title: Being an informal caregiver for a relative with liver cirrhosis and overt hepatic encephalopathy: a phenomenological study.
abstract: OBJECTIVE
  To explore the experiences of being an informal caregiver for a relative with liver cirrhosis and overt hepatic encephalopathy.
  
  
  BACKGROUND
  Overt hepatic encephalopathy is a common complication in patients with liver cirrhosis. It is associated with decreased quality of life for patients, and presents a major burden for caregivers. The involvement of informal caregivers in medical care is recommended, but it has not been clearly described. An understanding of the experience of caregivers is needed to improve the support provided to them by healthcare professionals.
  
  
  METHODS
  A qualitative, interpretative, phenomenological approach was used.
  
  
  METHODS
  Twelve informal caregivers participated in qualitative interviews. The analysis followed the six steps of the interpretative phenomenological approach.
  
  
  RESULTS
  Caregivers' experiences were described using five themes: (1) feeling overwhelmed by their loved one having unexplainable symptoms and behaviours; (2) learning that this and previous experiences were complications of liver disease; (3) becoming aware of the symptoms of hepatic encephalopathy; (4) having feelings of being tied down and (5) experiencing and overcoming obstacles in working with healthcare professionals.
  
  
  CONCLUSIONS
  This study provides insight into caregivers' experiences and the consequences for their lives. The first occurrence of symptoms was a shock, but receiving the diagnosis was seen as an important step in understanding and learning. Caregivers provide daily assessments of their relatives' conditions, and they feel responsible for medication management. Over time, the caregivers impressively showed how they were able to incorporate their personal experiences into caregiving and to accept more accountability in managing the disease.
  
  
  CONCLUSIONS
  Nurses should acknowledge caregivers as experts in caring for their loved ones. Nurses can assist caregivers in managing an episode of hepatic encephalopathy and can provide individualised interventions to ease the future burden.
authors.affiliation: Clinic of Gastroenterology and Hepatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland. patrizia.kuenzler@kssg.ch.|Department of Nursing, Cantonal Hospital St. Gallen, St. Gallen, Switzerland. patrizia.kuenzler@kssg.ch.|Institute of Nursing, Zurich University of Applied Sciences (ZUAS), Winterthur, Switzerland. patrizia.kuenzler@kssg.ch.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Künzler-Heule
authors.affiliation: Department of Abdomen and Metabolism, University Hospital Zurich, Zurich, Switzerland.|Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland.
authors.forename: Sonja
authors.initials: S
authors.lastname: Beckmann
authors.affiliation: Institute of Nursing, Zurich University of Applied Sciences (ZUAS), Winterthur, Switzerland.
authors.forename: Romy
authors.initials: R
authors.lastname: Mahrer-Imhof
authors.affiliation: Clinic of Gastroenterology and Hepatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Semela
authors.affiliation: Institute of Nursing, Zurich University of Applied Sciences (ZUAS), Winterthur, Switzerland.
authors.forename: Daniela
authors.initials: D
authors.lastname: Händler-Schuster
mesh_terms: D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology*; D005260:Female; D006501:Hepatic Encephalopathy / Q000150:complications / Q000451:nursing*; D006801:Humans; D007407:Interviews as Topic; D008103:Liver Cirrhosis / Q000150:complications / Q000451:nursing*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D013557:Switzerland
keywords: chronic illness; hepatic encephalopathy; informal caregiver; lived experiences; liver cirrhosis; nursing