Stress processes in caring for an end-of-life family member:Application of a theoretical model

Objectives: Family caregivers play a vital role in maintaining the lives of individuals with advanced illness living in the community. However, the responsibility of caregiving for an end-of-life family member can have profound consequences on the psychological, physical and financial well-being of the caregiver. While the literature has identified caregiver stress or strain as a complex process with multiple contributing factors, few comprehensive studies exist. This study examined a wide range of theory-driven variables contributing to family caregiver stress. Method: Data variables from interviews with primary family caregivers were mapped onto the factors within the Stress Process Model theoretical framework. A hierarchical multiple linear regression analysis was used to determine the strongest predictors of caregiver strain as measured by a validated composite index, the Caregiver Strain Index. Results: The study included 132 family caregivers across south-central/western Ontario, Canada. About half of these caregivers experienced high strain, the extent of which was predicted by lower perceived program accessibility, lower functional social support, greater weekly amount of time caregivers committed to the care recipient, younger caregiver age and poorer caregiver self-perceived health. Conclusion: This study examined the influence of a multitude of factors in the Stress Process Model on family caregiver strain, finding stress to be a multidimensional construct. Perceived program accessibility was the strongest predictor of caregiver strain, more so than intensity of care, highlighting the importance of the availability of community resources to support the family caregiving role.

Le care entre dépendance et domination: l'intérêt de la théorie néorépublicaine pour penser une "caring society".

L’éthique du care est confrontée à un problème qui a des allures de paradoxe: bien que sa politisation paraisse nécessaire, l’éthique du care ne semble pas pouvoir trouver en elle-même les ressources suffisantes à la formulation d’une théorie politique compréhensive. Il ne semble pas exister de théorie politique du care à part entière. Cet article examine la fécondité d’un rapprochement entre éthique du care et théorie néorépublicaine de la non-domination. Le résultat, non négligeable, serait de garantir des formes importantes de protections aux activités de care, mais il cela n’empêcherait pas nécessairement les représentations négatives de ces activités, dont on peut supposer qu’elle est l’un des facteurs de la marginalisation et de la répartition inégale qui les affecte. Pour bloquer ces représentations dégradantes, il faudrait que le care soit discuté et défini dans l’espace public non seulement comme un lieu possible de la domination, mais comme un aspect fondamental et positif de la vie individuelle et collective.

Existential issues in surgical care : Nurses’ experiences and attitudes in caring for patients with cancer

The overall aim of this thesis was to explore surgical nurses’ experiences of being confronted with patients’ existential issues when caring for patients with cancer, and to examine whether an educational intervention may support nurses in addressing existential needs when caring for patients with cancer. Previously recorded discussions from supervision sessions with eight healthcare professionals were analysed (I), written descriptions of critical incidents were collected from 10 nurses, and interviews with open questions were conducted (II). An educational intervention on existential issues was pilot tested and is presented in Studies III and IV. The intervention was the basis of a pilot study with the purpose of testing whether the whole design of the educational intervention, including measurements instruments, is appropriate. In Study III and IV interviews with 11 nurses were conducted and 42 nurses were included in the quantitative measurements of four questionnaires, which were distributed and collected. Data was analysed using qualitative secondary analysis (I), hermeneutical analysis (II), and mixed methods using qualitative content analysis and statistical analyses (III-IV). Results in all studies show that existential issues are part of caring at surgical wards. However, although the nurses were aware of them, they found it difficult to acknowledge these issues owing to for example insecurity (I-III), a strict medical focus (II) and/or lacking strategies (I-III) for communicating on these issues. Modest results from the pilot study are reported and suggest beneficial influences of a support in communication on existential issues (III). The results indicate that the educational intervention may enhance nurses’ understanding for the patient’s situation (IV), help them deal with own insecurity and powerlessness in communication (III), and increase the value of caring for severely ill and dying patients (III) in addition to reducing work-related stress (IV). An outcome of all the studies in this thesis was that surgical nurses consider it crucial to have time and opportunity to reflect on caring situations together with colleagues. In addition, descriptions in Studies III and IV show the value of relating reflection to a theory or philosophy in order for attitudes to be brought to awareness and for new strategies to be developed.

Paternal Care Decreases Foraging Activity and Body Condition, but Does Not Impose Survival Costs to Caring Males in a Neotropical Arachnid

Exclusive paternal care is the rarest form of parental investment in nature and theory predicts that the maintenance of this behavior depends on the balance between costs and benefits to males. Our goal was to assess costs of paternal care in the harvestman Iporangaia pustulosa, for which the benefits of this behavior in terms of egg survival have already been demonstrated. We evaluated energetic costs and mortality risks associated to paternal egg-guarding in the field. We quantified foraging activity of males and estimated how their body condition is influenced by the duration of the caring period. Additionally, we conducted a one-year capture-mark-recapture study and estimated apparent survival probabilities of caring and non-caring males to assess potential survival costs of paternal care. Our results indicate that caring males forage less frequently than non-caring individuals (males and females) and that their body condition deteriorates over the course of the caring period. Thus, males willing to guard eggs may provide to females a fitness-enhancing gift of cost-free care of their offspring. Caring males, however, did not show lower survival probabilities when compared to both non-caring males and females. Reduction in mortality risks as a result of remaining stationary, combined with the benefits of improving egg survival, may have played an important and previously unsuspected role favoring the evolution of paternal care. Moreover, males exhibiting paternal care could also provide an honest signal of their quality as offspring defenders, and thus female preference for caring males could be responsible for maintaining the trait.

