Psychiatric Mental Health Nursing by Videbeck

534 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS

Caring for clients with dementia can be emotion-
ally and physically exhausting and stressful. Care-
givers may need to drastically change their own lives,
such as quitting a job, to provide care. Caregivers
may have young children as well. They often feel ex-
hausted and as if they are “on duty” 24 hours a day.
Caregivers caring for parents may have difficulty
“being in charge” of their mothers or fathers (role re-
versal). They may feel uncomfortable or depressed
about having to bathe, feed, or change diapers for
parents.
Role strain is identified when the demands of
providing care threaten to overwhelm a caregiver.
Indications of role strain include constant fatigue
that is unrelieved by rest, increased use of alcohol
or other drugs, social isolation, inattention to per-
sonal needs, and inability or unwillingness to accept
help from others. Caregivers may feel unappreci-
ated by other family members as indicated by state-
ments such as “No one ever asks how Iam!” (Small,
2000). In some situations, role strain can contribute
to the neglect or abuse of clients with dementia (see
Chap. 11).

Supporting the caregiver is an important com-

ponent of providing care to clients with dementia at

home. Caregivers must have an ongoing relationship

with a knowledgeable health professional; the client’s

physician can make referrals to other health care

providers. Depending on the situation, that person

may be a nurse, care manager, or social worker. This

person can provide information, support, and assis-

tance during the time that home care is provided.

Caregivers need education about dementia and the

type of care that clients need. Caregivers should use

the interventions previously discussed to promote the

client’s well being, deal with deficits and limitations,

and maximize the quality of the client’s life. Because

the care that clients need change as the dementia pro-

gresses, this education by the nurse, care manager, or

social worker is ongoing.

Caregivers need outlets for dealing with their

own feelings. Support groups can help them to ex-

press frustration, sadness, anger, guilt, or ambiva-

lence; all these feelings are common. Attending a sup-

port group regularly also means that caregivers have

time with people who understand the many demands

continued from page 533

Giving the client an implement while stating its

related function is an approach that compensates

for memory loss.

Providing links with previous behaviors helps the

client to make connections that he or she may not

be able to make independently.

It is important to maximize independent function

and to unobtrusively assist the client when mem-

ory function has deteriorated further.

It is important to preserve the client’s dignity and

minimize his or her frustration with progressive

memory loss.

Provide verbal connections between implements

and their functions rather than assuming the

client will know what is expected of him or her.

For example, “Here is a washcloth to wash your

face,” “Here is a spoon you can use to eat your

dessert.”

Integrate reminders of previous events into cur-

rent interactions such as “Earlier you put some

clothes in the washing machine, it’s time to put

them in the dryer.”

Increase assistance with tasks as needed, but do

not “rush” to do things for the client that he or

she can still do independently.

Use a matter-of-fact approach when assuming

tasks the client can no longer perform. Do not

allow the client to work unsuccessfully at any

given task for an extended period of time.

Adapted from Schultz, J. M. & Videbeck, S. L. (2002). Lippincott’s Manual of Psychiatric Nursing Care Plans (6th ed.). Philadelphia:

Lippincott Williams & Wilkins.