Family caregiving skill: development of the concept.

Families increasingly are expected to provide complex care at home to ill relatives. Such care requires a level of caregiving knowledge and skill unprecedented among lay persons, yet family caregiving skill has never been formally developed as a concept in nursing. The purpose of the study reported here was to develop the concept of family caregiving skill systematically through qualitative analysis of interviews with patients (n = 30) receiving chemotherapy for cancer and their primary family caregivers (n = 29). Open coding and constant comparison constituted the analytic methods. Sixty-three indicators of caregiving skill were identified for nine core caregiving processes. Family caregiving skill was defined as the ability to engage effectively and smoothly in these nine processes. Properties of family caregiving skill also were identified. Conceptualizing skill as a variable and identifying indicators of varying levels of skill provides a basis for measurement and will allow clinicians to more precisely assess family caregiving skill.

Families and hospitalized elders: A typology of family care actions.

The extensive care provided by families to their elderly relatives in the home is well documented. Although family caregiving is likely to be continued during hospitalization of elderly relatives, limited research has been conducted to address the nature of family care for hospitalized elders. The main purpose of this qualitative study was to refine the content domain of family care for hospitalized elders. Altogether 25 interviews were done. Of the 16 participants, 6 were family members, 6 were patients, and 4 were nurses; 7 participants were interviewed once and 9 participants were interviewed twice. Qualitative analysis based on Lofland and Lofland's (1984, 1995) approach resulted in the identification of three major content domains: family members providing care to the patient, working together with the health care team, and taking care of themselves. This typology suggests a shift of research in this area from its current focus on family needs to a view of family caregivers as partners with the health care team.

Finding a balance point: a process central to understanding family caregiving in Taiwanese families.

The grounded theory method was used to explore the psychosocial process of family caregiving to frail elders in Taiwan. Interview and observation data from 15 family caregivers were analyzed using constant comparative analysis. Caregivers used the process of finding a balance point to achieve or preserve equilibrium between and within caregiving and family life. Caregivers who did better in finding a balance point provided better quality care to frail elders. Caregivers who were good at finding a balance point anticipated competing needs, conceptualized multiple strategies to meet the needs, and predicted accurately the consequences of the strategies. They described a wide variety of balancing strategies.

Conceptualization and measurement of doing family caregiving well.

PURPOSE: To review progress in the conceptualization and measurement of five concepts related to doing family caregiving well: caregiving mastery, self-efficacy, competence, preparedness, and quality. Families are increasingly involved in providing complex care to ill or aged family members at home. Their ability to do caregiving well is vitally important and a focus of nursing practice in many clinical settings. ORGANIZING FRAMEWORK: Concepts were organized into two groups: those that refer to caregivers' perceptions of how well they are providing care and those that refer to professional assessment of the quality of care provided. SOURCES: Family caregiving literature from nursing, gerontology, psychology, and social work, 1987-1996. FINDINGS: There is growing interest in doing family caregiving well. However, research in this area is limited by the current state of development of ideas and measures. CONCLUSIONS: Two issues that should be addressed to advance research are the perspective taken on doing caregiving well and change over time in doing caregiving well.

Living with a person who has Parkinson's disease: the spouse's perspective by stage of disease. Parkinson's Study Group.

The objective of this study was to examine the experience of spouses caregiving for their spouse with Parkinson's disease (PD) and to determine whether their experiences differed by stage of disease. By using a cross-sectional design and mail questionnaire data from 380 spouse caregivers across 23 sites of the Parkinson Study Group, key caregiver variables were examined by stage of PD. Three categories of variables--caregiver role strain (10 measures), caregiver situation (four measures), and caregiver characteristics (four measures)--were analyzed by using t tests with Bonferroni correction. Specific types and amounts of role strain accumulated as the disease progressed, and they differed significantly between stages (p < 0.05). In the caregiving situation, the mean number of caregiving tasks tripled by stage 4/5. Negative changes in lifestyle plus decreases in predictability in caregivers' lives increased significantly in late-stage disease (p < 0.05). Caregiver characteristics of physical health and preparedness did not significantly differ across stages of disease. Depression was significantly higher by stage 4/5. Mutuality, the positive quality of the relationship as perceived by the caregiving spouse, declined beginning at stage 2. Caregiver strain is experienced across all stages of PD and accumulates significantly as the disease progresses. This study defines types and amounts of strain by stage of disease, which will be helpful in designing formal intervention trials to provide more effective help for spouse caregivers.

Development of use and cost measures in a nursing intervention for family caregivers and frail elderly patients.

The purpose of this pilot study was to refine and evaluate methods of measuring costs of an innovative home-health nursing intervention designed to support frail, older persons and their family caregivers. We evaluated a multifaceted strategy to collect a detailed utilization profile from 22 caregiver/care receiver dyads for hospital, ambulatory, home health, nursing home, and community services. The strategy was feasible for most participants, maximized accuracy of cost data, and minimized research burden on study participants. Lower overall costs were found in the intervention group, but the difference was not significant. Approaches to the measurement of costs in this study can serve as models for evaluating other innovations in nursing, home care, and long-term care.

Working-out caregiving systems in African American families.

This study focused on family caregiving of older people in the African American population. Specifically, it used the constant comparative method to describe caregiving processes in these families. In-depth interviews with 17 caregivers revealed that caregiving activities were initially difficult and stressful but became somewhat easier for the caregivers over time. This report describes the major process that accounted for this difference (working-out systems) and describes the steps involved in working-out systems.

