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Sunday, November 1, 2009
Learning Objective 1: The learner will be able to describe the significance of resistive behaviors that occur during the context of daily care in the home setting.
Learning Objective 2: The learner will be able identify gaps in understanding- the impact of care resistive behaviors on caregivers’ biopsychosocial well-being.
Alzheimer’s disease affects the lives of millions of families, as this devastating neurological disorder progressively diminishes the person’s cognitive capacities. Seventy percent of people diagnosed with Alzheimer’s disease are cared for at home by a family member or a close friend. As the disease progresses, the person with Alzheimer’s disease requires increasing assistance to safely complete basic activities of daily living (ADLs). Compounding escalating caregiving demands, cognitive impairment often prompts resistance to or refusal of the care being offered. A wealth of literature links such caregiving difficulties with stress and burden; however, there is paucity of research examining resistive behaviors in the context of home-based care. Therefore, the purpose of this dissertation study is to document the frequency of resistive behaviors exhibited during activities of daily living (i.e., eating, bathing and dressing) and the family caregivers’ perceptions of these events. Preliminary work included a principle-based concept analysis of the concept of resistiveness to care. This analysis revealed gaps in scientific understanding, including inconsistencies in definition and close associations with the concepts of agitation and aggression. Most often, only those resistive behaviors that escalated to agitated or aggressive responses were addressed in the current literature. The proposed dissertation will employ a mixed methods design using a form of ecological momentary assessment (i.e., daily diary instrument) and weekly behavioral scale to more fully explicate how often family caregivers experience forms of resistiveness to care during ADLs, the range of behavioral manifestations attributed to resistiveness, and the caregivers’ perceptions of resistive behaviors within the context of informal caregiving.
By understanding the frequency and impact of these difficult experiences of family caregivers, nurses will be better prepared to offer supportive interventions to sustain the critical work of family caregivers—our instrumental partners in care.