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CAREGIVING RELATIONSHIP: A DYADIC PROCESS

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Providing care to elders can be a complex process; the more challenging the patients’ needs, the more complex, demanding, and stressful the caregiver’s role might be (Darer, Hwang, Pham, Bass & Anderson 2004). At the same time, it is important to consider obstacles and challenges of taking care of elderly people in order to work effectively with different generations and cultures. Elderly people consist a heterogeneous group, for which implementing a single management plan proves difficult to achieve. Caregiving can be stressful for the carers due to the demands emerging from the care receiver’s mental and physical deterioration. More precisely, the care recipient’s mental state and behavior are associated with caregiver’s emotional overwhelm, anxiety and depression.

However, the caregiving relationship, by definition, is made up of two people. Caregiving is a dyadic process involving the interactions between a care recipient and a caregiver in their relationship. These patterns of interaction can be both positive and negative. The relationship between the caregiver and the receiver consists of the cognitions, emotions, internalized expectations, and qualifications that the relationship partners construct as a result of their interactions with each other. In this respect, competences in caregiving relationships appear to require the ability of both people involved to find the balance.

The well-being of both the elder and the caregiver has an impact on the well-being of the other member of the dyad (Lyons et al. 2002). According to relevant theory and research, stress is frequently observed as a result of the caregiving relationship on both parties (Pinquart and Sorensen 2003). In other words, one party’s psychological condition mirrors the condition of the other and that distress of one party precipitates problems for the other (Mitrani et al. 2006). Moreover, caregiving dyads seem to be affected by any change related to the social and familial environment that they belong. 

The ways a caregiver alleviates stress is likely to influence the impact of the stressors on themselves and the dyad. The caregiver may experience burnout and become susceptible to mental and emotional distress as well as physical health challenges. This might affect their ability to make a correct assessment of the physical needs and health care status of the care recipient (Long et al., 1998). In addition, caregivers who feel being emotionally overextended may perceive the care recipient to be more impaired than they are. This may result in a negative and emotionally charged atmosphere which can induce a negative effect on everyone’s mood and behaviour and thus, alter the relationships between the variables.

In contrast, when the caregiving relationship is built on acceptance and emotional support, the likelihood of psychological morbidity reduces, and negative symptoms such as anxiety and depression can be decreased (Cooper et al. 2008). Caregivers need to apply different methods in order to cope with tension and meet the caregiving requirements. If their methods are not effective, they may experience what is frequently described as a ‘negative psychological load’ which can influence the quality of their services and their psychological state in general.

According to Isobel Menzies (1960), the working model of nursing and caregiving care, is the model that divides work into tasks, distributes the responsibilities for the care and reduces the emotional relationship with the patients, and thereby reduces the sources of work stress. To this extent, workplace culture adopts a medical-centric paradigm, and care becomes more impersonal and based on routine activities. The lack of an intimate relationship might give rise to feelings of boredom, exclusion, and social marginality. Consistent with this, emotional loneliness and social loneliness have been shown to have distinctive effects on psychological wellbeing in younger (Russell, 1982) as well as in older people (Green, Ericsson, &Winblad, 2001; Holmén, Richardson, Lago, & Schatten-Jones, 2000). Therefore, this working model reflects negative on the psychological state of the elderly and creates a negative circular journey.

In the case that the caregivers adopt a person-centred philosophy then they finally develop relationship-based interactions with the elders. In order to be able to develop and maintain good working relationships with the receivers, it is fundamental to this model for the caregiver to develop mechanisms to deal with a set of negative factors such as work-related stressors, the severity of the recipient’s condition, the role of a caregiver in general, and possible stressors of their private lives. However, this is something that requires time and experience processing.

In conclusion, the relationship established between the two parts of the duo should further be explored to understand the dynamics behind this dyadic interaction. Learning how to deal with this situation and applying the propitious models can be beneficial for both the caregivers and the care receivers. Creating high quality in these relationships will eventually provide benefits which might help sustain the caring aspect of caregiving.

Reference List:

Cooper Claudia, Cornelius Katona and Gill Livingston. (2008). Validity and reliability of the brief cope in carers of people with Dementia. The Journal of Nervous and Mental Disease, 196 (11): 838-843.

