The experience of being a grandmother who is the primary caregiver for her HIV-positive grandchild

Understanding Latino Grandparents Raising Grandchildren Through a Bioecological Lens

The purpose of this article is to provide a summary of the published research addressing the challenges and strengths of Latino grandparents raising grandchildren in the United States. Using the bioecological framework as a guide to organize and understand the published literature addressing Latino grandparent caregivers, we examined refereed articles published over the past 19 years. This framework provides a lens for understanding and situating research on Latino grandparents raising grandchildren to discover Latino grandparents' strengths and challenges. The areas of foci include financial challenges, intergenerational relationships, reasons for caregiving, health status, language barriers, and culture. This article concludes with future research opportunities and a call to action for more research on Latino grandparents raising grandchildren.

“Nobody Ever Asked Me Before”: Understanding Life Experiences of African American Elders

With the unprecedented growth in the African American elderly population, there exists an urgent need to prepare nurses to deliver culturally competent care. The purpose of this study was to increase the knowledge available about the cultural heritage, worldviews, and life experiences of African American elders. Reminiscence interviews were conducted with African American elders living in a medium-sized northeast urban community. Data were analyzed using Spiegelberg’s phenomenological method. The following themes emerged: (a) nobody ever asked me before, (b) stories of discrimination, (c) coping with discrimination, (d) the hurt of discrimination, and (e) self-discoveries. Nurses, through the use of reminiscence, can gain insight into the cultural heritage, worldviews, and life experiences of African American elders and improve their ability to deliver culturally competent care to this population.

Depression in caregivers of status-naïve pediatric HIV patients participating in a status disclosure study in Haiti and the Dominican Republic: preliminary report

A pilot study is underway to assess safety and acceptability of an intervention to disclose their HIV infection status to status-naïve pediatric antiretroviral therapy patients in Hispaniola [the island shared by Haiti and the Dominican Republic (DR)]. Of 22 Haiti and 47 DR caregivers recruited to date, 68.2% Haiti and 34.0% DR caregivers had clinically significant depressive symptomatology at the time of enrollment (p = 0.008). Depressive symptom prevalence was higher in Haiti caregivers who were female (81.3% vs. 0 in males; p = 0.02) and in DR caregivers who were patients' mothers (50.0%) or grandmothers (66.7%; 56.0% combined) than others (9.1%), (p < 0.001). Internalized stigma was more commonly reported by Haiti (85.7%) than DR (53.2%; p = 0.01) caregivers; 56.4% of Haiti and DR caregivers reporting internalized stigma vs. 26.1% of caregivers denying it had depressive symptoms (p = 0.02). Depression is common in Hispaniola caregivers possibly affecting disclosure timing. Study participation presents opportunities for addressing caregiver depression.

Impact of paediatric human immunodeficiency virus infection on children's and caregivers' daily functioning and well-being: a qualitative study

BACKGROUND

Human immunodeficiency virus (HIV) infection impacts not only upon the physical health of affected children, but also their psychosocial functions, family relationships and economical status. Caregivers are confronted with complex challenges related to the physical, emotional and financial demands of raising these children. The purpose of this study was to enhance our understanding of the impact of HIV disease on both children's and caregivers' well-being, using a qualitative inquiry approach.

METHODS

A total of 35 primary caregivers of HIV-infected children participated in in-depth interviews. The issues discussed included the major negative impacts on children's daily functioning and well-being, and the perceived caregiver/parental burden. Participants included parents (40%), grandparents (22.8%), other relatives (e.g. uncles, aunts) (34.3%) and one foster parent (2.8%).

RESULTS

Qualitative analysis revealed that the major negative impacts of HIV/AIDS included physical symptoms, school performance and relationship changes. The major negative impacts on caregivers' well-being included acceptance of the diagnosis, dealing with the financial burden and keeping the diagnosis private.

CONCLUSIONS

Approaches are needed to address these challenges by enhancing families' coping skills and building supportive networks.

