Over the river and through the woods: The evolution of involvement by primary family caregivers in nursing facilities

The study explores how a person serving as the primary family caregiver for an elder who is a first-time resident of a licensed nursing facility becomes involved in its multi-faceted social fabric. This dissertation builds on the theoretical framework provided collectively by Friedemann's (1995) systemic organization of family caregiving, the skills acquisition model of Dreyfus and Dreyfus (1986) and life satisfaction measures introduced by Maas and Buckwalter (1993).;The research aims of this qualitative study are to: (1) identify elements of discovery that are typically experienced by a primary family caregiver (PFC); (2) determine what PFCs view as "critical turning points" along the continuum of their social integration into the Nursing Facility (NF) community---concentrating on the acquisition, development and effective application of new information and new relationships; (3) describe a model of involvement that depicts the process of a PFC's gradual integration into, and eventual separation from, the NF community; (4) investigate how PFCs determine their criteria for self-assessment of whether they are effectively meeting their own goals as PFCs; and (5) propose possible interventions by an NF that could effectively promote a more fulfilling experience for PFCs.;An NF resident's PFC commonly faces a new environment, prompting both "fear of the unknown" and uncertainty about how to best contribute to the welfare of his or her significant elder. The PFC's caregiving responsibilities change, and his or her expectations about institutional quality of life for the resident evolve with the lived experience. In-depth interviews conducted with thirty PFCs---ranging in age, gender, relationship to the resident and the resident's length of stay---reveal that a sense of familial duty is a strong motivational influence for becoming and remaining a significant elder's PFC, and that PFC satisfaction is derived from feeling as though he or she has provided appropriately for the resident's care. A seven-phase model is proposed to illustrate how a PFCs involvement in the NF community evolves over the course of an elder's residency.;The findings suggest the need and potential for developing deeper insight into the motivations for becoming and remaining an NF resident's PFC.