Catherine Ward-Griffin

Relationships between Nurses and Family Caregivers: Partners in Care?

Increasing reliance on family care of elderly people at home calls for a critical analysis of the relationship between formal and informal caregivers. Although much has been written about how health professionals and family caregivers should relate to one another, we know very little about the relationships that develop between them. Using data from a qualitative study, this article illustrates that relationships between community nurses and family members caring for frail elders are complex, dynamic, and multifaceted. Shifting boundaries in caring work leads to changes in nurse-family caregiver relationships, which can be categorized as four distinct, yet interconnected, types: (1) nurse-helper, (2) worker-worker, (3) manager-worker, and (4) nurse-patient. Each type is described, and implications for nursing practice and research are discussed.

Reconceptualizing the relationship between “public” and “private” eldercare

Abstract Recent changes in patterns of care provision for the elderly, including a withdrawal of the formal system and increasing reliance on family care providers, call for new conceptualization and theoretical development. Existing models of the relationship between formal and informal care are reviewed, but found wanting in neglecting the dynamic relationships between formal and informal providers as they negotiate the nature and allocation of caregiving as work. Data from a Canadian study of community nurses providing care to frail elders over the age of 65 years, and family members also providing such care, are used to illustrate the utility of a new model grounded in socialist-feminist thought. Study findings suggest a number of implications for future theory development and research.

The Experience of Empowerment in In-Home Services Delivery

ABSTRACT In-home health services strive for client-centredness, involvement, and ultimately, empowerment, but economic constraint may undermine these aims. The purpose of this study was to explore the everyday experience of in-home care, with particular attention to the enactment of empowerment in the care partnership. In-depth interviews with a maximally varied sample of clients, informal caregivers, and providers uncovered relationships largely reflecting the traditional expert model of care. Findings afford insights into the unrecognized and undervalued personal knowledge of clients, caregivers, and in-home service providers, the professional and structural hegemony and consequent disempowered group behaviour of those who share the experience of care, and the hesitance of clients to engage as equitable partners in care. Strategies to achieve empowerment approaches to in-home health services are identified.

Dating violence and the health of young women: a feminist narrative study.

Dating violence is a significant public health problem in the lives of young women. Their age, in conjunction with perceived pressures to engage in intimate relationships, makes these women particularly vulnerable to dating violence. The pressures to be in relationships can be intense and therefore may add to young womens willingness to overlook, forgive, or excuse the violence that is occurring. The authors’ purposes in this feminist study were to examine the experience of dating violence from young womens perspectives; investigate how contextual factors shape their experiences; examine how health is shaped by these experiences; and explore ways that dating violence is perpetuated and normalized in young womens lives. Findings revealed that family environment and gender are critical in shaping young womens experiences. The participants described a range of physical and emotional health problems and perceived few sources of support. Their efforts to obtain support were often met with skeptical and dismissive attitudes on the part of health care providers and other trusted adults. Recommendations for health care practice, education, and research are presented.

Patient Empowerment After Total Hip and Knee Replacement

Purpose This research was designed to gain an enhanced understanding of empowerment within in-home care relationships after hospital discharge of elderly patients who had undergone total hip or total knee replacement. Method An interpretive phenomenology method was used. Sample Nine participants were interviewed on audiotape, guided by a semistructured interview guide. Five themes emerged centering on a strong desire to maintain independence. Overall, participants experienced disempowered relationships with professional in-home care providers and a more equitable empowered relationship with nonprofessional care providers. Conclusion Disempowered relationships with professional personnel were not identified as a dissatisfier to most participants. Rather, patients expressed deference to the traditional expert model of healthcare. Further investigation is needed to understand the effect of empowerment on client satisfaction and clinical outcomes.

Mother-Adult Daughter Relationships Within Dementia Care A Critical Analysis

Evidence suggests that intergenerational caregiving between mothers and daughters will become increasingly common, and yet, we know very little about the specific relationships between adult daughters and their mothers with dementia. Guided by socialist-feminist theory and a life-course perspective, 15 mother-adult daughter dyads participated in two individual, semistructured interviews. Data analysis revealed four dynamic types of mother-daughter relationships: custodial, combative, cooperative, and cohesive. Custodial and cooperative relationships mainly focused on the provision of and receipt of tasks, whereas combative and cohesive are emotion focused. At the same time, custodial and combative relationships are based on deficits compared with strength based cohesive and cooperative relationships. In addition, certain contextual factors, such as expectations of care and levels of support, shaped the development of these relationships. Moreover, study findings highlight a number of implications for practice, policy, and research necessary to support individuals with dementia and their families.

