CHAPTER 1

INTRODUCTION

Caring is central to all helping professions, and enables persons to create

meaning in their lives. Caring must have connection between the care giver and

the patient; it is established from the built trust, and good working relationship

between the care giver and the patient. Mutual recognition must also be present

in caring, the care giver and the patient must know each other, and must set

common goals within them, and that is promoting the wellness of the patient.

Involvement between the care giver and the patient is also a priority, just as

clients benefit from the caring practices provided to them, the care giver involves

in these situations also experience caring through knowing that they have made

a difference in the lives of their patients. This is a credit to the care giver’s feeling

of satisfaction.

The caregivers are known, anyone who routinely helps others who are

limited by chronic conditions. Caregivers are simply the advocate of patients who

are physically, emotionally and socially unhealthy. A caregiver can be formal or

informal caregiver. Formal caregivers, they are volunteers or paid employees

connected to the social service or health care systems and agencies. While

informal caregivers, may either be family members or friends of the patients, who

render primary care for nearly three-quarters of the impaired older adults who live

in the same community. The caregivers’ role has traditionally included activities

that assist the client in terms of physical, psychological, developmental, cultural,

and spiritual levels while preserving the client’s dignity. Caregivers assist with

1

such basic tasks as bathing, dressing, and preparing. Some have the added

responsibilities of administering medications, making sure that an immobile

person is turned frequently to avoid developing pressure sores, and other tasks

related to the person’s illness or disability. The required act of care of the

caregiver may involve full care for the completely dependent client, partial care

for the partially dependent client, and supportive-educative care to assist clients

in attaining their highest possible level of health and wellness. Caregivers focus

much on taking care of the patient using their hands, hearts and souls.

Caregivers’ hands imply doing proper interventions for the disease of their

patients. When the care givers are using their heart, the interventions are done

with compassion and willingness to bring patients to the state of well-being. And

referring to caregivers’ souls, involve courage and devotion to their work no

matter what happens. They are dedicated to serve and to love their patient

wholeheartedly.

2

REVIEW OF LITERATURE

Care giver

Care giving refers to the provision of assistance to another person who is

ill, disabled, need help to perform daily activities. It often requires attention to the

physical, mental, social, and psychological needs and well-being of both the

caregivers and the elderly persons requiring care.  Care giving is a “reality”

confronting many people in our communities today.  More than 22.4 million

persons are informal caregivers – providing unpaid help to older persons who live

in the community. One in four Americans is in a care giving situation.  These

caregivers include spouses, adult children (most often the eldest daughter), and

other relatives and friends.  Despite changes in family size, geographic mobility,

workforce participation of women, and other such factors, family caregivers still

provide 80-90% of all personal and medical-related care to elderly relatives.

A caregiver is someone who provides different types of care to another.

Giving care to another person is not new. It starts the minute a baby is born. A

baby is totally dependent on family. As a child grows to be more independent,

less care is required. When people age, and their health declines, they can

become less independent and more dependent on family to provide care. Care

giving is helping someone out, assisting someone, nurturing them. It can range

from Saturday grocery shopping for a grandparent to providing total care, such

as transporting, bathing, feeding and dressing. The person you take care of

doesn’t have to live with you for you to be a caregiver. Assisting someone who

3

does not live with you is also care giving. So you see, if you help someone you

are providing care – you are a caregiver.

Care giving as vocation

According to A. J Conyers (2001), “vocation” is distorted by two disastrous

misunderstandings: a secularized idea of “career” and a monastic concept of the

religious life. Both are less than the biblical idea of vocation, of which Jesus’

raising Lazarus is a rich image. Vocation is about being raised from the dead,

made alive to the reality that we do not merely exist, but are “called forth” to a

divine purpose.

In order to disentangle the term “vocation” from both its religious and

secular misunderstandings, and restore a sense of its original mystery and

power. In both Jewish and Christian contexts, the human sentiment of a divine

call plays an important role, and gives to the society in which it is embedded a

certain character that is distinctly non-modern. Four distinctions must come to

mind. First, the idea of a call implies an agent outside of the one who is subject to

the call. One does not simply “choose” a course of action, but one responds to a

summons. A person might be “free” in either case; but in the case of one

responding to vocation, the freedom is not an inner-directed impulse, but the use

of the will to respond to an unforeseen and perhaps unknown reality.

Caregiver is a vocation from which they are all devoted to their job. They

give compassion, true caring and sincerity especially in rendering care to the

4

patients. All things should be in favor of God, from which they doing these to

serve God, to continue the works of Jesus.

Care giving affects Personal Life

Lim and Zebreck (2004) studied and document how caring for chronically

ill family members or significant others at home influenced multiple aspects of

caregivers' lives. They established effects such as physical, psychological and

social and may include worsened physical health, impaired social and family life,

and increased stress, anxiety and depression. Placing these conditions

experienced by caregivers in the context of family stress theory and quality of life

advances our understanding of caregivers' experiences by examining how

multiple aspects of caregivers' lives their quality of life may be partly influenced

by other existing environmental stressors, stress appraisal, coping methods and

social support.

The importance of family stress theory in studying normative family

transitions and adaptation to major life changes and illness is based on the

central role that family strengths and capabilities play in understanding and

explaining psychological and behavioral outcomes. In family stress theory, the

family is "viewed as encountering hardships and changes as an inevitable part of

family life over the life cycle". Given that caring for a seriously ill family member

arguably is (or is quickly becoming) an inevitable part of family life, current

research has begun examining family stressors, stress appraisal, coping

methods, and social support as they influence QOL outcomes, or as they

5

attenuate the effects of other patient or caregiver characteristics or health-related

variables on caregiver QOL.

Quality of life is a construct that encompasses health and functioning,

socioeconomic status, psychological, emotional and spiritual aspects, and family.

Wyatt & Friedman also identified concerns related to QOL in those with chronic

physical illness, and suggested that considering multidimensional aspects of

QOL for them is essential. Although some scholars have different points of view

regarding the dimensions of QOL, most researchers generally agree that QOL is

multidimensional, subjective, and relating to a state of physical, psychological,

social, spiritual well-being. However, QOL for caregivers includes more aspects

such as burden and family functioning. Further, some researchers use QOL

together with life satisfaction, adaptation, health, and distress. Such

comprehensive consideration has led to an awareness of QOL as a broader and

more appropriate concept for determining how care giving affects family

members. This work will also consider 1) the lack of consensus on concepts like

stressors, stress appraisal, coping methods, and social support, and 2)

inconsistent results regarding factors influencing caregivers' QOL.

Social support is described as provision of assistance, guidance and

feelings of affection or personal obligation toward the patient, usually provided by

family members or friends. Social support has been found to influence a variety

of complex human behaviors and the way people perform their social roles.

Social support activities may take many forms such as concrete assistance with

personal or household tasks, advice or guidance, companionship, and the

6

provision of emotional encouragement. (Cohen & Syme, 2000) Epidemiological

studies have found links between some individuals’ health conditions and

emotional states, and the nature or degree of their received social support

(Cohen & Syme, 2000).

Care giving is a Rewarding Experience

Center of Aging Society (2002) had studied the experiences of caregivers

of older persons. The result was 47 percent of caregivers strongly agree that they

appreciate life more as a result of their care giving experience. They also stated

that care giving has made them feel good about themselves. Other studies have

suggested that care giving has lead caregivers to feel useful or proud, and

experience personal growth or an enhanced relationship with the care recipient.

Alkhalaf, et. al. (2009) studied about the satisfactory level of the health

care providers in terms of their job. The data showed that more than 75% of the

participants that they gathered are satisfied. This was because of the physical

working conditions, relationship with the colleagues, fellow workers and the

working hours that they had. The satisfaction for freedom to choose on their own

method to work on, variety of tasks and the job satisfaction today in comparison

to the past varied from 60 to 70% of the total sample population. In addition, the

study showed that an increased in job satisfaction was because of the increase

salaries, increase in men power and other facilities that added in to the hospital.

7

Uniqueness of Care giving Experiences

Care giving experiences are just as unique as the people involved. Each

caregiver has different needs, feelings, challenges and rewards. And each family

member's relationship with the care receiver is unique, influencing expectations

and the overall caregiver experience. Much has been learned about the

differences in these experiences as the result of a growing body of research they

say that care giving can affect us in multiple ways. It can cause changes in

physical and emotional health, finances, and time available to participate in other

family, social, work, leisure or community activities. And care giving can be

stressful at times. Yet, people who perform the same task may have very

different experiences. One person might feel very uncomfortable emptying a

commode, while someone else may not give it a second thought. Caregivers also

experience different types and levels of stress over time.

