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Managing caregiving at home: Thai caregivers living in the United States
Journal of Cultural Diversity, Spring, 2004 by Yaowaluk Limpanichkul, Kathy Magilvy
Abstract: The researchers designed a qualitative descriptive study informed by grounded theory and ethnography to generate a beginning substantive theory that illuminates the process of caregiving in Thai families living in the United States. A purposive sample of seven Thai caregivers of chronically ill relatives in the western and the midwestern regions of the U.S. participated in interviews, provided observations and wrote memoranda. Three categories emerged from "managing caregiving at home:" (a) being caregivers, (b) the consequences of caregiving and (c) coping with the difficulties of caregiving. The study participants describe caregiving, as a willing burden and an. unavoidable, duty, attitudes which are clearly influenced by Buddhist beliefs. The results of this study provide nurses with a better understanding of the caregiving process, especially as it exists in the Thai American population.
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Key Words: Thai American, Thai, nursing, nurses, caregiving, caregiver, home caregiving, family caregiving, chronically ill, grounded theory, ethnography
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Approximately 25% of all households in the United States provide home-based health care to family members (National Alliance for Caregiving and the American Association of Retired Persons, 1997). As a result of changes in the institutional nature of health care, as well as advanced technology in health care practice, patients with chronic illness are living longer and are more often being cared for at home by family caregivers. Shifts in health care policy toward community care, the growing number of the elderly and changes in the structure of the family unit (Carlisle, 2000) comprise the social factors that contribute to the importance of home caregiving and its significance for health care providers.
Although numerous studies have documented the negative side effects of long-term caregiving, such as fatigue, lack of sleep, faintness, dizziness, stress, anger, short temper, hurt feelings, discouragement, discomfort and boredom (Subgranon & Lund, 2000), evidence also suggests that caregiving can be satisfying work. A sense of fulfillment for the caregivers, an increased feeling of closeness between caregivers and their relatives, and pleasure from day-to-day interactions with care recipients reportedly are some of the positive aspects of caring for dependent relatives (Harper & Lund, 1990; Kinney, Stephens, Franks, & Norris, 1995). Whether caregiving is perceived as rewarding or burdensome, caregiving can potentially improve the quality of family relationships and therefore may improve the quality of life of patients and their families.
Although caregiving has been measured in terms of specific empirical variables, the emphasis on measurement in the body of research limits nurses understanding of the multiple ways in which caregiving is important to caregivers and patients. Therefore a need exists to explore qualitatively the meaning and process of caregiving, and to examine the personal experiences and perspectives of caregivers as they provide care for their relatives. There is limited research on the culturally specific experiences of family caregivers of the chronically ill. For example, research has not focused on the ongoing process of family caregiving to Thai patients with chronic health conditions, particularly from the perspective of Thai caregivers who live far from their homeland. Personal beliefs grounded in religion and culture presumably play a major role in the caregiving process, prompting the researchers to question whether a conceptual, Westsern framework about caregivng can be used effectively in Asian populations, particularly Thai. The lack of an appropriate framework for caregiving that is sensitive to Asian culture and religion may result in a disparity in healthcare delivery.
To enhance quality of care and quality of life for patients and caregivers, health care providers must develop appropriate interventions. This goal cannot be achieved without understanding the caregiving process. Therefore, the overall purpose of this study is to generate a beginning substantive theory to describe and explain the process of caregiving, based on the perspectives of Thai caregivers of chronically ill Thai patients living in the United States. Informed by ethnography and grounded theory, this design facilitated and emphasized the structure of culture and the caregiving process. Consequently, the results of this research support the development of interventions that will benefit Thai patients with chronic illness and their family caregivers.
METHODOLOGY
Qualitative descriptive design informed by grounded theory (GT) and ethonography guided the design of this study. Grounded theory is a method developed by Glaser and Strauss (1967) to discover participants' points of view and how they process information over time. The objective of GT is to develop a theory that explicates basic social patterns common to the area under study. The GT approach was selected because the purpose of this study is to gain a deeper understanding of caregiving processes and to develop a beginning substantive theory of the Thai caregiving process.
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