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This is to certify that the

thesis entitled

A Descriptive Study to Determine Frequency and
Satisfaction with Instrumental Support Received
By Wives Caring for Disabled Husbands

presented by

Charlene Theresa Lasocki

has been accepted towards fulfillment
of the requirements for

MASTER OF SCIENCE degree in NURSING

 

C figségé/Moaai (/v.

Major professor

Date /0ljgx;//I9d

0-7639 MS U is an Affirmative Action/Equal Opportunity Institution

 

   
   
 

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University

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By
Charla 1'. Laeocki

A deecriptive, crue-eecticnal attaiy of so oaregiving wivee ages
52-80 wee mdertakm, utilising a enle tron a larger lmgitudinal
etialy by aim and <3in (1985). greetiuDairee were adainietered in
thehanhytraineddataoolleotoretogatherhachgronata, the
tramway of inetrmtal ewport provided by fully were and
triode/neigtbora, and their overall degree of aatiafactiai with
ewport provided. lo reliability or validity teeting wee dare on
theee inetnmta prior to thia etndy. ‘lhe reeulte indicated that
very limited ewport m provibd to the oaregivere, but overall,
oaregivere were mite aatietied. they were met tmtly Imported
hyf-ilyuidfrinbepuidingtiaekeqingtheirhnhandoatpmyand
least likely to receive lmg-terut reepite for a “ad or linger.
Became of the linitaticne idmtified with the inetnmte med, the
correlatiaial malyeia ”t he omidered with outtiat.
mum. for instant revieim, alaig with inlioaticne for
mining reeeardt lid practice are preeated.

 

aim, c. a 01m, 3. (1985). W
m at hm. Grunt Ian-um @8564. Michigan State
(hiveuity, bet Lansing, MI. mliehed ”script.

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Copyright by
dnrlene Theresa Lasocki
1990

I would like to thmk the esters of w cardttee: Clare
Collins, Barbara aim, alarm King md Jackie Wright. 'lhank you all
for your expertise, patiuice, and mgoing mt which helped
to rake the cmpletim of this project a reality. 'l‘hromhout this
project, you challatged tie to seek out in true potmtial and for this
I an appreciative. A special thank you to Manfred Stml, the
statistician who helped to nuke the task of data mlysis lus
hurdmsane and actually enjoyable. I sincerely appreciate Barbara
and Queries Given allowing 1. to utilise part of the data Eran their
caregiver study. _

heat Iwould liketothmkallugwmderful friandswhoheardne
speak of this project, ally to wander it it would ever be emulated.
Hell, it is emulated and I thank you all for not giving in on me.
thank you for providing I. with moral smart and the mtivatim I
needed to keep loving alatg. I cherish each of your friardships very
latch

Finally, I wish to thank u flaily for their cmtirmed
mt throufliout this project. Tonqmther, thankyoutor
your love, patiaice, andfaithinm. these last fewyearsheveheai
difficult for both of us, but I finally acccnplished my goal. Your
lessen m determinatim helped it. to succeed. To my brothers,
RicherdandRohert, I thankyoubothforhelpingmtocbtainthe
emiimt whichmabledneto typeandprintutydraftsmdfinal copy
inthecuiorts ofnuhune. Your landietmceswport-idedvice
were also greatly appreciated.

Toeverymewhohelpeduinmywaytoachievewgoal, I
sincerely thank you. I could not have data it alme.

iv

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TABLEOF'WPS

Page
List of Tables .................................................... vii
List of Figures .................................................. viii
Chapter
I. W10! TO '1!!! STUDY
Introductim .......... ........................... 1
Background to the Problen .................................. 2
Purpose and Significance of Study ......... . . . . . ....... ..14
Statuary ............ . . . . . . ................................. 16
Research Questims ........................................ 17
Definitions of Concepts ................................... 18
Assmptims ............................................... 2O
Limitatims .............................................. 20
Overview of the Chapters .................................. 21
II. m m
Overview ................................................ 23
Selecting a emceptual Prunework ........................ ..23
Framework by Kahn S- Antmucci ............................. 28
Definitims of Cmcepts... ............. ..............28
Application of the Model to this Study .................... 34
Inportanceof this Study touursing........ ........ .......38
Statuary ................................................... 39
III. REV!!! Cl' nu: LI'I'EA'I'URE

Overview ................................................ 40

Instrumtal Support Provided by the Informl
Support Network ......... . . . .......................... 41
Inportance of Examining Satisfactim with Support ......... 54
Utilizatim of the Rain 5. Antamcci Model ......... . ....... 66
W. . . . . .......................... . .................. .73

IV. W AND W

Overview ................................................. 74
Descriptim of the Research Design ........................ 74
Suple ......................................... . . . . . . ..... 76
Recruitment of Participants ............................ 76
Sutple for Ourer Analysis ............................ 77
Data Collectim Procedures ............................. . . .77

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Gnapter Page

Operatimalization of Variables. . ..... . .......... . . . . . . . . .80
Instrunentation. ................................ . . . . . . 81
Reliability and Validity of Assistance Questiormaire. . . . . .82
Data Statuary for Purposes of Analysis ............ . . . ...... 84
Surnary......... .......... ...... . .......... . ........... 86

V. M WATER

Overview .................................................. 88
Results” ............................................. 88
Description of the Stuiy Sarple ................ . . ..... 89
Background Characteristics of the Participants ...... 89

Background Characteristics of the
Caregiving Situatim9l

ResearchQuestims ................... 93
Question II ....... ..... ...... ...........96
Reliability Testing of the Instnlmt...............97
Questim III .......... . ....... ......... 99

Additicrtal Findings ................... . ............... 103

Statuary... .......... .................................. 103

VI. WNW ND MT!”

Overview ............................ . ........ . . ......... 106

Interpretatim of Results” 107
Background Characteristics of the Participants. . . . . . . . 107
Backgromd Characteristics of the

Caregiving Situatim ..... ...111
Question I ..... 113
Question II....... .......... ...... ........ ...117
Question III ...... .. ......... ................. 125
Results as They Apply to Kahn S- Antmucci's
Fralework ......................................... 129
Inplicatims and Recurrendatims ..... ............. 133
Inplications for Nursing Research...” ................ 133
Inplicatims for Nursing Practice.. ................... 147
Statuary .............................. . .................. 149
APPENDIXA - 1mm 9mm. . .153
mes-anmm ............ ....... 154
APPENDIX C - WIND IM’I‘IC!‘ (1' mm, GRE-RECIPIENP,
ANDQREEIVIM SITUATIG'.... ...... 155
mm D - ASSISTANCE mm BY «IVE m PHIL!
momma/emanate ....... 158
APPBlDIX E - SATISFACI'ICN WI'II'I seem m onus ................ 160
amrxr-mmmumms.... ...................... 161
mm ................... . .................................... 162

vi

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5.2

5.3

5.4

5.5
5.6

LISPG'TABLEB

Page
Background Characteristics of the Caregivers and
Gare-recipimts ....................................... 90
Depmdexwy Status of the Care-recipient Including
the Pregnancy and Percmtage of Dependmcies .......... 91
Backgrmnd Characteristics of the Caregiving
Situation .................................. . .......... 92
Provision of Instrumtal Support by Panily and
Friends/Neighbors ..... . . . . ............................ 94
Degree of Satisfactim with Support ................... 97
Correlatim Coefficients for Individual Categories
of Swport and Degree of Satisfactim ................ 100

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Figure 1.

Figure 2.

LIST (I PI“

Hypothetical determinants and affects of cmvoy
properties as developed by Kala & Antcnucci (1980) ...... 29

Adaptatim of Rain 8 Antmucci's frmrk (1980)
to the Stuiy ............ . ............................... 35

viii

O

In

m1: Minimum

Introducticn

Growing interest in the elderly populatim has led to extaisive
researdlregsrdingtheagedthrmttheworldduringthepast few
decades. According to the 0.8. Bureau of the Census (1989), 12.2% of
auricuuwereovertheageot651n198‘llidit isprojectedthat
this will increase to 138 in 2000 and 21.88 in 2030. Brotasn (1981)
projects, through malysis of previous dwgraphic data, the group of
75-84yearoldswill increesebysotandthegrowoverageflwill
increase by 80‘ iron the year 1981-2000. may, health care
planing nut be tailored to net the needs of the growing elderly
populaticn.

Asthepopulatimagesthereismincreuedprevalmce of
chrcnic illness. logy-1 6 Lutheder (1986) fund chrcnic illness
prevmts about 18‘ of the older populatim fraa participating in save
activities of daily living. These individuals frequently rely m
fuily where as their primry source of help. Detwem 80‘ and 90%
of persmal care for the elderly is provided by failies, prinrily
wives and daughters (Day, 1985).

Stan, Gafferata 6 annual (1987) (and that infornl caregivers
were predalinantly tale, with a sizable under over the age of 65.
Less thi: 10‘ of the caregivers rqorted the use of feral services,
with about 33 providing care without any usistmce. Also, less
thenaotutilisedinfoml motmt. newtprovided
to caregivers of the elderly has been a tmic of interest since
thoseprovidingthecarehavebemtouldtoexperimoeagreatdeal

of stress.

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its purpose of the following study is to ermine the
imtrumtal support provided to caregivers by fanily and
trim/neighbors. The degree to which each caregiver was satisfied
is also of interest. rantedt, Way 6 Sullivan (1989)
recomiaedtheinortmcaotstudyingtheroleofaecmdary
caregivers. Ibo secmchry caregiver was tint individml idio assisted
the primry caregiver in providing care to the care-recipimt. The
prinry caregiver is the persm who provides aajority of the care to
the care-recipimt. the authors believed that seccndary caregivers
would provide arklitiaial help thich would increase the mat of care
receivedby theolderparsmandaeet theirneads for helpnore
cQIetely. thiortmately, mt stuiies lave fact-ed m the role and
activities of the print-:7 caregivers alme with no causidaratim
givm to the activities of the secmdary caregivers.

'lhe older «tilts of the 1980's, overall, were more educated,
hadheld jobsmdweremre finnciallysecurethmmyof their
predecessors. Asaresult theywaremreinvolvedintheirhealth
care and dundsd me persmalised care (Schsie, 1980). The older
achlt of the 1990's will be able, with the help of caregivers, to
r‘ininthecaaanityformextmdedperiodoftine, inthe
presume of physical lidtatims. may, health professimals
have developed .1 interest in who is swporting the elderly and their
caregivers Cid how they are being simported.

m to tb m-
As life espactmcy increases, elderly nrried cowles are
rminingtogetber lmger. hocordingtofloomS-Lutbader
(1986), ale half of the pqulaticn over age 65 is untried and

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3
living with their spouse. Spouses are most frequently identified as
the prinnry caregiver in times of illness or debilitatian. If a
caregiving situatican develops for an elderly couple, the fanale
spouse is more often than not the primry caregiver (Robinson,
1986b).

Hives are caregivers Imre oftan than husbads, due to a langer
life expectancy of m canpared to man. Day (185), tangler 6
Goodrich (1979) and Shanas (1979) fona'd waten were most often younger
thantheirspousesleadingtoalifeexpectancyaveraging7tos
years longer than their sale counterparts. Robinsan (1986a) fourd
movertheageofGStobethefastestgrowingmtofthe
populatican ad anticipates 1 out of 14 people to be a walan 65 and
older by the year 2000.

These elderly female spouses, when thrust into a caregiving
role, are cansidered by Pengler 6 Goodrich (1979) to be at risk for
physical and quotional problem due to the isolatian, laneliness and
role overload they experiance. 'llnese wives may, in my instances,
be debilitated thaselves asking it even more difficult for than to
fulfill the role of primary caregiver (Cantor, 1983). Despite the
fact that these wives are elderly themselves ad have their own
health problems with which they uust cope, they have mital
obligatians which they are expected to fulfill.

Apart fran the physical hurdan of caregiving, these wanm also
nust deal with the emticanel aspects of caring for a husbard who
my now be quite depend-it can then. Zarit, Todd 6 Zarit (1986) fourd
my wives look to the later years in life for a chance for more
perscrnal opportunity ad growth ad, cansequently, they any resant

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the role of caregiving. Many also fird their husbands' dependency
very upsetting. The physical burden of caregiving, alang with the
anotional strain involved, may lead to the increased risk of health
problem for the elderly female spouse caregiver.

In canclmian, it is evidant that famles in general have
accepted a traditianal role which lnas resulted in their being
selected as the primary caregivers in my instances. It is a role
which my warm feel obligated to accept regardless of physical,
anotianal or financial cost to tlnerselves. The wives of disabled
elderly husbads have been fourd to be nader greet stress in
fulfilling caregiving obligatians ad are the focus of this study.

1213 in gremlins me mileage rm lead fer axial me
In order to assist wives in their role as caregivers, it is first

inportant to uderstand what areas of caregiving put strain can their
daily lives. flnroughout the literature there are cauparisons made
betwean spouses ad adult children with regard to the degree of
burdan associated with specific aspects of the caregiving role
(cantor, 1983; fiooynnn 6 Lustbader, 1986; Soldo 6 Myllylualn, 1983).

A few areas where inportant differanees lave bean feud include
the degree of isolatian fran others, the anomt of time devoted to
cmtinuous caregiving activity, the financial status of the caregiver
ad the overall level of stress experienced. Zarit, Reever ad
Bach-Petersen (1980) fourd the frequancy of cantact with others
outside of the caregiving relatianship helped to ndnimize the burden
felt by the caregiver.

'Ihe spome caregiver lives with the care-recipient ad,
cansequently, my have miniml contact with others outside of the

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hare. 'n'ne wife frequently feels a sense of duty and obligation to
her lmsbard ad will forfeit activities outside the have to be with
her husband (Fitting, Rabins, Lucas 8 Eastham, 1986).

Horowitz and Debrof (1982) found that spouses devoted a
significantly greater nmber of hours to caregiving responsibilities
then did other caregivers. Spousal caregivers have continual contact
on.a day-to~day basis with.the care-recipient and feel an.obligation
to devote any tine they can to caring for their husbad (Cantor,
1983).

Hooyuen 8 Lustbader (1986) alang with Day (1985) ad Cantor
(1983), discussed the issue of caregivers' finances. ‘Hhere adult
children are willing to sacrifice additional income to assure
adequate care for their parents, spousal caregivers fear losing all
that they have and, therefore, may be hesitant to spend.mnney to
obtain,assistanee.

Consequently, Hooyman & Lustbader (1986) found wives were
hesitant to obtain.fonmal services for which they were required to
pay and also unwilling to institutionalize, due to»the fear of losing
all of their savings. 'lhe wives believed the best solutian, in their
attanpt to mintain their savings, was to provide exclusive care for
their spouse thereelves. This enabled than to fulfill their
perceived responsibilities and still maintain.a hope of security for
the future.

In this review, it is evident that the role of caregiving
affects each caregiver in a unique way. Researchers have studied the
strain which wives, in particular, experience in fulfilling their

role as caregivers .

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Fangler & Goodrich (1979) identify these wonen as "the hidden
victim". There is an obvious concern regarding the adequacy of
snoport provided to these wanen since they are designated the
respansibility for caregiving in nest instances ad are provided
miniml, if any, simport.

The elderly populatian is growing rapidly ad the need for
fanily caregivers is also likely to grow. In order for caregivers to
min in their roles, health professianels ad governmt officials
aust recognize their underlying needs ad provide adequate
assistance. To understand the stressors these individnls encounter,
it is inportant to naderstand what swport is available ad whether
it is adequate to meet the needs of the caregiver. 'l'he next section
will focus can the various ways to define social support, the functian
of social support as a nediator of well-being ad the inportance of

social swport in caregiving.

1m 1!!!! 129 Define £29111 m

Social support, as defined by ‘lhoits (1982), is the degree to
which an irdividual's basic social needs are met through interaction
with others. In reviewing the literature, it is evidant the role of
caregiving ad the stress it brings about are affected by the various
types of smart available to the caregiver (Cantor, 1983; Fangler 6
Goodrich, 1979; George 6 Gather, 1986). Social snpport is iuportant
in minimizing stress, but what exactly is social support? Social
support has been defined in my ways by various authors (Cobb, 1976;
Dianad 6 Jones, 1983; Weiss, 1974). (he difficulty frequantly
ancountered in the social support literature is the lack of

specificity in the operatianalizatian of the cancept.

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According to House 8- Kahn (1985), social support can be defined
in three general ways. It can first be defined by the existence or
quantity of social relationships. Second, it can be defined in terms
of the structure of a persan's social relationships. Third, social
support can be defined in terns of the fmctianal cantent of
relationships.

when defining social support based an the existence or quantity
of social support, the frequency of cantact with friads ad
relatives is usessed alang with the actual number of relatianships
that exist betwean tlnese individuals. Also, infomtian related to
aarital status ad living arrangaants as well as unenbership in any
organizatians, such as a church or other private group is cansidered.
Evaluating the existence of social support based can these
characteristics is relatively objective ad cancrete. Cansequently,
many studies are based an this type of data.

When defining social snoport in terns of the structure of a
person's social relationship the alphasis is placed an the
characteristics of the social network. finese characteristics were
best described by Israel (1982) who labeled than as structural ad
interactianal characteristics.

'nne structural characteristics of the social network include
size or range ad density. The range is represented by the amber of
individuals a person is able to either see or speak with at any point
in time. The dansity is the extant to ndnich all the irdividuals know
one another. This is represented by the degree of fariliarity
betwean the individuals within the network.

'nne interactianal characteristics identified by Israel (1982)

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are as follows: First is content which refers to the meaning
individuals give to their relaticxnship such as friend, kin or
neighbor. Secad is directethess or the extent to which assistance
is reciprocated. Third is durability or the extent of stability
betwean individual relatianships. Fourth is intensity or the
amtianal closeness between irdividuals. Fifth is frequency, the
number of interactians between the focal persan ad the network
mbers. Sixth is dispersion or the ease with which a persan can
nuke cantact with network numbers. Seventh is the hannogeneity or
similarities the network anthers share such as education level,
incane level or religiom preference.

In smry, to define social smart in term of the structure
of a persans social network, there are my characteristics to be
cansidered. 'linere are the two structural characteristics which refer
to the actual number of individuals in the network ad the degree to
which they know ane another. Then there are the seven interactianal
characteristics including cantant, directedness, extant of stability,
intansity, frequancy, dispersian ad hannogeneity. These
characteristics refer to tlne individual relationships within the
network, ad enable us to describe the support network in greater
detail.

When defining social support in terns of the functional content
of relaticanships, aphasis is placed an the type of support directly
provided to the individual. This could inelnde affective or
annotimal support meaning the provisian of unral support, caring and
love. Functional social support could also refer to instrunental
support such as provisian of tangible aid or services such as money,

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transportatian and meal preparation. Another type of support is
cognitive support or that which includes advice, feedback or new
lanowledge ad infometion. a final type of support is that of social
outreach or the accessibility to social cantacts.

Realistically, when defining social support as it pertains to
structure, the existence or quantity of social relatianships and the
functianal cantant of relatignships frequently overlap. Researchers
do, lnowever, try to make distinctians between all three dimensions
when defining social support.

Social support is most frequently defined in tonne of the
functianal cantant (House 6 Kahn, 1985). Ibis specifically relates
to the elnnotional concern for others, as well as the instrunental or
tangible aid provided. As noted by Darla-n (1983), social networks
are the web of social relatianships that surronad the persan ad
provide the social support defined as the anotianal, instrunnental or
cognitive.

There are two types of networks which provide social support:
foruel ad infernal (Cantor, 1983; Goodnen, 1986). Support provided
by an established agency or organizatian outside of the hane is
support provided by a formal network. The services provided by a
formal network can be provided either inside or outside of the halls
ad are financially supported either through private pay, insurance -
or govermnental funding.

Sources other than establ ished agencies dnich provide support
are cansidered informal sources of support. The assistance is
usually, but not always, provided without a nmetary charge to the

caregiver, ad is frequently considered a nonnative obligatign.

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Contrary to preview beliefs, Cantor (1983) found the infernal
sipport network, eunsisting of friads ad fannily, provided more
assistance to caregivers than did foruel networks such as hospitals
and health care agancies. Stoller 6 Pugliesi (1988), however, foud
thatupeopleagetheirsnoportnetworkaeychangebasedontheir
neat, resulting in rare utilization of in-hau for-l services as a
sunpl aunt to infernal assistance.

Inthisstudy, social snaportwill bedefinedinterseofthe
functianal euntant. aphasia will be an the instrumtal sunport
provided by the inforael network to the caregiver.

MMnamaW
luaerous research stndies have focnnad an the relatignship

betwean the availability of social support and its effect an
andifying stress and mintaining health (Cobb, 1976; Israel, 1982;
Gottlieb, 1981; Lakey 6 Heller, 1988; Baillie, lorbeck, 6 Barnes,
1988). 'lhere are two aejor vials as to ban social snaport can affect
an individuals health and well-being. fine first view is that it acts
asabufferinprevantingillnessandtheaecudviawisthetheory
that social mart exerts a direct effect an health and well-being.

The lanffering hypothuas d-cribad by @110 (1982) suggests that
social swport facilitates an individual's dnility to cope with a
crisis as it develops and helps to dainaize the effects of a crisis.
Baillie, llorback 6 Barnes (1988) were unable to deteraine a buffering
effect of social sunport, but noted that althowh saw studies find
significant buffering effects for social sunport my find anly main
effects.

fine direct effect theory, as dacribad by 'l‘hoits (1982),

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suggests social identity and self evaluation originate in social
interactim, which cmsequently influences a person's sense of well-
being. Because social support helps to strengthen and unintain
social idmtity aid self-esteem it my irdirectly influence well-
being. Therefore, social support can directly affect an individual's
state of health ard irdirectly influence their well-being,
itdepcdmt of a major life change or crisis.

My researchers have focused (11 how social support inpacts
health atd well-being. However, it remins unclear which specific
aspects of the stopartive social relatims are respmsible for these
effects.

astigmatism ta m; m
Berlonn (cited in Krame, 1987) irdicated that the benefits of

support my be attributed partly to the feelings of caitentlmt aid
belcnging which my arise fran social relatimships. Krause (1987)
mmested that feelings of cmtentnent did not arise directly fran
the mere provision of swpart but were based on subjective
evaluatims of the adequacy of support received. Purthermre, the
feelings of satisfactim with support were believed to arise only if
the need for support had been met. Based am this, satisfactim was
believed to be a subjective represaitatim of the degree to which
adequate support is received.

Determining the best indicator to repreth the baiefits
received by caregivers fras their social swpart networks is of
critical inpartance. 'l‘here are various factors such as the frequency
of smart, measures of well-being, aid ixdividual perceptions which
may be utilized as irdicatars, but all have varied degrees of

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reliability.

Sclnefer, Gayne aid Lam (1981) faud the perceptim of
social smart to be the best indicator of how helpful a supportive
actim is to the recipiqit. Ward, Shem 6 Mary (1984) also noted
that whether a perscn perceives he lns adequate social support is
minortantthmdeterudninginmobjectivesensevmetherhehas
W. Perceptims seen to be the best indicator by which to
mute satisfactiai with stuport.

Percepticns of satisfactim with swpart can represent adequacy
of support, but those pechticns ny also be influuiced by other
variables. Vaux 6 Harrism (1985) ad Lyles, King, Give) and Given
(1989) identified a few of these variables which include past aid
present levels of swpart, network sise, ad closuss of
relatimships. Gaitralling for tlnse variables is not within the
realm of the preset study.

may, knowing the caregivers' percepticns alme will
not allow the researcher to have mlete uderstuding of
satisfactim related to actual noport. It will, however, cable a
carrelaticnal malyses between the various categories of smart ad
the degree of satisfactiai. This will pravifi a clearer
\sderstading of inch mortive fmcticns are lost strmgly related
to an individual's level of satisfaction, with regard to social
swpart, Id my ultimtely ilprove their state of well-being.

mmfimmnm
mycaregiversdiadanatwmttobethesolesourceafhelp

have indicated to researchers that it would be baieficial to have

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13
support fran outside sources to help relieve sane daily
respcnsibilities (Baines, 1984). Wives, m the other hand, tmd to
be less willing to accept help fran others. Wives feel that through
the caregiving role they are fulfilling their obligatim to their
hub-ids and at tines have felt guilty if mable to provide total
care to their um (Room 8 Lmtbader, 1986).

Another determt to accqting assistance relates to financial
statm, since in most cases neither spmne is working. Hives fear
paying for any help since it my dismt their savings and eventually
leave tin with nothing. may, they swpress this optics: for
as lung as possible.

The usistmce met oftm regmsted by caregiving wives is
respite care. Respite takes the form of m who cans to stay
with the patiait so that the caregivers thmelves are able to leave
for awhile (Baines, 1984; myder & Keefe, 1985). Mowing that they
have til. for the-elves is the greatest relief for wives, since
frecmmtly they are caregivers twenty-four thurs per day. Respite
allu- thea tin to be free of caplete respmsibility, to be mg
othersandbefreeofthecmstntstresstheyenerimce.

In cmclmim, research has show that m are usually
cauidered the primry caregivers. Wives are met oftm the primry
caregivers followed by daughters, if the wife is disabled, or if the
care-recipimt is fnle. lhe fule spouse caregivers, idmtified
as”hiddmvictim", bsvebemtargetedasmeofthegrowsat
hidaest riskforprdalmbecameof thelainiml swporttheyreceive
or are willing to utilise.

There are mltiple ways in which the caregiving role my place a

n
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14
strain (11 an individual's life style. The Irajor concerns noted by
wives were the effects caregiving had m their financial status and
the mt of time the caregiving role required (Cantor, 1983;
Fengler 8: Goodrich, 1979).

Informal social support frcm family and friends sears to be the
source of support Imst readily utilized by famle smal caregivers
if smart is utilized at all (Tmtedt, McKinlay 8 Sullivan, 1989).
Even though nuch data is available aphasizing the risk of the ferale
spouse caregivers, little has been dcne to evaluate the type of
smart most and least frequmtly available, and how strmg the
relationship is between the frequency of support provided and the
caregiver's degree of satisfacticn with support.

Throughout the literature wives have been sham to differ fran
other caregivers on various issues with regard to support needed,
available and utilized in the caregiving role. The area related to
smart provided by the infoml network and the degree of
satisfactim with that support is me more area which requires
further research. Consequently, it seem reasmable to investigate
the type of smart wives are receiving, particularly fran the
informl network, since this seem to be their greatest source of
smart. Also of inportance is the degree to which they are
satisfied with the support they are receiving.

Purpose lad Significance of surly
The purpose of this study is to idmtify with what frequency

instrumental smart is provided by funny and friends/neighbors to

the femle spouse caregivers, to what degree the femle spouse

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15
caregivers are satisfied overall with the support provided, and
whether there is a relatimship betwea frequency of smart provided
and degree of satisfactim.

Thedata callectedinthis stirlyareaasures of thesmort
available frcn the infoml network to caregivers. fins is of
significance to nursing since Cobb (1976) has found social smart to
be protective agaimt pathological states in people trying to cope
with a great deal of stress, particularly in nu roles. Researchers
have shca that the fen-1e spouse caregivers utilise very fun foruel
servicesandchoosethefalilyasthefirstsourceafsmortwhen
assistace is needed (myder a Keefe, 1985; Baines, 1984; Gator,
1983). lherefare, it is isportant to \slderstund as such as possible
about the smart received by caregivers fro: the infornl smart
grm. ‘lhis can tha be added to the already existing knowledge.

lhe presat study will aable health professiaals to begin
idatifyingareasinwhichtheinforlal gronnpdcaanddcesnatmeet
theneecbof thecaregivers. Bydeterudningthadegreeof
satisfacticn with the smart provided, researchers can tha begin to
idatify indivichals duo are not satisfied aid loci: were closely at
the type of mrt that say be deficiat.

malysing the infoml social smart grow tron this
perspective nay acourage health professimals and govermt
officials to wider why certain types of assistance are not
providedbythisgroup. Purtherresearchaythabeperforuedto
determine that incatives are needed by the faily ad friads to
aable greater participatia a their part.

Since nurses frewatly are the caregivers' link to obtaining

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16
assistance when needed, it is very important that nurses identify the
smart available to the wives through the infomel support system
ad their degree of satisfacticn with that smart. If wives are
table to receive what they perceive as adequate assistance fran this
group of friads/neighbars ad fanily, tha utilizatim of smart
fran the formal network any need to be cmsidered in the future.

Hmtganery (cited in Thais 8- Deitrick, 1987) fou'd caregivers
did not seek assistance fran outside sources until they reached a
paint of eshamtim or experienced a crisis. To study the
utilisatim of forml services is not within the scope of this
project. Therefore, the data obtained will be used ally to determine
how the infoml network could be better utilised to provide
assistance.

The data fran this study could also be used in the future. . A
cmarism could be nude with other caregivers to determine how
availability of smart differs ad whether there are similar
carrelatims betwea types of smart ad degree of satisfaction.

may, this research study will be of great significance
to nursing research. First, it will provide new knowledge regarding
areas of assistance which are not being provided by the infoml
support system. Becca-d, it will provide a database fran which
further research can be developed enabling continued growth in this

area of research.

a—ry
'l‘o sunrise, the topic of caregiving has taken a great
interest over the last decade due to the changes in danographics ard

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17
resulting strain m the health care system. Researchers have
identified fennles as the prin‘ary group of caregivers, with wives
being the nest deeply involved in the care of family anthers in most
instances (Shaman, Ward, 8: LaGory, 1988). Whenever a situation
requiring care of an itdividual arises, wanen are first to be
selected ad they feel obligated to assist. This occurs regardless
of the already established roles these wana nay have.