Rhonda Montgomery, PhD and Karl Kosloski, PhD worked the theory

called Caregiver Identity Change. In essence, it claimed at care giving

experience over time involves a systematic process of change--in activities,

responsibilities, and in the partner-like relationship between the caregiver and

person receiving care. It also involved a change in the way the person giving

care views him- or herself in relation to the person being cared for. This new role

would grow out of the earlier relationship between the two care partners. It

involved five phases; the first phase was the career is the period of role onset. In

this phase, caregivers are rarely aware of their care giving role identity. The

second phase the care giving career begins when the caregiver acknowledges

8

that his or her care activities are beyond the normal scope of the initial familial

role. This is the point of self-identification as a caregiver the third phase begins

when the care needs of the care recipient increase in quantity and intensity to a

level that requires assistance that is substantially beyond the normal boundaries

of the initial familial relationship. The caregiver is often torn between maintaining

his or her initial identity as a relative and assuming the role of caregiver as a

primary identity. The phase four can continue for an extended time period during

which the caregiver continues to revisit the option of nursing home placement.

And last the phase five, begins when the care recipient is moved to a setting that

relieves the caregiver of primary responsibility for care, most often in a nursing

home, assisted living facility, or the home of another family member. During this

final phase, the caregiver is often able to shift his or her primary identity back to

the initial familial role and significantly reduce the salience of the caregiver role.

The care giving role unfolds over time as the caregiver takes on greater

responsibility--helping with everyday household affairs, personal care and

decisions. Care giving involves an identity change process. The journey is

different for each person in terms of when and how we begin to identify ourselves

as caregivers. Caregivers who are providing assistance for a short period of time

may never see themselves as a caregiver, while those providing care for years

may see themselves and act more like a caregiver than spouse or adult child.

Personal rules and expectations play an important part in how we each feel

about what we are doing in the care giving role. Montgomery and Kosloski find

caregivers experience increased levels of stress when a mismatch occurs

9

between what they are doing and what they think they should be doing on behalf

of the individual receiving care. Often, the source of distress is not the activity

itself, but how the caregiver feels about it.

Hugh Marriott (2002) says, Care giving is like being in love. When it

happens to you it changes your entire life, and the emotions are so overpowering

that you think you must be the first person in the world ever to feel this way.

Patricia St Clair, states that motivation in care giving affects their feeling,

attitudes and actions. They give care because they believed that people or their

loved ones need them and they need to sacrifice their pleasure and their patient

becomes their center of their world.

According to James Patterson (2009), care giver is a big responsibility and

it can be isolating. He says that every action are hardworking for him and all

actions are just part of our way of our life, so "thank you's" aren't needed or

expected anymore, and when one comes along, it's a real big deal. And care

giving is a learning process, but you should be patient.

Gail Mitchell(2000) gives stress on empowering care givers; she stated a

list of experiences and feeling encountered by the caregivers. First is about

doubting your own abilities. Second you have a strong need to control or change

others. Third you never satisfied with your accomplishments or achievements.

Fourth you feel like you always have to prove yourself to others. Fifth you always

refuse to take risks. And last, setting limitations on what you believe you can do.

Empowering caregivers allow them to nurture their body, mind, soul and spirit.

10

Being a caregiver is the most difficult and painful job one will likely

experience. At the same time it is most rewarding and privileged gift one can

ever receive or give. Care giving is much more than just changing bedding and

bathing. A caregiver, for our intents and purposes, wears too many hats to list, as

the list is ever-changing. From basic care, to legal matters and sometimes

overwhelmingly big medical decisions, nothing is meaningless during this time of

intensive caring. The closeness and trust that forms between the dying and the

caregiver is a bond that is like no other. As we all can only be born alone, so it is

when we die. We so often hear that no one wants to die alone. Though the dying

frequently does wait until no one is by their side when they do finally let go, they

only do so because they feel safe enough to go. Caregivers show the ultimate

love. Not because they withstand bodily fluids and changing body functions. Not

because they somehow find superhuman strength to lift the body that can no

longer lift itself. Not because they learn to perform medical procedures that the

general population may have never even heard of, and not because they learn to

sleep lightly when we sleep at all in case we must suddenly spring into action.

(Jeri Lynn Platt 2006)

Issues in caring

There are some issues in why we should care, Brykcynska, Gosia (2001)

stated different issues in caring: contractual issue, ethical issue and spiritual

issues. First was the contractual issue, states that the health professional render

care because of their financial contract. Or the health care providers render care

11

just because they want something in return. Second was the ethical issues states

health team member, care because it was according to what is legally right and

wrong, or what is universally right. In ethical issue it has two types, the

categorical imperative and utilitarianism. In Kant’s Categorical imperative states

that behavior was illustrating a universal law of behavior. We do things to what

we believe it is legally right and correct. Mill’s Utilitarianism tells that good is

causing the greatest happiness of the greatest number; it means that caring

cause great happiness in great number of people. And last was the spiritual, it

contain spirit term as a belief in signifying the inherent spirit of the person. It tells

about that we care due to the teachings in the bible and the teaching of the Lord

in the Bible.

Caregivers stress

According to the Help Guide Mental Health (2004), stress is a natural body

reaction to difficult or challenging situations. Stressful feelings happen as the

body gears up to handle it. The causes of stress are compounded by going

through clinical rotations and working hands-on with patients. The effects of

stress can impair concentration and affect sleep patterns. This can affect a health

care provider’s performance and cause them to have low wage. Caregivers

should be alert for symptoms of an elevated stress level. Some stress is normal,

but it becomes a problem when it impairs the caregiver’s personal life. Warning

signs include being irritable with other people, continual feelings of anxiety,

difficulty concentrating on work and other things like social withdrawal.

12

Davis (2004) advises stressed-out caregivers to find the underlying

sources of the stress. These might include poor time management practices, or

too little social contact. Caregivers often can make changes to alleviate the

problem, like learning to manage time more efficiently, expanding their social

support network and scheduling down time. Davis (2004) also recommends

breaking big tasks into small steps. Exercise can offer a physical release for

stress, and it can be done as little as 30 minutes a day three times per week to fit

into a busy nursing schedule.

Elizabeth Scott (2007) had listed seven common causes of stress and it is

namely, (1) Fear of guilt, the care giver are scared that someday someone in

their life may experience the condition of his or her patient. (2) shift of role. It is

the shifting of role that the care givers see herself or himself being taking good

care of by the other care givers. (3) Financial pressure, due to the low salary the

caregivers may experience stress since they are thinking about the expenses. (4)

Isolation, caregivers may feel alone due to the greater time that they should

spend to their patients. (5) Little time alone, isolation and little time alone can

never be separated, due to the greater time that they spend to their patient, they

don’t have time for solitude, since this is important to every individual.(6)

Demands of constant care, the care giver feel that they should be always there

for their patient and it is a feeling of “always on duty” , and last, (7) the feeling of

guilt.

13

Caregiver burden and caregiver strain are terms that refer to the

numerous negative outcomes of providing care to or for another person (Hunt,

2003). Negative outcomes of care giving may include social isolation, disruption

of leisure or employment time, depression and anxiety, physical symptoms or

illnesses, and emotional instabilities (Berg-Weger et al., 2001; Dillworth-

Anderson & Gibson, 2002). According to them, the emotional, psychological, and

physical tolls associated with care giving, subjective appraisals of stress by

caregiver, and a sense of being trapped are associated with institutionalization

because primary caregivers view institutionalization as a relief.

They also maintain that as care giving requires more physical assistance,

institutionalization is further expedited. In other words, the desire to

institutionalize is greatest when caregivers experience high level of stress and

when the care giving is physically burdensome. Aneshensel, Pearlin, and Schuler

(1993) also note that increased levels of caregiving strain are associated with

institutionalization.

Patient Factors why they are difficult to handle

Hull and Broquet (2007) listed different characteristics of patient why they

are different to handle. This are the angry, defensive, frightened or resistant

patients, Manipulative patients are often play on the guilt of others, threatening

rage, legal action or suicide. They tend to exhibit impulsive behavior directed at

obtaining what they want, Somatizing patients often suffer from comorbid anxiety,

depression and personality disorders, Grieving patients have signs of depression

14

and maladaptive behaviors and last "frequent fliers" are patients may stand out

due to the sheer bulk of their medical charts. They may be lonely, dependent or

too afraid or embarrassed to ask the questions they really want answered.

