Healthcare in America is an issue of finances. Healthcare is an issue, especially for the financially strapped family. The following paper will focus on the care-giver burden of a patient who cannot afford to be taken care of because of lack of insurance or lack of funds in general. In the following pages care-giver burden will be addressed using several articles concerning care-giver burden and three theorists; Martha E. Rogers, Imogene King, and Dorothy E. Johnson.
The articles are in design stressing the issue of guilt and depression when a family decides they don’t have the time or the money to keep a loved one at home and must face putting them in a care facility (Sanders article Shouldering the Burden of Care). Other articles address the issue of keeping a family member at home (child) and the upkeep cost that entails such as home health aid cost, medications, or leaving a job (Wilson, Leslie S. et al. The Economic Burden of Home Care for Children with HIV and Other Chronic Illnesses).
Also, the review of patient care for nurses and the burden of lack of authority in administration this presents is another form of care-giver burden (Welchman, Jennifer & Glenn G. Griener, Patient Advocacy and Professional Associations: Individual and Collective Responsibilities). Each of these issues involves a direct relationship to the patient and their concerns for the burden they may become for their family, or for themselves in regards with money and insurance.
There are many facets to unravel in the primary care system but for this paper, care-giver burden is the primary concept in terms of money. Three Approaches to the Concern Approach of Martha E. Rogers. Roger’s theory involves four postulates: energy fields, openness, pattern, and pandimensionality. (Barrett et. Al 2000). Each of these postulates involves the client’s concern over their health and the relationships they form with not only the nurses but with their own families.
Rogers goes on to explain that power is at the core of each of these relationships, “(power)…is the capacity to participate knowingly in the nature of change characterizing the continuous patterning of the human and environmental fields. The observable, measurable pattern manifestations of power are awareness, choices, freedom to act intentionally, and involvement in creating change” (Barrett et al. ) Most care-giving authority is given to nurses; both in a hospital setting and during stay at home cases.
The preceding concept or the patient is its important to have a strong trusting relationship with the care-giver in order for them to feel more comfortable and also feel their issues and concerns are being heard. If the patient does not feel comfortable then the care-giver burden becomes apparent in scowling-unreceptive-to-therapy patients. However, in Welchman and Griener’s article, Patient Advocacy and Professional Associations, a rising concern over nurses’ burden when taking care of patients begins to be seen, “…nurses are being taught to be patient advocates and both nurses and patients are the worse for it.
The nursing profession’s redefinition of the nurse’s role from loyal handmaid to patient advocate in the 1980s was supposed to protect patients by empowering nurses to think and act autonomously in their dealings with other health professionals. …individual nurses have been burdened with a responsibility that most professions assign…to their professional associations. It is not a responsibility that individuals can readily fulfill. Unless or until the duty of advocacy is taken off the shoulders of individual nurses and returned to the professional bodies that represent them, nurses and patients will continue to suffer unnecessarily”(2005).
The nurses’ role in patient care involves everything a patient needs or may potentially need (feeding, bathing, bathroom visits, company) and according to Rogers’ theory making the patient part of the active choice of their own health. Therefore, in the context of this theory there is no control, because control is not held one over the other (nurse over patient) but power is shared, as Rogers’ theory states, “…people can knowingly participate in creating their reality by actualizing some of their potentials rather than others.
In this theory there is no control; control is an illusion since other persons or groups and their environments are likewise simultaneously also participating in what is being created”. Each of these duties cannot be accomplished without proper support from family/administration, and without this support and the lack of performance in a nurse’s duty a patient will lapse in trust. This is the contention in the make-up of care-giver burden; nurses cannot fulfill their role to maximum potential without the backing of the hospital rules.
The burden is twofold for the nurse and the patient. As Welchman and Griener state in a final cul-de-sac, “Advocacy for improvements in access to and deliver of health care is best viewed as a collective responsibility of health professions owed to society as a whole, not as the sole province of individual practitioners”(2005). Approach Imogene King. King’s theory lies in the clients’ perception of self. This perception ranges from their body image to their own growth and development before and after surgery or during care-giver visits.
As such, the crux of King’s theory is that of communication. Her theory subsists of human beings as, “…open systems interacting with the environment” (Williams, Imogene King’s Interacting Systems Theory, 2001). Throughout the relationship of nurses and clients communication is the key to better health. This occurs through the patient forming several relationships with different people around them; these include personal systems, interpersonal systems, and social systems.
Thus, King’s ultimate goal stated in the theory is goal attainment. However, there are outside factors that stand in the way of working and healthy relationships. In Wilson et al. ’s study of patient care for ill and HIV children the stats for financing reflects a tremendous burden, “.. in-home care for ill children (ranging from approximately $19,000 to $36000) is higher than that of hiring caregivers for healthy children (approximately $10,000)” (2005).
This burden is further emphasized for the family if they are not equipped to pay a professional care-giver and are dependent upon themselves for such care; this issue raises the other issues of job attendance (some families pass up promotions, decline extra working hours, or quit their jobs entirely in order to care for the ill which makes the financial burden that much more potent). These numbers also reflect the elderly who are put in homes or whose family members choose to have them stay at home.
Thus, it is important within King’s theory that each relationship remains free from outside stress factors in order for the recovery of the patient to be successful. The dyad of the nurse and the patient must remain free from concerns of money, otherwise the nurse is seen as merely a worker and not a concerned care-giver and the patient is stressed because they may not have coverage for certain operations or insurance to properly cover the care-giver’s assistance.
In King’s theory, communication led to recover, “King believed that interactions between the nurse and the client lead to transactions that relate in goal attainment. Furthermore, King proposed that through mutual goal setting and goal attainment, transactions result in enhanced growth and development for the client” (Williams). Therefore, the issue of money cannot come between the dyad.