Positive Affect in the Midst of Distress: Implications for Role Functioning

Stress has been shown to deplete the self-regulation resources hypothesized to facilitate effective role functioning. However, recent research suggests that positive affect may help to replenish these vital self-regulation resources. Based on revised Stress and Coping theory and the Broaden-and-Build theory of positive emotion, three studies provide evidence of the potential adaptive function of positive affect in the performance of roles for participants experiencing stress. Participants were students (Study 1), caregivers of ill children (Study 2), and individuals recently diagnosed with HIV (Study 3). In cross sectional analyses, using role functioning as an indicator of self-regulation performance, we found that positive affect was significantly correlated with better self regulation performance, independent of the effects of negative affect. The effects were not as strong longitudinally, however, and there was little evidence of a reciprocal association between increases in positive affect and improvements in role functioning over time. The results provide some modest support for hypotheses stemming from the Broaden and Build model of positive emotion and revised Stress and Coping theory, both of which argue for unique adaptive functions of positive affect under stressful conditions.

Empowerment: a framework to develop advocacy in african american grandmothers providing care for their grandchildren

Purpose. Based on a review of the literature, this paper presents a unique and innovative model that offers an empowerment framework, which may be used to develop advocacy in African American (AA) grandmother caregivers. This proposed framework centers on education as a catalyst to the empowerment process in these grandmothers. Application of this model has potential to guide the practice of healthcare providers as they assist these caregivers in managing their own lives. Methodology. Various empowerment definitions and research were used to develop this empowerment framework. Discussion. This framework offers an empowerment education program for AA grandmothers providing care for their grandchildren on topics that they feel are necessary to appropriately care for themselves and their grandchildren. Outcomes of this empowerment education are to develop skills within these grandmothers so that they will be able to advocate for themselves, their grandchildren, and others within their communities. This education will ultimately produce skillful AA grandmothers who will develop abilities to empower themselves and other AA grandmothers who are in similar circumstances.

"Give me some sugar!" the diabetes self-management activities of African-American primary caregiving grandmothers

PURPOSE

To compare the diabetes self-management activities of African American primary caregiving grandmothers before and after the initiation of caregiving and to compare the diabetes self-management activities of African American primary caregiving grandmothers to diabetic women who were not caring for their grandchildren.

DESIGN

Using a cross-sectional, descriptive design, 68 African American women 55 to 75 years of age were recruited as part of a larger study examining the impact of caregiving responsibilities on the diabetic health of African American primary caregiving grandmothers. Each participant was asked the frequency of their performance of six self-management activities. Caregiving grandmothers were asked about these activities before and after the initiation of caregiving.

RESULTS

Dependent and independent t-tests with Bonferroni correction were used to analyze the data. Statistically significant differences were noted in diet (t=4.400, p=.000) and self-monitoring of blood glucose (SMBG; t=3.484, p=.001) before and after the initiation of caregiving. For the caregiver versus non-caregiver comparison, statistically significant differences were noted in SMBG (t=-3.855, p=.000) and eye examinations (t=-3.211, p=.001).

CONCLUSIONS

The findings provide preliminary data to support further research examining the self-management activities of diabetic African American primary caregiving grandmothers. Diabetic African American primary caregiving grandmothers may have a decreased ability to integrate self-management activities into their daily patterns of living. Additional research is needed to determine what factors prevent this population from performing these tasks routinely.

CLINICAL RELEVANCE

African American primary caregiving grandmothers were found to have more difficulty performing some of their self-management activities, which may severely impact their overall diabetic health.

Family-based care and psychological problems of AIDS orphans: does it matter who was the care-giver?

