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Family care givers at the University Hospital of Orthopedics and Rehabilitation of Granada

Aurora Quero Rufián1, Rafael Briones Gómez2, Mª Ángeles Prieto González3, Nuria Pascual Martínez4, Adela Navarro López5, Carmen Guerrero Ruiz3
1Escuela Universitaria de Enfermería Virgen de las Nieves, Granada. 2Departamento de Antropología, Universidad de Granada. 3Escuela Andaluza de Salud Pública, Granada. 4Hospital Universitario San Cecilio, Granada. 5Hospital Universitario de Traumatología y Rehabilitación, Granada

Mailing Adress: Aurora Quero Rufián. EUE "Virgen de las Nieves". Avda. Fuerzas Armadas, 2. 18014 - Granada, España

Manuscript received by 29.01.2004
Manuscrito accepted by 19.04.2004

Index de Enfermería [Index Enferm] 2005; 48-49: 14-17 (original version in Spanish, printed issue)

 

 

 

 

 

 

 

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Quero Rufián A, Briones Gómez R, Prieto González MA, Pascual Martínez N, Navarro López A, Guerrero Ruiz C. Family care givers at the University Hospital of Orthopedics and Rehabilitation of Granada. Index de Enfermería [Index Enferm] (digital edition) 2005; 48-49. In </index-enfermeria/48-49revista/48-49e14-17.php> Consulted

 

 

 

Abstract

Introduction: Generally hospitalization affects familiar relationships and it also obvies to take certain changes in families' routine. That is why family caregivers have acquired an important role, as they fulfil the needs of the patients. Most of the times, this activity is performed by women.
Aims: The aims of this article are: to explain family care givers profile and the kind of care they provide in the following units: Maxilofacial, Neurology, Neurosurgery and Traumatology in the University Hospital Traumatología y Rehabilitación in Granada.
This article will analyse different needs and problems family caregivers find within the hospital and inform about nurses opinion concerning the role of family caregivers.
Design: A qualitative design has been used by means of systematic observation and focal group. Surveys and in-depth interviews have been carried out within 2 different groups: nurses and auxiliary nurses. The results obtained have been analysed by the programme Atlas/ti 2.4.
Results: The results mentioned above were the appropriate for an hospital in relation with family caregivers as far as activities, level of information, and requests are concerned.
Conclusion: On the whole atmosphere in hospitals is somehow hostile to family caregivers. For this reason it will be convenient to set up a different kind of professional relations between health staff and family caregivers. Moreover, it is necessary to recognize the importance of family caregivers role in the hospital.
 

 

 

 

 

 

 

 

Introduction

     Hospitalization is usually a very important event in the lives of people because it alters the normal rhythm of their lives as well as the net of relationships in which their daily life develops. As Augé and Zempleni argue, illness is an episode that evolves into strong emotional burdens and pushes social processes. The sickness affects not only the ill person, but also his or her relatives as well as his or her closer social surrounding. The sickness thus, goes over the scope of the individual person (illness) to the point of acquiring a social dimension (sickness), that is, the social recognition of the incapability of the sick human being to develop his or her social role.1 In this way, the vital aspects of a person's life are objective experiences capable of altering the daily activities of an individual. This approach forces us to review the type of nursing care provided to the patients, that is, to deconstruct the treatments. This is called Anthropology of Care or Nursing Anthropology.2-4
     From the moment of hospitalization on, the daily roles of the patient change completely as his or her life gets immersed in the life and structure of the hospital. These changes are the result of the need to adapt by themselves to a new surrounding that is usually scary. The sick person is scared about the uncertainty that surrounds any illness, and also about the limits for communicating within the hospital structure. The patient feels also uncomfortable about his or her new social status: "being a patient". This situation shows how the patient finds him or herself on a difficult situation, and that should be the starting point when analyzing the process of hospitalization.
5
     This is the context in which the activity of the care givers, also called informal care givers or non professional care givers, evolves family care givers. By hospital care giver the author understands the person who is connected to the patient by personal ties and has taken the responsibility of looking after the sick person. This translates into a constant presence of the care giver in the hospital right next to the patient.
     There are many general articles about family care givers, but few of them focus on care givers in the hospital.
5-10 That is why this paper is original and provides important findings.
     The main aims of this paper are: first find the profile and type of care assistance provided by the care givers in the Max-Fax, Neurology, Neurosurgery and Orthopedics Unit; secondly, to analyze in depth the needs and problems of those who look after a relative in the hospital have to face. Thirdly, to get to know how the ill person has an influence on the family and the community. Finally to get to know the opinion of the nurses about the care givers.

