Learning Objective #1: understand the influence of previous relationship with care recipient and obligation to care on health outcomes and health promotion in women caregivers of family members.

Learning Objective #2: consider the implications for discharge planning and nurses’ support of women caregiving for adult family members when their past relationship has been difficult or abusive.

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Despite the fact that family relationships are often difficult and 1 in 4 women have a history of abuse from parents or partners, the social expectation that women will care for family members persists. Studies of factors such as the caregivers' age, hours and type of care provided, availability of help for caregivers, social support, and functional ability of the care recipient have not explained why caregiving is harmful to the health of some caregivers and not others. The influence of past relationship on health outcomes for caregivers has been ignored. In earlier grounded theory research, we found that health outcomes and health promotion in women caregivers was related to the quality of past relationship with the care recipient and obligation or duty to care. Women who had a difficult past relationship or who had been abused by the care recipient had poorer health outcomes and less ability to promote their own health. Based on the grounded theory, we developed, piloted and administered a survey instrument with sub-scales measuring a) obligation to assume caregiving, b) past relationship with care recipient, c) woman's health, and d) health promotion to a convenience sample of 236 New Brunswick female caregivers of adult family members. Structural equation modeling was used to test the fit between the theory and the data. Findings offer preliminary evidence to support the premises of the previous grounded theory research. Past relationship had a negative effect on women's health directly and indirectly through obligation.  It also had an indirect negative effect on helath promotion through health.  These findings draw attention to the need for nurses to explore with caregivers the quality of their past relationship with the care recipient, and to identify options for care and/or the resources and services needed to sustain caregiving safely.