Caregiving has been a focus of debate among nursing specialists since recently because of the tendency to provide a patient with caregiving services within the family setting, therefore, refusing professional help. The tendency for family caregiving specialists to provide their services seems to have become especially frequent among African American families, as well as African American singles.
Despite the fact that nursing specialists may have better qualifications for providing patients with dementia, as well as aging people with the required health care, African Americans, especially families of African American caregivers, should be granted permission to offer their healthcare services to patients with dementia and aging people, seeing how their devotion to the community contributes to patients’ re-acquiring social skills faster and more efficiently than in hospital setting. However, because of high rates of depression among African American caregivers, it is recommended that a strict schedule should be approved for couples and especially single caregivers.
Introduction: Research Background. Caregiving in African American Community
The issue of family caregiving is, perhaps, one of the most controversial dilemmas in XXI century medicine. On the one hand, an aging person that has physical and/or mental disorders must be under constant observation of nursing specialists. On the other hand, researches show that mental disorders develop more slowly in the setting of a loving family and caring relatives. Hence the dilemma regarding the use of professional healthcare services at a hospital vs. home caregiving arises. The given issue is especially complicated in the African American community, where family ties are especially strong and where people tend to mistrust nursing specialists.
However, because of strong devotion, African American family caregivers develop rapid depressions and neuroses. Because of the necessity for African American aging patients with or without dementia to remain within the community and caregivers’ need to retain their upbeat and positive attitude towards patients, it is recommended that caregiving within African American setting should be encouraged, yet specific schedules for community caregivers should be established and that shifts with at least a five-hour lapse were introduced.
Research Rationale: When a Patient’s Life and Sanity Depends on the Choice of the Type of Nursing
Seeing how culturally, African American patients develop stronger ties with their community and family, they need to remain within either the former or the latter in order to recover. However, the devotion that African American caregivers have for their patients begs the question of whether such hard work affects the caregivers negatively.
Because of the unsettling health issues paradigm that has been spotted among the African Americans providing caregiving services, it has been suggested that, due to major stress caused by over-involvement with the patient’s progress, African American caregivers may be more subjected to depression, neuroses and other psychological disorders. The dilemma between providing high-quality services to a patient and remaining physically and psychologically fit, therefore, creates the premise for major research of the issue in question.
Research Questions: Exploring More Opportunities for Efficient Treatment of Patients with Dementia and Aging Patients in a Specific Cultural Context
Are caregiving services provided by close relatives or members of the African American community that the patient with dementia belongs to more efficient than the services provided by professional nurses in the hospital settings and, if so, what are the key social, economical and cultural factors predisposing the given phenomenon?
No matter how important it may be for a patient to be able to communicate with his/her relatives in the course of medical treatment, the quality of the nursing services provided is still the major factor in the patient’s recovery. Therefore, it will be required to check whether the system developed within the African American community and accepted among caregivers for the people with dementia, as well as foraging people in general, is actually any better than the one suggested by official healthcare services, as well as suggest the means to reduce the influence of the factors causing stress in caregivers.
What can be done to improve the quality of healthcare services for the members of the African American community provided by spouses, family members or married couples belonging to the community in question?
As it has been stressed above, with all due respect to the efforts of the African American caregivers for aging people and particularly for people with dementia, providing nursing services to patients with the aforementioned issues is not an easy task, especially seeing how most African American caregivers suffer greatly from the tension created by the unceasing stress. It is important to keep in mind that the hardships typically associated with caring for aging and demented patients are combined with the emotional strain caused by the concern for the family member, therefore, putting the caregiver under even stronger stress.
Literature Review: Caregivers for People with Dementia and Aging People in African American Community
While the given research has an admittedly unique premise, the idea of African American caregivers’ efficiency in attending to the needs of patients with mental disorders, as well as patients with disorders in general, has been mentioned quite a few times in the recent history of healthcare research.
