Empirical testing of a longitudinal model derived from the Roy adaptation model

Older Husbands as Caregivers

The purpose of this study, based on Pearlin et al.'s model, was to determine the factors associated with the health of older husband caregivers and with their intention to end home caregiving for their wives. The results showed subjective stressors to be associated with outcomes. Role overload was linked to psychological distress and to lower self-perceived health, whereas role captivity was associated with psychological distress and the intention to end home caregiving. The likelihood of ceasing home caregiving increased when caregivers reported high relational deprivation. A high percentage of the variance in psychological distress was explained (51%). The quality of prior husband-wife relationships, the frequency of disruptive behaviors, family conflicts, and self-efficacy were associated with this variable. Selfefficacy had a mediating effect between subjective stressors and psychological distress, whereas the number of services received had a moderating effect on the intention to end home caregiving among husbands with high role captivity. This study provides avenues for interventions sensitive to male caregivers.

Changes in Health Outcomes among Older Husband Caregivers: A One-Year Longitudinal Study

This one-year longitudinal study carried out on a sample of 232 older husband caregivers sought to describe changes in psychological distress and self-perceived health, and to examine relationships between factors drawn primarily from Pearlin's model of caregiving and changes in these two health outcomes. Prediction analyses shows that nearly two thirds of the husbands have unsuccessful outcomes with respect to these two dimensions, that is, most husbands obtain either steadily poor scores at both times of the study or worse scores on one or both outcomes. Higher levels of education and informal instrumental support at time 1, as well as an increase in role overload, are predictive of unsuccessful outcome for psychological distress, whereas an increase in self-efficacy predicts successful outcome for self-perceived health. Overall, husband caregivers vary in their response to caregiving over time. The findings support previous study results showing subjective stressors, rather than objective stressors, and caregiver resources to be significant predictors of caregiving outcomes.

Using the Roy Adaptation Model to explore the dynamics of quality of life and the relationship between lung transplant candidates and their caregivers

Using theory to support nursing research may be considered superfluous by some authors, yet a theoretical framework provides structure and consistency to a research study. This article presents the use of the Roy Adaptation Model within the theoretical framework underpinning an investigation of quality of life as perceived by lung transplant candidates and their caregivers. Each step of the research process is identified in this article and the link to the theoretical framework is demonstrated. The use of nursing frameworks to guide research strengthens the theoretical framework itself and also adds another dimension to the body of nursing knowledge.

The health of family caregivers of older impaired persons in Lebanon: An interview survey

BACKGROUND

The majority of older persons in Lebanon live with their family, which provides the help and care required when their relative is functionally impaired. Knowing that taking care of an older impaired relative is considered a source of enrichment for the caregiver and an act of gratitude towards the older person in Lebanon. However, there are few formal resources to support these families. This study is informed by a theoretical framework of stress.

OBJECTIVE

Identify the dimensions of the caring context related to the health of Lebanese family caregivers living with an older impaired relative.

DESIGN

Exploratory correlational study.

PARTICIPANTS

Convenience sample (N=319) drawn from all the regions of Lebanon according to predetermined quotas on the basis of relative demographic weight and socio-economic class. The inclusion criteria are: aged 18 years or over; primary caregiver; provided help with at least one ADL or IADL once a week; lived with the older impaired person. 13.5% refused to participate in the study. The caregivers recruited were female (84%), adult children (48%) or spouses (22.6%) with a mean age of 46 years. Almost half of them reported a post-compulsory level of education and a low monthly household income and no medical coverage for 68% of them.

METHODS

The data were collected during a face-to-face interviews with the caregivers in their homes.

RESULTS

The results from regression analyses indicate that the degree of functional impairment, the frequency of depressive and disruptive behaviours of cared-for relative are linked to at least one of three caregiver health indicators (p<.01). Also, caregiver cognitive appraisal of these stressors is associated with either role strain or feeling of helplessness (p<.05). The informal emotional support received by caregivers is positively related to well-being (p<.001), whereas interpersonal conflicts with family and friends diminish caregiver well-being and increase role strain (p<.001). Sufficiency of emotional support received is negatively associated with role strain (p<.001).

CONCLUSION

Many stressors proved associated with one or other of the health indicators under study and the resources emerged as significant factors related to caregiver's health.

Older husbands as caregivers of their wives: a descriptive study of the context and relational aspects of care

The purpose of this study was to describe the context and relational aspects that characterize male caregiving. The sample comprised 323 older husbands caring for their wives in Quebec (Canada). Nearly 60% of them spent at least 84 h/week caregiving and about 40% regularly performed personal care and instrumental tasks. Family provided emotional support above all and service utilization was limited for certain services. Husbands perceived relational deprivation but also personal gain relative to their role. Conflicts seldom occurred with family members. Comparisons between husbands of wives with and without memory problems revealed selected differences on context and relational variables. This study contributes to knowledge on male caregivers and provides directions for nursing practice and research.

Testing a theory of chronic pain

BACKGROUND

Chronic pain is highly prevalent among older people with arthritis, with depression as its major outcome. The psychopathological process of chronic pain and its outcomes in older people with arthritis have not been the subject of extensive research. The purpose of this study was to test a middle-range theory of chronic pain derived from the Roy Adaptation Model, a nursing theory whose validity has not been tested in the context of chronic pain.

METHODS

The study used a convenience sample of 71 older people with arthritis. Two subscales of the Arthritis Impact Measurement Scales were used to measure pain and physical disability. Social support was measured by Part II of the Personal Resource Questionnaire, and the Elderly Daily Stress scale was used to measure daily stress. Participants also completed the 10-item Center for Epidemiological Studies of Depression scale. Univariate analysis, correlation, and path analysis were used to analyse the data.

RESULTS

Overall, the data supported the hypothesized model in which pain, disability, social support, age, and gender are predictors of daily stress and daily stress further predicts depression. The direct effects of chronic pain, disability, and social support accounted for 37% of the variance of daily stress, which in turn predicted 35% of the variance of depression. Age and gender had no influence on daily stress. The chi-square index suggested a fit between the data and the model, and therefore the current model is temporarily accepted. Other fit indices also showed a good fit of the model to the data. To simplify the model, a revised version was developed.

CONCLUSIONS

This study validated a middle-range theory to explain the effects of chronic pain in older people with arthritis and highlights the importance of chronic pain in the development of depression.

A middle-range theory of caregiver stress

The Roy adaptation model is a widely used nursing theory, but only a few studies have used it in the context of caregiving for the chronically ill. Many caregivers with chronically ill relatives suffer from stress and its consequences, and in an aging society, more and more people will be affected by stress. In this article, the author presents a middle-range theory of caregiver stress based on the Roy adaptation model as the first step in understanding the applicability of the Roy adaptation model in the context of stress in caregivers.