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NURS 3510 - Supportive and Palliative Care > Week 5 > Flashcards

Week 5 Flashcards

1
Q

what is caregiving

A
  • providing unpaid support to family members or friends who have physical, emotional, or practical needs d/t an illness, disability, or aging
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2
Q

a pt’s ability to be cared for and die at home is heavily dependent upon…

A
  • the efforts of family caregivers
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3
Q

describe caregiving in canada (5)

A
  • 8.1 mil family caregivers
  • provide 66.5 bil worth of care/year –> “invisible providers”
  • 80% of all care at home is provided by fam caregivers
  • principle source of support for pts who are dying at home
  • need for family caregivers will increase dramatically in the coming years
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4
Q

why will the need for family caregivers will increase dramatically in the coming years because… (4)

A
  • population is aging
  • longevity is increased
  • those w chronic illnesses are living longer and have increasingly complex health care needs
  • formal health care system is overwhelmed
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5
Q

what is the caregiver recognition act (2)

A
  • MB legislation passed in June 2011
  • purpose is to acknowledge vital role of caregivers & set up general principles for gvmt agencies to better support caregivers
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6
Q

how effective has the caregiver recognition act been (2)

A
  • other than designating 1st Tues of every April as caregiver recognition day in MB
  • no tangible actions taken to increase caregiver experiences
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7
Q

palliative care is…

A
  • an approach that improves the QOL of pts and their families (!!!) facing the problems associated w life-threatening illness, thru the prevention and relief of suffering by means of early id and impeccable assessment, and treatment of pain and other problems - phys, psychosocial, and spiritual
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8
Q

what is caregiver-centered care

A
  • care that values caregiver as central

- outlines 6 competencies

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9
Q

what are the 6 competencies of caregiver centered care

A
  1. recognize the caregiver role
  2. communicate with family caregivers
  3. partnering w family caregivers
  4. fostering resilience w family caregivers
  5. navigate health and social systems and accessing resources
  6. enhancing the culture and context of care
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10
Q

describe the competency of “recognizing the caregiver role”

A
  • be aware of & identify their role and responsibilities
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11
Q

describe the competency of “communicating w family members” (4)

A
  • communicate in a matter than demonstrates respect, empathy, and compassion
  • listen actively
  • provide timely info in ways they can understand
  • consistent documentation & info
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12
Q

describe the “partnering w family caregivers” competency (5)

A
  • directed by our attitude towards them (some HCP annoyed or ignore them)
  • understand benefits of including them on care team
  • do WITH caregivers as essential partners in care
  • value their knowledge of pt
  • include them in assessments and care planning
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13
Q

describe the “fostering resilience in family caregivers” competency

A
  • identify & assess their needs r/t their ability to provide care and maintain their own health & wellbeing
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14
Q

describe the “navigating health & social systems and accessing resources” competency (3)

A
  • work together to collab to access applicable supports in timely manner
  • communicate w and make referals to other providers in accordance w family caregiver’s needs & preferences
  • work together to overcome barriers to access services & supports
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15
Q

describe the “enhancing the culture & context of care” competency

A
  • recognize that care & caregiving are effected by societal views
    ex. consider how ageism may effect our caregiver’s experiences
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16
Q

who are caregivers? (7)

A
  • 54% women, 46% men
  • ~25% are >65 yo
  • ~70% are >45
  • sandwich generation
  • most commonly family relationship
  • may be friend or neighbor
  • most likely to be retired (but often not)
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17
Q

what is the “sandwich generation”

A
  • generation who provides care for their parents and children at same time
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18
Q

what stresses can be associated w caregiving (3)``

A
  • physical
  • psychosocial
  • financial

(but dont make assumptions)

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19
Q

describe how the time commitment and intensity of caregiving changes in a chronic progressive illness (2)

A
  • caregiving experience is fundamentally uncertain

- time commitment and intensity increases at end of life

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20
Q

why does time commitment and intensity of caregiving increase at the end of life (2)

A
  • distressing symptoms

- pt becomes more functionally, and sometimes cognitively, impaired

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21
Q

what caregiver feelings are common in caregiving for someone w a chronic progressive illness (6)