Wives are cmsidered to be at significant risk for health
problem, but recognising the smart available to then as well as
their satisfactim with the smart, my allow health professionals
to minimise that risk. Easily ad friads/neighbors, ushers of the
informl smart systa, have been identified as the priuary
providers of smart to spouse caregivers.

The informal network can be smarted by identifying areas in
which assistance my be needed. 'lhis will alable the needs of the
caregivers to be met. Assistance could be provided through
incentives or through direct provisim of services. Caregivers and
their smart network are presatly being physically, «rationally ard
financially over-burdaed by their roles. Regardless of the means
used to provide assistance, it uust be provided if the role of
caregiving is to retain in the hate.

Research Dustin:
I . What categories of instrunatal smart are provided by
fmly embers ad- friads/neighbars to wives who are caregivers?
11. What is the caregivers' overall degree of satisfaction with
the smart fran fanily leathers ad frierds/neighbors?

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III. that are the relationships between the categories of
instruamtal smart provided aid the overall degree of satisfaction

with swport?

We!“
file follaing are definitims of the cmcepts introduced in the
ruearch gnatims and mad thrmduout the stub.

mmmmm
Aaangiverisapersmndioprcvidesassistmetomindividml

in need of help. the fule spome caregiver will be at least 65
yearaafagemdidmtifiedasthepri—rycaregiver taherlusband.
newifewill be livinginthesnehomeholdwiththecare-
recipiait. lhe caregiver will be providing assistance in at least
we activity of daily living (All) or instrtnmtal activity of daily

living (In).

Minimum
Instnmtal mt has bemdefined bylloue (lfll) as swpart

pravidedthrolflihelpingbdnviorsawhastheprcvisimafmyar
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provihd by fuily "hers Ill friab/neigflnrs ta wives who are
hnctiming as primry caregivu‘s for a disabled elderly lam.

'l'he categories of swport to be evalmted will include care
related to am, the provisim of anterial goat, and the provisim of
assist-ice, cabling the caregiver to have me tin for the patimt
lad herself. {he instrmtal Import includes helping with physical
carechringthedayudnidit‘dmneeded, providing trmpartatim,

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19
and providing financial assistance or other material goods as needed,
such as food and clothing. Another area of support thought to be in
greatest demnd, the provision of respite for a day or longer, will
also be exauined ('l‘heis 5| Deitrick, 1987; myder & Keefe, 1985).

Beam of Mine
his sttrly will determine a level of satisfactiai based on the

caregivers' perceptims. In identifying their degree of
satisfactim, it is expected that the individuals' perceptions will
reflect the adequacy of support provided. ‘lhus, for purposes of this
study satisfacticn will be defined as the caregivers' percepticns of
the adequacy of support. It will be important to determine the
degree to which they are satisfied in order to determine whether the
overall support they are receiving is adequate. 'lhe level of
satisfaction will be a measure of how the caregivers view all
infoml support provided to than overall. 'Iheir perceptions will be

usasured by a single questim with a four point amwer scale.

mu m
htdly numbers are individuals who are related, either through

blood, narriage, or adoption, to the caregiver. They will live
either with the caregiver, or outside of the caregiver's household.

W
triads/neighbors are individuals who are not blood related or

untried to fanily timbers. They will live within an unspecified
distance outside of the caregiver's household and will be self-
idmtified by the caregiving wife.

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92231.1 MIL
All support provided by the infomal group to the caregiver,
including amtimal and instrunental support, will be cmsidered when
measuring the degree of satisfaction with support provided.

Mime

For purposes of this study, the following asstnptions were trade:

1. The respcnses to the interview reflect hanstly and
accurately the individuals' perceptims at that point in time.

2. Ihe questicns are smsitive slough to determine level of
satisfaction based «1 quantitative, as well as qualitative aspects of
support.

3. The caregivers will be able to differuitiate their
satisfactim of support provided by fanily and friends/neighbors.

4. Social support is inportant to wanen who are providing care
to their disabled husbands.

5. The experience of caregiving affects the potential for
receiving social support.

Lilltatims

The following limitatims were idmtified in this study:

1. The availability of informal support is based a1 a three
umth period of time. 'Iherefore, the findings of this study may not
reflect the type or frequency of infoml support provided at any
other time.

2. 'me smole, though state-wide, was selected based m
willingness to participate rather than in a randan fashicn.

Therefore, the research findings my not apply in the suns way to

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21
various etlnic groups which were not included in the sanple or to
wife caregivers in general.

3. Due to the design of the questimnaire, there will be no
distinctim between support provided by neighbors or friends. They
are cmbined and cmsidered one of the two infaml sources of
support.

4. The inpact of the my extraneom variables, such as the past
levels of smart and eapectatims of the support network, on the
caregivers degree of satisfacticn with support, are not within the
scope of this research study.

5. The researcher is limited to using the database as it exists
with no recourse to redesigning the study when ming secmdary data.

6. The degree of satisfactim will be determined with a single
item measure.

7. The accuracy of recalling the frequmcy of support provided
may be affected due to the use of retrospective questicning.

Overviu of the dnpters

This study is organized into six chapters. Included in Chapter
1 are the background to the study, the purpose for the study,
definitim of cmcepts, limitatims, and assmptims umderlying the
stuiy. The cawepts relevant to this study are integrated into a
cmceptual fruit-work upm which the research questicns are based in
Chapter 2. A review of the literature is presented in Chapter 3
indicating pertinent backgro‘md infomtim relevant to the research
questims and those variables which they address. In Chapter 4, the
methodology, design and procedures are explained. A description of
the population and setting of the study, data collection procedures,

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22
instnments and method of data analysis are presented. An analysis
of the data collected in answering the research questions is
presmted in Chapter 5. A salivary and interpretation of the findings

are presented alcng with recamendatims for further research in
Chapter 6.

‘4

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m2: mm

Overviu

This chapter will be separated into four sections. The first
secticn will include the steps followed to select the framework most
appropriate to guide this study. In the second section an overview
of the Rain 6- Antonucci (1980) frenework is presented including a
description of its carponents and the relaticnships between
cmts. The third sectim will include an explanation of how
this study's concepts are linked with those in the franework
selected. In the fourth section a brief overview of why the study of
social support is important to the nursing profession will be

presmted.

Selectim a Will W

In selecting a cmceptual frmork to use as a basis for this
study, I considered the key cmcepts and how they were related, as
indicated by previous research as well as my own practical
experience. The min concepts in this study are ferrule spome
caregiver, instrunental support and degree of satisfaction. The
purpose of this investigation was to idmtify with what frequency
instrmtal support was provided by funily and frimds/neighbors to
the fqale spouse caregiver, and to what degree the femle spanne
caregiver was satisfied with the overall support provided.

Family I“! are neat likely to accept the role as caregiver,
due at least in part to a sense of obligatim. The female caregiver
has been idmtified as the primry caregiver in nut instances
(Jolmsm & Catalano, 1983). wives unst often fulfill this

23

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24
respausibility whsu causidering elderly catples in a caregiving
situaticn. “hm caupared to husbands who provide care, wives provide
a greater percmtage of hands-m care, primrily due to the way they
were socialised. Time m are oftau under ndical care thuselves
usiprovidecaretotbirlanbuubmaflhourbasis. m, these
wives are likely to be under causiderable stress and strain.
livesudpprovidecareareundergreatstressluditis
isportmttoknwthetypeuflmtofsuppcrttheyarereceiving.
With this infornticn health professicnals my be able to gain a
better understuuding of the support east frequmtly cud least
frequently utilised by caregivers. Mther mum of the
satisfacticn with this support could thn be perfcrnd.
Inthestusiyof support providedtocaregivers, thereareuany
dimiaus of support whichny be cmsidered. Ith Bone (1981)
es-dnedsocial support, hecmcludedthat therewarefour types or
fusuctiaus of support. The four types of support included “tidal.
instrumtal, inforntiaual, and appraisal. Home a Rain (1985)
suggested that the functiaual cmtuut of social relatimships was
studied the most often. Their definitim of functicnal support
referred to the degree to uduich the relatimships involved «national
concern, instrumtal aid, cud/or provisiau of inferntiai.
humus-Kelp (1”5) studiedthedminofsccial support
they idutified three criteria by which to esdne the functimal
cmtmt of social support. These criteria included the type of
mat, the source of support, and the quantity of social support.
In the ccnceptual fruvork described by Kala 5 Patmucci (1980)
the criteria lane 5 Rain (1985) utilised to exuuine social support

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25
could also be applied in the es-uinatim of the "cmvoy"
characteristics. Kala: a Antcnucci (1900) described the may as the
supportnetwcrk, withuphlsisauthetypeofsupportprovidedby
mecific imiividu-ls over the course of life. Kala a Antauucci's
frmkccuuldeesilybeuledasaguidetomqecificsources
of support uduich provide wecific types of support.

Indeteruningthedegreecfsatisfactimwithmt. it is
likely that the quality of the ralatiauship will be a great
influmce. finite (1902) supguted tint mtity cud frequeucy of
social cautactsalauewerenotadequ-termtatimofsacial
sqpcrt. flue believed tht the actual mtaticn of support
resided in the fulfillmt of neat uduich indicat- a are
qualitative evalmtim by the individnl receiving support.

Krau-e (1987) also suggested that feelings of cautautuut did
notarisedirectly fratheurepravisiauofsuppcrt, butwerebased
msubjectiveevalu-timsofthaadequacyofnppcrtreceived. The
feelings of satisfactiau with support were believed to arise truly if
theneedforsuppcrthadbenut. Therefore, utilisingthedegree
of satisfactim as a subjective 'asure alla- fcr the adequacy of
support to be determined based au individnls' overall percaptiaus.

George & Gwyther (1986) suggested that the perceived level of
adequacy could be a strung imlicator of tln caregivers' wall-being.
Tiny also found the resources available ad characteristics of the
caregiving situatiau have the met direct influence up the well-being
of the caregiver. m. r-earchers live found a relaticnship
between situatiaual clnracteristics, adequacy of support, and level
of well-being. It is iaportant, therefore, to have a clear

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26
understanding of the support provided to feuele spoume caregivers, to
know who is providing it, and to know whether it is adequate to neat
the caregivers needs.

Insumusry, thefocuu of thisstudyiscnthewivesinthe
caregiving role, to determine the mount of instrumental support
provided to than and their level of satisfacticsu with the support
provided. ‘lhe functiaual dinmsicn of social support will be
evaluated. This dimensicn of support will be evaluated in term of
the type of support provided to the caregiver, the source of the
support, the frequency with which it is provided, and the perceived
adequacyofthesupport. 'lheperceivedadequacyof supportwill be
represmted by the degree of satisfactim expressed sutjectively.

Based m the caucepts iduutified as iuportant to this study,
Kala 8 Antcnucci's framework (1980), linking social support and
well-being, was chasm for this study. Prior to selecting this
frunwork a few other undels were cuneidered.

Initially, Imogen King's (1981) nursing model was considered
almg with other nursing models. time of these models, however, were
appropriate for displaying the relatimship betweau the support
provided to an individual and the perceived satisfactiau with that
support.

In reviewing other social support models, the we initially
causidered was developed by Maren 8 Ream (1973). This model
depicted the relatiauship betweau societal conditims, individual
characteristics, and the health service systeuu. 'lhe uphesis of
mom'smdel wasmthefactorswhichinflumceda
persau to obtained support fran foml services. The focus of the

_i

27
present study is on utilization of support frcm the informal network,
with specific euphasis on the source, type, and frequency of support
provided. In addition the degree of satisfactim is also of
interest.

Based m m review of the conceptual frameworks, Kahn &
Bntcnucci's (19%) was selected. Their franework is based on the
cautral proposition that social support is inportant to individual
well-being throughout the life course, both directly and indirectly
buffering the effects of stress.

In the past it was thought that present behaviors and well-being
of individuals were strmgly depudmt a1 their behavior and well-
being of the past. Brim 8 Regan (cited in Kahn & Antmucci, 1980),
however, have cmcluuded through their studies that individuals have
the capacity for change across the life span.

The findings of Brim & Ram (cited in Rain 8 Antmucci, 1980)
suggested that researchers uuust beccue umre aware of present personal
ad situaticnal factors. The factors to cmsider include any
simificant recnut evmts, recognition of transitim periods, and
swarm of factors which would facilitate successful coping.

In this study we goal was to determine how satisfied the
caregiving wives were with the support provided by the infoml
network. 'lheir level of satisfacticn could be an indicatim of the
likelihood of their ability to cope with the situation of caregiving
and ability to mintain their state of well-being. 'lhus, the central
propositicsu of Balm & Antmucci's frunework and the general
assuuptim of this study have a similar focus, naintaining a persm's

level of well-being.

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28
huswork by Kelp mud Intmucci

This sectium will cmsist of a descriptim of the Kahn &
Antmucci (1980) mdel and its cmcepts. An explanation will follow
to suggest how the caucepts in their mdel will be related to the
caucapts id-utified in this study.

In understanding the frauework of Balm 8 Antmucci (1980), it is
inportant to ranauber that they are cmsidering the determinants of
individual well-being throughout the course of life. 'lhey supgest by
their cautral propositim that the social support needed and the
influence it has in helping irdividuals ulnage stress will vary
throughout the course of life. There are my factors, such as
declining fauuily size, increased usability of family numbers, and the
increased number of wam who are auployed, which could influch
the social support available to individuals today, ccnpared to that
available 20 years ago.

Kalli 8 Antcnucci (1900) aphasised the iuportauce of interacticn
betwequ variables. the individuals idmtified in a support network
are individuals aucouautered during the participatiau in various roles
throughout life. Thus, as roles changesouaythesupport group, as
well as the type of support needed.

mm of M
In their framrk Kala 8 Bntauucci (1990) iduutified a cautral

caucept "the cmvoy", which is influenced by individual and
situatiaual factors (see Figure 1). Based m the adequacy of the
cauvoy in providing support, a persau's perfornsnce in their roles
and state of well-being are affected. Following is a descriptim of

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30
the caupauauts idautified in Kain s Antauucci's (1990) model.

The first two caupauauts depicted in the undel are the
properties of the parser: ad the properties of the situatiau (see
Figural). Theprwertiesofthepersauincludeagealmgwithother
deucgraphic claracteristics. m individual's perceived need for
assistance ad abilities to fulfill those needs are also causidered
as properties of the persau.

'l'he prcperti- of the situaticn include role eapectatiaus,
opportunities available. demds of others ad resources. This
meant reflectstheneedsofothers, ratherthanthepersmal
needs of the individual who any provide assistance.

The nest capcnaut, influauced directly by the persual and
situatiaual properties, is the requiruts for social support. If
anindividual hasmyrespmsibilitiesandneeds, butdoeenothave
the ability to handle than, this will influauce whether support is
needed ad desired.

All these three mu will jointly influmce the structure
ofapersau's "cmv , thenett wt of theardel (see Figure
1). m calvoy is an individual's social network through which
supportisprcvidedadreceived. htanypointintimau
individual's support network will causist of persms ca whunu he or
sherelies forsupportadthosewhoralyauhimorherforsupport.
me social network is likely to charge as a1 individal's roles
chauge, due to alteraticns in the interactiaus betweau individuals.

flue structure itself causists of fauuily, friads ad others who
nayhavebecauueapartofthesupportivenetworkatvariouaperioh
intima. ‘lhedevelomt ofthisnetworkisnotdepadautauan

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31
individual's defined role, but rather a an overlapping of my
roles. 'nnus, this network casists of individuals acountered
Wam's lifetiaeadisthoughttochangeasapersau's
needsforvarioustypesofsupportchsnge.

The cavoy ca be defined are specifically by idatifying the
njcr network paupertias or by idatifying characteristics of the
rel'atiauship betwaa the focal pereau ad the network eaters. 'lhe
Iajor network properties include sise, stability, haungaeity,
smtry ad camecteduess. mesa properties relate to the
structural characteristics of the network as a duole.

firepropertiesofthedyadic linksbetweathefocal persuauad
othernetuucrknaberslavebeaidatifiedaddefinedbyBarnee
(cited in Rain 5 Antaucci, 1900) in his network analysis. the
properties analysed include interacticn frequacy, type, ngnituda,
initiative, rage, duratim ad oaacity. In whatever mar the
cavoyisdefined, thesupportprovidedbyitsmbersisofgreatest
inportace.

Social support las bea defined differatly by my authors.
House (1901) defined social support as causisting of four categories
of supportive acts naualy, emtiaual (affect, truat, cacern),
appraisal (affiraatia, feedbadt), informticnal (advice,
supgestias) ad instrumtal (aid, labor, tine).

Rain & tntaucci (1900) define social support as interpersonal
traaactiaus which include as or aura of the follauing elemts:
affect, affiratia and aid. 'l‘hrcuph a affective trasactia the
individual esperiaces a feeling of being ahired, respected or
loved. In transactiae of affinatiau there is an expressicn of

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32
agreauat or acknowledguuat regarding the appropriateness of sane
act or stateuaut of another individual. In additicn, transactims
are casidered supportive wha there is a provisiau of aid. This
includes provisiau of may, inforuetiau, tine ad/or goods.

m these authors there are similarities in the categories of
social support but differaces in the wording. Bcuae (1901)
saerated infomtiaual support free instrusuantal where as, Bald &
Antauucci (1900) casidered than as me category.

Bdequacyofsunort (seeFigure1), thenextcnupauat ofKalm
8 Antauucci's (1900) nodal, is influaced by the persaual ad
situatiaal properties as well as the cavoy characteristics. mce
theindividual candeterminehisneeabasedmthaspecific
situatia, he ca deteruudne if the support available free the cavoy
is adequate.

Bow individual's evaluate whether other individuals are
supportive or not has duly recatly becaae of interest. Kahn &
Antaucci (1900) suggested that in order to evaluate adequacy of
support, aumgotherthings, thereunatbeways todistinguish
betwea objective ad subjective masures of social support.
Subjectivesupportreferstoadequacyofsupportasperceivedbythe
persa receiving it. How well a individual is able to perform in
his roles ad ueintain a ease of well-being, could be influaced
by persaual and situaticnal properties as well as the perceived
adequacy of support.

Wdiscuasimofthismdel, thereisastragauphasis
placed a interactiau betwea variables. An iuportant iuplicaticn of
this interactiaal relatiauship is that the nodal allows for change

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33
throughout the life com‘se, depending m the individual situatimal
and persmal factors. This meets that support could, therefore,
be inappropriate if these factors are not cmsidered.

To smrise, based on Kala 8- Antmucci's (1980) explanatory
fruework (see Figure l) linking social smport and well-being
throwhout the life cycle, the follouim propositims have beam
suggested:

1. A perscn's requirunmts for swport at any aim time are
determined jointly by properties of the persm and of the situation.

2. The structure of a persm's cmvoy is deterudned jointly by
these Catharina properties of the persm, the situatim, and the
persm's requirumts for social swport.

3. Theademncyof social swportisdeterudnedbyproperties of
the may, and by persmal and situational properties.

4. Well-being and performce in unjor life roles are detemnned
by adequacy of social support, and by perscnal md situatimel

properties.
5. lbs influnce of persmal and situatimal factors an

perform and well-being is underated by cmvoy properties and by
the adequacy of social suppon thu provided.

In cmclusim, the cmvoy or social network is very iuportant to
a perscn's well-being. 'me social network provides the swport which
cables the individml to fulfill his my respmsibilities. M an
individual ages, his respmsibilities almq with perts of his social
network, change. 'lhesechanqesmtbecmsideredinorderto
\nderstandwhyapersm'snetuorkmynotbeable tomethisneeds

calpletely.

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34

Cobb (1976) outlined the idea that support could influmce a
persm's well-being during pariah of acute stress and role dnnge
thrwghwt the course of life. Kala: 8 Mtamcci (1980) described the
findings of variom authors related to the buffering effect of
swport. Social support is sea as a buffer to help individuals cope
with stressful situaticns and change, tbs, Cabling than to maintain
a good state of health md well-being.

bplicatim of the m to his m

The frulework developed by Kala: 6 thucci (1900) is an
excellent guide for this study (see Figure 2). m though this
researcher did not evaluate the outcm of well-being specifically,
the reescns for asking the questims ultimtely reflect m the
gmeral well-being of the caregiver. In this secticn m esplmatim
will beprovidedtosmesthowthecmceptsofthisstmare
related to the cmcepts idmtified by Rain 8 thucci.

Initially Ital-n 8 thucci (1900) diseased the isportmce of
midering persmal and sitmtimal factors (see Figure 2). These
factors were isportant in the developmt of this stuiy as well.
Differnces have beam idmtified betwea: various grows of caregivers
(Cantor, 1983; Room 8 Lutbeder, 1986). m of the research has
bee: related to m, but particularly middle-aged was: who are
caring for their permts. Riddle-aged m have be.) cmsidered to
be at risk, in particular, due to role overload as a result of their
respmsibilities to their fudly, their career and their pemts.
may, research in this area he hem whesised.

mtheotherhand, fewrweseerchershavebeminterestedinthe

fun

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35

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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doauueuuwuem \\ euuoow I
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25qu .MI I] .HmuceaauuncH
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36
older fuels spouse caregiver because they were thought to have fewer
respmsihilities. Hives now are thowht to be at eqml or greater
risk, heceuetheyaretryingtodoeverythingmtheiran, theyare
anreisolated, ndlnvetheironnheelthprohlutooopewithas
well (ruler a Goodrich. 1979). m. the need for swport is
likely to vary based In the persmal and sitmtimal characteristics.

In the presut stuiy the perml and situatimal
clnracteristicswereinortant, hutthedrinfluuoemtheother
variables was not a sajor focus of stuly. A ample with specific
persmal ad sitmticnal properties (elderly fule spot-e
caregivers) Insselected forthisstudy. Beceuunoowerismwas
mdehetwemvariougrowsofindivith-ls, themtsofpersmal
ad situational properties were not dqicted in the unequal mdel
rQresating this stIrly's variables (see Figure 2).

Rest, menu-met (1900)descrihedtheoawoyesthecore
omoept sywolising the ever changing social network. ‘l‘he gmeral
and specific properties of the cmvoy were defined. they all were
cmsideredtobeinortntindetersdningtheadegmcyofswport.
Inthisstudthesisnsnotmthenjornetmrkproperties, such
as sise, canectechess. entry, or stability, but rather a: the
propertiesofthedyadic linkshetwenthefooel perm. or
caregiver, and the infor—l avert m m incltrling fuaily
and frinds/neidnbors. 'lhe anjor structural characteristics of the
netwrkas awholes-ybeinflutial, butwerenot cmsideredin
this study.

firscmvoyclnracteristicofprinryinterestusthe
instruantal noportprovidedhytheswportgrowtothefocel

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37
person, the caregiver. Specific characteristics of the instrmmtal
mpport provided could 111le how an individual my determine
their degree of satisfactim with the support. The characteristics
ofinstnnartal apportcmsideredinthisstIdyinclIdedthesource
of stupor-t, thetypeofswport, adthefrequmcywithdlichthe
amport was provichd.

Therefore, asdepicted (sealigureZ) theoverall cmvoy
characteristics of Rain in Antonucci's model were represaited by the
specific characteristics of imtnsamtal swport provided by the
infoml swport grow. those characteristics imltded the source
(fanily ad friads/neighbors), the type (categories of instrmtal
swport), ad the fregumcy of support (nuke to alsnst all the time)
provided. Buedmtheinfluaweofthssecharacteristics, the
degree of satisfactim with swport was determined.

'l'he last wt of Relax I: Intuncci's frank which related
tothisstIdyI-stheadequcyofsocialm (seel'igureZ). the
researcher's interest with social swport revolved around the type of
inforsal swport provided ad its frequancy, hut mre inortantly how
thecaregivervieweditsadegmcyinuetingherneeb. Rains
Intcnucci (1980) suggested that the clnracteristics of the swport
network ad the swport provided, could influmce an individual's
Mine of the adequacy of apport.

Regardless of the swport available, if tln irdividml is not
satisfied, this that hecmes a cmcern for health professicnals. ‘l‘he
adegmcyofsocial swportnyheaiindirectweyof evaluatingthe
quality of the swport provided, based at the perceived satisfactim
ofthecaregiverasaabjectiveuesure. m, theadeqmcyof

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38

support as defined by m 8 Mtomoci was oporatimalisod in this
stuly based an the degree of satisfactim as indicated by the
caregiver (see Figure 2).

mlike Kala: 8 Antcnuooi's (1900) {mm the outoau of the
presmt study was to determine if the caregivers were satisfied, and
than idmtify the relatimship betas.) satisfacticn and firm of
swport. Indirectlythisintou-timoouldheuedtodeterdmm
irdiviclual's state of well-being. Homer, for purposes of this
study well-being was not investigated.

In omclusim. m 8 Intanaoci's (1900) {mark as an
excel let guide to dauntrate the interrelatimship m the
amoepts of this stuiy. lhe Ms idutified, i.e. f-l. spome
caregiver, instmtal swport and degree of satisfactim, easily
fit into the more general comm-its of Kala a latcnuooi's Em.
Overall. uiththeuseof this frmrktheresearcheruasableto
analysespecificcmoeptsfundwithinthehtoedermtsofthe
chasm frmrk.

W at his m to nursing

Social smorthssaluayshemmilportmt topictonurses.
“any researchers such as Gassel (1976), Cobb (1976), and lorheck
(1908) have fun! social Import to have hmefioial effects in
helping to nintain an individual's health all state of wall-being.

'l‘his project will provide mrses with additiaial infomtim
abwttlnadeqmcyoftheswportprovidedtooaregivinpwives.
Nursing professimals have a respmsihility to help individuals
unintain the best possible health available to than. More, it

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39
is bauficial for nurses to know what swport is utilised by
caregivimwivesuxltdiethertheswport isadequatelymeting their
needs.

Norbeck (1981) devised a rm to incorporate social swport
into clinical practice. {he nursing process was applied to the mdel
devised by Kala & Antamcci (1980). This rm is a helpful
uddetormseevdnostudytheinortmoeofsocial smart to
individmls at variom time in their lives. lore dismim of this
frmrk and its butits to nursing will follow in the iwlicatims
sectim of dnpter 6.

m

In this dlpter, first a: esplmaticn was aim at the process
of selecting a frmrk to guide this study. aecmd. a detailed
deecriptim of Item & Datmucci's (1980) tumor}: was preemted,
inchaiingthemtsandhcwtheyrelatetomeanother. 'lhird,
an esplanatim wes givm incorporating the stair ccnoepts into the
selected rm. Fourth, the study of social support and its
inortmce to the nursing protessim was explained.

'lhe appropriatoess of using Rain :- Intmucci's rm as a
guide for this stuly was clearly dmtrated. fine interrelatimship
mthecmcqtsinthestmwesshantobeverysisdlarto
those described in the tr-uwork. m revia of the literature will

be presmted in Chapter 3.

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m 3: KEVIN G ms lem

Overview

Researchers have developed an interest in the caregiving role,
particularly during the past decade. Due to rigid restrictions on
who my and my not rennin hospitalized, an increased nunber of
disabled individuals are cared for in their am hcmes. “axis has
becane a growing concern for health professimals who know of the
stress and strain experimced with the role of caregiving.

'lhe infomal support system, consisting of family ard
friends/neighbors, has been identified as the primry source of
support to caregivers. Support to the caregivers has becam of
utnnst inportance in helping to maintain their health status and
well-being. Many researchers have studied the effects of social
sipport on well-being, however, few have looked at how individuals
view the adequacy of support.

Kalli and Antmucci (1980) suggested that the adequacy of support
would influence a persm's well-being. A persm's well-being could
thm influuice his ability to continue in the role of caregiver.
Goodlm (1986) noted that it was iuportant to determine what would
enable carers to cmtinue caring. Alalg with knowing the effects of
social swport on well-being, it is also inportant to know what
support is available and mavailable, and how this correlates with a
persm's perceived adequacy of support. Informticn about this
relatimship will help to better trderstand what type of assistance
most significantly influences a caregiver's level of satisfaction

ard, therefore, influences their willingness to cmtinue caring.

40

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41

‘lhis literature review will begin with an overview of articles
focusedmtheiuportanceoftheinforualswportnetworktothe
caregiver, the instnsmtal swport provided by the infernal network.
and the united research available in this area, particularly within
the realm of nursing. a selectim of articles foaming a: the
W of stunning perceived satisfactim din sttdying social
swport will the: be mind. In cinch-1m, a reviu of the
literature will be prssmted m studies desiwsd aroud the
omceptual undel developed by Rain 5 Intanoci (1900).

M assert W by tlu rates-1 snort m

Variom articles have beat writtm Cl the inortmce of social
mttoarqivmudthhndofnmtwwiddbytb
infoml support network. threes have writtu articles with a foam
mcaregiving, Mahasisedtheisportmceofmderstadingthe
healthrisks caregiversenerimceudtheneedformnrsssto
caitinue studying m in the caregiving role.

Sime1986mrseshavebeoaeminvolvedinthesttdyof
caregivers ad the role of caregiving. my articles luvs be.)
theoretical in nature. Very for mass, hwevsr, have dais actual
research studies to evaluate the kind of swport available, the
adequacy of swport available or the bufit of a swportive
intervntim.

Bunting (1989) was interested in the health threats caregivers
could esperimce whm caring for a elderly relative. as suggested
tht caregivers were likely to cmtinue caring for the relative,
oft.) neglecting their one: health care needs. hating prssmted

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42
nursing interventims that could calplmt and swport caregivers
in their role.

Phillips (1989) Wired the iuportence of canidering the
elder-ceregiver dyed, rether that the elder elme, in providing
care. Further ex-Iinetim of the elder-caregiver reletimehip wes
Mtoieprovethemirsingcereof theelderly.

