Stress Coping, Social Support, and Quality of Life for a Patient Who Suffered Stroke - Essay Example

Sandra Noble Essay Sandra Noble is a 56-year old woman who has suffered a stroke. She has suffered the stroke on the left side of her brain and her speech has been affected. Prior to the stroke, Sandra smoked 30 cigarettes a day and her diet was made up of convenience food; she has a BMI of 35. She also drank about 21 units of alcohol a week and worked in a call centre. Sandra lives with her husband who is an off shore worker and they live 15 miles form the hospital. Sandra also is being treated with thrombolytic drugs because she has a blood clot on her brain that the doctors say was the reason for the stroke. Sandra is unable to speak at this time which also means that she cannot work; her husband has to quit work so that he can take care of her. The purpose of this discussion is to design information that can help Sandra and her husband cope with what has happened and insure that they will have a quality of life. Psychological Effects of Stroke According to The Stroke Association (2009), there are many psychological changes that a person can experience after a stroke. Depression is a common result because a person must deal with physical changes that are different from what they experience before the stroke. Many people are not assessed for depression so it is a good idea for Sandra to have an assessment for depression. Fear and anxiety can affect an individuals psychological well-being because they have lost the ability to use part of their body or they have been affected in other ways. In Sandras case, she is unable to speak and she has lost the use of her right side. Sandra will need to adjust to this situation in order to be successful in rehabilitation. Although each stroke is different, because Sandras left side of her brain has been affected, she may experience outbursts of anger or she may find herself crying for no known reason (Stroke Association, Fact Sheet 10, p. 1). These bursts of anger and crying are often linked to their frustration of not being able to take care of themselves for their daily needs (Ryan, 2009, p. 1806). Many stoke victims have a loss of sexual desire, and perceived loss of control or "the relinquishing of defined roles" of their daily routine. (Thompson and Ryan, p. 1807). The family is also affected because initially it is a shock. Most people do not feel that they are going to have any health problems and a stroke happens suddenly and dramatically. Family members may also feel a sense of loss because the person they have known and loved is now different. The doctors cannot really determine how much recovery a person will need or how much time it will take which is also a very unpredictable situation (The Stroke Society, Fact Sheet 4, p. 4). Becoming a carer is a large responsibility and it is stressful and often difficult. Many carers find themselves on the emotional roller coaster also with feelings of guilt, anxiety, depression and resentment; a stroke can change the lives of everyone in the family. Sandra may also find that her emotions will differ from moment to moment and some days may be like a roller coaster ride. Many stroke victims find that they lack motivation and feel apathetic about their lives. There can also be a feeling of loss and grief because an individual has lost their life as they once knew it (The Stroke Society, Fact Sheet 4, p. 4). The entire family will be affected because of the changes. In Sandras husbands case, he had to quit his job in order to take care of her. He will now have to do the work around the house, cook, and manage the household and basically take care of the life for two people. Huang et al (2008) studied carers of persons with strokes and found that the major challenge from them psychologically was depression. They studied Taiwanese women because it is often women who are primary carers in health situations (p. 509). Coping Mechanisms for Stress and Psychological Support According to Rogers et al, "Stroke affects 140,000 people in England and Wales each year and it is the commonest cause of severe disability" (p. 425). In other words, there are many people dealing with life after a stroke and many carers who must take care of them. Although emphasis is put on the stroke victims needs, the carer also has needs. Some of the needs for carers that need to be met include: 1. They must have information about the causes, nature and consequences of stroke. This will help them understand what to do and how to cope better with what is happening to their family member. 2. Stress and depression are very prevalent for carers and stroke patients which can create a negative situation for everyone. The carer may need to be assessed for depression also. 3. They need to balance their needs with the needs of the person they are caring for in order to stay refreshed and renewed. The carer must find activities they can do away from the stroke victim in order to help lower their stress, their own feelings of isolation and their general dissatisfaction. (Rogers, et al, p. 425). By getting their needs met, carers are able to cope with the problems they encounter on a daily basis. Support groups for carers, one on one training in how to care for stroke victims, and counselling for carers where needed are all ways that the carer can cope. They also need training in problem solving and social support. Each individual must find those programs that work best for them because they do not all help. As an example, Rogers et al found that interventions that only provided support or information were not helpful in reducing carer stress or improving their quality of life (p. 426). Instead, carers learned more form interventions that were structured and were geared specifically to carer needs. The best interventions also provided psychological interventions. In Sandras husbands case, it will be necessary for him to have people he can talk to who are going through the problems he is going through so that he understands that he is not alone. There may also be group counselling available through the hospital or through a community organization. Dorsey and Vaca (1998) pointed out that the financial burden that comes to a family when someone has a stroke. The burden of drugs and the various durable medical equipment and direct care costs create the burden (p. 63). Family support will be very important for financial and emotional support during these times. If they have family that can help, perhaps they can give Sandras husband some respite; pay or status and community resource report can also help. Another way that Sandras husband can be helped is to stay focused on helping Sandra only when she needs help. In other