The purpose of this study is to compare psychological symptoms among double AIDS orphans (i.e. children who lost both of their parents to HIV/AIDS) who were in the care of different family-based caregivers (i.e. surviving parent, grandparents, other relatives, and non-relatives) before they were replaced in orphanages. The participants include 176 double AIDS orphans from four AIDS orphanages in rural China. Prior to being replaced in AIDS orphanages, these children had received family-based care by different caregivers, which included surviving parent (38%), grandparents (22%), other relatives (19%), and non-relatives (22%). The psychological measures include traumatic symptoms, depression, and loneliness. Both bivariate and multivariate analyses suggested that children who were previously cared for by non-relatives scored significantly higher in traumatic symptoms, depression, and loneliness scales than children who were previously cared for by their surviving parent, grandparents, and other relatives. Children in the care of grandparents reported the best scores on all psychological measures among children in the care of non-parent relatives. Multivariate analysis, controlling for children's gender, age, length in orphanages, number of household replacements, and total duration of replacement, revealed that the type of caregivers was significantly associated with psychological problems. Results in the current study suggest that children under the care of their grandparents reported the best psychological outcomes when their parents were unable to care for them because of AIDS. Appropriate psychological support and counseling services are needed for AIDS orphans who were either currently or previously under non-relative family-based care in China.

Maintaining love and hope: caregiving for Thai children with HIV infection

In this grounded theory study, the author explored how primary caregivers dealt with problems in caring for children with HIV infection in Thailand. A total of 27 family caregivers of HIV-infected children participated in open-ended interviews. Maintaining love and hope represented a condition for the continuing process of caregiving. Caregivers had to deal with the stigma of AIDS while providing care for children with HIV. They had high anxiety and fear of loss, bore much burden of care, and faced many difficulties because of limited resources. The results suggest that psychosocial care and informational support are needed to enable these caregivers to provide better care for children with HIV infection.

Primary care parish nursing: academic, service, and parish partnership

Health care providers who want to make a difference in today's health care environment must support the idea of collaboration. To address the concerns of a university, a major medical center, and the community, a collaborative group shared their vision and developed creative strategies to serve the community. The critical components of this project included gaining the services of a nurse practitioner and nurse case manager, establishing physician liaison, assessing congregational health care needs, providing for both primary health and continuity of care needs, and maintaining the spiritual component of the faith community. Essential to the success of this program was the achievement of pastor and congregational support, enthusiasm, and involvement.

Psychometric Properties of the Grandparent Perceptions of Family Scale (GPFS)

BACKGROUND

For the majority of grandparents, rarely are their perceptions of family assessed, acknowledged, or viewed in the context of potential effect on individual and family health.

OBJECTIVE

To develop and test an instrument to measure grandparent perceptions of family.

METHOD

An inductively derived semantic differential instrument comprising 112 items, 8 stimuli, and 27 adjective pairs within 2 domains and framed by the Becoming a Grandparent theoretical model was content validated by an expert panel, revised, and evaluated on a convenience sample of 306 community-dwelling grandparents, aged 41-92 years (M = 64, SD = 9.8), 72% female, 93% U.S. born, 62% college educated, 55% economically comfortable, and 71% living with a spouse or partner. Assessment procedures included internal consistency reliability, item and scale correlation coefficients, and principal components factor analysis with varimax rotation to evaluate construct validity, structure, and magnitude of the scale.

RESULTS

The final scale consists of 25 items using 3 stimuli (grandparent's view of grandchild, mother of grandchild, father of grandchild) measuring a single domain (overall view of family). The Grandparent Perceptions of Family Scale (GPFS) includes 5 factors for a total explained variance of 60%. Coefficient alpha for the total scale is .90.

DISCUSSION

The GPFS should be helpful to clinicians and researchers in their assessment of grandparents within multigenerational families and in planning appropriate interventions to address the roles and relationships of grandparents within families. Further GPFS evaluation is suggested with grandparents of diverse racial or ethnic identification; social economic position; education; and family definition, roles, composition, and structure.

Grandmother caregivers and caregiver burden

PURPOSE

To describe the experience of grandmothers who are parenting their grandchildren, and determine the amount of caregiver burden felt by the grandmothers.

STUDY DESIGN AND METHODS

This descriptive correlational study had a sample of 104 grandmothers, reporting on 249 custodial grandchildren. Grandmothers completed the Caregiver Reactions Assessment to determine perceived physical health, family support, financial status, and caregiver burden.

