Using the connecting process to meet family caregiver needs

Using the Connecting Process to Meet Family Caregiver Needs SHIRLEYR. RAWLINS, RN, CS, DSN*

lndlviduals who engage in caregiving responsibilities for dependent family members in the home setting face challenges that are little understood by others outside the circle of care. Because a large portion of energy Is devoted to caregiving tasks, caregivers potentially fail to devote attention to meeting their own needs. The purpose of this study was to develop a beginning substantive theory describing the needs perceived by caregivers and the processes by which these careglvers are able to get their lndivldual needs met. Grounded theory methodology was used to facilitate the identification of these needs and processes. This study concluded that the needs for help, hope, and happiness are the most crucial needs of family careglvers. The basic social process of connecting was identified as fundamental to meeting caregiver needs. Subprocesses of mlsconnecting and disconnecting were identified as concurrent processes that existed as functions of connecting and that affected the connecting process. The connecting process was seen as an organizing concept that could both give direction to the practice of nursing care for caregiving families and lay the foundation for continued research and theory development. (Index words: Connecting; Misconnecting; Disconnecting; Family Needs; Caregivers) J Prof Nurs 7:213-220, 1991. Copyright 0 1997 by W.B. Saunders Company

need for theory egiver

needs,

proposed:

development

(I) What

caregivers!

related

the following

research

are the needs reported

(2) Are those needs being

are the basic processes

N

direct care to families, especially in psychiatric and community settings. If nurses are to be effective in the delivery munity,

research

of services to families efforts

must

in the com-

focus on the holistic

by family

met? (3) What

by which caregivers

get these

Assumptions Two

primary

assumptions

in this study

there are basic processes for getting common

to all groups

of the nature searcher’s analysis

of family

of the caregiving

were: (1)

needs met that are caregivers

regardless

tasks, and (2) the re-

own life experiences

would

influence

data

and theory development. Definition

of Terms

Three major terms were used in this research study. Needs are tangible

objects

states of being perceived ual to be necessary

or nontangible and reported

to well-being

emotional,

or

by an individThe

people who engage

perceived

and/or

feelings

or survival.

f arnz ‘IY’1s a g rou P o f’ Interdependent

in tasks aimed at eliminating in providing

carwere

needs met?

psychosocial, URSES have long been involved

to family questions

physiological,

spiritual

burdens

of

another

individual

in the family.

Basic processes are

dynamic

methods

used and reported

by most individ-

uals for achieving

certain

outcomes;

explain a considerable portion dividuals (Glaser, 1978).

these processes

of the behavior

of in-

needs of those family systems and how those needs are met.

Limitations

The process

related

to how family

their needs met has not been described such a way as to formulate retical

framework

group

in the home

for

intervention

In light

get

or explained

the beginnings

nursing

setting.

caregivers

in

of a theofor

this

of the established

*Associate Dean, Georgia Baptist School and College of Nursing, Atlanta, GA. Address correspondence and reprint requests to Dr Rawlins: Georgia Baptist School and College of Nursing, 300 Blvd, NE, Atlanta, GA 303 12. Copyright 0 199 1 by W.B. 8755-7223/91/0704-0009$03.00/O

Saunders

Journal of Professional Nursing,

Company

Vol 7, No 4 (July-August),

Acknowledged time restrictions presence of a tape a potential lack These limitations and the resulting

limitations

of this study

related

to

for data collection and analysis, the recorder during the interviews, and of generalizability of the findings. may have influenced data collection formulation of an emerging theory.

Conceptual

Framework

The qualitative approach to this research study was guided by grounded theory methodology and family 1991:

pp 213-220

213

214

SHIRLEY R. RAWLINS

systems theory. a theoretical

Using grounded

framework

using information jects (Glaser,

theory methodology,

was constructed

from the data

from the life experiences

of the sub-

caregivers, nature

to viewing

dynamic

group in which anything

ber would influence & Enestvedt,

with the primary

a harmonious

affecting

one mem-

the whole family (Lapp, Diemart, of grounded

and appropriate

framework of family

Grounded

theory methodology

the-

for synthe-

caregivers.

of explanatory 1986).

theory generation

A beginning research.

literature

scription

review was done to provide

of reference for the conduct

major bodies of literature systems

The concept in the nursing

of the study.

were searched:

and literature

Two

literature

literature

as well as in writings

other social science disciplines. general

family

ture, and organizations,

functions,

mon conclusion:

processes,

struc-

as well as the effect of change

family

systems

theories ducted

in relation

TABLE

Family

1 2 3 4 5 6 7

1.

also served as

The majority

of studies

on specific types of caregivers and for the family

to caregivers

ill children,

the researcher’s local community caregiving study.

activities

ality required

among

to participate

the families,

which allowed

and other demo-

semi-structured

ill adults

Fam-

by theoreti-

for choices of sampling

were developed.

was accomplished through oneinterviews with family caregiver

were interviewed questions

and adults in the

together to guide

using

a set of

the collection

of

data.