Darer JD, Hwang W, Pham HH, Bass EB, Anderson G. (2004). More training needed in chronic care: a survey of US physicians. Acad Med.; 79 (1): 32-40

Green, L. R., Richardson, D. S., Lago, T., & Schatten-Jones, E. C. (2001). Network correlates of social and emotional loneliness in young and older adults. Personality and Social Psychology Bulletin, 27, 281-288. doi:10.1177/0146167201273002

Long, K., Sudha, S., & Mutran, E. J. (1998). Elder-proxy agreement concerning the functional status and medical history of the older person: The impact of caregiver burden and depressive symptomatology. Journal of the American Geriatrics Society, 46: 1103–1111.

Lyons, K. S., Zarit, S. H., Sayer, A. G., & Whitlatch, C. J. (2002). Caregiving as a dyadic process: Perspectives from caregiver and receiver. Journal of Gerontology: Psychological Sciences, 57B: 195–204.

Menzies IEP. (1960). A case study in the functioning of social systems as a defence against anxiety. Hum Relat, 13: 95–121

Mitrani Victoria B., John E. Lewis, Daniel J. Feaster, Sara J. Czaja, Carl Eisdorfer, Richard Schulz, Jose Szapocznik. (2006). The Role of Family Functioning in the Stress Process of Dementia Caregivers: A Structural Family Framework. The Gerontologist, Volume 46, Issue 1; 97–105.

Pinquart, M. & So Rensen, S. (2003a). Predictors of caregiver burden and depressive mood: a meta-analysis. Journal of Gerontology, Psychological Sciences, 58: 112–128

Russell, D. (1982). The measurement of loneliness. In Peplau L. A. & D. Perlman (Eds.), Loneliness: A sourcebook of current theory, research, and therapy. New York, NY: Wiley. 81-104.

PINQUART,M.&So¨RENSEN, S. (2003a). Predictors of

caregiver burden and depressive mood: a meta-analysis.

Journal of Gerontology,Psychological Sciences,58,

P112–P128

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The Caregiver and Their Feelings

Caring about someone

It takes determination and strength to help the sick or elderly in their daily life. Caring is also a job people prefer to do. Caregiver is a job to be respected. Caregivers can be called upon to provide a wide variety of assistance with activities of daily living, including bathing, toileting, dressing, medications, and eating. Almost all caregivers have to work long hours, and they have to be quite careful at this time.

Caregiver’s Feelings

  Caregivers feel a lot of emotions all of the work-day. Some important emotions, impatience, fear, guilt, lack of appreciation and loneliness. Spending all your time caring at someone makes you feel tired. At the end of the day, they may be too tired to join social activities, this leads to a worsening of family and social relationships of caregivers which place more responsibility on caregivers.

Some caregivers blame themselves for a bad relationship or they think them forgotten. These are reasons to cause a psychological and physical sickness. Some caregivers always face the feeling of guilt, for not loving or even liking the person in need of care at times. If the person in need of care gets hurt or something else happens, there is guilt about it being your fault that it happened.

Commonly, caregivers don’t share the feelings with no one. Sharing emotions with others relieve fear. Some people in need of care, don’t listen to caregivers and they don’t want to do what they say. Caregivers occasionally have to spend a long time to do a task and this situation can make caregivers more impatient.

How To Manage Your Feelings

 Emotional support:  Sharing emotions with others relieves stress and may offer a different perspective on problems. These are helpful steps to improve the emotional and physical health of caregivers. Talk to friends or family who give you positive support. A therapist can be a great help, too. 

 Wellness actives : Many caregivers neglect their own emotional, physical and spiritual needs. Wellness encompasses healthy all-around living. Some studies suggest eating a balanced diet, getting at least seven hours of restorative sleep, regular exercise caring for emotional health by way of a mental health provider. Try to :  Get enough sleep, meditate or yoga.

 Stay active and social: Connecting with others in similar situations is powerful, because you no longer feel isolated and you can learn from others. And keep up with hobbies, community groups, and activities that bring you joy and meaning.