Methodology

     The method used in this paper is a qualitative one. The qualitative methodology is necessary in papers that search for an understanding about natural phenomena, about experiences, motivations and evaluations made by the people and that help us the get to a better understanding of the events and social facts.11-13 Another one of the techniques used for this project is: A) Systematic observation, which allowed us to value the surrounding and difficulties on the every day life of the care givers, as well to contrast their opinions (objectives 2 and 3). B) Focal Groups.  One focal group was with nurses and another one with nurse assistants. The results of the focal groups have provided us with information regarding the opinion the professional care givers (objective 4) have regarding the role and activity of the family care givers. C) Surveys. Method used to get to know the activities of the care giver at the hospital and in order to adjust his or her profile (objective 1). D) Interviews. Help us to get to know the problems and needs faced by the hospital care givers and know how they have an effect on their daily life and social surrounding (objective 2 and 3).
     Subjects of The Survey: family care givers in the Orthopedics and Rehabilitation mentioned units at the University Hospital of Granada. The field work developed since July 2002 and until June 2003. The participants were selected according with the following profiles:
     -Old Man
     -Young woman with little kids
     -Old woman
     - Outside the house working woman without family responsibilities
     - Outside the house working woman with family responsibilities
     -Young man (student or not)
     We wanted to reflect the type of population the can be found at the hospital area. This systematic sampling is very common in qualitative research projects and it's not based on probability. The researcher has to select the subject that match with the characteristics of the profiles.
     Since we did not find in the consulted bibliography any criteria for segmenting the sample of "family care givers in the hospital", we took into account participating observation and the comments of the nurse of the pilot study.
5 Even though men are not the classic "family care giver", we found it would be interesting to take their opinion into account for our pilot study, and that is why they are part of this project. Thus, the design of the profiles is open and flexible so that it can adapt to the reality that we wanted to study.
     Our key informants were the supervisors of each unit. They know well not only the sick people but also their relatives. They were also the ones that provided us with the best place to do our interviews.
     Also the nurses of these units have shown their interest on this project and they have informed the authors of this study of the families that meet the profiles.
     We have done one interview per profile on each of the four studied units. That gives us a total of 24 interviews. The interviews developed according to the format depicted in table 1.
     The questions are open ones and attempt to get precise information. They are organized in a logical way, and allow us to explore the experiences, opinions, feelings and knowledge regarding the hospital atmosphere of the interlocutors.
     The development of the interviews was the following: once we had arranged a meeting with the interlocutor, we would go and pick him or her up at the room to then go to the interview room (usually the office of the supervisor or the doctor's workplace). After a brief welcoming introduction, we would thank him or her for participating on our project underlining how important their collaboration was for us. We would ask for permission to use the tape recorder clarifying that all the information would be confidential. After the interview, we would thank him or her for their time and availability and then we would accompany him or her back to the room.
     The analysis of the information
14-15 was done with the program ATLAS TI-4.2. The categories of our analysis were: Time (Chart 1), Hospital Habitat (table 2) and exterior Life (table 3).
     Once the interviews were transcribed, the text was codified with software. This coding of the information was done according with the profiles and mentioned categories.  The categories and codes were previously defined by the researchers in order to guarantee the reliability of the process. The results corresponding with the "Hospital Habitat" category were obtained once the data was confronted against the rest of the techniques used for this project such as observation, surveys and focal groups.
16-17

