Psychosocial needs and challenges of caregivers at Eldoret Hospice in Eldoret town

Abstract

Hospice care is a type and philosophy of care that focuses on the palliation of a terminally ill or seriously ill patient's pain and symptoms, and attending to their emotional and spiritual needs. In Kenya’s hospice there have been many challenges faced by caregivers that cuts across social, economic, political and psychological. Many efforts have been done and even institutions created to address them but there is still more to be done. In Eldoret Hospice, cancer clients and their caregivers go there for care. The structure is in such a way that hospice forms social network with neighboring hospitals and do follow ups in home setting. This gives institutional caregivers’ big workload. The emerging trends of home care and institutional care give leeway for most care to be done in home setting by family members (nuclear and/or extended) and friends to the cancer clients. These caregivers are less trained to take care of these clients and are likely to show sympathy and not empathy because of close relationship. Therefore, professionalism is at stake. Theoretically, many studies conducted on caregivers’ psychosocial needs and challenges have been carried out outside Kenya, in western world, and a few done in Africa. The specific objectives of this study were: to find out psychological needs and challenges faced by caregivers at Eldoret Hospice in Eldoret town, to investigate social needs and challenges faced by caregivers and to find out the coping strategies for psychosocial needs and challenges faced by caregivers. The study was based on self-care deficit nursing theory by Dorothea Orem. The study was conducted in Eldoret town and was a mixed research (qualitative and quantitative) in nature. The sample size was 18 respondents; 6 caregivers from MTRH hospital, 6 caregivers at home setting and 6 caregivers from Eldoret Hospice. Psychological assessment, in-depth interviews, focused group discussion and life histories were used as the study methods. Research instruments were Self Rating Scale by Judy Bradley, Self-analysis questionnaire by Dr. Charles Spielberger, in-depth interview guide, focused group discussion guide and interview guide. Validity was ensured through piloting the instruments, methodological triangulation, peer consultation and consultation with supervisors. Reliability was ensured through test re test of instruments. Data collection procedures were embedded in the instruments used in the study. Saturation method marked the end of the process. Data was analyzed through recursive abstraction technique where descriptions, narrations, quotes and citations were used. The findings revealed Psychological challenges of caregivers were caregiver stress, compassion fatigue, depression, burnout and mood disorders. Psychological needs of caregivers were Information, debriefing, supervision, and training. Again, socially caregiving had affected caregivers’ personal relationships and social life as they find themselves ‘carrying their work home.’ Caregivers need training on culture, modern visa vise indigenous medicine and traditional visa vise modern counseling. Caregivers used differentiation of self, basic counselling skills, self awareness, spirituality, seeking knowledge, clinical supervision, sharing and debriefing, reflection on lessons and insights as coping strategies. A conclusion is arrived at that all psychosocial challenges are universal; anyone is at risk. Psychosocial needs vary with personality, context, location, knowledge, gender, age, occupation, and status as well as coping strategies. Recommendation was that training programs adapted for caregivers should capture the aspect of culture from which the clients comes from and caregivers should embrace team work for better results.