Data Analysis

of

disease. These authors im-

Family Demographic

household

in

in the

process was the only common-

were selected

Data collection time, tape-recorded

1) from

who were engaged

were invited

The caregiving

were con-

of the elderly,

and of chronically

and those with Alzheimer’s

sample of seven families (Table

groups in their own homes. Children

related to family caregivers

of social support

chronically

the health and coping

of its members.

by nurse researchers

Data Collection

sources as the concepts in

and

1980).

cal sampling,

be studied

for this study.

concepts

one com-

of individuals

a background

of emerging

anal-

pieces of

made such a sig-

implied

unit as a whole should

Literature

comparative

of multiple

for interview

on the health outcomes understand

A constant

ily caregivers

impact

mechanisms

(Stern,

or

than a de-

were not controlled.

that the family

order to effectively

themes

rather

graphic or process variables

Nurse authors and oth-

the family context

was gen-

focused on basic dom-

the comparison

data with an identification

A purposive

from

& Swanson,

framework

or behaviors

of individuals.

on

Nurse researchers have

and crisis on family dynamics. ers who examined

Description

on family caregivers.

of the family as a system was prevalent

(Chenitz

theoretical

social processes

ysis facilitated A preliminary

data for the purpose

erated from the data rather than from the literature previous

Related Literature

nificant

in

allowed for the col-

lection and analysis of qualitative

and family systems theory provided

data from this group

described

affective

or financial.

Methodology

inant

family

of needs in family

needs being

rather than instrumental

the family as an interdependent,

1990). A combination

ory methodology

a point

of a multitude

1978). Family systems theory offered an

approach

sizing

plied the existence

The processes occurred

of data gathering

simultaneously.

and data analysis

As data analysis of the tran-

Data Person Receiving Care

Caregivers (Age in Yr)

Occupation

Husband (35) Daughter (8) Father (50) Mother (49) Wife (58) Wife (57) Son (36) Grandmother (66) Daughter (60) Niece (73) Niece (76)

Attorney Student Salesperson Community service worker Retired secretary Real estate agent Corporate executive Retired nurse Unemployed Retired secretary Retired teacher

(Age in Yr) Wife (34) Daughter

Disability Back pain

(14)

Husband (65) Husband (62) Father Grandson (4) Mother (88) Aunt (101)

Retarded Disabled amputee Alzheimer’s disease Retarded Frail, elderly Frail, elderly

USING THE CONNECTING

scribed interviews applied

began, a system of open coding was

that reflected

behaviors

the substance

of the people interviewed.

pared and similar an initial sought

label.

codes clustered Main

during

themes

the coding

gories. Theoretical

sons who were expected

Codes were com-

expressed

into categories

or core variables

and development

dens of caregiving

were

spite as positive,

the data to a con-

a tentative

framework

data and the theoretical selected

and core categories

literature

was generated

memos.

provided

ships to supplement

using the

A second search of

additional

that was woven into the observed

iden-

Caregivers especially

theoretical

and support

the emerging

home

the-

vital,

needed

perceived

re-

and “at the top of the list of help from health

for dealing

left them

feeling

with

parent of a disabled

the caregiving

with

tasks at

and afraid,

as if

from every crevice.”

One

child shared that connections

were

to make with physicians

understandable

professionals,

Less than adequate

vulnerable

they were “hemorrhaging

take time

relation-

or relief from the bur-

and overwhelmingly

in the area of teaching.

difficult

information

to offer this help. Caregivers

needs. ”

preparation

level.

were named as those per-

the need for respite

with

of cate-

and raise description

As the data were analyzed tified,

home, and family members

of the words and

memos served to connect

with the final analysis ceptual

215

PROCESS

the family

because they did not

or explain

and sensitive

things

in an

way.

ory .

Establishment of Validity Face validity purpose

was assessed

of evaluating

was reflected

for this study

the degree to which

in the data. A questionnaire

the family caregivers

that described

ships of the three identified

for the the truth

was sent to

the interrelation-

needs with the processes

used to meet those needs. Caregivers were asked to open-ended manner to the respond in a narrative, summaries

offered and to offer further

comments

families provided

for the findings.