Communication as part of caring

Garcia (2006) enumerated a list of different techniques in providing a

therapeutic communication. Namely, using silence, accepting or giving indication

of reception, giving recognition, offering self, giving broad openings, offering

general leads, making observation, restating ,exploring, digging further into the

subject or idea, providing information, voicing doubt, and summarizing . Using

silence indicates to the patient that the nurse expects him to speak, to take the

initiative to communicate. Much non verbal communication occurs during this

interlude. The nurse needs to be alert as to what to be alert as to what she is

communicating o perceiving. Even a momentary lost of interest can be

interpreted as indifference by the patient. Accepting or giving indication of

reception indicates that nurse has heard and has followed the trend of thought.

Giving recognition or acknowledging, indicating awareness, “when a patient

accomplishes something that is the fact, a nurse may say so.” Offering self or

making one’s self-available, the nurse offers her presence, her interest and her

desire to understand; this must be made unconditional. Giving broad openings is

to make way for the patient to take the initiative in introducing a topic. Offering

general leads refers in giving encouragement to continue; this leaves the

direction of the discussion almost entirely to the patient. Making observation or

15

verbalizing perceptions. The nurse can bring her observations to the awareness

of the patient; this encourages mutual understanding of the behavior of feeling

through discussion. Restating refers in repeating the main idea expressed, this

gives evidence to the patient that an idea has been communicated effectively. If

his thoughts have been misunderstood, he can reword and restate them until he

makes himself very clear. Exploring, digging further into the subject or idea

indicates interest on the part of the nurse. Providing information is making

available the facts the patient needs; this builds up trust. Voicing doubt is to

express uncertainty as to reality of the patient’s perception; this permits the

patient to become aware that others do not perceive events in the same way he

or she does. And last, summarizing refers to organizing or summing up what was

done before, to bring together the important points of the discussion and to give

each participant an awareness of the progress made toward greater

understanding.

Kozier (2004) enumerated barriers in communication in giving care to the

patient. It is namely the stereotyping, agreeing and disagreeing, being defensive,

challenging, probing testing, rejecting, changing topics and subjects, unwanted

reassurance, passing judgment and last giving common advice. Stereotyping is

offering generalized belief to the group of people. Agreeing and disagreeing is a

judgment that implies the client of being right or wrong. Bering defensive is giving

negative response to protect self or health provider. Challenging is giving

message that allows that client to prove his or her point of view. Probing is asking

question without the intent to assist. Testing is a statement that allowing the

client to admit something. Rejecting is to refuse certain topics. Changing topics

16

and subjects is to directing the topic to self interest. Unwarranted reassurance is

statement that comforts the client. Passing judgment is giving opinion or

approving or disapproving to certain things. And last giving common advice was

telling the client on what to do in a certain situation.

Care giving to Leprosy

Shamron Samraj (2000) said that there are self-care groups consisting of

leprosy affected people with various disabilities who meet on a regularly to lend

moral support to each other and find ways to cope up with social stigma attached

to the disease. With support from friends in a self-care group, life with leprosy

becomes more bearable. Self-care groups may also form a savings group,

supporting each other to earn a living after receiving a Leprosy Mission loan.

One of the most remarkable acts made by nurses in the nineteenth

century was an outstanding expedition of a British nurse Kate Marsden into

the remotest part of the East Siberian taiga to investigate living conditions

of lepers among the Yakut people, an ethnic minority that lived deep in the

forests. This journey, the details of which sound astonishing even today, more

than 110 years later, gave a powerful impetus for setting up a colony for the

lepers.  Miss Marsden was so impressed by the terrifying effects of the disease

that she decided to devote her future life to alleviating sufferings of lepers.

Miss Marsden definitely deserves that her name would be marked out in

the history of leprosy in Siberia. We must pay homage to her extraordinary

energy and distinguished self-sacrifice that helped this young woman, who could

17

not speak or understand Russian, to overcome unbelievable  hardships of the

journey throughout Siberia in order to reach the, so called, “dead places” in

Yakutia, where the natives expel their lepers. Moreover, not only did she

thoroughly describe what she had seen there, but she also came back and

roused Russian society, raised necessary funds in a foreign country, and in fact

determined the Yakut lepers' destiny. 

Yuri Bessonov stated that nursing can come across lots of outstanding

examples of selfless devotion in bringing help to the people suffering from

poverty, wars, and diseases.  As to caregivers, they tend to sacrifice their lives

for the wellness of the patients. They have those innermost feeling to care and to

serve people for goodness sake and did it with willingness and sincerity.

There are over 2,500 different types of topical wound care products on the

market for treating both acute and chronic wounds. As health professionals strive

to provide quality wound care in a cost-effective environment, their choices of

wound dressings may be constrained. How do professional nurses choose the

most appropriate dressing to meet their patients' need, with limited resources and

an overwhelming number of wound dressings? This question can be somewhat

perplexing because wound healing is a complex process. Unfortunately there is

no one dressing for every wound, and dressing choice should focus on the

patient's overall health status, etiology of the wound, and the micro-environment

of the wound (Barr, 2005).

To create the optimal wound care environment, several factors should be

considered before choosing a dressing. Of primary importance is identifying the

etiology of the wound. Treatment will then focus on the cause; for example,

18

compression therapy is essential for managing venous leg ulcers, relieving tissue

load is important for managing pressure ulcers, and proper shoe fitting is

essential for managing diabetic foot ulcers (Barr, 2005). In addition, variables

such as debridement of necrotic tissue, eliminating infection, and wound

cleansing are of equal importance in managing wounds. Lastly, controlling wound

exudate, providing thermal regulation, protecting the wound from trauma and

contaminants enhance the wound environment.

Men Vs. Women in Field of Nursing

Patrick Sullivan (2001) said some nurses view their profession as a

symbol of women’s struggle to find a field that not only accepted them but was

also respected and valued, “and hence believe it should remain a women’s

profession.” However, “there is a need to recruit men actively into all areas of the

profession to tap into the energy, strength and ideas they could bring to nursing.”

They conclude that career counselors must start promoting nursing as a viable

career for men and recruiters must make greater efforts to portray males in

nursing. “As male role models become more evident within our profession, the

number of men joining will continue to increase.”

Spirituality in Nursing

Mary Elizabeth O’ Breien (2000) stated that prayers in life of nurses are

important, wherein the nurse always pray for his/her patient. They are not only

providing medical intervention that would help the patient to get rid of his or her

illness but also because of the prayer that being offered to them.19

According to Chang (2003), spirituality means different things to different

people. It may include faith or what provides a sense of personal meaning in life

and death. When dealing with illness, spiritual issues often come to the forefront

of the patient's life, as well as the care giver’s. Illness and other adversity disrupt

the patient’s sense of meaning, their values, and even their faith. Caregiver’s

addresses their own spiritual needs to the patient that can help them deal with

their concerns and open the possibility of growth from the situation. In doing so,

they may better able to accept the situation, and even find some positive aspects

in your role as a caregiver.

Some studies indicate that family members who practice religious beliefs

to cope with the task of providing care exhibit less care giving strain and positive

psychological well-being than others who do not. Koenig (2004) notes that

indices of religious coping have been associated with lower rates of depression.

Caregiver depression is known as a factor associated with earlier admission of a

loved one to a nursing home. Chang (2003) reports that caregivers who use

religious or spiritual beliefs to cope have a better relationship with their care

recipients, a factor associated with lower levels of depression.

20

THEORETICAL FRAMEWORK

According to Rosemarie Parse’s Human Becoming Theory includes

totality paradigm wherein man is a combination of biological, psychological,

sociological and spiritual factors. And it is a simultaneity paradigm is that man is

a unitary being in continuous, mutual interaction with environment and last, it

involves originally man-living-health theory, wherein they are all interconnected

to each other. Parse give three principle: meaning, rhythmicity, and

transcendence. Meaning arises from a person’s interrelationship ‘with the world

and refers to happenings to which the persons attaches varying of significance.

This principle means that people co-participate in creating what is real for them

through self-expression in living their values in a chosen way. It has three sub-

concepts: Imaging, Valuing and Languaging. Imaging is persons’ explicit-tacit

knowing of their personal realities. Valuing is a process of choosing and

embracing what is important. And lastly, languaging is about the ways persons

are with the world and in relationships with others and self. Rhythmicity is the

movement toward greater diversity. This principle means that the unity of life

encompasses apparent opposites in rhythmic patterns of relating. It means that

in living moment-to-moment one shows and does not show self as opportunities

and limitations emerge in moving with and apart from others. And last,

transcendence is the process of reaching out beyond the self. This principle

means that moving beyond the "now" moment is forging a unique personal path

for oneself in the midst of uncertainty and continuous change. . She views a

human being as an open system freely able to choose from among a series of

options side giving meaning to a situation.

