Community Nursing

Community Nursing

Physical Effects of Caring for a Patient with Multiple Sclerosis
Caring for a relative with multiple sclerosis can significantly affect the physical well-
being of those providing care (Ramagopalan & Sadovnick, 2011). In most cases, it is usually a
collective responsibility of other family members who are expected to concentrate on the sick.
Irrespective of needed support, taking care of a person with multiple sclerosis can be challenging
and involves cleaning, moving them around and interruption of sleep. The paper evaluates the
physical effects that Geoff is likely to present while caring for his wife that suffers from multiple
sclerosis (MS) based on a presented case scenario.
Geoff’s Care Burden as a Primary Care
Evidence-based practices indicate that caregivers endure so much in their everyday
endeavors as far as caring for the sick are concerned. Caring for a Multiple Sclerosis patient has
not been an easy thing for Geoff who is certainly giving up largely because of the distress and
hopelessness of Karen’s deteriorating condition. In reality, the increased responsibility threatens
to impair not just Geoff’s everyday schedule but piles the mental stress that may lead to other
complications (Wood et al., 2012).
Increase Responsibility and Increase Work Hours to Meet the Financial Need for the
Family
Geoff is under intense pressure to juggle the demands of work and home responsibilities.
At home, for instance, Geoff has to cook for Karen and children and ensures that Karen takes a
bath with his assistance. This is evident for instance when Geoff goes to work late in the morning
and also comes home late after work, perhaps because he has to work overtime to meet family
obligations. The suggestion that Geoff is increasingly helpless about Karen’s current condition

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and what the future holds for the family explains just how excruciating the experience presents.
The assertion that “I just don’t think I can do this anymore” demonstrates how depressed Geoff
is and this trend is obviously leading to a change in physiological health habits (Hughes, Locock
& Ziebland, 2013).
Health Related Issues with Geoff
The concentration of caregiving afforded by Geoff to Karen is highly likely to lead to
other health related issues, whether quantified in terms of the amount of care provided (Simpson
et al., 2011). Karen’s suffering has a bearing on Geoff’s wellbeing as well. What is more
challenging is the fact that while Geoff is dedicated to providing the needed help to Karen, her
condition seems to get even worse. In reality, it becomes frustrating laboring to provide help that
is unable to enhance the quality of care, an aspect that culminates into negative health effects
(Palmer, 2011).
Other health issues associated with Geoff include Karen behavior, mental impairment,
functional disability; constant supervision of Karen to control self-injuries. In addition, Geoff is
not only depressed but also distressed, which may adversely affect his physical health. For
instance, based on the case, Geoff feels that their lives are falling apart due to Karen’s
deteriorating condition. According to Jones et al., (2012) caring for a patient with multiple
sclerosis is extremely challenging because the patient requires close supervision and depressed
due to the changing condition. Based on the case, Karen finds it harder to look after her family
while remaining positive about her new condition. These aspects are connected to adverse career
outcomes (Latimer-Cheung et al., 2013).
Family Disturbance and Unhappiness with Relationship and Sexual Issues

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As a result of Karen’s condition is likely to affect their sex relationship, family
disturbance, and unhappiness. In the recent past, studies have concentrated on caring for a spouse
leading to distress and carer’s perception of the level of pain the patient is experiencing (Bowen,
MacLehose & Beaumont, 2011). In this case, Karen’s suffering is depicted in different ways;
evident physical signs like blurred vision, unable to hold her walking sticks, dragging her left
foot and difficulty in holding heavy objects. Additionally, Karen’s voice is becoming weak,
especially; when she talks she cannot be heard. Karen’s suffering can lead to Geoff’s depression.
It is evident that due to increased burden of caring for Karen and other family responsibilities he
is not only powerless but also worried about their future.
Geoff’s Care Burden as a Primary Care
The physical health of the primary carer is adversely affected due to Karen current
condition. Increased stress levels, anxiety, and psychological health issues are common (Bozic et
al., 2011). Much as Geoff has increased levels of depression, past studies demonstrate that he
may present remarkable signs of depression (Sellner et al., 2011). In addition, depression and the
burden of caring for Karen may reduce Geof’s functional condition. Therefore, significant levels
of depression are common among people caring for patients with multiple sclerosis (Mansell,
Beadle-Brown & Bigby, 2013). Furthermore, the majority of carer’s are depressed as well as
psychological stress (Langdon, 2011). Anxiety and depression in primary carers can worsen,
particularly if the patient is placed in a nursing home. The majority of primary carer’s that
institutionalize a family member present high levels of depression similar to those when the
patient was at home (Wingerchuk & Carter, 2014). A depressed career may have chronic
disorders, dependence on drugs and anxiety disorder. On the other hand, depression is a primary
condition related to suicidal thoughts (Benedict & Zivadinov, 2011).

