Role recognition and changes to self-identity in family caregivers of people with advanced cancer: a qualitative study

Purpose : Family caregivers of people with advanced cancer can provide extensive support to the patient. However, the role is not well defined and their experiences are poorly understood. This study aimed to explore how caregivers view their role and the impact of their caregiving.

Methods : A symbolic interactionist framework guided the in-depth individual interviews and grounded theory methodology was used to analyse the data. A total of 17 interviews were conducted: 13 with active caregivers and 4 with bereaved caregivers.

Results : Three dominant codes are presented. Caregivers lacked role recognition, as they struggled to recognise their role existed, even though they took on extensive and challenging tasks. Caregivers reported substantial loss or changes to their self-identity: with some caregivers reporting not being able to stop thinking about caregiving and others having difficulty answering questions about themselves. Caregivers also demonstrated difficulty in taking a break: active caregivers did not consider taking a break, whereas bereaved caregivers retrospectively admitted needing a break but reported an inability to take one.

Conclusions : Caregiving is complex and extensive. People who care for those with advanced cancer are in need of intervention to provide support and assistance to them in their role. However, this needs to be structured with consideration for how caregivers view their role.

Psychological wellbeing among same-sex attracted and heterosexual parents: Role of connectedness to family and friendship networks

© 2015 Australian Association of Family Therapy. Increasing numbers of lesbian, gay and bisexual (LGB) adults are entering into parenthood. Previous studies indicate many of these parents receive little or no support from their families of origin due to family members' negative attitudes toward homosexuality. This study looks at the extent to which LGB parents report a lower sense of connectedness to family of origin and friendship networks than heterosexual parents and whether this has an impact on psychological wellbeing in either of these groups. Data were derived from two studies of parents: Work, Love, Play, a study of Australian and New Zealand LGB parents (n=324); and the Longitudinal Study of Australian Children, a population-based study of young children and parents (n=6460). Structural equation modelling was used to explore the relationships between: parent sexuality and family/friendship connectedness, family/friendship connectedness and psychological wellbeing, parent sexuality and psychological wellbeing. LGB parents reported feeling less connected to their families of origin but more connected to their friendship groups than heterosexual parents. Counter to previous studies, we found no difference in the psychological wellbeing of LGB parents compared to heterosexual parents when examining the direct effect of sexuality on psychological wellbeing. Clinical implications for counsellors and family therapists are discussed.

Corporate opacity and cost of debt for family firms

This paper uses a sample of Chinese firms to examine the impact of corporate opacity on the relationship between family control and firms’ cost of debt. We find that family control is associated with a lower cost of debt on average, and a negative impact exists mainly in firms with relatively low corporate opacity. We further provide evidence that the moderating effect of corporate opacity becomes more pronounced when investors’ perception of controlling families’ moral hazard of expropriation is higher. Our results are robust to alternative opacity proxies and controlling for endogeneity of family control using the instrumental variable method. Our study highlights that controlling families are heterogeneous in their impact on the shareholder–debtholder relationship in family firms, and debtholders view corporate opacity as an important reference in assessing the extent of potential agency conflicts in China.

The experience of family carers of people with dementia who are hospitalised

Hospital admission of a person with dementia can have a significant impact on the family carer, who temporarily relinquishes caring to health professionals. A descriptive qualitative design using in-depth interviews with a conversational approach was used to elicit data. Adjusting to the change in the carer’s role can be challenging and result in feelings of helplessness, loneliness, loss of control and being undervalued. Family support can assist with the transition but family conflict increases anxiety. Good communication between clinicians and the carer is vital. The carer should be included in decision-making as the ‘expert' in the care of the person with dementia. This article discusses findings of a larger study specifically related to the emotional support required for the carers of people with dementia, who are admitted to hospital. The carer and the patient must be considered as a dyad in relation to discharge planning.