21

For Patricia Benner’s Novice to Expert Theory states that experience are a

prerequisite for becoming an expert. She described five level of experience:

novice, advanced beginner, competent, proficient, and expert. The levels reflect

movement from reliance on past abstract principles to the use of past concrete

experience as paradigms and change in perception of situation as a complete

whole in which certain parts are relevant. Each step builds on the previous one

as abstract principles are refined and expanded by experience and the learner

gains clinical expertise. She introduced the concept that expert nurses develop

skills and understanding of patient care over time through a sound educational

base as well as a multitude of experiences.

To the caregivers, in order for them to render good quality care to the

lepers they should become a human being as said in Parse theory, wherein they

give meaning to their experiences. Meaning has three sub-concept the valuing,

imaging and languaging. Caregivers imagine things by accepting or rejecting

ideas, values, beliefs and practices in their worldview, they value things through

their experiences by choosing what is the most important in their lives, and last

they express themselves through language to other persons and to the world.

Only themselves can interpret or tell what the meaning of their experiences is.

Caregivers are the one who will decide if they want tell or not to tell what are

happening in their daily experiences and they will set limit on their own decision,

and own choice in their lives. The caregivers will strive for other possibilities that

may happen in their lives that may reach their hopes and dreams; they are open

for every change that may happen in their lives that will make them better

22

persons as a caregiver. Through their experiences in their daily practice it will

help them to reach their expertise as said in Benner’s Novice to Expert Theory.

STATEMENT OF THE PROBLEM

The study aims to determine the experiences of employed care givers in

rendering care to the patients with leprosy.

Specifically, it aims to answers the following:

1. What is the profile of the respondents according to:

a. Age

b. Gender

c. Years of experience

2. Is/ are any unforgettable experience/s they have had in their job/s as

caregivers to patients with leprosy?

3. Is/ are there any difficulties in giving good quality care in taking good care

with patients with leprosy?

4. Aside from rendering physical care to patients with leprosy, what other

aspect/s of care can you render to them?

5. Have they learned from their job?

23

6. What are different activities do they render in giving care to aptient with

leprosy?

7. What are the factors that make them stressed in their job?

8. Have they been contented and satisfied with their job?

9. Have they considered their job as profession or vocation?

10.Has caring for the lepers affected their personal lives?

DEFINITION OF TERMS

For better understanding of the study the following terms were

operationally defined;

The term Care givers refers to the persons who are directly involved in the care

of patient with leprosy.

Caring is feeling of empathy for others.

The word Lepers refers to the persons who are experiencing disease called

leprosy and social stigma.

Leprosy is also known as “Hansen’s Disease”, caused by Mycobacterium leprae

that affects the skin, peripheral nerves, eyes and mucosa of the respiratory tract.

Experience refers to the general concept which comprises knowledge of or skill

in or observation of something or some event gained through involvement in or

exposure to that thing or event.

24

CHAPTER 2

METHOD

This study utilized descriptive phenomenology in which the researchers

gather information to the participants in order to explore, analyze and describe

the particular phenomena specifically the experiences of the caregivers in

handling patients with leprosy.

The researcher used a quota sampling which was a subtype purposive

sampling method that used criteria that made by the researchers in order to get a

subject to become a part of the study and the researchers decided how many

participants was part of the study. As the participants met all the criteria, they

would be the subject of the study.

The process started in making permission in having a research in the Dr,

Jose N. Rodriquez Memorial Hospital, and the letter was approved. There were

five selected participants who met the criteria and then they were interviewed by

the researchers to gather necessary information that would help them in their

study and the data was known. It was sort out on their common themes and

subjected to data analysis.

PARTICIPANTS

The study required care givers who were handling leper patient at Dr.

Jose N. Rodriguez Memorial Hospital. The study required at least five care givers

who met the criteria. The criterion first was that the caregivers had at least five

years of working experience at Dr. Jose N. Rodriguez Memorial Hospital.

25

Second, they rendered care to the patient with leprosy. And last, they were thirty

five years old and above.

SETTING

Dr. Jose N. Rodriguez Memorial Hospital (DJNRMH) was formerly known

as the “Central Luzon Sanitarium”. It was established in the year 1940. In the

past, primarily they only accommodate patients suffering from Hansen’s Disease

or Leprosy in the entire Luzon region in the Philippines. Dr. Jose N. Rodriguez

Memorial Hospital was known to be the largest leprosarium in the Philippines. It

was currently located within the district of Tala, in Caloocan City, Metro Manila.

In the year 1970, there was a high success rate of treatment of the first Hansen

patients from a research and the advancement of procedures done within the

current medical practice. There was a significant drop of Hansen patients, and

because of this, the hospital started to consider admission of general cases, they

started treating general medical cases. The hospital served as the principal

referral hospital for leprosy patients and the premier training and research center

for leprosy care and management in the Philippines. It also serves the public

health needs of community members of Tala and nearby areas.

Dr. Jose N. Rodriguez Memorial Hospital envisioned to become a Tertiary

General Hospital and a center for rehabilitation and care of Leprosy Patients by

year 2010,  with fully Departmentalized Medical Services, equipped with all

updated facilities and complete manpower complement of a 200-Bed Tertiary

Level Hospital,  Leprosy and Dermatology Center.

26

MEASURES

The study was measured by utilizing questions that were based on the

opinions of the researchers but it was validated by the expert. The following

questions would help the researchers to gather necessary information to the

participants that would answer the problem of the study. The questionnaires that

used for interviews were tend to answer the questions that could help the

researchers to know more about the experiences of the caregiver when handling

patient with leprosy

PROCEDURE

The researchers asked permission from the hospital administration of Dr.

Jose N. Rodriguez Memorial Hospital to conduct the study and the letter was

given to the director of the said hospital. As soon as the permission was granted,

the researchers coordinated to the caregivers of the Lepers. Five participants

purposively select as they met the criteria to the subject. The researchers

introduced themselves to the caregivers so as the caregivers to the researchers.

They were fully informed about the objectives of the study and the procedure in

the experimentation. The information was provided orally.

The researchers conducted an interview with the five caregivers for twenty

minutes each and the answers were recorded via a voice recorder. The

questions which was asked, answered the objectives of the study and

determined the experiences of the caregivers in handling patient with leprosy

As soon as data were collected, they were taken and sorted out based on

their common themes and were subjected to data analysis.

27

CHAPTER 3

The aim of this research was to explore the importance of the experiences

of the care givers in handling patient with leprosy. This chapter presented

discussed, analyzed and interpreted the date gathered in the study with

implications.

SIGNIFICANCE OF THE STUDY

The study would be beneficial to the following:

To the nursing students, the study would help them develop and

enhance their core values as individuals and as a student, such as

compassionate service, simplicity, co-responsibility, respect for human dignity,

commitment to Vincentian excellence, and to become advocates of persons who

are poor. It would help them to have broaden their knowledge in health care

giving that they can apply to their future field of work or career.

To the care givers, their knowledge on care giving and leper patient

would more enriched and supplemented. They would practice their skills more

efficiently in dealing to the patient with leprosy and evaluate if their skills in

dealing to lepers are effective enough. It would make the caregivers realized their

importance and significance of their roles in the field of health care giving and in

terms of caring patients with leprosy. It could also give credits and

encouragements to the caregivers’ devotion and love to their work and patient as

well.

28

To the patients with leprosy, they would realized and see the support,

love, and care of other people around them. This would make them see and feel

the expression of love and care, and commitment to the job of the caregivers that

can increase their self-esteem and self-worth. It would be able to see and realize

the presence of feelings of closeness and love given to them, sharing humor and

fun, and the pleasure of knowing someone well, these can make them to be

encouraged and willed to recover and heal fast.

To the people, they would have a better understanding and knowledge of

what leprosy is, how acquired and treated, and the different managements and

interventions done to cure the disease. It would inspired them upon reading and

knowing the different stories of experiences of the caregivers in handling patients

with leprosy. They would understand more that patients with leprosy can be

treated and cured and they should be loved and cared more. They would

appreciate the significance of the roles portrayed by the caregivers in the field of

health care giving.

To the future researchers, this study would give them background about

the different experiences of caregivers in handling patients with leprosy and

allows them to make use of the study as reference regarding care givers, care

giving and therapeutic act of care to patients. As a result, it would give them

better outcome to their future research.

