Thesis advisor: Dorothy A. Jones / The purpose of this qualitative research study was to answer the following questions: What is the life pattern manifested by individuals caring for spouses who have had coronary artery bypass surgery? What are the thematic expressions of life patterns among individuals caring for spouses who have had coronary artery bypass surgery? The theoretical framework guiding this study was Margaret Newman’s Health as Expanding Consciousness. The research method created by Newman facilitated the understanding of the individual participant’s experience, pattern identification, similarities in pattern across participants and the potential for expansion of consciousness. The study sample included ten women and two men whose spouses were recovering at home following cardiac surgery. These twelve spousal caregivers shared their life stories and their spousal caregiving experience in the first two weeks at home following their spouses discharge from the hospital. There were various levels of potential for expansion of consciousness for these spousal caregivers. Looking across participants six themes emerged from the data. First, disruption in the spousal caregivers’ roles and responsibilities impacts the relationship between the spousal caregivers and their spouses and shifts life patterns. Second, spousal caregivers face coping challenges with changes in lifestyle and response to illness. Third, Spousal caregivers experience vigilance in an effort to ease the uncertainty of the recovery process. Fourth, knowledge helps spousal caregivers gain a sense control in the face of uncertainty. Fifth, mutuality within the partnership of nurse and the spousal caregiver relationship impacts the potential for transformation. Sixth, Spousal caregivers’ awareness of their life pattern gives meaning and offers the caregivers a new perception on life they have left to live. Findings from this study have important implications for nursing theory, practice, research, education and health care policy. The study adds empirical support to Newman’s Theory of Health as Expanding Consciousness and provides a new way to examine spousal caregiving and the nurse-client relationship. / Thesis (PhD) — Boston College, 2008. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

No description available.

The purpose of this descriptive correlational study was threefold: (a) to assess the relationships between boundary ambiguity, spirituality, marital relationship quality, and caregiver strain and depression among older African American spousal caregivers of persons with Alzheimer’s Disease (AD); (b) to identify which variables are the best predictors of caregiver strain; and (c) to identify which variables are the best predictors of depression. The sample consisted of 25 female and 15 male spouses, who were ages 60 to 87. The data were analyzed using descriptive statistics, Pearson correlation coefficients, and multiple regression. Marital relationship quality was correlated with the two dependent variables, caregiver strain and depression. In hierarchical multiple regression, a model containing gender, years since spouse’s diagnosis with AD and marital relationship quality predicted 40% of the variance in caregiver strain. Marital relationship quality was the only significant predictor for depression. The model containing marital relationship quality predicted 22% of the variance in depression. Additional findings were that participants scored high on the spirituality measure, that years since diagnosis of AD was negatively correlated with boundary ambiguity, spirituality, and caregiver strain, that there was a significant decrease in the quality of the marital relationship since the spouse became a caregiver, and that almost half had no help with caregiving. There was limited support for the proposed conceptual model, therefore, a revised model was proposed. Based on the study results, in dealing with spouses who are providing caregiving to AD patients, nurses need to assess the quality of the marital relationship, and to recognize that the longer the spouse is a caregiver the greater the strain and depression, and that community resources need to be mobilized to assist the spouse with caregiving. A depression screen and marital assessment may provide cues regarding psychosocial needs of spousal caregivers.