Caregivers

the processes perceived

and with

to meet those needs. This con-

offered a face validity

for the anal-

ysis of the data and for the relationships These families validation

written

unanimously

agreed with the needs that were identified census of caregivers

if

were perceived

and professional

Friends were identified as another source of help, but their involvement was perceived as being different from that of the family. visitors

desired. A total of five caregiving validation

Three recurring cafegiver needs emerged from the wealth of family interview data . . . help, hope, and happiness . . .

proposed.

to be the best source of

experts were not consulted

in this process.

provided

fered a different

caregivers

with expressions and “God

used another

such as “looking

wealth

of family

caregiver interview

data.

These

from the

needs were

category

of words

for strength

inside”

strength.”

One caregiver stated she “needed to hear that there was always hope, ” and another stated she did not ever want to be given

“false hope,”

These descriptive

phrases

The caregivers

needs emerged

kind of help and

to build

but desired

other people.

of the

the need for hope.

in this study verbalized

Many caregivers

there was a purpose

honesty.

led to identification

offered hope from two sources: Three recurring

that of-

the family group.

uses these situations

second core variable;

Family Caregiver Needs

of nonfamily

to the situation

but equally valuable

served to re-energize Family

The presence

a freshness

a need to be

from God and from expressed

in everything

a belief that

that happened

and

help, hope, and happiness (Rawlins, 1989). The first core variable that emerged was the needfor help. Caregivers used such expressions as “doing more” with “not enough time.” Tasks were “heavy”

Caregivers used many negative words and expressions that indicated unhappiness. They spoke of “not

and in one case described as “more than I can stand.” Caregivers spoke of having to wear a “different hat” and to do things they had never done before. Caregivers’ roles were described as situations of “doing more” and “expecting more.” Caregivers needed help in giving direct care to the dependent person in the

being able to smile anymore.” Descriptions of birthdays without recognition, a loss of “life’s pleasures,” and having to “bypass what I want” were words that emphasized the need for happiness. Caregivers needed support in an expressive as well as instrumental nature, and caring rituals were valued

that God used these human tual faith.

situations

to build

spiri-

216

SHIRLEY R. RAWLINS

as an important

link to happiness.

One caregiver

de-

scribed the absence of caring rituals in her life and the subsequent

unhappiness

that resulted:

three

help,

primary

hope,

needs

and happiness

they subsumed

in family

caregivers

were foundational

all other expressed

how her elderly

in that

needs.

One family

very evident caregivers

tions with viable, periencing

a meeting used

One family scribe

helpful

and the family. connec-

resources was crucial to ex-

of their perceived

the words

the process

that making holistic

“connecting

they used for getting

needs.

was a lack of attention

caregiver’s

to all family caregiving

also emerged

of

process.

Family caregivers recognized that making connections with viable, helpful resources was crucial to experiencing a meeting of their perceived holistic needs.

Caregivers

frequently

they first entered by many needs groped

they had made used

that

words

opportunities, pride.”

In their

efforts

and

happiness,

hope,

for meaningful

situation

the

time

connections

a misconnection was not helpful

truthful

seemed

multiple

when

a resource

roles.

One caregiver

shared

by both the as to the

needs:

care professionals help to caregivers information.

were perceived

to offer

in the way of providing

In recounting

the story of how

birth

defects,

one mother

with

shared these per-

My gynecologist came Poor thing, he didn’t hardly got his head in what was wrong with

in the door walking out. . . . know what to say to me. He the door. . A nurse told me the baby.

or

Caregivers would sometimes experience misconnections with friends and other family, thus making their efforts at seeking

help less productive:

Caregivers

that

there

was a process that occurred that was less than ideal and that prevented caregivers from connecting in helpful ways with other people. This was eventually labeled misconnecting and was seen as a process that frequently preceded connecting. Caregivers misconnected with help in assuming their

experienced

their

caregivers

to indicate

only iso-

They gave no con-

ceptions:

such as “not knowing,” “missed ” “distasteful things,” and “too much

These phrases

as touching

she first learned her baby had been born retarded

and often found with

were perceived

for her

The nurses who come out here come to take care of H’s foot. They won’t touch anything else. They come out here to take care of what they’re paid to come out here and take care of, and they don’t bother anything else. I guess they think if they do something and later it got worse, I would sue them. Sometimes I need advice about other things and it’s hard to get that advice, too. They call, they come, and then they leave.