29

DATA ANALYSIS

The researchers listened attentively to participant’s data description, and

then the recorded data was written in the paper and read again in order for the

researchers to get immersed in the study. After reading the data, the researchers

was able to identify and extract significant data to participant's written verbatim.

And the data was sorted out by their common themes. After sorting out the

necessary data, it was transcribe into data management file for ease of ordering

later in the process.

SCOPE AND DELIMITATION OF THE STUDY

. The study focuses in the experience of care giver that are handling

patient with Hansen disease. This was conducted to determine their experiences

in dealing patient with Hansen disease. The researchers’ limited setting of the

study is at Dr. Jose N. Rodriguez Memorial Hospital located at Caloocan City.

The researchers used face-to-face communication method as gathering tool

which was answered by five care givers in the said hospital. The data gathering

was conducted only for one week. The length of time of data gathering was

started on August 26, 2010, which was the initial visit of the area and the asking

of permission for the conduction of study and ends on September 2, 2010

wherein the interview of the participant was conducted. The duration of interview

lasted for twenty minutes in every care giver that were subjected for the study.

30

RESULTS, DISCUSSIONS, AND IMPLICATIONS

TABLE 1

The frequency and percentage of the Demographic Profile of the Participants

Variable F %Age

36 – 55

56 – 75

TOTAL

3

2

5

60%

40%

100%Gender

Female

Male

TOTAL

3

2

5

60%

40%

100%Years of Experience

6 – 20

21 – 35

TOTAL

2

3

5

40%

60%

100%

Table 1 shows the frequency and percentage of the demographic profile of

the care giver participants as to age, gender and years of experience in handling

patients with leprosy. As to age, three care givers’ age were ranging from thirty

six to fifty five years old that comprises sixty percent of the total sample

population with a mean of 45.5, while two care givers’ age were ranging from fifty

six to seventy five years old, having forty percent of the total sample population

with a mean of 65.5. For the gender, there are three females that encompass

sixty percent of the sample population and two males with a percentage of forty.

31

And for the years of experience, two care givers are handling patient with leprosy

for six to twenty years with a mean of 13 and three are having twenty one to thirty

five years of experience with a mean of 28.

The data reveals that most of the care givers’ ages were in the middle to

late adulthood and it was because of the high incidence of leprosy cases at the

year of 1940. It was also the year where Tala Leprosarium was established, that

was to cater leprosy patient. And there was a need for the care givers to handle

patient with leprosy even though that in that time leprosy was highly

communicable, care givers have the courage to took care of them even though

that they knew the risk for communicability of the disease per se. Out of five

care givers, two were men and three were female, that was because historically,

care giving was more likely to be provided by women, little research attention

has been given to the experiences, needs, and challenges faced by male

caregivers but it was contrary to Sullivan(2001) that men’s number were

increasing to the field of caring due to the need of energy, strength and ideas

that they could contribute. And the years of the care givers experience were

longer, this was because of their perception to their job that they are satisfied at

their career and was also because of they being used to their job and satisfied

to it said by one care giver and it was parallel to the study of the Center of Aging

(1999) that forty seven percent of the care givers were happy at their job and

value their life more due to the feeling of being useful or proud and experience

self growth or enhanced the relationship to the care recipient. And two care

givers admitted that care giving to leprosy was their second chance in their life

because they became a patient, and before they were also one of the patients

32

with leprosy, and since then after being cured, they never left the hospital and

became a care giver to other patients with leprosy.

The table 1 implies that care giver’s demographic profile is not very

significant when they are handling patient with leprosy. Most of the participant’s

ages were in the middle to late adulthood. There is no basis that age, gender and

years of experience can affect their responsibilities to their patients especially to

those with leprosy.

33

TABLE 2

The frequency and percentage of the perceived experiences of the care givers.

VARIABLE F %

Unique Experiences as Caregivers

Positive Experiences

Negative Experiences

TOTAL

0

5

5

0%

100%

100%

Table 2 shows the frequency and percentage of the perceived unique

experiences of the care givers as to the positive and negative experiences. The

positive experiences have zero frequency as well to the percentage. The

negative experiences had frequency of five out of five, and a percentage of one

hundred percent of the total participants.

The data gathered shows that five out of five participants has negative

experiences that were supported the study of Patterson (2009). He stated that

care giving was a big responsibility and it could be isolating. Care givers stated

that caring leprosy patient was not an easy thing to do, it required a lot of

knowledge and skills to be able to render good quality care; and there was a less

social relationship in the outside world and most of the patients were very

sensitive and stubborn, and the care givers experienced nagging from them. In

contrast to this, Marriott (2002) believed that care giving was being in love that

could change the entire life, which fell under the positive experience, contrary to

the result of the study. This opposed the study because caregivers believed that

34

they have no positive experience in the institution in taking care of leprosy

patient.

Table 2 implies that all of the caregivers had negative experiences in

taking care of patients with leprosy because of their attitude that they portrayed.

It tells that if an individual has a negative feeling about his or her own body, he or

she may portray negative attitude towards to other, as the patients’ portrayed to

the care givers. And because of that attitude, care givers felt bad about them.

The attitudes that caregivers should possess were understanding and patience

towards their patients. They must knew and understood the situation of the

patients because some patients were treated by other individuals in a wrong way

because of patient’s medical condition, but still, caregivers take care of them, and

still stay with their patients and let them feel that they were going to be treated

properly and recover.

35

TABLE 3

The frequency and percentage of the perceived experiences of the care giver in terms of difficulties.

VARIABLE F %

Instances in Difficulty in Giving

Quality CareYes

NoTOTAL

3

2

5

60%

40%

100%

Table 3 presents the frequency and percentage of the perceived

experiences of the care givers in terms of difficulties in giving quality care as to

yes and no. Three of the participants answered yes, with the highest percentage

of sixty. While two of the participants answered no, with a percentage of forty

from the total number of participants.

The data gathered shows that three of the participants have instance in

having difficulty in giving quality care reinforcing the study of Hull and Broquet

(2007). They listed different characteristics of patient why they are difficult to

handle, these are anger, defensive, frightened or resistant patients, and

manipulative patients They also stated that patients tend to exhibit impulsive

behavior directed at obtaining what they want, somatizing patients often suffer

from co-morbid anxiety, depression and personality disorders, grieving patients

have signs of depression and maladaptive behaviors and last "frequent fliers",

these patients may stand out due to the sheer bulk of their medical charts. They

might be lonely, dependent or too afraid or embarrassed to ask the questions

36

they really want answered. Caregivers stated that they had difficulty in taking

care of patients because they were hard-headed, very sensitive and stubborn.

On the contrary, two caregivers stated that they don’t have difficulty in giving

quality care to patients with leprosy because some of the patients obey the

caregiver’s rules.

Table 3 implies that three out of five caregivers are having difficulties

taking care of patients with leprosy. The explanation is somewhat related to table

2 because it implied that attitude is the main problem. Oftentimes, patients are

projecting bad attitudes to caregivers and two out of five caregivers enjoys taking

care of those patients. They are committed to their work and they are dedicated.

They love their work and they treat their patients as if they are part of their family

despite of the leprosy patients’ attitude towards them.

37

TABLE 4

The frequency and percentage of other aspects performed by the caregiver to their patient

VARIABLE F %

Other Aspects of Help Held By the

Caregiver Aside To Physical Needs

to the Lepers

Spiritual

Emotional

Social

TOTAL

2

2

1

5

40%

40%

20%

100%

The table 4 represents the frequency and percentage of other aspects of

help performed by the care giver to their patient as to spiritual, emotional, and

social. As to spiritual, two caregivers preferred to render spiritual support to their

patient with a percentage of forty. For emotional, two caregivers chose emotional

support to their patient with a percentage of forty. On the other hand, one care

giver thought that she/he could provide social support to the patient with a

percentage twenty.

The data shows that spiritual support was also a care that can be given to

a patient with leprosy as the caregivers were aware that these patients needed it.

The result gathered by the group supported the study of O’ Breien (2000).

According to her, prayers in life of the nurses for their patients were important.

