Department of Public Health, Southern Connecticut State University, New Haven, Connecticut, USA.
Center for Aging, Tulane University, New Orleans, Louisiana, USA.
Issues Ment Health Nurs. 2020 May;41(5):445-454. doi: 10.1080/01612840.2019.1678080. Epub 2020 Mar 18.
The purpose of this study was to gain an understanding of the ambiguities and uncertainties experienced by a diverse group of African-American caregivers. The study applied Schlossberg's transition theory (TT) and Mishel's revised uncertainty theory to narratives of self-identified African-American caregivers who provided care at least 5 h a week. The men (6) and women (8) were mostly unmarried, mostly caring for a parent or grandparent. The caregivers' average age was 52 (SD = 19; ages ranged from 24 to 82 years); and the care recipients' average age was 84 (SD = 9). Six care recipients had dementia and the remainder had multiple disease diagnoses. Narratives were obtained by in-depth interviews or focus group discussions. These were audio-recorded, transcribed verbatim professionally and analyzed independently by trained coders. Schlossberg's TT contextualized whereas Mishel's RUIT illuminated the characteristics of the transition, its associated uncertainty, and their relationship to the development of caregiver stress. Situational factors such as difficulties with illness symptoms of the care recipient, conflict between previous experience and current expectations and the adjustments to the new caregiving role, burdened younger caregivers more than older caregivers. Self-factors related to lack of knowledge about the illness and feelings of lack of control. Social support was predominantly provided by family members, and its absence resulted in conflict among siblings and caregiver stress. The most common coping strategies include religiosity, expectations of reciprocity, and coming to terms with the uncertainty. Understanding the feelings, perceptions and needs of caregivers in transition is tantamount to providing nursing care.
本研究旨在了解不同的非裔美国家庭照顾者所经历的模糊性和不确定性。本研究应用 Schlossberg 的过渡理论（TT）和 Mishel 的修正不确定性理论，对自我认同的非裔美国家庭照顾者的叙述进行了分析，这些照顾者每周至少提供 5 小时的护理。其中 6 名为男性，8 名为女性；他们大多未婚，主要照顾父母或祖父母。照顾者的平均年龄为 52 岁（标准差=19；年龄范围为 24 岁至 82 岁）；被照顾者的平均年龄为 84 岁（标准差=9）。6 名被照顾者患有痴呆症，其余的人有多种疾病诊断。叙述通过深入访谈或焦点小组讨论获得。这些都是专业的录音，逐字转录，并由经过培训的编码员独立分析。Schlossberg 的 TT 使过渡的背景具体化，而 Mishel 的 RUIT 则阐明了过渡的特征、其相关的不确定性，以及它们与照顾者压力发展的关系。情境因素，如照顾对象疾病症状的困难、先前经验与当前期望之间的冲突以及对新的照顾角色的调整，对年轻的照顾者的负担比年老的照顾者更重。与疾病缺乏知识和缺乏控制感有关的自我因素。社会支持主要由家庭成员提供，如果没有社会支持，会导致兄弟姐妹之间的冲突和照顾者的压力。最常见的应对策略包括宗教信仰、互惠期望和接受不确定性。了解处于过渡状态的照顾者的感受、看法和需求，等同于提供护理。
