Caregiving Responsibilities of People with Mental Illnesses

Small et al. (2010) lament that the mentally ill are frequently overprotected. Informal family caregivers provide excessive care. There is a lack of awareness about what informal carers are meant to do to assist patients. As a result, they spend far too much on persons suffering from mental illnesses, to the point that caregiving has become a burden. According to Scazufca (2012), the informal care load is more expensive because it delays mental health recovery and raises medical costs. Furthermore, overprotecting the mentally ill instills in them the belief that they are too unwell to be left alone, which influences their behavior (Andrén and Elmsthl, 2007). Informal caregivers believe in always been there for the mentally ill. They tend to think that their physical presence and helping the mentally ill in their duties is in the best interest of the patients. Hence, they are always busy shopping of the mentally ill, cooking for them, cleaning their effects, and ensuring that the ill are never alone in the house (Small et al., 2010). Humanly, no one can give this kind of care for long without getting tired. After a while, the informal family caregivers develop a feeling that the mentally ill is a burden. In addition, they caregivers get tired performing the perceived care. Thus, they do not offer care because they are willing but because they have to. Care giving becomes a burden for the informal caregivers.

According to Awad and Voruganti (2008), informal family care burden delays the process of recovery for the people living with mental illnesses. They sick feel that their condition is so critical that they cannot be left alone. The feeling that the patient does not have so much time left exerts pressure on their body and brains, which increases the severity of their symptoms (Campbell et al., 2008). Therefore, informal caregivers are actually breaking the wellbeing of the people living with mental illnesses than building it.

This essay will focus on how psychotherapy can be used to help the informal family caregivers understand the simplicity of what is needed of them. The nurse practitioner should counsel family caregivers and the patients of the most appropriate behavior to aid the recovery process. Thus, psychotherapy will counter the problem of care burden in healthcare.

Significance of the Problem

I am choosing to study this topic because I have seen most of the family caregivers to the people living with mental illnesses in my community tired and give up on care giving. Initially the family caregivers seemed passionate and were always there for the mentally ill. However, they got tired with time and care giving became a burden. The parents started delegating care giving to their children and nannies. When they could not take it any longer, some of the patients were neglected, and suffered in stigmatization.

Addressing the care burden of the informal caregivers of the people living with mental illnesses is of great importance for both the caregivers and the patient. It helps the informal caregivers understand the simplicity of the care they are supposed to provide, which relieves the caregivers the burden of care giving (Small et al., 2010). In addition, addressing the problem of care burden promotes the recovery of the patient (Awad and Voruganti, 2008).

Assessing the care burden on the informal family caregivers will help them understand that they are supposed to empower the patient in the recovery process rather than doing everything for him or her, and being physically there for the patient. Again, assessing the care burden will result to more stable health conditions, where the cases of relapsing and hospitalization are minimal. Furthermore, assessing the care burden will reduce the possibilities of caregivers developing mental illnesses, as they will be relieved a great portion of stress (Scazufca, 2012).

In addition, addressing the problem of care burden will add to the field of knowledge, in that it will establish effective care interventions that can be adopted to ease the work of informal caregivers. The results obtained in this work will equip the nurse practitioners with relevant skills of the therapeutic activities; they will be able to counsel the informal caregivers on what is needed.

Current Interventions to Care Burden

Often, informal caregivers delegate their roles to their children when they can take them no more (Small et al., 2010). When the children get tired with caring for the ill family members, the parents opt for a nanny to take up the responsibility. When the nanny is tired and quits, the family opts for another nanny. Therefore, the burden of care is never solved. There is no tangible approach to enhance the quality of care especially if the family members think that an illness is incurable.

Only a small proportion of caregivers are aware of the simplicity of care giving. The rest think that physical presence and doing all the duties for the mentally ill is helping the patient. For the informal caregivers that apply the skills advised in psychotherapies, the care burden is lighter and they enjoy taking care of the patient (Andrén and Elmståhl, 2007). Again, the patients’ wellbeing is promoted.

