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LITERATURE REVIEW OF CAREGIVERS STRESS AND COPING

A Literature review is a critical summary of research on a topic of interest often prepared to put a research problem in context .A literature review helps to lay the foundation for a study and can also inspire new research ideas.

A systematic review of literature and appraisal of all the relevant scholarly literature on the specific topic involves an in depth study. An extensive review of literature was done on the related research and non research literature.

The literature was reviewed under the following areas and analyzed:

2.1. Literature related to caregivers stress

2.2. Literature related to coping measures used to reduce stress

2.1 Literature related to Caregivers stress

The role of the primary caregivers is stressful. They are unable to balance between providing care for a loved one and maintaining their own health status. It has been shown to be influenced by number of factors like duration of care given, functional impairment, dealing with crisis, loss of friends, social isolation, loss of intimacy, anxiety and depression of the caregiver.(Susan Mockos Parks, 2000)

A comparative study was conducted among Euro- Americans and Latinos to study the relationship between family burden of schizophrenia and socio cultural context. Findings suggest differences in levels of family distress in relation to socio-cultural factors like gender, ethnicity, diagnosis, and living situation, across cultural and diagnostic groups. ( Jenkins,J.H. and Schumacher ,J.G.1999).

Two Indian comparative studies were conducted in different states of India on the caregivers’ burden of schizophrenia and OCD patients. Ninety two First degree relatives/ spouses were compared. One study showed higher burden in OCD group that was high among spouses than relatives of schizophrenia group . The same author done another study showed higher burden in schizophrenia than OCD. (Guru raj, 2008).

The study was conducted to measure the perception of burden by caregivers of patients with schizophrenia at Institute of Mental Health and Hospital, Agra. the Burden Assessment Schedule (BAS) was correlated to spouse, physical and mental health, external support, caregiver's routines, support to patient, responsibility-taking, other relatives, patient's behavior and caregiver's strategy. A number of sample is thirty four caregivers of patient with schizophrenia. A low positive correlation was found between urban domiciles and support of the patient and the caregiver's routine. There was a low positive correlation between age less than 30 years and the physical and mental health of the caregiver, and with taking responsibility. (Sunil Srivastava ,2005)

This comparative cross-sectional study assessed family burden among caregivers of patients with OCD and schizophrenia in an Indian setting. Findings shows Indian families experience significant degrees of burden in the care of their relatives with OCD and schizophrenia. Relatives' demographic characteristics did not influence burden severity. Illness severity and patients' disability had a direct positive relationship with perceived family burden. This study suggests to develop local needs based support programme for families of patients with psychiatric disorders in India. (Rammohan, A., 2002)

A case study was investigated the incidence of chronic sorrow in parents of chronically mentally ill children like schizophrenia or bipolar disorder. Convenience samples of 10 parents (four couples and two mothers) of adult children were interviewed using the Burke/NCRCS Chronic Sorrow questionnaire (Caregiver Version). Results showed that 8 out of 10 parents experienced chronic sorrow and suggested that healthcare professionals could assist them by providing information about their child's illness and by involving them in the treatment process. (Georgene G. Eakes., 2004).

A study was examined on psychological distress among Latino family caregivers of adult with schizophrenia. The interview was done by using Zarit Burden Scale. The results shows that younger caregiver age, lower levels of caregivers' education, and higher levels of the patient’s mental illness symptoms were predictive of higher levels of caregiver’s depressive symptoms. Caregiver’s perceived burden mediated the relation between patients psychiatric symptoms and caregiver’s depression. (Sandy. M. Magana., 1997).

According to Ascher-Svanum and Sobel the comparative study was conducted to study the caregivers of mentally ill relatives to explore the relationship between gender and perceived levels of burden. Ninety-seven caregivers (76 women, 21 men) were interviewed. Women were found to experience a greater sense of burden and frustration than men in caring for their mentally ill relatives. The authors concluded that women encountered a wide range of difficulties centered on family and child rearing. (Gloria Denise Mays.,1989).

A study explores the influences of selected social and psychological factors that are associated with perceived caregiver stress among 263 primary caregivers of the elderly in Allahabad City in northern India. The results indicate that although male caregivers' perceived stress depends only on the size of the role overload, female caregiver’s perceived stress depends on the interrelationship between the size of the role overload and adherence to Asian cultural norms. (Rashmi Gupta.,2010).