Caregiving as a part of the African American culture
It has been quite recently since the impact of kinship on the quality of African American healthcare services has been spotted (Prick, de Lange, Scherder & Pot, 2011). As a rule, the lack of trust towards nursing professionals is the key reason for resorting to family caregiving (Kennedy, Mathis & Woods, 2007). For example, a 2010 research has revealed that in cases of diabetes in African American children, the grandparents of the latter, particularly, their grandmothers, prefer to handle the problem without the interference of a professional (Carthron, Johnson, Hubbart, Strikland & Nance, 2010).
The same unwillingness to trust professional services goes for people with mental disorders in African American culture (Warren-Findlow, Laditka, Thompson & Laditka, 2013). Cultural mistrust is traditionally defined as the key reason for the aforementioned phenomenon to take place (Moseley, Freed, Charrel & Goold, 2007).
African American caregivers for people with dementia and aging people: case studies overview
As recent researches say, due to much stronger ties between the representatives of the community, African American people provide more efficient healthcare services than nursing specialists do (Moseley, Freed, Charrel & Goold, 2007). While over-involvement can have admittedly poor results on patients’ health state (Merritt & McCallum, 2013), the fact that African American nurses are more passionate about doing their professional duties than other nurses cannot be doubted (Shin & Brown, 2009, p. 1040).
However, the African American caregiving system, particularly the one that has been designed for taking care of aging people and people with dementia, has its basic flaws, numerous researchers say (Chadiha & Rafferty, 2003). Because of the psychological strain that African American caregivers are constantly under (Mitchell & Knowlton, 2011), nervous breakdowns, stress and even depressions are very common (Chadiha & Rafferty, 2003). Some steps have been made to ensure that caregivers should abstain from the restless nursing process and have an opportunity to “recharge their batteries” by providing the so-called “respite” (Noelker & Browdie, 2012, p. 103).
Nursing facilities for African American patients with dementia and aging patients: hospitals vs. caregiving provided by family or community members
The obvious over-engagement with the progress of the patient is African American nurses and especially caregivers for aging or senile people however begs the question of whether such emotional involvement serves for the patient’s benefit. In other words, it is necessary to check whether African American caregivers are actually any better than professional nurses at assisting patients with dementia and aging people in general. As Hinojosa’s case study shows, African American caregivers spend 6.82±5.76 hours per day providing consistent nursing services to their patients (Hinojosa, Rittman, Hinojosa & Rodriguez, 2009, p. 226).
The given number, though clearly lower than the one of Puerto Rican caregivers, still provides a number of reasons for concern and is related to both caregivers for people with dementia and aging people. Moreover, some of the researches clearly state that “Black or African American CGs are also less likely to invoke formal supports than their White or Caucasian counterpart” (Hilgeman, Durkin, Sun, DeCoster & Allen, 2009). Moreover, some of the studies go as far as claiming that caregiving reduces the quality of marital relationships between African American spouses and, thus, contributes to major conflicts and that caregiving is a “burdensome” on the marital functions of African American caregiving spouses (Chadiha & Rafferty, 2003, p. 480).
Theory and Practice of Healthcare for People with Dementia and Aging People
Judging by the fact that African American caregivers are highly subjected to depression and can even develop a neurosis when taking care of an aging or demented family member, the reasonability for caregiving for the patients in question can be seen as rather low. Therefore, an additional comparison of home caregiving and professional nursing should be carried out. There can be no possible doubt that traditional hospital nursing has a tremendous effect on the health state of aging people and people with dementia; however, recent researches have shown that home caregiving also has its upsides, including more opportunities for a patient to be in touch with the community and, therefore, remain socially active, thus, having better chances for recovery.
In addition, the support of a loving family also matters greatly for an aging patient. For instance, Courts (2001) made it obvious that all family caregivers share a sense of responsibility for their patients. However, Courts also makes a very strong argument by stating that “moving to a nursing home does not end a family involvement or responsibility” (Courts, 2001, p. 45). While the given statement has a grain of truth in it, it should still be mentioned that communication with family members is much more restricted in the given case, though.
