Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-20T15:24:19.587Z Has data issue: false hasContentIssue false
  • English
  • Français

Identifying socio-environmental factors that facilitate resilience among Canadian palliative family caregivers: A qualitative case study

Published online by Cambridge University Press:  11 November 2013

Melissa Giesbrecht ,
Faye Wolse ,
Valorie A. Crooks  and
Kelli Stajduhar
Melissa Giesbrecht*
Affiliation:
Simon Fraser University, Burnaby, British Columbia, Canada
Faye Wolse
Affiliation:
University of Victoria, Victoria, British Columbia, Canada
Valorie A. Crooks
Affiliation:
Simon Fraser University, Burnaby, British Columbia, Canada
Kelli Stajduhar
Affiliation:
University of Victoria, Victoria, British Columbia, Canada
*
Address correspondence and reprint requests to: Melissa Giesbrecht, Simon Fraser University, Department of Geography, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

In Canada, friends and family members are becoming increasingly responsible for providing palliative care in the home. This is resulting in some caregivers experiencing high levels of stress and burden that may ultimately surpass their ability to cope. Recent palliative care research has demonstrated the potential for caregiver resilience within such contexts. This research, however, is primarily focused on exploring individual-level factors that contribute to resilience, minimizing the inherent complexity of this concept, and how it is simultaneously influenced by one's social context. Therefore, our study aims to identify socio-environmental factors that contribute to palliative family caregiver resilience in the Canadian homecare context.

Methods:

Drawing on ethnographic fieldnotes and semistructured interviews with family caregivers, care recipients, and homecare nurses, this secondary analysis employs an intersectionality lens and qualitative case study approach to identify socio-environmental factors that facilitate family caregivers' capacity for resilience. Following a case study methodology, two cases are purposely selected for analysis.

Results:

Findings demonstrate that family caregiver resilience is influenced not only by individual-level factors but also by the social environment, which sets the lived context from which caregiving roles are experienced. Thematic findings of the two case studies revealed six socio-environmental factors that play a role in shaping resilience: access to social networks, education/knowledge/awareness, employment status, housing status, geographic location, and life-course stage.

Significance of Results:

Findings contribute to existing research on caregiver resilience by empirically demonstrating the role of socio-environmental factors in caregiving experiences. Furthermore, utilizing an intersectional approach, these findings build on existing notions that resilience is a multidimensional and complex process influenced by numerous related variables that intersect to create either positive or negative experiences. The implications of the results for optimizing best homecare nursing practice are discussed.