Good-1 (1986) preeated e reviav of the literature a: the role
of the idly in cering for en elderly relative. are idmtified who
the primry caregivers were, the neture of their reepaleibilitiee,
end the physical and untimel costs of caring.

InherreviavooodmuSBS) found fewreeeerchenlndex-eined
dust the ceregiver waited, ad nugeeted service provisicn wee not
elloceted es Qproprietely as it could he. be M further
reeeerch, perticulerly true e musing perspective, to deterune whet
“bled cerers to cantinue oering.

Robinsal(1986h)wroteehouttheiwortmoeotmrseeincering
for ceregivers. are deecrihed elderly m caring for their
W, endtheirheelthriskschetothehidllevelsotstrees
they water. We: believed the priority for nursing reeeerch
shouldbemthecereoftheelderly. anrecomisedtheurgeto
lininize inetitutimelisetim. end M tint reeeerch he
focued m inroving the infoml end tonal cmity ewport
syst- ot the elderly.

In her review Robin-m (1986b) fomd ally four erticlee in the
nursing litereture related to oeregivim. file min discipline that
sealed intereeted in idly ceregiving were individnls in social
germtology. Irmicelly, they Ind eleo Initiated the importance of

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314.3351“ alum {.151 41:14 Lm mum ‘rjf: vi :1". Erik-1 mi .
3' 2;-.- ’ «9-1251 £311-: 1. T -. (“JR it‘ll gal 12. ‘ .\_i.‘-c .‘ I" J.‘ .Kf.‘ .v ..

43
nurses role in caregiving.

Preetm & Grime (1987), both registered mes, recomised the
iuportenoe of infoml Md: to the elderly, but wheeised the
inortmoe of miderinp individual differmcee. mach es gander end
nritel status. For their research study a run, stratified,
probability mle wee selected. the scale misted of 311 sale
and 589 fule (#900) elderly individnls in the Iortheest. A
limitatim of this stuiy m that no indicetim Ins 91m whether the
individuals in this stuiy were caregivers or required phyeioal care
thallelvee.

lhe date was gathered through interview, than cross-tender
analysis elm: with an «mere testing were perfor—d. the
inetmtsmedintbestulybyl’restmetkius (1987)werenot
presmted, but mle queetims were provided.

fliereepmdmtswereeekediftheyreoeivedsocielswportin
tom of aocio-eutimal and instrumtel aid and whether it wee
provided by family, frimb, or enother source of swport. 'mey
:89“qu (1) orb-mmmt (0). m-
ajority of ell the meet eveileble to nrried .les as provided
by spa-es. m the ocntrery, njority of inetnmtel eid eveileble
to nrried fuel- was provided by spaces, but socio-wtimel
swport wee provided by tadly. For both untried rules end mles
theujority of ell support wee provided by futily.

Preston & Grins (1987) omoluded there were simificmt
differooesbetwemthepetterneofsociel swportbetwemmend
m. Pauleewere found tomehelp tmell awrceemoretlnn

mlee,withmlye4tmeofegmcyeesistenoe. 'l‘herewerethree

311.! £23.. I...» 32.31 m‘ntlul fui’i.‘ .../11 ~‘ You Mr...) 1 I. i- -’- :- I

ad? 32:31:22.1‘435 3nd .‘(l'ia—x :c- 911': a ‘I ‘:r :24). 1.1.:3. ‘2..‘. 'v °'

[156 14;)17’i‘5 .1) 1‘, vb"; .-"."'.N‘.‘:".:tl: l-i'.-L\'7l In '.1 it‘ll. 1:')’) IN) ' 4"
.b‘stjsnjja Jud...- z 5 '~_'bu*1&: .‘i‘;‘.b—~&.—,1 '119-11’.‘ mi .....f: '. .:

«1m: Ii‘c‘ in Pajamaucv) ~1£ any". :..-. .r.---? Mia; «131..
A .tesvriju VI add “1 LEE. L-I‘..i:1‘il fly} ‘- ...... .‘

"nil "i'i:{T.):{-.~J ..‘V.L_ mu 11x): f:"::‘ ..L mm 1.111 1.». .f'n ": run? I

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can .(U) jlvgiya .a 9:: rd ~n {l- ‘v'ru7' in ”pd as b-;

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leiLlit..V£~ figs If.*r1‘i‘m'JJCfl.i i.) fj‘lmm'l .sz 1.1m -1 3:" .13; ..'- ."(-‘

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inuniinpla new :i-‘J‘LFlj £322“ 5'1. 1‘. vi) : v.4“. l. .-
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44
likely reasons for this pattern of service use (a) informal help was
sufficimt, (b) they were too proud, or (:2) they did not require the
type of assistance offered. ‘l'hme three hypotheeee stranly swport
theimortnceofstuiyingmrecloeelytheinfoml swportnetwork
Id the Import it providu.

Preetai 8 Crime (1987) helped to dmtrete the imrtmce of
stmimtheelderlymdtheirneedtorsociel swportmen
individual buis. “they took into midereticn see ad .ritel
statm retherthnerudhingtheelderlyeeehmmeommof
indivichnls. Preetmeorinsqlmisedtbneedtornrsee tohelp
in struthnino the swport network of the elderly.

'l‘heie 5 Deitrick (1987), two registered nurses, investigated the
neat of caregivers who provided care to frail elderly individuals in
their hm. lhe investigators utilised e self-selected, mince
sale of caregivers living in e damtern city. the reepmdute
werelocetedthrmtheVieitinplureeeAesooietim. ottheleo
eligible participate, 90 caregivers reepalded. She careoim were
51to§0yearsotepemdcaredprinrily£or£uleeeveraging75
years of age.

AmotZSit-wasdevelopedforthisstudy. Itwae
utilised to obtain We inforntim. the care-recipimt's
degreeofdoudocy, thekiniotservic-utilisedbytbcareoiver,
ad services deeired by the areaiver. Ms 5 Deitrid: (1Q?) fomd
a Minite d-ire for me respite care aervicee my the caregivers
ndthetidmtifyingcarepivers' ”datum. 'l'heeuthors
Wtbtotherserviceenyhveelreedybenprovidedine
sufficient mt.

H‘-
asw gin: iu‘r...u1ni (i, tar“: ~ 1;) r11.s‘:;g £1.11?- .:-..-.1 amiss” x ; 3.1..
(Hi3 411113-31 Ifl'm int» .=-.m 1"; .C: immiq an»? 314w anij {dc .t..~i"iiiu".
Jinqqrr; ylpmizja .:'.':-;-.-.1-.113q\::: a 1d: Masai." .I‘vwéfio 21.16.321.15 ju wyi
.mwwt--£'1 #1.: 42.1.2. 11.121414: «A? vI-mnl') wmn Uflixthfl-z in ‘1.)11511'W83Li em.‘

.asrzvosq 31 Jloqqua on? but

if MHz-r1 mind. of I.» g[ vi xii-L"! L3 3: {.11} ,6 m I'. -x'1’

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33 quolp axn.:~ponpd 5 as ylusrls an: guLUUISKQ nfidl .9fi7r1 aujaf.
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.1119119 9d? 3m Hzowssa 31ngre a-= pfljurfifpfl6138 A:
Md] hwiggLTHani ‘nwaxuu bw1«¢u.ps1 Um} .{V¢~I) Awixfrvd a 813d.

n1 ar'JFIvzan vi) fie I1£.i c: 935. fagivCJg gw a- .....i In 2% 'J
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val ed: In .fluifnifiuL;A 29.1un guijxazv an: n.rr:al Lujhnuf 1.4w
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gr: ' . ant-.41 '3'; u] Li

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.ups io EJL9V

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. 1. 4.14:- ‘3 { -...l.- ...- IV .-o- 0 La.-. an] .V.Ll.$..1u-9{-. IJ 311;. .:
bnuoi (Vaul) N3i.319fl 6 aida .1evrpn;r? nfi xi fell. L a z,»1:; b-b
1.1"‘,‘.".'.'~'.". uf’ Luann» 5;:J'If‘7S-Hfi 31:") ziiit§«".”a1 It‘txx‘n All “min-at" “-.U‘fz'H [-00 5
auodtu: sfiT .Juajxogvi Law ejeen '21»..p::£: painlifiunbz 3'1: :.r
1".zf.47br.p;.v+«i Ybfifllio acid yam 29':¢1:2 1wd§0 1.x: In*::nyrr

-\
e

.jLHIuE Jhrijlilua

45

There were sane definite limitatims to the study by Ms 8-
Deitrick (1987). Became the sulple was selected iron the m, it
was midered biased. ‘l‘he participmts say have already beat
receiving assistanceandwauldnothavebemrepresmtativeaf the
totalneedsofthecalaulity. 1heinstmtsmedinthestudyhad
limited reliability and validity testing and further testing with a
snare represmtative ample was recmded. la actual results were
presumed related to the type of swport utilised or d-ired. Only a
writtm eaplmatim at the results was provided.

he strengths of the stuiy by lheis ‘- Deitrick (1987) were the
me of the Concern scale cad Activity scale. Bimifiomt
carrelatims were found betweu itu an the two scales indicating
sens omstruct validity in the scales.

Nurses have beam to dmtrate m interest in caregiving, but
have dam very little to investigate specific dimims of social
swpart. Nurse researchers tad to investigate the social support
cmoeptinverybroadterue, mtratingmmtndtypeof
mart received. thereareveryfuvstudiesndlichfocummarsing
intermticns that any help to alter a individnl's mart status.
'lhis ismareainadaichmrsesshauldhavesnreinterest, sincea
major hactim of nurses is to be amortive.

therearealsoveryfumrsingstdies‘hichrelatetaother
studies. there are my isolated stuiies, each with a dittermt
foam, limiting the mefulness of the results. lursu should we
existing research as a base wax which to develop future studies.

m thmuh nurses have not W the pravisim of
instrumental smart by the infaml network in great detail,

J

‘A

\a. k re 1 v V *
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a a I -9

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[MW 5 ~31 Iri earn.

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0U:;.‘&J;"h 3“] ‘e.

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m. 01am .81 n um: -’.--~"4";.-.

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V.
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46
researchers in other prafessicnal disciplines have dale so. A review
of articles is presented nest alphasising the inpartmce of the
infomlnetworktothespameceregiverandthekindafsmart
provided. mdnotprovided. bythisnetwark.

lacy-i 8 lantbeder (1986) in their reviav of the literature,
cmcltrled tht fudlies provided appraaintely 00‘ of in-haae care to
persu- qe 75 years of age Ind older. Initially, Inst swpart was
financial or “timel. but as the cere-recipimts' neeb increased,
thswpartduigedtapravisimafmrecmcretedailyservices.
liaretieemdcdtmtwerereguiredhitwerenotalways available
tathecaredvercrtheirswportsysta.

Day (1985), in her review of the literature, found 45‘ of the
nlecare-recipimtsageSSta'Myearswereceredforbytheir
wives, aswere35tofthecare-recipiu1tsage75t084years. Most
wives were found to bear the burdn of caregiving with very little
outside help, resulting in lcnelinees, isolatiai lid eshsmtiau

Doom 8 lustbeder (1986), almg with Day (1%5), were were of
the clinging social trade ad the increased likelihood of limited
availability of informl mart persms in the future. According to
my, families are getting .ller resultim in fatal: persms to care
for the elderly of the faily. and pale are living lager resulting
in older and possibly lure Mt elderly requiring care. Day
calcluded that these factors .y affect the availability and
willingness of relatives to mdertake estuive in-htee care. his
obeervatimswpartstheneedtoevalmtethetypeafswpart
available frm f-ily and trick and to detemne duther the

smart is perceived as adequate.

‘- 'U3f 33.51

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‘1 p1 3'» u; z .‘*-o ; flu .

47

Intheirresearch,Crosmn,Lmdm&Barry(1981)ex-1d.nedthe
issuesandproblaeesperimcedbyaldermceringfortheir
disabledlanbucb. Aswpartprogruthratdithemityms
inlutedmatrialbasistafulfilltheswpartneebnotuetby
theinforaelnetwark.

mappertprogrunsfirstdevelapedtabeapeerswpart
grow, but thawes developed intoa respite project which
incarpcratedseveralservices,s@uadult&ycare,halecare,and
estudedreepitecare. Mtheswpartgm,wivesshared
weaperiacesauleaplored alternatenthabof capingwith
theirproblu. mehmcerepragruuabledthewivestahavea
mlrseassistthuinthehtuuproxi-tely4haursperweek. If
persanlcarensnatneeded,themrseprovidedcapenimshipmd
swervisim for thepetiat anduotimal swpart tathewives. 'lhe
mtimal support was a boatit which was not mticipated initially.

Mtheavernightrespiteprogrea,cerempravidedina
nm-institutiaial settingbynursesmaflhmrbasis. ‘lhefacility
uscpumirsdaylnmingthrmumdaymrning. finhnbendscauld
steyfarzehaursorthefullfourdays.

thewiveswereveryappreciativeaftheservicesprovided
thrawhthehcucarendavernightrespitepragm. lhesepragrm
abledthewivestahevetintathuelvestocqletediaresmd
mahledsmtatakevecatiautheyhednatbemahletatakein
12yeara. Almg withtlnfreetiuavailable,thewives could also
feelcmfiduttlnttheirlaMwerereceivingthecarethey
needed.

Mmsmtmmh-lpfulbrmtheamrt

an? ham“; ..3 (i -.t-‘i) {44.31 - :4. 111.3; .1£.r.rr..:.« :'- .3514' '-4 .;.-u';' .41
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48
network farthecaregivers,allowingtheataaddressneedswhich
cwldnotbemtbytheatheravailablemcesafswpart. Several
ofthewmhadhecaeemreessertivecndassmdnarecmtralin
theirolnlivesasaresultofthepeerswpartgra‘p. fixeelderly
“participatedinthemfeltverycafortable withthe
assistnceprovided,hiowingthatitnsdqudablemdtlnttheydid
nathavetoimoeecnothers.
mmmledgedtheboefitsafhsvingninfauel
swpartnetwark,butalsandenoteafareasinnhidiswpartwes
lacking. Iliietwabiggestcmceamswererespitecareandfinances.
'lhedeecribedswpartprogr-pravidedreepitewidxwufmtly
\navailable fratheinfornlswpartsystu.
Overall.thisreseardxwashelpfulinprumtingafoml
smpartpragr-‘diichwmldhelpeeet caregivers' needs. Itprovided
infamtimregardingthetypeofnppartceregiversarelackim,
midxwescanistmtwithatlnrreeearcher'sfindinm. ibeeuthars
desired the inartucenm'ses play in helping the elderly obtain
theassistncetheyneed. naystressedthebuefitafthenursein
providinguatimalswpcrttathecaregiver.
'Dopicsswgestedforfurtherreeeerchincludedtheiapectaf
lm—terncaremtheceregiverndneapluatimofthefactars
thatinfltmcetlnoaregiver's decisicntaseekimtitutimal care
for theirspaue. hinitial stqintheeaploratimofthesearees
istafiinmmderstandingoftheneebofthearegiverandthe
awortutilised.
myderl-Aeefe(1905).hothsocialworkere.eadnedtheheelth
probl- associated with caregiving. the existence of infoml

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49

support system, the me of tonal social services, and the need for
witicnal smortive services. Mr sale cmsisted of 117
caregivers, of in 3/4 were spanes, who had ban participating in
caregiver aim-rt grows lid caregiver workshops. Participants were
also cmtacted tbrm mars, nuclettcs ad "suicr"
ntlicatims in the an rrmcisco area. he mle the selected a: a
m, voluntary buis. ibe disorders Inst prevalot anug the
disabled grow incluied MW's Diseue Ind related disorders
(45‘). file r-ining individuals were afflicted with a variety of
physical disabilities.

mly 43% of the caregivers imitated they received kelp Eran
their infoml network, and of those ally 20‘ indicated assistance
was cmsistnt. Caregivers did not ccnsider infrequnt relief as
sufficient assistmoe with the arguing "sensibilities of
caregiving. Oftbell‘l caregivers, sabrqnestedtlnt r-pitebe
provided at a canistut basis. lbs caregivers indicated a need for
respite care “bashing lager breaks in caregiving, allowing than
to do are tbm shop or run errant.

Alidtaticnoftbestudybyliydert-Keefe (1985)wutbe
possibility that the caregivers in tbe sqle were are sophisticated
intbedrhicwlehectserviceeavailablesincetbeylivedinanarea
rich in social services. the caregivers say luvs bad needs differmt
fraucaregiversintbegmeral pondstimsincemrtiveservicee
were sure readily available. The caregivers ny have also had i
“to: mud. of tin Import network.

11» findinu of myder in Keefe's (1905) study were spin
canistat with ctbu: stuiies, pusiny W the inability of

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in vfti:d pt 9d} pungvipua vFHrwenq .aeihuiz l9d’0 driw 1n9jgianuu

b

50
the inforuel swport systqn to provide assistance related to lung-
ten respite. 'lheee findings any swgest that the assistance
required was not available or if available, was not provided what
needed a: a cmsistmt basis.

W the litmture it has ban suggested that caregivers
receive Inst of their Import fran the infoml emport system
myder 8 Keefe (1985) fomd infornl swport was not readily utilised
mdalsosingested-lninl meof fornl services. their findings
my imlicate an millinmess to utilise assistnce, no need for
assistance or availability of inadequate assistmce.

In reviewing the data collectim uthods, there was no awnticn
of a questim allowing resparlnts to specifically idntify in what
ways their inforael network provided assistmce. 'lherefore, no
specific infomtiai could be gathered related to the utilisatim of
informl assistance. ibis was viuvad as a lisdtatim since the
mastic: of specific utilisation patterns would lave ban
beneficial in helping to straigthm the swport network.

In their study, W, McKinlay 8- Bullim (1989) wanted to
deterninetdiotheseomdarycaregiverswereuflthetypemdmnt
ofhelpprovidedbytha. Otherquestimswereafiressedbutarenot
relevmt to the prescxt review. A ruidm, stratified sale of
individuals m selected fro the populatim of eastern
Wts. Of the 429 prinry caregivers interviond, 701 were
fules.

A three-stage field design was mad to idntify the respmdmts
and collect data. Ithe first stage of data collectim cmsisted of a
lo-it- index to determine frailty of the are-recipimts. The

ta.

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51

secad stage canisted of survey interviews of the frail elder saple
todetemline‘diotheprmrycaregiverswereadthetypeof
assistace provided, alcng with other data. he third stage involved
telepbae interviews with the prinry caregivers. mta regarding the
secadery caregivers were collected in these interview. [to further
inforatia related to the instants was provided.

firstindingsofthestulyindicatedtbatthereasincreased
involvaatof friaadneidlborsintberoleofsecahry
caregiver (20), mend to the 10‘ fulfilling the role of primry
caregiver. Also, narelatives were likely to be secahry caregivers
not ally to distat relatives in the role of pri-ry caregiver, but
alsotospomeeaowareprinrycaregivers. Itinestmatedthet
selectiaofseoaderyoaregiversaynotbebasedathehierarclu
of smart m, but rather a availability factors.

lhroum further evaluatia, the type of care provided by
seoaalery aregivers was idatified. 'lbe security caregivers were
less involvedinperscnel careadMing, htteoreinvolvedin
areas requiring interudttat help such as trasportatia ad
m. flue findirus indicate a swplwtary pattern of
assistacebythesecmderycaregiver, rathertlmepetternof
abstitutia.

filamentcfcareprcvidadbythsseoaahrycaregivuwas
straigly related to the relatianhip of the prinry caregiver to the
care-recipiat. Ifthepriaryaregiverasaoffspringor
relative, the seccndery caregiver provided approxiately two-thirds
unlabelputbeprinryaregiver. m, ifthepri-ry
caregiverwasaspome, theseoaderycaregiverswerefomdto

5

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52
provide only 12‘ of what the spome provided. Overall, it was
suggested tint the relatimship of the primry caregiver to the elder
Insunreinortsntthmthemwerof caregiversteterudning
the total mat of care received by the care-recipimt.

the sale selectim process increesed the ability to gmeralise
the finding of the souls to the pqlulatim. lhe instants
utilised were not available for critique, however the data obtained
were quite detailed and inforntive. In caiclmim, the stuiy helped
todoclmttheinortuceoftheintomlnoportnetmktothe
priserycaregivermdtheusistanoemst likelyprovidedbythis
network. ‘l'he researchers also suggested the potmtial risks to
spouse caregivers since lisdted swport is utilised by this group of
caregivers in particular.

In usury, min of the literature omsistmtly found the
informl mortnetworktobeofprimryisoortmcetothe
caregiver. nu instrumtal swport needed, however, was not always
available. It is apparmt that multiple factors intlmoe the
smortneededatmypointintise,butitseauoertaintypesof
mt are mistatly lacking.

Research by nirses related to elderly wife aregivers is limited
butespmdinginquntity. Nurseshevebenocouragedtoocntime
staking spams caregivers. More specifically, the inl-mtatim of
interventimstuiieshesheureomdedsinosmtseshevethe
ability to iwlmt a clmge and follow it w to the point of
evaluatim.

lbre specific infomtim is needed cu how the infernal network
provides assistmoe. Very to! studies have M the assistance

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53
providedhytheinfoml networkandtheinportanoeofseemdary
caregivers to the care-recipimt.

Beret 5 Jolnem (1990) critiqued the caregiving literature.

The) identified a -jor prdal- in caregiving research which cmdd
relate specifically to the issue of we caregivers ad the type of
instrmtalswportpravided, ornotpravided, tothu. Bareri:
Jamal “quested that it would be easier to evalmte involvumt of
thecaregiveraswellasnmtnetwutiftheneebofthe
recipimt wild he specifically idutified. Caregivers and their me
ofnupartcwldhemaredhasedmspecificneebofthecare-
recipiut. Ming specific infomtim related to care-recipimts'
needs would usable mists: of findings may care-recipimts with
sidlar needs.

Overall. apomecarepiversareheaadmathewjectsatqreater
interest may reeearclurs of the 1990's. he intent of this review
mtoqheisetheinortmoeofstmingspecificgro‘pof
caregivers lid to idmtity the type of inetmtal mt available
lid unavailable to thu, partimlarly firm the infoml Import
network.

In the preeut study specific categories of inetrumtal swport
wereemined. Itwasdeteraineddutswportisprovidedhy
Erich/middle“ and “I: m to spare caregivers. Also, the
for. of usistaoe providedanat attend least attnhythesetwo
”new. Inthanestsectimotthisd-pterm
min of the literature will he presented apheeisinp the
inortncedcmeiderinptheadem-cyofmtaeperceivedbythe
caregiver.

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54
Importance of attaining satisfactim With Support

A review of the literature focusing on satisfaction with social
support will be preamted in this sectim. Very few articles with a
focu m caregiver satisfactim were feud in review of the
literature. Mom articles were feud m caregiving, but the
primry focus was mlly a1 availability of stwport. Oftm tines
qhasis was an frequmcy of support available with little data
obtained a: the adequacy of the support available.

M previomly amtimed the availability of social swport to
caregiversisinportant tonurses, sincenursesarealareofthe
buefits to the caregivers' health atd well-being. In Raging with
thenursingprocaas, mevaluatimmt bemde regarding the
adequacy of sipport available. In this review ally me of the
articles preamted was writtm by a nurse. Nurses have done little
to evaluate caregivers' satisfactim with the swport available to
then. In the review to follow a my of articles is presented.
'lha articles will help to aphasise how inortmt it is to wider
the degree of satisfacticn dun sttdying the availability of social
swport to caregivers.

Krame (1987) feud in his review of the literature, that people
have variaticme in their need for swport, ad the hneficial effects
of emport my be attributed in part to feelings of cmtmtment and
security. Ihe feelings of cmtmtmt were “and not to arise
directly frmthennre provisicnof smart, but werebasedm
abjective evaluatims of the adequacy of swport.

In his cross-sectiaial study, Krame (1987) randanly selected
351 participants, 65 years of age ard older, aid caducted face-to

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55
face interviews. self-reported health was measured with a single-
itea indicator which hrl heal utilised in a water of previam
stldies. Social smpart wu measured with a andified version of the
Inventory of Socially emportive Behaviors by Barrera, Budler 8
may (cited in Krame, 1987). The reliability scores rmed from
Alpha: .67 to .83 Ill-l the scale was sudivided. mive smtals
were naasured by a scale with a reliability score of Alpha = .86.

“lysis of name's (1987) data swgested tint the mat of
tangible smart received by the older achlt failed to affect health
(Beta = .026), but satisfactim with this mt Qpeared to be an
Wt correlate to health (Beta - .154» (.01). his findings
also shaved a simificant aarrelatial betwem satisfactial with
notimal swpart Cd health (Beta 8 .218; p (.001) as mused ta
fregmcy of “tidal swpart Id health (Beta = .025).

The relatimship betweu the frequency of smart ad
satisfactial with swpart was also estinted free the analysis
performed in this study. 'lhe fixdings of the study by Irene (1987)
revealedtbttheassesmtsafadegucyafswpartmres-de
indepcdnt of the mat of social mart received. “the mat of
infomtialal ad tangible mart shaved no significant effect «1
thedegreeaf satisfactimwiththeseswpart indicators. Kraue
swgested that a weak usaciatial .y ildicate tbt an increase in
thefreglmcyafswpartwauldnatnecessarilyresultinmincrease
in satisfactim with swpart ad that individnl variatials in
swpart alight exist.

Overall, in his stldy name (198?) faud the satisfactial with
swport to be an inortant Wt of ll individual's state of

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56
health. Also in analyzing the relatimship betweal the frequalcy of
support ad satisfactim, it was not possible to me ale as a
determinalt of the other. The relatialship was fousd to be more
owler ad could he influalced by naltiple variables, including the
nature of the specific stressar cmfrmting the individual.

'lhe radaa selectial ad large swle sise, slung with
utilisaticrl of reliable instants were the straugths of this study.
'lhefindingsafthestudywerelilitedbythefactthatthedatawere
collected cross-sectimally. This .de it difficult to idaltify
duetherdmgesinsatisfactimwithsuaportpreaededdlalgesin
healthordletherdlalgesinhealthresultedintheinabilityto
obtain adequate support. messing satisfactial with smart ad
health would have heal better addressed with laugitudinal data.

Ward, alerm 8 LaGary (1984) looked at satisfactial mg the
elderlyingaueral. Host researchalthesacial networksof the
elderly have dealt with the qumtity, rather t1.) the quality of the
relatiaiships. A stratified, rqresautative saple of 1,185
individuals, 60 years and older, was selected frauu a Iatrwalitan
area of New York. 'lhe participants were Mt better educated ad
healthier than the natiaual data indiated for this pquulatical. the
purposeofthestudywastoea-inetheeffectafobjectivead
subjective integratim a1 mrale.

Interviews were performed to obtain inforntiau related to
social ties ad support. Both objective and subjective assures of
social networks were utilised. Ban questiaus were siauilar to those
used by altar ad Wellm (cited in Hard, filer-u 8 LaOory, 1984).
The subjective evaluatical of well-being was auaasured by the 17-iteuu

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57
Philadelphia Geriatric Gauter Morale Scale by Lawtcn (cited in Hard,
Sher-nan & LaGory).

Stralgths ofthestudyincludedthemauberaf respadautsad
the sapling process utilised. Also, the uae of objective ad
subjective assures of instrumtal smart was canidered a
straugth. A linitstiau was the lack of data related to the quality
of support, indicating uby mrt uas thauaht to be adequate.

i'hefiudingssuggestedthat respadmtslndauaudmrtbath
objectively ad subjectively. lhst of the respadauts (558) saw or
heard regularly fro a relative in the area, 'dlile ally 58 indicated
thattherewasnometheyaauldturntofarimtrmtal usistalce.
Majority of the respcrdalts had at instrumtsl mrt (928) ad
aiouah expressive support (95‘).

'lhe subjective measures of smart were me strangly related to
anrale than were the objective seasures. For emle, perceiving
that «laugh imtrunaltal mrt was available as are straugly
related to morale (r = .23) than the radar of helpers available
(r = .06). M though detailed indicators of social smart were
utilised as assures of mrt, the quality of suaport was not
adequately investigated. having that and mrt uas available
didnot alabletheresearcherstoidaltifydatuasnaltbythis.
There was clearly a need for sore detailed amtualisatial ad
operatimalisatial of the qualitative aspects of social amt, but
this was not in the resin of Hard, berm 6 LaGary's (1984) study.
he iwpartsnae of subjective evaluatial, however, was mhasised
throughout the study.

The imtruaalts uaed for Hard, m, 6 man's (1984) study

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58

were a good attarpt to indicate the iuportance of ambjective
uessurea. Further developmt of the instnmts are now needed to
look at more qmlitative aspects. The process of instant
develomt will be quite involved. Ibis process my be beat
initiated by allowing individuals to idntify day they feel a certain
typeofswportisadeqmte, however, firstadeqmcyofswportnuet
be deteMned.

Baillie, lorbeck ‘- Barnee (1908) in a stuly of social swport
lid its interactim with psychological distress, hypothesized that
satisfacticn with social mart would be negatively related to
psychological distress. A total of 87 caregivers with a sea: age of
52.5 years old were asked to camlete a fat Mullins.

Single-it. checklists were med to gather We
infornticn lad duracteristics of the caregiving sitmtim. The
perceived stress and satisfactim with social mart were assured
by newly develqaed questiaae with stundsrdised Alpine 8 .90 aid .84,
respectively. Psychological distress was ensured by the Profile of
flood states (FOB) developed by ”air, Lorr and Dropplm (cited in
hills.) Norbeck 8 Barnes, 1988).

