How do family caregivers of older adults cope with relationship strain?

OBJECTIVE: Studies of families' experiences with caregiving to older adults most often focus on overall burden and stress. Yet, caregiving is also a type of relationship, and the onset of caregiving can contribute to relationship strain between care partners. Despite implications for both care partners, little is known about how caregivers cope with caregiving relationship strain. METHODS: The authors conducted nine focus groups and 8 interviews with a purposeful sample of racially and ethnically diverse family caregivers in Los Angeles. Conventional content analysis was applied to transcripts to identify how caregivers cope with relationship strain. RESULTS: Analyses revealed four overall coping approaches to manage relationship strain: (1) Self-Care; (2) Adapting Behaviors, (3) Adapting Feelings and Cognitions, and (4) Help and Support. Selected strategies likely vary by care recipient condition. For example, caregivers for persons living with dementia emphasize adapting their own behaviors and feelings, rather than trying to change their loved one's behaviors. CONCLUSIONS: Findings suggest that caregivers cope with relationship strain using both interpersonal tension and care management strategies. We also identified possible variations by care recipient condition and caregiver race and ethnicity. These results suggest a need for interventions focused on caregiver coping should also be tested for effects on relationship strain.

Exposing the Backstage: Critical Reflections on a Longitudinal Qualitative Study of Residents' Care Networks in Assisted Living.

In this article, we analyze the research experiences associated with a longitudinal qualitative study of residents' care networks in assisted living. Using data from researcher meetings, field notes, and memos, we critically examine our design and decision making and accompanying methodological implications. We focus on one complete wave of data collection involving 28 residents and 114 care network members in four diverse settings followed for 2 years. We identify study features that make our research innovative, but that also represent significant challenges. They include the focus and topic; settings and participants; scope and design complexity; nature, modes, frequency, and duration of data collection; and analytic approach. Each feature has methodological implications, including benefits and challenges pertaining to recruitment, retention, data collection, quality, and management, research team work, researcher roles, ethics, and dissemination. Our analysis demonstrates the value of our approach and of reflecting on and sharing methodological processes for cumulative knowledge building.

Towards Patient Safety: Evaluation of Care Transitions Training Needs Among Key Providers Involved in Patient Care Transitions.

Significant morbidity, mortality, and increased healthcare costs of up to 20.1 billion dollars annually occur as a result of poorly executed patient care transitions. The critical role of providers in ensuring patient safety at discharge requires provider knowledge of required care transitions processes to ensure optimal execution of transitions of care. The present study was designed to determine provider perception of their care transitions training, curriculum content, and self-identified care transitions knowledge gaps. A cross-sectional survey was conducted among key healthcare providers at the Grady Memorial Hospital, a 953 bed urban safety net hospital. Of these, 131 participants completed the surveys including 73 internal medicine residents, 51 nurses, and 7 social workers. Among participants, 13% reported that they had never had any formal training on care transitions. Of these, 88.2% were medical residents, while 11.8% were bedside nurses. Among participants who had received care transitions training, only 40% received their training prior to graduation. Healthcare providers across disciplines were least exposed to training on discharge settings of care, determining the most appropriate next level of care for patients at discharge, and communication and coordination with post-acute care facilities. Providers made recommendations regarding topics they considered important to be included in care transitions training. Defining the full discharge process and responsibilities of various healthcare providers were topics recommended by most providers as important to be included in care transitions training. This study has highlighted the extent of exposure to formal care transitions training among providers from multiple disciplines involved in various aspects of discharge care. It has demonstrated a paucity of formal care transitions training at the health professional school level. It has also highlighted self-identified care transitions training needs and will form a foundation for design of care transitions curricula for a broad range of healthcare professionals.