Keywords

Family caregiversResilienceEthnographySocial environmentPalliative
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 3 , June 2015 , pp. 555 - 565
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Allen, R.S., Haley, P.P., Harris, G.M., et al. (2011). Resilience: Definitions, ambiguities, and applications. In Resilience in aging: Concepts, research, and outcomes. Resnick, B., Gwyther, L.P. & Roberto, K.A. (eds.), pp. 1–13. New York: Springer.Google Scholar
Armstrong, P. & Kits, O. (2001). One hundred years of caregiving. Ottawa: Law Commission of Canada.Google Scholar
Bialon, L.N. & Coke, S. (2012). A study on caregiver burden: Stressors, challenges, and possible solutions. The American Journal of Hospice & Palliative Care, 29(3), 210–218.Google Scholar
Bluglass, K. (2007). Resilience and its narratives. In Resilience in palliative care: Achievement in adversity. Monroe, B. & Oliviere, D. (eds.), pp. 9–28. Oxford: Oxford University Press.Google Scholar
Burns, C.M., LeBlanc, T.W., Abernethy, A., et al. (2010). Young caregivers in the end-of-life setting: A population-based profile of an emerging group. Journal of Palliative Medicine, 13(10), 1225–1235.Google Scholar
Canadian Caregiver Coalition (2009). The Canadian caregiver strategy: Consultation. Retrieved November 11, 2010 from http://www.ccc-ccan.ca/content.php?doc=43.Google Scholar
Canadian Caregiver Coalition (2011). Caregiver facts. Retrieved May 23, 2011 from http://www.ccc-ccan.ca/content.php?doc=43.Google Scholar
Canadian Institutes for Health Information (2012). Supporting informal caregivers: The heart of home care. Health System Performance Series. Ottawa: Canadian Institutes for Health Information.Google Scholar
Canadian Policy Research Networks (2009). Working and looking after mom and dad: The face of caregiving in Canada. Retrieved July 3, 2009 from http://www.cprn.com/doc.cfm?doc=1998&l=en.Google Scholar
Carlsson, M.E. & Rollison, B. (2003). A comparison of patients dying at home and patients dying at a hospice: Sociodemographic factors and caregivers' experiences. Palliative & Supportive Care, 1, 33–39.Google Scholar
Carstairs, S. (2005). Still not there: Quality end of life care. A progress report. Available online from http://www.sfu.ca/uploads/page/28/still_not_there.pdf.Google Scholar
Charles, G., Stainton, T. & Marshall, S. (2012). Young carers in Canada: The hidden costs and benefits of young caregiving. Ottawa: Vanier Institute of the Family. Available online from http://www.vanierinstitute.ca/modules/news/newsitem.php?ItemId=444#.UjxxEH8eAb4.Google Scholar
Coon, D.W. (2012). Resilience and family caregiving. Annual Review of Gerontology & Geriatrics, 32(1), 231–249.Google Scholar
Crooks, V., Williams, A., Stajduhar, K., et al. (2007). The information transfer and knowledge acquisition geographies of family caregivers: An analysis of Canada's Compassionate Care Benefit. Canadian Journal of Nursing Research, 39(3), 36–54.Google Scholar
Currow, D., Allingham, S., Bird, S., et al. (2012). Referral patterns and proximity to palliative care inpatient services by level of socioeconomic disadvantage: A national study using spatial analysis. BMC Health Services Research, 12(424), 1–7. doi:10.1186/1472-6963-12-424.Google Scholar
Diehl, M., Hay, E. & Chui, H. (2012). Personal risk and resilience factors in the context of daily stress. Annual Review of Gerontology & Geriatrics, 32(1), 251–274.Google Scholar
Exley, C. & Allen, D. (2007). A critical examination of home care: End-of-life care as an illustrative case. Social Science & Medicine, 65(11), 2317–2327.Google Scholar
Funk, L. (in press). Home health care and family responsibility: A critical discourse analysis of talk and text. Healthcare Policy Special Issue. Forthcoming.Google Scholar
Giesbrecht, M.D. (2012). Intersectionality and the “place” of palliative care policy in British Columbia, Canada. In An intersectionality-based policy analysis framework. Hankivsky, O. (ed.), pp. 69–91. Vancouver, BC: Institute for Intersectionality Research and Policy.Google Scholar
Giesbrecht, M.D., Crooks, V.A., Williams, A., et al. (2012). Critically examining diversity in end-of-life family caregiving: Implications for equitable caregiving support and Canada's Compassionate Care Benefit. International Journal for Equity in Health, 11(65). doi: 10.1186/1475-9276-11-65.Google Scholar
Grunfeld, E. (2004). Family caregiver burden: Results of a longitudinal study of breast cancer patients and their principal caregivers. Canadian Medical Association Journal, 170(12), 1795–1801.Google Scholar
Hammersley, M. (2007). Case study. In The Sage encyclopedia of social science research methods. Lewis-Beck, M.S., Bryman, A. & Liao, T.F. (eds.), pp. 93–95. Thousand Oaks, CA: Sage Reference.Google Scholar
Hancock, A.-M. (2007). Intersectionality as a normative and empirical paradigm. Politics & Gender, 3(2), 248–254.Google Scholar