The researchers foul! satisfactial with social mort was
negatively correlated with psydlologicsl distress as hypoth-ised
(r = -.48; p <.001). Became a straw native correlaticn was found
betwaen satisfaction with swport and psychological distress.
additimal research was recouuided to explore factors which any
cmtribute to satisfactim with social swport.

A lisdtatim of the stuiy was the me of a volmtary.
cmvmim s-ple. the ability to quaralise the findings to other

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individuals, therefore, was limited. The instrunmts utilised to
treasure satisfactim ard swport had high internal cmsistalcy
reliability, but alteratims in the instruamts were recammded to
validate the sttdy's finding.

In the preset study specific factors whid: Isidat influmce
satisfaction will not be aslysed. Instead this researcher believed
itiaisportmt tohsveabetteruderstadingofhmsatisfiedthe
elderly caregivers were. After cmsidering the findings of Baille,
lorbeckinarnee (1908), itisinportmt tohavesaeeknowledgeof
satisfacticd with swport aid how it ay relate to the mort
provided. psrtimlarly if it could be related to an indivichel's
psychological statm.

Vaussnarrisa: (1985) watedtodsterlinedntswportnetwork
characteristics were lost likely associated with swport
satisfactim. Il'heir research project wa me of a fat attats to
idmtify duet ay cmtrilute to a perem's satisfacticn with swport.

A mince sale of nmtraditimsl wax stud-its, ages 30-
61, was radaly selected fra a Hithatern (hiversity.
Questiadsires were ailed to each subject with a 50. return rate.
flares instnats were sainistered. the first instnalt assured
enacts of the social swport network. the secad assured
satisfactim with ewport ad the third instnalt assured perceived
swpcrt. 'lhe internal mistacy reliability scores for the
satisfactim scale (Alpha 8 .88) ad the perceived swport scale
(Alpln = .91) were very good.

The ata analyses were perforad minp bivariate correlatims
std hierarchical regressim. “also teclmiques were selected became

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60
they camlmted me another. Thrcwh bivariate correlatims, the
prapartim of close friqu atd esistmce of a spade lad the
straigest relatimship to mart perceptions std satisfactim, with
correlatim coefficients of r = .39 std r = .26, respectively.
Network resource variables which were strmgly related to
satisfactim were clasaess (.27), caplesity (.28) Id d-nity (.34)
of relatimships. It as also amended that swport network
resourcesrarelyaccannt fararetlnnatbirdofthevarimcein
swport satisfacticn.

Vans & narrism (1985) lindted the external validity of their
findingssaatbymingaselectgrowofwastiduts. I[heir
asses-at of the swpart networks ad the stub of mt
satisfactim ard percqtims, however. were are carehmsive than
ast other studies.

Finding fra Vans 5 Barrisai's stldy (1985) provided a basis
for further research in the area of satisfacticn with social swport.
Researchers were alerted to the sultiple factors, such as preartim
of close frica ad iadiate faly, clasaess of relatianhips,
udpresaceofaspoaediichayinfluaceaindivid-l'sdegree
of satisfactim at my point in tia. The It‘ll! by Vaus 8 flarriscn
was an inspiratiai to m satisfactiai amg caregivers em if
not at such a Win level.

Scott, Roberto & mttm (1986) sttdied 23 priary caregivers of
Alsheiar's petiots to deteaine the relaticnehips betwen the
stoport provided, the satisfactiai with smart ad the level of
burda. Also, 19 adiiticnal caregivers were interviaved to provide
anotherperspectiveoftheswpartprovided. ‘lhefocusofthestudy

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61
was a the instrunatal and social-antimal smart provided by
f-dlies to caregivers. It was anticipated tlnt the more adequate
theswportasforthecaregiverthelesswo‘ddbethesenseof
burda by the caregiver.

thecaregiversareselected franaeof theauthar'spool of
patiats ad fra a local chit activity cater. the caregivers
rudedinagefraafl taOOyears, caredfarpetiatswith
Alsheiar's ad were either spam-es (878) or hunters (138) of the
patiat.

(pa-add interviea ad a battery of iatnats were med for
the data collectia. filo all luau iatnats are utilised atd
incltded Zarit. Reeve: 8 Bach-Petersa's 22-itsa Burda scale, and
the Mini-natal State gmtiansire by Polstein, Polstein a w
(both citd in Scott. Roberto ‘- fiuttai, 196). lbs instnaltal
usistace as assessed by interview ad as casidered in the list
ofrespasesalyaabathrstersabtainingthedatalistedthesa
respase. 'IheinterviasarecadedbyZor3raterstoinsure
internal reliability. the matiansires thaelves had reliability
and validity scores of .70 or better.

‘l‘heresesrchersofthesttdy foudfinacial assistacead
physical tasks were provided the least ofta. a. type of assistace
appreciated ad provided the ast freguatly incltded the provisim
of respitesothecaregivercouldgetoutofthehome.

Chly19§ of thecaregivers indicatedtheydidnotreceiveamgh
help. 'l‘hase caregivers duo were not satisfied indicated visits by
f-dlyaberswereinfrewat, ardthet thereasa lack of
willingness to stay with the patiat. Although a few caregivers

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62
indicated support was inadequate, the majority seated satisfied with
the total smart received fraa faily uabers.

Scott, Roberto 8 Hutta (1986) also fond that caregivers who
irdicatedtheydidnct receiveaoughmrt, slagwiththasewho
received are then aough, also indicated high burda scores. 'lhe
differaces in the burda scores were not atirely clear ad
arrated further investigatia.

Secaaofthecmvaiacesmlechasa, thefindina cauldnot
be gaeralised to other sales. Saver, the results provided
pnliflmryevidacenngestingtheimrtaceofsmorttothe
caregiver. The data collectia teclnigues were very thorough with
edegate assures taka to insure reliability.

ragler 8 Goodrich (1979) fond inforal social smart to be an
influacing factor of life satisfactia. 1hey believed wives were
”victim" as such as are their disabled “bade. In their sttdy
Pagler 8 Goodrich (1979) esanined the special nab ad problem of
elderly wives caring for ”loads who are disabled.

lhe sale canisted of ale physicias ad other health-care
workersdiohadbeahadiceppedadoutofworkforaperiadof
tia. 'l‘heywererecaadedforthevolmteerwcrkshaphutwerethen
radaly assigned to the project ad control groups in the really
Study. The inforatia obtained as part of an evalatia sttdy of
the volmteer workshop in aich these a participated. Part of the
evaluatia dais by Pangler 8 Goodrich (1979) focused a two grams,
thesixirdividalsaoscoredthehighestadsixaoscoredthe
lowest a a life satisfaction matianaire, the SL8 group ad the

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63

Paigler 8 Goodrich (1979) fusd the 111.8 grum had support
offered freely atd fregumtly, fuir of the six stating that their
childruvisitedaore fregtmtlythanuiceaweek. latheuagrup
notmuaeofthesixcuildmtiuithem. 'l‘hewivesintheuB
grup idmtified isolatiui, luielinas, ecuudc hardship ard role
overload as the mat freguntly countered problu.

In omclusiui, their findings suggested that infoml
instrmtal smart was buficial to the well-being of the
caregiver, ad culseguently buficial to the care-recipiut. Eva:
thunhthemparticipatinginthissttdywerenot r-dualy selected
as part of the volmteer workshm. they were still ruddy assimed
to grows for the lazily Bttdy.

The life satisfactiui unstimires swgested that their was a
relatimship betweui hidily satisfied hub-lb Id wives. Mler 8
Goodrich (1979) waited to idotify the factors which could have
inflmced the scores. Eva: W the sqle size in .11 (#12),
wins: the factors Idlich were thuuit to influmoe satisfacticn were
unlined, there were definite differmoes fund betweu the grows.
this increased the reliability of the findings. It as singested
thatfurtherstidyisneededtomnoportavailabletovariun
grams of caregivers fra infoml, as well as foraal, sunroes of
amort-

Gilhooly (1984) waited to id-itify duch factors were associated
with the psychological well-being of caregivers unportim a
dating relative in the mity. flue also united to determine
the relatimship betweo satisfactiui with swport ad well-being.

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64
diagnosis of smile damtia. The depadent variable, psychological
well-being, was measured in two ways, via mrale and umtal health.
'l‘heKntneruoralescalebyMtner, Pushel, 'l'ogo8nmerndthe
mas mltidinlnsicnal Ptncticnal Mt anstiunaire's ‘mtal
health' scale by the Duke miversity Center for the study of Aging
ad m Develomt (cited in Gilhooly, 1984) were utilized.
'l'bere were aultiple indepcdut variables in Gilhooly's sttdy (1984)
including ”satisfacticn with help fro relatives”, daioh is of
interest for purposes of the wt study. A 5-point scale ranging
frun very satisfied (5) to very dissatisfied (1) wu mad for rating
purposes.

Linitatiuis were again related to scale size and the use of a
ncnrudm suple. Also, the wt of satisfactiui with nnport
was quite general limiting the researczher's ability to obtain
infomtiui related to the kind of swpart inich resulted in
caregiver satisfacticn. lhe utilisaticn of well bun instruumts to
measure morale and mtal health were strugtln.

Results nnported premiu- research which fund freguncy of
ocntact with fricds and relatives as not simifiomtly correlated
with nnporters' male or Intel health. flutever, satisfaction with
help received frcn relatives was significantly correlated with norale
(r = .254; p (.10) ad mtal health (r = -.«9; p <.01). Thus
findings suggested that the caregivers' ”reactiuis" to help were more
iuportant determinate of well-being thm the freguncy with vnich
help as provided. flhn trying to predict n1 indiviunl's state of
well-being freguuicy of swpart alcne was not the best indicator, but
amasureof satisfacticnwas recmdedndunsideredtobean

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65

iuportant variable.

'l'o cmclude, it is evident by this review of the literature that
little has bean dare to study the degree of satisfactim with social
swport, especially by muses. Most researchers have looked at
satisfactim in relatimship to well-being aid have omsistently
found in individuals were satisfied with swport they were also in
a positive state of well-being.

Ithssbemsmgestedthatmyfactorscminflmcem
individml's degree of satisfacticn; may, wt of
satisfactim has hen Wane. Researdlers, however, tnve
recomised the influmoe of satisfactim a1 well-being and co level
of hard.) and still feel it is inortant to investigate whether
individuals are satisfied ad idly they are satisfied. Increased
satisfactim m caregivers hm beam related to increased
satisfactim mug care-recipiuits.

For purposes of this study, degree of satisfacticn was analysed
to determine if there was a relaticnship betweu the fremmcy of
amt provided aid degree of satisfactim. I'his informtim will
thmbehelpful indetendnimdntcmbeofferedtoincreaselevel
of satisfacticn lid ultintely ilptove well-being.

lbs next secticn will provide an overviu of stuiies in thich
tin socisl support model, developed by Balm 8 Antanacci (1900), was
utilised. Through this review, the appropriatmess of Kala 8-
Mtamcci's model (1900) for the preset stmly will be presmted.

 

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66
Utilisatiai of the Kala: 8 htaucci lbdel (1M)
Ingersoll-Daytm 8 Antanacci (1988) were interested in the
perceptim of reciprocal Id nmreciprocal social swport m
middle-aged and older adults. It was guarally believed that social
relaticnships cmtribute to well-being. However. lallstcn, Alana,

DeVellis ad Mellis (cited in Ingarsoll-lhytm 8 htaaacci. 1988)
mted the relaticnship betwen social swport std positive
auto“ m not be as predicted.

In red-ling the literatm‘e, Ingersoll-Daytal s Intmucci (1988)
fond Mal esdmgss within a: olbr pqallatim resulted in
feeling of lanlinsss Id dissatisfacticn with social relatimships.
‘lhsir interest was to determine how older individuls perceived their
patterns of reciprocity.

'lhesswlecmsistedof’lla respadnts, SOyearsofagsatd
older. chose: nmrudaaly fro a naticnsl rmtative sqle of
2,458 homeholds. A cross-sectianl sttdy was perforud mating
Iidile-aged std older adults a: variat- issues.

'lhe instants used included a drawing of three mtric
circles to portray those individnls mst Wt in the
respadnt's life. Mans were asked to obtain infomtiai a:
smortprovidedudreceived. Muindeswascmstructedto
assessdnethsrornotnoportusreciprocated. Asimle-itan
uasurewasusedtoobtaininfornticn relatadtonetwortduudatd
a 5-point sale was utilised for scoring. (laurel wall-being was
paired by a single-it- nasure of life satisfacticn ad an index

of 4 it. saesuring negative affect.
Lidtatia- of the stuiy inchded the nmrudaa selectim of

 

 

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67

participants aid the mixture of uales and famles in the surple. It
was suggested that guder lay influaice how an individml views
reciprocity of swport. A stragth of the study was the large salple
sise.

'lhe results indicated tht mst individuals (81‘) felt
relatimships ware gmerally reciprocal. lavever, fregtmtly older
adults fond thuelves in meciprocal relatiauhips and
esperiuced less distress in they overbmefited rather than
Isderbalefited. It was mted tht people adopt a life course
reciprocity perspective with faaily “era taking into account
previom life periods whm thy did are providing tlm receiving.
More, scue balmce us evmtmlly achieved.

'lh differaices in the perceptims of nmreciprocity .mg
middle-aged ursu older adults, qahasise the inortmoe of
calidering social swport relatimships within a life oottrse
permective. Individuals my view satisfactim with swport
differaitly clouding m duo is providing it, fricxb versus f-dly
wars.

In evaluating caregiver satisfacticn with stuport it is
inortmttocmsiderthereciprocityofswporthtwemth
aregiversandthe‘ersofthswportnetworh. Ifthecaregivers
feel thycannot reciprocatetheswport providedtoth-byf-dly
or funds/neighbors, th caregivers fly indicate thy are satisfied
withswportprovidedtothu. Thcaregivers' respmsesnybe
influ-Iced by their feelims of Qpreciation for any stoport, knowing
thymnotreturntheswportatthepresot tine.

Intaancci 8 any. (1”?) loded at social networks of older

 

 

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68

adults to determine infomticn m the structural and fmctimal
clnracteristics of the social network. ‘lhe respcsdmts were
separatedintothreegrowsbyage, arddatawereobtainedmthe
provisim Id receipt of stoport by each grow of individuals.

A national probability saple of 718 indivichals, age 50 to 95,
as selected cross-secticnal ly. In-hm, stmctured interviews were
performd. ‘lhe hiu'archical upping teclnique developed by Antamcci
(cited in mtcnucci 8 skim, 1987) wss utilised to obtain network
structure data. Questims related to functicnal ad stmctural
chracteristics were asked with refermoe to the first 10 people
listed in th network. The stmctural characteristics were quite
extensive incltding age, sex. closuress. years hols). proximity and
fregimcy of contact. noctimsl characteristics were limited to the
mmtypeofswportiveservioasprovidedudreceived.

'lhe findings swgested no significant differmce in size of the
network related to th age of the individml. 'lhre were differences
fond, havever, related to perceived swport reciprocity betweai the
younger Ill older grows of individmls. ‘lhe oldut grow received
aboutthsaaeauomtofswportfrmothersasdidthyomger
groups, butprovidedlessswporttoothrsthndidtheyomger
individnls. 'lhisswgestsmdmgesthatuyoccurthromlrmt
the life-spun thich could influmce a: individml's parcqticns of
satisfactim.

Aspeopleage, thewaytheyviathesupportfrmfudlyud
friuds/neighbors cu: vary. This is particularly true for elderly
caregiversdiosayreguireswport inthir roleascaregiver, but
are hesitmt to accept assistmce. tkderstatding th kind of support

 

 

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69

provided to caregivers and Hlnthsr the support is adequate, my help
researchers to basin mdsrstanding caragivsrs' View of smart
providsd. It was suggests! that furtbsr infomtim bs obtained to
distinguish mt firm triads and fully.
Astmtboftbsstudyawsawainmstbssamlasissmdtbs
wt of Illupl. structural dnractaristics. A lidtstim was
tbs us of a cross-sactianl dssim mung actusl svaluatim of
dun-unwisimofslmtavsrtiu. hotbsrlilitatimuas
tbs limited mt of fmctimal data obtainsd.
last, a project by Witt, Antamcci, Clark, Rattan 8 Finley
(1985) was Mart“ to analyss tbs structurs of social «wort and
its rslatim to baaltb, attact ad lifs satisfactim, wring two
sqlas of tbs sldarly. l'ocus was a: tbs availability of smortivo
ralatimsbips to rasidnts in tbs Soutbltl-Il Bascb araa in
mists: to a natiaial mla. tbs variaticn in may (support)
characteristics was unlined slam with tbsir ralatimsbip to
bsaltb, affect and lifa satisfacticn.
mamtbuidnsacbsulsofuindividnls. mrtbsaqsof
65, was My sslactad firm tilas at a 1977 radsvslopmt survsy
ofall rssidmtsintlnaraa. m1 intarviumoaxhctadto
obtain We, smart ad wall-lasing intomtiai.
mmmtuasursmistadottbrssmtric
circles in micb tbs mu idmtifiad indivicb-ls in tbsir
swportnstm. human-sauna: totbsbiararcbical_
upping dsscribad asrliar. mum qu-tims wars tbm asked to
obtain spacific infers-tics: rslatad to tbs mart notwork. The
masurss of wall-lasing incluisd tbs m “fact leancs Scale by

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70

Bredburn (cited in Levitt, mtmuoci, Clark, Rottm, 8 Finley, 1985),
. check-list of health problem, and a global meemre of life
satisfactim.

m the Iliad Beach ()8) respmdmts, the correlatim between
networksisemdaffectsamestedthatevmtlnnbtbsresidmtswere
less likely to erclmoe swport with flailywers «spared to the

naticnal (I) suple, they did not rqort sure health problals

(JOB-.13, III-.06), or mre dqressicn 003.34, [8.16). They were,

homer, less satisfied overall (ins-.03, Ila-.07) with the auditions
in which they lived. thy, eva in the elderly sesued to
be coping well with insufficimt swport they were still likely to be
faced with the strus of physical lidtetims which resulted in
overall dissatisfactiai.

lhe data obtained frun this study were prisarily descriptive
with no significance levels established for the onerisms of the
two sules esninsd. Differences between the two suples, however,
were lurked and: to sxmest sane ml calclmian.

Io informatics: m the reliability of the imtmts was
provided, but sue specifics of the instants were aim. 1he
ruidm selectim of the sqle cables the fits to be malised to
sane degree in other similar populatims.

'lhepresmtprojectqaluisestheisportanoeofsttdyimtbe
elderly, particularly those within specific settitns or with siudlar
life styles. m caregivers who say have li-ited resources of
swport, it is isportmt to omsider whether tbs swport available
will help to saintain the caregim' well-being. With the
understanding that satisfacticn infltmces at individual 's state of

 

37“.,

 

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71

well-being, it is reasmable to plan a study to investigate mart
utilised by caregivers and whether they are satisfied with the
mo

Stoller 8 [Kali-i (188) eadned the inact of chnges in
older mle's health Id fmcticnal capacity at the onositim of
their swport networks over tine. 'lbis study differed frm most
others in that it as laigittdinal.

A prwability swle of 173 mu, age 72 to 80+, with a
sun age of 78.1 years as utilised. Data were gathered throtnh
perusal interviau utilisim m indsa of network mitim which
incorporated rqorts of assistmoe with Activities of Daily Living.
fin effectivusss of the networks was operatiaislised as a two-
oategory variable (s. or better) Ill (worse), calstructed froa
changes in fmctimal statu.

lhefindims indicatedtbstdthtintbsdllneinnetworksm
mually afiitive. With tin the swport previously provided was
still utilised, but satin additicnsl amt us also provided.
Itwes likelytbatnnportwmfldbemlmtaryratlnrtlm
sdastitutive.

Apatternof miminthenetworkwasnotedudwas
mistntwithtbsnoticnofaomvoyofsocialswportaswell asa
hierarchical pattern begiming with spome, till wing to childra:
udotherf-rllyudfriobasneeded. Ituspossibletbstan
espusiaiintheswportnetworkdidnotoocur, butactivatimof
sourcesofswport resultedinachmeinnetworkmitim.

Lidtatia'as of thestidyutbeomsidsreddminterpreting
thsruults. 'l'hesqlecmsistedof itdividuslsdiowerein

 

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72

relatively good health. A change in level of disability mung sulple
numbers could result in diffeer needs of assistance. In evaluatim
of the change of smart over tine, several variables were not
cornidered, such as socio-eccnauic status, proximity of adult
children and charge in Iarital statm. mesa variables could
influmce the change in pattern of assistance.

To have m mderstuiding of support provided to elderly
caregivers was believed to he of critical inortance in helping to
unintain an individual's level of well-being. In the presait study
it was decided tint an investigaticn of the provisim of stoport was

of mre value than an investigatim of the umber of individuals in a
stuport network.

Norbeck (1981) utilised the model developed by Rain 8 mtmucci
(1900) in a diffemt m. She dunntrated how nursing could
intervals to assist individuals in obtaining the assistance they
needed through the life-span to help reduce negative outccmas.

'Ihestepsofthemarsingproceeswereincorporatedintotlu
model to identify where nurses could intervme. me article was very
helpful in providing specifics a: what nurses could do at each step
of the process. This was the mly article fund incorporating the
nursing perspective into the undel.

In calclusim, through the review of this literature it was
eviduit that little Ins baa: dune to evalmte social moport networks
over time, particularly by nurses. Iva: though laigituiinal studies
would be met buficial, my studies have beat cross-sectional and
are also buficial. All the stuiies reviewed were also focused
around the elderly, snorting the notim that knowlwe of the

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73

elderly' social support network has become a mjor issue.

M
the first section of the literature review focused m the

isportance of the infoml swport network to caregivers. Articles
sverereviuedtodmnstrateinhtwaysthenmportnetwork is
baleficial to caregivers, ways it my fail tonet the needs of the
caregivers, andwhythisismilportmtissueformrses.

'Ihesecmdsectimof theliterature reviewwu focusdmthe
isportance of ea-dning satisfacticn with social swport. Little
has been daze to evaluate satisfactim with swport sung caregivers
undthis reviewwasanattelpt to reoomisetheinortnceof this
issue, particularly for nurses.

its third secticn of the literature reviu was inclined to
misehowtheccncqtualmdel clnoserxforthisstuiyhubeen
utilised until now. The nodal Ms beam utilised to study changes in
smart networks of the elderly, however, very little research has
bee: dale utilising the nursing perspective.

In Chapter 4 a camlete descripticn of the mthodology and
instrmtation used for this study will be presmted. The chapter
cmcluies with m esplanatim of the statistical analysis to be
utilised.

 

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Overviu

The purpose of this study is to idmtify with what fregumcy
instrmtal stoport is provided by fdly Id triads/neighbors to
the fuels spouse caregivers, to what degree the tale spouse
caregivers are satisfied overall with the swport provided, ad
whether there is a relatimship betweu fregumcy of swport provided
ad degree of satisfactim. Specific bachgroud characteristics with
a descriptim of the caregiving sitmtim were obtained to provide
infomtim about the suple.

Inthisd-pterthecriteriamedforselectingthesupleare
outlined ad the data collectiai procecMres are explained. file
variables of the sttdy are maratimally defined ad a dascriptim
of the instnmts is provided. Il‘he (inter cmclides with an
esplanatim of the statistical analysis to be utilised.

D-oriptim of the leseardl Duin

Aseccrdaryanalysisnsperforudmbtacollectedaspartof
a sttdy titled "Caregiver Wes to “aging Elderly Patimts at
nae". fine Ratimal Institute on Aging-alarded a three-year grant to
Dr. Charles W. diva (College of m lbdicine) Id Dr. Barbara A.
aim (College of nursing) at liichigm state thiversity in 1985 to
st‘dy respaues of caregivers waging elderly fdly m at
has.

A longihdinal survey it. utilised to follow: 307 aregivers at
fivepointsintineovertheperiodofmeyear. lbs-inpurpose
oftheresearchwastoes—dnehowthecaregivingsitustimforthese

74

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75

subjects chaged over time.
Specific aim inchded:

1. To describe how the amber and severity of patiats'
flnctiaal , "til Id social limitations were related to caregiver
involvmt Idperceivedburdaof care, Idhovtheseareluediated
by the econcfic resources of the patiat-caregiver dyad Id the
iactiaal, mtal Id social resources of the caregiver.

2. To describe, over tin, tlu interrelatialhips betwea
patiats' liIitatias ad caregivers' health statu, their
involvaat in caregiving, ad their perceived burda of care.

3. To describe, over tin, how patiats' li-itatias ad
aregivers' health status, involmt in care, Id perceptions of
burda predict the mat and type of health care resources utilised
Id patiats' imtitutiaalised.

A retrospective approach as med to collect data fraa, arng
others, 80 fIale spouse caregivers age 52-80. ‘lhe survey
guestiasnire as developed to assure the fregtmcy of instruaatal
smortprovidedIdthedegreeofsatisfactiawiththisswportby
caregivers. The maestimire as abinistered in the caregivers'
has by trained data collectors.

Cross-sectiaal datafraflaveSoftheabovesttdywasmedin
the present descriptive research to deterane the freguacy with
aich instrumental swport was provided to the fule spome
caregiver by dey Id friads/neidbors. lest, the degree of
satisfactia with the swport provided was ascertained. Lastly, it
mdeterdmddnethertherensarelatiashipbetweathefreguacy
of swport provided to the caregiver Id their degree of satisfactia

 

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76
with the support.

Jule

mm of mm

its target populatia for this sttdy as caregivers providing
care for a iaaired elderly fIdly “er. its initial mle to be
acreIiedwasobtainedmingavarietyofsourcesIdathods. The
mjor sources used to locate subjects were health-care agacies.
Over250agaciaagreedtoassistinrecruitmtIdofthose, 34
were utilised.

lheathodmedtorecmit caregiverstbjectswasacard-bsck
systa. Ibis systa muted of a m sat to individisls
inguiringdnethertheyormtheyknuasafdlycaregiver.
If so, theywereukedtoail apostpaidcardhackwith infomtia
aabling contact by the research staff.

To ahace recruitmt and to facilitate networking for the
project, extasive pnblic relatia activitia were outdated. A
press release was sat to Ilichiga newaaers ad M“ of
the project were punished in my misatianl nIIletters.
Additiaal mm“ were ads at local ad state-wide
caferaces.

All irdividmlsdiorapadedsecadarytoagacyoatactwere
catatedbytheresearchpersanel. l'ollowingtherapaseof
potential subjects, phaecatactas-debytheruearchstaff
within two weeks.

A total of 815 caregivers were interviewed by trained Clinical
Nurse Special ist sttdats for participatia in the longittdinal

1..- rd: '

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signsa

6.3qu a £31551 io imam: Lilli“:

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77
study. Of this crow, 307 caregivera met all criteria for mtry into
the lauitudinal study and hem part of a nmrandaulzed,
nmprohability scale. 'l‘heae participants had hem caregiving for a
mean duratim of five years lid were thuelvea in "relatively good
health".
the criteria for mtry into the atuiy incluled (a) caregiver:

uhouthecaringforatlailynwerovertheageof 65, (h) the
idly “er had to he deficit in at least we Activity of Daily
Living (mg. toiletinp or dressing) or Inetmtal Activity of Daily
Living (ea. truportatiai or food preparatim), and (c) the

caregiverhadtohetheadmledgedpri—rycareuivertortheir
relative.

.11 19: gm! mum

Of the total rule (#307) aalyaed by div.) 5 (Sim (1985) for
trait study (Grant 81 moi-m), eo tale apome caregivers
raining in the study at HAVE 5 were utiliaed. lbe was included

inthiaatmlywerethoeecmtimiingtoprovidecareinthehcueat
the laatuaaureof theatuiy.

hta Galactic M.

Participate were inforud by the research ataff tint the attdy
they were volunteering to participate in was a lanitulinal atudy,
thichwould involveaeveral matters W theyear. 'l‘hey
were told that Wing of any queetian nae volmtary ad they did

nothavetoanauer it theypreferrednot to (hppullixn). Btatmta
of cmtidmtiality were diacmaed with the participanta and an
interned mt form we aimed (Mix 8).

 

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as bus ajasqizviiuq 9d} mm [>92me emu villain-abduct) in

.(8 xghraq-m) bfmpfa 3.514 mm} iuuawm tannin:

 

78

The majority of the participants received an in-hale interview
and convicted a self-administered booklet upcn mtry into the study.
Participants were thai cmtacted by phme at three, six and nine
math intervals and were also asked to caplete survey instrmts at
two of these data collectim points.

‘lhesecmdarydatamedinthisstudywasthelastoffivewaves
ofdatacollectedovertheperiodofmeyear. fiasfifthwaveof
data was utilised because, the assistance questimire was
adainistered at this point did participants were also asked how
satisfied they were with the assistance they were receiving. 'l'he
collecticn of the lat wave of data took place in the caregivers'
hue approxintely 12 tenths after the initial caitact wu undo.
8am dsmgraphic data was collected citing the first phase of the
lalgitulinal study and will be presmted as it relates to this
specific study.

'lhedatamedforthisstulywassecmdarydatacollectedbya
variety of indivichals. To help sinimlse incmsistmcy in the data
collection process, data collectors were required to attud at least
two, three-hour training sessims. During the training sessims,
mastimsregardingthestudymreaddressedandaprotocol bookwu
explained in detail. Debriefing sessions were also held to dime
problue watered during specific interview sessims.

To initiate the last phase of the data collection process, a
trained data collector cmtacted the caregiver by plane approaimtely
ale wed: prior to the intanded lusting date. In mat instances the
data collector wu the sun individual who hed previmsly interviewed
the caregiver. A convenimt meeting time was idmtified by the

 

 

 

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__—‘_I—" ‘1’.—

 

 

79

caregiver.

