crucial in nursing science and practice. Caregiver burden is like being exposed to a severe and long-term chronic stressor. Globally, there can be huge implications for the healthcare system if there is a lack of awareness around the caregiver burden. The following databases were searched; CINAHL, MEDLINE, Health Source Nursing, Academic Search Complete (ASC) of EBSCO, COCHRANE, Google Scholar, and Health and Medicine (Gale). Keywords were combined in different ways including “caregiver burden”, “carer burden”, “informal caregivers”, and “fatigue, stress, burden, strain or burnout”. Reference lists were manually examined to identify additional literature that could be included
RESULTS AND DISCUSSION
My research addresses two questions: are the findings across the countries comparable? Could prior findings suggest that caregiver burden harms mental health? The answer to the second question is yes. Caregivers whose patient has limitations to undertake everyday activities experience more depression compared to those whose patients do not suffer such limitations. The comparison of the quantitative impact of care provided to a needy parent to that of not giving care to a needy parent produces a significant difference in Georgian women and Bulgarian men. France has a larger per-capita income than the other countries, greater longevity, better health, and larger investment in health and care facilities. It has high levels of non-caregiver stress with no evidence of caregiver stress. The parents of French respondents are much older and hence require more care needs than those of the other four countries. Georgian women exhibit significant levels of non-caregiver stress. Russian men also exhibit significant levels of non-caregiver stress. According to Giarchi (1996), the French think that the family is a central component of eldercare.Similarlevels of care provision were found by Brandit et al. (2009) after using data from the Survey of Health and Aging and Retirement in Europe. They argue that countries that have high levels of health care public expenditures experience "crowding in" for helping tasks but "crowding out" for caregiving.
Caregiver burden can be defined as the strain or load of an individual who cares for disabled, chronically ill, or elderly family members (Stucki and Mulvey 2000). Caregiver burden is linked to the well-being of both the caregiver and the patient, hence it is important to understand the attributes associated with caregiver burden. According to Hoenig and Hamilton (1966), the concept of burden could be divided into an objective and subjective burden. The subjective burden involves the personal feelings of carers developed while caregiving. The objective burden is defined as activities or events associated with negative caring experiences. The burden is the extent to which caregivers perceived their physical health, emotional, social life, financial status as a result of caring for their family member (Zarit, Reever, and Bahc-Peterson 1980, p261). They considered the burden to emanate from a particular, non-objective, explanatory procedure. Collins et al. (1994) state that caregiver burden refers to a sense of hopelessness, physical health issues, psychological pain, impaired family relationships, financial and social strains, and other negative outcomes of care tasks. According to Nijboer et al. (1999), caregiver burden is a multidimensional concept that includes both pessimistic and optimistic aspects of care provision.
The dictionary defines burden as “a duty, responsibility, etc., that causes worry, difficulty or hard work" (p. 196). To date, the literature supports the idea that caregiver burden is a complicated concept due to its multidimensional construction. There is a lack of clarity around the caregiver burden concept and usage of terms like tension, distress, stress, and burnout instead of a burden. Mostly stress is used by researchers in literature to represent caregiver burden. Caregiver stress is considered both objective and subjective. Objective stress mainly considers the care responsibility assumed by the caregiver which is a quantification based on the need of the care recipients. Subjective stress is the cognitive or emotional responses of the caregiver like fatigue, inequality, or the cognizance of the current state of caregiving.
Defining attributes of caregiver burden.The three key attributes of caregiver burden recognized from literature are multifaceted strain, self-perception, and overtime. Self-perception is how the caregiver reflects on personal experience in the process of caregiving. According to Bhattacharjee et al. (2012, p.114), caregiver burden is defined as “the negative or positive feelings and perceptions of the caregiver linked with providing caregiving functions”. The level of perceived burden varies among caregivers in the same nursing context. A study shows that a quarter of caregivers expressed how burden negatively affected their daily life while half of the family carers experienced a high level of burden.
There is an extensive demonstration in the literature of the fact that caregiver burden is multidimensional. Caregivers of patients with end-stage cancer pay limited attention to their health status due to long-term care. They develop health issues like weight loss, sleep disturbances, and fatigue. Psychological and emotional stress are also common among carers. Caregiver burden causes alienation or deteriorates family relationships. Long-term care can disrupt the lifestyle and schedule of the caregiver, thereby limiting social activities and causing the feeling of being socially isolated (Arian, Younesi, and Khanjani 2017). In essence, the caregiver burden is not static. A study by Lee et al. (2018) suggests that the longevity of caregiving, family support, and the illness trajectory significantly affect the level of burden on caregivers. Overall burden levels realized by caregivers changed dynamically over time and having another relative in need of care was significantly correlated with change in caregiver burden. According tostress adaptation theory,caregivers master different nursing skills systematically and gradually adapt to the pressure arising from the caring tasks. The informal caregivers’ burden of breast cancer patients illustrates that external support helps caregivers adapt to changing roles, thereby reducing the burden.
Cases:according to Walker and Avant (2011), the description of cases incorporate the facilitation and in-depth understanding of the concept under study. Borderline cases, model cases, related cases, and contrary cases are the most commonly used cases. The model case illustrates all the defining attributes of the concept and hence it is the best example of using a concept. Following the death of her husband, Mei was diagnosed with Alzheimer’s disease. Her two sons live in another city. Her daughter, Lily, is her primary caregiver and takes care of her daily life. Her two sons can only call once a month to say hello. Lily does cooking, laundry, accompanies her mother on hospital visits, and also manages the medication regime. Lily is preoccupied with her mother and does not participate in activities with her friends. Lily is feeling burdened and stressed(self-perception)which is causing a loss of appetite, insomnia, and irritability (multifaceted strain).Lately, her mother's condition is getting worse and sometimes fails to recognize Lily. Regularly, Mei forgets to take her medicine or turn off the gas. Therefore, Lily leaves her job and cares for her mother full time. Her mother is not safe to be left alone. Lily feels more burdened than before because of insufficient family support and lack of institutions to provide day-to-day care in the community. Recently, she suffered from depression, weight loss, and other health-related problems(over time).This case includes all the attributes of caregiver burden which are highlighted in bold. Lily was well aware of the burden of caring for her mother. Financial pressure occurred when Lily left her job to care for her mother full-time. Lily began to show signs of strain. Lily lacked community or family support. Lily's health deteriorated even more over a while.