Mier, in her turn, makes it clear that specific character traits and behavioral patterns, which can be attributed to a particular ethnicity, affect the choice of therapy for patients with dementia greatly. As Mier explained in her study related to a similar issue concerning caregiving for Hispanic dementia patients, “If ethnicity can be conceptualized as symbols that individuals use to create identity and meaning and to act, think or feel […], there is no doubt that the caregiving experience can be shaped by culturally-based ideas that the caregiver’s role, idioms of distress or ‘burden’” (Mier, 2007, p. 12). More importantly, caregivers have to define what constitutes good – and bad, for that matter – healthcare, thus, solving a range of ethical dilemmas.
Therefore, though caregiving is obviously more preferable to hospital nursing services, it is still questionable whether a family of caregivers and, which is even more doubtful, a single caregiver can possibly deliver better results than nursing staff does. The stress issue should also be kept in mind; according to the data provided by Czekanski, “caregivers who reported caregiving strain are 63% more likely to die within four years than non-caregivers” (Czekanski, 2007 p. 6).
Caregiving vs. hospital treatment: pros, cons and reasonable suggestions
As efficient as African American nursing strategies for aging people or people with mental dysfunctions may be, the question of whether home nursing services can be a decent replacement for the ones provided at the hospital still remains legitimate. Researches say that both caregiving systems usually work well with patients suffering from such syndromes as Alzheimer’s disease: “studies have shown the experience of caregiving to be both rewarding and a daunting task” (Bivins, 2013, p. 16). After all, family caregiving is nothing to be sneezed at – “Family caregivers are the backbone of America’s long-term services and support system” (Thompson, 2010, p. 34).
Key specifics of African American caregiving: the power of a community
As it has been stressed above, African American people, who have family members or the members of the community affected either by dementia or any other age-related disorder, rarely resort to the services of the hospital staff and prefer to take care of such patients on their own. The interviews conducted with married couple caregiving for years and a single person, who has also been aiding an aging patient, have shown that in their efforts, African American caregivers prefer to rely on the power of emotional ties that a patient develops when communicating with the person assisting him/her.
As a result, the number of African American caregivers suffering from heart conditions, depression and other related health issues is several times more than the number of caregivers belonging to other ethnicities: “The United States Renal Data System (USRDS) (2010) annual data report indicates that the incident rate among African Americans is nearly four times higher than the incidence rates among Caucasian Americans” (Byers, Wicks & Beard, 2011, p. 426); as the recent researches show, the deterioration of health and health risks are also typical for the caregivers providing their services to aging patients, especially those with dementia or similar mental disorders.
Essential nursing strategies for people with dementia and aging people and their implications
The papers studied to analyze the issues emerging in the course of caregiving for people with dementia and aging patients, in general, have shown that the given process is truly emotionally devastating.
Research Methods: Interview and Its Analysis as the Basics for Developing a Grounded Theory
Interview as the key tool of a qualitative study: participants and their roles
In order to evaluate the challenges that family caregivers, as well as single caregivers, face when providing their services to people with dementia, Alzheimer’s and other age-related disorders and determine the ways in which these challenges can be approached, as well as decide whether caregiving is actually better than professional nursing services provided in hospitals, two interviews are going to be used. In the given paper, the answers to the interview questions received from an African American couple and a single caregiver are going to be compared and analyzed.
Interview analysis tools: coding and decoding and their efficiency
For measurable results to be acquired in the process of analysis, the interviews are going to be coded with the following categorization and classification of codes.
Grounded theory: Learning to analyze facts and make the right conclusions
As soon as the information gathered from the interviews is processed and the required conclusions are made, a theory concerning the efficacy of caregiving in general and single caregiving in particular, as well as the means for caregivers to cope with stress, will be provided.
