Critically appraise the article by Crist, J. D. (2005), “The meaning for elders of receiving family care” using the “ Critique: ANA Research Critique” guidelines.   

ISSUES AND INNOVATIONS IN NURSING PRACTICE

The meaning for elders of receiving family care

Janice D. Crist PhD RN

Assistant Professor, College of Nursing, The University of Arizona Health Science Center, Tucson, Arizona, USA

Accepted for publication 11 May 2004

Correspondence:

Janice D. Crist,

College of Nursing,

The University of Arizona Health Science

Center,

1305 N. Martin,

PO Box 210203,

Tucson,

AZ 85721-0203,

USA.

E-mail: jcrist@nursing.arizona.edu

C R I S T J . D . ( 2 0 0 5 )C R I S T J . D . ( 2 0 0 5 ) Journal of Advanced Nursing 49(5), 485–493

The meaning for elders of receiving family care

Aims. This paper reports a study undertaken to broaden nurse clinicians’, policy-

makers’, and researchers’ understandings of what it means to elders to receive family

care.

Background. The number of older people receiving assistance at home will increase

tremendously in coming decades in proportion to the rapidly increasing aged pop-

ulation. Seventy to 80% of the care received by elders is provided by family

members. As more elders with fewer family carers are predicted, nursing’s insight

into the family care phenomenon becomes even more important. The literature

contains reports of specific aspects of family care. Most results include reports of

elders dreading giving up their independence in the context of Euro-American

United States society’s highly valued cultural norm of independence. No studies

have explored elders’ views of the meaning of receiving family care.

Methods. Hermeneutic interpretive phenomenology was chosen, and a sample of

nine elders (five women and four men) was interviewed. Participants were asked for

descriptions of their day-to-day experiences of receiving family care in two to five

interviews, and were observed interacting with their family carers in naturalistic

settings.

Findings. Elders living at home were found to incorporate help from family mem-

bers comfortably into their lives. They viewed themselves as autonomous and able

to maintain balance between autonomy and dependence on loved ones.

Conclusions. Receiving family care may have positive meaning for elders, especially

when the care is provided within the context of positive relationships with family

carers. These findings are in contrast to previous reports. If validated in further

research, they could be used to inform practice and policy in health care systems

involved in collaborating with families to develop care arrangements for commu-

nity-living elders.

Keywords: elders, family care, gerontological nursing, qualitative research,

interpretive phenomenology

Introduction

It is estimated that between 1990 and 2030 the percentage of

the population in United States of America (USA) aged

65 years or older will increase from 12Æ5% to 20%. The

percentage of elders needing help with at least one activity of

daily living (ADL), for example, walking, getting outside,

bathing or showering, transferring, dressing or toileting, now

ranges from 10% for those 65–74 years to 50% for those 85

and older (Hobbs & Damon 1996). With the rapidly

increasing aged population, the number of people receiving

some assistance will increase tremendously in coming

decades. Seventy to 80% of the care received by elders is

given by family members (Scharlach & Kaye 1997). Family

carers devote and average of 20–40 hours per week to elders

over an average of 4Æ5 years (Family Caregiver Alliance

� 2005 Blackwell Publishing Ltd 485

2001). As more elders with fewer family carers are predicted

(Spillman & Pezzin 2000), nursing’s insight into the family

care phenomenon becomes even more important.

Background

In response to the rapidly growing family care phenomenon,

a rich literature on family caregiving has developed. The

majority of research has focused on family care giving, with

fewer studies focusing on family care receiving. Published

studies have dealt with specific aspects, for example, Coeling

et al. (2003) reported on family carers’ and elders’ processes

for negotiating rules about the dyadic relationship. Parsons

et al. (1989) measured elders’ satisfaction with family care,

reporting that the quality of the relationship was more

important than level of elders’ impairment. Russell (1994)

identified ‘dependency work’ that elders performed to retain

control in their relationships with family carers. Becker’s

(1993) exploration of the meaning of living with chronic

conditions identified the importance of autonomy in the

context of being dependent; and Charmaz’s (1990) study of

chronically ill people revealed that relationships became even

more important as needs increased. None of these studies

explored the specific phenomenon of receiving family care.

Noticeably absent in the literature are elders’ voices about

what the experience of receiving this kind of care meant to

them. Research such as this is needed (Phillips 1996) and this

gap was the impetus for this study.