Hankivsky, O. (2004). Social policy and the ethics of care. Vancouver: UBC Press.Google Scholar
Hankivsky, O., Cormier, R. & de Merich, D. (2009). Intersectionality: Moving women's health research and policy forward. Vancouver: Women's Health Research Network.Google Scholar
Hankivsky, O., de Leeuw, S., Lee, J.A., et al. (eds.) (2011). Health inequities in Canada: Intersectional frameworks and practices. Vancouver: UBC Press.Google Scholar
Hankivsky, O., Grace, D., Hunting, G., et al. (2012). An intersectionality-based policy analysis framework. In Intersectionality-based policy analysis. Hankivsky, O. (ed.), pp. 33–46. Available online from http://www.sfu.ca/iirp/ibpa.html.Google Scholar
Heaton, J. (2008). Secondary analysis of qualitative data: An overview. Historical Social Research, 3, 33–45.Google Scholar
Kinsel, B. (2005). Resilience as adaptation in older women. Journal of Women & Aging, 17(3), 23–39.Google Scholar
Lilly, M., Laporte, A. & Coyte, P.C. (2007). Labour market work and home care's unpaid caregivers: A systematic review of labour force participation rates, predictors of labour market withdrawal, and hours of work. The Millbank Quarterly, 85(4), 641–690.Google Scholar
Lilly, M.B., Robinson, C.A., Holtzman, S., et al. (2012). Can we move beyond burden and burnout to support the health and wellness of family caregivers to persons with dementia? Evidence from British Columbia, Canada. Health & Social Care in the Community, 20(1), 103–112.Google Scholar
Luthar, S.S., Cicchetti, D. & Becker, B. (2000). The construct of resilience: A critical evaluation and guidelines for future work. Child Development, 71(3), 543–562.Google Scholar
Masten, A.S., Hubbard, J.J., Gest, S.D., et al. (1999). Adaptation in the context of adversity: Pathways to resilience and maladaptation from childhood to late adolescence. Development and Psychopathology, 11, 143–169.Google Scholar
Melin-Johansson, C., Axelsson, B. & Danielson, E. (2007). Caregivers' perceptions about terminally ill family members' quality of life. European Journal of Cancer Care, 16(4), 338–345.Google Scholar
Monroe, B. & Oliviere, D. (2007). Introduction: Unlocking resilience in palliative care. In Resilience in palliative care: Achievement in adversity. Monroe, B. & Oliviere, D. (eds.), pp. 1–7. Oxford: Oxford University Press. Available online from http://fds.oup.com/www.oup.com/pdf/13/9780199206414.pdf.Google Scholar
Newman, T., Yates, T. & Masten, A.S. (2004). What works in building resilience. Barkingside: Barnardo's.Google Scholar
Parliamentary Committee on Palliative and Compassionate Care (2011). Not to be forgotten: Care of vulnerable Canadians. Retrieved from http://pcpcc-cpspsc.com/wp-content/uploads/2011/11/ReportEN.pdf.Google Scholar
Payne, S. (2007). Resilient carers and caregivers. In Resilience in palliative care: Achievement in adversity. Monroe, B. & Oliviere, D. (eds.), pp. 83–97. Oxford: Oxford University Press.Google Scholar
Pinquart, M. & Sorensen, S. (2006). Gender difference in caregiver stressors, social resources, and health: An updated meta-analysis. Journals of Gerontology Series B: Psychological Science and Social Sciences, 61(1), 33–45.Google Scholar
Rose, G. (1997). Situating knowledges: Positionality, reflexivities and other tactics. Progress in Human Geography, 21(3), 305–320.Google Scholar
Savage, J. (2000). Ethnography and health care. British Medical Journal, 321(7273), 1400–1402.Google Scholar
Sharpe, L., Butow, P., Smith, C., et al. (2004). The relationship between available support, unmet needs and caregiver burden in patients with advanced cancer and their carers. Psycho-Oncology, 14(2), 102–114.Google Scholar
Skinner, M.W. & Rosenberg, M.W. (2005). Co-opting voluntarism? Exploring the implications of long-term care reform for the nonprofit sector in Ontario. Environment and Planning C: Government and Policy, 23(1), 101–121.Google Scholar
Stajduhar, K., Funk, L., Wolse, F., et al. (2011). Core aspects of “empowering” caregivers as articulated by leaders in home health care: Palliative and chronic illness contexts. The Canadian Journal of Nursing Research, 43(3), 78–94.Google Scholar
Stake, R.E. (1995). The art of case study. Thousand Oaks, CA: Sage.Google Scholar
Stewart, M., Neufeld, A., Harrison, M., et al. (2006). Immigrant women family caregivers in Canada: Implications for policies and programmes in health and social sectors. Health & Social Care in the Community, 14(4), 329–340.Google Scholar
Van Herk, K.A., Smith, D. & Andrew, C. (2011). Examining our privileges and oppressions: Incorporating an intersectionality paradigm into nursing. Nursing Inquiry, 18(1), 29–39 Google Scholar
Winslow, B.W. (1998). Family caregiving and the use of community support services: A qualitative case study. Issues in Mental Health Nursing, 19, 11–27.Google Scholar