A
  • helplessness
  • vulnerability
  • uncertainty (r/t unpredictable trajectory)
  • feel ill-prepared
  • pressured to provide care
  • uncertain abt their abilities
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22
Q

what are 3 aspects of caregiving

A
  • family effect
  • caregiving responsibilities
  • self-care
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23
Q

what is family effect and what does it describe (3)

A
  • states that merely having a family member living w a chronic progressive illness will have impact those around them
  • family also experiences loss, grief, uncertainty abt future, what things will look like as disease unfolds and after they pass
  • family has to also deal w own emotions and responses to having a family member who is ill
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24
Q

what are some of the responsibilities of caregivers (9)

A
  • managing symptoms (ex. constipation)
  • domestic chores & household tasks
  • personal care
  • assisting w ADLs
  • emotional and social support
  • be a spokesperson, advocate, proxy decision maker for them
  • coordinate all aspects of their care v
  • develop new skills
  • acquire lrg amts of new info in short amt of time
25
Q

describe caregiver self-care (7)

A
  • caregiving = disruption in own routines & restrictions on time and energy to engage in activities they usully do
  • social isolation common
  • cease activites outside of home
  • may stop attending community activities they normally are part of for companionship & social support
  • signif fatigue , sleep deprivation
  • postpone own health & wellbeing, medical appts
  • may find it difficult to find time to engage in activities that increase their health (exercise, eating well, etc.)
  • notorious for prioritizing needs of the pt at the expense of their own needs
26
Q

describe the psychosocial burden associated w caregiving (5)

A
  • sense of disruption in “normal life”
  • social isolation common
  • obtaining support hampered by the fact that many family members do not identify themselves as legitimate recipients of help; focus instead on dying person
  • high psychological stress
  • cease activities outside of the home
27
Q

what emotional stressors are associated w caregiving (5)

A
  • vivid awareness of impending death
  • face uncertain future
  • grieve successive losses
  • high anxiety lvls
  • experience depression
28
Q

describe the physical burden associated w caregiving (4)

A
  • long hours of provision of care = signif fatigue
  • sleep deprivation
  • improper nutrition
  • postpone their own medical appts
29
Q

describe the financial burden associated w caregiving (3)

A
  • many caregivers quit working or reduce their hours
  • where benefits are available, difficulty in negotiating the system
  • limited paid leave or job security if take time off work
30
Q

what some issues associated w Canada’s Compassionate Care Benefit (3)

A
  • limitations of benefit
  • strict eligibility
  • short duration of assistance
31
Q

despite feeling overwhelmed, many family caregivers report… (6)

A
  • caregiving as life-enriching
  • derive signif benefits
  • sense of accomplishments
  • belief that they are able to give something back to the indiv
  • allows them to spend intimate times together
  • share final moments together that are meaningful
32
Q

what are some motivators for pt’s desire for care at home (2)

A
  • more familiar enviro

- poor experiences w acute care

33
Q

`what factors impact caregiving experience? (6)

A
  • age
  • culture
  • family dynamics
  • reasons for taking on role
  • view of role within large system
  • preferences for location of care

can impact (+) or (-)

34
Q

describe how age can impact caregiving experience (5)

A
  • if older adult, may not be able to support as much physically & own chronic condition
  • retired vs still working or in school
  • consider developmental stage
  • impacts coping mechanisms
  • have different life demands
35
Q

describe how culture can impact caregiving experiences (4)

A

different expectations:

  • who should take care of them
  • is it their “duty”
  • attitude towards older adults
  • voluntary vs obligated
36
Q

describe how family dynamics can impact caregiving experience (3)

A
  • pre-existing tension = more challenging
  • disagreements between children r/t who should be caregiver
  • good vs poor communication
37
Q

describe how the reasons for taking on a caregiving role can impact caregiving experience (2)

A
  • voluntary vs obligated

- some make promises to providing care at home out of a sense of duty, love, and obligation

38
Q

describe the view of role within larger system can impact caregiving experience (2)

A
  • if they feel like they are an essential part of the healthcare team
  • vs if feel like a burden
39
Q

describe how preferences for location of care can impact caregiving experience

A
  • pt may want to be at home, but the caregiver may have individual needs that make it difficult
40
Q

what factor plays a main role in health outcomes of the caregiver

A
  • caregiving does not = poor health outcomes
  • main factor is how caregivers cope w their role and how they appraise and perceive the situation

review chart from previous week

41
Q

describe assessment of family caregivers (2)