The study

Aim

The purpose of this study was to discover elders’ perspectives

of receiving family care, in order to improve practice, policy,

and research.

Methodology

A hermeneutic interpretive phenomenological approach was

chosen (Heidegger 1962/1975). The chiefly ontological goal

of this methodology is to increase understanding of shared

meanings for people with similar experiences, rather than the

epistemological goal to theorize, generalize or predict causal

relationships (Koch 1995, Annells 1996).

Participants

A convenience sample of nine elders, of whom five were

women and four men, in urban and rural areas of the Pacific

Northwest, was recruited. This means that transferability of

the findings are limited to similar informants in a similar

context. Six were Anglo-American, one Hispanic-American,

one Asian-American, and one American Indian. They were

recruited from three home health agencies, one adult day care

centre, and one neurological clinic. Elders were eligible to

participate in the study if they were aged 65 years or older,

and had an identified family member who provided daily

assistance with at least one ADL and/or management of

health problems. Participants needed to speak English, and be

cognitively intact or have only mild cognitive impairment/

dementia (in the case of two informants). The Short Portable

Mental Status Questionnaire (SPMSQ; Pfeiffer 1975) was

used to screen those who volunteered to participate. They

were accepted into the study if scores were 6 or better,

indicating a range of mild to no dementia. One elder was

excluded because her dementia measured more severe than

‘mild’ on the SPMSQ. Twelve people volunteered to parti-

cipate, but two withdrew before the initial interview.

Those with a variety of chronic illnesses were included

because shared meanings for people with chronic illness have

been found, regardless of type of illness (Charmaz 1990,

Gullickson 1993, ReNel & Magilvy 2000).

The participants had received family care for periods

ranging from 1 1/2 to 30 years. In hermeneutic interpretive

phenomenology, recruitment ends when findings within a

homogeneous sample become saturated. This has occurred

when interviews yield no additional data, or provide rich

descriptions of the same shared meanings (Benner 1994).

Saturation had clearly occurred by the time the ninth

informant had been interviewed in this study.

Data collection

Multiple, open-ended, in-depth interviews, observation, and

other methods were used to gain an understanding of what

selected experiences meant to participants. Informants were

allowed to control the pace and direction of dialogue with the

investigator and to describe experiences as they were lived,

rather than to offer reflected-upon, theorized, abstract

explanations (Mishler 1986).

Elders were asked for descriptions of their day-to-day

experiences of receiving family care. Between November

1998 and April 1999 two to five interviews were conducted

by the investigator with each elder, starting with a general

overview of family care experiences in the first interview and

gradually becoming more focused on emerging themes in

later interviews (Seidman 1991). Interviews lasted 30–

60 minutes. All were conducted in informants’ homes. When

carers occasionally made themselves available, elders were

J.D. Crist

486 � 2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 49(5), 485–493

observed interacting with them. Observations that occurred

naturally during the interviews were included with the

transcribed text and analysed simultaneously.

Data analysis

The analysis/interpretation was conducted during the same

period of time as the interviews by a data analysis team,

which was consulted during each phase of the work (Crist &

Tanner 2003). The interpretive team comprised three nursing

professors who were experts in either family care or

hermeneutic interpretive phenomenology. A research log

containing a record of all discussions and analysis decisions,

in the form of meeting minutes, was submitted to the team

after each meeting to verify emerging interpretations and

methodological decisions. The investigator’s and team’s

assumptions were acknowledged as much as possible and

considered during the interpretations of the narratives and

observations. Acknowledgement of team members’ preun-

derstandings is the forward arc of the hermeneutic circle

(Packer & Addison 1989). Team members discussed their

initial impressions of meanings emerging from initial

narratives. The team’s co-construction of the interpretation

is the return arc of the hermeneutic circle. This ‘movement of

uncovering’ (Packer & Addison 1989, p. 275) involved the

continuous and simultaneous examination of narratives

within the whole emergent interpretation, protecting the

integrity of the story within its particular context. Common

concerns, exemplars, or common themes across informants,

and paradigm cases were identified. Paradigm cases are

particularly compelling stories to which the team returns and

examines from new angles. For example, the meanings from

one elder’s narratives included positive relationships with her

carers, and her view that her life contained a balance between

autonomy and the need for help. Once demonstrated clearly

in her narratives, these patterns were more easily recognized

in other family care situations. Lines of inquiry were

identified during each analysis session to focus later inter-

views, either with the same or with subsequent informants,

keeping open to the text of current transcripts (Benner 1994).