Participants Selection: Choosing the Most Appropriate Candidates for an Interview
Since the given research is focused on not only determining the benefits of personal caregiving as compared to the nursing services received at the hospital but also defining whether a family of caregivers can possibly contribute to the patient’s recovery better than a single caregiver, it is most reasonable to pick a family of caregivers and a single caregiver for a personal interview and the evaluation of their performance, as well as compare the effects that caregiving has had on them, therefore, defining the key risk factors that may possibly enhance the stress rates in a person providing caregiving facilities.
African American couples providing caregiving services
As has been stressed above, two African American caregiving couples have been interviewed for the research. The first one, Mr. and Mrs. Stein, aged 66, claimed that they have been providing nursing services since they were 20. In the course of the interview, the husband and the wife were asked about their experience, the effects that their approach has had on the patients, the reasons for them to become caregivers and the issues that they have faced in the course of providing caregiving for their community. As the interview results have shown, Mr. and Mrs. Stein became caregivers at the age of 20, when they had to take care of their grandparents, particularly their grandmothers.
The couple has put a very strong emphasis on the necessity for a caregiver to be emotionally involved with the patient; as Mrs. Stein explained, prayers and love were the key medicine for their patients. As for the coping mechanisms, Mr. and Mrs. Stein have confirmed that giving vent to their feelings (e.g., laughing, crying and using emotionally colored speech) were the key means to escape depression. However, when they felt that they were completely exhausted, they had short vacations and resorted to the support of their families.
Another couple that was interviewed for the study, a husband and a wife, who are also in their sixties, have provided ample information regarding caregiving within the African American community. In contrast to the couple described previously, these people stated that watching over their parents was the pivoting point at which they decided to become caregivers. According to what the couple said, conflicts with capricious patients and the need to give vent to their feelings when there was no opportunity to were clearly the hardest parts of being a caregiver.
It is remarkable, though, that a mere act of sitting in silence with the patient – the mother, in this case – and letting the patient know that his/her feelings are understood, accepted and appreciated helped the couple settle most of the conflicts. Unlike the previous two caregivers, these two never took a vacation from their caregiving routine. A cup of coffee at the end of the day was the key solution to most of their problems. Thus, it can be concluded that having the support of a spouse is the key advantage of married caregivers. In addition, a husband and a wife can take turns in nursing a patient, which may help each of them avoid a number of stressful moments, when they are too exhausted to provide top-notch services.
Single caregivers vs. nursing couples: advantages
Unlike the couples mentioned previously, the first single caregiver has been providing nursing services solely to her mother; being a caregiver for 22 years, the woman, aged 65, seems to have most issues with having too many responsibilities to handle. Most of the information acquired in the course of the interview came from non-verbal elements, i.e., the hasty way in which the woman paced her conversation, the interruptions that she had to make in order to check on her mother, the overall nervous attitude, etc. In her case, a couple of glasses of wine and a cigarette seem to be the key means to survive the stress.
Finally, the second single caregiver, a 66-year-old man, who also has to take care of his mother, is clearly dissatisfied with the situation and is obviously willing to give up on his new responsibilities. However, his “duty” makes him nurse his senile mother. Much like the first couple, though, the man resorts to praying. Listening to calm music also appears to be one of the few ways to relax for him. It is clear that he is worn out both physically and emotionally since he states openly that he has grown detached from his mother.
Data Collection: Methods and Processes Specification
Unless collected, stored and processed in a proper way, the data obtained in the course of the research will be useless. Therefore, an appropriate means of information management must be introduced.
Interview as the basic method of information acquisition in studying the specifics of African American caregiving
Interviews were the basic means of collecting the research data. Apart from conducting interviews, though, a thorough check on caregiving in general and caregiving among African Americans has been done. Thus, a more objective assessment of the problems faced by African American caregivers can be carried out.
Observations: when non-verbal elements of communication say more than verbal ones
The interviews being the key source of the research data, it was crucial to not only transcribe the participants’ words but also to analyze their behavior, mood and general attitude. Therefore, observations were also used as a part of the interview in order to note the explicit non-verbal elements of the conversation, which provided additional information (i.e., gestures, poses, the manner of speaking, etc.).
