by Diane Forrest, RN
Part Four (It’s a tough job, the physical part of giving care)
Taking care of a family member is a tough job but also a very rewarding one! So far I have talked about how to listen, how to take care of yourself, and how to write notes. Now how to do the actual work. Each person's experience is different. Some family members require more care than others. For example, my grandmother lived to be 86 years old. During the last 6 years of her life she lived with my parents. She had no medical problems, was alert, and was able to perform her personal needs. She moved in with my parents because she lived far away, and my mother didn't feel safe with her being alone and not being able to get to her fast enough should a problem come up. The care she provided to her mother was minimum. Providing food and shelter and companionship was all she required.
My husband's aunt, who is 95, lived with her husband, 90, in a senior apartment complex. They required no care until the uncle passed away suddenly from a heart attack at home. His death caused the aunt to have bouts of confusion. Her granddaughter decided to bring her to live at her home, but she became disoriented and combative and destructive. Having small children at home, she opted to place her grandmother in a nursing facility, where she could be cared for and be safe from harming herself or others, but continues to oversee her care and provides basic necessities and companionship.
Another married couple, in their 80's were living together without any problems until the wife had a stroke. Her husband took great care as long as he could, but it became too much for him. She was moved to a nursing facility, however he gets up every morning to get her up and ready for breakfast, helps feed her, spends the entire day with her and puts her to bed each night. They recently renewed their wedding vows having been married for 65 years.
On New Year’s Eve, a 17 year old boy in my town was involved in a car accident, leaving him paralyzed below the waist. He requires assistance getting up and laying down, but is able to care for himself in every other aspect. Then there was my husband, who was bedridden and required total care.
Each of these relationships; parent, child, grandparent and spouse, require different types of care, however, the ability to provide care may be difficult for some. The first and probably main issue to conquer is embarrassment. Body image is a powerful thing. When you spend the first part of your life being cared for by your parents, then later in life to return the favor to your parents can be a difficult chore. It's one thing to have your mother change your diapers when you are a baby, and it's totally different to change your mother's diaper. Not only do you want to respect their privacy, but you also want to make sure that no problems are developing.
When I told you about the SOAP charting, I mentioned that A stands for assessment. This is best done first thing in the morning during morning care such as bathing. If the person you are caring for is able to perform this action for themselves, then you will need to be close by, offer assistance and support. If they require assistance, the first thing is maintain privacy. For example, while my grandmother was at my parents she was able to perform self-care. Once she had a spell of confusion and my parents were out of town and asked me to stay with her in case she fell or became disoriented. When it came time for her shower, I placed the necessary equipment within reach for her, kept her covered with a towel while assisting her out of her clothes. Assisted her into the shower stall before removing her towel, then had it ready for her to wrap in once the shower was complete. Minimum exposure is necessary for maximum comfort.
The most important tool for providing comfort is conversation. While the procedures you are doing may be embarrassing for you, imagine how the other person feels. Simply chatting during this time will ease both parties involved. Talking about the weather, the neighbors, the children or grandchildren will take their minds off what is going on, and will put you both at ease.
My husband was an extremely shy person, even with me. It was very stressful for him when I had to perform his catheter care. He was concerned about changes in his body and his appearance. I was aware of these concerns, and during these times I made sure to have him completely covered, except for the area I was working on, and constantly reassured him that my love for him had not changed. In the last year, his doctor had ordered home health visits once a week to help me with his care. While he loved to flirt and "carry on" with his aide, he made it perfectly clear that he did not want her to see his body. I explained this to her. Even though she was there to help bath him, and he didn't want that help, it was important that he have interaction with someone other than me. We devised a plan to allow her to wash his feet. He was completely covered except for his feet. He enjoyed his weekly soaks and spending time with someone other than me for an hour a week. When I questioned him about why he didn't want anyone else to do his care he would say, well ... what if it was you laying here, would you want someone looking at you and washing you all over? Of course, I wouldn't like to be in that position so I tried to use this reasoning each day as I cared for him. How would I feel? What would I want done or not done?
Some things are easier to take care of than others. Cuts or scrapes are not embarrassing problems to tackle. Fingernail and foot care can be enjoyable for the person on the receiving end. Once you get to other problems such as catheter care or bowel evacuation things get more personal. These things are necessary, just try putting yourself in their place, and imagine how you would want to be treated.
While I was in nursing school I was assigned the patient nobody wanted. He was a 17 year old boy who had been in an accident. His injuries were not critical, having a broken leg. His father was with him constantly, and was quite a bear! He would yell and scream at everyone, nobody wanted to go in that room. I was faced with a problem. I had a job to do, a patient to take care of, and a bulldog to get past! When I first entered the room for my assessment and talking with the boy and his father I determined that the main problem was fear. The boy was afraid of being hurt and exposed while the father was afraid of the possibility of the fact he could have lost his son, and he didn't want to see him in pain or distress. I began by putting them at ease. I noticed a baseball cap with a company logo, the same company my father worked for. I began talking about that with the father until he began to relax. Then I noticed the boy, who had been hospitalized for about two weeks by this time, had greasy hair. It has not been washed since he had been admitted. Just a simple job like a shampoo made the boy relax and his father relieved so that I was able to complete the day without any problems and perform all the necessary procedures without any resistance. In fact they were both so grateful they sent a box of candy to me at the school.
So, remember that while you are caring for your loved one to put yourself in their shoes, imagine how you want to be treated and things will go much smoother for everyone. Like the Golden Rule says, “Do unto others, as you would have them do unto you."