Rigour

Evaluation of interpretive phenomenological research ‘con-

siders whether one’s concern has been answered’ (Packer &

Addison 1989, p. 279). Five criteria directed how to proceed

in the interpretive process: coherence, external evidence,

consensus, practical implications (Packer & Addison 1989)

and transferability (Lincoln & Guba 1985). Coherence was

judged by whether the report represented themes, exemplars

and paradigm cases consistently and with credibility. The

iterative process – the team’s reflection on and discussion of

the texts and developing interpretive report – ensured that

this criterion was met. Keeping detailed records of each step

of the iterative process and all methodological decisions

helped to evaluate the credibility of the report. The inter-

pretation was taken back to informants during the second or

third interview to evaluate external evidence. Each informant

was asked to reflect on themes that had unfolded through

analysis of their narratives. Their feedback confirmed the

interpretations. Consensus was ensured by the team’s com-

paring the emerging interpretations among individual mem-

bers, as well as with other researchers and other interested

parties, assuring anonymity and confidentiality. The practical

implications of the research findings were periodically eval-

uated by other experts during the interpretive process.

Emerging interpretations were taken back to elders during

the final interviews, and they confirmed the findings and their

usefulness. Experts, including gerontological teachers, doc-

toral students and home health agency interdisciplinary

clinical staff, confirmed the practical implications of the final

interpretation. The same experts also confirmed that mean-

ings for elders in the sample would be transferable to similar

elders in a similar context.

Ethical considerations

Approval for the study was obtained from the Institutional

Review Board. Initially, elders were contacted by telephone

by the investigator and asked for permission to come to their

homes. In the home, elders were informed of the purpose of

the study, their rights, including the right to withdraw at any

time for any reason without repercussion, and the investi-

gator’s legal requirement to refer the elder to the State’s Adult

Protective Services if abuse were suspected and to local

agencies if depression were suspected. Elders did not object to

these conditions of participation, and were asked to sign

consent forms. Pseudonyms have been used to protect

participant identity.

Findings

The findings gave a new perspective on the phenomenon of

receiving family care: (a) elders incorporated family care

comfortably into their lives while still viewing themselves as

autonomous; (b) they had positive relationships with their

family carers; (c) the acceptability for them of receiving

family care was tied closely to positive relationships between

them and their carers and (d) most elders believed that they

were able to maintain a balance between sometimes receiving

Issues and innovations in nursing practice Elders receiving family care

� 2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 49(5), 485–493 487

more care than they needed and maintaining their own

autonomy.

Incorporating family care while

maintaining autonomy

A specialized meaning of ‘independence’ became evident

early in the study. When elders said that independence was

important to them, they meant that they still retained some

control or ‘autonomy’ although they received family care.

Nurses have traditionally measured independence as the level

of a client’s functional ability; for example, as being able to

take a bath without needing help. The elders in this study,

although functionally impaired and dependent on family

members to carry out some of their ADLs, still viewed their

lives as autonomous.

Ms Canta was aged in her early 70s and had relocated

from another state, bought property, and built a house to

live near her daughter. Her daughter, son-in-law, and their

daughters lived in a mobile home on the property. Her

daughter had visited her every day for a month to change

dressings on an abdominal wound. Ms Canta’s conscious

reflections including the word ‘independent’ conveyed that

she valued not being dependent: during the second of three

interviews, she claimed,

I am very independent. I like to have my own place. I like to do my

own things when I want, and the way I want. I am that way.

However, her actions showed that she also valued being close

to her family and she had chosen to live next door to her

daughter, who later became her family carer. Ms Canta’s

narratives and the choices she had made in her life revealed

that she defined ‘independence’ as the freedom to make

choices and to arrange her life as she wished, even within the

context of receiving family care.

Ms Post, who was in her 80s, had a progressive disease that

caused weakness of the limbs. Her family carers were two

younger male relatives with whom she lived. She said,

Course I can’t get around like I used to; I don’t see like I used to; so,

you just kinda mellow out. I take life as it comes. You live with what

you got!

