Support should be provided for family caregivers who experience a burden associated with caregiving, as might negatively affect the outcome for both family caregiver and the patient (Hannon et al., 2015; Streid, Harding, Agupio, Dinat, Downing, Gwyther et al., 2014). A number of authors have documented several forms of social support, including:
emotional, informational, spiritual and instrumental (Epiphaniou, Hamilton, Bridger, Robinson, Rob, Beynon et al., 2012; Hudson and Aranda, 2013; Sandy, Kgole and Mavundla, 2013; Wong, Ki, Maharaj, Brown, Davis and Apolinsky, 2014).
In developed countries such as the United States of America, Australia and the United Kingdom, support for patients can take the form of Medicare, Medicaid / medical insurance and insurance policies covering pension, disability and death (Cruz, 2016).
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Family caregivers might receive support in form of carer’s allowance, emotional, information and psychological support (Australian Government, 2010; Family Caregiver Alliance, 2011). In the USA, Medicare also provides home health care to patients requiring dialysis services (Cruz, 2016). This policy provides substantial relief to family caregivers who will then not have to pay for hospital bills and home health care.
In contrast, few countries in sub-Saharan Africa provide government funding for renal care including RRT (Naicker, 2013). This does not occur in Nigeria, where family caregivers bear all the costs associated with caregiving for ESRD patients without any form of assistance from the government (Arogundade, 2013). Inadequate resources (financial, emotional, social etc.) is linked to psychological distress, with family caregivers with adequate support being more likely to cope with the burden associated with caregiving better than those without support (Epiphaniou et al., 2012; Girgis, Lambert, Johnson, Waller and Currow, 2012).
An essential form of support is provision of information, its absence causing confusion, uncertainties and frustration in family caregivers (Eslami, Rabiei, Abedi, Shirani and Masoudi, 2016; Sandy et al., 2013). Technology driven, computer based information support have been found to be relevant and acceptable in high income countries, such as the United States of America (Chi and Demiris, 2015; Godwin, Mills, Anderson and Kunik, 2013) as family caregivers benefited from online education, internet support groups, computer-mediated interactive voice-response systems and online skill building (Godwin et al., 2013). Although the use of technology reduced cost of transport and waiting time for family caregivers who must accompany their sick relatives to the hospital, the resources needed for setting it and sustaining its use can place extra financial burden on family caregivers.
Furthermore, family caregivers are sometimes overwhelmed with irrelevant disease- related information from the media and web-based resources, and can become confused and uncertain about what to believe (Rabiei, Eslami, Abedi, Masoudi and Sharifirad, 2015). Family caregivers may also experience confusion when nurses do not provide them with relevant information that meets their needs. For this reason, nurses can provide coherence and evidence based information to family caregivers to avoid uncertainties
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and psychological burden associated with spurious information (Gaeeni, Farahani, Seyedfatemi and Mohammadi, 2015; Rabiei et al., 2015).
Access to information through various sources is increasing worldwide, from which family caregivers in LMICs, including Nigeria, could also benefit. However, the level of literacy needed to use technology to the extent that it can meet urgent needs for information may be lacking. Most of the LMICs access to internet is limited, power supply is erratic and funding for its sustained use could be lacking. Information could be provided by health care professionals to family caregivers by sending Short Message Service (SMS.
Modelling is another type of support for family caregivers and entails a family caregiver who had achieved a good level of adaptation in caregiving may support others facing similar challenges to enable them function efficiently and manage challenges of caregiving (Eslami et al., 2016). Modelling could provide opportunities for family caregivers to share ideas about similar challenges and model the exemplary family caregivers who have gone through similar experiences. Eslami et al. (2016), argue that modelling is an important support needed by family caregivers to maintain their identity, persevere and function maximally in the prolonged time associated with chronic caregiving. Such groups can meet in the hospital when patients are keeping appointment with their physician thereby reducing the cost of transport. However, family caregivers differences in values and inability to discern those ideas that are worth imitating might cause confusion from information overload leading to psychological distress (Benbassat, 2014). Nurses can provide leadership in guiding discussion during such meetings to avoid distortion and ambiguity of information and increase knowledge of family caregivers.
Family caregivers might use faith and religion to find meaning in caregiving (Sánchez- Izquierdo, Prieto-Ursúa and Caperos, 2015). Spiritual activities could be done through praying, believing, transcendental meditation, relaxing etc. (Sánchez-Izquierdo et al., 2015; Sequeira, 2012). However, the adoption of spirituality alone might not necessarily mitigate the burden associated with caregiving, family caregiver’s perception of receiving help from the Supreme Being might promote coping, resilience and adaptation
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needed for the process. Spirituality has been a source of motivation and means of health promotion and wellness among caregivers globally (Delgado-Guay, 2014; Sercekus, Besen, Gunusen and Edeer, 2014). In studies conducted in the US among Latino’s family caregivers and African American breast cancer survivor and their caregivers, religion and spirituality provided guidance, acceptance and optimism (Hodge and Sun, 2012;
Sterba, Burris, Heiney, Ruppel, Ford and Zapka, 2014).
Members of religious groups have prayed on behalf of the sick and the family caregivers, and knowing that someone is praying seems to give hope and courage for family caregivers (Sterba et al., 2014). Globally, religion and spirituality are two sources of support that family caregivers can utilize to manage caregiver burden. Religion can provide the platform for family caregivers to connect with God, receive comfort, cope with and accept difficult caregiving situations. Nurses must recognize this need and permit religious leaders to visit family caregivers regularly while their sick relative is hospitalized. Family caregivers could be permitted to engage in spiritual activities as allowed for by policies guiding the hospital.
Support interventions are expected to add value to caregiver’s level of satisfaction and ability to cope with various issues and improve outcomes for the person receiving care.
However, sharing of the caregiving space with those providing support made family caregivers experienced loss of privacy and resulted in caregiver burden (Wittenberg- Lyles, Washington, Demiris, Oliver and Shaunfield, 2014).