ONS Connect - November 2008 - (Page 18)

FIvEmINUTEINSErvICE As sEEn in thE CliniCal Journal of onCology nursing Put Evidence Into Practice to Manage Caregiver Strain and Burden [By Elisa Becze, BA, ONS Staff Writer] any patients with cancer require the support of a family caregiver, which may involve tasks ranging from help with activities of daily living to fulltime, around-the-clock care. Strain and burden are common in caregivers and have the ability to affect their physical and mental health. Nurses are in a unique position to assess and manage caregiver strain and burden because of the amount of time they spend with patients and their families. The ONS Putting Evidence Into Practice® (PEP) Caregiver Strain and Burden Project Team reviewed, critiqued, and summarized the research evidence for nursing interventions for caregivers experiencing strain and burden. Their work was reported in the June 2008 issue of the Clinical Journal of Oncology Nursing (Honea et al., 2008). See Figure 1 for a summary of the PEP team’s recommendations. Caregiver burden Caregiver burden can be measured objectively or subjectively. Objective measures take into consideration variables such as the number of hours that care is provided or the number of tasks caregivers perform on behalf of patients. Subjective measures involve more accurate representations of caregivers’ emotional reactions to the impact of providing care, particularly in relationship to the M development of depressive symptoms (e.g., the way that caregivers perceive the bother associated with those tasks). A number of tools are available for measuring caregiver strain and burden. • Appraisal of Caregiving Scale: measures burden related to harm/loss, threat, challenges, benefit, and benign • Caregiver Demands Index: measures burden related to meals, intimate care, movement and comfort, medications and treatments, supervision, rest, and acquisition of new skills • Caregiver Reaction Assessment: measures burden related to self-esteem; lack of family support; and impact on finances, schedule, and health • Caregiver Strain Index: measures burden related to financial, physical, and social well-being and time • Memorial Symptom Assessment Scale: measures burden related to frequency, severity, and distress of patient symptoms • Zarit Burden Inventory: measures burden related to health, psychological well-being, finances, social life, and relationship with patient Nursing Interventions The ONS PEP team performed an extensive literature search but found only 20 intervention studies, of which only eight specifically cited outcome measures for strain and burden. The studies fell into seven categories. During the initial PEP analysis discussed in this article, none of the interventions could be recommended for practice, but several were considered likely to be effective. Psychoeducational interventions relate to structured programs of information. Programs that taught symptom management, discussed psychosocial issues, identified resources, discussed coordination of services, or taught caregiver selfcare were included in this category and are considered likely to be effective. Key Definitions Caregiver strain: occurs when caregivers perceive difficulty performing roles or feel overwhelmed by their tasks Objective caregiver burden: involves activities associated with the caregiver role, such as delivering practical physical care on a day-to-day basis or managing challenging behavioral changes in patients Subjective caregiver burden: involves caregivers’ emotional reactions to the caregiving role, such as worry, anxiety, frustration, or fatigue Five-Minute In-Service is a monthly feature that offers readers a concise recap of a full-length article published in the Clinical Journal of Oncology Nursing (CJON) or Oncology Nursing Forum. This edition summarizes “Putting Evidence Into Practice®: Nursing Assessment and Interventions to Reduce Family Caregiver Strain and Burden” by Norissa J. Honea, RN, AOCN®, CCRP, RuthAnn Brintnall, PhD, AOCN®, CHPN, APRN-BC, Barbara Given, PhD, RN, FAAN, Paula Sherwood, PhD, RN, CNRN, Deidre B. Colao, RN, BSN, OCN®, Susan C. Somers, BA, RN, BSN, OCN®, and Laurel L. Northouse, PhD, RN, FAAN, which was featured in the June 2008 issue of CJON. Questions regarding the information presented in this Five-Minute In-Service should be directed to the CJON editor at CJONEditor@ons.org. Photocopying of this article for educational purposes and group discussion is permitted. 18 ONS CONNECT November 2008

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ONS Connect - November 2008 Contents Editor's Note Just In Lean on Me You Tell Us A Year in the Life-- Month Eleven Put Evidence Into Practice to Manage Caregiver Strain and Burden Web Connect Capitol Connection Caregiver Care New Technique Monitors Patients with NSCLC Calendar of Events Working for You Staying on Top

ONS Connect - November 2008

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