Severe traumatic brain injury (TBI) is a pervasive and devastating condition, often resulting in permanent alterations in cognition, behavior, and personality. As such, survivors of severe TBI usually rely on the assistance of caregivers to navigate situations of daily living throughout their life span. Spouses of individuals with TBI have been shown to experience greater levels of burden than parental caregivers of TBI survivors (Kreutzer et al., 1994; Mauss-Clum & Ryan, 1981) and subsequently rates of divorce and separation have been documented within the research literature to be high (Thomsen, 1984; Wood et al., 2005). Although marital breakdown has been frequently studied, research on marital satisfaction and coping within long-term marriages where one spouse has survived a severe TBI remains insufficient. The purpose of this study was to provide a descriptive analysis of long-term spousal caregivers of individuals with severe TBI. First, demographic variables of caregiving spouses of individuals with severe TBI, who remained married at least 10 years post injury, were described and comparisons to other spousal caregiver samples were addressed. Second, the relationship between marital adjustment and demographic variables, coping, and quality of life was examined. Finally, an analysis of primary stressors was conducted to better understand the caregiving spouses' continued experience of stressors. Twenty-one spousal caregivers who remained married for at least 10 years post injury to their spouse who sustained a severe TBI participated in the study. Analyses revealed that spouses had remained married an average of 19 years post-injury and in general were mildly dissatisfied within their marriages. Furthermore, marital adjustment (Dyadic Adjustment Scale total score) of long-term spousal caregivers of severe TBI was not significantly different than spousal caregivers of individuals with chronic illness. Higher marital satisfaction scores were associated with higher endorsement of emotion-focused coping strategies and greater mental health quality of life. In addition, marital satisfaction was positively associated with the longevity of the marital relationship, the age of the spouse at the time of the injury, and the length of the marriage at the time when the injury was sustained. As expected, higher scores of marital satisfaction were associated with higher levels of mental health quality of life. There were no significant relationships between physical health quality of life and marital satisfaction. An analysis of primary stressors show that long-term caregiving spouses continue to report similar types of stressors as indicated in the research literature from caregiving spouses during the first 5 to 8 years post injury. Findings were discussed in relation to implications for practice and additional research.

The purpose of the present study was to explore the ways that spouses of persons with ABI experience a process of change in roles, routine, and overall lifestyle and the subsequent implications for their support needs. The present study used a qualitative narrative inquiry methodology to examine the process of the experiences of this population of spouses. In-depth semi-structured interviews were conducted with 15 spouses, each of whom was engaged in a heterosexual relationship. There were 10 female and five male participants whose ages ranged from 40 to 61. Twelve of the participants were formally married, and three were in a common law relationship. In the interviews, the participants were asked about the changes in their lives after the onset of their spouses’ brain injuries. The data analysis was informed by narrative inquiry with attention paid to the structure of the participants’ stories. A three phase trajectory of caregiving emerged from the analysis which provided details regarding the process of change in the spousal caregiving role and how various role transitions within this role were intertwined with stressors and other feelings. The research highlighted three phases of caregiving including an Embryonic, Immersed and Modified Caregiver phase. The findings were theoretically important for identifying: how these spouses situate themselves within role transitions; coping strategies; various support needs; and future directions for research in this area.

The purpose of the present study was to explore the ways that spouses of persons with ABI experience a process of change in roles, routine, and overall lifestyle and the subsequent implications for their support needs. The present study used a qualitative narrative inquiry methodology to examine the process of the experiences of this population of spouses. In-depth semi-structured interviews were conducted with 15 spouses, each of whom was engaged in a heterosexual relationship. There were 10 female and five male participants whose ages ranged from 40 to 61. Twelve of the participants were formally married, and three were in a common law relationship. In the interviews, the participants were asked about the changes in their lives after the onset of their spouses’ brain injuries. The data analysis was informed by narrative inquiry with attention paid to the structure of the participants’ stories. A three phase trajectory of caregiving emerged from the analysis which provided details regarding the process of change in the spousal caregiving role and how various role transitions within this role were intertwined with stressors and other feelings. The research highlighted three phases of caregiving including an Embryonic, Immersed and Modified Caregiver phase. The findings were theoretically important for identifying: how these spouses situate themselves within role transitions; coping strategies; various support needs; and future directions for research in this area.