A
  • whole person approach

- recognize that they may be impacted & have needs in any 4 domains

42
Q

what is used to assess caregiver needs

A
  • carer support needs assessment tool (CSNAT(
43
Q

what is the CSNAT (4)

A
  • tool used in the caregiver centered approach
  • not a checklist, way to guide convo
  • represents 14 domains of support needs
  • 7 focus on need that will enable to carer to provide care
  • 7 focus on direct support for carers
44
Q

what are the benefits of using the CSNAT

A
  • provides visiibility abt area of support the caregiver need
  • often dont know what they dont know
45
Q

list the 7 domains of the CSNAT under the “enabling carers to care” category

A
  • knowing who to contact when concerned
  • understanding the pt illness
  • knowing what to expect in the future
  • managing symptoms & giving meds
  • talking to pt about their illness
  • equipment to help care for pt
  • providing personal care to pt
46
Q

list the 7 domains of the CSNAT under the “direct support for carers” category

A
  • own physical health concerns
  • dealing w their own feelings and worries
  • beliefs or spiritual concerns
  • practical help in the home
  • financial, legal, work issues
  • having time for themselves in the day
  • overnight break from caring
47
Q

what are the 5 stages of the CSNAT approach

A
  1. intro to CSNAT
  2. carer consideration of needs
  3. assessment convo
  4. shared action plan
  5. shared review
48
Q

when should the CSNAT be initiated and used? why is this imp?

A
  • initiate early
  • re-visit regularly & as situation changes
  • imp to check in voluntarly & regularly to demonstrate care & understand there needs and if theyve changes
49
Q

what are the take home messages r/t caregiver assessment (6)

A
  • do not make assumptions
  • engage in conversation w family caregivers
  • acknowledge family caregivers
  • genuinely listen
  • do with family caregivers
  • check in w family caregivers regularly and voluntarly
50
Q

describe the importance of not making assumptions abt caregivers (3)

A
  • do not assume they are under only (-) stresss
  • do not assume their needs
  • do not make assumptions abt their experiences
51
Q

describe the importance of engaging in convo w family caregivers (5)

A
  • get to know them
  • use whole person approach
  • learn how illness is impacting them & their needs
  • listen to their story
  • ask open ended questions
52
Q

what is meant by “do with caregivers”(3)

A
  • partner with them , not “do to” or “for them”
  • find out what they need
  • value what you know abt them
53
Q

what should you not say to caregivers? why?

A
  • “you need to take care of yourself”

- they know they need to, may be offensive, not helpful

54
Q

what are some questions to guide care/assessment for the caregiver (6)

A
  • what does the caregiver view as benefits to self-care?
  • what does the caregiver identify as barrier to self-care?
  • how confident is the caregiver that they can overcome these barriers?
  • what kind of self-care activities does the caregiver enjoy?
  • who will support the caregiver to engage in these activities?
  • where is an attractive, safe place to engage in these activities?
55
Q

what are some appropriate supportive resources for caregivers (6)

A
  • referals to approp colleagues (homecare, social work, spiritual care)
  • disease specific resources (alzheimer society, CCMB pt & family support services)
  • caregiving w confidence
  • canadian virtual hospice
  • carers canada
  • employment insurance caregiving benefits
56
Q

what EI caregiving benefits are available for caregivers (3)

A
  • family caregiver benefit for children (max 35 weeks)
  • family caregiver benefit for adults (max 15 weeks)
  • compassionate care benefits (max 26 weeks)
57
Q

what is imp to consider regarding approp supportive resources

A
  • need to be matched and individualized to their needs
58
Q

what should caregivers know abt stress (4)

A
  • there are warning signs
  • various sources of stress
  • things you can and cannot change –> focus on the things you can
  • there are things we can do to reduce stress
59
Q

what are some warning signs of stress (4)

A
  • irritability
  • sleep problems
  • weeping
  • changes to appetite

NURS 3510 - Supportive and Palliative Care (11 decks)

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