Providing end-of-life care in the intensive care unit : issues that impact on nurse professionalism

With death a frequent event in intensive care units how, people die and the impact on family and staffs is becoming increasingly recognised as an issue requiring significant attention. Caring for a dying patient in these environments challenges the dominant ethos of seeking to cure critically ill patients. Family members require particular care as they keep vigil with their loved one and this forms a major area of work and concern for nurses. Mortality rates are higher in intensive care units than in most other settings and this impacts on staff. This paper builds on a qualitative exploratory study utilising focus groups that was undertaken to describe how nurses support family members during and after a death in the intensive care unit. This study identified issues that challenged the nurses' ability to maintain professionalism and the ways in which nurses ensured self-care. They highlighted organisational constraints, support for families and for their nursing colleagues as important issues for discussion.

Dividends, leverage, and family ownership in the emerging Indonesian market

We examine the roles of dividends and leverage to mitigate agency problems within familyfirms in Indonesia. Using simultaneous equations, we find a significant negative associationbetween family ownership and dividend payout and a two-way negative relation betweendividend payout and leverage. Our analysis reveals that, compared to non-family firms,family firms tend to maintain a lower dividend pay-out and higher leverage. The presenceof large non-family ownership appears to have an impact on determining levels of privatebenefit control. During the Asian and global financial crisis, family firms changed theirdividend pay-out more than non-family firms did.

Family violence in domestic homicides: a case study of women who killed intimate partners post-legislative reform in Victoria, Australia

This article examines the impact of legislative reforms enacted in 2005 in Victoria, Australia, on legal responses to women charged with murder for killing their intimate partner. The reforms provided for a broader understanding of the context of family violence to be considered in such cases, but we found little evidence of this in practice. This is partly attributable to persistent misconceptions among the legal profession about family violence and why women may believe it necessary to kill a partner. We recommend specialized training for legal professionals and increased use of family violence evidence to help ensure women's claims of self-defense receive appropriate responses from Victorian courts.

The old mind the house: the elderly and their place in the modern Minangkabau family in Indonesia

The many local cultures of Indonesia are often thought of as being more family-oriented than is usual in western societies and taking a more communal approach to providing care for individuals who require it within the context of traditional family and social structures. While this situation does represent an idealized conceptualization of traditional values, the reality of modern life in Indonesia has often not supported the maintenance of such patterns. This paper investigates the dilemma faced by many Minangkabau families in caring for elderly relatives in modern Indonesia. Based on a large study of aging among members of this ethnic group, it describes the social forces that shape modernIndonesian life and their effects on traditional social structures with a focus on the impact of such change on the experience of older individuals. In the context of increasing life expectancy nationwide, care alternatives for the elderly are required as traditional structures either no longer exist or are increasingly inadequate to accommodate the needs of older people who often have significant health problems. This paper focuses on the way Minangkabau families are addressing the needs of older relatives and the changing experience of these elderly themselves relative to the culturally expected norm of the past.

Caregiver burden as a predictor of depression among family and friends who provide care for persons with bipolar disorder

OBJECTIVES: Over one-third of caregivers of people with bipolar disorder report clinically significant levels of depressive symptoms. This study examined the causal relationship between depression and caregiver burden in a large sample of caregivers of adult patients with bipolar disorder. METHODS: Participants were 500 primary caregivers of persons with bipolar disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD).This study evaluates the strength and direction of the associations between caregiver burden and depressive symptoms at baseline and at six- and 12-month follow-up using cross-lagged panel analyses, controlling for the clinical status of patients and sociodemographic variables. RESULTS: Higher levels of overall caregiver burden at baseline were associated with increased levels of depressive symptoms among caregivers at follow-up (F = 8.70, df = 1,290, p < 0.001), after controlling for baseline caregiver depression, gender, race, age, social support, and patients' clinical status. By contrast, caregiver depression at baseline was not significantly associated with caregiver burden at follow-up (F = 1.65, p = 0.20). CONCLUSIONS: Caregiver burden is a stronger predictor of caregiver depressive symptoms over time than the reverse. Interventions that help alleviate caregiver burden may decrease depressive symptoms.