For her, ‘living with what you got’ included accepting family

care. For example, she described her frustration about not

being safe walking to the door to welcome visitors, but her

narratives revealed that she had the autonomy in deciding

who could come to visit. Most elders had integrated receiving

family care into their daily lives so seamlessly that they did

not mention it. When they indicated an awareness of

receiving family care, as Ms Post did in her five interviews,

their statements were either positive or neutral. For most of

those in the study, being care receivers was not part of their

self-image; rather, they focused on other aspects of their lives.

In contrast to others in the study, it was difficult for one

informant to ‘live with what you got’. Mr Elloway was aged

in his 70s and had become unable to walk due to what he

considered an error during surgery 2 years before the initial

interview. He currently needed several daily medical proce-

dures and assistance with most ADLs. He focused on his

physical disabilities, viewed his life as disrupted by his

disability and dependence, and no longer recognized any

continuity with his former, autonomous life. Contrast cases

such as this helped to illustrate more clearly the common

meanings being uncovered in the overall interpretation (van

Manen 1990, Benner et al. 1996).

Ms Johnson was in her 80s, a widow, and had a chronic

illness that could be stable for months and then develop

unexpectedly into an emergency situation. She lived alone in

a mobile home park, but a constellation of extended family

members, some living in the same city and others in the same

state, provided intermittent care as needed. Without prompt-

ing, Ms Johnson volunteered that it was important to her that

she was ‘independent.’ She led an autonomous life, including

attending dances held at her mobile home park and never

asking directly for help from her carers. Like most other

elders in the study, she continued to maintain a sense of

autonomy, which she valued highly, while receiving family

care.

Positive relationships with family carers

There were important similarities in the situations of elders

who accepted family care easily. The most obvious of these

was their positive relationships with their carers. For exam-

ple, Ms Johnson said that she only occasionally asked for

help; but, for the most part, she viewed her family carers as

anticipating her needs:

Oh, she volunteers, yes. I don’t ever ask. I just bawl her out, see, ‘You

don’t have to do all that! It isn’t that dirty!’ ‘Oh, just shush and sit

down!’ ‘OK!’ No, she volunteers everything. I never ask her. Only I

might ask her to stop at the store and get me something…But she’ll
always ask, ‘Can I get you this?’ or, ‘Can I stop at the store?’ She’s

available. She’s willing to do anything for me.

It was apparent that, although Ms Johnson’s autonomy was

important to her, she viewed the care she received as

embedded in mutually caring family relationships that

included her family carers’ constant availability and willing-

ness to help.

Mr Kelly had been healthy all his life; but had slowed down

in the previous 2 years because of several illnesses and

J.D. Crist

488 � 2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 49(5), 485–493

fluctuating energy. Now aged in his 80s, his need for

family care also fluctuated, ranging from total and constant

assistance with most ADLs to being able to bathe without

assistance. He was matter-of-fact about the help he received

from his wife. He revealed that he wished he could do more,

yet showed that he did not question his wife’s helping him:

‘[chuckling] I’m used to her!…No, it doesn’t bother me.’
When prompted with ‘…you’re used to your wife helping
you…’, he replied, ‘Oh yeah, that’s second nature!’ His
comments showed that the care he received was acceptable

because of his close relationship to his wife. Family care was

thus viewed by most elders as support that carers wanted

to give, and as a positive continuation of relationships.

Mr Elloway’s story contrasted with this positive interpret-

ation, and his five interviews did not show evidence of

closeness to or enjoyment of his caregiving spouse.

Positive relationships between elders and their carers

resulted in personal growth. For example, Mr Lewis had

been a professional man most of his life. He was in his early

70s, and had abruptly become disabled. Being dependent on

his wife, as he slowly recovered from aphasia and multiple

disabilities, taught him to be patient. He viewed himself as

acquiring this quality, which he had not had in the past. He

was learning that his connection to his wife-carer helped him

accomplish his new rehabilitative goals with prolonged

progress and a slower approach to life. A positive family

care context facilitated his willingness to incorporate receiv-

ing family care into his life.

Acceptability: elders’ and family carers’ positive

relationships

Most elders did not view family care as help with specific

tasks, but as help inherently available as part of the

relationship. The care that elders received reinforced the

belief that they were loved, and the largely effortless

acceptance of family care was facilitated by their familiarity

with their carers. They trusted and were comforted by their

carers because they had a shared history with them. Ms Post,

for example, was continuously motivated to do as much as

possible, for example putting away the dishes. She acknow-

ledged her acceptance of family care in the context of positive

relationships:

We’ve always been a close family…It is hard to have people help you.
But I’ve gotten to the place where I’ve got to have it, and I know I

have to have it, so I try and make the best of it.