Impacts of Care Burden

The care burden is mostly felt by the informal family caregivers and the impacts are sour to the patient. The care burden adversely affects the patient’s and the family’s cultural background; the family’s values, preferences, and health behavior changes.

The care burden makes the family feel that living with a sick person is so demanding and tiresome, as they have to be there for the patient all the time and do the patient’s duties on his or her behalf. For the patient, values change as he or she feel that living with a mental illness makes him or her a bother to the family members. Therefore, the patient hates his or her conditions and longs for the day he or she will recover to stand independently and lift up the burden from the family members.

In addition, the care burden problem changes the preferences for both the patient and the family members. For a person who has lived with a mental illness for long and there are no signs of recovery, the care burden makes the family caregivers prefer to live without the sick family member to living with the patient as a burden (Awad and Voruganti, 2008). Therefore, most families prefer the death of the patient. Again, a change of preferences is seen in the patient as influenced by the care burden. The patient feels a bother to the family and prefers to live alone to seeing the family suffer because of him (Campbell et al. 2008).

Furthermore, the care burden results to a change in health behavior. The informal caregivers are so stressed caring for the sick that they never want to be sick themselves. As a result, they will do anything to avoid falling sick. They will avoid high-risk factors to ensure they stay healthy so that not anyone else will go through what they face in care giving. For the patient, the health behavior changes; he or she will do anything to promote recovery so that he or she will lift up the care burden from the family members. Thus, care burden positively promotes health behavior.

PICO Model

P (patient/problem)

Care burden

I (intervention/indicator)

Psychotherapy

C (comparison)

Use of medication in absence of psychotherapies

O (outcome)

Reduced burden on informal caregivers

PICO Questions

Do psychotherapies reduce the care burden on informal caregivers?

How does the use of medication compare to using psychotherapies in reducing care burden on informal caregivers?

Conducting the Search

According to Qureshi et al. (2015), developing a relevant search strategy helps the researcher obtain the recent and the most relevant results on the selected topic. Evidence-based literature search locates literature evidence from databases allowing scholars a deeper understanding of the topic of concern and shows what have been done to avoid duplication of work.

In this assignment, I developed a search strategy containing four words, “care burden AND psychotherapies.” I used these terms to search the CINAHL database, as it is rich in nursing information (Aveyard, 2014). Once I logged into the London South Bank University (LSBU) page, I selected library search, subject resources, health and social care, and finally opted for the nursing course.

In the first search, I used the search terms care burden AND psychotherapies. In the search mode, I selected the Boolean/phrase and applied several limiters, which were full text, abstract available, reference available, English, 2008-2017. The search generated one result that I found very interesting to use for my study. However, since I needed more than one article, I reduced the limiters to obtain more results.

In the second search, I changed the search mode to find all my search terms. I limited the results to full text, abstract available, reference available, English, and articles published between 2008 to 2017. The search obtained four articles of which one was present from the previous search. Out of the three new articles, I went through the abstract and choose one that I found very interesting. Its overview will be presented later in the essay.

For the third search, I intended to obtain research articles since previous searches were focused on reviews. I adjusted the search mode to search any of my search terms but retained my search terms. The search generated 78 results from which I chose two guided by the abstract.

Results Overview

Soellner, R., Reder, M., Machmer, A., Holle, R., & Wilz, G. (2015). The Tele.TAnDem intervention: study protocol for a psychotherapeutic intervention for family caregivers of people with dementia. BMC Nursing, 14(1), 1-6. doi:10.1186/s12912-015-0059-9

This was a research article. The researchers aspired to examine the effectiveness of telephone therapies in helping reduce the care burden on informal family caregivers. The researchers detail how they used their telephone-based therapies on informal caregivers and the results prove that the intervention improves the outcome. Therefore, the researchers made the intervention available to the public and recommended support services to this care intervention.

