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Family caregiving continues in nursing homes
November 21, 2002 -- by Annette Trinity-Stevens
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| Family nurse practitioner Cindy Walton studied the behavior of 18 family members who placed an elderly relative in a nursing home. |
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BOZEMAN--Having an elderly relative enter a nursing home doesn't mean families stop providing care, reports a recent study by a Helena family nurse practitioner.
Acknowledging the guilt, sadness and sense of failure many families feel when they decide to institutionalize a relative, Cindy Walton said family members still provide some of the most important aspects of elder care, even after the older person no longer lives at home.
"Families expect the [nursing home] staff to provide the technical care--the bathing, toileting and help with dressing," Walton said. "Families feel their responsibility is preserving the elder's sense of self, their self-esteem."
Walton researched the caregiving behaviors of 18 family members who placed an elderly relative in a nursing home for her master's thesis at Montana State University in Bozeman.
"Their stories were different, yet similar, and they just touched me on that personal level," Walton said. "I was very empathetic, looking at this from their viewpoint."
"By and large the biggest complaint [with nursing homes] is the lack of staff," Walton said.
Families and nursing home staff need to recognize themselves as collaborators on patient care, Walton found.
"Most family members want to maintain their position as caregivers but they're uncertain about what their role is," said Walton.
While the staff takes care of technical or medical needs, families can monitor that care and provide some direct care themselves, for example.
"Who's going to brush teeth at night--the staff or the granddaughter? The families and staff should clear up those ambiguous roles," Walton said.
Families and staff should also provide the type of care that contributes to the patient's emotional well being. This care--called preservative--includes maintaining family connections, patient dignity, their sense of hope and a sense of control over themselves and their environment. (See sidebar for suggestions.)
Walton also noticed that family members often become more spiritual, especially when the relative is near the end of life. Families maintain hope through believing that their relative is going to a better place or will be free of pain and suffering.
"Caring for a relative in a nursing home is a very real possibility for many families, particularly as more people approach the end of life," said Helen Lee, MSU associate professor of nursing and Walton's advisor. "This study gives relatives and nursing home staff some very real data that support care options."
Walton found that while female relatives have long provided the bulk of care to the elderly at home and in facilities, men are becoming much more involved.
"Gender was not a huge factor," Walton said, noting that the husbands of women with Alzheimer's or related diseases in her study group often would feed their wives.
"It's a way to make a connection, especially for men who aren't affectionate or who can't show emotion," said Walton.
Walton plans to do more research in geriatrics while she pursues a Ph.D. in nursing. She's also interested in working primarily with elderly patients as a family nurse practitioner.
Currently she commutes from Helena to Great Falls where she is completing the clinical portion of her master's degree.
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Ways families can promote high-quality care of a relative in a nursing home
Maintain Family Connections
• Visit or call the relative often.
• Plan a day trip with the relative outside of the nursing home.
• Personalize the relative’s space with pictures, photos or other memorabilia.
• Bring a favorite food the relative enjoys.
Maintain Dignity
Families can help staff to:
• Provide privacy when performing personal care activities.
• Maintain personal hygiene and clean clothing.
• Provide prompt intervention when the relative has been incontinent.
• Respect the relative’s individual preferences and uniqueness.
Maintain a Sense of Hope
Families can:
•Encourage personal interaction with others.
•Promote access to the larger world through television, radio or newspaper.
•Encourage participation in games or group activities.
•Encourage expression of spiritual beliefs and practices such as reading the Bible, praying, or listening to spiritual music.
Maintain a Sense of Control
Family and staff can encourage independent choices such as:
• When to sit up in a chair.
• When to have visitors.
• What foods to eat.
• What clothing to wear.
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Contact: Cindy Walton, (406) 442-8810 or cnkwalton@earthlink.net
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| [View or Download] | 1. | Family nurse practitioner Cindy Walton studied the behavior of 18 family members who placed an elderly relative in a nursing home. |
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