RESULTS

Overall, grandmothers perceived the health of their grandchildren as excellent. Of the grandchildren who had been born prematurely (30%), the primary health problems were hyperactivity and asthma. Parental drug use was reported as the reason for child placement with the grandmother in 80% of the cases. The range of time grandchildren had been living with the grandmother was 6 months to 15 years. Low ratings of grandchild physical health correlated with low ratings of grandmother physical health, which correlated strongly with low levels of self-esteem, a strong perception of poor family support, and poor financial status, all of which represent measures of caregiver burden.

CLINICAL IMPLICATIONS

This study demonstrated that the well being of the grandmother and grandchild are both linked to good physical health. Thus, indicators of poor health for both grandchild and grandmother must be identified early. Grandmothers in this study were surprised at how much had changed in every aspect of child health since they had raised their own children. Nurses working with grandmothers who have custody of grandchildren should understand the dynamics of the relationship, the possibility of caregiver burden, provide anticipatory guidance about the changes in child care and child healthcare in the 21st century, and help link grandmothers who have little support to community programs.

Review of research on the health of caregiving grandparents

AIM

To provide a critical review of research literature on the health of grandparents raising grandchildren, and identify directions for future research.

METHODS

Approaches used to access the research studies for this review included a comprehensive search using relevant electronic databases and a thorough examination of the references in each published study.

FINDINGS

All studies but one were published after 1990. Samples consisted primarily of African-American and Caucasian grandmothers in the United States of America. Earlier studies tended to describe health and other related concepts while more recent studies began to examine relationships between concepts. Most of the studies had a cross-sectional design and only one evaluated interventions. Inconsistencies in the results of these studies were prevalent.

CONCLUSIONS

Evaluation studies, longitudinal designs, and more varied study samples including cross-cultural comparisons are needed to advance knowledge about grandparent caregivers' health.

Dynamics of Hope in HIV/AIDS Affected People: An Exploration of Significant Others’ Experiences

Hope is an important protective phenomenon in human life, particularly given that long-lasting despair or hopelessness may threaten human existence. However, previous knowledge on the topic related to people affected by HIV/AIDS is scant. The purpose of this study was to explore the dynamics of hope in significant others of people living with HIV/AIDS and persons living with HIV (PLWH) or AIDS (PLWA) from the perspective of significant others in Finland. Eleven interviews were conducted with six significant others. The data were analyzed using the grounded theory method. The dynamics of hope, as it emerged from the data, is constructed of three main elements: hope, despair, hopelessness, and their reciprocal relationships. An alternating balance between hope, despair, and hopelessness based on the factors contributing to them emerged as central in the dynamics of hope. The dynamics of hope are closely connected to the basic process of searching for one’s own way with HIV/AIDS, in becoming HIV-positive, and living with HIV/AIDS. In significant others, the dynamics of hope are closely connected to the basic process of HIV, changing from abstract to concrete in a relationship with a PLWH/PLWA.

Service needs of male caretakers of HIV-infected and affected children: policy and practice implications

The number of male caretakers (biological fathers and other men) of HIV-infected and affected children is substantial and may increase in the US and elsewhere as more women become infected. Little information exists about the needs these men have for support services to help them better perform their parenting roles as male caretakers (MCs). This paper discusses the service needs of MCs at Ryan White CARE Act Title IV programs, the challenges providers at these programs face in serving MCs, and the strategies they have found effective in working with MCs. Providers report that MCs have specific service needs including the need for emotional support. Title IV programs meet these needs in a limited way because they are organized primarily around the needs of female rather than male caretakers. We discuss how Title IV programs can tailor existing service delivery and implement organizational change to facilitate MCs' service access and utilization. Further research directly with MCs is necessary to learn more about their service needs and the barriers MCs face in accessing services.

Health disparities among vulnerable populations: evolution of knowledge over five decades in Nursing Research publications

BACKGROUND

Considerable attention has been focused recently on conducting research on the health disparities experienced by some Americans as the result of poverty, ethnicity, and/or marginalized social status. Nursing research has a major role to play in developing this body of knowledge.