Care Transition Experiences of Spousal Caregivers: From a Geriatric Rehabilitation Unit to Home

The purpose of this study was to develop a theoretical framework about caregivers’ experiences and the processes in which they engaged during their spouses’ transition from a geriatric rehabilitation unit to home. We used a constructivist grounded theory methodology approach. Forty-five interviews were conducted across three points in time with 18 older adult spousal caregivers. A theoretical framework was developed within which reconciling in response to fluctuating needs emerged as the basic social process. Reconciling included three subprocesses (i.e., navigating, safekeeping, and repositioning), and highlighted how caregivers responded to the fluctuating needs of their spouse, to their own needs, and to those of the marital dyad. Reconciling was situated within a context shaped by a trajectory of prior care transitions and intertwined life events experienced by caregivers. Findings serve as a resource for scientists, rehabilitation clinicians, educators, and decision makers toward improving transitional care for spousal caregivers.

Making care decisions in home-based dementia care: Why context matters

D’ici à 2038, le nombre d’heures de soins non rémunérées aux aînés offert par les membres de la famille devraient tripler. Les membres des familles sont souvent suppliés d’aider dans le processus parce que vivre avec la démence peut inhiber la capacité pour prendre une décision. Cette étude ethnographique a soumis les relations au sein de soins de la démence à domicile à un examen critique par le biais des entrevues face-à-face et les observations des participants des clients, des aidants naturels et des prestataires de soins à domicile. Les résultats ont révélé comment les décisions sont imposées dans le contexte du système de soins à domicile formels, et ont mis en évidence trois thèmes: (1) L’accommodation de la compétence/incompétence, comme définie cliniquement; (2) La prise de décisions inopportunes; et (3) Le renforcement de l’exclusion des déments dans la prise de décision. Ces thèmes illuminent la façon dont les valeurs culturelles (la compétence), les croyances (l’immuabilité du système) et les pratiques (le réglage des décisions) dans le système de soins à domicile sont finalement déterministes dans la prise de décisions pour les déments et leurs aidants. Afin d’optimiser la santé des déments qui se font soignés à domicile, il faut accorder d’attention supplémentaire aux pratiques collaboratives et inclusives des membres des familles. The hours of unpaid elder care by family members are projected to triple by 2038. Because living with dementia can inhibit decision-making abilities, family members are often besought to assist in this process. In this ethnographic study, relationships within home-based dementia care were critically examined through face-to-face interviews and participant observations with clients, family caregivers, and home care providers (n = 51). The findings revealed how the formalized home care system contextually imposes decisions, and revealed three themes: (1) accommodating clinically defined competence/incompetence, (2) making untimely decisions, and (3) reinforcing exclusion in decision making. These themes shed light on how cultural values (competency), beliefs (immutability of the system), and practices (timing of decisions) of the home care system are ultimately deterministic in decision making for persons with dementia and caregivers. Additional attention to the collaborative and inclusive practices of all family members in dementia home care is imperative in order to optimize health.

Dementia Home Care Resources: How Are We Managing?

With the number of people living with dementia expected to more than double within the next 25 years, the demand for dementia home care services will increase. In this critical ethnographic study, we drew upon interview and participant data with persons with dementia, family caregivers, in-home providers, and case managers in nine dementia care networks to examine the management of dementia home care resources. Three interrelated, dialectical themes were identified: (1) finite formal care-inexhaustible familial care, (2) accessible resources rhetoric-Iinaccessible resources reality, and (3) diminishing care resources-increasing care needs. The development of policies and practices that provide available, accessible, and appropriate resources, ensuring equitable, not necessarily equal, distribution of dementia care resources is required if we are to meet the goal of aging in place now and in the future.

Canadian families caring for members with mental illness: a vicious cycle.

The purpose of this qualitative, descriptive study was to explore the perspectives of individuals who were caring for a family member with a mental illness, with particular attention to housing, quality of supports, and formal care services. Eleven focus groups with family caregivers (N = 75) were conducted. Both individual and team thematic analyses were undertaken until interpretations of the experiences of the participants were inductively developed and conceptualized into a holistic interpretation. Findings revealed that family caregivers were part of a “circle of care,” supporting the independence of the individual with mental illness while attempting to protect their family member with mental illness. However, findings suggested that this circle of care led to a “vicious cycle” of caregiving. Three major themes were identified: witnessing inadequacies, working behind the scenes, and creating a better world. Health-promoting family nursing practice and policy implications, as well as areas for further research, are discussed.