Caregiver Stress

The United States has a significant and growing crisis with caregiver stress. There are about 1. 4 million older Americans living in nursing homes, 6 million receiving care at home, and a significant number going without any help at all (International Longevity Center, 2009). The current demand for caregiving services is going to worsen considerably with the aging of baby boomers and the United States has no caregiving system in place, which means that the caregiving crisis is receiving less attention than it warrants. An estimated 44.

million Americans (National Alliance for Caregiving, 2007) or “80%-90% of families serve as informal caregivers” (Hanson, Gedaly-Duff, & Kaakinen, 2005). Caregivers tend to be so immersed in their caregiving role that they neglect to take care of themselves. They are not able to recognize signs and symptoms of stress so they tend to use “limited services or access services late in their caregiving experience” (Winslow, 2003). Because of the chronic pressure due to caregiving activities, caregiver stress can be associated with physiological problems and psychological changes such as “depression, grief, and fatigue” (Sullivan, 2002).

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If left undiagnosed caregiver stress will result in “ineffective functioning, lower self-esteem, lower role enjoyment, less marital satisfaction” (Tsai, 2003) and premature institutionalization of patients because of unmet needs. The Caregiver Self-Assessment Questionnaire (CSAQ) was developed by the American Medical Association. It can be a useful tool to help healthcare providers and caregivers determine how families are coping with the additional challenges of being a caregiver. The results from this instrument can identify gaps in services.

The CSAQ is an eighteen-question survey with 16 “yes/no” items and two global scale items designed to measure indicators of emotional and physical distress by the caregiver.

It was tested on a national sample of caregivers (n=60), employees participating in a work-site support group (n=30), and work-site seminars for family caregivers (n=60). The data were analyzed using SPSS. The caregiver distress index was computed by summing the "yes" items (range=4 to 15) and correlating the total score with the global scales.

Cronbach’s alpha was calculated to assess internal consistency among items and the reliability coefficient alpha was . 7804 (American Medical Association, 2009). The justification and needs assessment for developing this educational learning module was guided by research, data, an evaluation of the awareness/knowledge base of nurses through the use of the Caregiver Self-Assessment Test (CSAT), and informal surveys of patients at each of the clinical facilities.

The CSAT was intended to provide nursing staff with evidence-based practice knowledge and information necessary to recognize and understand caregiver stress. The components of the learning module were constructed with two interrelated sections for the learner: (1) Web site links to information about caregiver stress; and (2) customized educational information and tips specific to caregiver stress needs (Pierce, Steiner, & Smelser, 2009).

This learning module will be accessible to nursing staff via the hospitals intranet, a resource book, and brochures that will be made available to distribute to family caregivers. Objectives for this educational program were based upon Knowles Theory of Adult Learners because the locus of control resides with the learner and because the adult learner uses their experience and knowledge to solve real-life problems.

At the completion of the learning module, the nurses will have an increased awareness and understanding of the signs and symptoms related to caregiver stress. They will be able to show how caregiver stress can have a negative impact on the patient-family dynamics and talk about how they can implement evidence based practice interventions such as respite care to decrease caregiver stress. Evaluation of the learning objectives for the learning module will be obtained by the administration of a post-test and an informal survey.