Gallagher-Thompson, D., Tzuang, Y. M., Au, A., Brodaty, H., Charlesworth, G., Gupta, R., & ... Shyu, Y. (2012). International Perspectives on Nonpharmacological Best Practices for Dementia Family Caregivers: A Review. Clinical Gerontologist, 35(4), 316-355. doi:10.1080/07317115.2012.678190

This was one of the non-research articles I decided to use in this assignment. The aim of this study was to establish the best practices that informal caregivers can use in taking care of their patients to ensure the burden of care giving is reduced. The results revealed that psychosocial interventions are rarely administered yet they are the best approach to reducing the care burden on the informal family caregivers. The study revealed that lack of funds for psychosocial therapies is the main reason why psychotherapies are still unpopular although the best approach.

Lane, G. W., Podgorski, C. A., Noronha, D. O., & King, D. (2012). ”The Hidden Caregiver”: Kinship Caregivers and Lessons Learned from Dementia Family Caregiving. Clinical Gerontologist, 35(2), 195-203. doi:10.1080/07317115.2011.641708

The aim of this article was to establish the challenges that kinship caregivers go through as they take care of their patients, which makes patient care a burden. The researchers conducted a research to establish their own results. The results established that kinship caregiver have difficulties communicating with the patient, the doctors, lack of time for oneself, and low motivation to personal interests were the major reasons the kinship caregivers thought the care giving was a burden. Again, the results indicated that psychotherapies were a relieving factor. Psychotherapies helped both the patient and the kinship caregiver understand the condition better. Further, psychotherapies helped both the patient and the kinship caregiver understand the approaches to improved wellbeing. As a result, the caregiver was freed sometime away from the care giving, since the patient was empowered to take care of himself. Therefore, psychotherapies are effective in reducing care burden on informal caregivers.

Cody, R. A., & Drysdale, K. (2013). The Effects of Psychotherapy on Reducing Depression in Residential Aged Care: A Meta-Analytic Review. Clinical Gerontologist, 36(1), 46-69. doi:10.1080/07317115.2012.731474

This research article carried out trials on the existing literature to establish the influences of psychotherapies on reducing care burden. Out of the 17 trials, 10 trials revealed that psychotherapy is effective in reducing the care burden on informal primary caregivers. The researchers noted that psychotherapies reduced stress on the patients, which made the patient’s condition more stable thus, the caregivers had more time to attend her or his duties. As a result, the caregivers reported that psychotherapies reduced their workload as well as the care burden.

Practice Change

Medications are not as effective as psychotherapies when it comes to care interventions for the people living with mental illnesses. According to Shia (2009), psychosocial therapies reduce depression in the patients, which helps the body and the brain resume normal functioning. As a result, the wellbeing of the patient improves and the informal caregiver does not have to be always be there caring of the patient. Thus, the informal caregiver is relieved of the care burden.

According to Palmer and Glass (2003), medications are only aimed at the patient. Thus, administering medications to the mentally ill overlooks the ultimate contributor to the adverse health conditions. Keeping the society out of the care interventions denies them the chance to understand the health condition. Again, it alienates them from the patient and all they can do is offer help they think beneficial to the patient. However, behavior of the family members is paramount to the direction the progress takes. It can either improve or deteriorate.

Therefore, there is the need to change focus as the results prove that psychotherapies are more effective in reducing the care burden than the medications. Nurse practitioners should endeavor to offer psychotherapies to the mentally ill and their families as they seek to reduce the care burden. There are different forms of psychotherapies that the nurses can administer.

First, the nurse practitioners can involve the patient and the families in talk therapies. The talk therapies can be divided into various sessions, each session addressing varied groups. For example, a nurse practitioner can hold a talk therapy with the patient first seeking to establish the feelings of the patient and what the patient thinks can be done to improve the condition. The second session can be between the nurse and the family members seeking to establish their thoughts about the patient’s condition and what they think can be done. The final session should be held between the nurse, the patient, and the family members seeking to create a common understanding and establishing a consensus of what should be done to help the patient.