PURPOSE

The purpose of this paper is to review the contributions that Nursing Research made through its publications over the last five decades in developing the body of tested knowledge about health disparities in vulnerable groups and to analyze the progress made.

METHODS

Criteria for reviewing the literature were established. All Nursing Research publications between 1952 and 2000 were searched manually, indexes of each year's bound volumes were reviewed, and computer searches were conducted. Included in the review were research reports, research briefs, and methodology articles.

RESULTS

Seventy-nine papers were found that met basic criteria for inclusion. The number of relevant publications increased each decade, with a sizable increase in numbers since 1990, and may be related to the social, political, and economic climate of each decade. The research questions asked and the methods used became more complex over time.

CONCLUSIONS

Nursing Research has made a significant contribution in disseminating the body of tested knowledge related to the health disparities experienced by vulnerable populations and the methodologies associated with vulnerable populations research. Areas for future research are community-based studies, intervention studies that provide tangible resources, and methodologic approaches that involve participants in the research process.

Grandparent parents. Intergenerational surrogate parenting

There is an increasing prevalence in the United States of intergenerational surrogate parenting. In fact, grandmother-headed households that include grandchildren without their parents are the fastest growing intergenerational surrogate family combination. This article reviews the intergenerational surrogate family phenomenon relative to its impact on the grandmothers' health and offers resources and implications for nursing.

Grandparents as parents: research findings and policy recommendations

This article presents an overview of research on grandparenthood in the latter decades of the twentieth century. Theories contributing to understanding of the grandparenting role are discussed, and significant factors affecting the grandparenting experience--including sex, age, retirement status, race, and ethnicity--are reviewed. The special case of grandparents raising grandchildren is explored through a review of demographics, outcomes for children in grandparent foster care, and the impact of raising grandchildren on grandparents. Interventions supporting custodial grandparents and the grandchildren in their care are examined. Drawing on the findings and implications of this overview, recommendations for policy, clinical practice, professional education, and future research are offered.

Empowerment: a case study of a grandmother caring for her HIV-positive grandchild

A case study methodology is used to explore the meaning and development of empowerment in a grandmother who is the primary caregiver of a child with HIV infection. Empowerment to this grandmother meant being strong, coming to grips with life's challenges, and then moving on. Empowerment developed over the grandmother's life span as a result of developmental and situational experiences such as motherhood, disclosure of the HIV diagnosis, sharing her positive and negative feelings with others, gaining knowledge about HIV, making management decisions, and her increasing sense of spirituality. This grandmother manifests her empowerment through her public commitment to influence others positively about HIV infections through speaking, writing, and leadership in groups. Clinical implications are discussed.

Psychological distress in grandmother kinship care providers: the role of resources, social support, and physical health

OBJECTIVE

The purpose of the present study was to investigate predictors of psychological distress in grandmother kinship care providers. More specifically, it was hypothesized that social support, family resources, and physical health would predict psychological distress in grandmothers raising grandchildren.

METHOD

One hundred and two grandmothers raising grandchildren in parent-absent homes completed the Brief Symptom Inventory, Short Health Form-36, Family Resource Scale, Family Support Scale, and a questionnaire requesting background and demographic data.

RESULTS

Results indicated that psychological distress was predicted by family resources, participants' physical health, and to a lesser extent, social support.

CONCLUSION

The findings indicate that family resources, social support, and physical health affected psychological distress in grandmothers raising grandchildren. Grandmothers who reported fewer resources, less social support, and poorer physical health tended to experience higher levels of psychological distress. This study suggests that greater attention be given to interventions aimed to decrease psychological distress and improve the financial resources and physical health of grandmothers raising grandchildren.

Caring for the child and family with HIV disease

Caring for children with HIV infection is a much more optimistic process than in the beginning of the epidemic. Antiretroviral therapies are available, and additional drugs are receiving approval from the US Food and Drug Administration. Cautious optimism must be tempered with an understanding that living with the disease is a complicated and daunting process for these children and their families. Although scientific knowledge and medical treatments are moving forward, the social and environmental uncertainties remain for families. Comprehensive care is a balance of health care services and supportive, community-based services offered in a compassionate manner.

