BetterConduct

One of the reasons journaling is often recommended to help caregivers reduce stress is the fact that it allows the caregiver to look back on what struggles ensued, what strategies worked, and which did not in the repertoire of responses chosen. If we write about what did not work, we may have ideas about adjustments we could make next time the situation occurs. If we ponder what made the day difficult, we can also imagine what can be done to prevent such days in the future. Caregivers can also write about what DID work. We can write about how we may have had to accept something close to what we wanted to happen. We may also realize when we need to have more help, or ways that we are improving in addressing complicated caregiver issues such as problematic behavior. This is problem-focused coping.

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As mentioned in a previous website article, Problem-Focused coping is beneficial to both the caregiver and IWD.  But what does this approach entail? In my view, the steps of Problem-Focused coping are listed below, with examples, as necessary.

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Identify problem

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Verify that it IS a problem

Is the problem for you (shaving) or IWD (not eating) or both (wandering/safety)?

Does the problem cause an emotional response from you? Is this response generating the problem?

Example scenario:  John needs to shave or be shaved daily so it looks like he has been well taken care of, which his carer views as a reflection on her ability to provide care. When he will not allow shaving, she scolds him and scowls. Her response is attention-getting, which he likes/needs. Even negative attention can be reinforcing. Try praise when he DOES allow shaving.

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Define problem.

If there is a problem, what exactly is it?

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How serious is the problem? Is it a health or safety issue?

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Try to ascertain what caused the problem (antecedents). First impression is not always accurate    

    as there could be many different issues contributing to the problem.

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Is the problem due to a mistake or oversight?

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Has the problem occurred before? (Is there a pattern?)

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Are there times when the problem did not happen or was less severe? If so, what was different?

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Look for solutions.

Is there more than one solution? If so, how many solutions are there? (brainstorming)

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If the problem has occurred before, what did you do? Was it successful in addressing the problem?

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Obtain more information if there are multiple solutions. In some instances, talk to others and use social support.

Example scenario: After years of back pain and comparison of past and current x-rays, it was determined Leon has a fracture in one of his vertebrae. He also has osteoporosis. To treat the osteoporosis and decrease the possible occurrence of future fractures, his primary care physician recommended a choice of two intravenous drugs. One is given by infusion through an IV, takes an hour to administer, and is prescribed once a year. The other is done by injection every 6 months. After weighing the pros and cons, the first medication was ruled out as Leon would not sit for the hour-long infusion and had managed to pull out IV ports in the past. The second drug had serious side effects (muscle pain, ear pain, severe abdominal pain, etc.) that Leon would probably not be able to communicate to us. Leon’s caregiver and guardian opted to increase vitamin D and calcium in his diet instead and incorporate more movement into his day.

Regulate your response to the problem so you can be as objective as possible.

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Are you taking time to care for yourself?

This may sound out of place anywhere in this sequence, but if you are caring for yourself, you can think more clearly and be more confident in your possible solutions.

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Weigh the solution.

Is the solution you have chosen worth the effort, work, cost, and/or time to correct the problem or can you do something else (show flexibility and/or lower expectations)?

            In the previous shaving example, perhaps a day could be skipped between shaves.

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Will the solution cause a problem somewhere else? What are the repercussions?

Example scenario: Tonya would not (or could not) say when she was hungry unless asked. She would go from breakfast at 11am till dinner at 6pm with a small (usually carbohydrate) snack midway. She was becoming agitated (hangry?) in late afternoon. It was suggested she have a protein-rich, more substantial snack at this time instead. Tonya started eating a larger snack in the afternoon and her agitation dissipated. This caused her to eat less at dinnertime due to decreased appetite. Overall, however, she was consuming more calories evenly throughout the day.      

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Decide if that solution will create more issues than it solves.

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Look forward. (Predict)

What do I predict will be the result of implementing this solution?

          Even if I predict this will not solve the problem, it might be worth trying anyway.

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Example scenario: Laurie purchased a vibrating pillow for her sister, Jean, who had chronic back pain. Jean’s husband thought the      pillow was too stuffed (thick) and vibrated too intensely for it to feel good behind Jean’s back. Laurie insisted it be tried anyway. Jean now asks for the pillow now if her back is really hurting. 

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If the predicted results do not occur, what might be the next approach/solution?

            Take some stuffing out of the pillow and try it again.

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Look back. (Evaluate)

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After implementing the solution, evaluate the results.

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Did it solve the problem? Were these the results I expected?

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Did the solution create other issues?

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What did you find was helpful in managing this situation?

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In dementia, the same solution in an identical situation may not work the first or even second time. The third time, however, it just might. And vice versa. Just because something worked the first time it was tried does not mean it will work next time. Again, a journal or other form of notetaking can help us see patterns, contraindications, etc. It is definitely worth a try.