Types of questions used: multiple, ideal and interpretive questions as the means to define the key caregiving principles
In the course of the interviews, special questions were used in order to attain the key information. In order to specify the data, general questions were also used.
Data Analysis: Defining the Means of Data Coding, Assessment and Interpretation
Another important stage of research, data processing will be much quicker and more efficient once the coding is utilized as the basic tool.
Adopting an inductive approach: the most reasonable way to look at the interview data
By using an inductive approach, one will be able to define whether home caregiving is better than nursing provided at the hospital. In addition, the differences between single and married caregivers will be outlined. Finally, key methods for caregivers to fight stress related to their daily routine will be provided.
Coding and decoding: information evaluation and processing
A list of codes will be provided for the analysis of the interviews. Thus, typical features of caregiving among African Americans will be specified. The codes will be compared in order to find a common pattern with the four interviews in question.
Noticing, collecting and thinking model adopted in the study
It is imperative that a particular method of information processing should be adopted for the analysis of the information used in the given paper. The noticing, collecting and thinking model traditionally used for a qualitative analysis will be suitable for the given research.
Methods of Achieving Validity
For the research to be credible, several steps will be undertaken.
Introducing statistical data into the research: when numbers matter
Despite the fact that the given paper has been defined as qualitative research, the information provided in it is going to be backed up by statistical data and credible academic sources.
Defining strong cause-effect relations between the elements of the research
The author of the paper will also use analysis and synthesis of the available information in order to create a chain of logical conclusions, which will eventually lead to the final conclusion.
Providing enough theoretical foil for the paper to be based on
The paper will be based on several major theories, including the theory of family caregiving, the stress and coping model for family caregivers and the stress process theory.
Potential Ethical Problems: What May Jeopardize the Well Being of Participants
Needless to say, the research is going to touch upon several major ethical issues. In order for the research to be carried out properly, possible ethical concerns should be dealt with now.
Doubting the success of their efforts: the possibility of participants being discouraged
In the course of the interview, it has been noted that such questions as “Do you consider your experience successful?” “Are you satisfied with the results of your caregiving?”, some of the participants (particularly the single woman) suddenly became less certain in expressing their opinion.
Sparking the argument between the representatives of processional nursing facilities and family caregivers
The given study states at some point that caregiving provided by relatives has a better impact on the patients, at least in the African American community. Thus, some healthcare specialists may consider that their competency is being doubted.
Interviewees’ privacy was disclosed and the related issues
Although in most cases, the participants preferred not to be named, the details of their personal life may hint at who they possibly can be. Hence, participants’ privacy may be jeopardized.
Limitations: Preventing the Research from Getting into a Dead End
Naturally, the study has a number of limitations, particularly in terms of its scope. Seeing how the survey method was chosen in order to answer the research questions, it is necessary to stress that the number of participants was the key limitation. Being a very time-consuming process, the interview method did not allow for including more than four participants in the study.
Information related limitations: embracing the entire range of possible outcomes
As interesting a challenge as it might seem, analyzing every single case of African American caregivers nursing a patient with dementia or an aging person is impossible. True, there may have been instances of different relationship patterns between an African American caregiver and a patient. However, the research had to be restricted to the cases that have been recognized as suitable for academic purposes.
Culture related limitations: studying relationships between African American people
It would be wrong to deny the gap between the African American culture and the rest of the cultures featured in the United States. Therefore, one must admit that embracing all specifics of the African American culture and explaining the way in which these specifics translate into caregiving so that the process could be understood by the representative of another ethnicity is nearly impossible.
Time-related limitations: what could have been studied more thoroughly
Apart from the limitations mentioned above, the time restraint that the given paper is under has also had a considerable effect on the study and its accuracy. While the research still embraces the key information required to analyze the interviews in question and provide credible results, it still would have benefitted impressively from a more thorough and, therefore, longer evaluation of key factors causing African American caregivers stress.