Results and Discussion

     The patient accepts as inevitable his or her new situation within the hospital life although with nostalgia: i.e.: Isn't it?, There is nothing like one's home? That is normal, but if you have to be here, you have to be here".
     The patients demand more often information from the health staff: "...but there is something that I think they should do at the family level, and that is to inform us more frequently, I mean, talking to me today but not saying nothing the day after tomorrow".
     The majority of the patients agree about the good relationship between the family and the staff, although it could be better. In any case, that good relationship is based on individual cases: "...kindness...its something that some people have, and that is why you can not expect everybody to be friendly, but any way." "You know? They do not even say good morning, [...] some, others are very loving". "...the manners depend...on the nurse...and they think you are getting on their business or something like that and that is not true." "Some doctors are not very polite (...), at least...they know a lot, but they do not...you have to talk to them...they do not even stop, or they tell you things that..."
     The answer to the problem of feeding has two alternatives: either the cafeteria, or parts of the food of the patient: "I have to buy my own food, ...maybe sometimes my husband did not eat his because he was feeling sick and then I ate it, and like that I saved three euros". "We go to the cafeteria down stairs or go somewhere else outside". "I go to a bar, I mean...you know, I am already retired and I want to look for better food, you know." "I would eat his food because he was on saline solution [...] sometimes I would only ask for a glass of milk, only that, because I felt so bad asking for it."
     In terms of personal hygienic, the answer of the families was unanimous: they used the toilet of the patient, since there is no other toilet for the relatives on the floor: "Yes, (I use) the toilet of the room to shower and other things, sometimes I went somewhere else, but...". "I...go to the toilet of the patients [...] in the room..."
     The basic care they provide to their sick relative is multiple: they clean them up, they give them food, accompany them, look after their intravenous solution bottle, etc. "...the nurses are very helpful, but if the patient wants a glass of water,  I am not going to call the nurse, so I will be the one to do it" "...right now there is little we can do with my brother, maybe fixing his pillow, and if he needs anything we call up the nurse." "The only thing we do is to spoil her, only that [...] I give her and take away her plate [...]" "I help her with the bedpan, with the chamber pot, things like that." "I bath her, I force her to eat because since she has the bandage there she does no want to eat...I take care that she...in case she wants to go to the toilet." Other one says: "Yes, I clean him up, I shave him, [...] well, if I have to move his feet because he is wearing a bond cushion boot or something like that." "I clean my husband!" I do not have curtains! I take a bed sheet and...I have showered him because he was embarrassed". "That someone puts down your trousers being a stranger...that is hard for the patient, and that is why I think that I better do it myself."
     Regarding the demands of the family care givers, they are mainly concerning the furniture of the room, the conditions of the health center and the impact of the visits of the neighbour patients: "...its very hard to sleep because...the seats should be...at least they should be able to open...because these ones you can open them a bit, but not all the way." "...more comfortable seats, because the ones we have are not." "I would like a better seat." "I am very uncomfortable in this seat because they say you can open it, but it's not true, you can not." "I would ask for a bed, a bed for the relative that is accompanying the patient, but that is asking for too much." "I see this a bit...a bigger room, because here the beds are too close together..." "This would improve if there would be two beds instead of three..." "A bedroom for each patient would be impossible, wouldn't it?" "...the toilet, the room for... [...] yes, the room of the patient" "a lock, because what we have now is nothing like a lock and its so small you can hardly fit anything and that is why we do not bring clothing to get change" "...the visits...the patients go crazy with all these visits, and that could be better controlled if the visits were under some sort of order." "Sometimes eight or nine relatives come at the same time and the room becomes a mess and...it's very suffocating in the afternoons..." "...the visits...its too much people."
     The value of the work done by the family care givers it's very important since they satisfy the basic needs of the patient. Their activity was in most of the cases done by women what reveals how the process of hospitalization could be analyzed from a gender perspective.
5
     In any society the family has played a basic role in the protection of its members. Solidarity and reciprocity are feelings that become visible when people share responsibilities, obligations and mutual help.
18,10 This is clearly reflected on the answers that we have presented in this paper and what is more, we have seen how, in terms of assistance and care, women play a major role because they feel it's their "obligation". The analysis of the discourse of the family care givers from a gender20,21 and relationship perspective22,23 will help to deepen in the problems that affect this group in order to improve their situation and their activity within the hospital system.

Conclusions

     -The care giver makes an effort to adapt to the health structure
     -The hospital structure as a whole keeps out of the family care givers
     -It is important to develop a new relationship between professionals and care givers
22
     -The hospital sphere is hostile for the family care giver
23
     -The important presence of women as family care giver demands a study from a gender perspective. The interviews developed according to the format depicted in table 1.
     -It is necessary to make visible the social-hospital reality of the family care givers and to give the value their activities deserve.

