Problem-solving is focus of caregiver course
Expert advice used in planning strategy for care
Caregivers need to learn to be managers, handling problems on their own, rather than relying on health care professionals to solve them, says Peter S. Houts, PhD, a professor in the department of behavioral science at Pennsylvania State University College of Medicine in Hershey. That’s why Houts developed the Prepared Family Caregiver Course for cancer, advanced cancer, HIV, and AIDS.
The course is designed to be taught by a nurse, human service professional, counselor, or clergy. Materials include a teaching manual, an instruction manual for class participants called a home care guide, and a videotape to reinforce the lessons. The aim of the instruction is to teach participants how to use the guide to solve their problems.
Instructors teach COPE techniques for solving problems. This backward acronym stands for:
Expert advice: Using the guide, caregivers learn to find the expert advice they need to solve the problems they encounter when caring for a patient with cancer or AIDS. For example, when a cancer patient is suffering from nausea and vomiting, the caregiver can go to that section in the book and learn what symptoms require professional help and what to say to the medical professional when making the call. Caregivers also learn how to make the best use of nausea medicine and other methods of relief such as giving the person dry crackers to eat.
Planning: The course curriculum, along with the home care guide, teaches family caregivers to develop an orderly, systematic plan to deal with the problems and stress of caregiving. To create a plan, the caregiver must understand the problem and have a clear goal on the outcome he or she wishes to achieve. They also need to anticipate obstacles and develop possible solutions. For example, the cancer patient might not cooperate. In the nausea and vomiting chapter, there is a brief explanation on why cancer treatments often cause these symptoms. It also lists the caregiver’s goals: Call for help if needed; make the best use of anti-nausea medicines; do what can be done to ease the ausea and vomiting. With guidance from the chapter, the caregiver creates a plan that fits his or her situation.
Optimism: The caregivers develop an optimistic attitude during the process, says Houts. They believe it is something they can do to get control over the problems.
Creativity: Family caregivers are also taught to be creative, so the plan they devise is tailored to the person they are caring for. Creativity often is needed to handle the obstacles and challenges many family caregivers face daily when looking after cancer patients. For example, if a patient suffers from fatigue, the caregiver can make a list of activities the patient enjoyed before his or her illness that can be enjoyed in spite of fatigue.
"Caregivers who attend the course keep the guide as a reference source. It is a resource they can use for suggestions and ideas on how to approach some of the issues that come up," says Ana Marchena, MA, health education specialist at Memorial Sloan-Kettering Cancer Center in New York.
Marchena offers a day-long session for caregivers of cancer patients at Memorial Sloan-Kettering. She formerly split the course into three sessions, but caregivers had trouble finding someone to stay with the patient on three occasions. Now the class begins at 9:30 a.m. and concludes at 3 p.m.
Class participants learn to solve problems by working on two case scenarios. For example, the scenarios for the cancer course focus on a patient’s fatigue and depression. The video is used to present the cases and stimulate discussion.
Script provides versatility
Recently, Houts developed a new version that replaces the video with a script. People in the audience play the various roles in the scenario. The script has been easier to adapt to different groups. For example, he created a version for home visit volunteers.
"While we teach family caregivers how to problem solve, we teach volunteers how to support a family in problem solving," he explains.
The other advantage of the script is that it can be downloaded from the Internet, and people don’t have to purchase the video tapes, says Houts.
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