Health

to meet

to them.

nurses who

and his wife, nor did they inquire

inadequate

their roles as a period characterized

difficulties.

for help,

described

visiting

as sit-

and were seen to operate as functions

the connecting

by health

to assist a wife in caring

to the depression

patient

The processes of misconnecting and disconnecting

uations.

sideration

by

aspects of both the patient

In one situation,

husband

help.

This

encountered

lated parts of the family situation.

up” to de-

basic social process of connecting was later identified a major process common

disabled

misconnection

to the holistic

came periodically recognized

at-

for

The Meeting of Caregiver Needs caregivers

demanded

tention:

professionals

Family

mother

She consumed me. I felt like she just swallowed me whole. Everything I did revolved around her. When I did get together with my family, we talked about her until we finally realized what we were doing. We might as well be there with her as to have her dominate our lives even when we were away.

Even at Christmastime last year, not one person offered to let me go with them to a shopping center except my mother. . I didn’t even get Christmas (presents) last year; it was like another day. These

she described

her perceptions

as

They just left it up to me to keep her. One sister told me she’d come every Tuesday to stay. She came twice and then called me to say that was the only day she could play cards with her friends and she wouldn’t be back.

Misconnections also occurred with sources of hope as caregivers struggled to make sense out of life’s circumstances. Even though they expressed faith in God to support them in their burdens, it was difficult for hope to be ever-present in their thinking. One care-

USING THE CONNECTING

giver described

217

PROCESS

her faith as sometimes

running

down-

of a person from a situation.

was eventually

hill like a glass of water. Caregivers

separation

and their

families

desired

gentle honesty from other people, experienced

misconnections

and shallow

reassurances

tactful

and

but they sometimes

with others as false hope

seen as a more definitive As caregivers many

of them

One thing I don’t like, though, is the kind of people that tell me what they think I want to hear; ‘You’re going to do good’ or ‘It’s going to work out.’ And you know durn well you’re facing a really tough road ahead and it’s not as easy as people think. I don’t know if they’re trying to be soothing and saying the things I want to happen or whether they are unaware.

Caregiving tivities

tasks in many

or relationships

caregiving

situations

were so life-

that there was no time to pursue that afforded

wife of an Alzheimer’s

happiness.

victim

nection

that

another

interfered

with happiness.

shared these

variation

in a misconInvolvement

in the care of a disabled person enmeshed the caregiver in an involuntary connection that pulled that caregiver along in a negative

they

and friends

over time,

had disconnected One of the most

of disconnection

with

family

was offered by the son of an Alzheimer’s

victim:

By my observation, most of the people, family, friends, and such disappear. It’s almost like a cancer house because no one wants to come around. . . . The net effect on the family is that the caregivers are in isolation. Not only do you have a problem, but you’ve got it by yourself.

One

Taking care of a sick person in the home is no easy job . . The part that is devastating is the heartbreak of seeing someone you know and love not know your name. We were driving along the street and he looked over at me and asked, ‘Where do you live? Do you have an apartment?’ Then he realized what he had said and he broke down and started crying. . It was a horrible thing to see the strength of the family in a position where he was crying.

described

to function

that

the ac-

feelings:

Caregivers

descriptions

and was

process than misconnecting.

continued realized

This process

as disconnecting

with certain resources and situations.

were offered:

poignant

consuming

identified

direction:

It’s impossible to keep your own mind if you’re continually subjected to nothing but a demented person. . . When a person is degenerating and you’re taking it on, you’re going the same way they aredownhill, too.

Whenthe cafegivers came to the realization that their needs were not being met, they engaged in a process of withdrawing from that nonsupportive of draining relationship and sought other ways to cope.

There purposeful

were times

in the lives of caregivers

disconnections

whelming caregiving need for relief:

were made with

role. One caregiver

shared the

You just have to have some relief. There’s no other way you’re going to make it. . You have to have it because you do it 24 hours a day for every day of your life. Even if you love a person dearly, you just need some time away from that routine or you will go bonkers.

