The Complex Nature of Informal Care in Home-Based Heart Failure Management - Literature review Example

Critique of "The complex nature of informal care in home-based heart failure Management" Introduction Informal care has been taking on increased importance in conditions like Chronic Heart Failure (CHF). Clark et al (2007) attempts to chart carer's help in managing CHF patients. Informal care is increasingly recognized as being indispensable. There are deficiencies in informal carer's management of CHF patients - as surveys have shown. Informal carers were deficient in technical or clinical knowledge of CHF, however the extensive informal understanding of the respective patient built up profile of concerned patient like no formal care could have managed. If these informal care givers are provided basic clinical education in recognizing the CHF symptoms then informal care giving will not only improve but also help manage the quality of CHF patient's life better. Purpose of the study Management of CHF requires shared responsibilities as increasing number of CHF patients have decreased formal care provision. Informal care is an avenue that has best potential for ensuring adequate quality of life for CHF patients, and at the same time also ensuring that CHF patients get more attention than would have been possible in formal care. Clark et al (2007) survey of informal carers and their patients has pointed out that informal care givers have been able to manage and ensure adequate quality of life for CHF patients. Authors have pointed out that informal and invisibl3 care could be even better managed if the informal care givers were given basic training for recognizing and managing some of CHF symptoms. Literature Review Francine et al (2002) provides enlightening statistics that in 2002 there were at least 41 million people with chronic debilitating conditions. Another issue might be increased longevity through intervention better nutrition and quality of life - thus the proportion of old people afflicted with chronic conditions is continually rising. Informal caring which may be through family or friends (and usually is honorary) has taken on increasingly important role as formal carers reduce in proportion to the chronically ill. Incidentally most of the informal care is given by women, be it daughters or sometimes wives. The toll on women caregivers is quite stressful with many women being forced to take lower paying jobs that allow them more time for. Care giving has also been known to be mentally taxing and causing emotional stress. Caregivers are more susceptible to indigestion and high blood pressure and caregivers, who care for patients with Alzheimer and psychopathological disorders, may have bouts of depression. Informal care givers are not given adequate governmental support and many of the services performed for ill disposed may not be reimbursable through NHA or Medicaid. Francine et al (2002) reiterate that policies should be introduced that recognize the efforts and work performed by the care givers. As care givers tend to be over 40, many of the social workers and care givers might themselves be in need of support in coming years (Francine et al 2002). Understanding Chronic Heart Failure may be important to appreciate the need for informal care. Donovan (2008) defines CHF as condition affecting older population which affects temperament and frequently is terminal. Using survey of care givers gave 3 dimensions which were important in informal care. Caring for CHF patient was frequently a shared activity and involved both visible and invisible methods of caring. The severity of symptoms determined the type and quantity of intervention requirements. The carer's lack of formal knowledge was contrasted by knowledge gleaned from experience with CHF patient. The informal care givers were cognizant of patient's mood, physiology temperament changes and could relate to these changes with corresponding requirements of more intensive care provision. The visible caring activities, managing medicine and personal care, were found to be tiring. As CHF conditioned worsened CHF patients were found to require more frequent intervention and even simple acts taken for granted was a chore for CHF patients. The invisible dimensions are where nursing practice can learn from the expertise of the care giver. The role of informal care giving also takes an important role when we consider that many of the patients are non aware of the services that have been entitled to and ease of access of such services. As Gott et al (2007) suggests in UK more than 60 percent of survey respondents with aggravated CHF received no assistance services. Ironically Gott et al (2007) opines that advanced cancer patients received more intensive services while CHF patients were treated equally irrespective of advancement in heart disease. Methods, procedures and ethical aspects Selman et al (2007) describes survey of staff working in alleviative care services for CHF patients. Organization of care was found to be a significant issue and foremost challenge for care givers. Joint working group between palliative care, nurses and GP's was required to manage these patients efficiently. Here nursing was seen as essential to give adequate care. Resource allocation in line with increasing number of patients and proportion of decreasing specialists might form a bottleneck. Informal care, especially if it can be provided basic training might help in reducing load off primary care staff (Donovan 2008). Algera et al (2003) reviewing Home care needs of patients with long-term conditions suggest that four major factors impinging on usage of professional home care. The first aspect deals with patient's condition. Morbidity and combination of symptoms enforced home care in contrast to patients with lower incidence of the disease. Secondly besides perception impairment through CHF, stroke patients or having cancer increased possibility of acquiring home based care. Patient perception of own health status also was an important factor in requisitioning home based care - negative perception of own health status was also found to be associated with increased need of home based care. Also another group of persons who had used such care in the past were more likely to utilize such care in the future as well. Home care user thus describes patients who satisfy the need related determinants are more likely to avail such services, while younger persons generally do not avail such services (Algera et al 2003). Results and discussion Li (2004) uses data from US care giving survey that used a sample of 157 Asian American caregivers whose services had been used for past one year. The survey assessed service barriers and gauged unmet service needs. Older Asian Americans were deduced to be hesitant to access home based support services and often the services, that did reach theses persons, were deficient in meeting