Caregiver Role Strain

 

Instructions: Fill out this form, print it, and hand it in with your assessment to your instructor. When you click on Next at the bottom of the page, you see the data you submitted. Please follow the instructions on how to save the data on the next page.

AOL users: Read this instruction.

Definition: caregiver's felt or exhibited difficulty in performing the family caregiver role

1. Your initials (required): 

2. Defining Characteristics- check those that apply to your client:

None- high risk diagnosis  changes caregiver's health status inability to complete caregiving tasks  difficulty performing caregiving  fear of possible institutionalization of care receiver 
3. Related Factors- check those that apply to your client:

insufficient support from significant others insufficient resources (transportation, money, supplies) family dysfunction
unrealistic expectations of care receiver change in level of care needed by care receiver
physical problems experienced by caregiver psychosocial problems experienced by caregiver
competing role commitments of caregiver inexperience with caregiving


4. Goal (ultimate, long term) 

5. Outcome Criteria (short term) 

6. Evaluation: Was the outcome criteria met? 

Yes- Give Evidence: 

No- Explain how you would change the plan: 

7A. Interventions 

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7B. Rationale for each intervention
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