World Kindness - Caring for our Nation’s Caregivers

Caring for our Nation’s Caregivers: The Importance of Caregiver Wellness to Patient Care  When dissecting the caregiver-patient relationship, it is important to recognize that caregiving is largely a symbiotic system. In an article discussing the complexities of this relationship the authors noted that “due to the mutual influence both individuals have on each other, it seems to be reasonable and effective to design psychosocial support in a dyadic manner rather than focusing on one of the two individuals separately.”(Wiegelmann, H.)   In this article, we will break down the mechanics of stress, how caregiver stress correlates to patient care, and what caregivers and healthcare facilities can do to ensure the mental and emotional wellbeing of caregivers.  

What is stress? 

Stress is well… stressful. But if we understand what it is, we'll be better able to deal with it. 
In a biological context, stress is a physical, mental, or emotional reaction that causes bodily or mental tension. Stress is a universal survival mechanism, that allows us to notice and change aspects of our environment; it can reveal itself in that ways that our bodies and minds respond to pressure. There is good stress that we can use to our advantage and bad stress that overtime can cause harm to our health. 
Good stress can get us out of trouble when we perceive danger. Our hearts pump furiously to increase blood pressure, while glucose is sent to our muscles like a fuel injection. In this emergency mode called fight or flight, we become hyper-focused to help get us out of danger. But this type of stress is only meant to be felt in short bursts, but in this day in age, we almost live in a perpetual state of fight or flight. This is problematic because in this mode our bodies are so focused on our immediate survival that other evolutionary necessities like memory and rational thought are tossed to the side.   
 What is anxiety? 
We tend to think of anxiety in a negative light, generally because the experience is uncomfortable, but our sense of anxiety is a strong evolutionary tool that has helped to keep our species alive. The amygdala in our limbic system is what detects possible threats in our environment. So, in layman’s terms, anxiety is our body becoming hypersensitive about the environment around us. During the process of fight or flight, our brain tells our body to forget about digestion and other habits of long-term survival. Anxiety is our brain and body focusing exclusively on short-term survival. Our hearts speed up and our blood vessels dilate, sending oxygen rich blood to our muscles. This can explain the “super-strength” that some people experience when they are in immediate danger. It is this change, when our body is considering to fight or flee, that causes the tingle often associated with feelings of anxiety.   
How do long-term stress and anxiety manifest in the body? 
So, on a surface level, anxiety and stress are good evolutionary superpowers that help to keep us out of harm’s way. The trouble comes when our bodies are stuck in this state of high stress and anxiety for too long. Our bodies start to exist in a chronic state of exhaustion, our brains don’t work as efficiently, and our immune system suffers leading to physical illness. 
How does caregiver mental health relate to patient care? 
Studies show that the quality of mental health in a caregiver directly correlates to the plausible risk factors for patient mortality. The mental health of caregivers can affect patients in numerous ways. Firstly, the mental health of the caregiver can greatly influence the quality of care that they provide (in other words, you can’t pour from an empty cup). Depressed or anxiety ridden caregivers are more likely to engage in patient neglect behaviors that are known to predict patient mortality. Caregiver mental health problems can also weaken the social bond between patients and caregivers which understandably can affect the progress of care of the patient. Lastly, researchers have found that poor mental health in caregivers can rub off on the patient through emotional mimicry or emotional contagion. In other words, it is likely that the poor health of the caregiver can be indirectly transmitted to the patients that they are caring for. 
 
How Can Caregivers Prioritize their Mental Health? 
Reactive Tips for Reducing Stress and Anxiety: 
Our feelings of stress and anxiety are primitive and inherent, so the symptoms will always appear and that sense of fight or flight will always come back, but that doesn’t mean that we are slaves to these feelings. 
• Take a few deep breaths  
A few steady, deep breathes can help counteract the immediate physical effects of stress such as muscle tension and racing thoughts. In addition, controlled breathing techniques summon the rest-and-digest system in our bodies (aka the parasympathetic nervous system). Measured breath fills the body with more oxygen, slowing down our heartrate and easing our body back into a balanced state. Essentially, intentional deep breathing can help you control your stress before it controls you. 
• Laugh 
It may sound odd and a bit counter-intuitive to laugh when stressed, but forcing a laugh or a smile is another subtle way to show your brain that the frustration and anxiety you are feeling in that moment is not life-threatening. The stressing agent is a bother for sure, but a little laugh can take your body out of fight or flight mode which can allow you to think more clearly, aiding in finding a resolution to your stressor.  
Laughing in a state of stress can be incredibly challenging at first. If you are having trouble with this option, consider trying laugh yoga, which incorporates different breathing and laughing experience without the use of humor, so even if you aren’t able to find humor or joy in a moment of stress, you can still get the benefits of this suggestion. 
• Put on a happy face 
Much like how deep breathing and laughter can show your mind and body that you are not in immediate danger, so can forcing a smile.  
• Listen to music 
It has long been understood that music can have a great effect on our body and our mood. Listening to music associated with happy memories can momentarily transport our mind and body back into that calm, happy or joyful state by releasing yummy chemicals like endorphins and dopamine which counteract the cortisol (aka the stress hormone). 
• Dance 
In addition to the chemicals that are released when we listen to music associated with positive feelings, dancing while listening to these songs can help reduce stress as well. Not only does dancing get your blood pumping and relieve tension in the body, but movement to music that calms or levels you can be a powerful mental and emotional experience as well. 
• Don’t combat stress alone 
• Take control of your mind 
Our bodies function a great deal in autopilot. This is another evolutionary tool that humans have developed over the course of our existence. There are many things that a body must do to survive, but our brain subconsciously handles a lot of that work without our conscious thought, allowing us to divert our attention to other things. For example, the entire time you have been reading this article, your lungs have worked to draw in oxygen and exhale carbon dioxide, all without your direct knowledge or intent. Because of our body’s independence, when we are under constant pressures our bodies cannot separate a chronic stressor from an immediate threat. This means that when we are feeling stressed by things like our jobs or school, our brain naturally gravitates to the feelings of stress in order to “fix it.” This makes us hyperfocus on the negative and pushes us even further into a state of fight or flight. We can combat this by deep reflection, by understanding our stressors and reinforcing the idea that not all things that stress us out are life- threatening. This is a skill that takes practice and consistency. 
  