client's needs. Specifically service barriers resulted from availability and awareness of such services. Personal barriers, such as pride, may also be stopping needy persons from requisitioning such services. Other barriers may include limited supply of ethnic specific services and lack of appropriate education on culture specific elements might result in unsatisfied clients. Unmet needs were focused on adult day care, meal provisions, and personal care. Adult care was reported deficient when care givers failed to be sensitive to language and cultural needs while lack of ethnic foods may raise unhappiness with meal provisions. Personal care aspect may be due to Asian American's older generation's pride not allowing asking for such care until these clients can't manage on their own (Li 2004). As we have seen informal care may be required by significant population and as proportion of older persons grows there will be corresponding more demand of informal care giving. It is known that effective caring both from medication management and from behavioral side can thwart onset of CHF. Clark et al (2007) assert that both patients and healthcare professionals have limited knowledge of CHF management in an appropriate manner. Informal care, as we have seen, is usually provided by partners, family or friends. Active support from nursing practitioners is required to enable informal care givers to be better educated about CHF management. Clark et al (2007) describes survey of care givers in which the carers' skills were elicited. One important limitation is that the survey recorded only the description of care giving activities as reported by the care givers. This effectively introduces carer's perception and self beliefs rather than actual practice of care givers. The amount of care was conditional to observable symptoms by care givers and as needs of patients changed the attention and care giving activities changed accordingly. An important aspect is the experiential symptom management that caregivers had. Care givers learnt from the patient adjusting as the client's observable condition or symptoms changed - there was a distinct lack of clinical or formal knowledge base background. This means that if nursing practitioners can intervene and provide education to care givers the quality of care giving would also improve and care giving could correspondingly be not only from experiential observation but also from clinical knowledge. Carers monitored patient's limbs for fluid retention however there was lack of behavior management intervention for managing such condition, however on the other hand care givers were proficient in understand subtle cues - including mood swings, and physiology changes. Such variations are not normally noticed in formal care because of lack of attention or lack of time available for single patient. Visible caring activities including managing medication, behavior observation while invisible caring included surveillance and monitoring activities that allowed registration of subtle changes in patient. Visible caring was time consuming and tiring- invisible caring also required efforts but the efforts were less demanding. Carers through constant surveillance had developed a barometer for reading patient's conditions in more incisive way than perhaps understood by patient himself. Carers also made judgmental calls as when to call for professional intervention. Informal care extends beyond the obvious and it is this invisible work that needs to be recognized and bolstered with care giver education for similar proficiency in the visible segment as well. Care givers role should be better publicized and appropriate education intervention provided to care givers for improving quality of their work. Nursing practice gets significant help from such informal care as most of nursing work is already covered. Nurse led support of care givers can help provide carers with skills for improved quality of care and scientific understanding of what they learn intuitively. Conclusion The Article by Clark et al (2007) is easy reading yet the information cited is based on data that was collected in 2001, and article was published in 2007. The time lag between the data collected and data reported may be significant. Also the data is only for patients from two outpatient clinics in Glasgow, limited to 30 carers. Therefore with larger sample size spread over different geographical areas may provide different results. Open ended questions provide data that is unstructured and usually result in biased interpretation as would be expected from free text. Further as also mentioned above the study only reported accounts of carers' rather than first hand observation of carers. The general results are validated according to other results from surveys for incapacitated patients care givers hence there is not a significant deviation. The authors of the study are either professors or cardiologists hence the credibility of information is unquestionable. Authors however do point out at the outset that there is need for more research into lay person care giving as well as the dimensions of invisible care giving and therefore larger sample size might be recommended for future study of this sort. List of References 1. Algera M; Francke AL; Kerkstra A; van der Zee J. (2004 May) "Home care needs of patients with long-term conditions: literature review" Journal Of Advanced Nursing Vol. 46 (4), pp. 417-29; 2. Clark, A. M.; Reid, M.E.; Morrison, C.E.; Capewell, S.; Murdoch, D. L.; McMurray, J. J. (Feb2008) "The complex nature of informal care in home-based heart failure management" Journal of Advanced Nursing, . 61 Issue 4, p373-383, 11p 3. Conway-G. F.; Crowley, A.; Gorin, S. H. (Nov2002) "Crisis in Caregiving: A Call to Action" Health & Social Work, Vol. 27 Issue 4, p307-311, 5p; 4. Donovan, S. (Apr2008) "Chronic heart failure" Primary Health Care, Vol. 18 Issue 3, p30-30, 1p 5. Li H. (2004 Sep) "Barriers to and unmet needs for supportive services: experiences of Asian-American caregivers" Journal Of Cross-Cultural Gerontology, Vol. 19 (3), pp. 241-60; 6. Molloy, G. J.; Johnston, D. W.; Johnston, M.; Chuan G.; Witham, M. D.; Struthers, A.D; McMurdo, M. E. T. (Sep2008) "Using the demand-control model of job strain to predict caregiver burden and caregiver satisfaction in the informal caregivers of heart failure patients" British Journal of Health Psychology, Vol. 13 Issue 3, p401-417, 17p Bibliography 1. Algera, M.; Francke, A. L.; Kerkstra, A.; Van der Zee, J.( May2004) "Integrative Literature Reviews And Meta-Analyses Home care needs of patients with long-term conditions: literature review" Journal of Advanced Nursing, Vol. 46 Issue 4, p417-429, 13p 2. Hughes, C.; Alford, J.; Campbell, L.; Rule, M.; Armstrong, M.; Such, C.; Ward, R.L. (Sep2002) "Caring for the chronically ill: a clinic for final-year medical students" Medical Teacher, , Vol. 24 Issue 5, p564-566, 3p; Read More