From the Other Side of the Bed: Lived Experiences of Registered Nurses as Family Caregivers

The Experiences of Nurses as Double-Duty Caregivers for a Family Member at the End of Life: Interpretive Description

Increasing numbers of individuals with complex, advanced illnesses are living longer and being cared for in the home by family members. As a result, family caregivers often experience physical, emotional, psychological, and social distress. A unique subset of this population are nurses who find themselves providing care in both their family lives and work lives, a phenomenon known as "double-duty caregiving." This study explored the experiences of nurses providing end-of-life care for family members while continuing to work as a nurse and the consequences of this experience. A qualitative design, using semistructured, in-depth interviews, was used to capture the double-duty caregivers' experiences. Four overarching themes were identified: It Takes a Village, Driving the Bus, Juggling Many Hats, and Moving Through and Looking Back. These themes captured the components of a support system that are essential for the double-duty caregiver to perform this work, the multifaceted expectations placed upon the double-duty caregiver, the double-duty caregiver's relentless need to balance multiple roles, and the immediate and long-term impact of double-duty caregiving. As nurses, we must acknowledge the need for self-care during this experience, and as a profession, we must provide support for the double-duty caregiver to preserve their personal and professional well-being.

Amant O, Ward-Griffin C, Anderson S. Double-duty caregivers enduring COVID-19 pandemic to endemic: "It's just wearing me down"

The COVID-19 pandemic has considerably strained health care providers and family caregivers. Double-duty caregivers give unpaid care at home and are employed as care providers. This sequential mixed-method study, a survey followed by qualitative interviews, aimed to comprehensively understand the experiences of these Canadian double-duty caregivers amidst the pandemic and the transition to the endemic phase. The multi-section survey included standardized assessments such as the Double-duty Caregiver Scale and the State Anxiety Scale, along with demographic, employment-related, and care work questions. Data analysis employed descriptive and linear regression modeling statistics, and content analysis of the qualitative data. Out of the 415 respondents, the majority were female (92.5%) and married (77.3%), with 54.9% aged 35 to 54 years and 29.2% 55 to 64 years. 68.9% reported mental health decline over the past year, while 60.7% noted physical health deteriorated. 75.9% of participants self-rated their anxiety as moderate to high. The final regression model explained 36.8% of the variance in participants' anxiety levels. Factors contributing to lower anxiety included more personal supports, awareness of limits, younger age, and fewer weekly employment hours. Increased anxiety was linked to poorer self-rated health, and both perceptions and consequences of blurred boundaries. The eighteen interviewees highlighted the stress of managing additional work and home care during the pandemic. They highlighted the difficulty navigating systems and coordinating care. Double-duty caregivers form a significant portion of the healthcare workforce. Despite the spotlight on care and caregiving during the COVID-19 pandemic, the vital contributions and well-being of double-duty caregivers and family caregivers have remained unnoticed. Prioritizing their welfare is crucial for health systems as they make up the largest care workforce, particularly evident during the ongoing healthcare workforce shortage.

Use of Motivational Interviewing by Advocates in the Context of an Elder Abuse Response Intervention: The RISE Project

Purpose

Despite the increasing number of elder abuse and self-neglect (EASN) cases, many older adults are reluctant to engage with formal support services, such as Adult Protective Services (APS). This study examined the use of motivational interviewing (MI) by advocates, as a component of a larger EASN intervention, RISE (Repair Harm, Inspire Change, Support Connection, Empower Choice), implemented in partnership with APS. Advocates applied MI as part of RISE to help clients explore and resolve ambivalence around pursuing change and ultimately enhance service engagement.

Methods

This study conducted qualitative interviews and a focus group with all RISE advocates (n = 4) to understand how MI is applied in the context of an EASN intervention with older adult clients. A descriptive phenomenological approach involving two independent assessors was used to code verbatim transcripts into themes.

Results

Three domains were identified: (1) therapeutic relationship, which describes the importance of foundational relationship building in MI to support older adults who have experienced EASN; (2) techniques, which refers to MI strategies advocates apply and adapt in the context of EASN intervention; and (3) implementation challenges, which reflects the difficulties advocates encounter when using MI in cases of EASN.

Conclusions

The experiences of advocates suggest MI is a beneficial and amenable approach to help older adults who have experienced EASN navigate issues of ambivalence and explore their motivation for change. This study represents the first in-depth exploration of MI in the context of EASN intervention.

Involvement un-enabled? An ethnographic study of the challenges and potentials of involving relatives in the acute ambulatory clinical pathway

Background

Involving a patient’s relatives is a complex endeavour, especially in emergency departments (EDs). Generally, relatives are recognized as vital partners in health care, but in-depth knowledge on how these family involvement processes take place in the everyday practices of EDs is sparse. The aim of this study is to explore the practice of involving relatives in the acute ambulatory clinical pathway in the ED, as seen from the perspectives of patients and relatives.

Methods

The study was conducted as ethnographic fieldwork in an ED at a Danish Regional Hospital. Two months of participant-observation were carried out focusing on 43 patients. Of these, 18 patients and/or relatives were selected for telephone interviews after 1 week, and of these 11 were selected for in-depth interviews 3 weeks later.

Results

Unpredictability is a basic condition of any ED. For the patients and relatives, who are unfamiliar with the routines in the ED, unpredictability translates to a sense of temporal and existential unpredictability, reinforced by a sense of not knowing when the examinations will be completed or if/when they will be sent home. Relatives’ involvement in the ED is affected by this sense of unpredictability and by the existing relations between patients and their relatives prior to entering the ED. The stay in the ED is only one ‘stop’ in the complete acute ambulatory clinical pathway but relatives’ involvement also concerns the time before and after the stay in the ED. Practices of involving relatives leave (some) relatives invisible in the clinical pathway. As a consequence, they are often not addressed, which un-enables their involvement.

Conclusion

Involvement of relatives presupposes recognizing the relatives as participants if they are to be involved in the patient’s clinical pathway in the ED. As a start, it is advisable that the medical staff ask the patients on arrival who has accompanied them in the ED, and if and in what way they want their companions involved in the ED. There is a need for a more integrated and contextualized understanding of relatives’ involvement, as it takes place along an extended acute ambulatory clinical pathway.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-020-05923-x.