Problem-solving skills ease stress for caregivers
Problem-solving skills ease stress for caregivers
Teach ways to create plan and overcome obstacles
Cancer not only impacts the person with the disease, but all those close to the individual. People have a lot of fear concerning cancer. In addition to emotional issues, families must deal with the care of the cancer patient as he or she goes through treatment. That care often involves managing medications and their effects, managing symptoms such as fatigue or nausea, and helping to meet the emotional needs of the cancer patient, says Carol Marcusen, LCSW, BCD, director of social services and patient education at USC-Norris Comprehensive Cancer Center and Hospital in Los Angeles.
That’s why the health care facility offers the Strength for Caring course made available by Raritan, NJ-based Ortho Biotech, a subsidiary of Johnson & Johnson. While physicians provide some training and visiting nurses offer support, the caregivers don’t have someone at their side 24 hours a day to answer questions. "Programs such as Strength for Caring are significant for caregivers. They provide tools that help the caregiver determine what to do or if they should call the doctor. Also, these programs put them in touch with other caregivers so they realize they aren’t the only one having to deal with these issues," says Marcusen. (For information on how to obtain the course materials mentioned, see source box on p. 104.)
During the course, caregivers are taught problem-solving skills and given materials on symptom management. At USC-Norris Comprehensive Cancer Center, caregivers are asked what problems they are having and given materials that specifically meet those needs.
For example, if the caregivers are trying to care for a patient with nausea and vomiting, they learn what might be causing those symptoms — such as certain smells — so awareness of the problem is expanded. Then, professional help is discussed, such as working with the physician to obtain anti-nausea medication or a dietitian at the clinic to determine how to lessen the effects of nausea.
Patients are coached on how to be prepared to answer questions they might be asked if they call the physician or nurse, such as how long the nausea has been a problem, what activities it interferes with, and what medicines have been tried.
Concrete solutions to nausea are provided, such as making sure there is fresh air in the patient’s room. "We help them explore their options, create a plan which may have some of the options in it, and then we address obstacles that might occur," says Marcusen.
The Strength for Caring course can be tailored
to the problems the caregivers are having in the group or cover a wide spectrum of problems,
says Anne Delengowski, RN, MSN, AOCN, oncology clinical nurse specialist at Thomas Jefferson University Hospital in Philadelphia. At the health care institution, course participants are given symptom management sheets for all symptoms that might occur. "Even if the symptom has not manifested yet, it might later, so they have the handout to address that issue," says Delengowski.
Often in the group there are caregivers of newly diagnosed patients, as well as those in hospice care, so symptom discussion can be complex, says Delengowski. For example, the instructor might go over shortness of breath in the newly diagnosed patient vs. shortness of breath in someone who is dying.
Two-part class offered
Delengowski prefers to conduct the class in a four- to five-hour session, but others teach an hour-long class over several days or a two-day session. (To learn more about determining class structure and promotion, see article on p. 105.) During the first half of the course, she discusses cancer, the treatments, the role and needs of the caregiver, the physical symptoms of cancer, such as pain, fatigue, nausea, and vomiting, and what to do about them.
In the second part of the class, she discusses communication with health care professionals, handling the depression and stress of the caregiver and the patient, and changes that occur in family roles. Vignettes are played out in class to help people learn to deal with such issues as depression. Videos are available that teach caregivers such skills as making a bed with the patient and how to keep a patient clean.
The Prepared Family Caregiver for Cancer program is the curriculum of choice at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute in Columbus, OH. This course teaches caregivers a problem-solving model called COPE, which has four components. To solve problems, caregivers learn to apply creativity and optimism while planning ahead for needs and problems and acquiring and using expert information.
The model encourages caregivers to use the help of other people around them, creatively come up with patient-centered ideas, anticipate and deal with issues and challenges, and observe and communicate about the patient’s needs effectively with the health care team, explains Susan Scrichfield, MSW, MA, coordinator of consumer health educa-tion at the cancer hospital. During the class, caregivers and the instructor tackle scripted problems before addressing issues participants have.
"The problem-solving model is encouraging to people because it helps them look at problems as trials where you brainstorm for ideas, select the best ideas, make a plan, implement the plan, evaluate how it went, and modify the plan accordingly. They don’t feel so defeated," says Scrichfield.
Class participants also receive The American College of Physicians’ Home Care Guide for Cancer. Chapters address the various symptoms caregivers confront when caring for a cancer patient, such as tiredness and fatigue, and guide the caregiver through the problem-solving process. This process includes understanding the problem, when to get professional help, how to personally help, possible obstacles, and carrying out and adjusting the plan.
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