2.2 Literature Related to Coping measures to Reduce caregivers stress

A study revealed primary caregivers with more active coping strategies perceive low level burden. This findings suggest the nurses to derive problem focused coping strategies for the caregivers. (Schultz, R.Beach., 1999)

A analytical study conducted at Iran to identify caregivers at risk for adverse health effects associated with care giving, the stress, coping, and health. The sample size used was 500 primary caregivers of patients with bipolar disorder. The results shows burdened caregivers had less coping levels, lower mastery and social support. Effective and stigmatized groups had better health outcomes and less service use than the burdened group over time; stigmatized caregivers had poorer self-care than effective caregivers. (Perlick, D.A.., 2008).

A descriptive study was examined the effectiveness of a stress relief initiative for primary caregivers of adolescents with intellectual disability (ID) at Taiwan. Seventy-seven primary caregivers of people with ID were selected the study, which involved participation in one stress management workshop (intervention group only) and both groups reading an education booklet on stress management. They found that 22.1% of caregivers in the study were at high risk of depressive stress and in need of mental health consultation; this prevalence was nearly six times that of the general population. The study results show that a "face-to-face" workshop is an effective way to decrease levels of depressive stress. (Hu, J., 2010).

The pilot study was conducted to assess the level of stress experienced by caregivers of brain tumor patients and to examine both their interest in and preferences for stress reduction programs at North Carolina in USA. Convenience sampling technique was used. The sample size is 60 adult caregivers. The study examined the caregivers' level of stress, beliefs, past experiences, and preferences in regard to stress reduction programs. A seventy two percent of the caregivers reported elevated stress levels , eighty seven percent caregiver believed that stress reduction techniques can help reduce stress ,eighty one percent caregiver were interested in learning about programs to reduce stress . Overall, sixty five caregivers wanted to receive information about stress reduction programs and seventy three percent caregivers were interested in programs such as exercise to reduce stress. Overall, fourty four percentages of caregivers were interested in participating in the various stress reduction programs presented to them in this study. These data provide further evidence that caregivers experience elevated levels of stress and are willing to learn more about and participate in programs to reduce stress .(Keir,S.T.,2007).

The descriptive study was to examine the effects of music, progressive muscle relaxation (PMR), and music combined with progressive muscle relaxation on the reduction of anxiety, fatigue, and improvement of quality of life in family hospice caregivers at university of Kansas in USA. Sample size is 32 .The duration of study was 2 weeks. Paired t test indicated that the control and PMR group exhibited a significant difference in pre and posttest quality of life scores. Results shows that a significant correlation between anxiety and quality of life, anxiety and fatigue, fatigue and quality of life. (Choi,Y.K.,2010).

A mail survey was conducted using a representative sample of 998 employed Chicago residents who provided informal care for at least one person. Ordinary least squares regression models were computed to examine the relationship between caregiver burden and drinking outcomes. Results suggest that caregivers who experience social and emotional burdens related to care giving are at risk for problematic alcohol use and warrant attention from health care and mental health service professionals. (Rosependa, K.M., 2010).

A comparative study conducted in Australia to investigate the relationship between depression, nutritional risk and dietary intake in a population of older caregivers. Mailed questionnaire with sub group participating in a home based interview was used. Seventy-six community dwelling caregivers aged 50 years or over from Victoria, Australia. The data collected related to weight, height, hours of care, depressive symptoms, nutritional risk and appetite, dietary intake and shopping, cooking and meal consumption habits. Results shows thirty two percent of caregivers had depressive symptoms, twenty one percent were at risk of malnutrition, and twenty one percent reported their appetite was bad. Caregivers with depressive symptoms (32%) compared to those with no depressive symptoms (53%) had a poorer appetite (p < 0.05). Of the 20 caregivers who participated in the home interview, 25% reported they ate their meals alone. A result suggests older caregivers had depressive symptoms, were at risk of malnutrition and had poor appetites, although the majorities were overweight or obese. (Torres.S.J.,2010).

A randomized comparative trial was undertaken comparing yoga with relaxation in South Australia. One hundred and thirty-one subjects with mild to moderate levels of stress. One hour sessions of relaxation or hatha yoga for 10 weeks .Following the 10 week intervention stress, anxiety and quality of life scores improved over time. Yoga was found to be as effective as relaxation in reducing stress, anxiety and improving health status. Yoga was more effective than relaxation in improving mental health. Vitality, social function and mental health. Yoga appears to provide a comparable improvement in stress, anxiety and health status compared to relaxation.(Smith, C., 2007).

A pilot study of a yoga and meditation intervention for dementia caregiver stress. Twelve older female dementia patient family caregivers were participated. This study planned to help caregivers cope with stress. Pre test and post test revealed statistically significant reductions in depression and anxiety and improvements in perceived self-efficacy. These findings suggest that yoga and meditation may be a feasible and effective intervention for family caregivers and may improve affect, coping, physical well-being, and stress management.(Waelde, L. C.,2004).


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