Usually supportive primary person (family member or close friend)

provides insufficient, ineffective, or compromised support, comfort,

assistance, or encouragement that may be needed by the patient to

manage or master adaptive tasks related to health challenge


• Attempts to assist the patient with unsatisfactory results

• Displays of protective behavior disproportionate to the patient’s

abilities or need for autonomy (family member)

• Expresses concern about the family’s response to health problem

• Reports preoccupation with personal reaction to the patient’s



• Exhaustion of supportive

• Lack of reciprocal support

capacity of significant people

• Temporary preoccupation by a

• Incorrect information by a pri-

significant person

mary person

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Behavior

• Coping

• Communication

• Emotional status


The family members will

• Assume responsibility for roles and activities formerly held by the


• Express feelings about assuming responsibility of care for an older

family member.

The patient and family members will

• Identify and make use of appropriate community services.

• Express satisfaction with improved ability to cope with current crisis.


Caregiver Emotional Health; Caregiver–Patient Relationship; Care-

giver Stressors; Family Coping; Family Normalization


Determine: Identify the primary caregiver in family and assess roles

of other family members. Determine usual coping mechanisms

employed by this patient and family. Describe patterns of communi-

cation used in problem solving. Identify what support systems exist

for the family and patient outside the family. Identify strengths and

weakness in the family’s communication patterns. Assessment data

will assist with establishment of interventions.

Perform: Direct development of short- and long-term goals by the

patient and family members. Initially, the family members will need


help from the caregiver until they understand more about the

process of planning.

Identify appropriate community services for the family to assist

with coping.

Inform: Educate patient and family members about the process of

aging to assist patient and family to understand how changes in the

patient have affected the family.

Teach family members ways of maximizing the use of coping

strategies that seem to have worked for them in the past. Teach new

coping strategies and have family members role model them. Prac-

tice will help the family practice the behaviors in real situations.

Attend: Avoid becoming involved in a power struggle between

patient and family members. The patient may no longer be able to

fill ordinary roles and the sudden shift in roles may lead to a power


Encourage family members to express feelings about caring for an

older family member. Be nonjudgmental when listening to the

family; discuss the issues associated with caring for an older person.

If the nurse is judgmental, the family members may not be comfort-

able discussing their problem.

Provide emotional support for primary caregiver. Some families

may hesitate to accept outside help. Other families may be unwilling

to make even small sacrifices to care for an older family member. If

family members have not been supportive or caring for the elder

member before, they are unlikely to change.

Manage: Refer to community agencies (e.g., adult day care, respite

care, and geriatric outreach services) that can assist the family in

caring for the elder. Communicate to the hospice nurse where the

patient is at present in coping with the terminal illness.

Refer to case manager or social service to assist with ongoing

coordination of the patient’s needs after hospitalization.

Refer to a member of the clergy or a spiritual counselor when

deemed appropriate. Patients will often be more inclined to talk to a

spiritual counselor.


Caregiver Support; Coping Enhancement; Family Involvement

Promotion; Respite Care


Garity, J. (2006). Caring for a family member with Alzheimer’s disease: Cop-

ing with caregiver burden post-nursing home placement. Journal of Geron-
tological Nursing, 32(6), 39–48.