Mr Kelly was grateful for the help his wife gave him, and

valued this even more because it was given specifically by his

wife, with whom he had a very close relationship:

[Care by his wife] is better than to have to have somebody come and

do it all…You know, when I was complaining about being a burden,

and, not being able to do anything, [wife] cut this out for me once

[hands the investigator a cartoon drawing from the newspaper of a

little girl and boy arm-in-arm]. The caption reads: ‘Love is…being
thankful for every day spent together’. (Love is 1998)

Receiving care from his wife intensified Mr Kelly’s affection,

appreciation and commitment to his marital relationship.

Mr Elloway, however, felt more discomfort when someone

close, such as his wife, gave him care. He preferred hired

carers’ help, which he considered part of their job:

If you had a legitimate caregiver that’s getting paid dollars for doing

it, it’s routine…I wouldn’t want to do it, for a person. But if you got a
caregiver that’s just doing it out of…I can use the word ‘love’ or

‘necessity’, or anything you want!…She doesn’t care for it, I know.
And I don’t care for it either…I still have a guilt feeling when

somebody has to, or, when she has to work on me, not when

the…[home care nurse] comes, she’s a pro, she knows what she’s

doing, it’s like when a nurse takes care of you in the hospital.

Mr Elloway’s statement that his wife ‘worked on him’

revealed his view that he was ‘broken’. His words also

suggested that, from his point of view, his wife’s care was an

act of duty rather than of love. He considered his wife as

performing tasks, not as helping a husband about whom she

cared. He found it easier to cope with his physical disability

by hiring a person to ‘work on’ his body.

Some of the interviews suggested that long-standing

familiarity and affection eased elders’ experiences that might

have been awkward with less familiar carers. During one

interview, Ms Post’s main family carer, who was in the

adjoining room, pointed out that Ms Post had changed his

diapers when he was a baby. Her laughing response was,

I paddled his butt (spanked him when, as a child, he misbehaved)

many a time, too!

The exchange demonstrated the context of familiarity that

facilitated her comfort in receiving family care.

Balance: accepting more care than needed while

maintaining autonomy

Elders believed that they had a balance with regard to

carers’ performing some tasks that they thought they could

or should do for themselves. In a previous study (Crist

et al. 1998), some elders complained that family carers did

too much for them and would not let them do what they

themselves thought they could or ought to do. However,

elders in the present study accepted family carers’ helping

Issues and innovations in nursing practice Elders receiving family care

� 2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 49(5), 485–493 489

them when it might not have been absolutely necessary.

They sometimes chose not to do some things for the sake of

safety and conservation of energy. Ms Post, for example,

admitted that although she was tempted to do certain

activities, she was convinced that it was probably unsafe

for her because of her frailty and potential for falls. She

struggled with wanting to step down into the wash room to

get clothes out of the dryer, and reluctantly paid attention

to reminders from her carers:

Sometimes [chuckling] I get up to do something and they give me

holy hell because I’ve gotten up to do it, when he would have done it.

But, I figure, ‘Well, I’ll just go get it’, you know. [It] don’t always

work [laughs].

Even when Ms Post was tempted to continue doing things for

herself, she acknowledged that her previous ways of doing

things without assistance needed to be modified. The positive

perspective with which she viewed receiving family care

helped her achieve a balance in what she felt she could do.

Her level of acceptance about her new level of dependence

was aided by a sense of humour.

Mr Kelly was aware of his energy limitations and, for him,

they justified his wife’s doing what he thought he could have

done:

She [chuckling] probably does too much. In some ways. What I mean

by that is if I want a [glass of] water or something, I would go get it,

but she will get it for me…Like with a bath, she has to help me. No, it
doesn’t bother me. In some ways, sometimes maybe it does. I think I

ought (to) do things, but I get so tired, you know.

Elders and their family carers revealed a comfortable

familiarity within their relationships, which allowed humour

to be used in promoting autonomy in the context of family

care. The familiarity and ease with which interactions

occurred made them appear to be a pattern that probably

had been effective in the past and had thus continued.

Narratives of Mr Lewis with his family carer contained this

lightness:

Mr Lewis: I’m teasing her!