One of the most devastating When the caregivers came to the realization that their needs were not being met, they engaged in a process of withdrawing from that nonsupportive or draining relationship and sought other ways to cope. Caregivers shared how a person’s “mind was gone” or how people “just stay away.” They talked about “escape” being critical at times and how friendships would “disappear.” These phrases pointed to another process that was occurring that was characterized by a definite separation of one person from another or the

that

the over-

types of disconnection

occurred as some caregivers experienced the gradual, irreversible slipping away of the body, mind, and spirit of the person for whom they were caring. The wife of an Altheimer’s victim described her disconnection with her deteriorating husband through writing a poem that described her pain and broken heart, and the slow death of her love for him. She asked why God could leave a man’s body but take his brain. Although many examples were found to illustrate how caregivers disconnected from sources of help and

SHIRLEY R. RAWLINS

218

happiness,

no evidence

was found.

of a disconnection

from hope

As bleak as some of the situations

hope was still caregivers.

alive in the hearts

and minds

the course of each caregiver’s

experifound

disconnected

As the caregiving happiness

Caregivers and missed

from sources

farther

time

with

people

spent

with other

especially

with children.

Caregivers

tendency

to disconnect

gled to deal with cumstances

of happiness.

away.

disconnected

they

family

loved

members,

also recognized

a

from their spouses and strug-

changed

feelings

that threatened

and shifting

the stability

cir-

of the mar-

riage . One of the most distressing was a caregiver’s

shared the importance

to do.

of his friends

I had friends who were not associated with this family

tasks became more life-consuming,

appeared

One caregiver

day

in this respite process:

ence, there were times when these individuals themselves

that she needed time alone-a

or an hour to do exactly what she wanted

were, of the

Hope had not died.

Throughout

was, she answered

who helped me and probably saved my life. I probably would have jumped off a building somewhere if it weren’t for my being able to go outside this household. That escape was critical. Friendship relationships are critical.

Maintaining givers

hope was a basic need for family care-

and they connected

ways: through with people.

communion Searching

with

hope

in two basic

with God and interactions

for a purpose

in the situation

was part of the process of connecting

with hope.

sources of unhappiness

disconnection

with himself

self. Needs or desires for self-fulfillment for lack of a means to participate

or her-

Maintaining hope was a basic need for family caregivers . . .

were unmet

or a lack of energy to

invest: The more I had to look after him, the less I was able to be my own person. I gave more of me over to his needs and there was less of me to do anything else.

Connecting observed

with

giver happiness to the amount A final process

was identified

that was related

to

the processes of misconnecting and disconnecting, but that was more positive in enabling caregivers to get their needs met. Descriptions of “family support” that “made things go easier,” church friends who did “precious things, ” and “connecting trated tant. doing

how contacts Further

with

phrases

is right”

other

up” with others illuspeople

such as “believing

pointed

happiness

in the caregivers’

was the final

was frequently

described

of love and concern

by other people.

One caregiver

who accepted her regardless

of how many wrinkles

were impor-

Discussion

what you’re

out a need for coming

to an Help,

hope,

and happiness

were the three

interrelated

the self. This was labeled

needs met.

Ideally,

individuals

to enter into relationships

process.

The process of connecting was conceptualized as creating a bond of relationship, cooperation, or mucould be intentional

or un-

and was the basic social process that en-

abled caregivers

to realize a fulfillment

she

had or how well her hair was combed.

Three

intentional,

to them

her feelings

about herself and how people who loved her shared that love. Those from whom she felt love were those

needed to be made, either with other people or within

tual effect. Its occurrence

in relation

expressed

described

inner peace. All of these descriptive phrases and coded words indicated a process by which a connection the connecting

process

lives. The degree of care-

of their needs

for help, hope, and happiness. Connecting with needed help was accomplished many ways. Caregivers learned that lay people could master technical skills and could function well in assisting a patient when they were informed and aware. Connections with help through respite opportunities were treasured by caregivers. When one daughter caregiver was asked what her greatest personal need

needs

perceived

basic processes

by family

basic,

caregivers.

were used in attempts

a connecting process enabled

to get these

with others to

receive the proper help and to hear the words of hope and

encouragement

These connections in a realization

that

brought

also potentially

of the pleasures

peace

of mind.

offered happiness

and beauty life had to

offer. Circumstances that robbed people of control and critical thinking ability led caregivers to make misconnections with sources that were only a mirage of help. These bonds were fruitless in that they offered little source of help or hope, and they brought frustration and sadness rather than happiness. Disconnectionsoccurred that could be perceived as helpful, painful, or both. This process had the potential to enable care-

219

USING THE CONNECTING PROCESS

givers

to eventually

allowed

make

the perceived

positive

connections

and

ness in caregivers and concern

needs to be met.

by simply

that

bers in recognizing met.

them

Nurses

struggles

the caregivers

personal

through

disconnections

and assist families

in making

IMPLICATIONS FOR THEORY DEVELOPMENT ANDRESEARCH

As nurses

the process of

that are so painful, connec-

tions that will enable them to realize help, hope, and Nurses can offer crucial help to family caregivers to sustain

the family’s

and to strengthen caregivers

the informal

expressed

ious community their facilities

centers

to care-giving resources

also sponsor

be persuaded

to offer

series of presentations aimed at providing

by

useful

with

perhaps

the most po-

programs

families

to support

provide

to go for inspiration

broken

relationships,

for the development 1984).

they

inner

family

but could

continually

evaluate

in this study,

also desired

meaningful.

of this study

fessional

Use of the findings

and theory caregiving

in more in-depth

development

related

research

to holistic

care for

families.

