Self-care has been defined as "a process of maintaining health through health promoting practices and managing illness". Self-care may be performed for several reasons, whether in response to disease or injury, to manage chronic conditions, to maintain health, or for the preservation of self. There are many different factors that may influence self-care, including knowledge and educational background, physical limitations, economic status, culture, and social support, to name a few. Additionally, the process of self-care can be performed individually or with the assistance of a caregiver.
Caregiver-patient interactions form dynamic relationships that vary based on multiple factors, including disease, comorbid conditions, dependence level, and personal relationship, among others. The term "caregiver" can refer to people who take care of someone with a chronic illness or a supporter who influences the self-care behaviors of another person. Couples often form an interdependent relationship that is linked to their health. The close dynamics of these relationships can influence self-care behavior and transform it from a self-centered behavior to a relationship-centered behavior. Adopting a relationship-centered mindset can lead to enhanced motivation for both partners to carry out self-care behaviors and support one another in the process.
Multiple studies have demonstrated the significant role that caregivers play in promoting self-care in persons with an illness. A study observing the effects of a supportive intervention for caregivers of patients with heart failure found higher and statistically significant self-care behavior scores in the intervention group. Another research study conducted by Chen et al. identified higher social support as one of the main factors associated with improved functioning and a higher quality of life in patients with chronic obstructive pulmonary disease (COPD). The presence of higher social support also had positive effects on the physical and mental health of these persons. COPD patients with a caregiver were found to have lower rates of depression and increased participation in pulmonary rehabilitation, indicating the critical role a caregiver plays in influencing patient success.
As mentioned, caregivers can promote self-care in a variety of ways. A research study performed in Lebanon found that family-centered self-care has the potential to reduce the risk of hospital readmission in patients diagnosed with heart failure. Additionally, having the support of a family member can motivate patients to perform adequate self-care and increase adherence to their treatment plan. The environment surrounding a patient and disease has proved to be an important factor in improving clinical outcomes. Specifically, family-focused caregivers providing supportive interventions can help to improve the self-care behaviors of patients with various different diseases. When patients were asked to describe the influence of family or caregiver support, they stressed the critical role these supporters played in remaining on track with their medications, dietary choices, and exercise behaviors.
Clinical decision-making
Despite the evidence of self-care promotion, caregivers are consistently underused during clinical encounters. Caregivers can contribute significantly to promoting patient wellness, including promoting patient independence and self-care. However, despite studies demonstrating caregivers' daily and positive contributions to patients' self-care, and their ability to offer perceptions, insights, and concerns, providers are not meaningfully engaging caregivers during the decision-making process for chronic care management. Ignoring the caregiver not only leaves the burden of illness on patients' shoulders but may also prevent caregivers from obtaining the knowledge they need to provide clinically effective care and promote self-care.
The perceptions and needs of caregivers are inconsistently and seldom incorporated in designing and implementing interventions. Supporting research concludes that when caregivers are engaged in provider-patient encounters, patients report higher satisfaction with the clinical experience. The benefits of engaging caregivers during the clinical decision-making process include—and are not limited to—better patient understanding of provider advice, enhancement of patient-provider communication, better prioritization of patient concerns, and emotional support for the patient. These benefits are essential to the performance of self-care.
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