She believed that aside from the medical support and treatment provided by the

nurses for the recovery of the patient with leprosy, prayers could also help the

38

patient to be well, as she claimed that prayers could help the patient to restore

his/her faith, and maintain the positivity in the life, with the same area of study of

Gosia (2001)that stated one issues in caring, the spiritual issues, it means that a

person cares because the Lord teaches in the bible that we should care to other

person, like the Lord did. As one care giver said that he consecrate his job to the

Lord, and because of that he also pray for his patients. The study was also

supported by Chang (2003), according to her; the patients when dealing with

their illness, spiritual issues often come to the forefront of their lives, as well as

the care giver’s. Illness and other adversity disrupt the patient’s sense of

meaning, their values, and even their faith. Caregiver’s addresses their own

spiritual needs to the patient that could help them deal with their concerns and

open the possibility of growth from the situation. In doing so, they might better be

able to accept the situation and find some positive aspects to strive harder to

recover from their illness. Koenig (2004) also stated that the patient would

recognize the value and importance of care giver in maintaining their health and

the use of religious or spiritual coping could lower the depression. It was known

that spirituality was an awareness of something greater than the individual self,

the simplest way to express it is through prayer. Patients need not only different

nursing interventions rendered by the nurses but spiritual care as well; prayers

could help the patient accept his/ her situation, reduce the stress and anxiety of

the patient, and promote a positive outlook in life. In emotional aspect, the care

givers tends to sympathized to the feeling of their patient, they try to explain the

situation of their patient, which was supported by Garcia (2006) that the care

givers may verbalize their perceptions towards patients behavior and they are

39

entitled to provide some information to their patient that will build trust between

the two of them. In social aspect, the result shows that caregivers also render

social care or support to their patients with leprosy. The outcomes signified that it

supported the study of (Cohen &Syme, 2000); they stated that social support was

described as provision of assistance, guidance and feelings of affection or

personal obligation toward the patient. Since, stigma was present to the leprosy

patient there is a need for the building up of social support which was parallel to

the study of Samraj (2000) that establishing self-help group would help the

patient to have moral support to each other and will find ways to cope to the

social stigma that is being attached to the patient with leprosy, and having social

support. There are different forms social support activities and this was concrete

assistance with personal, giving advice or guidance to the patient,

companionship, and the provision of emotional encouragement. These activities

can be very helpful to the patient’s progress in his/her physical, emotional and

mental health. Care workers need to make care environments enjoyable and

fulfilling for their patients with leprosy this might involve carrying out

social activities with those in care for them to handle patient more bearably.

Table 4 implies that caregivers or other health care professionals attend

the needs of their patients not only in the medical-health related type of care, but

also by rendering spiritual, emotional and social support to the patient. Most of

the caregivers responded that spiritual and emotional needs are the things they

give to their patients with leprosy. Caregivers are ought to give care to their

patients. They are expected to encourage, comfort and somehow alleviate the

40

pain that the patients felt. Caregivers must know the religious beliefs that their

patients have to give the appropriate dealing for the patients.

41

TABLE 5

The frequency and percentage of the learned experiences of the care giver from their patient.

VARIABLE f %

Learning in Rendering Quality Care

to Patient with Leprosy

Genuine love for others

Interaction different kinds of

people Patience

Others

TOTAL

1

1

1

2

5

20%

20%

20%

40%

100%

Table 5 illustrates the frequency and percentage of the learned

experiences of the care givers while they are taking good care of the patient with

leprosy as to genuine love for others, interaction to different kinds of people,

being patient and others. One caregiver learned genuine love for others which

was twenty percent of total sample population. Interaction to different people was

learned experience of one care giver which encompasses the twenty percent of

the total sample population. As to patience, one care giver learned patience

when she was handling patient with leprosy with a percentage of twenty, and two

care givers stated other answer that are not in the criteria of the questions that

comprises forty percent of the total population.

Genuine love for others can be defined as real love and caring for others.

The data presented shows that a caregiver can learn genuine love for others

through rendering care for the patient for a very long time, which is agreed by

42

Platt (2006) that care givers shows ultimate love to their patient and this was

because of the closeness and trust that was build to the care giver and patient.

The care giver also learned interaction to different kind of people, since all people

have different characteristics. Patient with leprosy was difficult to handle due to

their character as listed to Hull and Broquet (2006). One of the characteristic of

the patient that they listed was angry, defensive and resistant to the medical

intervention, because the different characteristics exhibited by the patient with

leprosy, the care givers learned to interact with them by means of socializing and

attending to the needs of their patient. Patience is a virtue, and it was learned by

the care giver who are handling patient with leprosy, as one care said that patient

with leprosy was very sensitive due to their disease they should be practice

patience because sometimes the patient tends to shout at them. Without

patience, the care giver cannot gain the trust of their patient. Some care giver

indicate that some of their learned experience are not listed in the list of choices

such as accepting the reality and don’t be judgmental. Accepting the reality what

God has done for you will release you from burdens, since some patient were in

denial that they were manifesting the signs and symptoms of disease leprosy

they are not taking any medication that was provided by the care givers. And

lastly, being non judgmental means that care givers value patient’s feeling and

not letting down their feelings, and it was supported by Kozier (2001) that being

judgmental is a barrier in communication.

The table 5 implies that care givers have different learning as they handle

patient with leprosy. It means that for every experience that one individual may

encounter he or she will learn from it. And through those learnings, care givers

43

were able to embrace their experiences and may enhance their skills in rendering

good quality care to their patient with leprosy.

44

TABLE 6

The frequency and percentage of the activities performed by the care givers to their patient.

VARIABLE f %

Activities on Taking Care of

Leprosy Patient.

Wound care

Medication

Others

TOTAL

2

2

1

5

40%

40%

20%

100%

Table 6 shows the frequency and percentage of the activities performed

by the care givers to their leprosy patients as to wound care, medication, and

others. Two of the participants answered they perform wound care which has

forty percent of the total participants. In addition, two of the participants answered

that they give medication, with a percentage of forty from the total participants.

One of the participants stated that his answer is not included in the choices so he

choose others and claimed that he use nursing assessment to patients with

leprosy and it comprises the twenty percent of total participant.

The data gathered showed that wound care and medication have the

same value of percentage and other which is rendering nursing assessment got

the least. According to the care givers leprosy nowadays is treatable because of

new medication invented such as Dapson, Rifampin and Clofazimine they said

that leprosy is easily treated by religiously taking this kind of medication that’s

why they prioritize in giving medication. On the other hand some of care givers

45

choose wound care and rendering assessment because one of the complication

of the leprosy being numb due to the affectation of the peripheral nerves, they

are prone to injury, that’s why most of the patient with leprosy are having wounds

that needs to be clean and dress properly which is supported by Barr (2005)

according to him to create an optimal wound care environment some factors

must be considered such as patient's overall health status, etiology of the wound,

and the micro-environment of the wound which can be obtain in rendering

assessment to the patient this factors are the basis of the care giver in giving

proper wound care or wound dressing.

Table 6 implies that giving medication, applying wound care and rendering

nursing assessment is the basic necessities needed by the patient with leprosy.

Care giver must enhance their skills and knowledge in giving proper medications,

application of right dressing into different kinds of wound and reliable and

competent nursing assessment.

46

TABLE 7

The frequency and percentage of the care givers stressors.

VARIABLE f %

Caregivers Stressors

Patient

Time of Duty

Salary

Co-workers

TOTAL

4

0

1

0

5

80%

0%

20%

0%

100%

Table 7 shows the frequency and percentage of the care givers’ stressors

as to patient, time of duty, salary, and co-workers. Four out of five care givers

chose patient as their stressor with a percentage of eighty and on the other hand

the remaining care giver chose salary with a percentage of twenty. No one the

participant answered that their stressor are time of duty and their co- workers.

Stress according to the Help Guide Mental Health (2004) stress is a

natural body reaction to difficult or challenging situations it also state that working

hands-on with patient can contribute to building-up stress since providing health

care services to a patient is not an easy task to the care giver We know that care

giver are not only focusing in rendering health care services but they also focus

on how they can help the patient to improve other aspect such as emotional ,

spiritual , psychological and social aspect that is a handful job to a care giver this

may contribute in building up their stress. The five participants’ answer supports

the study of Scott (2007) which is the demands of constant care, the care giver

feel that they should be always there for their patient and it is a feeling of “always

47

on duty”; and financial pressure, due to the low salary, the caregivers may

experience stress since they are thinking about the daily expenses. As to the

patient the care givers stated, that patient with leprosy are very demanding and

they have an attitude which is very annoying. Since some patient with leprosy

experienced humiliation and social stigma as a solution to this they try to isolate

themselves and even shows negative attitude towards to others due to fear of

humiliation and some of them deny the presence of their disease thus resulting in

rejection of care. As to the salary, one respondent said that the salary is too low

and it can’t support the daily need of his family. To the time of duty and co-

workers, there are no participants who claimed that they are stressed because

they are satisfied and they have nothing to say about it.