words, he must allow her to do as much for herself as she can. In this way, he will understand what must be done for her and what she can handle. This action will empower both of them in a positive way. Also, listening to Sandra -- whether this is written communication or verbal attempts to speak -- will help Sandras self-esteem and help her husband become more aware of what Sandra actually needs from him (Dorsey and Vaca, 1998). Dorsey and Vaca also found that successful caregivers had strong self-esteem, strong social support, and strong social skills. When the caregiver is successful, the rehabilitation for the patient who had the stroke is successful (Dorsey and Vaca, 1998). `There are a number of support groups that are specifically geared towards stroke victims. Some are a part of hospitals and others are programs in the community. Sandra should check with her doctor to see what programs are close to her home. Sandra will be participating in rehabilitation services so that she can train her left side again. This will also give her confidence because she will be able to see progress and move towards her independence again. Coping strategies will be different for each person. Sandra will need to involve herself in activities that she can accomplish and see herself make progress in. She will need to learn strategies for herself through counselling or through a support group. Her husband will need to have people he can talk to and who can help him get respite away from Sandra sometimes so that he can refresh himself. Both parts of the couple must view the stroke in a positive way in order to be successful. Other Indicators for Sandra There are several other issues that Sandra should address in order to possibly prevent future strokes. A good idea for her would be to take a nutrition class with her husband. This would help them both understand the value of good nutrition and could give her husband ideas for cooking at home. Also, smoking and drinking have been part of her life and she will need to understand the value of stopping these behaviours for better health. One of the reasons this is important is that women who have a poor diet and who smoke are at high risk of stroke (The Stroke Association, 2009, Fact Sheet #38). Although the doctors state that a blood clot on her brain caused the stroke, her general lifestyle could have also been a contributing factor. Another idea for Sandra may be to join an exercise program as she progresses through her physical therapy. This would help her find social interaction with people there; perhaps there is a local day program or recreation centre that may have these types of programs. Benefits and Legislation According to Bremner (2009), "an estimated 150,000 people in the UK have a stroke" each year (p. 1) and stroke is "The third biggest killer and the leading cause of disability" (p. 1). When people suffer a stroke, they are usually in need of financial benefits because they will lose time from work or be forced to quit the job permanently. In addition, spouses often have to quit their jobs to take care of the stroke patient. Because of the loss of work, there are several ways that an individual and their carer can find support. The Stroke Association (2010) has a series of fact sheets that provide information on benefits that are available to stroke victims and their families. They suggest that the Department of Work and Pensions (DWP) is the first place to begin the process because they can help families apply for those benefits where they qualify. The DWP can also provide a Disability Living Allowance for people under the age of 65 who work and who are not eligible for a similar benefit from an employer. Both Sandra and her husband can receive these benefits (The Stroke Association, 2009, Fact Sheet #38). The Carers Allowance s also available for those people caring for someone at least 35 hours per week. Sandra would have to be receiving The Disability Living Allowance at the "middle or higher rate" (The Disability Law Service, 2009). It is not known whether a family is eligible for all of these benefits so they must apply for them in a timely fashion. Sandras husband might also find a way to create a part-time at home by talking to people or by joining a job support group if there is one in his area. This would give them a small stipend as well as create an opportunity for him to feel valued and give him something else to do beyond caretaking. The Benefits Agency also provides a living allowance for those who qualify. References Bremner, I. (22 June 2009). Help for Wiltshires stroke victims. Liberal Democrats. Available from http://trevorcarbin.org.uk/news/00382/help_for_wiltshire_stroke _victims_html. [Accessed 01 January 2010]. Dorsey, M.K. and Vaca, K.S. (1998). The stroke patient and assessment of caregiver needs. Disability and Rehabilitation. 16 (3) pp. 62-67. [Online]. Available from Science Direct. DOI: 10.1016/S1062-0303 (98) 90003-6. [Accessed 01 January 2010]. Note: This article is older than suggested, however it is one that I felt was pertinent to this discussion. Huang, C-Y., Sousa, V.D., Perng, S-T., Hwang, M-Y., Tsai, C.C., Huang, M-H., & Yao, S-Y. (2008). Stressors, social support, depressive symptoms and general health status of Taiwanese caregivers of persons with stroke or Alzheimers disease. Journal of Chemical Nursing. 18. pp. 502-511. [Online]. Available from Blackwell Publishing. DOI: 10.111/j.1365-2702.2008.02443.x. [Accessed 01 January 2010]. Disability Law Service. (2009). Carers allowance. Available from http://www.dls.org.uk/advice/factsheet/welfare_benefits/carers_alalowance/Carers%20Allowance.pdf. [Accessed 01 January 2010]. Rodgers, H., Francis, J.J., Brittain, K., & Robinson, A.:. (2007). Who cares? Caring for the carers of stroke patients. Disability and Rehabilitation. 29 (5) pp. 425-427. [Online]. Available from Academic Search Premier database. DOI: 10.1080/09638280600834369. [Accessed 01 January 2010]. Thompson, H.S., and Ryan, A. 92009). The impact of stroke consequences on spousal relationships from the perspective of the person with stroke. Journal of Clinical Nursing. 18. pp. 1803-1811. [Online]. Available from Blackwell Publishing. DOI: 10.1111/j.1365-2702.2008.02694.x. [Accessed 22 December 2009]. The Stroke Association. (2009). Stroke: A carers guide. Fact Sheet #4. [Online]. Available from http://www.stroke.org.uk. [Accessed 21 December 2009]. The Stroke Association. ((2009). Women and stroke. Fact Sheet #38. Available from http://stroke.org/uk. [Accessed 21 December 2009]. The Stroke Association. (2010). RO1 Benefits resource sheet. Available from http://www.stroke.org/uk/information/our_publicatins/factsheets/benefits.shtml. [Accessed 21 December 2009]. Read More