For the larger research project, quasticsmaires with a few opal-
anded item, but prinerily closed ended it“, were set to the
participate prior to the interviewers going to the caregivers'
hens. The caregivers capleted the follating self-administered
guestianaires: (a) the social provieime scale, (b) social resources
scale, (c) currmt feeling of the caregiver, (d) bdiaviors of the
relative, (e) caregivers feelings of how caregiving has inscted
his/her life, (f) instruntal activiti. of daily living of the
caregivu, and (g) self-care practices of the caregiver. lane of
these gmtimires will be utilised in this etdy.

mrimthalslevieitagmstianairemunisteredface-to-
face by the interviewer to the spouse caregiver. lhe following
inforuticn was obtained for was of the larger etuiy: (a)
background infometicn, (b) physical health of relative, (c) physical
health of caregiver, (d) health service utilisatia: by
caregiver] relative, (e) mat of assistance provided to caregiver by
others, (f) satisfactim with aseietmce fraa others; (9) assistance
required by relative, (h) spouse finances, aid (1) caregiver
finances.

The data regarding the (a) background infomtim (Appendix C),
(e) the aunt of aseistmce received fra others (Appendix D), (f)
the caregiver eatiefactim with assist-ice provided (hppndix l) and
(g) the mat of assistance rewired by the relative (Appmdis c),
were utilised for this etuiy. Prior to my data analysis, the
University admittee a: Research Involving m ”jects approved
the utilisatiai of the idmtified sqle for this project

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(Appmdix F) .

weratimalisatiaa of Variables
nulls mm m m
lucareoiversinthisstulyuereuives‘dzoadmmletbedthat
they were the primry caregiver for ”hands in were debilitated.
'Ihe characteristics of race, age, and wloymt status were
determined as indicated by respmdmt. “lent status in
determined at the first, third and fifth cmtact.

W

'lhecare—recipientuesahnband, 65yeersofageorolder,uho
was imired in at least we Activity of Daily Living (All) and/or
Instnlmtal Activity of Daily Living (mm).

M an:

In this stuiy instnmtal smart was weratimalised by two
sets of sevm statute which rqresmted behaviors apportive to
the caregiver in providing direct assistance in the caregiving role.
11:. caregiver was asked how oftai assistance had hem provided over
the past three mths, first by ffily and than by friends/neighbors.
Miners were recorded at a four point scale including 1) rarely or
mofthetime, 2) saueofthetiln, 3)uostoftlntiue, and4)
almst or all of the time.

line followim list mists of the instrmtal swport item
which were masured.

. Helps with physical care
. Keeps relative my

Provides care for relative for short period of time (hours)
Provides care for relative for layer period of time (days)

QUNH

as Lin: 1m] to no r is: l I 311201.15 I9qO

(29v: 3) ‘Jfi'np‘IJSW 9:13:12.

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81
5. Has gotta: up with relative at night

6. Helps with transportation
7. Helps with provision of my or unterial goods

m of mimic:

fine variable of satisfactim was operatimalised by two separate
questims. ‘lhe caregivers were asked cmeetian to determine overall
how satisfied they were with the assistmce they were curmtly
receiving frm family and than trim/neiglbars, to care for their
relative. ‘lhe moors were recorded cn a four point Likert scale
raging treat 1) very satisfied to 4) very dissatisfied.

Instrmtatim

There were three sources of instrmtatim utilised in this
stuiy: (a) guestiamaires to obtain background inforuatim about the
caregiver and care-recipimt (Appodix c), (b) guestims to obtain
infornnticn a: the caregiving situaticn, md (c) m assistmce
gueatiMre developed by Given £- Gim (1985) fron which
infatuation regarding social support provided fran fuwlly and
triads/neighbors was elicited (Appmdia D). 'l'wo simle-itaa
guestian referring to the degree of satisfactim with the swport
provided were also included in this guestiomaire (Appaidix E).

‘lhe baclngromd informtim was obtained fraa «pastime related
to sociodemgraphic informtim which included age, and race of
caregiver and care-recipimt, and alploymt statm of caregiver.
'lhe other backgramd inforuetion related to Activities of Daily
Living (ADD) and Imtnmtal Activities of Daily Living (IADL) was
obtained from the caregivers respmses to mastims inquiring about
theanount of assistanceprovidedbythecaregiverarotherstothe

:44 f

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82
elderly person. To determine depmdency in ADI. they were asked
guestims such as, "Does you relative need help with eating, or
dressing and mdressing " Another included ”Does your relative need
help with bathing or toileting?” ”parses to the questions were (1)
yes or (2) no.

Pneuleafaguestimtomedqmdmcyinlflis: ”Does
your relative need help with cooking, arranging tmsportatiai,
shopping, latndry, homework, or hmdling of my?” RespaAses to
these question were also (1) yes or (2) no. An index was calculated
by totaling the mater of Wes of the are-recipint that
were reported by the caregiver.

Infantim obtained related to the caregiving sitmticn
includedduraticnof careudreasmfar care. Duratimof carewas
aeasuredbyaqmstimmichaskedthearegiverwlmshebegmto
provide direct care for the elderly individual. Reasms for care
wereobtainethhecaregiversansweredtheguestion, "Hastherea
specific health probl- or illness that led to caregiving? If yes,
that?”

Reliability all Validity of Assistance Muslin

M11

Reliability refers to the degree to inch the research
instmt produces cmsistmt results or data a: repeated as
(Wilsan 1989). This is met fregumtly related to the
investigator's ability to stlidardise the praaewre for aduinistering
the instant.

'l'here are three ways to assess reliability. 'lhe aspects of the

 

 

 

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83
reliability cmcept nest oftm assessed include stability, internal
cmsistency and eguivaluice. Stability refers to the extant to which
a reaeardner would get the sue results m repeated achinistraticns
of an instalmt (Polit a lhngler, 1983).

'lhe seasure of reliability by internal cmsistocy refers to the
degreetandzichthestbpartsoftheinstrmtalluasurethesm
dimim or attribute (Polit 5 mngler, 1983). Crmbach's Alpha is
fregumtly mad because of the ability to me tln
interaorrelatim of all it. in the scale siuiltmeamly. me
caefficimt cm range fraa 0.0 to 1.0, with the hi“ values
(.7,.8,.9) dnoting greater reliability.

Itaa-total correlatims are also cmsidered vim determining
Idiich it... “I eliminated. .y help to iwprove Crmbach's Alpha
ad th- overall reliability. This is a fmctim to uasure the
degree of interrelatechees m it- in a scale (Heat a Gatansaro,
1988). It cmsists of a m of single correlatims betwem each
it- and the total score of the attire imtrumt.

lguivalmae refers to the degree of sililarity betwen two or
acre farm of m instasmt (Woods 8 catmsaro, 1988). Having two
eguivalmt fares would be of ispartance if an instant was
achinistered a: several occasiau in a short period of time.

Decamethecurrentdatasetcmsistsofcnlymecross-
sectimal wave, stability of the imtmt could not be unlined.
Also, forpurposesofthepreamt studytherewasnoneedforuore
thm me versim of the imtmt. flan. the installmt's
reliability ms evaluated by Mudning its internal cmsistmcy
using Crmbach's Alpha with consideration givm to the itm-total

 

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84

correlatims. The Alpha coefficients obtained were .77 and .73
indicating sufficient reliability. No previom reliability testing
had hem daze with this instant.

mum

Validity is the degree to which an instalmt assures what it
is expected to measure (Polit & Burglar, 1983). Ila previous validity
testing had been dme m the assistance instrumt used for this
stuiy other that testing for cmtmt validity. This masticaxnaire
was initially developed for the purposes of the stu'ly mdertakm by
Give: a diva: (1985).

'meinstrumtwasdevelopedandreviuedbyapanel ofeaperts
in the field of caregiving. Various alteratiau were nde in the
instant based at the review of the literature as well as
interviewer contents. No attqpts were nde to m criteria: or
cuntruct validity. For purposes of the preeut study no further
validity testing was required. mu, there is limited criteria by
which to determine the validity of the imtrumts utilised in this
study, resulting in a limited degree of validity.

Data M for Exposes of minis

In the statistical analysis descriptive statistics were
utilized. 'lhe backgromd characteristics for the aregivers (age,
race, alploynmt statu), the care-recipimts (age, race, outer of
ADI. and mu. depaadmcies), and the caregiving situatim (duratim of
caregiving, primry reasai for care) were collected and prescited
in freguaicy distribution tables.

To answer the gustims, "Ilhat categories of swport are

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85

provided by flldly timbers and triads/neiglflaors?" descriptive
statistics were utilized. A neon fremaency score and standard
deviation score were determined for each of seven categories of
smart. the table is presented represaiting the swport (run

both sources of support, f-dly new.” all Erich/aim. lhe
categories are listed in order of {regency of swport provided, frau
met (rem-3t to least tremmt.

The caregivers' degree of satisfactim with the overall smart
received trcnbothsources ofswportwereelsopreeutedine
frequmcy table slang with a m an and stulderd deviatim score.
Mmuenmdstmderddeviatimsooreswerepmted torthe
degree of satisfacticn with smort received, firm f-dly md
triads/neighbors, respectively.

To determine the relatimshipe between the categories of
imtruemtal swport provided and the degree of satisfacticn with
overall swport, the Peerscn product-mt correlatim (r) u.
instituted. m. statistical eethod of oorrelatim 0“ selected
became of its appropriatmees in analysing the relaticnship betweax
intu'val data. M the relatia'nhip nelysis, the swport
provided in. fully ‘ers lid fricxb/neidbors we analysed
mtely.

Initially. reliability testim was dune by even-ting the
internal mistuoy m the categories of swport. Crawech's
Alpha m canted to deterdne the reliability coefficimt. Based
on the reliability ooefficialt, it us than detetILned whether a
reliable scale could be developed firm the categories of smort.

Next, it- by it. oorrelaticns were pertomd. Ibo man score

S

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'a‘ ‘i A'- - eh‘~\\;a'e'

86
of each category of instrumtal support was consisted with the mean
score representing the degree of satisfactim to determine a
correlatim coefficient. These analyses provided infomtim
regarding the relatimship betwem the variom categories of support
and the degree of satisfaction with overall swport.

Using the scale developed as a result of the reliability
testing, anemscalescoreusdeterdnedndlns thucorrelated
with the nu: score mresmting degree of satisfactiai. A final
correlatim was dale to ermine the relatimship betwem the swport
provided by fudly and triads/neighbors.

I.”

Inanter Nadiscuesimofuthodologyuspreented. I[he
lejor secticns of the chapter were:

1. The research is a descriptive study wing a survey-type
design.

2. The utilisatim of secaldary data was Qloyed III a
description of the data collectim prooetnres were preeuted.

3. The operatimal definiticns of fnle spot-e caregiver,
care-recipicxt, instrmtal apport and degree of satisfactim were
identified.

4. The instants med included the «pastime related to the
beclngromd infomtim, the caregivim situatim and t1. parts of the
assistance guestimire dealing specifically with the categories of
swport provided and the degree of satisfactia: with Import overall.

5. Reliability and validity was shone: for the assistance

questimire.

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87

6. Descriptive statistics with the Pearsm product-nunmt
correlatim coefficient were utilized for the data analysis.
In dnpter V the data will be prasmted.

 

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M5: ”MIC.

Over-via

'l‘hepurposeof thisstudyastoeunethefrequacywith
which certain categories of instrmtal swport are provided to wife
caregivers and to evalute their overall degree of satisfactia with
social stoportprovidedtotha. 'lbisclnterwill catainthe
stuly's results. ‘

The beckgromd characteristics of the participate will be
preeated slag with descriptive data of the caregiving sitmtion.
Data to address the research guestias will tha be preeated. 'me
statistical athob Qloyed to preeat the data incluie frquacy
distrilnltias. percatages, mates of catral talacy. standard
deviatias ad correlatiau. A deecriptia of the reliability test
performed a the "assistace" guatianaire will also be included.

A reliable scale of swport categories will be praated to aable
further statistical testing.

Rants

Adescriptivestulyasperforaduingthes‘bgrotp of
caregiving wives (#80) frm a larger project mdertaka by Giva &
Giva (1985). m queetias to be eaained are as follows:

1. flint categories of instmtal swport are provided by
faily m ad friatb/neighbors to wives in are caregivers?

2. flat is the caregivers' overall degree of satisfactia with
the swport fra fdly was ad friab/neighbors‘?

3. flhat are the relatianhipe betwea the categories of
instrumtal snort provided and the overall degree of satisfaction

 

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yo behLvCJQ 215 jlcq;u3 lb‘huflliJZFI to aoixcyajso 3;“. .1

("I ' I'". h ‘ ‘ "" . ‘ o :I . -.A\ .' . t n ’ ,'
1&1-"-'~L"’ir=-‘ ”It: M‘. awn-l v1 .1 1h -. £‘~11\-;.;!'3;11 his. ..I amt/1 \v :1 vi

dixw noximzlaijba 30 955p k Iibxevo 'Elvviyuifiu adj ai judw .S

Vv udnvxua\abn9t1! bus erwfimvu {Innattnvll tiuqup 5;}

a":

30 i-L'VIJI’qL'BjLO 911'? JET-B‘is‘aij‘v.‘[ C-gut'ijJLI-J! uni) "19:: fluid

‘ .1'?I..2 tr) is-upfi; l[.-_ x mm 2.311 [-.na [win-Lg." - tr; ism-.2515. I: h: ”1;. .u:

 

 

89

with support?

A discussia ad interpretatia of the results as well as
iwlicatias of the research finding. will be preeated in Chapter
6.

Walkman-ls
Immanuel“
anracteristicsof thearegiversea-inedinthissttdy include

age, race, ad aployaat statta. alaracteristics of the care-
recipiats eaadned in this sttdy inclrded age, race, ad meter of
depadacies in Activities of Daily Living ad Imtmtal
Activities of Daily Living. lbs bedugroud claracteristics of the
participate are preeated by freguacy distributias, nears ad
percatagee in Il'ablee 5.1 ad 5.2.

m 'lheaaegeoftheoaregiverswaeflfiyears. Gatofthe
aregiverswereovertheageofGSyears. 'lhecare-recipiatstaded
tobeaproxiatelySyearsolderthathecaregivers. 'lheaeanage
of the care-recipiats was 72.9 years. A reguirant of this study
was that the care-recipiat be at least 65 years old.

n the caregivers ad oare-recipiatswereatcheda this
variable. The ajority of the caregivers ad care-recipiats (n=78,
97.5” were Cataasia. flue raining (382, 2.5‘) were Bladt.

mm Ofthewcaregivers 73 (91.2‘) werenot
Qloyed. A total of 7 (8.8%) were either caloyed part-tine or
full-tia. (see Table 5.1)

~ ‘y. 3.. VlfiyVF'E' 5" f“ —_,

 

 

0' e ~~’- - e .'e o . fl 5 ... e ;
4‘1. [.31. a... 7.711;qu -’ if - 2.. 3.. “u . 22'

193-324. ’ r1. h—tror—xq ad 11 w 44:41. xii n'.~1.s~w.+'g - i' 3 ..1 .17 7). ‘ 3'1

slqmsf: vbu 3, ad: 10 aoqu3'ioa-L'sfl
eiasqioijisq ed: 10 aoxsaxuejoSISdb bnuozpflosa

tmuiw. .:m't .:t [Hawaii 413"“ 91m"; x? l) -.1 ‘(.L n ..~

n ‘ r‘ -; ' .. ' 1“\ I" ‘ ‘* , ( ‘ r ,
.2 - .'JA. 3. c";ji'.11‘:‘l hitu. .LJ"f.'e 7.._'.‘ .‘ ...w inn. .‘ ' . .1;

V . 7 ,. I J
1‘35}: {Has . "..i . . ~’ .'1 ;.il L" 3’ ’1 {T 1 1 . . ~ . f. , ‘
LILTII'J‘HLU‘: ’ THU) i. .“.'Iu "lib; f" '_' ‘. ‘. -. 6 ' .‘I . ..- s -l‘ 5.!

.2.” [411-3 [.' LAIRT 1:. "1n '. ‘ s

:5... Jr“: nnmrf .42 ~( ‘1 tn .» . H.214 1-' 1
"Y! ’ ' - ' 3 — .. .. .
1H ‘Nll .( I- 'r ' t 1-.' 1" 4.17 s I As. a. If ‘ ‘A K 19’ 1:.0‘11' ’3 3 i ‘ I ‘ +
‘ ~ a a a {.‘ 9 O
.1 l h- -..s“‘11.'f: ‘l A .. “I ... I- ' ' 1" ' ‘1 ' ._ .' 3

‘ ‘I --r f < r- - . ‘:" .
..L) . '1! hit! :K‘MJ 'l.:l1f'-:. .3“. "31,1: 5’214. gl‘l'l : 1n - ‘i.’.n ”v.53

.ai-gf . .f ‘1 J in... :;‘.v"a=..'-"n*w;-”.\ Y M .’ x '. .:n ~.:"." .--{.1 "

.«i r 1'? ...-1,. muff H.-u’} .'rrtysy 1 " a~ . ‘ ‘

. .2 {"2 ' . mix: L .: .CU’ZI'JL‘Z T313261” .3“!
.:II: {:1 n.~ MY: arsyih \I .'t~ .ihtipm

 

 

Table 5.1: Iacbgroud Garacteristics of the (hregivers ad

 

 

Gare-recipiats
Caregivers Care-recipiats
(Ir-80) (11:80)
Age flea =- 67.5 years flea = 73 years
Range = 52-80 years Rage 8 64-88 years

8td.Dev.=5.3years 8td.Dev.=6.5years

hce Canasia = 7807.58) (hacasia = 78(97.5%)
Black 8 2(2.5\) Black 8 2(2.55)

”loymt Statm lot aaloyed 7361.28)
Part-ti. 5(6.38)
Pull-tine 2(2.5\)

ulna-113W fil- cere-recipients
required assistaoe with a average of 5.3 Activities of Daily Living
frca a total of ta activities. ‘lheee activities incltrhd eating,
dressing, bathing, toileting, outing hair or shaving, walking,
getting armed the home, cleaing following incatinace of urine or
stool, ad getting in ad out of bed. lore tha half (52.55) were
depadat in at least six to ta activities.

Ira a total of 6 Instrmtal Activities of Daily Living
assistancewes reguiredwithaaveregeof 4.8aswell. ‘lheee
activities included cooking, tramportatia. m. laadry,
homework, ad hadling of my. Nrtherare, are tin: half (55‘)
were daadat in all six M's. Overall, the care-recipiats in
thisswlewerequitedaadatatheir caregivers forbothAILad
IADL (see 'l'able 5.2).

bas aIsVLpezsa 9d: 30 aurjaxjsjsszsda bnucszvba :I.E eldsT
ajnsqujaz 9153

: is»? . - .i- ‘4 ' ' : :1 -
p: , :2: to ~.) ' n_.:.~:i . ~
:13- 6.5 : ..3'.! .£.:- -3.IF':~,: {.5 : 1 I if;
{((j I‘d-s - I II \_I II) I\ :-I If.
36ft}: .1."le 1‘. I - .-
‘ I ' s . I I J ‘1. I
~ It . pk; I 61.1 I .113."
'. {I I " I 11'.
E h;- aria-'91- 1 .1“) 137'!" .‘I'IEIHIOEE"E°JD 341‘ '30 8'3"."51’3 XClEGE‘SEC
m.’.‘vt.l {USN} It!) 89-31“.va ’1’. 8.6 1 1 ..~ : :n- min! 3143.-.‘ .r- . : do, -.

.pnxjna rennin”; Parixvzj'b c it ..w. i .7.i ' ‘ Ar' 1 r. "
.{u' {inn} .‘.;.’\.'.il". 10 135-" 1+?!" ‘ ‘71:! ,T I-iai {.1 .l '.'~

10 snizu Io 9'r~“::auon1 Lflifiiii’

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t a.

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91-14 ( 1 ii..-i uni} ennM .'r‘vari in mo in. .11 '*~ Mr.)

’

.:_ '.-::.UE.[ wart-Time .1.‘-:L.’z-l 3;. .. :. .-~-1f.’i' ; :-.
r~ 3— . - . . .. .~- .. .. .. . . g . . .. . - «
(ETC) 3.5.". 1121i, 9101 .Sliuili'fd 41]": .~ 7‘ L. ‘ " - "— —I ~- I '

{It am-atqz'wn an." mi) .Hmvn. ..2'.

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Eur. .11.“. did ‘10? 815.74.)“.19: lit-Ii? .12, hr-

 

 

91

'l'able 5.2: Daadacy statta of the Care-recipiat Including
theheguacyadl’eroatage of Daadacdee

 

 

[Outer of

Depadacies Preguacy Percatage

m 0 8 10.0
1-2 . 11 13.7
3-4 12 15.0
5-6 16 20 .0
7-8 18 22.5
9-10 15 18.8

I
:0,
8
'3' l

m 0 5 6.3
1-2 6 7.5
3-4 11 13.7
5-6 58 72.5
flea =- 4.8 80 100.0
Std. Dev. = 1 8

ma Win at lib m am

mum: W characteristics are mm to provide a
catest in which to mderstad the caregiving sitmtia. these
characteristics include chratia spat providing care ad the primary
reasaforprovidingcare. finderaoteristicsofthecaregiving
situatia are preeated in 'l‘able 5.3.

mam. 1h- ltrout parent-wot car-91m (n=46.
57%)lndprovidedcarefrm1to4years. lheduratiaof care

ragedfrcnltoGOyears. 'lheaejorityof caregivershadprovided

“-"' -""I—mr

5 ohxvouq OJ Laineaejq 915

pnibulonl ineiqiosz-9153 ed: 10 aujsja yousbasqea
asionsbasqefl io epsiasoxeq baa voaaupexi ed:

:S.é eidsT

 

Maw—r ‘eaflo

r1171. Ill )3 1 VI

'— --.—- -‘-.4 -- —_—-_—.— '*--‘—-‘ “—.....- 7-..-

m4mm
'40
H

V‘ .
’1

--.—v‘ ee-q

0.001

YI.'ZI{'li}p-' a 1'1

 

C0 M 02 W
I}; rm.

.-.—- ‘.

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H: .‘Hflnl «161

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CD '3' '7 b‘)
_ : a
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ft:

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at' I;

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2~ 1
b-£
r) .3

8.0 =
4 .vad

mean
.biii

noiisuiia pnivipersa adj io aoijaixsiosxsdD humorpflosa

.‘1‘22'4' HI

a").‘.17:'.":‘-+T~fi1£d .- I.IJL.'().‘;_~.4‘ mi

.nnzjsuita puIVLpHxhw ad} bflnlh

iriz.

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him” 01’ 11.1 I12

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w 111 7): "9:11."!

Y.nni11 adj Lu; e1»? QHJIruu41 in 93 fl‘ijitbh abuiuul Loijajjafiwlxwdu

outVLnetsu ed} 10 QJtizixajfis; in 9d?

.1? 11)

fii'lb') 10 (101313? Ill?) {MT

3315..) Quf'nt‘figi] ‘13:? {EucF‘fi-Ji

.£.8 aldrT at bejnuaejq 91f n01?tu:xa

:21 mtp'a'mr) in '-.'fl_*blxl"")I“='{ Laud mi?

.3353 10 HOITAHUU

.21531 P 01 I ”WEI! 3353 bwfiiuuzq r,d {.

LaiijJq bfd uzevipvusu io Y7IJULHH adT

.EtliA-o‘; Ufa (3.1 1 mm} iwgrzrw

 

 

92

Table 5.3: Wand Wu of tho Our-gum
Bitmtim

 

mumminungnm. mungthQQ, awake

1-2yrs 22
3-4m 24
5-6yrs
7-8m
9-10m
11-12m
13-14yra
15-16m
20-21m
x!“

N
O

a I a
o Hnnnuwu
“‘8
EPPP9???
0000000000

g |
0

Mom mum = 5.2 yrs

 

Emmamumflmgn nmmmz
Strm 29 (36.2%)
Alshoimr's 11 (13.7”
Putnam's 9 (11.2”
Heart Disease 5 (6.3‘)
Mtiplo Sclerosis 3 (3.7‘)

3 (3.7\)
m 3 (3.72)
0th.! 16 (20.0‘)
“in 1 (1.20

80 (100‘)

m.mtmmrandedtotlnmtmth.

 

w as ‘7“? “-..

 

 

Qnivipeusfl 9d: 30 aorjaixeTstsdD bnuoxpflusa :£.E sldsT
HOLJSU113

Q | -v. . '\ - w D ,
, - £1 I ') t‘Lf' L) .3 - L-l') 1 .— ’ - - a;

q‘.
\ 2. §-. 1.1.? ..
l "' 1 ¢

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I. ' CL‘.’U{_‘-’
, ‘3 .. r _ ~'
J‘ ' K 6.13.31 I}
‘.l (“.1 L!
0.3 C 2 . ‘ f
- . ( .
[~‘a \ -V‘A

‘ ‘l | ' ‘. 1 llf ( 31 ' . '1
’ 4 o J :
- 1‘1 . 1 w ,1 1 X-x x
‘ ‘ t I U4. ‘: .
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{1%, \ ‘ 11 C. ' —‘ . M
[l I ‘ “'1': ... q
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' lL'l

 

93

cereior leutbaGyeerswithonlyeiewoeregiversaolndbea
providing cere for a utmly lcng time. all! ae'ceregiver bed
providedcereiorGOyeere. ceringioreduretimoi3yeeremthe
met ireguat reepaee (n=16, 200).

nun-nun. Strobe“ tbeaet om (31:29,
36.20) pri-ry reeea ior cere. followed by Alzhiar'e (gr-11. 13.7%)
ad Perkinoa'e Dieeeee (1189, 11.20). Other illneeeee including
beert dieeeee, w. diabetee, ulcer, irectured hip, llnltiple
Scleroeie, petalegic. ad poet-op caplicetlme were eecb reported
by leee tba 7t oi the 8‘10.

nun-mm
Mainmpoeeoitbieettdyuetoobteina-nretothree

«nae-um. findeteobteinedtoauertbeeegueeumeuillmube

preeated.

m 1
“lat cetegoriee oi lutrII—Itel’mt are provided by iadly
new». ad triads/helm: to ulvee ao ere oeregivere?

'l'be oetegoriee oi instant“ ewport received it. idly
“here ad triads/mm, elag with their ma ireglmcy eooree
ad etaderd deviatims ere preeated 1n 'l’eble 5.4.

Inreviewoitbedete, ewporttotbei‘leepomeceregivere
irm ia'lly “or: ad friends/addicts an ion! to be very low,
it it oomrredet ell. 'l‘bereaireguaciee oi eechcetegory oi
animal ewport received ircn idly Iii-bore raged iron 1.04 -
1.75 (I: 80). the ma iremaaciee oi eecb cetegory oi instrumental
support received ital iriab/neiglbore raged iron 1.00 - 1.47

7 *— ."~' V“? N _w"--_—.._.

 

Head. bid on”; 31:. wag-12.2» w-x'i 1. 111110 .:*-'w . .rwg -1 :u ..w, 1. . ~. 1. .' :
bud xnvzvawnfi aJu {Inn .avif puuf {L1r,ttA1 as to! anru “Uidz'al”
9d? aiw satay t in nnIJbtub 5 no? pdlfilj .aj£sv 04 301 25:3 IHIL’- 1
.(;.w; .1i'11) a‘ma.1 at Li‘Ufflvtl Jl'ui

.9911? momma) 35mm 9511 3.er mflz-Jfii‘. .EEAD 80‘! mafia Yfifilvfifiq
(3V.ti .Li a) a'1wnzadxffl vi bawollot .3153 101 nognal YlfiJ-'q (32.09
pniiwltmi 233 2911111 191130 .(cf'...[j. .9-n) away] 3'“. ennui Ins
alquIuM .qzd bnxulvnat .IBUHBD .:n?=1.t£:.suena¢f¢ws .a-a«2.L 31n~d
Ia310q01 dose e19w ancijSI-gan 1u~1awq bur .:;p91]::rq .ajnujalz.

.'-%:-§""3.”. “-.‘23 in m-zi? «'1'."1l v'i

2.1101339qu 119359393
mm 03 axowans muslin 0.1 2591 ngJa am? to esp-.1103 an“: «if
94 won Iij snot: «up seed? IQWLUE cj Lnn1L+dv flflb BAT .Lu0111MVp

« hi4»... 11

1 {101383119
{(1.12 vii hvhivgxq '31.". 33.711111 [.:‘.1'{‘{IEJI".;;J( I» ..:{J.;.r>.r.?..') 31441-3
7:;xw.z_’rp€~3£~'3 531.6 ofiw a-.~~Jiw 01 CifdgigI‘JH‘I‘hI: .4} tum. ;,s~ ...:r ~.n

{Irma} mu} tawny): 310'1‘1'53 [hm-«35111241: i) .-; 1i.1"1;~')J.-v.-1 mi."
{.91"i"8 Y"»r191r;ezi Imam 115d: dine ((1011:. .muid;1n;1\:-f.ic-. 13 L1»? .1542er
45.8 shifl‘ {ii inhumauq 9m .:-1 ui‘: its-J; 6.1.131... ;.,; 1:11..
2]HV.Ip"-1’15'3 531':.1:: 9181.12”? mi} (3 14.11143. .M-f'v “1"} ‘1... u in“! :;
.w:)[ 1113'.) PM. a? haunt LVW ...‘11«'ni.igi«.1\.,.:x ..«r .i im. "1 «Raf-'1'! ',’1' 24:1 .63 .I
3.0 Y'Jcigivixg' dis-:1 it! :—--~L'-u:«111-~13 £159.". 42.? .Eu. '1 I Win ff 1.
{-0.1 {Tu-ll [smzsx £11 a . ~:l '~;l.r_.fr'.} mat [31,.“ « 1 u ?. 1.; . L; .r.. 1? 4;.
[k +(z';wn'1.‘.s=..1i 71. ‘{1('.‘p'e'b') .v-x~~.~ "m t‘t'g':;;“~t'r.-u.‘i m»: 03.13" .-.L'” 1:5 «“121

”Ml ')(~‘.[ I‘Jlif £73651“! 710.1115;I‘MI\f’.E.:E-‘si'1.1 mn'ii i H.111: 11 7%

 

Table 5.4: Provide: o! Intrutal mt by “I, did

Print/Id.

