A study from 2017 defined caregiver burden as, “the strain or load borne by a person who cares for a chronically ill, disabled, or elderly family member.” Nurses are all too familiar with the instinctive concern for patients, and often equally so for the person sitting at the patient’s side. Many caregivers give up proper sleep, nutrition, recreation, and financial resources to care for a family member with a disease that requires comprehensive, and often constant, care. Many caregivers work in addition to caring for their loved ones and have personal and family commitments of their own. The caregiver burden begins when the caregiver sees that something has got to give, and the first thing to go is their own well-being.
Because the nurse is responsible for patient care, it may seem like it’s outside a nurse’s scope to address issues with caregivers. In fact, nurses are equipped to empower patient family members to lighten the burden of caring for sick family. This can be done by nurse researchers who can expand on current awareness, and by direct-care nurses who participate in caregiving with family.
In recent years, research has demonstrated the very real physical consequences of caregiver burden. Studies show that caregivers literally age faster. Research is growing in this area and with that, resources are expanding. The devastating effects of caregiver burden reach beyond temporary distress and eventually create an emotional and physical strain on the caregiver. Too often, the caregiver becomes a patient.
Nurse researchers can contribute to the solution by researching and publishing on this topic, empowering family members to take care of themselves, and urging health care professionals to create health care systems and policies that patients and families can trust.
Nurse as Caregiver Support
Nurses can introduce family caregivers to resources that alleviate the stress of being a caregiver. Social services can step in and address insurance, facility transfer, and patient service allocation. Nurses can also encourage family members to leave the bedside and sleep in their own bed, get a coffee or a hot meal, or encourage them to go for a walk and offering to call if anything urgent comes up.
Many caregivers insist on performing nursing tasks, such as bathing, toileting, and positioning, so they can be assured it is done “right.” Perhaps they have had experiences that have weakened their trust in nurses and other providers. Nurses can gain this trust back by offering to perform tasks in front of, or in conjunction with, caregivers, and eventually, give the caregiver the comfort to step away. Lastly, nurses can give caregivers information about support groups which may act as a pressure release valve and allow caregivers to share their experience and concern, and connect to others going through similar circumstances.
Nurse as Caregiver
Any discussion of caregivers is incomplete without acknowledging the possibility of burnout in nurses themselves. The major difference between a nurse as caregiver and a family member is that boundaries of care between nurses and patients are finite. Nurses have a scope of practice that only encompasses a specific range of skills and tasks, and their work as caregivers ends when their shift does.
This assumes that nurses are not caring for their own family members, which many are. Furthermore, nurses are trained to augment their skill set with the practice of compassionate care and empathetic interactions with patients. Many nurses also work more than full time increasing the time they spend as professional caregivers.
Finding a Solution
The analogy of the oxygen mask on airplanes offers caregivers a guiding principle—put the oxygen mask on yourself first. The yardstick of caregiver burden is misery. Caregiving from a state of personal deficit is not only ineffective but creates a situation where there is not only an ill patient, there is also a depleted and distressed family member. There is nothing wrong with being a caregiver unless it starts to take from the giver.
National Association of Indian Nurses of America (NAINA) joined the Nursing Now global campaign in July 2019, and NAINA marked the official inauguration of its campaign activities at the 2019 Clinical Excellence conference held on November 2nd in New Jersey. As part of Nursing Now, NAINA is collaborating with the American Nurses Association as well as other local nursing organizations and global campaign supporters.
On February 27, 2018, Her Royal Highness, The Duchess of Cambridge Kate Middleton, patron for the Nursing Now campaign, officially inaugurated the campaign that runs through December 2020. The campaign was launched in response to the World Health Organization’s (WHO) Triple Impact report. The Triple Impact report accentuated that “developing nursing will improve health, promote gender equality and support economic growth.”
A Well-Timed Campaign
The year 2020 will be a historic year for nursing profession as it marks the 200th anniversary of the birth of Florence Nightingale.The nursing world is preparing to honor and celebrate this great nurse. As the global community prepares to celebrate nursing, momentous endeavors are in the planning. WHO has designated 2020 as The Year of the Nurse and Midwife. The WHO State of the World’s Nursing Report that highlights nurses’ role in Universal Health Coverage and the Sustainable Development Goals is anticipated in April 2020. The Robert Wood Johnson Foundation team is releasing another landmark report in 2020 as a follow up of the 2010 Institute of Medicine report, “The Future of Nursing: Leading Change, Advancing Health.” The RWJ report will highlight the nurse’s role in addressing the social determinants of health and health equity. To set the stage for these great events and to create global momentum to mark the epic year, Burdett Trust for Nursing in collaboration with WHO and the International Council of Nurses (ICN) launched the Nursing Now global campaign. As of October 2019, Nursing Now has spread to 103 countries.