Family embeddedness and entrepreneurship experience: a study of Indian migrant women entrepreneurs in Australia

GroupIndia has emerged as a major source of migrants for developed countries including Australia; yet, there is a dearth of research on Indian migrant entrepreneurs, particularly women. Using qualitative methods of enquiry, we explore the perceptions of Indian migrant women entrepreneurs (MWEs) and their partners in Melbourne, Australia, about their entrepreneurship experiences from a family embeddedness perspective. More specifically, we explore how family embeddedness of Indian MWEs is influenced by certain factors which in turn influence their entrepreneurship experience. Our findings suggest that entrepreneurship among Indian MWEs is a complex phenomenon influenced by their being an Indian, a woman and a new Australian, all of which interact and influence their family dynamics and entrepreneurial experience. Our findings shed light on the duality of Indian culture which exerts both an enabling and a constraining influence on the family dynamics of MWEs, the constraining role of gender and the positive impact of their integration into the host country’s sociocultural context which all influence their family embeddedness and entrepreneurship. Contributing to the discussion on ‘ethnic’ and ‘women entrepreneurship’ from a family embeddedness perspective, we offer policy implications for facilitating entrepreneurship in the growing but under-researched cohort of Indian MWEs.

Initiation, influence, and impact: adolescents and parents discuss the marketing of gambling products during Australian sporting matches

BACKGROUND: Harmful gambling is a significant public health issue. Alongside the rapid diversification of gambling products, are rapid increases in the marketing for specific types of gambling products, such as online wagering. While concern has been raised about the impact of gambling promotions during sporting matches on the gambling beliefs and behaviours of adolescents, very little research has explored adolescents' and parents' attitudes towards the marketing of gambling products within sport.

METHODS: A qualitative study was conducted with 59 family groups comprising of at least one parent and one adolescent (14-18 years old) in Victoria, Australia. Parents and adolescents were interviewed separately and asked questions relating to their gambling attitudes and behaviours. They were then brought together, and advertising reception techniques were utilised to prompt discussions about the marketing of gambling during sport. A thematic approach to analysis was used, constantly comparing similarities and differences between and across groups.

RESULTS: Three main themes emerged. First, was initiation of sport as a platform for the promotion of gambling. Adolescents perceived that the use of embedded promotions (for example during the match) and the use of athletes in gambling promotions were significant mechanisms for creating an alignment between gambling companies and sporting teams and codes. Second, was the influence of marketing messages in creating a perception that gambling was always accessible, and was an integral part of the sporting experience. Third was the impact of marketing messages on adolescent's discourses about sport. Parents described that they had noticed that wagering, and 'odds' discussions, had become embedded in adolescents narratives about sporting matches.

DISCUSSION AND CONCLUSIONS: Gambling marketing during sport has significantly increased. While the gambling industry states that it does not aim to intentionally target young people, adolescents are increasingly aware of the relationship between gambling and sport. Future research should explore the impacts and influence of gambling promotions during sport on the gambling attitudes and consumption intentions of adolescents. Effective public health policy is needed to develop comprehensive regulatory frameworks to protect young people from unnecessary exposure to the marketing for this potentially harmful adult product.

Mealtime behaviour among children with disabilities: family interactions and stress

 The impact of feeding problems on parental stress, quality of mealtime interactions and opportunity for socialisation and naturalistic learning during mealtimes was examined in children with developmental disabilities and typically developing children through survey and qualitative analysis of video recordings of family mealtimes.

Developing family businesses through ongoing learning: case studies of Chinese urban and rural family businesses under market-oriented reforms

This study advances organisational learning research by exploring how and why learning patterns differ between different family businesses at different layers of China’s marketoriented transformation. The focus is the locational difference, namely the separate urban and rural environments and outcomes. Combining case studies and in-depth interviews, the study investigated how family businesses interact with their institutional environment and consequently build learning patterns. Learning initiatives undertaken by relevant and motivated family members are found to reflect a dynamic process involving personal learning, business growth, and business innovation. Family conflicts and business growth were also found to impact learning in family businesses. Implications for organisational learning are discussed at the end of the paper.