 Accept help: The more help and support you accept, the better it will make you feel.  You do not have to do it all, nor is it healthy to do it all. The best way to avoid burnout is to accept help. People often want to help; just ask.   Whether you become a caregiver gradually or all of sudden due to a crisis, or whether you are a caregiver willingly or by default, many emotions surface when you take on the job of caregiving. Whatever your situation, it is important to remember that you, too, are important

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The characteristics of the caregiver

Characteristics of the perfect caregiver of the elderly

Caring for the elderly comes with a great responsibility. Definitely not everyone can successfully cope with that role. In order to succeed in this job a person should have certain set of characteristics presence of which will allow the workers to be satisfied with their work. In this article I will deal primarily with mental immunity and so-called caregiver stress syndrome, but at the beginning I will also mention other personality traits and characteristics necessary to practice this profession.

First of all, we need to remember that a good caregiver is a composed and patient person. Both of these features are extremely important in dealing with dependent people who, because of their age and disease might feel nervous, lost or be in a bad mood. Another important feature is the ability to react quickly in crisis situations and resistance to stress. Putting a brave on things in a the event of sudden deterioration in the well-being of an elderly person and the ability to provide first aid are amongst the most important responsibilities of a senior care assistant. Knowledge about diseases and illnesses affecting the elderly is also very useful. A good caregiver should be empathic and sensitive to the feelings and needs of the elderly. It is vital to support, talk and build positive relationships between the caregiver and the mentee. Important personality traits undoubtedly include warmth and cordiality, which a person can bestow on their mentee: it’s mainly about the ability to create a situation where the senior will feel good and safe. It should also be remembered that the basic principle in the care of the elderly people is respect for the mentee. Certainly, good physical condition is an important feature of an elderly person’s caregiver. Everyday activities related to the care of the dependents require efficiency while performing various types of duties.

To sum up, the work of an elderly person’s guardian is a demanding job, and therefore it should certainly not be done by random people (whose main motivation is for example to earn money), but those who have the appropriate predispositions for it.

Mental resistance and work with the elderly and the so-called caregiver stress syndrome

 “Mental resistance is a personality trait that largely determines how well we deal with challenges, stressors and pressure, regardless of the circumstances” (Strycharczyk, Clough, 2015).

Even the most resistant people can lose their resistance after long-term care of a chronically ill person. Performing tasks under constant stress has certain emotional and social consequences.

This situation can lead to symptoms that are called the Caregiver Syndrome (or CSS – Caregiver Stress Syndrome).

Caregiver Stress Syndrome is a new phenomenon in psychology, scientists in the world have only been dealing with it for 20 years. In Poland, this phenomenon was highlighted a few years ago. So let’s get to know what caregiver’s stress syndrome is and how to deal with it.

Caregivers often complain about the lack of gratitude on the part of the elderly. Paradoxically – by devoting their time and strength to the person looked after, the elderly often become their greatest enemies, because they constantly demand, forbid or order something. This situation may lead to symptoms that are called the Caregiver Stress Syndrome.

The Caregiver Syndrome – symptoms


The “Caregiver Syndrome” is characterized by specific symptoms:

• physical (e.g. pain, tiredness),

• psychosomatic (e.g. problems with sleep, appetite),

• psychosocial (e.g. feelings of emptiness, loneliness, isolation).

They can occur in people with responsibility for caring for the sick and are compounded by chronic fatigue and neglect of their own needs. The environment – both medical staff who take care of the sick and the immediate environment (family, neighbours, etc.) – expects the carer to fulfill his duties perfectly. Everyone accounts for the caregiver, at the same time forgetting about him and his rights. If the caregiver does not devote himself completely to his role, he is assessed as uninvolved, not caring for his mentee. In such circumstances, self-care would be a manifestation of unacceptable selfishness of the guardian. A danger for the person who deals with the sick are the symptoms of depression. Symptoms of the guardian’s syndrome develop slowly, parallel to the deteriorating health of the mentee. The caregiver often experiences sadness, feelings of emptiness, loses interest in the current forms of activity. In depression, he can neglect his duties, posing a threat to the mentee and himself. In very extreme cases, suicidal thoughts may occur. Especially when the caregiver is a sick person and needs help.