Nursing Now Global Campaign
Nurses practice in many settings and in different roles. Nurses have different levels of education and competencies, which makes nurses capable of generating positive outcomes in health care. With their education and training, nurses are adroit in health care policy decisions. However, there is a paucity of nurses’ involvement in health care policy and decision making. As the WHO Triple Impact report highlighted, empowering nurses may create a paradigm shift in health care that will address global health care concerns. To highlight nurses and to improve the status of nursing, the campaign chose five focus areas:
- Health Care Policy – Create global awareness on positive impact of nurses and midwives in health policy decisions
- Clinical Practice and Education – Influence investment in nursing education and training
- Leadership – Empower nurses to assume leadership positions; increase the number of nurses in leadership positions.
- Research Priority – Identify areas where nurses have a potential for the greatest impact, explore impediments to achieving their full potential and practicing at the scope of their training, and generate practical solutions for workplace conundrums
- Best Practice – Share examples of best nursing practice
Nursing Now USA
American Nursing Association, U.S. Public Health Service Chief Nurse Officer, the University of North Carolina Chapel Hill School of Nursing, and the University of Washington School of Nursing collaborate in leading the Nursing Now USA campaign. With the vision, ‘Nurses Lead America to Health,’ Nursing Now USA is developing and leading activities focused on creating public awareness on nurses’ vital role in achieving equitable quality health care for all.
Nursing Now NAINA
National Association of Indian Nurses of America (NAINA) decided to join the global campaign as a local group because NAINA’s vision and goals align with the campaign focus. The official launch of Nursing Now NAINA campaign took place at the 2019 Clinical Excellence Conference. The theme of the Clinical Excellence Conference – ‘Population Health: Bridging Gaps and Improving Access to Care’ aligns with the overarching aim of the campaign. The Clinical Excellence Conference provided a venue for NAINA nurses to share examples of best clinical practice, which is one of the priority areas of the global campaign. Susan Michaels-Strasser, PhD, MPH, RN, FAAN, Senior Implementation Director & Associate Director for Nursing Programs at Columbia University discussed “Nursing Now: Empowering Nurses and Tackling Health Care Challenges” and NAINA lead the campaign. Letha Joseph, DNP, AGPCNP-BC discussed NAINA programs that commemorate with the campaign. Nursing Now NAINA will create opportunities for NAINA nurses to improve their competencies, maximize their professional contributions, and enhance their influence. NAINA’s campaign focus areas are enhancing clinical practice by ongoing education, empowering nurses to be leaders at bedside and beyond, and sharing examples of best nursing practice while recognizing nurses for their contributions to health care and professional nursing community.
More information on the Nursing Now global campaign is available at www.nursingnow.org. Updates on NAINA’s activities are available at www.nainausa.com.
A recent merger of several nutrition-focused organizations is highlighting the need for a new attitude about what people eat and drink. The opportunity for nurses to bring this into their daily practices is huge as they can help patients with the food choices that will have the greatest health impact.
The newly formed nonprofit American Nutrition Association is a merger of the American College of Nutrition; the Board for Certification of Nutrition Specialists; the Center for Nutrition Advocacy; the Accreditation Council for Nutrition Professional Education; and the American Nutrition Association Foundation. The new group sees better nutrition as a broad-sweeping problem that requires a broad scope of experts to help fix it. From the people who grow and distribute food to the policy proponents who can bring change into schools and neighborhoods to the funders who can support new initiatives, the group aims for an ecosystem approach to change.
The driving factor behind the new association is the enormous health risk poor nutrition brings to human health including those that are greater than known health-wreckers like smoking or a sedentary lifestyle. Food, in essence, is a nonpharmaceutical medicine people can use to improve their health.
Nurses are proponents of good nutrition because they know the direct result it can have on all ages—from children’s development to chronic illness in adults. A lack of proper nutrition has far-reaching impacts where it can create problems in both physical and emotional health. Nurses also know some of the barriers patients face in having access to or preparing healthy meals. Personalized nutrition is one of the new group’s pillars, and nurses can use this as a way to talk with and help patients choose food that nourishes their bodies and is affordable and attainable. They can help them explore alternatives for their usual diet.
In addition to access, education is an essential part of a proper diet. For nurses, who are well-informed and educated about the benefits of kale over crackers, helping patients understand their choices and how that can fit into their lives provides an important foundation to build on. Showing patients what good nutrition looks like is a starting step.
Nutrition is also important because it is something people can change when they think about a healthier lifestyle. People can’t choose their genetics, but they can change what they eat for dinner or what they snack on. And it’s simple to make small changes. Patients don’t want to hear they have to make an entire overhaul of their diets (unless their illness forces that kind of top-to-bottom change). In fact, many people who think they have to cut out everything they love will find that kind of plan too overwhelming to even begin.
Hearing that you can still have a big impact on health with small modifications is often motivating. Patients can swap out a serving of pasta for a salad or a serving of vegetables. They can bring a lunch instead of relying on a takeout lunch that’s generally higher in fat, salt, and calories and lower in essential nutrients.
What kind of changes can you help your patient population with?
