Part I: My Guide for Caregivers When Your Loved One is in the Hospital

My Guide for Caregivers When Your Loved One is in the Hospital

Hospitals are strange places. We come to them seeking healing, yet routinely uncover only more barriers to wellness. Yes, hospitals are not ideal.

A few weeks back I discussed aspects of my approach with hospitalized pediatric (and adult patients) during the course of the overall healing process.

This week, however, I wanted to address and provide some practical recommendations for CAREGIVERS when it comes to supporting and healing your loved ones during a hospital stay.

As I said before, the modern hospital is not the ideal place for most to begin the healing process and it can be quite challenging to incorporate fundamental ancestral, lifestyle, and integrative healing principles into one’s care in such a place. However, with present awareness, an open mind, and some helpful guidance (hopefully from a few of my tips) your loved one can recover quickly and be restored to optimal health and avoid some of the potential harms of being cared for in the modern hospital setting.

To start things off, I think it is important to recognize a disappointing, but purposeful observation.

1. Hospital healthcare workers, trainees, and students are often overworked, sleep deprived and frustrated by numerous internal barriers to providing personalized holistic care.

This is not an excuse. I repeat, this is not an excuse. It is simply a statement of observation, but one that we must first accept in order to begin a therapeutic relationship as a caregiver. We can all be stressed, tired, burned out, fatigued, depressed, etc, and we must realize this simple truth in order to more fully accept all individuals. As healthcare providers, we seek to understand and meet the needs of our patients, no matter the circumstance, and as caregivers we seek to be present for and to tend to the needs of our loved ones as we perceive them.

Problems often arise when the perceptions of the patient’s needs from the caregiving party are vastly different than the perceptions of those of the hospital staff (example: the physician is stressed and worried about the patient’s elevated Creatinine-  a marker of kidney function, while the family is worried that their father hasn’t slept well in 3 days). Where this gets really troublesome is when both sides fail to acknowledge the relative burden of “caregiving” as either the physician or family caregiver, and fail to accept the other’s current state of stress or worry.

We recognize as providers that we will see patients in their most vulnerable and worried states, but what is often not acknowledged, however, is that as a patient or caregiver, you too may see a doctor, a nurse, a respiratory therapist or a patient care technician on perhaps one of their “worst” days as well. We all have rough days and sometimes they will overlap.

But we won’t know unless we ask, and we cannot fully embrace other’s pain unless we seek to fully accept their ability to be hurt, tired or relatively broken.

Now, from a place of acceptance and understanding we can move into some more accessible tips for cultivating the best relationships with your loved one’s care team.

2. Be Available

Hospital rounding and schedules are often incredibly busy, with only minutes to spend with certain patients and families. It can often be confusing as a caregiver, being present during all of your loved one’s stay, as to why all of these strange people wearing white coats come at one time and then never come back when you actually want to talk.

It is not a perfect system by any means, and once again I make no excuses, but it is a present reality.

Ways to negotiate this system as a caregiver:

Rather than demand or ask the doctor or nurse to return to answer your questions and address your concerns at specific times available to you, offer a range of times in which you will be around and willing to talk. Afternoons are often variable in the afternoon and a good start for finding free time, but as a caregiver if you express to the team in the morning that you would like to speak more about your loved one’s care, suggest a range of times to your doctor and see if you can find a mutual time. Providers will be more than happy to speak over the phone or in person if they do not feel stressed my demands they are unsure they can meet.

Additionally, demands can be perceived as threatening- consciously or unconsciously and as such, healthcare workers may be less willing to return to see your loved one if they have perceived you to be demanding, a burden or a challenge to implementing their care plan.

3.  Optimizing Sleep

    Hospitals are notorious for being difficult places to sleep: alarms, vital sign checks, early morning rounds, you name it- it is challenging. What can you do to address this?

        1. Ask the team or nurse if they can skip overnight vital sign checks. For example ask if they can do there final vital sign check at 10 PM, skipping the 2 AM check and checking again at 6 AM providing a full 8 hours of uninterrupted sleep.

