Fulfilling the commitment: the adjustment process of primary family caregivers of nursing home residents, a grounded theory study

Abstract

Prolonged caregiving of older relatives has become common in families as people live longer, often with multiple chronic health problems. Primary family caregivers are characteristically women with a strong attachment to their role. For many who provide high levels of care at considerable personal cost, relinquishing their duty of care is unthinkable. Thus, admitting a relative to a nursing home is a most difficult experience for family caregivers, accompanied by emotional turmoil and a sense of failure. How family caregivers make the adjustment to nursing home caregiving in order to maintain their duty of care, and how nurses might support caregivers were the questions that stimulated this inquiry. -- A grounded theory approach was chosen to study the process of caregiver adjustment. A convenience sample of 10 primary family caregivers of residents who had been in nursing homes in western Newfoundland for5 to 16 months, were interviewed. Constant comparative analysis revealed a basic social process called fulfilling the commitment, which occurred throughout three phases of the caregiving experience. These were home caregiving, admission caregiving and nursing home caregiving. Three adjustments were identified in each phase: taking it on, accelerating responsibility, and reaching an end in the home caregiving phase; finding a place, getting the relative settled, and feeling the loss in the admission phase; and getting used to it, rebuilding life, and coping day to day in the nursing home phase. Dimensions of each adjustment and factors affecting progress were identified. The common factors sustaining and constraining adjustment were: rewards, social support, and emotions. Findings were discussed in relation to pertinent literature, and contributions and limitations of the study were identified. Implications for health care policy, and nursing practice, education and research were proposed.