Chronic stress severely strains our immune system, a caregiver more often than usually becomes ill with various types of infections. Due to fatigue, the ability to think and concentrate also deteriorate. A common manifestation of the Caregiver Syndrome is anger at the mentee, the situation in which the caregiver finds himself, and reluctance to perform everyday activities. The slightest failure can then cause irritability and irritation as well as anger that is difficult to control. It also happens that a person caring for a sick and elderly person is accompanied by a constant feeling of guilt because of neglecting their duties, their improper performance or suppressed anger at the patient. Most symptoms can be greatly exaggerated, that is, they can be felt by a person who performs his duties correctly and properly. In summary – the main symptoms of the Guardian’s Syndrome are:

  • connection
  • exhaustion
  • feeling guilty
  • anger
  • anxiety
  • depression
  • feeling of powerlessness
  • deterioration of physical health
  • pain
  • insomnia.

According to the report published by the website www.health.com, carers of the elderly are in the first place in the ranking covering professions that can contribute most to the appearance of mood disorders. Nearly 11 percent of those performing this occupation suffer from depression.

How can you deal with the Caregiver Syndrome?


           Most caregivers do not seek professional help because they do not realize that they suffer from a medical condition. What is happening to them they usually interpret as weakness of their character or lack of skills. Meanwhile, the significance of the problem is demonstrated by the results of research carried out at the University of Pittsburgh by Richard Schulz and Scott Beach, according to which the care of a chronically ill person increases the risk of death by 63% compared to a group of peers who do not work as caregivers.

           It is important for the caregiver to watch not only the patient but also himself. If he wants to be good at what he does, he must take care of himself first. Someone who is exhausted, irritable, depressed – will not be a good guardian. That is why “healthy egoism” is needed – that is, above all, taking care of one’s own needs. A good guardian is a smiling and relaxed guardian. A serious mistake is to take the posture: “I have to manage, I have to be independent, I will not ask anyone for help.” With proper support, the role of guardian may become easier. First you need to take into account informal support, which includes family, friends, neighbors. They are a good source of help, especially emergency help, and their presence can improve the patient’s mood. It is a mistake to isolate and avoid people who would like to help or even listen to the problems. It is advisable to talk about matters related to the syndrome and to accept the help offered.

Caregivers should think about support systems at an early stage of their career. Thanks to regular help focused on the physical and emotional needs of the caregiver, crisis situations are prevented, which in the context of many long years of care for the elderly person is crucial for the health and quality of life of not only the caregiver but also the caregiver’s mentee.
         

The first symptoms of the Caregiver’s Syndrome may be controlled by the caregiver himself, but it is worth remembering that the more serious symptoms of the disease usually require the help of a psychologist. The caretaker of the elderly person should remember that apart from working for their mentee, they also have their own life and must not forget about it during everyday activities. Our work will be better and more efficient if in everyday life we ​​plan time to rest, relax, go for a walk, clear our thoughts from the patient’s problems and deal with the things we like. It is important not to blame yourself for the patient’s condition, not to give up if the disease wins again, and not us, and to find strength in fighting other health problems of the patient. If the patient is troublesome, cranky and frustrated, it is worth explaining his behavior with illness and suffering, and not with deliberate malice directed against us. It facilitates work and changes our attitude towards the mentee.

None of us is self-sufficient. It is more obvious that in a situation of a loved one’s chronic illness, we should be able to use the help of others. It will certainly be useful for both caregivers and the sick. It is worth remembering the following possibilities:

• support of family, friends and even neighbors,

• support groups (it’s easiest to contact the attending physician to contact them),

• help of specialists – doctor, psychologist, nurse,

• relax – that is, all those forms of activity that bring relaxation to a given person (walking, reading, cooking, jogging, nordic walking, listening to music, meeting with friends, etc.)

If the caregiver understands that he is not irreplaceable and there are no contraindications for some of the duties to be taken over by others, and additionally he will take care of his mental comfort – there is much less chance of being touched by the Caregiver’s Syndrome.

Article by: psychologist Małgorzata Mitura-Cegłowska

Bibliography:

Lasarus R. S. (1966), Psychological stress and the coping proces. New York: McGrow-Hill

Kristof-Brown A. L., Zimmerman R. D., Johnson E. C. (2005), Consequences of individuals’ fit at work: A meta-analysis of person-job, person-organization, person-group, and person-supervisor FIT, Personnel Psychology

Selye H. (1983), The stress concept: Past, present, and future. New York: C. L. Cooper

Styrycharczyk D., Clough P. (2015), Developing Mental Toughness. Coaching strategies to improve performance, resiliences and wellbeing. London: Kogan.

www.health.com