Bivins, M. A. (2013). Influence of gender on caregiving for early and moderate stage Alzheimer’s disease patients. Ann Arbor, MI: ProQuest.
Byers, D. J., Wicks, M. N. & Beard, T. H. (2011). Depressive symptoms and health promotion behaviors of African-American women who are family caregivers of hemodialysis recipients. Continuing Nursing Education, 38(5), 425–430.
Carthron, D., Johnson, T. M., Hubbart, T. D., Strikland, C. & Nance, K. (2010). “Give me some sugar!” The diabetes self-management activities of African American primary caregiving grandmothers. Journal of Nursing Scholarship, 42(3), 330–337.
Chadiha, L. A. & Rafferty, J. (2003). The influence of caregiving stressors, social support, and caregiving appraisal on marital functioning among African American wife caregivers. Journal of Marital and Family Therapy, 29(4), 479–490.
Czekanski, K. E. (2007). The experience of transitioning to the caregiving role for a family member with Alzheimer’s disease or a related dilemma. Ann Arbor, MI: ProQuest.
Courts, N. F. (2001). Family caregivers’ attitudes toward aging, caregiving, and nursing home placement. Journal of Gerontological Nursing, 27(8), 44–52.
Hilgeman, M. M., Durkin, D. W., Sun, F., DeCoster, J. & Allen, R. S. (2009). Testing a theoretical model of the stress process in Alzheimer’s caregivers with race as a moderator. The Gerontologist, 49(2), 248–261.
Hinojosa, M. S., Rittman, M., Hinojosa, R. & Rodriguez, W. (2009). Racial/ethnic variation in the recovery of motor functions in stroke survivors; the role of informal caregivers. Journal of Rehabilitation and Research Development, 46(2), 223–232.
Kennedy, B. R., Mathis, C. C. & Woods, A. K. (2007). African Americans and their distrust of the health care system: Healthcare for diverse populations. Journal of Cultural Diversity, 14(2), 56–60.
Merritt, M. & McCallum, T. J. (2013). Too much of a good thing? Positive religious coping predicts worse diurnal salivary cortisol patterns for overwhelmed African American dementia family caregivers. The American Journal of Geriatric Psychiatry, 21(1), 46–56.
Mier, N. (2007). The caregiving experience among Hispanic caregivers of dementia patients. Journal of Cultural Diversity, 14(1), 12–18.
Mitchell, M. & Knowlton, A. (2011). Caregiver role overload and network support in a sample of predominantly low-income, African-American caregivers of persons living with HIV/AIDS: A structural equation modeling analysis. AIDS Behavior 16(20), 278–287.
Moseley, K., Freed, G. L., Charrel, M. & Goold, S. D. (2007). Measuring African American parents’ cultural mistrust while in a healthcare setting: A pilot study. Journal of the National Medical Association, 99(1), 15–21.
Noelker, L. & Browdie, R. (2012). Caring for the caregivers: Developing models that work. Journal of the American Society on Aging, 36(1), 103–106.
Prick, A.-E., de Lange, J., Scherder, E. & Pot, A. M. (2011). Home-based exercise and support program for people with dementia and their caregivers: study protocol of a randomized controlled trial. BMC Public Health, 11(8), 894–901.
Shin, S. H. & Brown, T. A. (2009). Racial and ethnic disparities in caregiver strain and the use of child mental health services: A structural equation model. Psychiatric Services, 60(8), 1039–1045.
Thompson, C. E. (2010). The relationship between aging anxiety, caregiving role and personality type in adults with a parental history of Alzheimer’s disease. Ann Arbor, MI: ProQuest.
Warren-Findlow, J., Laditka, J. N., Thompson, M. E. & Laditka, S. B. (2013). Effects of social ties on self-rated physical health among African American adults. Original Communication, 105(1), 23–32.