Common caregiver issues and nursing interventions after a stroke.

A fter rehabilitation, most stroke survivors return to the community and continue with their daily lives, despite stroke-related functional, cognitive, and behavioral changes. 1 Caregivers are the primary support system for these survivors after discharge and an integral part of the healthcare team that contributes to survivors' rehabilitation and recovery. 2,3 However, caregiving is stressful, and caregivers often experience a variety of interrelated individual, interpersonal, and organizational issues in managing stroke-related deficits. These issues and potential nursing interventions for addressing them will be discussed in this article. Individual caregiver issues commonly relate to insufficient knowledge and skills to understand and manage stroke sur-vivors' physical, cognitive, emotional, and behavioral problems. 4 Initially, caregivers request information about the stroke diagnosis, prognosis, complications, and predicted recovery. 5 As stroke survivors begin the transition to home care, caregivers require information about assuring their safety, including fall prevention, medications, and prescriptions ; adequate nutrition; and management of physical , instrumental, psychological, and behavioral problems. 3 Empirical data support caregivers who also require information and support about how to manage complex feelings and interactions with stroke survivors who experience memory problems, depression, anxiety, frustration, withdrawal, and are argumentative. 6–8 Empirical literature also indicates that caregivers feel uncertain and unprepared in the caregiving role. 9 Caregivers need open and honest communication about their role and stroke survivors' abilities, 3,10 while also offering hope. Conducting a comprehensive predischarge nursing assessment of caregiver physical and psychological health and social, financial, and spiritual needs initially and during follow-up is essential. 11 This assessment is vital to understand how caregivers' skills, abilities, and resources match stroke survivors' needs for follow-up care better. On the basis of this assessment, nurses should develop a highly individualized case management plan to help caregivers attain skills and services necessary to facilitate success and seamless postdischarge transition. 2 Although nurses provide important information, stroke-and caregiving-related information commonly is not remembered by overwhelmed caregivers. Therefore, basic information should be provided throughout acute and chronic care in both oral and written formats, with frequent reinforcement of specific information in the caregiving trajectory. 12 Caregivers also request that more extensive services be offered during rehabilitation , especially on weekends 13 because competing work and other responsibilities (family, home, and church) make attending rehabilitation therapy difficult during the week. 4 Furthermore, although guidelines exist, some resources suggest there is no consensus about what caregivers need in rehabilitation and the guidelines …