Recreating life: a grounded theory of caregiver and care recipient relationship development in acute home care

The purpose of this study was to generate substantive theory describing processes used by caregivers and care recipients to develop and maintain satisfying caregiving relationships in home caregiving situations in which acute care is required and care recipients are not cognitively impaired. The development of the caregiving relationship is a dynamic process that evolves from interactions between a caregiver and a care recipient. Interactions occur within the context of a broader environment that also may impact the relationship's evolution. This study addressed the types of literature related to home caregiving and the paucity of research related to the development of the caregiving relationship in which acute care is the primary focus of care. Grounded theory methodology was used to develop this beginning theory of 'recreating life.' Nine caregiving/care receiving dyads were interviewed once; four dyads were interviewed twice; and one dyad was interviewed three times. A semistructured questionnaire guided initial interviews. Questions changed, as needed, to elicit information and to pursue theoretical sampling of categories. Constant comparative analysis was used to analyze concepts emerging from interview data. The substantive theory that emerged, recreating life, suggests that caregivers and care recipients respond to uncertainty resulting from disrupted realities caused by acute or chronic illness by redefining self and redefining the relationship. Redefining self and redefining the relationship occur simultaneously. Intervening conditions affecting recreating life include prognosis, progress, social supports, and professional supports. Theory fit to subject experience was established through interview of four caregiving dyads. Results from this study will assist hospital and home health nurses to prepare patients for discharge, assist in earlier mastery of treatment skills, provide better support, and assess and intervene when necessary in the processes leading toward recreating life.