Wife: He teases me a lot. Especially when he’s taking a shower. He

likes to take the [showerhead] and squirt it at me [laughing].

Mr Lewis [mischievously shaking his head in denial]: I’m very

innocent.

Wife: He laughs and laughs…I’m just happy to have him here [Mr

Lewis affectionately taps her on the knee with his cane].

This excerpt shows that a bath given by his wife, a form of

intimate personal care that represented Mr Lewis’s dependence

for many aspects of his life, meant to him that there was a

sustained mutual affection embedded in his receiving family

care.

When these elders accepted care that might appear unnec-

essary, they referred to rational reasons, for example, their

own safety or energy conservation. They allowed and even

embraced, with humour, insight and sensitivity, variations in

the ways tasks were accomplished, by them or others. They

did not see themselves as being forced to accept overbearing

or oppressive assistance. These elders felt there was a balance

between accepting help and maintaining autonomy, which

was accomplished through mutual caring and trust.

Discussion

These findings help gerontological nurses ‘create new visions’

(Benner 2000, p. 10) of receiving family care. Shared positive

meanings of receiving family care were uncovered, in contrast

to results of earlier descriptive or correlational studies that

report elders’ discomfort with receiving family care. An

important theme in literature has been the overwhelming

values held by many elders in Western society on individu-

alism, productivity, autonomy, competence, stoicism, and

privacy, even within kinship relationships (Bellah et al.

1986). Previous research has shown that when many elders

were no longer able to conform to these accepted norms, they

viewed themselves as failures or as indebted to family

members providing care for them (Kaufman 1983, Thomas

1993, Crist et al. 1998). The surprisingly positive meanings

that emerged were found across gender mix of elders/carers,

type of kinship, ethnicity, diagnosis and timespan since

elders’ original disabilities began.

The interpretation that most of the elders still viewed

themselves as leading autonomous lives, even when receiving

various levels of family care, has important implications for

nurses because it challenges conventional assumptions that

elders in Western society view receiving family care negat-

ively. The interpretation does not disprove that some elders

do have this view; in fact, the contrast case (Mr Elloway)

demonstrates it well. Rather, the interpretation adds a new

dimension to nurses’ background or personal knowledge of

possible meanings for elders, and sensitizes them to be open

to different possibilities. Nurses, policymakers and research-

ers need to be aware that, for elders, independence may

equate with autonomy, although the health care system

defines it according to functional ability. Nurses can now

more readily recognize elders’ situations in which it is

possible to maintain autonomy within the context of existing

positive relationships with family carers.

J.D. Crist

490 � 2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 49(5), 485–493

Some elders in this study may have been sharing their views

on family care for the first time. In clinical practice, nurses

can facilitate a dialogue with elders about what receiving

family care means to them. This nursing intervention may

promote elders’ continuing sense of autonomy by encour-

aging them to express their concerns, facilitating better

understanding in families, and modelling ways for family

members to continue to elicit elders’ individual perspectives.

Nurses may be able to facilitate families’ ability to minimize

disruptions and enhance incorporation of family care into

their daily lives by teaching them to use enrichment strategies.

Such strategies may include ‘fine tuning’ of current meaning-

ful activities or creating new mutual activities to maintain

both autonomy and close family relationships (Cartwright

et al. 1994, Archbold et al. 1995).

Nurses can recognize and respect the delicate balance

between autonomy and family care that elders value.

Sometimes from a rehabilitative perspective, nurses may

take a narrower view than necessary of family members’

doing something for elders that they might do for themselves.

Nurses may be vigilant about family carers’ doing too much

for a disabled elder. Nurses are trained to prevent ‘dysfunc-

tional overprotectiveness’ (Thompson & Pitts 1992, p. 116),

which can be ‘demotivating and guilt producing’ for the elder

(Dunkel-Schetter et al. 1992, p. 102) and detrimental to

elders’ physical and emotional well-being. However, it is

apparent from this interpretation that some elders and their

family carers had already established what was important for

the elder to do. Elders viewed their conception of autonomy

as being in balance with their concerns about safety and

energy conservation needs. Nurses should examine and

respond to elders’ and caregivers’ explanatory models, in

order to provide culturally sensitive and meaning-centred

care (McSweeney et al. 1997). Nurses need to be open to the

possibility that elders and their carers may have achieved

balance between dependency and autonomy, and should

recognize, respect, support, and facilitate this balance.

