As the population ages, more of your patients will receive care at home from someone without a medical background. Registered nurses and advanced practice providers play an important role in educating informal caregivers, empowering them tend to their family member to the best of their ability. In addition, family caregivers can provide a wealth of important health info, and their cooperation is crucial when planning a patient’s discharge.
That’s why clinicians should familiarize themselves with the best ways to communicate with caregivers and common challenges that occur when building this relationship. Below are some tips from the American Journal of Nursing.
You must take patients’ and their families’ beliefs and values into account when educating caregivers. Research shows that minority patients, especially black, Latinx and Asian individuals, report higher levels of dissatisfaction with the education they receive that whites. The AJN recommends asking patients and their caregivers about important cultural practices, especially when planning for discharge.
Nonverbal and language barriers
Many caregivers you encounter will not speak your language. What’s more, nonverbal signals can also carry different meanings from culture to culture. The best solution is to avoid assuming that an individual understands based on nonverbal cues, like head-nodding; to use respectful titles, such as Mr. and Ms.; and to use the facility’s translator whenever possible. If one isn’t available, only use family members as translators as a last resort because you cannot be sure of their understanding of medical terminology. When talking to someone who doesn’t speak your language, avoid using jargon and slang.
Because patients’ and caregivers’ knowledge — from their understanding of medical terms to overall literacy — can vary widely, it’s important to assess their education level and adapt the information you share accordingly. One popular and effective tool that health professionals can use for this purpose is Pfizer’s Newest Vital Sign test, which asks patients to read a nutritional label and answer questions about it. This will help you gauge how much they understand and explain information appropriately.
“Teaching back” is another popular technique, which also includes an educational element. You simply ask the caregiver (or patient) in a non-shaming way to explain in their own words what you’ve communicated or demonstrate what you’ve asked them to do. Don’t leave “teaching back” to the day of discharge, either. According to the National Quality Forum, it’s one of 50 essential safe practices in health care that should be part of daily practice.
Often, one member of an aging couple will care for the other, which hearing and vision loss are common among caregivers. If either exists, make sure you provide educational materials that accommodate the caregiver’s limitations. For example, use large fonts, black and white ink, and add pictorial representations if necessary. For hearing challenges, provide an amplified hearing device for the hospital and at-home use.
Again, caregivers often have their own health problems. Conduct your own cognitive appraisal and general health status assessment by observing the caregiver and during your own interactions. If the caregiver tires easily, considering staggering the education you give. If the caregiver is struggling to retain information, then the healthcare team should consider that the patient and caregiver both need more support in the home.
Lack of motivation
The desire of caregivers (and patients) to learn varies. To maximize your education, provide the information when it’s most pertinent, and explain why it’s important and its benefits. If a caregiver or patient expresses concern that a task is too much for them to handle, find a safe alternative that will help them maintain their lifestyle and health. You may want to impose your will, but as the AJN article authors note, doing so “[negates] their beliefs or desires” and ends “any change in learning or behavior.”
Overestimating your own skills
According to the AJN article, providers often believe they are more effective educators than they actually are and underestimate patients’ and caregivers’ needs for information. Don’t assume that you’ve successfully communicating something or that a patient or caregiver knows about a given symptom or treatment strategy. Always ask and receive confirmation.
Supporting Family Caregivers: Teaching Essential Skills to Family Caregivers, American Journal of Nursing.