Establishing partnerships with family caregivers. Local and cosmopolitan knowledge.

Families now provide most of the care received by older people in the United States. Proposed changes in the health care system will mean that families must take an even greater role in delivering health care. It is crucial that nurses practicing in a variety of settings be prepared to establish partnerships with family caregivers in order to attend to the long-term care needs of older people.

The PREP system of nursing interventions: a pilot test with families caring for older members. Preparedness (PR), enrichment (E) and predictability (P).

The PREP system of nursing interventions, designed to increase preparedness (PR), enrichment (E), and predictability (P) in families providing care to older people, was pilot tested for acceptability and preliminary effectiveness. Eleven family units were assigned to the PREP group and 11 to a standard home health control group. The PREP group scored approximately one SD higher than the control group (p < .05) on the Care Effectiveness Scale, indicating greater preparedness, enrichment, and predictability. Further, on a rating of overall usefulness, the PREP group rated their assistance from PREP nurses (M = 9.75) as significantly higher (p < .01) than the control group rated assistance from the home health nurse or physical therapist (M = 6.57). Although not statistically significant, mean hospital costs for the PREP group ($2,775) were lower than for the control group ($6,929). Results provided support for a full intervention trial.

Reasons for caregiving in African American families.

The researcher conducted in-depth focused interviews with 17 African American caregivers for older, ill relatives regarding their reasons for caregiving. Reasons for caregiving were identified and categorized as familial (duty, maintaining extended family integrity, role modeling), relational (reciprocity, affection, respect), and personal (beliefs, values, attitudes). All of the participants noted the importance of religious beliefs and the value of caring for one's own as reasons for assuming the caregiving role. The findings suggest that understanding the reasons for caregiving may influence caregiving experiences and outcomes.

Enrichment processes in family caregiving to frail elders.

Interview and observational data obtained from caregiver-care recipient dyads were analyzed in developing a theory of enrichment that explains how some families use pleasurable or meaningful experiences in their caregiving to frail elders. The personal history and frailty trajectory of both caregiver and care recipient, the quality of the dyadic relationship, and the caregiving situation are antecedents to enrichment processes. Core elements influencing the nature of enriching events include acquiring symbolic meaning, performing activity, and fine tuning. Categories of enrichment events are customary routines and innovative routine breakers. Consequences of enrichment are relationship and identity sustenance for both caregiver and care recipient, comfort for the care recipient, and rewards of meaning for the caregiver.

Establishing partnerships with family caregivers. Local and cosmopolitan knowledge.

1. The concepts of local and cosmopolitan knowledge may be used by gerontological nurses in creating partnerships with family caregivers to frail older people. 2. Local knowledge is the understanding and skills that the family brings to the caregiving situation; cosmopolitan knowledge is the understanding and skills that the gerontological nurse brings to the situation. 3. Four nursing interventions are guided by the conceptualization of local and cosmopolitan knowledge: acknowledging and affirming local knowledge when it is adequate; developing or enhancing local knowledge when it is inadequate; assisting family caregivers to apply local knowledge to problem solving; and blending local and cosmopolitan knowledge.

Family caregivers of post-hospitalized older persons and persons receiving hospice: similarities and differences.

The study reported here explored similarities and differences between 103 family caregivers of older persons who had been discharged from the hospital and 70 caregivers of terminally ill older persons receiving hospice care. Caregiving variables were selected for examination based on role theory. Major findings include: hospice caregivers provided significantly more personal care and medically related tasks, significantly fewer transportation tasks, and worried less than the post-hospitalized sample. Otherwise, the two groups were strikingly similar. Similar patterns of correlations for the two groups were also found.

Nursing intervention studies require outcome measures that are sensitive to change: Part Two.

Ohis article is the second and concluding part of a discussion of the importance of sensitivity to change in selecting an outcome measure for a study evaluating a nursing intervention. In Part One of the discussion, (Stewart & Archbold, 1992) the relative lack of attention to measurement sensitivity in the nursing and measurement literature was described. Three factors to consider in selecting an outcome measure for an intervention study were reviewed: the conceptual link between the intervention and the outcome variable, the extent to which the outcome variable is amenable to change, and content validity. In Part Two, four additional factors are discussed: construct validity, distribution of scores on the outcome measure, reliability, and correlational stability over time.

Nursing intervention studies require outcome measures that are sensitive to change: Part One.

In selecting an outcome measure for a study evaluating a nursing intervention, the criterion of sensitivity to change should predominate. Researchers commonly justify their choice of outcome measures for experiments based on such psychometric criteria as high internal consistency reliability and patterns of correlations reflecting convergent and discriminant validity. Although such criteria are appropriate for measures to assess individual differences, they are insufficient when the measures will be used for intervention studies. Researchers may need to develop new measures that are tailored for experimental studies if existing measures are valid mainly for the assessment of individual differences. In this first portion of a two-part article, three of seven factors to consider in selecting an outcome measure for an intervention study are outlined and recommendations for application of principles of reliability and validity in the context of sensitivity to change are given.

Mutuality and preparedness as predictors of caregiver role strain.

Data from 78 older persons and their family caregivers were obtained at 6 weeks and 9 months after hospital discharge. Hierarchical multiple regression was used to determine whether mutuality and preparedness for caregiving were related to lower levels of caregiver role strain. The results indicated that, after controlling for five other variables commonly found to be related to caregiver role strain, mutuality and preparedness ameliorated some but not all aspects of role strain.