CASE STUDY: Caregiver Role Strain

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Ms. Sandra A. Sandra, a 47-year-old divorced woman, received a diagnosis of stage 3 ovarian cancer 4 years ago, for which she had a total hysterectomy, bilateral salpingo- oophorectomy, omentectomy, lymphadenectomy, and tumor debulking followed by chemotherapy, consisting of cisplatin (Platinol), paclitaxel (Taxol), and doxorubicin (Adriamycin). She did well for 2 years and then moved back to her hometown near her family and underwent three more rounds of secondline chemotherapy. She accepted a less stressful job, bought a house, renewed old friendships, and became more involved with her two sisters and their families.
Sandra developed several complications, including metastasis to the lungs. Then she could no longer work, drive, or care for herself. She had been told by her oncologist that there was nothing else that could be done and that she should consider entering a hospice. She met her attorney and prepared an advance directive and completed her will. She decided to have hospice care at home and, with the help of her family, set up her first floor as a living and sleeping area. She was cared for by family members around the clock for approximately 3 days.
Sandra observed that she was tiring everyone out so much that they could not really enjoy each other’s company. At this time, she contacted the Visiting Nurse Association (VNA) to seek assistance. Her plan was to try to enjoy her family and friend’s visits. After assessment, the VNA nurse prioritized her problems to include fatigue and caregiver role strain. Other potential problem areas that may need to be incorporated into the care plan include anticipatory grieving and impaired comfort.
Reflective Questions
1. What are some of the stresses on Sandra’s middle-aged sisters and their families?
2. What resources are available to manage these stresses and support the sisters while caring for their dying sister Sandra?
3. Describe Sandra’s feelings about dependency and loss of autonomy because she is unable to do her own activities of daily living any longer.

 

 

Sample Solution

Sandra’s middle-aged sisters and their families are likely experiencing a number of stresses, including:

  • Emotional stress. Caring for a dying loved one can be emotionally draining, even for the most resilient people. The sisters may be feeling a range of emotions, such as sadness, grief, anger, and guilt. They may also be struggling to cope with the uncertainty of Sandra’s prognosis.
  • Physical stress. The sisters may be feeling physically exhausted from the demands of caregiving. They may be getting little sleep, and they may be having to juggle their caregiving responsibilities with their jobs, other family commitments, and their own health.
  • Financial stress. The sisters may be facing financial challenges as a result of Sandra’s illness. They may have had to take time off work to care for her, or they may have had to pay for medical expenses.
  • Social isolation. The sisters may be feeling isolated from their friends and other social supports. They may be spending less time with their friends and family, and they may be feeling overwhelmed by the demands of caregiving.

Question 2:

There are a number of resources available to help Sandra’s sisters and their families manage these stresses and support Sandra during her final days. These resources include:

  • The Visiting Nurse Association (VNA). The VNA can provide a range of services to help with Sandra’s care, such as nursing care, home health aide services, and social work support.
  • Hospice care. Hospice care is a specialized type of care that provides comfort and support to people who are dying and their families. Hospice care can be provided in a variety of settings, including at home, in a hospital, or in a hospice facility.
  • Support groups. There are a number of support groups available for people who are caring for a dying loved one. These groups can provide a safe space for the sisters to share their experiences and to get support from others who understand what they are going through.
  • Individual counseling. Individual counseling can help the sisters to cope with the emotional and psychological challenges of caregiving.

In addition to these formal resources, there are also a number of informal resources that can be helpful. These resources include:

  • Friends and family. The sisters’ friends and family can provide emotional support, practical help, and a break from caregiving.
  • Faith communities. Many faith communities offer support groups and other resources for people who are caring for a dying loved one.
  • Online resources. There are a number of online resources that can provide information and support for people who are caring for a dying loved one.

It is important for the sisters to find the resources that work best for them. There is no one-size-fits-all approach to caregiving, and what works for one person may not work for another. The sisters should be open to trying different things and to asking for help when they need it.

Question 3:

Sandra is likely feeling a range of emotions about her dependency and loss of autonomy. She may be feeling sad, angry, frustrated, and scared. She may also be feeling guilty about the burden she is placing on her sisters.

It is important for Sandra to express her feelings and to be honest with her sisters about how she is feeling. Her sisters can then offer her support and understanding. It is also important for Sandra to find ways to maintain her sense of control and independence, even though she is no longer able to do everything for herself. This could involve asking for help with specific tasks, but also finding ways to participate in decision-making and to have a say in her care.

Caring for a dying loved one is a difficult and challenging experience. However, with the right support, Sandra and her sisters can get through this difficult time together.

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