There was a limitation in the sampling procedure.

Approaching the experience of receiving family care from

additional and different perspectives might have increased the

richness of findings. For example, recruitment efforts might

have targeted informants receiving family care but who had

not received formal home care services, or elders residing in

communal care facilities and other care centres who had

previously received family care, may have enriched the

interpretation.

Implications for research include testing the promotion of

families’ existing rewards of care receiving (Archbold et al.

1995) and enrichment of existing positive relationships

between elders and their family caregivers by modifying

meaningful past mutual activities and rituals (Cartwright

et al. 1994). The positive aspects of this time of life should be

explored for elders, as has been done for family carers

(Archbold et al. 1990, Farran et al. 1991). Also, this

exploratory study should be repeated with elders of other

cultures, including Mexican American elders (Crist 2002,

Crist & Escandón-Dominguez 2003).

Conclusion

The ways in which elders view receiving family care has

not been explored in previous research, although the

meaning of illness and defined, specific, aspects of receiving

family care have been studied. Nursing’s ontology and

epistemology are broadened through a heightened sensitiv-

ity to how elders may view the experience of receiving

family care. The expanded view based on the findings of

this study creates a challenge to nurse clinicians, policy-

makers, and researchers to recognize that elders’ and their

families’ ways of being-in-the-world are not necessarily

defined by receiving family care. Some elders view receiving

family care as either an unremarkable part of their

autonomous lives or as a validation of their positive,

enduring relationships with family members.

Acknowledgements

The author would like to acknowledge Patricia G. Archbold,

Christine A. Tanner & Sheila Kodadek, Oregon Health &

What is already known about this topic

• Elders in Western cultures attribute negative meanings
to receiving family care.

• Elders are concerned with maintaining autonomy when
receiving family care.

• Rehabilitation-oriented professionals often view the
situation as dysfunctional when family carers do things

for elders that they could do for themselves.

What this paper adds

• Receiving family care has positive meanings for some
elders.

• Elders incorporated family care comfortably into their
lives while still viewing themselves as autonomous.

• Definitions of independence and appropriate level of
family care may differ between gerontological nurses

and elders/family carers.

Issues and innovations in nursing practice Elders receiving family care

� 2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 49(5), 485–493 491

Science University; Elaine Jones, University of Arizona; and

John B. Haradon. This study was funded by National

Institute of Nursing Research.

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Issues and innovations in nursing practice Elders receiving family care

� 2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 49(5), 485–493 493

Prepared by Louise Kaplan, PhD, ARNP, FNP-BC, FAANP

Senior Policy Fellow, Department of Nursing Practice and Policy
Louise.kaplan@ana.org

Framework for How to Read and Critique a Research Study

1. Critiquing the research article

a. Title – Does it accurately describe the article?

b. Abstract – Is it representative of the article?

c. Introduction – Does it make the purpose of the article clear?

d. Statement of the problem – Is the problem properly introduced?

e. Purpose of the study – Has the reason for conducting the research been

explained?

f. Research question(s) – Is/are the research question(s) clearly defined and if

not, should they be?

g. Theoretical framework – Is the theoretical framework described? If there is

not a theoretical framework, should there be?

h. Literature review – Is the literature review relevant to the study,

comprehensive, and include recent research? Does the literature review

support the need for the study?

i. Methods – Is the design appropriate for the study? Does the sample fit with

the research design and is the size sufficient? Was a data collection

instrument needed? How were data collected? Were reliability and validity

accounted for?

j. Analysis – Is the analytical approach consistent with the study questions and

research design?

k. Results – Are the results presented clearly in the text, tables and figures? Are

the statistics clearly explained?

l. Discussion – Are the results explained in relationship to the theoretical

framework, research questions, and the significance to nursing?

m. Limitations – Are the limitations presented and their implications discussed?

n. Conclusion – Are there recommendations for nursing practice, future

research, and policymakers?

2. Determine the level and quality of the evidence using a scale (several can be found

in ANA’s Research Toolkit www.nursingworld.org/Research-Toolkit/Appraising-the-

Evidence )

3. Decide if the study is applicable to your practice

a. Can you use the results and recommendations in your practice?

http://www.nursingworld.org/Research-Toolkit/Appraising-the-Evidence

http://www.nursingworld.org/Research-Toolkit/Appraising-the-Evidence