Caregiving, specifically caregiver burden, is commonly related to decreased psychological well-being. Conversely, marital quality is positively related to psychological well-being, though existing literature presents mixed findings as to whether or not a gender difference exists in this relationship. The current study examined the relationship between objective and subjective spousal caregiver burden and psychological distress with marital quality as a moderator. Gender differences in this relationship were also explored. 1,066 spousal caregivers from the National Study of Caregiving (NSOC) were used to estimate cross-sectional moderation models and plot significant interactions in Mplus. Results indicated a significant positive relationship between subjective caregiver burden and psychological distress, and higher marital quality protected against psychological distress in this relationship. The connection between objective caregiver burden and psychological distress was not significant, and no gender differences were found in the moderation of marital quality. These findings suggest that perceptions of caregiver burden are important for the psychological health of spousal caregivers, and higher marital quality may be an effective buffer of this relationship regardless of gender. Spousal caregivers who perceive caregiving to be highly burdensome may benefit from improving their marital quality to protect against negative psychological health outcomes.

The aim of this study was to explore spouses' roles in a relationship with a partner with dementia and to understand spouses' situations at home. The study was focusing on gender roles and authority in relationships between the spousal caregivers and their partners with dementia. The method used for this study was qualitative content analysis and the data was collected from seven interviews with spousal caregivers about their roles as partners of people with dementia. By critically examining Twiggs three models, carers as resources, caregivers as co-workers and carers as co-clients, we have been able to visualize how spouses can look upon their role to their partners with dementia. A fourth model has been added to a modification of Twiggs models, because spouse's roles didn't fit into any of Twiggs already existing models. There is not a big gender difference about spousal care for a partner, and the caregivers are in a highly extent affected of the situation with a partner with dementia. Spouses role can fit in with partners as carers, which is a fourth model added to Twiggs original three models.

The aims of this study were to explore partners' experiences of living with a loved one with bipolar disorder and how they coped with these experiences. Another aim was to explore whether these individuals felt that Counselling Psychologists could play a role with care-giving tasks and their own psychological needs. Five individuals, who were currently living with, or had been living with, a partner with bipolar disorder, volunteered and participated in a semi-structured interview. These interviews were transcribed and analysed using Interpretative Phenomenological Analysis (IPA) as described by Smith, Flowers and Larkin (2009). A table of super-ordinate and sub-ordinate themes was created as a result of this analysis. Partners' experiences are characterised by various phases which partners could move around and between. This was referred to as the 'cycle of changing illness awareness'. This theme adds to the existing literature. As partners moved around and between these phases they experienced different emotions, employed different coping strategies and had experiences of being 'in it together' interchangeably with being 'isolated and alone'. This research concludes that partners' experiences of caring for a loved one with bipolar disorder do not follow a linear, predictable path and as a result, professionals working with caregivers need to be aware of which phases of the 'cycle of changing illness awareness' partners are in when offering interventions. The analysis also suggests that partners cope differently when their loved one is manic and depressed. However, further exploration is still needed.

Caring for a family member or loved one with dementia places a heavy burden on those providing the care. Caregivers often develop chronic depression because of having to deal with this burden. A great deal of literature has been published discussing coping effectiveness, effects of social support, and other internal and external means of support for the caregiver. However, little has been written about the changes, if any, in depression that the caregiver experiences after the termination of care, either through institutionalization or death of the person with dementia. This study examined whether there is a change in depression of spousal caregivers after institutionalization of the dementia care recipient as well as any changes in depression that may have occurred as a result of the death of the dementia care recipient. Two theoretical models, the wear and tear model and the adaptation model were discussed in terms of caregiver depression after institutionalization of the dementia care recipient. Two other theoretical models, the relief model and the stress model, were discussed in terms of caregiver depression after the death of the dementia care recipient. Datasets from the National Institute on Aging sponsored Health and Retirement Study were analyzed. Results indicate that both male and female spousal caregivers report an increase in depression after the institutionalization or death of the dementia care recipient, but that as time passes, males report a decrease in depression while females continue to report an increase in depression.