Second, the nurse practitioner should make use of psychoeducation involving the patient, the family members, and friends. The aim of this form of psychotherapy is to ensure that the people surrounding the patient are aware of the behavior needs that contribute to the recovery progress (Nash, 2014). In this session, the nurse can also detail on the coping strategies seeking all the parties involved find peace with the patients.

In addition, a nurse practitioner can make use of the assertive community treatment, which brings together a large number of people whom the patient interacts with form time to time. The assertive community treatment strategy assumes that working at an issue together makes in easier than handling it individually. Thus, the community members are encouraged to support the patient, which reduces the burden exerted on the family caregiver.

Finally, the psychotherapy approach can make use of telephone therapies where the nurse practitioner calls the patient and the family caregivers to find out on progress. According to the results obtained, the nurse determines the direction to take in advising the patient and the caregiver. The advice given seeks to reduce the amount of work entrusted to the caregiver, so that the caregiver can find time away from the care giving practice.

Therefore, psychotherapies provide a wide range of ways in which the patient, family members, and the community can be brought together to reduce the amount of work entrusted to the informal caregiver (Lister, 2008). Further, psychotherapies empower the patient to undertake his or her duties, which ensures that the caregiver has some time off the practice. As a result, the care burden on the informal caregiver is lifted up.

Implementing the Change

Stakeholders

In adopting the psychotherapy intervention for the people living with mental illnesses, the nurse, the patient, and the family members are the key stakeholders. First, the nurse needs to be made aware of the preference of psychotherapies to medication. The nurse also needs to understand the content of the psychotherapies. For effectiveness, the nurse must be provided with the procedure of conducting the therapy sessions. A clear boundary has to be drawn between the content of one session and that of the next session. This ensures that the people involved in the sessions learn something new in every session, thus are eager to attend the subsequent sessions.

In addition, there is the need to inform the patient of the care intervention that will be administered. Informed consent ensured that the patient is aware of what others think should be done to help improve his or her condition, thus cooperates with them in the efforts. Considering that most of the people living with mental illnesses are nearly givi9ng up in medications, informing them that psychotherapies will focus on behavior will encourage them to attend the therapy sessions (Awad and Voruganti, 2008).

Again, the family members need to be made aware of the intervention and encourage them to take part in implementing the suggested care intervention. Considering that most family members have already given up on the patients and have delegated the responsibility to their children, there is a greater need to present the intervention to them, explaining how it will ease their burden (Andrén and Elmståhl, 2007).

Barriers in implementation

Communication skills are the most prevalent barriers to implementing new care interventions in the nursing profession. Convincing the nurse practitioners of the usability of the intervention needs the use of pathos and logos. A breakdown in the communication process translates to a failure in the efforts to implement the new care intervention. Therefore, researchers must be very keen in language use to ensure that the nurse practitioners clearly scoop the message the researcher is passing across.

Time is another barrier to the implementation of new care interventions. A researcher may come up with an outstanding research article but no one will find the time to search databases to retrieve it. The nurses are busy and often, only fellow scholars will come along the paper as they search information for their academics. Therefore, very effective ideas on reducing the care burden on informal caregivers but the nurses have no time to go through the articles. To overcome this barrier, the nurse practitioners should be advised to check regularly on the medical databases to acquire new skills in care interventions.

Again, lack of commitment among the parties may be a hindrance to implementing the new care intervention. Psychotherapies are demanding, as they need to be administered regularly for effectiveness. Often, the patient and the family members have already given up on recovery so they are not willing to ‘waste’ more time on care interventions. Therefore, there may be great ideas but the parties to help achieve the goals may be unavailable. To overcome this challenge, a researcher must write the studies using facts, so that the readers are enticed to take practical actions.