       2. Sleep aids such as Melatonin are a part of most hospital formularies and have been found to be quite helpful in maintaining normal circadian rhythm structure in patients. It can also be helpful in minimizing the potential for your loved one to become disorientated or delirious. 3 mg’s taken an hour or two before bed is a reasonable starting dose and as mentioned before available in most hospitals.

       3. Try to promote a normal sleep wake cycle by engaging in activity during the day and avoiding excessive day-time napping. Yes, we need sleep to recover, but we also need well entrained circadian rhythms for optimal hormonal release, wound healing, etc. Excessive daytime naps may make up for “lost sleep,” but they are not the best solution. See the first two tips in this section for associated recommendations to combat excessive daytime sleepiness.

4. Building a Nutritious Diet

    Okay this could be a long answer, but to put it bluntly, hospital food is often not the greatest. The food available in the cafeteria, while perhaps different than the food available to patients, is also often not much better. This is certainly an area needing improvement and I recognize the challenges of trying to choose between putting diabetic patients with heart issues on the “cardiac carb consistent diet” that includes orange juice, muffins and sugar laden yogurts or the low carb diet that consists of “scrambled” eggs, skim milk and bland oatmeal. Not ideal indeed.

A simple, but time-intensive solution is to bring in homecooked food. But you say, “I shouldn’t have to do that! The hospital should have nutritious food.” Yes, you are right, but unfortunately the hospital is neither ideal nor reliable.

Some foods that can be quick to prepare for your loved one include:

1. Bone Broth with cooked veggies
2. Foods Rich in Nutritious Fats: Avocado- Guacamole, Hummus made with Olive Oil, Hard Boiled Eggs- Add spices: Himalayan Salt, Black and Cayenne Pepper as desired. Organic Nut Butters with fruit such as organic apples or bananas, Snack Mixes with roasted, soaked, nuts, seeds, dark chocolate
3. Fatty Fish- Salmon, Sardines, Mackerel- (wild caught- canned is perfectly fine!)
4. Magnesium Rich Foods- Many of the above I have already mentioned are high in magnesium, but others include: full fat unsweetened yogurt, dark leafy greens blended into smoothies and kefir. Be sure to use organic full fat dairy products as tolerated and avoid taking them with certain medications such as Tetracycline antibiotics or Antacids. Also magnesium supplementation in the hospital is usually restricted to what is available on the formulary- often only Magnesium Oxide (which can cause GI distress) or IV Magnesium ( which is better tolerated, but quite expensive), and so I recommend food sources and if possible additional home supported supplementation as outlined in Part II of this post.
5. Smoothies can be a great vehicle for packing tons of nutrients into something much more palatable than anything else available in the hospital.

5. Supporting Stress Management

    Anything you can do at home, you can do at the hospital!

    Yes!!

Amazingly I have been able to cultivate a solid and diverse practice thus far during my residency training and spend much time helping my patients and caregivers with mindfulness practices to support healing. As a caregiver, explore the hospital asking about quiet spaces, green spaces or spaces for prayer or meditation. If your loved one is able, take them to such spaces, spending time outdoors in green spaces, or to places of warm light, free of relative noise and chaos.

I will not get into specific practices here, but some great exercises I use with my patients who spend much of their time in bed are basic relaxation and breathing exercises as well as progressive muscle relaxation. Technology can be a great friend too, using headphones to listen to calming music, meditation sequences or natural ambient sounds.

These practices are arguably the most important part of your loved one’s healing, even more so than a nutritious diet and restorative sleep. I say this recognizing the hospital is full of numerous environmental exposures and burdens to remaining joyful. I have unfortunately seen many patients become disillusioned, acutely depressed and simply overwhelmed with the lack of control in the hospital setting. And perhaps even more troubling is bearing witness to the acute loss of meaning in one’s life while wearing a gown. Hospital time is not real time, and hospital exposures are not normal exposures, and as such we need to recognize the tremendous need to cultivate spiritual, emotional and mental well being through the course of a loved one’s hospitalization in order to mitigate the negative effects of such exposures.

Tune in next week to read Part II of the Caregiver’s Guide, and in the meantime, please practice and share these ideas with all those in your life. Leave a comment or share an email with your thoughts from this post. We love to hear from you!