We’ve all had an experience with a caregiver that makes us cringe when we think about it.  The demanding wife who constantly criticizes the way we do her husband’s dressing.  The daughter or son who thinks their parent isn’t getting enough services.  The family member who calls all the time to direct the care of their parent but never visits him or her.
I think the most difficult caregiver is the absentee one.  When the sick older person needs someone to help care for him or her in order to stay at home, family and friends are no where to be found.

As a nurse manager, I’ve helped nurses deal with caregivers who are uncooperative, passive aggressive or downright nasty.  After a review of culture, customs, ageism, racism and other factors that may impact the nurse-patient-caregiver relationship we would try a simple approach:  Try to figure out why this person is behaving this way.  Never assume that all families are willing or capable of caring for their loved ones.  If you can determine the cause of difficult behavior, you’ve got a much better shot at a positive working relationship.  Taking some time to take care of the caregiver can work wonders.  Not all caregivers will let you, but even something as simple as sitting down for a few minutes and allowing the caregiver to vent can be a life raft for some.  Most of the time, problematic relationships have something to do with unmet or unrealistic expectations.  Clarify your role and the role of the caregiver early on in your relationship.  When expectations are misaligned try to reach a compromise. Many times caregivers are overwhelmed and tired.  Determining whether the caregiver is suffering from the burden of their loved ones care and intervening appropriately is as important as the direct care we give our patients.

CHAMP has a variety of tools to assist you in evaluating a caregiver’s strain and ability to care for your patient.  One of our top ten tools in 2010 is the Next Step In Care Guide, Assessing Family Caregivers: A Guide for Health Care Professionals.   Another tool you can access from the CHAMP website is the Modified Caregiver Strain Index. This tool has a demonstration video you can show to your nursing staff.  We also have a Family Caregiver, evidence-based clinical practice guidelines brief for those of you who would like to dig deeper.

There’s one more approach I should mention.  It’s not based in any evidence but has worked for me.  I learned it from a seasoned nursing colleague.  When all else fails, just shake your head and repeat to yourself  “You gotta love ‘em! “

Debra Bertrand, CHAMP Facilitator