Table 7 implies that one of the major contributors of stress in the care

giver is the patient itself and salary that they earn from their job. Dealing with

patient particularly patients with leprosy who experienced social stigma is not an

easy task to handle for a care giver. In order for a care giver to gain trust, proper

establishment of rapport and patience should be present in a care giver

48

TABLE 8

The frequency and percentage of the caregivers’ satisfactory level in their chosen career.

VARIABLE f %

Caregivers Satisfactory Level in

their Chosen Career Satisfied

Not satisfied

TOTAL

5

0

5

100%

0%

100%

Table 8 shows the frequency and percentage of the caregivers’

satisfactory level in their chosen career. All of the participants are satisfied with

their chosen career which has one hundred percent of the total participants. And

none of them said that they are not satisfied on their chosen career.

Satisfaction describes how content an individual to his or her present job.

The data gathered showed that all of the participants were satisfied with their

chosen career that supports the study conducted by the Center of Aging Society

(2002) about the experiences of the care givers when a handling patient, they

stated that the result of the study was forty-seven percent of caregivers were

strongly agree that they appreciate life more as a result of their care giving

experience. They also stated that care giving has made them feel good about

themselves. In addition to this, other studies have suggested that care giving has

lead caregivers to feel useful or proud, or experience personal growth or an

enhanced relationship with the care recipient. Caregivers stated that they are

happy and satisfied with their present career now, as a caregiver of patient with

49

leprosy. They also stated that taking care of these leprosy patients has now been

part of their life. And add the fact the benefits that was given to them by the

hospital as said by one of the participant. The data was also supported by

Alkhalaf, et. al. (2009) that care givers are satisfied with their job because of the

relationship with their colleagues, fellow workers and the working hours that they

had. In addition, care givers are satisfied due to the increase or adequate salary

that they have that can be supported of one care giver that had said that their

salary was sufficient for them because she was able to finish her daughter at

college.

Table 8 simply implies that care givers are satisfied to their present job,

though there may become stressed due to financial pressure and the patient

itself and the negative experiences they have encountered, it is not the barrier for

them to enjoy their chosen career.

50

TABLE 9

The frequency and percentage of the caregivers’ perspective on their job.

VARIABLE f %

Caregivers’ perspectives on their

job Care giving as vocation

Care giving as profession

TOTAL

5

0

5

100%

0%

100%

Table 9 presents frequency and percentage of the caregivers’ perspective

on their job as to care giving as vocation, and care giving as profession. Five of

the participants answered care giving as vocation and a percentage of one

hundred from the total participants. And none of the participants answered care

giving as profession, that results zero percentage of the total participants.

Three of the respondents answered that their job was all about

compassion, sincerity and a calling from God especially on rendering care to the

patients. It was all supported by A. J. Conyers (2001) that vocation is distorted by

two disastrous misunderstandings: a secularized idea of “career” and a monastic

concept of the religious life. Both are less than the biblical idea of vocation. It is

about being raised from the dead, made alive to the reality that we don’t merely

exist, but are “called fourth” to a divine purpose. However, a profession

demonstrates a high degree of autonomous practice. Nursing has a variable

degree of autonomy, has very little real freedom; indeed, nursing management,

with it’s ‘cost saving’ mentality, does its utmost to strangle any independent

51

thought or action, for fear of expensive litigation; there are ‘protocols’ for

everything, these days, and woe betide the nurse who dares to use initiative.

Table 9 implies that caregivers could be the one of the modest job in the

world. Most of the care givers considered their career as a vocation; they are

compassionate and sincere to their job. They were dedicated to become the

advocate of the patients specifically the chronically ill persons. In addition, they

were also the instruments to make the patients feel better. They are the one who

gives patients the motivation to continue their lives as good as possible. They

also helped the clients to grow in their physical, emotional, social and spiritual

aspects of their lives. Caregivers prepare them to live a normal life again.

52

TABLE 10

The frequency and percentage of the affects of care giving in their personal life

VARIABLE f %

Care giving affects personal life

Family Life

Love life

Social life

Others

Not affected

TOTAL

0

0

4

0

1

5

0%

0%

80%

20%

20%

100%

Table 10 shows that frequency and percentage of the care giving’s effects

to personal to life as family life, love life, social life, others and not affected. Four

of the total participants answered his social life as the one being affected when

taking care of patients with leprosy with a percentage of eighty of the total

participants. And one of the participants answered not affected, having the

percentage of twenty of the total participants. None of the participants answered

family life and others, both resulting to zero percent of the total participants.

Care giving can also affect the personal lives of the caregivers. These

effects are physical, psychological and social and may include worsened physical

health, impaired social and family life, and increased stress, anxiety and

depression. Social and family life could be largely affecting the lives of caregivers

as to family stress theory. Family stress theory and quality of life advances our

understanding of caregivers' experiences by examining how multiple aspects of

53

caregivers' lives their quality of life may be partly influenced by other existing

environmental stressors, stress appraisal, coping methods and social support.

Considering those factors will help us grow and ready as we enter the journey of

care giving. It was probably the role of the caregivers is to help them achieve the

patients’ lives by knowing their purpose as a human.

Table 10 implies that care givers’ experienced various things together with

their patients, co- workers, environment, etc., from which they were affected,

suffered and even sacrificed their own lives just to render care to the patients.

But it affects their social life in a positive way, in which they were interacting to

different kind of people in their surroundings.

As a member of the health care giving team, we must possess different

skills, abilities and knowledge to be able to give quality care to their patients.

Rendering care to ill persons will also help us to recognize the reality of life. We

should also be open- minded individuals to be able for them to cope with those

factors and easier for them to continue their work with all their hearts. We in the

field of care giving, we’re suppose to render good quality care with satisfaction,

competence, and dedication, it is because that if we feel good about our self and

our job, there is a positive outlook that we can express towards our patients that

will benefit them for their own good.

In addition, we should work according to the works of God. We should be

compassionate and sincere when rendering care to the patients, help them in a

manner that will give the power to stand with dignity. Serving God could be the

reason for us to do our job. We should also remember that we nurses do not only

54

prevent diseases but also cure their personal problems by letting them know that

we love them and also accepted in the society.

55

CHAPTER 4

SUMMMARY AND CONCLUSIONS

Care giving is essential in client- caregiver relationship. Both must set

common goals specifically in promoting wellness and maintaining a healthy

living.

As to our study, caregivers had different functions in the lives of patients.

Moreover, these are the various roles of a health care provider.

1. Demographic Profile of the Participants. It compasses the age, gender

and years of experience of the participants as they render care to the

patients.

2. Perceived experiences of the care givers. These include the positive and

negative experiences of the caregivers in handling patient with leprosy,

from which five of the participants had their negative experiences with

them. They stated that caring patients with leprosy was the challenging

part and needs more understanding.

3. Perceived experiences of the care giver in terms of difficulties. As to our

study three out of five participants stated that there are instances that they

had difficulties in handling patient. The main problem of the caregivers is

the bad attitude of the patients towards them, yet two out of five

participants were having fun taking care of them.

4. Other aspects performed by the caregiver to their patient. This theme

tackled about care givers’ unique aspect that they can render to the

patients, these involve the emotional, spiritual and social life of the

patients. Most of the caregivers responded that spiritual and emotional

56

care are the things that they can give to their patients, and one out of five

participants responded that social support is important because of

patient’s social stigma.

5. Learned experiences of the care giver from their patient. This includes the

genuine love for others, interaction to other people and patience when

taking good care the patients. All participants responded that they learned

as they handle patient with leprosy.

6. Activities performed by the care givers to their patient. As to this,

caregivers had also a part in doing wound dressing, giving medications to

the patients and nursing assessment. As caregivers, they also practice

their medical aspect for better way in giving care.

7. Care givers stressors. The patients and least salary of the caregivers were

there stressors. According to them dealing to patients with social stigma is

the hard part, therefore caregivers should have the ability to gain the trust

of the patients, proper establishment of rapport and patience.

8. Caregivers’ satisfactory level in their chosen career. Five of the

participants believed that they are satisfied to their job. Stress and

negative experiences are not the factors for them to enjoy their chosen

career.

9. Caregivers’ perspective on their job. All participants stated that care giving

is a vocation. Caregivers also included that they are devoted, had

compassion, which became the advocate of the patients.

