Carolina Lapena: "The pandemic has made us learn that we have to take care of caregivers more"
The study "Overload in informal caregivers of people cared for at home by primary care during the pandemic", developed by nursing residents of CAP Bon Pastor, El Carmel, La Mina and Poblenou has recently obtained two recognitions: the prize of the fourteenth Research Conference for Residents of Primary Care and the Community of Barcelona City (APBCN) and also the 1st prize of the 11th Conference of specialists in Family and Community Nursing of the Family and Community Nursing Association of Catalonia (AIFICC). We talk to Carolina Lapena, specialist nurse and researcher at the IDIAPJGol, who has been the tutor for this promotion.
How was this project born?
Within the training part of family and community nursing residents, one of the tasks is to carry out research work, and this came from the residents themselves. Initially they took into account different themes that could be interesting or stimulating. And one of the ones that came up was that. I also really liked the idea because from the initial approach it was clear to us that it would be a mixed study combining somewhat different methodologies, both quantitative and qualitative. And it also fit very well with my idea of what this formative process of tasting research had to be. We were clear that it would be a tasting because they were only two years old and we had to do a lot of things in a very short time, but it would make them try different methodologies and tools.
What did the research work consist of?
The project analyzed the variation in the burden on caregivers of people who were included in the Home Care Program (ATDOM) of primary and community care in Catalonia. which cares for people who normally cannot leave their homes, with the highest levels of dependency and fragility and therefore need someone to take care of them on a daily basis. We know that people who are taking care of others have a risk of fatigue because it is a task that requires not only a lot of physical dedication, but above all emotional. The pandemic meant that these assistants were at home caring for these people while the entire health system was prioritized in detecting Covid and treating acute pathologies and, therefore, all the support that was offered had to be readapted. We wanted to know how all this could have had an impact on the fatigue of caregivers when caring for these relatives or people close to whom they were caring.
And what are the conclusions?
Well, during the peak of the pandemic there was a worsening of the caregivers who cared for the people included in the program, but that this worsening was not because the state of health of the ATDOM had worsened, but because of fear or uncertainty that we all suffer, aggravated by our own health problems, or because family or social support preserved this caregiver from any outside contact. In this way, the assistant or assistant did not have the option of spreading out or breaking from time to time with that situation, and thus their fatigue worsened.
What have these awards meant for the collective?
It is a recognition of a job done by the residents. When they start the residency, I can understand that what they want is to see patients and touch the ground. And perhaps a research paper was not one of the things that a priori encouraged them much. So, I think that the fact that they finally see that they have finished this research work and that they draw conclusions that can impact their daily practice and that what you do in research has value for your healthcare work. I believe that this research work impacts them because they see that this is useful, and if this recognition also comes from outside in the form of a prize from an external third party who, in theory, is always more expert, I think it adds value all this work done. And if, in addition, the group of people awarded are male and female nurses, well for me it has even more reason, because historically we have a less recognized or less valued research tradition.
Tell us about the applicability of the project within primary care.
Although the context of this study was the pandemic, it does allow us to draw conclusions when it comes to rethinking our work a bit. In other words, we must make programs that are highly adaptable, because what has happened now we don't know if it will happen again, and it opens our minds to be clear that we must work in a network. Not only do we have health services, but there is a whole network of social resources, family members, neighborhood agents... We must take into account the characteristics of that neighborhood, of that population, of that family, of that person, the one we are attending and incorporating them, because each one has their circumstances, and how this conditions us. It can also give us clues about what kind of information we collect in medical records: we have realized that we are missing a lot of information from caregivers; we had a lot of information from the ATDOM person, but perhaps we should collect information from the person he cares for, which is equally or more important. And we must be aware of the importance of rigor, a methodology and evidence that justifies the practices we do. This helps us focus on what we should pay more attention to a person, for example, who is taking care of another. And what we always say: caring for the caregiver is more important than ever in studies like this.
How is the work you do as a tutor for resident nurses in family and community nursing?
What we do a little from the beginning is to plan the research work, which is the final objective. The first year may be more aimed at a more formative phase, more than explaining very basic concepts and ideas of everything that is research. We also take the opportunity to teach the resources that they can count on, both instrumental and to carry out searches, as well as physical resources of the Research Support Unit, and that they also know the people of the service or everything they can find, because they It can be useful to carry out this research work, but also when they finish their residency, if they want to dedicate themselves to it. Then they begin to do field work and we are seeing the applicability and how all this can fit into their specific work, with their subject matter and with the difficulties or things they are encountering, while the research progresses. And, ultimately, this also positions you before the profession, in how you question your day-to-day practice, when you get out of your comfort zone, wanting to contribute and wanting to learn more things to question yourself. After all, it is about never losing the bug of curiosity and research.
Does it cost the residents to get enthusiastic about the research?
At first it's hard to get excited; no one chooses to investigate. It is part of the curriculum that they must achieve and therefore, it is time to do it. Something that I repeat to them from the first day is that my goal is for them to learn four little things, but above all that they have a great time. If they have a good time, they will continue to do so, later. In these two years we have moments of euphoria, of being very satisfied and very happy, and also difficult moments, because it costs a lot to house it. But when the end comes, they see the result of their work and understand the grace that one enriches the other by talking with other colleagues and they see that they have all achieved useful things. And finally, when they value all this effort, they see that perhaps it was worth it, so that, at another time, they want to try it again. Why not?