The changing role of grandparenthood

For many grandparents in America, caring for grandchildren has become a full-time responsibility that has led to multiple stresses. Raising grandchildren may cause financial stress, cramped living quarters, role restriction, and social isolation among this group. However, advantages to this role among grandparents can include greater life satisfaction and a positive influence on the other generations within the family. Nurses and other health providers can play an essential role in assisting grandparents caring for grandchildren by strategically building family strengths and cohesiveness.

[Social and family characteristics in children born to women infected by the human immunodeficiency virus]

OBJECTIVES

To evaluate the social and family characteristics of children born to women infected by the human immunodeficiency virus (HIV). As secondary objectives, to analyse their schooling and the number of hospital admissions and lengths of stay that these children required.

DESIGN

A prospective observation study.

SETTING

HIV unit in a children's hospital.

PARTICIPANTS

INCLUSION CRITERIA

all the children recruited from the HIV unit who had their infection status defined during the study period, understood as between the first known case in 1985 and April 1994. The sample included 177 children (62 HIV-infected and 115 not infected).

MEASUREMENTS AND MAIN RESULTS

Through an interview the social, family and school variables were collected. On comparison between infected and non-infected children, there were no important differences as to the lack of protection of the new-born (8.1% vs 13%), scant mother-child relationship (31.2% vs 36.5%) or people responsible for the custody of these children. Less schooling and greater problems of school integration were detected in infected cases, with odds ratios of 2.68 (p = 0.004) and 11.36 (p = 0.004), respectively. Children infected also needed more admissions (4.3 +/- 5.7) than the non-infected (1.7 +/- 0.9) (p = 0.001), and more days of hospital stay (75.1 +/- 110.3 vs 23.3 +/- 19.6) (p = 0.0003).

CONCLUSIONS

Infected children and non-infected children had similar social and family characteristics. However, less schooling, problems of school integration, and more and longer hospital admissions were related to HIV infection in children, and not so much to their status as children of seropositive mothers.

Diagnosis disclosure by family caregivers to children who have perinatally acquired HIV disease: when the time comes

BACKGROUND

Children with perinatally acquired HIV disease (PAHD) can be relatively symptom-free and live to school age and older. These children often confront their caregivers with questions about the illness and complex treatments; however, caregivers may try to avoid disclosing the diagnosis of PAHD to the child.

PURPOSE

To generate a substantive theory that describes and explains how family caregivers manage diagnosis disclosure to a child who has PAHD.

METHOD

Using grounded theory, a substantive theory was constructed based on the accounts of 18 ethnically diverse families. Eight families had 10 children with PAHD who had been told their diagnosis. Ten families had 10 children with PAHD who had not been told their diagnosis.

RESULTS

The basic social psychological problem was identified as caregiver readiness to disclose the diagnosis. When the Time Comes was identified as the central phenomenon linked to the problem of caregiver readiness. Causal conditions, intervening conditions, and strategic responses of caregivers and children were discovered and are inextricably linked to the central phenomenon.

CONCLUSIONS

The process by which family caregivers respond to diagnosis disclosure to children with PAHD is based on the perceived self-readiness of the caregiver to disclose the diagnosis and illness-related information to their child.

HIV risk factors, HIV antibody testing, and AIDS knowledge among African Americans age 55 years and older

This study uses data from the 1992 AIDS Knowledge and Attitudes Supplement to the National Health Interview Survey to assess AIDS knowledge, prevalence of HIV testing, and HIV risk factors among 745 African Americans age 55 years and older. The results revealed that only one of the six respondents who reported an HIV risk factor had been tested for HIV. Overall, the respondents were very knowledgeable about the major modes of transmission, but they still had misconceptions about the likelihood of transmission through casual contact. Prevention programs aimed at African Americans age 55 years and older should focus on dispelling misconceptions about the transmission of HIV through casual contact, and enhancing their knowledge about the effectiveness of condoms in preventing the spread of AIDS.