Measuring outcome

The best indicator to measure the progress in outcome is diagnosing for symptoms at different intervals and comparing the results. Every time a nurse practitioner meets the patient for therapies, he or she should diagnose the severity of the symptoms and record them. A comparison of the results will help in establishing the effectiveness of the care intervention.

References

Andrén, S., & Elmståhl, S. (2007). Relationships between income, subjective health and caregiver burden in caregivers of people with dementia in group living care: a cross-sectional community-based study. International journal of nursing studies, 44(3), 435-446.

Aveyard, H., 2014. Doing a literature review in health and social care: A practical guide. McGraw-Hill Education (UK).

Awad, A. G., & Voruganti, L. N. (2008). The burden of schizophrenia on caregivers. Pharmacoeconomics, 26(2), 149-162.

Campbell, P., Wright, J., Oyebode, J., Job, D., Crome, P., Bentham, P., ... & Lendon, C. (2008). Determinants of burden in those who care for someone with dementia. International journal of geriatric psychiatry, 23(10), 1078-1085.

Lister, P., (2008). Care Planning in Mental Health: promoting recovery. Mental Health Practice, 11(7), pp.24-25.

Nash, M., (2014). Physical health and well-being in mental health nursing: Clinical Skills for practice. McGraw-Hill Education (UK).

Palmer, S., & Glass, T. (2003). Family function and stroke recovery: a review. Rehabilitation Psychology, 48(4), 255-265.

Qureshi, A., Bokhari, S.A.H., Pirvani, M. and Dawani, N., (2015). Understanding and practice of evidence based search strategy among postgraduate dental students: a preliminary study. Journal of Evidence Based Dental Practice, 15(2), pp.44-49.

Scazufca, M. (2012). Brazilian version of the Burden Interview scale for the assessment of burden of care in carers of people with mental illnesses. Revista brasileira de psiquiatria, 24(1), 12-17.

Shia, N. (2009). The role of community nurses in the management of depression. Nurse Prescribing, 7(12), 548-554.

Small, N, Harrison, J, & Newell, R (2010) Carer burden in schizophrenia: considerations for nursing practice’, Mental Health Practice, 14, 4, pp. 22-25, CINAHL Complete, EBSCOhost, viewed 15 June 2017.

Appendix

Evidence-Matrix

Authors

Journal Name/ WGU Library

Year of Publication

Research Design

Sample Size

Outcome Variables Measured

Level (I–III)

Quality (A, B, C)

Results/Author’s Suggested Conclusions

Soellner, R., Reder, M., Machmer, A., Holle, R., & Wilz, G

The Tele.TAnDem intervention: study protocol for a psychotherapeutic intervention for family caregivers of people with dementia

2015

Research article

1

1

ii

B

Boolean/phrase

Full text

Abstract available

Reference available

2012 to 2017

Gallagher-Thompson, D., Tzuang, Y. M., Au, A., Brodaty, H., Charlesworth, G., Gupta, R., & ... Shyu, Y.

International Perspectives on Nonpharmacological Best Practices for Dementia Family Caregivers: A Review

2012

Research review

4

4

i

A

Boolean/phrase

Full text

Abstract available

Reference available

2012 to 2017

Lane, G. W., Podgorski, C. A., Noronha, D. O., & King, D.

The Hidden Caregiver”: Kinship Caregivers and Lessons Learned from Dementia Family Caregiving

2012

Research article

4

4

ii

B

Boolean/phrase

Full text

Abstract available

Reference available

2012 to 2017

Cody, R. A., & Drysdale, K.

The Effects of Psychotherapy on Reducing Depression in Residential Aged Care: A Meta-Analytic Review.

2013

Non-research article

4

4

iii

C

Find all my search terms

Full text

Abstract available

Reference available

2012 to 2017

Shia, N.

The role of community nurses in the management of depression

2009

Non-research

7

0

iii

B

Find all my search terms

Full text

Abstract available

Reference available

2008 to 2017