Investigating a career choice for nursing based on social cognitive career theory

Nursing shortages still exist in the U.S. so it is important to determine factors that influence decisions to pursue nursing as a career. This comparative, correlational research study revealed factors that may contribute to, or deter students from choosing nursing as a career. The purpose of this study was to determine factors that contribute to a career choice for nursing based on the concepts of social cognitive career theory (SCCT), self efficacy, outcome expectations, and personal goals, among senior high school students, final year nursing students, and first year nursing students. Based on the results strategies may be developed to recruit a younger pool of students to the nursing profession and to boost retention efforts among those who already made a career choice in nursing. Data were collected using a three part questionnaire developed by the researcher to obtain demographic information and data about the respondents' self efficacy, outcome expectations, and personal goals with regards to nursing as a career. Point bi-serial correlations were used to determine relationships between the variables. ANOVAs and ANCOVAs were computed to determine differences in self efficacy and outcome expectations, among the three groups. Additional descriptive data determined reasons for and against a choice for nursing as a career. Self efficacy and outcome expectations were significantly correlated to career choice among all three groups. The nursing students had higher self efficacy perceptions than the high school students. There were no significant differences in outcome expectations between the three groups. The main categories identified as reasons for choosing nursing as a career were; (a) caring, (b) career and educational advancement, (c) personal accomplishment, (d) proficiency and love of the medical field. Common categories identified for not choosing nursing as a career were; (a) responsibility, (b) liability, (c) lack of respect, and (d) low salary. Other categories regarding not choosing nursing as a career included; (a) the nursing program and (b) professional (c) alternate career choice options and (d) fear of sickness and death. Findings from this study support the tenets of SCCT and may be used to recruit and retain nurses and develop curricula.

Caring and being cared -for: Perceptions of adolescent males at -risk for school failure

This qualitative study used grounded theory methods and purposeful sampling to explore perceptions on caring and being cared-for. Twenty-four adolescent male participants, identified as at-risk for school failure, completed a two phase interview process exploring these phenomena within three relationships; the relationship with the friend, with the most caring person they knew and with the teacher they felt cared for them. ^ Each participant was asked a predetermined set of open questions in an initial semi-structured interview. In addition each participant was encouraged to explore his own reflections on caring. A second interview allowed for member checking and for the participant to continue sharing his meaning of caring and being cared-for. ^ Line by line analysis with open, axial and selective coding was applied to interview transcripts along with a constant comparative method. Results indicated that the core category integrating all other categories was attachment bonding. Participants' stories manifested characteristics of proximity seeking, secure base, safe haven and distress upon involuntary separation from an attachment figure. ^ Strategies facilitating attachment bonding were influenced by the power positions of the relational players. Participants responded positively to the one-caring when they felt cared-for. Results further indicated that participants did not need to feel a sense of belonging in order to feel cared-for. Teacher behaviors indicating openness for authentic connections with students were specific to teacher's friendliness and professional competence. Teachers who nurtured feelings of being cared-for were uncommon in the participants' educational experience. ^ The number of adolescent males leaving high school prematurely is both a personal problem and a social problem. Despite a “mask” of indifference often exhibited by adolescent males at-risk for school failure, teachers might consider the social/emotional needs of these students when implementing the curriculum. In addition, policy makers might consider the social/emotional needs of this vulnerable population when developing programs meant to foster psychological well-being and connectedness for adolescent males at-risk for school failure. ^

Student, Teacher, and Administrator Perspectives on Harm: Implications for Implementing Safe and Caring School Initiatives

This article reports on a study that examines student, teacher and administrator perspectives on harm and how their schools address harm. It presents an overview of these perspectives within and across 3 different school environments. In doing so, the study contributes to a better understanding of the often ineffective implementation of safe and caring school initiatives. By drawing on restorative justice and relational theory, the findings illustrate how a focus on well-being and relationship is critical for meeting the needs of those harmed and those causing harm. Such a focus requires interaction rooted in social engagement rather than social control (Morrison 2012) and challenges current recommendations for combining the strengths of several current approaches for a more effective outcome (Osher et al. 2010).