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Risk of Injury
As a family caregiver, Geoff is faced with the risks of medical depression because of
caring for Karen who requires physical needs. As such, Geoff is highly likely to engage in
detrimental behavior toward their loved one. Moreover, Geoff is also at an increased risk for
poor physical health outcomes owing to depressive symptoms and mental health issues among
caregivers, coupled with the physical pressure of caring for Karen who can hardly undertake on
everyday activities like taking a shower, cooking, and other individualized activities. The
beehive of activities that have a toll order on Geoff’s physical wellbeing in terms of increased
rates of physical ailments such as; acid reflux, headaches and other discomforts. Moreover, these
ailments can result from Geoff’s depleted immune response that leads to recurrent infections
(Munger & Ascherio, 2011).

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References

Benedict, R. H., & Zivadinov, R. (2011). Risk factors for and management of cognitive
dysfunction in multiple sclerosis. Nature Reviews Neurology, 7(6), 332-342.
Bowen, C., MacLehose, A., & Beaumont, J. G. (2011). Advanced multiple sclerosis and the
psychosocial impact on families. Psychology and Health, 26(1), 113-127.
Bozic, C., Richman, S., Plavina, T., Natarajan, A., Scanlon, J. V., Subramanyam, M. … &
Bloomgren, G. (2011). Anti‐John Cunnigham virus antibody prevalence in
multiple sclerosis patients: Baseline results of STRATIFY‐1. Annals of neurology, 70(5),
742-750.
Hughes, N., Locock, L., & Ziebland, S. (2013). Personal identity and the role of ‘carer’among
relatives and friends of people with multiple sclerosis. Social science & medicine,
96, 78-85.
Jones, R., Mackenzie, A., Greenwood, N., Atkins, C., & Habibi, R. (2012). General practitioners,
primary care, and support for carers in England: can training make a difference.
Health & social care in the community, 20(2), 128-136.
Langdon, D. W. (2011). Cognition in multiple sclerosis. Current opinion in neurology, 24(3),

244-249.

Latimer-Cheung, A. E., Pilutti, L. A., Hicks, A. L., Ginis, K. A. M., Fenuta, A. M., MacKibbon,
K. A., & Motl, R. W. (2013). Effects of exercise training on fitness, mobility,
fatigue, and health-related quality of life among adults with multiple sclerosis: a

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systematic review to inform guideline development. Archives of physical medicine and
rehabilitation, 94(9), 1800-1828.
Mansell, J., Beadle-Brown, J., & Bigby, C. (2013). Implementation of active support in Victoria,
Australia: An exploratory study. Journal of Intellectual and Developmental
Disability, 38(1), 48-58.
Munger, K. L., & Ascherio, A. (2011). Prevention and treatment of MS: studying the effects of

vitamin D. Multiple Sclerosis Journal, 17(12), 1405-1411.

Palmer, A. J. (2011). Economic Impact of Multiple Sclerosis in 2010: Australian MS

Longitudinal Study.

Ramagopalan, S. V., & Sadovnick, A. D. (2011). Epidemiology of multiple sclerosis. Neurologic

clinics, 29(2), 207-217.