 

 

Mly (F80) trim (#80)
Categories of Mitt
I an I! so
1. mt time keeping your
relative my 1.75 .70 1.47 .68

2. Stayed with your relative
so you could do scathing
else for a few hours 1.51 .69 1.29 .60

3. Balped with transportaticn

(for either you or your '

relative) 1.50 .84 1.29 .66
4. Helped with physical are 1.40 .72 1.25 .65

5. Helped with my or
other mterial goat 1.16 .40 1.06 .29

6. Stayed with your relative
so you out take a vacatim

(for a week“ or lancer) 1.07 .36 1.01 .11
'7. Gotten up daring the night
with your relative 1.04 .19 1.00 .00

 

“1.1!. reepcnee scale of mour- omeieta of (1) Rarely or nme
of the time (2) sane of the tin (3) not of the til. (4) ahmet all
of the time

 

 

 

has '{Irms’i Yd noqqud 1530311113311! 30 miaxvoxq ma slds'r
axoddpisn \abrxs 1 1'3

.. - a. .p - - — --.. ...-......m —- - - —» -m—‘_>-- --.—.1, — — m . —**—.r‘ - .m— 4 —Ar—~o'— #-

 

 

33. Vb.l uT. EY.1 \:'1-.' «.Jitlr.

Hiifnial fu-' -‘1w h'zgij .1
purdjwn L on tiu‘o PQY L-
U‘. ELL “1. LC.[ ”UH: .1w~? 6 (H! "15.10

11,1*£:Jq«.:'-u.~. 1133-4 fr.;7~ i .h
'1!’e“{ : . 1; ‘{ 1~a1it .-: lL‘I )
an. 92.1 :3. 9;.1 (.vz'riox

(

O

3d. 8i.l CY. U$.[ 915w waf’Kfil dfaw h-{iwn

17'

so Yunom dilw laqiud
(C. JC.[ 0%. 31.1 abw p tbr'~+uu {amid

9vjjt’v1 1u~i n..w L*xi7fl .4
I.-a‘fh"2r1" 1% «it .* m?» Inc‘v‘f 0'.
.‘.

ii. [0.1 L5. Y”.l (ueuurl 2 run} 'v r ;k

+Jrin udf LnLgu} 1w ‘ufru
DU. Cu.l 01. F0 1 arifsiej lfltY djlw

..- ..., ..-—o ----. .—~.- -..- -.--.—-_ _ ----u-—- .- .- .--n—m- —‘..¢ fl-—r—- -. a- “4—4- —- a v. . ._....

“nun 30 virjgfl (l) 30 airi aw: a~:”:£wn in 9
li; *-dnin (9) ungj a}: to Inuv (2) anti ed? t- ~3w2 (g) wut?.u1i h)

anlfl rd; 1»

t”: aznvqaaj ‘JT .v7vH

- ...-~n—.-...--.-.’~ 4.-.- r"...— .h.. .—-.-..—H— .- _-— ~-*h‘-‘-‘ -..—h- --»——4 7’ -<

 

95

(N = 80). The scale of measure used to indicate frequmcy of swport
ranged firm 1) rarely or nane of the tine to 4) alumt all of the
tire; this, the reapmses suggest that swport is quite infregumt.

Caregivers indicatedthat‘dmswportwasprovidedhyeither
idly or trim/neighbors, it most often muted of spmding time
keeping the care-recipiait my. 'l‘he category of swport fund to
he provided the least ofta by both tally Ind trim/neighbors was
getting to during the nidit with the care-recipient. 111a secmd type
otswportprovided least ottobyhothsourceswasstayingwiththe
care—recipimt for a weehad or lcnger.

themscoresall seadquite lcwmthescaleof 1to 4.
'l‘hestmdarddeviatimswerealsoveryull. Inreviewotthe
variom categories of swport, 38! to 96‘ of the caregivers indicated
that finally embers provided swport rarely or nme of the tin.

m the cmtrary, mly 0‘ to 12.5% indicated that my specific
categoryofswportwuprovidedeithermtoftheti—oralmoet
all of the tin.

She categories of smart received Era friaxh/neiglbors was
mlunrasnotedbyflttolOOtreepmding"rarely”or"nmeof
tintiu”withmly0\t06§whoindicatedsmortfrmmyaxe
categorywasprovidedmst of thetinoralmst allot the tire.
‘l‘here was very little variability m the scores, with njority of
tbindivianlsreapariingrarelyornaaeoftheti-toallmtme
category which referred to keeping the relative m.

loch m score ad stmhrd deviaticn rmting swport tron
triads was slidatly lower thi: that firm idly We. Ihese
findings reflect the caregivers' peroeptims based m their

-.~ u,“

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.3.U*V}w‘li:.l ‘ #:14» ul igx.4lu'- {1 ja.«n: . ' A ' e

wart pnlruuqfi :0 bejalax‘; u-‘f 1. u.+r “; wf";y;;

'JW *; fik.-d‘}1¢c:ii J vi~"'31. 1 '1: i: ‘. J ' .*£' 3
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96

utilization of support received from the infernal network. 'lhe
respmses do not necessarily reflect the mutant of support available
to the caregivers fran the infernal network. Thus, the findings
suggest that smart fran flaily, as perceived by the caregiver, is
utilized a little mre frequmtly and that f-dlies vary a little in
the smart provided to the caregiving fanily luvber.

m 11
What is the caregivers' overall degree of satisfactim with the
smart fran funily anthers and frinds/neiglbars?

'lhe najarity of caregivers were either "very satisfied" (n=38,
47%) or "salewhat satisfied" (n=31, 39‘) overall with the support
they were curmtly receiving fran faaily tubers. (lily three
caregivers were "very dissatisfied" overall with the smart they
were currently receiving. The mean degree of satisfaction with this
source of smart was 1.7 (N= 80). The Likert scale med to measure
degree of satisfactim ranged fran (1) very satisfied to (4) very
dissatisfied.

Similar finding, "very satisfied" ($42, 56‘) and "Mt
satisfied" (3:23, 31%), were also found in relaticn to overall
satisfactim with smart fran trim/neighbors. The mean degree of
satisfactim with this source of smart was 1.6 (n=75). The mean
scores and standard deviatims stagest quite limited variability
m respmsee representing satisfactim with support free bath
friuthdfmfly. 'merewereailylstandmofcaregivers
dissatisfied with smart fran futily and friends, respectively.
Caregiver satisfactim with smart is preeated by freqmcies and

 

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Table 5.5: Degree of Satisfactim with inert

 

Mly
Pregnancy Percutage

l'regtmcy Percmtage

 

 

Very :
Satisfied 38 47 : 42 56
I
l
Sawdust :
Satisfied 31 39 : 23 31
I
I
Must 3
Dissatisfied 8 10 l 6 8
l
I
Very 3
Dissatisfied 3 4 l 4 5
II = I = 75
Hean = 1 7 New = 1.6
std. Dev = 80 std. Dev. = .85

percutages in Table 5.5.

W m at in mm

Inarder farmaestimnuberthreetabemredthe
reliability of the instrument needed to be addressed. its original
instant for Insuring assistmce frm faily and fault/neighbors
lad nine categories of smart, acne rot-citing instnamtal
smart and others mung mtimal swpart (diva: 8 <3in.
1986). In previous reliability testim lad bean due a: this
instant. may, for purposes of this study the reliability
of the instrunmt was tested by courting the Craabach Alpha
Coefficient.

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'l'wo Alpha coefficients were carnated, cue for the instrmmt
resuming family smart and the other for the instrmmt ueasuring
friends/neighbors smart. Woods 8 Gatansaro (1988) smested Alpha

coefficimts between 0.7 Id 1.0 indicate adequate internal
canistmcy of an install-it.

In the first capatatim of internal amsistuicy mug the nine
categories represmtiw mrt fro f-dly more, a Alpha
coefficient of 0.75 was ditained. In naming the internal-
canistncy sung the categories represnting stuport free:
frank/neighbors, an Alpln caefficimt of 0.73 wu obtained. Prior
to the latter ccnwtatim a zero varime was fond for the category
mtitled "gotta: to during the night with your relative". me, this
category was mitted in the cuputaticn of the Alpha caefficimt
roresaiting the questiamaire in relation to stuport fran
friends/neighbors.

Based m the low ital-total correlatim of .1066 betwea: the
category utitled "Helped you with may or other nterial goofi"
and the other categories in the funny smart questiaanire, this
category almg with the above smtimed category were mitted fran
further Alpha coefficimt cawtaticns. Thu far the Alpha
coefficients were acmtable, but improved slightly with the adssim
of the two mtimed categories.

A final cavitatim wu perforued to determine the reliability
of the masticsmaire misting of the sevm ruining catqories.
'lhis included the two categories of mticnal mrt. Alpha
coefficients of .77 atd .73 were cawuted for the scales measuring
fanily smart std friarb/neigflaars smart, Ir“Petfliively. These

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99

reliability coefficients were censidered sufficient. In the final
statistical correlations to be presented between the mean scale
scores representing the smart categories and degree of
satisfactien, data based on the seven smart categories including
the categories of enntienal mrt were censidered.

The categories of mtienal swpart were included in the final
carrelatiens since indirectly the unasure of satisfactien also
includes this dimiei of social swport. fine catqaries of
enotienal smart, however, are not incltded in the itea by itenn

carrelatiens .

“in 111
What are the relatienships between the categories of imtruuental
smart provided and the overall degree of satisfactien with smart?

The correlatien coefficients and p values for the correlaticns
between satisfactien ed individual categories of instrnamtal
mrt are presented in Table 5.6.

Initially, it- by itenn correlatiens were dens between the mean
scores of the irdividml categories of instrununtal smart and the
men overall degree of satisfactien with smart. Categories of
eutienal smortwerenotcensideredsincetheywsrenotthefocm
of this stndy. the Pearaen product-mnent correlatien was
calculated. Throughout this partien of the mlysis, the smart
provided free fendly m and friends/“diners m analysed
separately.

'lhe correlatien coefficients representing the relatienship
between each individual category of instnnmtal smart and degree

 

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100

Table 5.6: Correlatien Coefficients for Individnl Categories
of ”art and Degree of htisfactien

 

 

Categories of Mly (#80) Friends (11:75)-
mrt t P 1' P
1. Helped with physical care -.2273 .021* -.1801 .061
2. Spent tine liming your
relative cenpeny -.2471 .014* -.3057 .004*

3. stayed with your relative
so you could do seething
else for a few hours -.3119 .002* -.1658 .078

4. Stayed with your relative
so you can take a vacatiei

(for a weekend or lenger) -.0083 .471 -.0862 .231
5. Gotten to during the Min:
with your relative -.1734 .062 --I ~-

6. Belped with treapartatien
(for either you or your

relative) - . 1312 . 123 - . 2208 . 028*
7. Helped you with my or
other aaterial goods -.0039 .486 -.1424 .111

 

M2. r = Pearson carrelatien coefficient; p = statistical
significence.

'llissing five respenes
bcategory led sera variance, correlatien not cmuted.
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101

of satisfactim with swport from flldly tubers ranged fraa

r = -.0039 to -.3119 (8:80). A hidily simificant relatimship
(r = -.3ll9, p 8.002) was found betwea overall satisfactia with
snort ad faily was staying with the care-recipient so that
thecaregivsrooulddosmthingslss forafuhomrs.

lhe nemtivs oorrelatias reflect the diffsraoa in the
directicn of scoring the two instrmts. ‘lhesoelstouesure the
degree of satisfactia raged fro 1) very satisfied to 4) very
dissatisfied, with a low score rarssating a hid: degree of
satisfactim. m the ct” lad, the scale med to assure frequency
ofswportprovidedruigedfrcnl) rarelyornmsofthetinstofl
alanstall ofthetin, withalowscorsraruatimalow
frequacy. flue, a negative oorrslatia seas that hifier
satisfactim is associated with a greater provisim of mart.

The weakest rslatiaship Ins fund henna satisfactia ad help
with traaortatia (r = -.1312, p = .123). In relatia-hip was
found betwea satisfactiai ad the provisim of asterial goods (r =
-.0039) or betwea satisfacticn and staying with the are-rscipiat
for a weaad or lager (r =-.0083). lvatmlly tb oatqory
atitled "provisicn of setsrial M" was sli-inatsd fro the final
scale of it. vita the reliability testing was perforlaad.

The correlatia coefficiats rsprseating the rslaticnship
betwea the individual categories of instruaital stoport ad the
degree of satisfactim with swport true friab/nsidlbors raged
frcn r =-.0862 to -.3057 (n 8 75). A highly simifimt
relatiaship (r =.3057, p =.004) was found betwea overall
satisfactim with mart ad fricrk/neidlbors spading titre keeping

 

 

 

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102

the care-recipient catpany. The weakest relationship (r = -.1424,

p =.111) was fond betwea satisfaction and the pravisim of material
goak. There wu no relatimhip feud between satisfactim and a
friad staying with tln relative for a weekend or larger

(r = -.0862).

To determine the relationship betwea the degree of
satisfactim with overall smart and the scale score raresating
the cutined categories of smort, a reliable scale of smart was
needed. To deterndne a reliable scale of smart categories, the
internal canistency of the instrmmts were examined.

For the original scales utilised in assuring smart received
from fadly embers and triads/neighbors Crmbach Alphe's = .75 and
.73, respectively, were obtained. After the eliudnatim of two
categories of smart frau both the funily and friacb/neighbars
scale Crmbech Alpha's = .77 and .73, respectively, were obtained.
The reliability of the instrunat assuring support frun friends
iuproved mly slightly, louver the sane alteratims were nude to
both scales for the purpose of analysis. The ruining seva
catqories of smart were incltded in the final carrelatimal
cmutatims. 'l'hess categories included:

1. Helped with physical care.

2. Spat time keeping your relative my.

3. 8taysd with your relative so you could do salething else for
a few hours.

4. Stayed with your relative so you take a vacatim (for a
weeload or larger).

5. Given you «Intianl smart or acouragalmt.

 

 

 

 

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103

6. Helped with transportatim (for either you or your relative).

7. Checked a: you to be sure that you were all right.

Using the seva ital scale scores and the mean overall
satisfactim scores, Pearsm product-numt carrelatim coefficients
were determined. M correlatias were caIputed to represent the
relatiauhip betwea the sea level of satisfactia with smart
overall ad the total ma freguacy of smart provided by funily
tasters ad friads/neighbars respectively. the correlatim
caefficiats betwea satisfactia with anart ad freguacy of
smart fro fallly was r=-.42, p = .000 and triads/neighbors was
r=-.39, p = .000. Both of these were fomd to be hidlly simificant.

mm m

moe the reliable scale to masure assistance frat fadly and
friank was idatified, me additimal carrelaticn was amted. A
correlatim was counted betwea freguacy of assistance received
frm faaily numbers and friank/neiglbars (#80, r =.1306, p =.124).
This result repreeated a very weak carrelatim and not a
statistically simificat result. This result smested that smart
fraa fadly embers or friads/neighbars could not be mtituted for
use another.

m
The caregiver grow for this study casistsd of 80 wives with a
averageageof 67 years, caringfortheirdisabledhmbuuhwitha
average age of 73 years. Majority of the caregivers were Caucasia,
mloyed and lad provided care for a man duratim of 5 years.
A large percentage of the care-recipiats had baa diagnosed

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104

with either a stroke or Alzheimer's Disease, which resulted in
increased depadaice on their wives. (:1 average they required
assistaoe with 5.3 Activities of Daily Living atd 4.8 Instrunatal
Activities of Daily Living.

Overall, instrmtal smort free family meters and
friaib/neighbars was utilised a a very infrequent basis. The
smart utilised met frequatly mistsd of short-term visits with
the care-recipient. Caregivers received the least assistance in
caring for their Innsbands during the night. ‘lhe variability in
respmse was quite low suggesting respcnses were m.

Eva though assistance was rarely utilised or not utilised at
all, the wives indicated that they were quite satisfied with the
assistance from both fadly and friaik/neighbars. ihe standard
deviatims can this [assure also indicated tint respmses were quite
hanagaeous.

'l‘he Pearscn product-mt caefficiat was med to represat the
relatiaship betwea the various categories of smart ad the wives'
degree of satisfactia with that smart. 'lhe analysis indicated '
that there was a very weak rslatiauhip betwea satisfactia and help
with trasportatim fr. fadly enters. a: the other had, there
was a weak relaticnship betwea satisfactia ad the provisim of
mterial goods by frialb/neidbars. Satisfacticn was note likely to
be related to a funily umber caring for the cars-recipiat for a few
fans, or a friad spading tile just visiting with the care-
recipiat.

In this chapter a review of the results was preeated. In
dnpter 6 interpretatim of the results and recmuudatian will be

 

 

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105

preeated. Inplicatims for advanced nursing practice std research
will also be diseased.

 

 

 

 

A descriptive study was caducted using secondary data, to

canine the frequency with which specific categories of instrunatal
smart, provided by funily and friends, were utilised by wife
caregivers. ‘lha an analysis was date to examine the relatimship
betwea the utilisatim of support and degree of satisfactim with
smart.

The nejor findings included data that family numbers and friends
spat time keeping the care-recipient carpany more often than
providing any other type of instrunental support. Also, the
provisim of long-term respite (weekcd or larger) was fond least
ofta fran the sane smart groups, after eliminatim of the category
titled "gotta up during the night with your relative".

These results suggest that wives caring for their hubsrds
provide nejority, if not all, of the direct care with limited
involvemt frun family numbers and friends. This increases the
likelihood that spans caregivers will provide more care than they
are mtimally ard physically able to, which any result in an
increase in or worsaing of their as: health problem.

Overall, the wives indicated that they were satisfied with the
support that they had received. Multiple variables were suggested to
have a possible influace at the neasuranat of their degree of
satisfactim.

'l‘he carrelatim of variables resulted in the following findings.
The degree of satisfacticn was least likely related to fanily nurbers

106

 

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107

providing material goods and friends providing lmg-term respite. m
the other hand, the degree of satisfaction was nest strongly related
to the short-term respite received from fadly, ad most strongly
related to smart fran frields when tine was spat keeping the care-
recipiat may. Eva though the provisicn of specific types of
instnseatal smart was minimal, satisfactim was significantly
related to specific categories of smart.

This clnpter will cmsist of two sections. In the first section
an interpretatim of the results will be preeated in referaoe to
previous research and the Wind frmrh selected for this
study. ‘lhe secad secticn will incltde the inplicatims of the
research findings and recamudaticsis for nursing research and
practice.

Interpretatia of Adults

mm W9! Sit in W

Ml... 'l‘hemeanageof thecaregiverinthepresat studywas
67.5yearswith68tofthesapleovertheageaf 65years. A
requirelent for the presat study was that the care-recipiat be at
least 65 years old. Since the study was focused on the spmne
caregiver it was expected that the caregiver would be approximately
the age of the care-recipiat. Therefore, it is not surprising that
the caregivers' average age was 67.5 years particularly since wives
tend to be slightly yamger than their lanbaxds in m instances.

In Pagler 8 Goodrich's study (1979) the average age of the
caregiver was 67 years and in Fitting, Rabin, Lucas 8- Sestl’un's
study (1986) the average age was 65 years. In the study by Banach 8

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108

Spaid (1989) the mean age of the caregiver was 69 years. 'lheir
average was slightly higher than others noted; however, the saple
canisted of 70‘ females and 308 sales which may have influaced the
ace spread.

The ma age of the care-recipiat in the presat stidy was 72.9
yearswitharangeof64t086years. Inthestidybymlsrs
Goodrich (1979) theaverageageofthelnnbadswunyearswitha
similar rage of 65 to 86 years.

Intheirsttdy, hyderexeefe (1985) foudtheaverageageaf
thecaregivertobeGOyearsadthecars-recipiattobefiyears.
'l'heagerangeofboth,lnoever,was28t085yearsald22t093
years, respectively, with bath Ina ad was: included. The nsjority
of the studies reviewed included nele ad fuels caregivers in the
saple with no indicatia of age breakdown by sea, mtly
cmperism of this sttdy to others was mt difficult.

Overall, wha covering similar stidies, the prssat sttdy's
findings are cmsistat with past studies in regard to age of
caregiver and care-recipiat. ‘lhe wife caring for her tanband tuds
tobeapproxiaetelyStoSyearsyamgertbanherla-bud. 'l‘he
differaces inmaagetadedtovarydaadingaage limits aid/or
criteria for the sttdy.

n The individuals in the presat stidy were predadnantly
Caucasian (97.58) with wives ad lam latched a this variable.
Il'his findingueybeanindicatia of thecaregiversdioaremast
likely to unite thaselvss and their role a caregiver know to
others. The distributim in this stidy, havever, is not
representative of the larger papulatim of the lower Michigan area

 

 

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109

where approxinntely 85% are Caucasian and 13% are Black (0.8. Bureau
of the Germs, 1988).

The findings of this study are mistmt with the studies
reviewed for this project. he scale of caregivers were
may Gmcasian with the seams! largest group being Black
(Cantor, 1983; Baines, 1984; Baruch 8 apaid, 1989).

m m A large Inflority of the caregiver smple
(91.2‘) were not annoyed as was to he expected became of their
average age. This has best found mistmtly throughout the
literature (Cantor, 1983; Btme, Cafferata & sangl, 1987; Gilhooly,
1984).

Mcaregiversinthissttmweremaverageflfiyearsoldwith
a large percaitage over 65 years old. fine natimal average
retirmtageishetwemGZandGSyears, thereforeitwunot
mlikely that the majority of the caregivers in this surly were not
uployed. 'l‘hiswasespecially truewhmlmowingtheduuadsofthe
caregiving role.

mum Morethmhalf (52-3) Of the
care-recipimts in this stuiy required assistance in six to tax
Activities of Daily Living (All). Of a total of ta: m's, cere-
recipimts needed assistance with an average of 5.3 activities.

Incawarismtom. theremagreaterdepmdmcyin
Instrmmtal Activities of Daily Living (1am) for this salple of
care-recipiuits. of a total of six film's, 55\ of the sale
required assistmce with all six activities. The next highest
percentage of individuals requiring assistance was 17.5\ (n=14) with
W! in five activities. m the average care-recipients were

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110

found to need assistance with 4.8 IADL's.

Overall, the care-recipients required assistance with at least
half the ADL's and/or half the IAm's, a: the average. To require
this degree of assistance indicated that the care-recipimts in this
study were quite Mt m their caregivers for daily care. It is
also important to wider tint m are saluwhat socialized to be
Mt in IADL's, regardless of physical lid/or mtal
limitatims.

'lhe finctiaxal statm of care-recipimts is difficult to camare
across studies. Many researchers wider the fmctimal status of
the care-recipiait, but utilize a m of scoring mthods
(Gilhooly, 1984; myder & Keefe, 1985; framstedt, Way &
Sullivan, 1989), and a variety of criteria by which to masure
halcticnal statm.

Banach & Speid (1989) measured fmctimal statm by level of
depamduncy in All. tasks and mry and behavior prohlm. Zarit,
Reever & Bach-Petersen (1980) utilized Instrmmtal Activities of
Daily Living and Physical Activities of Daily Livim to unsure
functional statm. stone, Cafferata 5: Sang] (1987) determined level
of W based at whether direct assistance or ally supervisim
was required with certain activities.

Omsequmtly, the functional statm of a scale is helpful to
know when determining the mat of assistance required from the
prinary caregiver. m, camel-ism at this variable betwea!
sulple grams could be m.

 

..a.

 

 

1.4

(Q

 

111
mm W91 at in mm mum
g m The caregivers in the preset stuiy lave
provided care for an average of five years. More than half of the

caregivers (57%) have provided care frcnn 1 to 4 years with a range of
1t060years. 'l‘hennnodemthismeasurewasthreeyears. The
estrous value of 60 years found in this stu'ly my rqresmt a
misinterpretatican of the questian by the caregiver.

The average age of the caregivers was 65.7 years, representing
the young-old category of older Americans. It was not unlikely to
find mjority of the caregivers ind provided care for anly 3 years.
It is likely that with an increase in the caregivers' and care-
recipimts' ages the amber of caregiving years would also increase.
However, this could be an issue for further stnaiy since many factors,
such as cause of illness, caregiver health status and care-
recipiant's age at unset of illness, could all influaice the duratim
of care.

Baruch (1988) stnrlied spot-e caregivers who had hem caring for
maverageofGyearswithamdeof3years. Providingcarefora
duratianofthreeyearsinsbeanfoundtobeafrequuntrespmse
slung my caregivers. This could suggest a duratian of time nest
talented by caregivers and my be influmced by the care-recipient's
came of illness or degree of disability thich resulted in the need
for care. It must be understood, however, tint there are caregivers
who have provided care for a lunch langer duratica'n of tin and the
factors cabling than to do so are presently being studied by
researchers.

stane, Gafferata 8- Sangl (1987) studied 500 spouse caregivers

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112

with 44‘ providing care for 1 to 4 years. With a sanple of this size
44% is a large nunber of caregivers. (he fourth of the ample
provided care for 5 years or wore. Overall, the caregivers in the
present stnaiy have been providing care for approximately the suns, or
langer, duration of tine in cmpariscn to spome caregivers in other
studies.

m an. The largest momma of caregivers
in this study were caring for inabancb who had a stroke (n=29, 36.7%)
or had Alzheimer's Disease (3:11, 13.Q). Parkim's Disease was
the next met frequant disability idmtified. other disabilities
were represented, but in seller frequuncies.

Baines (1984) also fomd the diagnosis of stroke to be the most
prevalqnt clung her care-recipiants, while Snyder 8 Keefe (1985)
found 48% of their caregivers cared for individuals with Alzheimer's
Disease and mly 108 cared for those individuals with a stroke.

Many studies performed in the past four years have focused m
caregivers of Alsheiner's victims (Scott, Roberto, & Hutton, 1986;
Banach, 1988; Lawtan, Brody 8 Saperstein, 1989; Wilson, 1989a). The
primary reesm for care any influence the level of involvelmt, the
duratim of care and cansequuntly the need for various types of

support .

m Dustin
This section will cansist of the interpretatim of the data
addressing each of the three research questions separately. The
interpretatim will incluie how these findings canpare to previous
literature and possible explanatians for any differences in the

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113

findings. The findings will then be discussed within the cmtext of
the cmceptual fralework selected for this study.

mm 1
Mat categories of instrumtal sipport are provided by flatly
embers and fricris/neidbars to wives who are caregivers?

In this study limited apport by both fuily sewers and
frids/neiglbors was provided in all categories. mly a total of 11
respmses indicated tint smart free family was ”almst always"
provided and a total of 8 respmses, indicating the suns frcm
friends/neigmaors. These findings sweet that of the atmriu
investigated, very limited smart is provided in these areas. It is
possiblethatathersupportnsprovided, butwasnotueasuredbythe
questionnaire utilised in this study. ‘lhe limited assistance
provided in the support categories investigated in this study
suggests, as did other researchers, that spouse caregivers are at
risk for health problem as well as role overload (Rberg, Griffith,
8 Foxall, 1986; [angler 8- Ooadrich, 1979).

The category of noport untitled ”gotten up (hiring the night
with your relative" was least likely to he provided. In a few
instances the caregivers in this stuiy (9:10) indicated that saneme
else was living with than and their husband; however, the uajority of
caregivers (9:69) indicated tint they lived alcne with their husband.
This finding is mistmt with Ontor's (1983) findings indicating
that in most smal caregiving situatims it is unlikely to find
other individuals living in the hue. ‘lherefore, it is unlikely that
help would be available during the night.

 

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114

Law-term respite for a weekerxd or lmger was the secmd least
frequmt category of assistance provided. The limited availability
of lung-term respite was expected initially became caregiving wives
sewed reluctant to leave their hubuads evm for short periofl of
tine. Thus, the opportmity for lung-tern respite ins not likely to
arise m a regular basis.

Another reason for the lisdted provisim of long-tam respite is
the possible difficulty individuals of the swport network might
water in their attaipt to provide the quality of care provided by
the wife. Many individuals my feel they on not adegmtely uanage
the care of their relative or triad for a lung duratim of tine and,
therefore, hesitate to offer assistmoe to the caregiver.

ihefindingsafthisstuiyarecmsistatwiththefindingsof
myder 8- Keefe (1985) which angest that respite care is oftm
provided but in mats too call to be baxeficial, the caregivers
request more canistent lag-tern respite. m roearchers have
found caregivers in variom caregiving situatims fregumtly request
law-term respite (Croeui, Laden in Barry, 1981; Cantor, 1983;
Baines, 1984; llarowits s. Dobrof, 1982; Iheis G- Deitrick, 1987).
Scott, Roberto 8 Hutton (1986) also four! 508 of their caregivers
received respite fraa funny m, but indicated that this was an
area in which support was still lacking.

(n the other land, the dey elders and funds/neighbors were
fomd to keg the care-recipimt cm sore oftm than assisting in
any other instrulmtal activity. Alcng with the pravisim of
visiting with the care-recipient and providing short-tern respite,
assistance with transportatim followed by help with physical care

 

 

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115

were the next nest frequent provisims of smart by both funin atd
friends.

