Health Promotion: Prevention of Disease Case Study
CASE STUDY: Caregiver Role Strain: 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
Case Study Analysis: Caregiver Role Strain - Ms. Sandra A.
- Stresses on Sandra's Sisters and their Families:
Caring for a terminally ill loved one like Sandra can impose significant stresses on her caregiving sisters and their families. These stressors can be classified into various categories:
Physical:
- Demands of caregiving:Providing round-the-clock care for a physically dependent person can be physically demanding, leading to exhaustion, fatigue, and potential injuries.
- Disruption of sleep:Caring for Sandra during late nights and early mornings can disrupt the sleep patterns of caregivers, leading to sleep deprivation and further fatigue.
- Exposure to illness:Caregivers may be exposed to Sandra's illness and medications, potentially increasing their risk of contracting infections.
Emotional:
- Emotional strain:Witnessing Sandra's suffering and impending death can cause significant emotional distress, leading to feelings of sadness, anxiety, helplessness, and guilt.
- Anticipatory grief:The process of grieving for a loved one who is still alive can be emotionally draining and lead to depression, anxiety, and withdrawal from social activities.
- Difficult conversations:Caregivers may need to have difficult conversations with Sandra about her illness and end-of-life wishes, adding to the emotional stress.
Financial:
- Loss of income:If Sandra's sisters have to take time off work to care for her, they may experience a loss of income, adding financial strain to their families.
- Increased expenses:Caring for a terminally ill patient can be expensive, with costs associated with medication, equipment, and additional services.
Social:
- Reduced social interaction:Caregiving responsibilities can leave little time for socializing with friends and family, leading to social isolation and loneliness.
- Strain on relationships:The stress of caregiving can put a strain on relationships between caregivers and their partners, children, and other family members.
- Resources for Managing Stress and Supporting Caregivers:
Several resources are available to help manage stress and support caregivers while caring for Sandra:
Formal Support:
- Hospice care:Hospice provides comprehensive care for terminally ill patients and their families, including symptom management, emotional support, and caregiver education.
- Visiting Nurse Association (VNA):VNAs provide skilled nursing care, home health aides, and social workers to assist with daily living activities and offer emotional support.
- Support groups:These groups offer a safe space for caregivers to share their experiences, receive emotional support, and learn from others in similar situations.
- Individual therapy:A therapist can help caregivers cope with the emotional challenges of caregiving and develop coping mechanisms for managing stress.
Informal Support:
- Family and friends:Sandra's extended family and friends can provide valuable support by offering practical help, running errands, providing respite care, and offering emotional support.
- Religious communities:Religious communities can offer spiritual support, counseling, and access to support groups and other resources.
- Sandra's Feelings about Dependency and Loss of Autonomy:
Sandra likely experiences a range of emotions related to her dependency and loss of autonomy, including:
- Frustration:She may feel frustrated by her inability to perform daily tasks on her own and may feel like a burden on her family.
- Anger:She may feel angry at the situation and at her body for failing her.
- Fear:She may feel afraid of the future, of losing control, and of the dying process.
- Loss:She may feel a sense of loss for her independence, her health, and her control over her life.
- Acceptance:It is also possible that Sandra may have reached a stage of acceptance, focusing on enjoying the time she has left with loved ones and finding peace in the situation.
It is important for caregivers to be sensitive to these emotions and offer Sandra support and understanding. They can encourage her to express her feelings, validate her experiences, and help her find ways to maintain a sense of control over her life as much as possible.
Additional Resources:
- National Family Caregiver Support Program: http://acl.gov/programs/support-caregivers
- Family Caregiver Alliance: https://www.caregiver.org/
- CancerCare: http://www.cancercare.org/
- National Hospice and Palliative Care Organization: https://www.nhpco.org/
Conclusion:
Caring for a terminally ill loved one like Sandra can be a challenging and emotionally demanding experience. By understanding the potential stresses on caregivers and utilizing available resources, Sandra's sisters and family can better manage their own stress and provide the necessary support and care for Sandra during this difficult time. It is also crucial to acknowledge and support Sandra's feelings about her dependency and loss of autonomy, allowing her to express her emotions and find