Proactive Tips for Reducing Stress and Anxiety 
• Understand the foundations of mental health 
Understanding the components that contribute to positive mental health can help you better align your life with principles that contribute to your happiness and wellbeing.  
Components of Mental Health: Food, sleep, exercise and  
• Take time to really understand and highlight your personal stressors 
Understanding what heightens your fight or flight can help you be proactive in avoiding intense stressors and can also help you guide your mind through the process of feeling unsafe. For example, say you seem to misplace your keys every time you are on your way out the door. By being aware that losing your keys makes you feel worried because you don’t want to be late, you can reassure yourself in these moments of stress by remembering that you eventually always find your keys. You can follow some of the reactive steps mentioned above which can help ease your mind and maybe even trigger a memory that helps you find your keys faster 
• Be aware of what makes you feel good 
This is just as important as having a deep grasp of your stressors. Knowing what helps you feel more relaxed and at ease can help you regulate your body when it is thrown into fight or flight. This knowledge can also give caregivers a sense of what steps to take when they feel their fight or flight response being triggered by something that is not life-threatening. It’s almost like creating a fire-safety plan in advance of a fire, so that everyone knows how to behave, and the situation can be dealt with in an orderly fashion.  
Another reason for caregivers to understand what makes them feel better, is so that they can create a little palate cleanser after a stressful experience. Sticking with the example of the lost keys, even after you find them, your body is still feeling the effects of the stress caused while searching for them. Instead of hoping in the car and heading to straight to work (like most of us would), you could play your favorite song or take a few deep breaths to regulate yourself so you don’t carry the stress with you throughout the day. 
• Exercise regularly 
Regular, adequate exercise can do wonders for the body. As it relates to stress, a consistent exercise regime can help your body rid itself of the excess, pent-up energy. This can be a great resource for caregivers who need an outlet of release.  
• Socialize and have fun 
• Become one with nature 
• Practice daily gratitude  
Focusing on the things in our lives that are going well or have gone well is a great way to build optimism and resilience so that we can bounce back quicker from moments of stress. I prefer to practice grateful reflections in the morning. I find that starting the day with thanks for what I already have sets me up for a more productive and ease-filled day. Over time, this practice of daily gratitude will help caregivers feel centered, relaxed, and prepared for whatever life may choose to throw at them. This practice will make it so the plethora of times that you overcame challenges will stay fresh in your mind, making you feel stronger and more capable. 
 
How Can Healthcare Facilities Facilitate Better Caregiver Wellness: 
• Understanding the foundations of mental health 
• Understanding their role in Caregiver Burnout  
• Consistent scheduling  
• Develop safe-spaces within the workplace where workers can escape stress and maybe engage in anti-stress activities 
• Consider maintaining a Gratitude Wall 
 
#WorldKindnessDay, #FamilyCaregiversMonth, #CaregiverWellness, #CargiverHealth, #CaregiverSupport, #CargivingTips, #Wellness,  
 
Sources: 
• Delaney, Lisa. “The Cost of Caring: New Stats Shows How Caregiving Really Affects Mental Health.” Parade.com. Nov, 2022. https://parade.com/health/care...  
• The Family Caregiver Alliance. “Taking Care of You - Effects of Caregiving on Health and Well-being.” AWoman’sHealth. May, 2020. https://awomanshealth.com/heal... 
• Glaser, Janice-Kiecolt  and Ronald. “"Chronic stress and age-related increases in the proinflammatory cytokine IL-6." Proceedings of the National Academy of Sciences. June 30, 2003. 
• Katherine Smith, MPH, NBC-HWC, ACC et al. “Effects of Health and Wellness Coaching with an Adult Cancer Caregiver.” thepermanentejournal. Vol 26, No. 2. June, 2022. https://www.thepermanentejourn...  
• Lwi, Dandy J., et al. “Poor caregiver mental health predicts mortality of patients with neurodegenerative disease.” PNAS. Vol 114, No. 28. https://www.pnas.org/doi/full/...  
• Princing, McKenna. “This Is Why Deep Breathing Makes You Feel so Chill.” Right as Rain by UW Medicine. Sept, 2021. https://rightasrain.uwmedicine...  
• Schulz, Richard, and Paula R Sherwood. “Physical and mental health effects of family caregiving.” The American journal of nursing vol. 108,9 Suppl (2008) 
• Smith, Melinda, M.A. “Family Caregiving: Caregiver Stress and Burnout.” HelpGuide.org. Nov, 2022. https://www.helpguide.org/arti...  
• Wiegelmann, H., Wolf-Ostermann, K., Brannath, W. et al. Sociodemographic aspects and health care-related outcomes: a latent class analysis of informal dementia care dyads. BMC Health Serv Res 21, 727 (2021) 

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