Became nest of the wives in this study lived with their
husbard, theyprovidedcaremaflhoursadaybasis. Evaithmnha
few wives had another persm living in their household, they provided
nest of the care thus-elves because of their feeling of sarital
respcnsibility ad obligaticn to their tarbald. Other individuals
were probably nere cdortable die) they provided other forne of
stepart, suchaskeepingtherelativemorhelpingwith
transportaticn. mesa swportive actiau did not require lmds «I
care, but could stqgest tint the stoportive individlnl cared for aid
supported the prinary caregiver.

Hermit: 8 Dobrof, in their final rqart (1982), mentioned that
dm help m offered it was anally in mall malts ad usually the
least-labor intmsive, thin not likely to be related to physical
care. Ithey also foud 52.68 of the spome caregivers were carrying
the respmsibility of care capletely alums.

Basedmthefindingsofthepresmtsttdy, thespome
caregiverssecedtoprovidemst of thecarewith Muted, if any,
help. It is possible that very limited wt was actually provided
by funily std frienh as was irdicated by these caregivers. However,
it is also possible that the caregivers' percqtican reflected their
utilisatim, rather than smart that was actmlly available but not
utilized.

Paotheraspecttoconsideristhattheinstnsmtmedinthis
sttdy my have failed to seasure the type of smart actually
provided to the caregivers, such as amticnal, inforneticnal, aid

 

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116

fornel support. Therefore, the irdication of limited provisions of
smart nay not be reprasu'ltative of the smart actually provided or
received.

Stun, Gafferata 8- 8ml (1987) slung with Tumstadt, McKinlay 8
Sullivan (1989) have fund spunse caregivers to be the least likely
to utilise secudary suircas of smart and, cuuegumtly, are the
sole providers of care to the najarity of mrriad elderly. The
findings related to this guestiu: are mistmt with the previous
literature, but were suaewhat surprising to this researcher. It was
expected, as was fund in this stldy, that fudly m provided
nere assistance than friuds. Humor, the degree to which
assistancewasprovidadwasauchluverthmwasaspacted, andnay
have bani related to the imtrmt as mtimed.

When cuisidering this chta in the cmtaxt of the cmcaptual
frauwark aid social smart theory, it is suggested that frequency
of smart can influence adequacy of smart and ultinately an
individual's well-being. Ward, sherm a LaGary (1984) alcng with
others, weaver, have smastad that objective neasures of smart
are not as useful as subjective seasures in determining well-being.
Iberefare, even thumb the caregiving wives in this study itdicatad
that they received very little smart, the actual aunt of smart
received nay have no influmca (n whether the caregivers felt
cuntutad or satisfied.

In usury, utilising objective measures this researcher has
fund that the spune caregivers' inforaal suaroas of smart
provided very little, if any, smart to the caregivers. mm
smart was provided it was in limited mtities as perceived by the

 

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117

caregivers, ad the tasks requiring the least involvarmt

(i.e. visiting, transpartatim) were performed most often, while the
tasks requiring lung-term involvanmt (i.e. long-term respite,
hygiene) were provided the least aftm. These firdings were fund to
be very cmsistmt with previun research. It was recognised,
however, that the results say have reflected the smart accepted by
thecaregivers, ratherthmthesuppart afferedbythesuppart
network.

Becameabjectiveuesuresafsmartarenat cuisideredas
helpful as subjective mares in determining wall-being, the next
research questiui was raised. In esplanatiai is preeated of how
smart as well as other variables cm influmce m ildividual's
degree of satisfactiui with swpart.

11
What is the caregivers' overall degree of satisfactiui with the
support from fluily numbers aid friads/neighbars?

BpuIse caregivers received very little swpart fran their
infoml source of smart, but irdicated they were satisfied with
theswparttheyreceived. Thisreeearcherfuadunrethansstof
the caregivers were either "very" or "Mt satisfied" with the
assistance they received from dey tubers ad funds/neighbors.
The largest parentage of caregivers were "very satisfied” with the
assistance fran fauily (47‘) as well as fr:- friads (56‘).

The caregivers' irdicaticn that they were satisfied with the
swpart cuild not be interpreted to suggest the smart was adequate.
Their responses could mly suggest that they were contait with the

 

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118

support they utilised. The support any or my not have met their
needs, but at this point in tine they were cuitent.

There are several reascns why the caregivers in this sttdy my
luvesaidtheyweresatisfiedwiththeswparttheywerereceiving
frda funily and fricds. A few reasuis to cuisider whm interpreting
dry the caregivers were satisfied incltde the caregivers'
espectatims of the stopart network, the caregiving situation, the
pastandpresuit levels of sippart, thetypeafswportprovidedand
the fregumcy of smart provided.

If caregivers expect more assistance or prefer less, this will
influuice how they rate their degree of satisfactiui with stuport.
Wivesnyhavelowespectatimsofthetypemdmt of support
others shudd provide, since they fregumtly view the role of
caregiver as m obligatiui.

It is likely that the caregiving wives alcng with wet
irdividuals wuild expect mre swport frau fullly ”are tlnn from
friads. This we of obligatiui expected fraa fudly embers is
lost likely related to the close barb felt between the embers.
Eva: thunh individuals have espectatiuis of the kind and fregumcy
of support fanily meters shunld provide, most individuals do not
like to be a burdm to others. Therefore, individmls are likely to
askforassistanceuilydmtheye-notprovidethecareuitheir
um, ad are thm grateful for any assistulce they receive.

'l‘hrulghout the literature, wives lave beat fuad to be quite
indepmdentinprovidingcare, aswasalsofusdinthepresent
study. It is likely that the caregivers' degree of satisfactim with
the support provided by dey ad triads reflects their

 

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119

appreciaticn for the support provided, rather than their true
expectaticns of the support funin and friends should provide.

. Scott, Roberto 8 Huttcn (1986) found approximtely 80% of their
caregivers receivedmomhormrethmaxoughstpport frantheir
fuuily and, overall, sensed satisfied with the swport they received.
Their caregivers included spouses as well as childrm.

duaracteristics of the caregiving situaticn such as the duratim
of care way have also infhmced the caregivers' degree of
satisfactim. The caregivers in the presmt study have provided care
for an average of five years. ‘lhese caregivers are fmiliar with
their role and respmsibilities and my feel other individuals can't
provide the suns quality of care. Became the caregiving wives want
thebest for theirlnubmds, theystrivetodoasuaohastheycan
without assistmce frcn others. the wives my actmlly mider help
from others to be an inpositicn «1 their daily routine, thus
assistance frae others my not be desired.

Ban-oh (1988) fomd veteran caregivers preferred to mags
problalsontheiravn. 'lheyhadtheiro‘aicopingteclnigues
identified which my have resulted in thm rewiring less assistance.
If theneedfor lessswportmsperceivedthulessswportms
preferred. Cmseguntly, the duratim of care my be influmtial in
the determination of satisfactim with support.

Perceptims of satisfactim with swport my also be influmced
hyaccnhinaticnofcurrmt levelsofsmportaswell asthe
accmulation of support esperimced over a lifetime (Lyles, King,
Given 8- Given, 1989). 'lhis is mistmt with the prapositim
suggested by Rain 8 mtmucci (1980) that the cmvoy, or social

 

 

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120

network, changes throughout the lifetime. All percepticns related to
supportuaybeinfluencedbyutuatwehaveexperiencedinthepastas
well as the present.

In the presmt study it was not feasible to emuine the type or
frequaicy of support provided in the past. 'lhe measure of
satisfactiau was mly intaided to uneasure the caregivers degree of
satisfactim at that point in time, however, the researcher was aware
of the possible influence of the support provided in the past.

Becauseuanyof thecaregiversinthis studyhadbemproviding
care for a long period of tine, it is likely that tiny cmsidered all
theswporttheyreceivedchringtheirtimasacaregiver, whim
indicating their degree of satisfacticn. Omsequmtly, the
caregivers' responses to the queeticn of satisfaction my not
represait their satisfacticn with swport at the tin of
interviaving, but rather a more global iupressim, possibly resulting
in the discrepancy between low mart and high satisfactim.

Recall that the subjective measure of satisfactim in this study
usespectedtoreflecttheadeqmcyofsupportprovided. The
results of this study could be interpreted to suggest that caregivers
are cmtent with the support they received, but could not represent
the adequacy of support. A large percmt of the caregivers indicated
they were very satisfied with the swport they received. Alaig with
the factors previously mtimed including caregiver espectatims,
the caregiving situatiau, and the influence of past swport, there
could be other support available uduich was not masured, for mle
foml supportive services.

Il‘he caregivers were asked to evaluate overall satisfactim which

 

 

 

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121

is quite global and opal for individual interpretatim. It is
possible that having little informal support my be adequate based m
the factors mtioned, but if it is not, fornal services nay be
utilised to seat the caregivers' needs. Becaune the caregivers in
this study have provided care for an average of five years, their
espectatims Ill abilities to cope with the caregiving situatiau my
haveclnugedovertheyears. Theirpositiverespcnsesmyhavebeau
areflecticnof all thattheylnvemcounteredduringtheyearsasa
caregiver.

No specific cmclusiaus can be mde about this data becaune of
the multiple influential factors not masured in this study.
However, itcmbecmcludedthstthelargestpercmtageafspause
caregivers in this study were very satisfied with the swpart they
received fran their informal sources of swport. fluey were also
slightly sore satisfied with the sunport they received frm
friauds/neighbors caupared to fauily embers.

In such of the swport literature, an individual's perception of
satisfacticn with support is studied in relatim to health outcaees
(Gilhooly, 1984; Krause, 1987). Rarely are individuals asked how
satisfied they are with the sumport they receive. Because of the
difficulty in conceptualising satisfactim and cautrolling for the
variables which influmce it, this researcher now understands why
thereisalackof researchinthisarea.

It is difficult to weasure m individual's degree of
satisfactiau with support, because it is subjective and can be
influx-iced by mny factors. Individuals my actually find it
difficult to suggest that they are dissatisfied, then they truly

 

 

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122

appreciate any assistance they receive. It may be more appropriate
for the caregiver to identify what further assistance they could use
based m their needs, and is a more precise method of determining if
the support provided is adequate. This infomticn could be obtained
after the caregiver identifies the support presuutly received frauu
bothfuilyandfricds. ‘roknowwhatfurtherassistanceisneeded
wouuld cable researchers to coupare support which is inadequate
across sauples, and would gmerate ideas for future supportive
services, whether it be a forml or informl service.

The data collected in relatiau to this research questicn can
mly be interpreted to man that these caregivers are in fact
satisfied, overall, with support. If satisfactiau is a subjective
mushyuduichtouuasureadequncyof support, thmtheeecaregivers
nayalsofeel thesupporttheyarereceivingisadequate. lofurther
Wimcmbendesincethebasisupmwhiduthequestimwas
answered is unknown. It is possible that the questiai related to
satisfactim was not mitive mugh to measure what it was expected
tomasureudthe four respcnsecategories lisuitedprecise
respcnses. 'lhe respa'use categories did not allow for individual
variability mung the respaudmts. The questim misted of the
broad term "overall" which could be interpreted differmtly by each
individual and result in inaccurate respauses. ‘

It mt be understood that the respmse selected represauts the
individual's percepticn at axe point in tin mud could change at any
mt. At the time of interviewing there were certain feelings the
caregivers expericuced and inressims they recalled which may have
influuuced how they rated their degree of satisfaction with support.

 

 

 

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123

If the caregiver happened to recall an event whm a special friaud
helped with transportatiau of the caregiver's huusband, she would be
more inclined to respaud in a positive Wt. Hounver, recall of a
tiuuuewhuuaf-lllyunauber refused tocuaeoverat amounts notice
would have likely resulted in a negative respause.

Eva though the initial respauses related to frequmcy of
support indicated support was limited, whuu the caregivers were
asked, "overall, how satisfied" they were, miss wqu support was
readily available any have beau triggered. Causequautly, at that
pointintiuueuduauthequestiauwasprescutedasitu-s, the
caregivers' respme. any lave reflected their perceptiau at that
mt, but my have also beau influenced by past eaperiauces.

In sumry, the largest parentage of caregivers indicated that
they were satisfied with the support they received frauu family and
friuuds. There were my factors which couuld have influ-uced the
caregivers' respmses to this questiau. Bolus factors characteristic
of the caregiver dud caregiving situatiau include the caregivers
espectaticns of support, the duratiau of care provided, past
esperimces with support provided by fauuily cud friaucb, ad
availability of other fornl supportive services.

flare were also sauue specific limitaticsus of the questiaunaire
iduutified uduich could have influuuced the caregivers' rspmses.
The first limitation was the use of the tern ”overall” uduich my lave
suggested that the caregiver causider support provided new, as well
asinthepast,ubaugivingtheirrespmse. This ledtotheseccnd
lisdtatiau that the questiau assured satisfactiau with support at
thatauepointintiuuue, butwesinflumoedbytheotherfactors

 

 

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124

mticned which could have actually affected the reliability of the
responses.

A third limitation was partially related to the support
questiamuaire which only allowed for measuruuut of a few categories
of support. If the caregivers cauly causidered thee categories of
support whuu expressing their degree of satisfactiau, it is possible
that theyare very satisfiedwithsuppcrt inthsseareas, butnat
with support in other areas. In actuality this researcher wanted to
examine satisfactim with support duly related to instrumtal
support. However, becauuse of the wording of the satisfactim
question, the exuuinatim of satisfactiau with instrumtal support
alme was not possible.

file fourth linu'utaticru of the instrument was having (lily four
broad responses to select frcsu in neutering the Questiau. Ibis
prevauted lore precise individual interpretatiau with regard to the
degree of satisfactiau. Each caregiver my have responded with
differcut thoughts in sulnd based m the liuuuitatiaus of the
instmt.

Sued au the multiple factors ubich my lave influuuced the
caregivers' respauses to the quastim of satisfactiau, the respauses
must be cmsidered with cauticsu. It is possible tint all the
caregivers who participated in this study were not as satisfied, as
was indicated, with the support they were receiving fraa fuuily and
friuuds. Therefore, future study with a sinilar sqle, uning a
modified instrumt to measure satisfacticn in acne uuner is
recmded. Wtian far alterations in the instrument are
discussed later in this chapter.

 

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125

m 111
What are the relatimships between the categories of instrumtal
support provided and the overall degree of satisfactim with swport?

Initially, an itan by itan correlatim was date between each
category of support and degree of satisfactim. The responses for
the degree of satisfactim ranged fran (1) "very satisfied" to (4)
"very dissatisfied". In reviewing the results related to swport
frm flaily embers, three categories were significant at p<.05 when
correlated with satisfacticn. 'lhe three categories included helping
with physical care (r=-.2273, p=.02), spelling tim keeping relative
culpany (rs-.2471, p=.Ol) and staying with the relative for a few
hours (r=-.3119, p=.002). These findings suggest that evm though
these categories of swport are provided infrequently, they are
related to the caregiver's overall degree of satisfactim with
swport.

mug the caregivers participating in the preset stuiy, when
family miners helped with physical care of the elderly, kept the
elderly relative many or stayed with the relative for a few hours,
the caregivers' perceived degree of satisfactim with swport was
increased. his free time cabled the caregiver to perform other
tasks which needed to he capleted.

Hives are fregumtly idmtified as sole caregivers spmding
east, if not all, of their 24 hour day caring for their husbands. In
sane cases the wife is also Imaging her an health problem.
Causequmtly, it is not surprising that help in any of the categories
"antiqued would be welcaled.

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126

provide the physical care needed by her husband, particularly when he
is a victim of a stroke, as were me third of this study's care-
recipiuits. file najority of care-recipimts were also quite
depmdent in mm. as well as All. with alnnst half of then diagnosed
with either a stroke or Alzheimr's. Became of the delanding care
and supervisicn required by the individuals, any short periods of
time away fran the situatim were met likely welcaned by the
caregivers.

Krame (1987) studied the relaticnship betwea: satisfactim with
support and variam types of smart including infamtianal,
anaticnal and tangible smart. ‘lbe mly simificant relatimship
was betwea; mtimal smart mid satisfaction (r=-.208, p<.001).
Krause's findings are similar to the findings related to the support
fraa triads/neighbors found in the presmt study. However, since
the aphasia in the presuit stray was a: instmtal support, the
findings related to the emtimal swpart item included in the
assistance gustiomaire were anitted.

The data related to swpart frm triads/neighbors is different
from that related to swport frail fuuily tubers. There are two
categories that were significant at p<.05 whm correlated with
satisfactim and these categories were untitled ”spent tine keeping
relative carpany" (r=-.3057, p=.004), and "helped with
transportatim" (r= -.2208, p=.028). Horowitz 8n Dabraf (1982)
indicated that less-intmsive assistmce is likely to be provided by
friends/neighbors. This was reflected in the findings of the presmt
study and caregivers have indicated they were satisfied.

triads/neighbors frequently live close in praxflurity to the

 

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127

caregiver and are usually readily available if transportatim is
needed. Transportation is a service that friaids/neighbars often
express a willingness to provide, therefore provide it with little
resistance when asked. The caregivers in this study identified
transportaticn as the third most frequmt category of support
provided, but my have felt comfortable asking their friends for
assistance with this service what it was needed.

What assistance is not frequuxtly provided, but the caregiver
feels canfortable in knowing that the assistance is readily
available, the caregiver is likely to indicate a higher degree of
satisfaction with that support. This feeling my be part of what was
reflected in the caregivers' degree of satisfactim with support
discmsed in the previous research questim.

tollawing the item by item carrelatian a reliable scale of
smart item was developed so that further carrelatims could be
performed. ‘l'wo item were, deleted fran the original instrunent which
resulted in a scale with two items represmting amtiaial support and
five items representing instnmental smart.

For purposes of the presmt study the reliable scale as it is
now was adequate. However, Mcause of the mixture of enntional and
instrunmtal support categories, it would not be adequate for the
study of instrunental support alone in the future. The scale does
not incorporate all the dimmsicns of smart, so could not be used
to ext-nine support overall either. In future studies this researcher
recammds the eliminatim of the nautical categories of support and
the addition of new instnmental smart categories. The changes
will be discussed further in the last part of this chapter. These

 

 

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128
changes were not possible in this study since secmdary data was
utilized.

Correlations were done between overall satisfaction with support
and overall assistance received fran family and then
friends/neighbors. Both correlations were very significant with
p =.000. The correlation coefficients also represunted a moderately
strong relatianship between smart fran funily and satisfaction (r
=-.4167) and smart from friends and satisfaction (r =-.3872).

 

Researdners have known that there is a relaticnship between the
amunt of support an individual receives and how he/she perceives
his/her level of satisfaction. Ward, Slnernan and LaGory (1984) found
that whether an individml has enough smart in an objective sense
was not as inportant to well-being u was their subjective
perceptions that they had enough. They suggest that the quality of
the smart my influence an individual's state of well-being.

In the present study, knowing that smart was infrequent raised
the questim of what other factors affected the caregivers' high
degree of satisfaction. This is an area requiring further study and
research.

A final correlation was dune between the two mean correlations
of assistance received frcm fanily and fran friends (r=.1306,
p=.124) and no relatianship was found. Based on the differences
found between the frequency of assistance provided by family canpared
to friends/neighbors, this correlation coefficient is not surprising.

Evan though not statistically significant, the final correlation
is significant to practice. It suggests that assistance frcm one

source of smart will not necessarily influunce the availability of

 

129

support fron another source, particularly when studying the
instrnmental smart available to wife caregivers. Also, it is not
likely that smart fron one source could be substituted for smart
provided by another source. Each source of smart is beneficial to
the caregiver in its on way. An explanation of how this data can be
interpreted in the context of Kahn & Antonucci's fromrk (1980)

follows.

Malta he The: Mix 19 mm s We mos 118.91
One of the propositions of Kahn S- hntonucci's frolnewark (1980)

is that adeqmcy of social smart received by an individual is
determined by the properties of the convoy as well as situational and
personal properties. Therefore, it is suggested that a social
network characteristic such as size, but unre specifically, type,
source and frequency of smart received fron the network, could
influence the degree of satisfaction with smart provided.

The findings of the presont study are consistont with the
propositions suggested by Kahn 8 Antonucci (1980). Evan though not
all of tlne variables in their fratework were W in this study,
these variables still influenced each atlner.

In the present study the sample was pre-selected to consist of
fon'ale sponse caregivers. This criteria predetermined the properties
of the person and the situation to a certain degree. Because the
wives were elderly and possibly ill thorselves, this increased the
likelihood that they say require smart in their role as caregivers.
Based on these possibilities this researcher was inclined to further
evaluate the smart provided to this salple of individuals.

 

-. . mar- "Twain 1'4“- — . ' I ‘

 

 

130

The secod proposition of Kahn & Antonucci's fronework (1980)
suggested that the person's support network (convoy) is influonced by
the properties of the person and situation as well as the person's
requirolnents for social support. In the present study there is an
understanding of sons of the personal ard situational characteristics
which my influence the mitim of the swport network. novever,
the requironunts for smart were not emaned. Without determining
the needs of the caregivers, it is difficult to assess whether the
support network is providing adequate assistance.

'Ihe caregivers indicated that very little support was actually
provided. It is possible that the support they were receiving was
not represented in the assistance questionnaire. (in the other hard
as previously montioned, spouse caregivers are frequontly idontified
as sole providers of care and my not be willing to accept
assistance. 'lhe results of this study my be a representation of
the caregivers' unwillingness to accept assistance .

In their third proposition Rain 8 hntonucci (1980) suggested
that the adequacy of support is determined by the properties of the
person and the situation, as well as the convoy. In the presont
study the adequacy of support was snbstituted by the evaluation of
the caregivers' perceived degree of satisfaction with the support
they were receiving. If the caregivers were contont with the support
provided by the support network they were expected to irdicate that
they were satisfied. As previously unontioned the caregivers
irdicated that little support was provided, but they were still quite
satisfied. 'llne possible reasons for their responses have previome
been discussed.

 

 

 

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Kalm 8 Antonucci's last two propositions were not addressed in
the present study. The intent to examine the variables mentioned,
however, was to ultimtely inprove the caregivers' well-being which
is inclnded in the final propositions.

To conclude, in the examination of the relationship between
satisfaction with support and the frequoncy of specific types of
smart, a significant differonce was found whon cmparing the two
sources of support. This suggests that satisfaction with support my
vary when researchers consider the source of assistance, type of
assistance, atd frequency with which assistance is provided.

'nne variables and the results of this study fit appropriately
within the fronework of Kahn 8 kntonucci (1960). Even though not all
of the variables in their frmrk were esonined, it is reasonable
to believe that alterations in the properties of the person and/or
situation, such as in the emanation of child caregivers, would
result in quite different responses to the assistance and
satisfaction questionnaires.

Rain 8 hntonucci's (1900) frolewark was selected as a guide for
this study because the najor concepts of this stndy fit so closely
with the concepts found in their fronnewark. Consideration was given,
however, to how concepts fron Kahn 8 hntonucci's frontark could be
incorporated into a nursing theory. 'Rne most appropriate theory to
consider was that developed by Imagone King (1981).

King's (1981) theory is very such like Bysta- theory as is Rah-n
8 hntonucci's (1980). King described three apon systole interacting
with one another, nolnely the personal, interpersonal, ard social
system. Within the personal systonn she describes the individuals as

 

 

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132

perceiving, reacting beings. The personal systen is influenced by an
individual's perceptions of the enviroment as well as his/her own
self-inage. This syston is very nuch like what Kahn 8 mtonucci
describe as properties of the person including donographic
characteristics and needs, arnd properties of the situation including
roles and dolends.

The second system described by King (1981) was the interpersonal
system. This systen consists of two or mre individuals interacting
with the personal syston. Each individual has a role to fulfill in
the interaction process and they connunicate both verbally and
nonverbally in order to help unintain balance in a situation,
nunimizing the effects of negative stressors.

The concept of the convoy fronn Kahn 8 Antonucci's (1980)
froIBwork is very similar to the interpersonal syston described by
King (1981). The convoy consists of the swport network which
provides assistance to individuals particularly during stressful
periods of the life-cycle. Within the presont study, the infoml
snpport network could be considered the interpersonal systenn
interacting with the personal syston, the caregiver, minimizing the
caregiver's stress and onabling her to unintain her role as
caregiver.

Another and final concept described by King (1981), which is
also considered in the fronnework by Kalsn 8 Antonmci (1980), is the
concept of health. King described health as a continuous adjustment
to stressors in the onvirornent through optiuun use of one's
resources. Illness is defined as an interference or feeling of
dissatisfaction. Rain 8 kntonucci describe the adequacy of support

 

133

and its influence on an individual's well-being. In the present
study satisfaction with support was substituted for adequacy of
support and was expected to ultimately influence well-being. It
could be suggested that the level of satisfaction my depend on the
harmony and balance of the enviromont. finerefore, if caregivers are
dissatisfied, alterations in the enviroanent way be required to
restore harm and pronote health.

Utilization of King's (1981) theory exclusively for this study
would have beon colplicated, but through this col'parison it was
denunstrated how closely select concepts could have been
operationalized. 'Ihis corparison also domnstrated similarities

between a social swport fronework and a nursing fronework.

Inlications ond muons
‘Ihe implications of this research will be addressed in two
sections. The two sections include implication and recomnendations
for nursing research, and inplications for advanced nursing practice.
The discussion will be directed toward the primry care nurse in
advanced practice, specifically the Clinical Nurse Specialist.

museum for m m
This section will consist of three parts. The first will focus

on the instrunents utilized in this stuiy and how they can be used in
future research. In the second part of this section a review of the
conceptual fronework will be presented with an aphasia on the
frmvork's usefulness in this study and how the fronnework might be
used in future studies. he third part of this section will focus on
what further research is needed in the area of social support and

 

;..
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134

' satisfaction.

W

The instrunnents utilized to measure assistance and satisfaction
were newly developed for a larger research project by Givon 8 Givon
(1985). No previous reliability or validity testing had been done on
the assistance or satisfaction instrunont except in assessing for
face validity. 'nnerefore, sons changes are reconnended prior to
their use in future studies, particularly in the study of
instrmuntal support.

The internal consistency of the assistance questionnaire was
adequate, but inproved when two of the categories were eliminated.
Those categories eliminated fronn the instrnsunt were "gotten up
during the night with your relative" and "helped you with mney or
other material goods". 'nnere were also two categories which
represonted onotional support ard were considered part of the
reliable scale. Because the omtional categories of snpport were in
the scale, they were seen as limitations to this study since the
foons was on instrumtal support.

I would recounod substituting the two categories of emtional
support, "given yon onnotional support or encouragelnnent” and "checked
on you to be sure yon were all right" with two categories
represontative of instrumental support . A few reconnnendations
include "helping with financial setters, helping with chores around
the house, and helping with shopping".

This instrunont conld be very meful in future studies following
the alterations in the support categories. fine ability to measure
support fron various gronps such as fonily amber: and friends,

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135

separately, enhances this instrunents usefulness. The support
provided to wives, husbands and children who are caregiving can be
exonined using this instrunent, and adninistration of the instrunent
longitndinally my provide mare infomtive data. Further
reliability and validity testing is also reconnonded since it was
limited in the present study.

The second part of the instrumt measuring satisfaction
requires uultiple alterations to be of benefit in future projects
assuming satisfaction with support. The instrunont to “assure
satisfaction should not consider overall satisfaction, but should be
directed at satisfaction with instrumntal support exclusively.

Future researchers nay want to consider more than one question
to neasure satisfaction, since mltiple factors can influence this
variable. The satisfaction questionnaire should acconpany the
revised neasuronont of smart previonly discussed. A few
suggestions for additional satisfaction questions include, "Based on
the swport categories montioned in the previous questionnaire, how
satisfied are you with this support currontly provided?" also, "Based
on your expectations of support fron family/friends, how satisfied
are yon with this support currently provided?". This researcher also
recollnnods a neasuronnont of satisfaction for each category of support
rather than a global measure. Separate evaluations for each category
of support enables more accurate responses. It my be helpful to
expand the 4-point Likert scale to a visnnl analog scale, whereby
individuals could indicate their degree of satisfaction more
specifically and help to increase variation onong responses.

Once the questions are developed reliability and validity

 

 

 

 

 

q

s.

 

136

testing is needed. This will assure consistent results in the
measurement of satisfaction regardless of the sonple. It will also
assure that the questions are measuring what they are expected

to unsure.

'I'hronlnnt this stndy the exonination of satisfaction was very
cunbersone. It my be more useful to em the needs of the caregiver
and then adequacy of support in meeting those needs. The measurenent
of the adequacy of support is were specific when exandning whether
needs are net. If the needs are not net, an additional question mt
be asked to determine what assistance is still needed.

For the present study this researcher utilized secondary data.
Because the instrunnonts were developed and adninistered by other
researchers, the instrunents were not quite adeqnnte to measure the
variables selected for this study. Future alterations in the
instruments were recomneded to more accurately measure the variables
of instrnmontal support and satisfaction. Thus, future study of
these variables can be inplenented with mre reliable measures.

The next area related to research iuplications will consist of a
review regarding the use of Kalm 8 Antonucci's fronnewark (1980) in
the study of support provided to elderly caregivers. There are a few
studies which incorporated the idea of a "convoy" of social support
and were discussed in the literature review.

mum a m 8 We me

For the present study this franework was helpful in
understanding the relationship between the use of social support and
the degree of satisfaction with support. The presence of social

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137

support and the degree of satisfaction with the support were expected
to influence the caregivers' well-being, which is the ultimte goal
in the provision of support, particularly within the realm of
nursinng.

