Caregivers were found to endure mental stress due to their relatives’ injury and care-related issues. They were worried about the impact of the trauma on their clients’ health, outcome of treatment and longevity of care giving. The findings of this study were consisted with those of Dickson et al., (2011) that reported spousal caregivers of persons with spinal cord injury (SCI) experience worries as a result of uncertainty of the outcome of their partners’ health conditions, sudden change of role and chronicity of their roles. This study found that some caregivers were despaired by the poor outcome of their clients’ treatment when the care recipients could not walk during discharged. This concurs with the findings of a study reported caregivers were devastated and worried upon realizing the clients’ spinal injury was permanent (Lucke et al., 2013). The situation worsened their mental health by increasing their risk of developing depression (Rodakowski et al., 2013).
Thoughts of how to get money for treatment of clients culminated in obsessive thinking and worrying due to the high monetary requirement. Gardiner, Brereton, Frey, Wilkinson-Meyers, & Gott, (2014) gave similar description in their which suggested the cost of caring for a family member led to increased caregiver burden. This resulted in sleepless night and loss of concentration. Effects of financial burden on caregivers have also been reported to include increased worrying and difficulties in coping (Gardiner et al., 2014).
This study also found pains that persons with spinal cord injury (SCI) went through also emotional affected their caregivers. They were worried when the clients were going through pain or grief due to unexpected injury. They empathized with their care recipients when they were in pain. As commented by PP3 ‘When he went to the theatre and came back, that very day the doctors needed to do (wound) dressing, the way the child was shouting, I could not stand there. It was as if I was the one they were working on.’ The findings of this study is similar to those reported by Angel & Buss, (2011) among cohabitant couples whose partners had SCI in Denmark that the injured person’s pain increased psychological stress of healthy partners. Studies have also shown that caregivers go through sorrow without having emotional assistance (Lucke et al., 2013;Wells et al., 2009) but are however expected to provide emotional support to the injured person. This current study reported caregivers who could not control their emotions after their client’s injury wept upon seeing them immediately after the injury. Consistent with other findings, a qualitative study using grounded theory approach by Lucke et al., (2013) indicated that family caregivers of newly Latino persons with SCI experienced feeling of sadness during the early months of caring. The issue was not peculiar to only this study, Chen & Boore, (2009) reported that caregivers wept because of the incapacitation of their clients at the early stage of the injury. Dickson et al., (2011) also suggested moderate depression among 40% of caregivers caring for persons with SCI due to caregiver burden.
5.2 Challenges of caregivers
Caregivers reported being worried by myriad challenges. According to ABCX family stress model, stressors are the issues or needs that upset the caregiver or the family. The study revealed caregivers were faced with financial need because of the huge cost of treatment that affected the family’s finances. The findings of this study mirrors those by Monlinari, Gum, Roscore & Mills, (2008) which found family members were upset by the continual financial demands of caring for an injured relative. Similarly, Chen & Boore, (2009) reported caregivers and their families were faced with financial challenges after the unexpected injury. They were worried because of fear of lack financial resources required for the treatment of the disabled member (Chen & Boore, 2009). Caring for persons with SCI is financially intensive as a result, a huge financial burden is placed on families whose member is injured in the Ghanaian setting. A study reported financial cost included transportation to hospital, costs of medical service, prescription drugs and hospital bills (Gardiner et al., 2014; Sun, 2014). It was revealed that inadequate funding could limit the quality of medical treatment the client could access since the cost of treatment had to be paid by the family before certain services could be rendered.
The study also identified that, transportation of persons with SCI to the hospital was perceived a challenge for caregivers because the client’s condition, cost involved and scarcity of ambulances in certain remote parts of Ghana. Other studies found lack of access to transportation as a vexed challenge that made the need for physiotherapy and going out with the person with SCI for social activities difficult (Beauregard & Noreau, 2009; DeSanto-Madeya, 2009). Use of taxi and other commercial vehicles were employed to convey persons with SCI to the hospital and this sometimes caused the clients a lot of discomfort. This study result supports claims by Ahidjo et al., (2011), that indicated the use of ambulances and commercial vehicles for transportation of person with SCI in Nigeria. According to Ahidjo et al., (2011), the use of commercial vehicles and crouch positions were factors that negatively influence the outcome of the injured person condition.
Besides, the art of caregiving was as a major challenge that caregivers estimated as a difficult. Caregivers had to take care of all personal care activities that the clients could not perform personally. Caregiving tasks identified included bath??ing, dressing, diaper change, transferring, laundry, and transportation, feeding, managing medications (Rodakowski et al., 2013). Physical care of clients was reported by this study as a cumbersome activity that required extra training or caution. Likewise, 68% of caregivers in a comparable study reported being overwhelmed by their caregiving responsibilities (Arango-Lasprilla et al., 2010). They reported being anxious about the risk of causing further injury and pain to their clients because such clients require special attention (DeSanto-Madeya, 2009). This study reported their caregiving functions affected their physical health. Chen & Boore, (2009) gave a similar description when they reported, caregivers complained of exhaustion due to caregiving tasks. This study also found bed sore made caregiving tasks complex because the sores were never healing. Caregivers felt unprepared to deal with the complications of the client’s condition such as bedsores (Lucke et al., 2013). This was supported by PP1 as he pointed out ‘He is going to be discharged but here he is having some bed sores. Which we know it is not something which can be handled easily by us or any other person’Now how are we going to handle it’?
Though caregivers lacked the skills for caring for the injured family member, they were not given any training. A study found caregivers observed nurses without being able to assist their clients much at the initial stages of care. They further indicated how significant it is to involve relative in the caring process Angel & Buus, 2011). It is apparent that a special training for caregivers of person with SCI on the management of the injured family member at home in the Ghanaian setting would be worthwhile. This current study found that caregivers faced difficulties at the health facility during admission of their clients due to limited access to beds, uneasy access to medical specialist and unfriendly relationship of some healthcare providers. Brew Richardson, (2002) reported 7.7% of clients were delayed at the emergency because they had difficulty accessing hospital inpatients beds. This means that delays in access to inpatient beds could also delay certain specialist care. This study found that, relationship with healthcare providers had two facets. While some caregivers reported having supportive relationship with healthcare providers others were not treated friendly. The finding of this study is consistent with those by Lucke et al., (2013) which identified some caregivers found healthcare providers very helpful and supportive with the educational and physical aspects of care. Unfriendly relationship with family caregivers resulted in poor discharge information that complicated client’s condition. This finding pararelles other studies that suggested poor discharge information to caregivers can have direct effect on the care of clients in the community placing client safety in danger (Shivji, Ramoutar, Bailey, & Hunter, 2015). PP5 pointed out she was not given any information with regards to her daughters wound dressing at home except being told to come for review in two (2) weeks’ time. She was also not able to make enquiry from the nurse on duty because she was very unfriendly and that resulted in her daughter’s wound being infected. Accordingly, healthcare providers need to ensure good relationship with clients and their family caregivers so that their concerns can be broached for redress.
Also, caregivers were reported by this current study to spend more time at the hospital while their clients were on admission. Some caregivers came to the hospital early in the morning to attend to their clients and left there late in the evening. Similar findings have been reported by Lucke et al., (2013) that caregivers visited the hospital frequently while the family member was on admission, to learn to care for their loved ones.
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