Nurses are integral in the care of patients and their health. Exploring a plant-based diet may be beneficial to patients so they can take back their health. It is time for health care disciplines to be aware of a plant-based diet and to dispel any myths that exist. In fact, a plant-based diet is not a diet—it can be viewed as a way of life. A plant-based diet are foods consumed that is devoid of animal ingredients, such as dairy and meats. A plant-based diet relies on foods that are grown from the ground such as fruits, vegetables, whole grains and nuts, and seeds.
People are living longer, but we are also living with more chronic diseases, with heart disease being at the top of the list. Heart disease, diabetes, and hypercholesterolemia are contributors to sickness where medicine is the answer. Health care providers tell patients to lose weight by restricting food intake. While patients may see results initially, they usually do not adhere to this long term as it is not sustainable for them for a variety of reasons. In addition to that, the medications with their side effects usually do not highlight many benefits. One-third of animal products in the American diet are very concentrated in calories and are deficient in antioxidants and vitamins. Needless to say, the vast majority of chronic illness is highly correlated to what we eat. There is a different biological effect of meat versus plant-based protein such as beans. The body can store these amino acids and complete them without overshooting the hormone, Insulin Growth Factor 1 (IGF 1). On the contrary, processed foods and meats produce a lot of IGF1 where insulin ends up storing a lot of fat. It is also attributable to cancer and inflammation.
People have long touted the benefits of a plant-based diet. Brooklyn Borough President Eric Adams reversed his diabetes Type 2 due to a plant-based diet. He was already suffering from nerve damage as a result of his disease with a hemoglobin A1C of 17 (anything over 6.5% is considered diabetic), so his was very high and the doctor was surprised that he was not in a coma. Adams was placed on medications, but he also sought the help of Caldwell B. Esselstyn, Jr., the same doctor who treated Bill Clinton and author of the book, Prevent and Reverse Heart Disease. He was informed by doctors that he would be on insulin for the rest of his life. He was placed on medicine for his acid reflux, medicine for his high cholesterol, and medicine for his burning and tingling of his hands and feet. His family is diabetic and was told that it runs in his family.
This past August, there was a launch of a plant-based lifestyle program at Bellevue Hospital in New York City. Doctors, nurses, dieticians, and life coaches will help at least 100 patients across all five boroughs adopt healthy eating patterns focused on legumes, whole grains, fruits, vegetables, nuts, and seeds while reducing animal products, fried foods, refined grains, and added sugars. Michelle McMacken, director of NYC Health + Hospitals/Bellevue Adult Weight Management Program, is director of the program.
At Montefiore Hospital, Dr. Robert Ostfeld spearheaded the Cardiac Wellness Program where plant-based nutrition is the prescription for management of cardiac disease. The population most affected by these diseases are non-white populations. Dr. Kim Williams, past President of the American College of Cardiology, advocates for a plant-based diet for heart disease prevention. Affronted with a high cholesterol, he decided to take measures into his own hands, and adopt a plant-based diet.
While medical doctors are beginning to advocate this lifestyle, nurses should also set an example of this lifestyle approach. Nurses are part of the health care discipline and minority nurses, especially, need to set an example. We want patients to take control of their lives. We can teach patients eating a plant-based diet instead of a standard American diet, as a form of primary prevention. Like any diet, it may take time to adjust, but this is not just a diet, it is a lifestyle. Patients would need to make an informed decision as to whether they would want to incorporate it into their lifestyle or not. There is enough supportive evidence out there that a patient can access such as documentaries, “Fork Over Knives” and “Fat, Sick, and Nearly Dead.” There are a variety of resources, including the 21-Day Vegan Kickstart program, to include in dietary prescriptions to help patients treat and prevent obesity, type 2 diabetes, and heart disease. This will require support from the patient’s primary provider, and, whether the provider is an advocate of this lifestyle or not, it should be considered. Benefits such as less medication, weight loss, and improvements in mood as well as cholesterol have been shown. Dispel the myths about a plant-based diet and protein.
This is a plea as something to consider to take better care of ourselves and take control of our lives. There have been many initiatives and programs to lose weight. Drastic measures have also occurred due to the outcomes of being overweight, such as drastic surgery and restrictions from carbohydrates. Patients are sometimes misinformed and have to get rid of the idea that medications will solve the problem—it only delays the problem. There is a possibility of reversing diabetes and cardiac disease. This is a decision that the person has to make: continue with their lifestyle with animal protein and processed carbohydrates or see a reduction in their overall weight and health by incorporating a plant-based diet.
A plant-based diet may be considered “extreme” by some people in altering their lifestyle. But given the choice between a plant-based diet or open=heart surgery, it can be posed to the patient which one they consider as extreme. Again, it is a personal choice, an evaluation of familial and cultural values would be assessed to fit the needs of the patient. Surgery can be viewed as a band-aid in that it will manage the symptoms temporarily unless the patient alters their lifestyle. Of course, it helps if the patient has a supportive network to embrace the lifestyle. It can start off as small, simple steps, as little as incorporating a plant-based meal in their day and slowly add these meals to their lifestyle. There are vegan starter kits to kick a healthier you.