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
- What are some of the stresses on Sandra's middle-aged sisters and their families?
- What resources are available to manage these stresses and support the sisters while caring for their dying sister Sandra?
- Describe Sandra's feelings about dependency and loss of autonomy because she is unable to do her own activities of daily living any longer
Full Answer Section
Stresses on Sandra's Middle-Aged Sisters and Their Families
Sandra's sisters and their families face a myriad of stresses as they provide care for her. These stressors can be emotional, physical, financial, and social.
Emotional Stress
Caring for a dying loved one is emotionally draining. Sandra's sisters must cope with the constant fear of losing their sister, the guilt of not being able to do more, and the sadness of watching her suffer. They may also experience a sense of helplessness and hopelessness as Sandra's condition worsens.
Physical Stress
Providing physical care for Sandra can be physically demanding. Her sisters may need to help her with bathing, dressing, eating, and toileting. They may also need to lift her in and out of bed and assist her with walking or ambulation. This can take a toll on their physical health, leading to fatigue, muscle strain, and injuries.
Financial Stress
Caring for Sandra can be financially stressful. Her sisters may need to take time off from work to provide care, which can result in lost wages and increased expenses. They may also need to pay for home care services, medical equipment, and medications.
Social Stress
Caring for Sandra can disrupt the lives of her sisters and their families. They may have to cancel commitments, miss social events, and spend less time with their own families. This can lead to social isolation, resentment, and conflict.
Resources Available to Manage Stresses and Support Sandra's Sisters
Fortunately, there are several resources available to help Sandra's sisters manage the stresses of caregiving and provide support during this difficult time.
Professional Support
Professional support can be invaluable for caregivers. Sandra's sisters can benefit from counseling, support groups, and respite care services. Counseling can provide them with a safe space to express their emotions, learn coping mechanisms, and develop strategies for managing stress. Support groups can connect them with other caregivers who understand their experiences and offer mutual support. Respite care services can provide them with relief from the demands of caregiving, allowing them to take breaks and focus on their own well-being.
Community Resources
Community resources can also provide support for Sandra's sisters. They can access transportation assistance, meal delivery services, and housekeeping services. These resources can help them manage the logistics of caregiving and free up their time to focus on Sandra's emotional and physical needs.
Family and Friends
Family and friends can also play a significant role in supporting Sandra's sisters. They can offer practical assistance, such as providing meals, childcare, and transportation. They can also offer emotional support by listening, offering encouragement, and simply being present.
Sandra's Feelings about Dependency and Loss of Autonomy
Sandra's dependency on her sisters for her daily needs can be emotionally difficult for her. She may feel a sense of loss of control, self-worth, and dignity. She may also feel guilty for burdening her sisters and resentful of her reliance on them.
These feelings can be compounded by the loss of her autonomy. Sandra may no longer be able to make her own decisions, perform her own activities of daily living, or participate in activities that she once enjoyed. This loss of independence can be frustrating and disheartening.
Conclusion
Caring for a dying loved one is a challenging and often thankless task. Sandra's middle-aged sisters and their families face a significant burden as they provide care for her. The stresses of caregiving can take a toll on their emotional, physical, financial, and social well-being. Fortunately, there are resources available to help them manage these stresses and provide support during this difficult time. With the help of professional support, community resources, and family and friends, Sandra's sisters can navigate the challenges of caregiving and provide compassionate and loving care for their dying sister.