The fronework Rain 8 Antonucci (1980) developed was an excellent
guide for this stndy. 'Ihe concepts selected to be investigated in
this stndy fit appropriately within the fronework selected. In an
earlier chapter this researcher noted that not all of the concepts
discussed by Kahn 8 Antonucci were cashed in the present study.

The study of the other concepts described by Kahn 8 Antonucci were
nnot within the realm of this project, but could be of interest in
future studies related to the topic of instrumental support.
Recounendations of how Kahn 8 Antonucci's fronework could be utilized
more conpletely will now be presented.

The properties of the person and situation were of inportance in
the present study, but did not beconne concepts of nejor focus. The
senple grow was predetermined and consisted of a haungoneons group
with regard to sex, nerital status and role, thus nno cowarisons
could be made in relation to this variable.

The next concept described by Rain 8 Antonucci (19%) was the
requirenent of support. This concept was nnot exolnlned in the present
study, but conld easily be exonined in future studies. The
caregivers could be asked to identify their prinnry concerns and
needs. A list of possible responses conld be developed to allow
easier scoring of the respoues. Based on the identified needs, the
provision of support conld then be evaluated.

Kahn 8 Antonucci (1980) described the convoy as the next concept

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in their fronework and emphasized the ability for it to change
throughout life. In the present study a very limited part of the
convoy was investigated. alphasis was on a specific type of support,
but the sonrce was evaluated in a very general unnner. To utilize
this frenework as it was developed to be used, more specific aspects
of the ”convoy" or support network nust be exerdned .

A critical area to exanine within the network are the
individuals who are considered the inmediate network. It is possible
that the caregivinng wives are quite involved in their role ad say
have a very limited support network fronn which they can obtain
assistance. This could influence how such support they receive and
could also influence their level of satisfaction. How conld the
caregivers be dissatisfied with network embers who do not exist?

It is also inportant to lnave the caregivers identify other
sources of support, such as miners of a forual network of support.
These additional sonrces of support can affect the degree of
satisfaction with the informl network, if it supplements the smart
not provided by the informal network. Having an alternate source of
support may leave the caregivers with an overall feelinng of
satisfaction which my overcone any feelings of dissatisfaction.

Knowing who is in the support network is inportant, but it is
also helpful to know how long the individuals have been a part of the
network. Veteran nenbers may be more helpful in a crisis ad may
enhance the overall network . Caregivers may consider the presence of
a veteran umber vital, enabling then to saintain their role as
caregiver.

A conparison of change in network nelbers over time would be a

 

 

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139

valuable obervation in a longitudinal study focused on instrumental
support and satisfaction. The affect of change on satisfaction could
be quite interesting.

finere are my aspects of the support network that could be
exonined. mly a few aspects euphasised throughout the discussion
of Kahn 8 Antonucci's (1980) framework, were fond to be of special
inportance when considering the use of the frenework in the study of
social support and its affect on well-being. The aspects of
interest, as discussed, include the network numbers, their
relationship and degree of closeness to the caregiver and the pattern
of dnange in tlne network over time.

'lhe min proposition of Rain 8 Antonucci's franework (1980) is
that thronghout the conrse of life an individual's support network
will change, bunt so say their need for varions types of support.
Alteration in these two variables will consequently influence whether
the support is adequate to unset an individual's nneeds. The frenework
suggests the use of a longitudinal study to exanine the alterations
in these variables over tine.

Unfortunately, because of tine and cost to develcp longitudinal
studies, very few have been conducted. It wonld be helpful to have
more cross-sectional studies focused on individuals of varions ages,
specifically wives caring for husbands. A coparison across the
conrse of life could then be atteupted. 'Ihis wonld give researchers
a better perspective of how the provision of support may change and
how the degree of satisfaction with support could be altered.

A benefit to using this frenework is that it can be used for
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There are multiple variables to consider which allow for a variety of
projects to be developed. The fronework by Kahn a Antonucci (1980)
can be useful for the Clinical Nurse Specialist in the future study
of support and satisfaction since, like nurses, Nahn 8- Antonucci
consider an individual as a whole including his/her past and present
as well as his/her personal and situational characteristics.

In her article Norbeck (1981) explained how Rain 8 Antonucci's
frmrk (1980) could be utilised to incorporate the study of social
support into nursing practice. 'lhe incorporation of the four steps
of the nursing process, assessunnent, plamning, intervontion and
evaluation, into the frunework will now be presonted.

In their frauework Ralln £- Antonucci (1980) propose that the
properties of tlne person and of the situuation jointly determine an
individual's need for social support as well as the actual support
provided. fine assesanont process involves determining whether the
actual support provided seats the needs of an individual.

The Clinical Nurse Specialist begins the assesuont process by
first idontifying possible needs of the caregiver. This infatuation
can be anticipated based on previous research findings as well as
actual clinical experience.

During an interview with the wife, the Clinical Nurse Specialist
can idontify the wife's weaknesses and strongths in the caregiving
role. The Clinical Nurse Specialist can idontify wlnt coping
behaviors the caregiver previously used Id what resources she has
had available to her on a consistont basis. It would also be useful
to explore the caregiver's past experimees with seeking assistance

fron others .

 

141

After reviewing the needs and resources, it is inportant to
assess whether, accordirng to the caregiver, they couplenent one
another. If the wife irndicetes the assistance is inadequate, further
planning is required to facilitate the caregiver.

The plans for change must include the caregiver, the care-
recipiont if possible, and any family or support network numbers who
participate actively in the caregiving role. If support is
inadequate, planning is needed to idontify ways to alter the
situation or inuprove the support network in order to meet the need
for support.

'Ihe Clinical Nurse Specialist along with the caregiver and
others identified, must determine a plan to help meet their needs
adequately. If more respite is needed, the family and caregiver
should discuss the alternatives, with the Clinical Nurse Specialist
u the facilitator. Reconnendations can be offered by the nurse, but
they can only be inplononted by the caregiver and her support
network.

If the help is not provided by the informal support systan, the
support required by the caregiver must be obtained fron other
sources. Likewise, if support is adequate, planning my be required
to determine what long-term help is needed to unintain the support.

Intervention, the next step in the nursing process, involves
efforts to onhance the capacity of the social support systouu to
provide support. It is recomded that this be done with minimal
disruption to, or alteration of the support network, unless the
network is fond to be pathological. The intervention can involve

the support network available or result in use of supplounental

 

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142

support fron other sources, depending on the need of the individual.

The Clinical Nurse Specialist functions as a facilitator in the
intervention step of the nursing process as well. She should
encourage the caregiver's participation to the min. The Clinical
Nurse Specialist is responsible for coordinatinng the services
required by the caregiver. The services to be coordinated include
the referral to bone health agoncies and hone care supply conpanies.
The caregiver can be informed of what would best meet their needs
such as a bathtub rail or a portable phone, but must initiate the
actual purchase of aids or assistance on their on, whon possible.
This allows them to mintain their indepodonce with the guidance of
a professional person.

Evaluation, the final step in the nursing process, involves
evaluation of the actual ontcouue. The evaluation also includes
emdmtion of the intervention and planning nethods to determine if
they were appropriate to produce the expected ontoonue. Other
variables related to person and situation say also be discovered
through evaluation.

After an established period of time such as three to six months.
the Clinical Nuurse Specialist should contact the caregiver to
determine the status of the caregiving situation. At that time the
Clinical Nurse Specialist, along with the caregiver, should
reevaluate the changes innplanented to deterunuine their effectiveness
inuneetingtheneedsofthecaregiver. Ifmretinneisneededto
couplete errands or more assistannce is needed to help with physical
care, new plans should be devised. Plans should be devised
collaboratively between the caregiver and the hoalth care agency with

 

 

 

 

 

 

143

the Clinical Nurse Specialist again facilitating the contact when
needed.

Norbeck (1981), in her discussion of this fronework, considers
the four steps of the nursing process as well as the four couponents
included in nunost nursing practice theories - person, envirosnent,
health and nnursinng actions. Norbeck has shoan how closely this
fronework represents wlat nursing theorists have been euphesising for
years. Consequently, utilisation of this franework in future nursinng
research is recollmnded.

Kahn S Antonucci's frmrk (1980) could also be used as a
guide in a Geriatric Assesonunt settinng, such as the one in which
this researcher works. In the evaluation of an individual's social
support network, it is inportant to consider all the variables
mtioned, including the personal and situational characteristics and
the need for support. This inforuuation can be the basis upon which
additional support is provided if thought to be necessary.

Use of this fronework as a guide could prevent inappropriate
recomnendations of support to caregivers not willirng to utilize
specific types of support. Ann emle is a caregiver who is quite
meticulous in her chores around the house and would be very
frustrated with a housekeeper conning to her hone weekly. Knowing
sane of her personal characteristics, cann help in the identification
of appropriate and inappropriate assistannce. 'lhe iuuplications and
recomnendations for future areas of study related to the topic of

social support and satisfaction are presented next.

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Etna: Areas of m

The present study was descriptive as are my other studies
performed in the areas of caregiving and social support. As was
reconnended by Zarit (1989) and Stewart (1989), there is a need for
sore projects involving interventions. 'Ihe Clinical Nurse Specialist
has the ability to inplenent an intervention technique and then
evaluate its effectiveness in altering the depedent variable.

'Ihe Clinical Nurse Specialist has the ability to develop a
progren to instruct caregivers and feunily numbers on the provision of
physical care, such as bathing, repositioning, transferring, and
feeding of dependent individuals. For caregivers who have feuuily
numbers who are unable to help with care due to lack of ability, an
instructional progrenu my be helpful. It could instill confidence in
family numbers who are willing to participate, bunt are unconfortable
with the caregiving role.

After providing the progrouu, the Clinical Nurse Specialist can
then evaluate whether the progrenu had an influence on the increased
participation of other feuuily numbers in the role of caregiving.

This infatuation could be obtained fronu the primry caregivers
tlnenselves.

In the present study becauae wives on average were satisfied, it
would be difficult to evaluate a chege if additional support was
provided. When a more reliable instrument of satisfaction and
assistance is utilized, it is possible that the responses would have
greater variability. Iuplenentation of an intervention could then be
useful in prounoting a positive change. Of course other variables
influencing the perception of satisfaction would also need to be

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considered.

The literature review stimulated interest in other areas
requiring research as well. flare is a growing interest regarding
caregivers and the adequacy of support in nnneeting their needs. An
additional dinnension of interest should be on the simultaneous
evaluation of the care-recipients and their views regarding adequacy
of support (Barer & Johnson, 1990).

'lhrough the literature it was also suggested that enphasis be
placed on the whole support network, rather tlann juat on the prinary
caregiver (Tennnstedt, ”inlay & Sullivan, 1989; Barer & Johnson,
1990). The Clinical Nurse Specialist should recognise the secodary
caregivers and their innpact on the prinnary caregiver's role. In the
present study the researcher began to emuiune the effects of the
secondary caregiver's assistance on the primry caregiver's degree of
satisfaction with support. finis is only the beginning to
understanding all the variables which nnay influence adequacy of
support and satisfaction.

The strog relationship between frequency of support and
satisfaction is consistent with nnrnst previous research and is of
particular interest. They lave both been shoan to be related, hunt
in the present study in particuular becauuse support was so low and
satisfaction so high, the influence of other factors seens inportant.

Based on the results mentioned, fuurther studies are recoununeded
to exennine whether similar findings occur with otlner spouses. Then a
conparison to other caregivers is recomeded to determine if they
also receive support infrequuently buut indicate they are very
satisfied. It may also be of interest to conpare elderly individuals

 

146

other than caregivers to determine if results vary. This my help to
narrow the list of factors which influence the degree of satisfaction
with social support. Knowledge of the factors which have the
greatest inpact on satisfaction cann be useful in the provision of
adequate support.

Other recoumendations include evaluating other primry
caregivers such as other wives, huusbands and children, utilising the
modified instrument previously discuussed. Then a couperison of the
caregivers with regard to support provided and satisfaction with the
various support provided would be of interest.

Next, a study is reconmeded to investigate the support provided
by the infomel network versus the forml network folloved by an
exondnation of the satisfaction with the support. It would be
interesting to knnow dnether utilising both sources of support has any
influence on degree of satisfaction with support and whether the
caregiver believes the two sources conplennent each other or
substitute for one another.

More longitudinal studies would be helpful to enable couparison
of changes over time. However, further descriptive cross-sectional
studies utilizing the sons instrument in its revised and expanded
fornnat would be useful for couperison purposes as well.

Once it can be determined which factors say have the unset
positive influuence on an individual's level of satisfaction, an
intervention can then be innpleunented. The Clinical Nurse Specialist
could be part of the plannnning, the innpleunentation, as well as the

evaluation process previoaly discussed.

 

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147

museum; for menus footie
The findings of this study also have inplications for nursing

practice. In this study wives utilised very little support frouu
fondly and friends. However, when examined further the wives were
quuite satisfied with the assistance they were receiving.

To the Clinical Nurse Specialist, particuularly in her roles as
assessor, plannnner and counselor, these findings are inportant. As a
Clinical Nurse Specialist working in a Geriatric Assesenent Clinic it
is innportant to identify who is in the patient's and caregiver's
support network and what assistannce is provided.

The patient is of priunary interest in the progronn, however the
caregiver and other support providers becone a secodary concern.
The patient's well-being often depends on the physical and ennotional
status of the caregiver.

The Clinical Nurse Specialist must assess what support is
available to the caregiver, but must also identify whether the
patient's needs are adequately met. Kunming the feuale spouse
caregivers in the present study utilised limited support but were
satisfied, raises concern whether the patient's needs were adequately
met. There is also concern that the type of support needed by the
caregiver may not have been the type exeuuined in this study,
therefore no final conclusions could be node. It would be nice to
assume if the caregiver is satisfied, then no further assistannce is
needed. Review of the literature, however, has shown that multiple
factors can influence an individual's feelings of satisfaction.
Therefore, satisfaction may not be a true indication that the

patient's needs are adequately met.

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148

The Clinical Nurse Specialist in his/her role as an assessor
must consider the findings of the present study. There are nunjor
concerns regarding caregivers and the stress they encounter, however
when in a clinical situation the patient is of prinnary concern and
must be considered first when fulfillment of needs is exeuuined.

The Clinical Nurse Specialist as plannner could use the findings
of this study as a basis for developing planns of care for the patient
while also benefiting the caregivers. As a primry care provider the
Clinical Nurse Specialist has a responsibility to care for an
individual in a couprehensive munner. The responsibility includes
the consideration of all variables which any influence the
individual's state of well-being. Nhen an individual is the patient
of a caregiving dyad it is very iunportant for the Clinical Nurse
Specialist to recognize the needs of both the patient and caregiver.
Because the caregiver's health and well-being could be a nuajor factor
in the patient's health statua, the plan of care must include the
needs of the caregiver as well.

When an individual is the caregiver of a caregiving dyad the
Clinical Nurse Specialist must consider the strain of caregiving.

As a Clinical Nurse Specialist in Gynecology this issue because of
greater concern everyday, particularly since feuales are the primary
source of caregiving in our counntry today. Consideration of the
possibility that a patient uuay have the role of caregiver oursg other
roles should be of primary inportance for a Clinical Nurse Specialist
in the primry care setting. This is especially true since the
stress caregiving wonnen encounter nuay be a primry influential factor
in the development of future health problem.

 

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149

The Clinical Nurse Specialist as a counselor could also benefit
froln the infomtion obtained fron the present study. When
counseling a caregiver on ways to obtain assistance, knowing the
kinds of support likely to be unavailable froln the infomel network
can be helpful. Researchers have fond fonily numbers to be the best
source of assistance to spouse caregivers, but the assistance nay
consist of limited involvenent in physical care.

As a Clinical Nurse Specialist in a Geriatric Assessment clinic
the role of cosnselor beconnas very iuportant. The caregiver is
allowed time to verbalize concerns openly and is then encouraged to
me any problen-solving skills available.

In the present study the caregivers were satisfied with
assistance. This my be true for other caregivers as well, but they
should be encouraged to evaluate their caregiving situation and
express any concerns they any have. Initially my caregivers my
feel confident in their role. With access to counseling they may
find that they could benefit fronn utilization of other resources,
whether fron the informl or foul support network.

My
In this chapter an interpretation of the results was presented

followed by a discussion of the inplications to nursing research and
practice. Within the section on results it was stated that the
characteristics of this sonple are representative of uajority of
caregivers previously studied. The caregivers my not, however,
represent the overall caregiving population due to the self-selection

process utilized in recruiting participants.

 

 

 

 

 

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150

Through this study ferale spouse caregivers were found to
receive nest support from family and frieds by then keeping their
husband conpany. Long-term respite care was available least often.
These findings are consistent with previous studies.

Overall, support was provided at very limited intervals, however
caregivers were still found to be satisfied with the assistance
provided. The literature has indicated there are multiple factors
which could influence an individual's perception of satisfaction.
Therefore, uneasurenant of satisfaction must be utilized with caution.

There were limitations found with the instruunt wed in this
study and several recamnedations were node. Following is a winery
of those recoumedations alog with recounedations for future
nursing research and nursing practice.

and of Mine

1mm

1. Further reliability and validity testing.

2. Specific rather than global questions to measure
satisfaction.

3. Ann assistance instrument which assures only one dimension of
suupport such as instrumental or optional support, not both.

4. An instrument to treasure adequacy of support, rather than
satisfaction.

5. Use of a visual analog scale to increase response accuracy.

nature Area of m
1. Projects involving interventions to provide supportive

services followed by a measurement of change in satisfaction or

 

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151

adequacy in nnneeting needs.

2. Evaluate care-recipient satisfaction simultaneously with
caregiver satisfaction.

3. More studies focused on secondary caregivers and their innpact
on the primry caregiver's role.

4. Conparison studies between different groups of caregivers to
examine support provided and their degree of satisfaction with
support.

5. Project to exenine both infornnal and forml support available
and determine whether they are related to satisfaction.

6. Descriptive studies utilizing the revised instrument would be
beneficial initially for conparison.

7. Logitudinal studies are reconmeded to conpare change of
support utilized over tiunue.

8. Examination of other concepts within Kahn S- Antonucci's
(1980) frenawork such as the nneed for support and specific network
characteristics .

9. Specific network characteristics to consider include network
menbers, legthof timeasamenber, andthechangeof thenetwork
umbership over tinnue.

10. Further study on the availability of infernal and fornnel
support and how they are uused to conplennent or substitute for one

another .

2:19:12
1. When examining a care-recipient the Clinical Nurse Specialist

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152

their role as caregivers.

2. The Clinical Nurse Specialist must consider the role of
caregiver when assessing their clients. This nnay influence the
client's state of health.

3. Plans of care must be cmsidered with the role of caregiver
in mind, if it applies.

4. The Clinical Nurse Specialist mt nuke caregivers aware of
resources available.

5. The Clinical Nurse Specialist must counnsel the caregivers as

well as fenuilies on the ways they can obtain and provide assistannce.

Conclusion

The present study senple was self-selected and nonrandoaized
resulting in a nogeneralizable senple. The descriptive findings can
be used as a base upon which the Clinical Nurse Specialist can add
data as other groups of caregivers are studied. The findings have no
direct application to practice, bunt as described by Stetler 8- Narrenu
(1976) they have a cognnitive application. This suggests that
knowledge fronn this study may be used to enhance ulderstanding of
other caregiving situations which any result in future alterations

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APPmDIX A

Informed Consent Procedure

Before we get started, I would like to take sonue time to explain what
will be involved in taking part in this study and to answer questions
you my have about taking part .

Basically, over the course of the year, there will be two here visits
which will be arranged at your convenience as well as several
telephone calls and mailed questionnnaires.

There are sonue other things that are inportant for nnue to let you know
about relative to taking part in this study.

(he thing is that taking part in the study will not change the health
care or services that you are now receiving. The study does not
provide any services and cannot arrange for services for you.

Also, if your situation should change during the year so that you are
no longer helping your relative, we would still like to maintain
contact and ask quuestions of you.

It is inportant for you to know that all of your responses during the
course of the study are anonymous and confidential. Your none and
aunything which would identify you personally will be kept separate
fronu the annswers you give. Neither your none nor the none of your
fondly nnuenber will be given out to anyone else or uused in any written
reports of the study at any time.

We want you to be aware that taking part in the study is voluntary
and you are free to witl'draw fronu the study at any time without

consequence.
Do you have any questions about taking part in the study?

I have a written consent fornnn with me that I would like to have you
signn. I'll leave one copy of the consent fornnu for you to keep and
take one copy to keep with the records of the research study.

IFWHMWIS'ITOSIQM, IEAVEWACDPYANDW
WITH THE IRWIN. 1m ‘IHIS IWTIGU (I! THE MINER
ABM.

153

 

 
 
 

 

 

 

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APPENDIX B

MICI'IIGAN STATE UNIVERSITY
Fanily Caregiver Study

The study in which we are asking you to participate is designed to
learn more about the ways in which caring for an older fanily umber
affects the person providing the care.

Over the next year, fanily caregivers will be interviewed by a number
of the Purdly Caregiver Study research staff three times (at intake,
six nmths, and at me year). Each interview will take approximately
one and one-half hours to cmplete. Caregivers will be asked to
carplete written questionnaires and to answer questims asked by the
interviewer. They will also be asked to report, each three nmths
during the year, on any health care services used.

If you are willing to participate, please read and sign the following
statement:

1. I have freely cmsented to take part in a study of caregivers ~
and their patients caducted by the College of Nursing and the
Departmmt of Family Practice, College of mm Medicine, at
Michigan State University.

2. The study has been described and explained to me and I
mderstand what my participatim will involve.

3. I \nderstand that participating in this study is voluntary.
4. I understand that I can withdraw frcm participating at any time.

5. I understand that the results of the study will be treated in
strict confidaice and, should they be published, my m will
retain anmynnus. I understand that within these restrictims,
results can, upm request, be made available to me.

6. I understand that no immediate baiefits will result fran taking
partinthis study, butanamrethatmresponsesneyaddto
the understanding of health care professimals of the experience
of being respmsible for an older fanily umber. .

I, . state that I \mderstand what is required of
me as a participant and agree to take part in this study.

Signed Date
(Signature)

 

154

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APPENDIX C

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W W: Please answer the following qmstions about
yourself as the caregiver.

2. What is your date of birth?: ___/_/
amth/date/year

 

3. What is your race? (Check me, optimal)

 

Caucasian Pmerican Indian
Black Orimtal/Asian/Pacific Islander
__ Hispanic Other (Please specify )

 

._r_egi___Ca vet mm
1. Are you currently exployed for pay? (Cluck)

__ no __ YES Are you enployed: Full-time
Part-time

W W: Please answer the following questions
about your relative as the care-recipient.

1. that is the date of birth of your relative?: ___/_/__
umth/date/ year

2. “hat is the race of your relative? (Check me, optimal)
WINE MIR! m I? RELATIVE 18 M PRESENT

 

__ Caucasian hmrican Indian \
__ Black Oriental/Asian/Pacific Islander
__ Hispanic _ Other (Please specify)

155

 

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156

geistance Egg red s1 Relative

In the next set of questions, I an going to ask you about the kinds
of assistance required by your relative. For each activity I will
ask whether your relative requires assistance. Please respond either
YES or no to each questicn.

A. Questims related to ACTIVITIES OF DAILY LIVING

1. Does your relative need help with eating?

ms (1) m __ (2)

 

2. Does your relative need help with dressing and undressing?

YES (1) no __ (2)

 

3. Does your relative need help with cabing hair or shaving?
YEB (1) no __ (2)

 

4. Does your relative need help with taking a shower or bath?

 

m (1) no _ (2)
5. Does your relative need help with using toilet, bedpan or
comrade?
m (1) so __ (2)

 

6. Does your relative need help with walking?

as (1) no _ (2)

 

7. Does your relative need help with getting around the house?

YES (1) no __ (2)

 

8. Does your relative need help with getting in and out of bed?

 

 

as (1) no (2)
22. Does your relative need help to be cleaned u: what incmtinent
of urine?
as (1) no (2)

 

 

24. Does your relative need help to be cleaned up when incontinent
of stool?

YES___(1) too—(2)

 

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157

B. Questions related to INSI'RIMENI'AL ACTIVITIES OF DAILY LIVING

9.

10.

11.

12.

13.

14.

Does your relative need help with shopping?

(1)_ YE
(2) N0

 

Does your relative need help with housework?

(1)_ YES
(2) so

 

Does your relative need help with laundry?

(1)_ YES
(2) so

Does your relative need help with cooking?

 

(1)_ YES
(2) N0

 

Does your relative need help with handling his/her clan mney?

 

(1)_ YES

(2) no
Does your relative need help with arranging his/her own
transportaticn?

(1)_ YES

(2)_ N0

WWEWW

13.

14.

Wham did you begin to provide direct care for this perscn?
(HRH! IN m or YEARS AND mm)

Years Mmths

 

 

Was there a specific health problan or illness that led to

caregiving?
YE no

If as, what?

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APPDIDIX D

 

 

APPENDIX D

 

ASBIM mm 3! mm m ML! MID RIM/RIMS

The questims that I have jIBt asked are about assistance that you
receive through agglciee. Now I'm going to ask you questions about
the assistance that you receive fran other people to care for your

relative.

pay them or not.

By other people, I mean friends or relatives whether you

For the next set of questions, I would like you to pick one of four
categories of answers. You can choose fran "RARE“ (R m OF '11-!!!
TIME,” "8043 OF 1518 TIME," "DIET OF '1!!! TIME" or "mm ALL OF THE
TIDE."

1.

. Helped with physical care.

How often, over the past three amths, HAS ANYCIIE IN YCIJR EMILY
given you assistance in the following ways?

I
Spent time keeping your I
relative carpany. :

I

. Stayed with your relative

I
I
so you could do scmething I
else for a few hours. I
I
I

. Stayed with your relative I

so you can take a vacatim:
(for a weekend or longer) I

. Gotten up during the night:

with your relative.

Sim you statics-Isl
sipport or encouraganent .

Helped with transportatim:
(for either you or your I
relative). :

I

I
. Helped you with my or I
I
I

other material goods .

I
.Checkedmyoutobesure:
I
I

that you were all right.

Rarely or
nme of
time

 

Sane of I Most of I Almost
the the all of
time time the

time
(2) (3) (4)

 

 

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For the next set of questions, I would like you to pick one of four

categories of answers .

Youcanchoosefran'RARELYORmOF'lHE

$235,: "sons OF THE TIME," "1051' OF M TIME" or "MST ALL OF THE

1.

How often, over the past three nmths, have FRIENDS on NEIGIBORS
(not relatives) given you assistance in the following ways?

 

I

I

I

I

I

= I
. Helped with physical care.I
I

I

I

I

I

I

I

I

. Given you elntienal

. Helped with transportatian

.aneckedenyoutobesure

Assistance Category

.Spenttimekeepingyour

relative culpany.

Stayed with your relative
so you could do sanething
else for a few hours.

I
. Stayed with your relative I

so you can take a vacatienI
(for a weekend or lenger) I

. Gotten up during the nightI

with your relative.

support or encourag t.

(for either you or your
relative).

Helped you with mney or
other unterial goods.

that you were all right.

Rarely or
nane of
tine

(1)

SaneofIMostofIAlmost

the
time

(2)

 

l

the
time

all of
the
time

(4)

 

 

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APPENDIX E

 

3 ZILII'J I'M.

 

APPENDIX E

Overall, how satisfied are you with the assistance you are
currently receiving frann EMILY to care for your relative? Are

Very Satisfied (1) __ Sannewhat Dissatisfied (3)

__ Southat Satisfied (2)

 

Very Dissatisfied (4)

 

Overall, how satisfied are you with the assistance you are

. currently receiving fraln FRI... or warms to care for your

relative? Are you. . .

Very Satisfied (1) __ Sanewhat Dissatisfied (3)

 

__ Samwhat Satisfied (2) Very Dissatisfied (4)

 

160

 

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mm P

 

MIC

INNS
HUM

151’) 3

   

MICHIGAN STATE UNIVERSITY

 

UNIVERSITY COME! ON RESEARCH INVOLVING EAST LANSING 0 IICI'IIGAN 0 48824-1111
HUMAN SUBJECTS (UCIIHS)

106 mm HAL].

(517) 353-9738

April I7, 1990 IBM 90-154

Charlene Lasocki
9637 Quandt
Allen Park, MI 48l0l

Dear Ms. Lasocki:
RE: 'DESCRIPTIVE STUDY TO DETERMINE FREQUENCY AND SATISFACTION
WITH INSTRUMENTAL SUPPORT RECEIVED BY WIVES CARING FOR
DISABLED HUSBANDS IRB# 90-154“
The above project is exempt from full UCRIHS review. I have reviewed the proposed
research protocol and find that the rights and welfare of human subjects appear to be
protected. You have approval to conduct the research.
You are reminded that UCRIHS approval is valid for one calendar year. If you plan to
“continue this project beyond one year, please make provisions for obtaining appropriate
UCRIHS approval one month prior to April l7, l99l.
Any changes in procedures involving human subjects must be reviewed by UCRI? . prior
to initiation of the change. UCRIHS must also be notified promptly of any problems
(unexpected side effects, complaints, etc.) involving human subjects during the course of
.the work.

Thank you for bringing this project to our attention. If we can be of any future help,
please do not hesitate to let us know.

Sincerely,

J hn K. Hudzik, PhD.
Chair, UCRIHS

JKH/sar

cc: C. Collins

161

MSL" is an Affirmative Action/Equal Opportunity Institution

 

 

 

 

   
   
 
   

\

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'3‘.‘ 4'.

‘.‘.‘ f... 73‘“ . [Hunk u ‘3‘"

LISTOFW

 

 

 

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166

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U. S. Bureau of the Census (1988). U. S. Department of the Camerce.
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Printing Office.

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