Sellner, J., Kraus, J., Awad, A., Milo, R., Hemmer, B., & Stüve, O. (2011). The increasing
incidence and prevalence of female multiple sclerosis—a critical analysis of
potential environmental factors. Autoimmunity reviews, 10(8), 495-502.
Simpson, S., Pittas, F., Van Der Mei, I., Blizzard, L., Ponsonby, A. L., & Taylor, B. (2011).
Trends in the epidemiology of multiple sclerosis in Greater Hobart, Tasmania:
1951 to 2009. Journal of Neurology, Neurosurgery & Psychiatry, 82(2), 180-187.
Wingerchuk, D. M., & Carter, J. L. (2014). Multiple sclerosis: current and emerging disease-
modifying therapies and treatment strategies. In Mayo Clinic Proceedings (Vol.
89, No. 2, pp. 225-240). Elsevier.
Wood, B., Van Der Mei, I. A. F., Ponsonby, A. L., Pittas, F., Quinn, S., Dwyer, T., & Taylor,
B. V. (2012). Prevalence and concurrence of anxiety, depression and fatigue over
time in multiple sclerosis. Multiple Sclerosis Journal, 1352458512450351.

Karen Bailey is a 39 year old who was diagnosed with remitting Multiple Sclerosis 4 years
ago.
Karen is married to Geoff, and they have 3 children aged 3, 5, and 9 years old respectively.
They live in their own home which is spread across two levels. Geoff is Karen’s primary
carer – Geoff is a partner is an accountancy firm which involves a large amount of interstate
travel. He is often not able to get home before 7.00 PM of an evening.
Karen now needs to use a walking frame to maintain her level of ambulation and is finding it
increasingly difficult to mobilise easily. Karen’s sister, Lisa lives nearby and visits often. Lisa
is keen to be involved in looking after her sister; however Karen doesn’t want Lisa to see the
extent of her condition or her lack of independence.
Karen continues to look after the children on a daily basis, however some afternoons Karen
finds this more difficult than others. Karen is finding that it is harder and harder to remain
positive about her changing condition.
Karen has always enjoyed reading, however due to deteriorating eyesight and weaker arm
muscles, Karen is no longer able to focus on the text or hold the book. Lisa has arranged
some talking books for Karen, however increasingly the concentration required to use these
has become too tiring.
Geoff is struggling with the joint responsibilities of work and increasing role in Karen’s care.
He goes into the office later in the morning after assisting her with a shower; however this
results in him coming home later in the evening. He has indicated that he feels increasingly
powerless in this situation and is concerned about what the future holds for them.

TRIGGER
You are community nurse who has been allocated as Case Manager for
Karen. When you arrive on your first visit

Karen is home by herself and appears desperate to talk to you. Karen has a
close friend ,Bernadette, who is a naturopath. Bernadette is really trying to
get Karen to try alternative therapies as she thinks that the medications
Karen is taking are making her condition worse and thinks that an alternative
approach to care would have a better chance of curing Karen.
Karen doesn’t know much about the medications but concerned that if she
refused Bernadette’s offer, their friendship will be lost. This friendship is
important to Karen because a number of her friends have severed contact
with her.
In conversation, Karen tells you that over the past couple of weeks ,she has
developed a number of bruises on her arms and legs. Bernadette has said
that it must be Karen’s medications doing it to her and that means they must
be toxic to her. Karen is unsure and asks what you think?
The following day you are working in the community health centre when you
get a phone call from Karen’s husband, Geoff. Geoff tells you that Karen had
a fall in the lounge room last night and he needed to call the paramedics to
lift her off the floor as he did not know how to do this. He sounds very
stressed stating “I just don’t think I can do this any more”. Geoff is not able to
take any more sick days from work to care for the children and asks about
what help is available.
Given the urgency of this situation you visit Karen the same afternoon to
assess the situation. When you arrive Karen is home alone. Karen is concerned
about Geoff and has encouraged him to go to work. She is worried about her
family and how they are coping.
Karen has also noticed that she is now having some urinary dribbling. She
tells you she had a fall last night and said this is happening on a regular basis
as she needs to hurry to get to the toilet. Last night’s fall has shaken her
confidence consider ably and she now feels less able to be at home on her

own. When Karen discussed this with her husband, he said that he felt as if
“their lives were falling apart”. Karen indicated her two elder children were
responsible for many of the household chores such as washing and cleaning
whilst her husband did the cooking and help with her showering.
Karen has developed a persistent dry cough and also has a fever. She has also
been experiencing increasing symptoms such as blurred vision, difficulty with
holding her walking sticks, is dragging her left foot as she walks and is now
unable to hold heavy objects.
Karen’s voice is also becoming weaker and Karen is having difficulty being
heard when she talks.

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