This study

has raised several questions

for future

research: (1) How does the nzrrse’s need for help, hope, and happiness

affect his or her ability

needs in caregiving to meeting health connect

families?

and connecting

of clients

methods

with helpful

to meet these

(2) Do the processes of

disconnecting, needs

care settings

Are there

and

families

such as tertiary of assisting

apply in other

care centers?

family

caregivers

(3) to

resources that are more effective in this study?

Summary

promote

health

desired

Mallison

hope,

(1988,

p.

This study has provided lationships between needs suggested and the resulting to several additional

possibility.” Nurses can offer caregivers hope in the form of sharing possibilities, not statistics.

a greater

to interact

with

caregivers, it is important that the individual caregiver’s spiritual faith be encouraged. Faith in God was a common theme in this study of caregiver needs and this faith was the basis for hope. Caregivers described one facet of their happiness as that of being loved and accepted by others. Nurses, too, can promote happi-

an initial

process that is useful in meeting

research.

have the opportunity

as a

for practice and research would enable pronurses to engage

1,459) stated, “While others seek cures, nurses seek the compromises that infuse daily life with

As nurses

and to search for more effective and

of

of caregivers.

caregivers

honesty.

that interaction

and opportunities

of their own caring nature (Westthe effectiveness

in the

and

and hope, the healing peace,

families

there is a need to

ways to make nurses’ involvement

than those suggested

caregivers.

a place for individuals

All of these activities

and could facilitate As related

programs,

with caregiving

and in the home setting,

misconnecting,

families.

for community

These institutions

but

Since

help, var-

of all are the local church, temple, or synaThese religious institutions could not only of-

fer their facilities

berg,

caregiver system.

might

for a nonprofit

Community tential gogue.

to care

a need for educational

nurses or other professionals information

commitment

by

interact

community

framework

happiness. helping

to offer this affective sup-

needs

disconnec-

those positive

levels.

port.

that serve to

to get their

can assist with the necessary

tions or support inevitable

the misconnections

in their

energy

love

in home health care activities

have special opportunities

There are ways that nurses can assist family memfrustrate

a genuine

raises the family’s

Nurses who are engaged IMPLICATIONS FOR NURSING’S INVOLVEMENT WITH CAREGIVERS

conveying

Further

greater isfaction.

sensitivity

insight

caregiver

that are conducive

to

of the scope of these ideas

of these concepts to caregiver

into effective

This sensitivity

needs. Re-

and processes have been discussion has given rise

questions

expansion

and the application

look at one basic

may offer nurses needs

processes

and insight

as well

as

for needs satwould then en-

able nurses to strive for the ideal vision

proposed

by

Chinn (1989): a vision of individuals having the resources needed to make meaning of their lives, to participate in their own patterns of seeking health, and to resist that which would diminish their own health.

References Chenitz, W., & Swanson, J. (1986). From practice grounded

theory.

Menlo Park, CA: Addison-Wesley.

to

Chinn, P. (1989). Nursing patterns of knowing and feminist thought. Nlrrsing and Health Care, 10(2), 7 l-75.

220

Glaser, B. (1978). Theoretical Sensitivity. Mill Valley, CA: Sociology Press. Lapp, C., Diemart, C. A., & Enestvedt, R. (1990). Family-based practice: Discussion of a tool merging assessment with intervention. Family and Community Health, 12(4), 2 l-28. Mallison, M. (1988). To our president elect (editorial). American Journal of Nursing. 88, 1458.

SHIRLEY R. RAWLINS

Rawlins, S. (1989). Connecting: Meeting the Need of Family Caregivevs. Unpublished doctoral dissertation, University of Alabama at Birmingham. Stern, P. (1980). Grounded theory methodology: Its uses and processes. Image: Journal of Nursing Scholarship, 12(l), 20-23. Westberg, G. (1984). Churches are joining the health care team. Urban Health, 13(9), 34-36.