57

10.The affects of care giving in their personal life. Care giving affects the lives

of the caregivers especially their social lives. Caregivers enhanced their

interaction to the people around them.

Care givers are unique health care provider. They had different abilities and skills

when taking care of a patient. It is a vocation, yet the reflection of themselves as

they render care to them. Caregivers are the advocate of the patients; they serve

them as they serve God. Loving patients with leprosy cannot be seen by only

doing medical practice but also giving their lives for them to have a normal life

RECOMMENDATIONS

The researchers’ recommends to the following:

1. Care givers maintain the way they provide good quality care to the

patients.

2. The care givers attend seminars about effective communications

skills to their patient that would enhance their health care giving

ability and thus, improve care giver – patient relationship.

3. The care givers render more educational programs to the leprosy

patient as well to the community regarding the disease process,

medical management and intervention of leprosy.

4. The institutions give extra credits and compliments to the care

givers regarding their roles that they portrayed in the health care

team as outstanding care givers, to maximize their skills and

potentials in care giving with leprosy.

58

5. For the future researchers, they can increase their number of

participants of the study and the study would help them in their

future research serve as a reference regarding in care giving to

leprosy patient.

REFERENCES

BOOKS:

Garcia, E. (2006), Understanding Psychiatric Nursing Practice: Psychodynamic Approach (New Day Publisher)

Kozier,B. et al (2004), Fundamentals of Nursing (Pearson Education South Asia Pte. Ltd.)

Montgomery, R.J.V. & Kosloski, K.D. (2000). Family Caregiving: Change, Continuity and Diversity

Brykczynska, G. (2001) Caring: The Compassion and Wisdom of Nursing

Tomey, A.M & Alligood M.R (2004), Nursing Theorist and Their Work Fifth Edition.

WEBSITE:

Mitchel, G.(2000) Empowewring Care giversRetrieved August 2010, from http://www.care-givers.com/DBArticles/pages/carearticles.p

Samraj, S.(2000) Comet in SiberiaRetrived August 2010, from http://www.1888articles.com/author-sharon-samraj-10131.html

O’ Breien, M.E. (2000) The Spirituality of Compassionate Care giverRetrieved September 2010, from http://www.jblearning.com/9780763722935

Center of Aging Society (2002) How do Family Care givers Fare? A closer look at their Experiences.

59

Retrieved September 2010, fromhttp://ihcrp.georgetown.edu/agingsociety/pdfs/CAREGIVERS3.pdf

Sullivan, P. (2001) Nurses decry profession’s 1:19 male-to-female ratio Retrieved September 2010, from http://www.cmaj.ca/cgi/reprint/164/12/1738-b

Butt & Broquet (2000) How to Manage Difficult Patient Encounters: Patient Factors Retrieved September 2010, from http://www.medscape.com/viewarticle/561526_2

Patterson, J. (2000) Care givers SroriesRetrieved August 2010, from http://www.caregiver_stories_12.asp.htm

Scott, E. (2007) Common Causes of Caregiver StressRetrieved September 2010, from http://stress.about.com/od/copingwithcrisis/a/caregiver080507.htm

Alkhalaf, J.H et al(2009) Job satisfaction and stress level of primary health caregivers at Primary Health Centers in Qatar. Retrieved September 2010, from http://www.thefreelibrary.com/Job+satisfaction+and+stress+level+of+primary+health+caregivers

Conyers, A.J (2001) The Meaning of VocationRetrieved September 2010, from http://www.baylor.edu/christianethics/VocationarticleConyers.pdf

Lim, J. &  Zebrack B.(2004) Caring for family members with chronic physical illness: A critical review of caregiver literatureRetrieved September 2010, from http://www.hqlo.com/content/2/1/50

Barr (2005) Proper Wound Caring Retrieved September 2010, from http://findarticles.com/p/articles/mi_m0FSS/is_4_8/ai_n18608867/

60

APPENDIX A

LETTER OF PERMISSION

San Juan de Dios Educational Foundation Inc. (College)2772-2774 ROXAS BLVD. PASAY 1300, PHILIPPINES

September 2, 2010

Dr. Edgardo SA. Javillonar, MD, MHAChief of Sanitarium IVDr. Jose N. Rodriguez Memorial HospitalTala, Caloocan City

Dear Sir,

Let us serve the Lord with joy!

We, the Group 4 of BSN 4B students of San Juan de Dios Educational Foundation Incorporated (College) are currently conducting a research study as partial fulfillment of the course Research in Nursing.

With regards to this matter, we would like to request from your good office to please allow us to conduct a research study in your hospital with the title “The Experiences of the Care givers in Handling Patient with Leprosy”. Our study aims to identify, explore and describe the perceptions and experiences of five (5) nursing aid when handling patients with leprosy. We promise that there will be no video recording and picture taking during the stay at the institution.

As soon as we receive your kind approval we shall coordinate with the caregivers for the time and date we can interview them. Research in nursing group 4 is

61

composed of five (5) BSN 4 students. Your favorable response will be gratefully appreciated. God Bless you!

Sincerely yours,

Hannah Abigail TaborGroup Leader

Noted by:

Mrs. Jocelyn L. Cordero, RN, MANResearch adviser

Approved by:

Sr. Heidi A. Facto, DC.Dean of College of Nursing

APPENDIX B

LETTER OF VALIDATION

San Juan de Dios Educational Foundation Inc.(College)2772-2774 ROXAS BLVD. PASAY 1300, PHILIPPINES

August 30. 2010

Estella Garcia, RN, MAN, Ed.DPsychiatric Professor

Dear Ma’am:

Good Day!

We are the students BSN IV-B, Group 4, of the subject Nursing Research (NPP 105). In partial fulfillment of the academic requirement, we are conducting this research entitled “The Experiences of the Care givers in handling Patient with Leprosy”.

In connection with this, we are requesting your good office to please validate the questionnaires that we have made.

Data gathering will be for academic purposes only and be assured that strict confidentiality will be safeguarded.

Hoping for your kind consideration. Thank you.

Respectfully yours,Hannah Abigail Tabor

62

Group Leader

Endorsed by:

Mrs. Jocelyn L. Cordero, RN, MANResearch adviser

Validated by:Estella G. Garcia, RN, MAN, Ed.DPsychiatric Professor

APPENDIX C

QUESTIONNAIREAge:Gender:Years of experience:

1. Meron po ba kayong karanasan na hindi ninyo malilimutan nung simula kayong nagtrabaho dito?

a. Kung magandang karanasanb. Hindi magandang karanasan

2. Kamusta naman po ang tungkol sa inyong personal na buhay?a. Sa pamilyab. Sa lovelifec. Sa social lifed. Kung wala sa nabanggit, ano ito: ________________

3. Naranasan niyo napo ba ang mastress sa trabaho ninyo ngayon? Sa anu-ano pong mga kadahilanan?

a. Oras ng shift sa dutyb. Halaga ng Kitac. Sa pasyente mismod. Sa mga katrabahoe. Sa mga gamit ng ospital

4. Kuntento o masaya po ba kayo ngayon sa trabaho ninyo?a. Kung oo, sa papaanong paraan po?b. Kung hindi, anung dahilan naman po?

5. Ano-ano po ba ang mga ginagawa ninyo sa pag-aalaga sa pasyente?6. May panahon po ba na nahirapan kayo sa mga activities ninyo ng dahil

sa pasyente?a. Kung meron, anu po iyon?b. Kung wala

63

7. Bukod po sa pagbibigay ninyo ng tulong sa pisikal na aspekto ng pasyente ninyo, sa tingin niyo po ano pa po ang maaari ninyong maitulong sa kanila?

8. Para sa inyo po, masasabi niyo po ba na ang pag-aalaga ng pasyenteng may leprosy ay isang bokasyon o propesyon?

a. bokasyonb. propesyon

9. Sa pag-aalaga sa mga pasyenteng may leprosy ano-ano po ang mga natutunan ninyo?

a. Genuine love for the patientsb. Interacting to different kinds of peoplec. Compassionated. Patiencee. Others: (specify)

APPENDIX D

DEMOGRAPHIC PROFILE OF THE PARTICIPANTS

Participant C1

Age: 50 years old

Gender: Male

Years of Experience: 22 years

Participant C2

Age: 39 years old

Gender: Male

Years of Experience: 6 years

Participant C3

Age: 52 years old

Gender: Female

Years of Experience: 20 years

Participant C4

Age: 56 years old

64

Gender: Female

Years of Experience: 25 years

Participant C5

Age: 56 years old

Gender: Female

Years of Experience: 30 years

65