Caring and anxiety among registered nurses in an acute hospital setting

Background: Even though caring remains the essence of nursing it is still an ambiguous concept as the lens through which each nurse perceives caring differs. The differences are due to multiple factors including the setting in which the nurse works. Nurses experience high levels of anxiety when caring for patients in acute settings. Despite an abundance of published studies on caring there is a dearth of research available that focuses on the relationship between caring and anxiety. Aim: The aim of this research study was to investigate caring and anxiety in a sample of registered nurses working in an acute hospital and to determine the relationship between these and other variables. Method: A quantitative descriptive study using a correlational design was employed, with a sample of 280 registered nurses. The Caring Behaviours Inventory-24 was used to measure caring and the State Trait Anxiety Inventory to measure Anxiety. The study was guided by the Theory of Human Caring (Watson 2008). Findings: Nurses reported high levels of caring and low levels of anxiety. A statistical significant relationship was found between caring and anxiety and between caring and supportive work environment and job satisfaction. A statistical significant relationship was found between anxiety and work environment, job satisfaction gender, age, relationship status and education. Conclusion: This is the first study to investigate the relationship between caring and anxiety in an acute hospital setting. This research contributes to advancing nursing knowledge by providing evidence of the relationship between caring and anxiety among nurses in an acute hospital setting. Despite nurses reporting high levels of caring and low levels of anxiety, it is important to further enhance caring and reduce anxiety levels among all nurses. Thus, educators and managers need to explore strategies for the alleviation of anxiety among nurses, practising in acute care settings.

Caring for Children Dying from Cancer at Home: a Qualitative Study of the Experience of Primary Care Practitioners

Background. The rarity of childhood cancers makes providing palliative care in the community an unusual event for primary care practitioners. Providing this care requires effective interprofessional collaboration with the team that forms to provide the care often working together for the first and only time. Objective. To explore the experiences of primary care practitioners following their involvement in the palliative care of a child with cancer at home. Methods. The study design was a community-based qualitative study. The study location was the West Midlands region. Purposeful sample of GPs and community nurses involved in providing palliative care to 12 children. One-to-one in-depth interviews with 47 primary care professionals (10 GPs and 37 community nurses) and 5 facilitated case discussions were undertaken. Field notes were documented and grounded theory data analysis undertaken: chronological comparative data analysis identifying generated themes. Results. GPs had minimal input into the preceding care of children undergoing treatment for cancer but sought to re-establish their role at the child’s transition to palliative care. GPs felt they had a role to play and could add value to this phase of care, highlighted their continuing role with the child’s family and acknowledged that they had gained from the experience of contributing. However, lack of specialist knowledge and uncertainty about their role within the team made this more challenging. In contrast, community nurses were routinely involved in both active treatment and palliation care phases. There was little evidence of collaboration between the specialist and primary care professionals involved. There was considerable variation in out of hours provision across cases. Conclusions. Engaging primary care practitioners needs to be more actively anticipated and negotiated at the transition to palliation. Variation in out of hours care is another cause for concern. Enhancing inter-professional collaboration and planning during both active and palliative care phases may help. Keywords. Cancer, family medicine, palliative care, paediatric.

Teacher’s Conceptions of Caring and Protective Teaching Elements in Rwamwanja Refugee Settlement Schools

The purpose of this study is to find out what conceptions Rwamwanja refugee settlement teachers have about caring teaching methods. The study was conducted by analysing the data gathered from semi-structured interviews. Twelve teachers were interviewed in four different refugee settlement schools. The main theory of this study is based on ethics of care research by Nel Noddings. In addition, the framework was developed by combining the theories of resilience and psychosocial support which are often employed in research concerning emergency contexts. This study uses qualitative content analysis to describe the conceptions of caring teachers have and protective teaching elements they employ. The results of this study show that many of the key elements of caring and protective teaching were present in teacher’s answers. For example, in their answers, the majority of the teachers pointed out the significance of using soft discipline. However, many teaching elements considered ideal in emergency contexts were missing. These missing methods include routines and flexibility which are considered essential for vulnerable children. The teachers’ levels of conceptual thinking varied remarkably depending on their language skills. The communication was limited to very basic and concrete language in some of the interviews due to lack of mutual understanding. This also raised a question about the level of understanding between refugee pupils and teachers since there is no strong common language between them. The results of this research call for further studies about the effect of caring teaching elements in growth of resilience in refugee children. Keywords: The ethics of care, resilience, psychosocial support, education in emergencies, refugees, education, protection.

Feminist Disability Theory: Domestic Violence Against Women with a Disability

Women with a disability continue to experience social oppression and domestic violence as a consequence of gender and disability dimensions. Current explanations of domestic violence and disability inadequately explain several features that lead women who have a disability to experience violent situations. This article incorporates both disability and material feminist theory as an alternative explanation to the dominant approaches (psychological and sociological traditions) of conceptualising domestic violence. This paper is informed by a study which was concerned with examining the nature and perceptions of violence against women with a physical impairment. The emerging analytical framework integrating material feminist interpretations and disability theory provided a basis for exploring gender and disability dimensions. Insight was also provided by the women who identified as having a disability in the study and who explained domestic violence in terms of a gendered and disabling experience. The article argues that material feminist interpretations and disability theory, with their emphasis on gender relations, disablism and poverty, should be used as an alternative tool for exploring the nature and consequences of violence against women with a disability.