Abstract
BackgroundLiterature has shown the serious impact of severe mental illness on the daily life of caregivers. We studied reported caregiver support practices by mental health nurses for use in the development of a nursing intervention. We aimed to explore current caregiver support practices by mental health nurses.MethodsTwenty-one participants completed semi-structured interviews, and 17 participants attended two focus groups. All interviews were audio-taped, transcribed and coded for qualitative analysis.ResultsThe diversity in caregiver support could best be described by three prototypes: the tolerator, the preventer and the concerner, representing three approaches of involvement with caregivers. At one end of the spectrum are mental health nurses (MHN) who are essentially only concerned with the wellbeing of the care recipient and see the caregiver as a potential impediment in reaching the client’s goals. We call these the tolerators. At the other end of the spectrum are the MHNs who see the caregiver and the care recipient as inextricably connected with each other. In these cases the MHN directs her/his intervention towards both the informal caregiver and the care recipient. We call these the concerners. In the middle position are MHNs who realize that caregivers are important agents in the achievement of the client’s goals, and therefore consider preventing them from becoming overburdened as an important goal. We call these the preventers.ConclusionsBased on the extent to which the MHNs believe that the informal caregiver plays a necessary role in the client’s support system, and the degree to which they feel responsible for the caregiver’s wellbeing, three MHN prototypes can be distinguished. These prototypes determine how the nurses’ vision directs their understanding of their role and responsibilities and the content of their behaviour. This implies that a change in behaviour needs to be preceded by a change in vision. Therefore, promoting family support cannot be achieved by one-size-fits-all-programmes.
Highlights
Literature has shown the serious impact of severe mental illness on the daily life of caregivers
We studied reported caregiver support practices in two large mental health care organizations in the Netherlands
The mental health nurses (MHN) acknowledge the importance of family relationships, “nobody can do without a family”, but their caregiver support varies considerably
Summary
Literature has shown the serious impact of severe mental illness on the daily life of caregivers. Severe mental illness, including bipolar disorder, schizophrenia and depression, is associated with a substantial loss of quality of life [1], increased rates of mortality and morbidity, high levels of service use and huge economic costs [2]. It is the patients themselves who suffer. Mental health nurses constitute one of the core professional groups involved in the treatment and support of older psychiatric patients and their caregivers. For the development of a nursing intervention that matches the complex nature of both patient and caregiver needs, it is important to identify and refer to existing nursing practices [17, 18]
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