References

1. Bonte P, Izard  M. Diccionario Akal de Etnología y Antropología. Madrid: Akal, 1996: 235-237.
2. Torralba i Roselló F. Antropología del cuidar. Fundación Mapfre Medicina. Madrid, 1998.
3. Mínguez Arias J. Antropología de los cuidados. Cultura de los Cuidados, 2000; IV(7-8): 102-106.
4. Amezcua M. Enfermedad y padecimiento: significados del enfermar para la práctica de los cuidados. Cultura de los Cuidados, 2000, IV(7-8): 60-67.
5. Quero A. Los cuidados no profesionales en el hospital: la mujer cuidadora. Enfermería Clínica, 2003; 13(6):348-356.
6 Flores ML, Cano-Caballero MD, Caracuel A, Castillo A, Mezcua A, Osorio MV  y Vegas S. La calidad de vida de los acompañantes de pacientes hospitalizados de media y larga estancia. Index de Enfermería, 2002; XI(38): 18-22.
7. Flores ML, Cano-Caballero MD, Caracuel A, Castillo A, Mezcua A, Osorio MV  y Vegas S. La alimentación del acompañante del paciente hospitalizado. Enfermería Clínica,2000; 10(1): 7-12.
8. Portillo Vega MC,  Wilson-Barnett J y Saracíbar Razquin MI. Estudio desde la percepción de pacientes y familiares del proceso de participación informal en el cuidado después de un ictus: metodología y primeros resultados. Enfermería Clínica, 2002; 12(3): 94-103.
9. Bernat R, López J, Fontseca J. Vivencias de los familiares del enfermo ingresado en la unidad de cuidados intensivos. un estudio cualitativo. Enfermería Clínica, 2003; 10(1): 19-28.
10. Bernat MD, Tejedor R y Sanchís J. ¿Cómo valoran y comprenden los familiares la información proporcionada en una unidad de cuidados intensivos". Enfermería Intensiva, 2000; 11(1): 3-9.
11. Hurley RE. La investigación cualitativa y el profundo entendimiento de lo obvio. Health Serv Res 1999, 34 (Parte II) (5):1119-1136.
12. March JC, Prieto MA, Hernán M, Solas O. Técnicas cualitativas en salud pública y gestión de servicios de salud: algo más que otro tipo de técnicas. Gac Sant 1999, 13:312-319.
13. Pérez C. Sobre la metodología cualitativa. Revista Española de Salud pública 2002, 5 (76): 373-380.
14. Navarro P, Díaz C. Análisis de contenido. Cap. VII. Métodos y técnicas cualitativas de investigación en ciencias sociales. Madrid: Síntesis Psicología, 1995: 177-221.
15. Valles MS. La grounded theory y el análisis cualitativo asistido por ordenador. En: García MG, Ibáñez J y Alvira F, eds. El análisis de la realidad social. Métodos y técnicas de investigación (3ª edición). Madrid: Ciencias Sociales. Alianza Editorial,  1986: 575-603.
16. Calderon C. Criterios de calidad en la investigación cualitativa en salud (ICS): Apuntes para un debate necesario. Revista Española de Salud Pública, 2002; 76 (5):437-482.
17. Pla M. El rigor en la investigación cualitativa. Aten Primaria, 1999; 24: 295-300.
18. Prats M y Pueyo MJ. Las familias como eje central de la organización". Rev. Rol de Enfermería, 2003, 26(2): 154-158.
19. De la Cuesta C. Familia y salud. Revista ROL de Enfermería,1995; 203-204: 21-24.
20. Bover Bover A y Bauzà Amengual ML. Cuidador informal: mujeres al borde de un ataque de nervios.En: XXI Sesiones de trabajo de la AEDD. Valores e innovaciones en el umbral del siglo XXI. Su influencia en la práctica enfermera. Madrid: Fundación Mapfre Medicina, 2001.
21. Roca I, Caparà N. Las relaciones de género en el cuidado de enfermería. Enfermería Clínica, 1996, 6(4):164-170.
22. Serna C,  Millas R, Gómez MJ, Bastardo M, Arnal N  y Palacios G. La intercomunicación entre el personal de enfermería y los cuidadores de pacientes ingresados. Metas de Enfermería, 2002; 40: 25-36.
23. Segovia Gómez T y Pérez López ME. Rol del cuidador principal en el cuidado del paciente hospitalizado. Metas de Enfermería, 2001; 38: 16-22.
 

 

 

 

 

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