Research On The Family Resilience Of Disabled Elderly In Communities And Its Intervention Model

Objective:Disability is not only an individual injury and social issue,but also a "family affair".As the core carrier of the construction of social security and service system for the disabled elderly,the development of family functioning directly affects the quality of care and wellbeing of the disabled elderly.This study takes the families having elderly individuals with disabilities as the research object,explores the current situation,generation process and characteristics of the family resilience of the disabled elderly under the background of Chinese culture,analysis the factors and strategies that influence family resilience of the disabled elderly.On this basis,a family resilience-enhanced model of disabled elderly was developed to facilitate the family resilience and provide a reference basis for nursing staff to formulate targeted nursing intervention measures for families having disabled elderly.Methods:1.Literature research method: The main literature data sources are CNKI,Wanfang,Web of Science(Wo S),Pub Med,OVID and other databases.Literature review was conducted to summarize the concept of family resilience,main theoretical models,influencing factors and intervention strategies of the research field.Social network analysis software such as VOSviewer was used to performed cluster analysis and generated social network maps for keywords to analyze the research progress and frontier both at home and abroad in this field.Theoretical analysis was applied to discuss the possible mechanism of family resilience and the theoretical basis for guiding this study.2.Cross-sectional survey method: A cross-sectional study was conducted to investigate family resilience level and its influencing factors in 492 families with disabled elderly.The instruments include general data questionnaire(including the socio-demographic data of the disabled elderly,the socio-demographic data of the main caregivers,and the basic information of the family),family resilience assessment scale(FRAS),activity of daily living scale(ADL),family care quality scale,social network and social support scale,family burden scale of disease(FBS),positive aspects of caregiving(PAC),and role captivity scale,etc.SPSS 23.0 software was used for statistical analysis of the data.A multiple linear regression analysis was conducted to explore the contribution of correlated variables to the family resilience of the disabled elderly.3.Phenomenological research method: A descriptive qualitative design utilizing semistructured,in-depth,face-to-face interviews with 12 families with disabled elderly was conducted.Colaizzi’s seven-step analysis method is used as the main strategy for data analysis to reveal the real experience of family caring for disabled elderly,family coping strategies,the characteristics of family resilience and its adjustment process under the background of Chinese culture.4.Inductive and deductive method: An intervention model to facilitate family resilience of disabled elderly was developed preliminarily based on literature analysis,theoretical interpretation,quantitative research and qualitative research by carrying out deductive reasoning and inductive summary.Results:1.Based on literature review and visualization analysis,it is concluded that the research on family resilience in domestic and foreign literature presents an increasing trend year by year.the hot keywords in the field of family resilience include care/caregiver,disability and dementia,social support,qualitative research and intervention research.By theoretical analysis,an initial conceptual framework to guide the whole research was developed.2.According to the questionnaire study,the average score of family resilience with disabled elderly in urban communities was 141.87±14.65.From high to low,each dimension scored as making meaning of adversity(3.19±0.47),positive outlook(3.02±0.34),family communication and problem-solving(2.88±0.33),family connectedness(2.76±0.27),social and economic resources(2.63±0.30),and transcendence and spirituality(1.90±0.63).Time of disability,the level of family support,the level of relatives and neighbors support,subjective well-being of caregivers,positive aspects of caregiving,family burden of caring,the type of caregiver role,the elderly and children live nearby or not,the level of dependence in the ADL,family economic income,sense of role captivity,number of living siblings and number of children were positively correlated with family resilience.All the variables entering the model could explain 67.2% of the variance of the family resilience.Among them,disabled elderly factors,caregiver factors,family factors and social support factors could explain 23.3%,24.3%,16.4% and 3.7% of the variation of family resilience,respectively.3.From the results of the qualitative interviews,five prominent themes were emerged,including family belief system,family organizational patterns,family communication process,the process of family resilience and the types of family resilience for disabled elderly under Chinese cultural background.For the themes "family belief system",five subthemes were identified including the internalization of social ethics and value inheritance,blaming fate for adversity to reduce stress,the normal mentality of "living",get satisfaction from a downward comparison,and facing adversity actively and looking forward to the future.For the themes "family organizational patterns",three subthemes were identified including family flexibility,family connectedness,and social support and resource integration.For the themes " family communication process",two subthemes were identified including understanding without too much explanation and negotiate and solve important matters together.For the themes "the process of family resilience",four stages characterized respectively by sparing no effort in coping,helpless and depression,groping for adjustment,and acceptance and adaptation were identified.For the themes " types of family resilience",four subthemes were identified including complementary collaboration-inward orientation,complementary collaboration-internal and external compatibility,unilateral giving-cooperation,and unilateral giving-alienation.4.An intervention model to improve family resilience of disabled elderly was developed preliminarily.(1)Focusing on the improvement of the overall capabilities of the families with disabled elderly under the background of Chinese culture,an intervention model combining internal empowerment and external support is proposed around the three key processes of family belief system,family organizational patterns,family communication process and social support network.(2)The intervention can focus on the four stages of "sparing no effort in coping,helpless and depression,groping for adjustment,and acceptance and adaptation" of the family resilience,respectively and adopt the methods of preventsupport intervention,and promotion-growth intervention respectively.(3)Intervention strategies can be carried out and implemented based on four typical family resilience patterns of disabled elderly,namely,complementary collaboration-inward orientation,complementary collaboration-internal and external compatibility,unilateral givingcooperation,and unilateral giving-alienation.Conclusion:1.The family of the disabled elderly in this study reported a moderate level of family resilience.In terms of the performance of "strength",compared with the western families’ emphasis on stronger and greater forward "flexibility",the resilience of the disabled elderly families in China focuses on the performance of perseverance and "resilience" in peace.2.This study comprehensively revealed that the influencing factors of family resilience of the disabled elderly include individuals(disabled elderly and main caregivers),families,social support and other aspects,which can provide reference for carrying out diversified and multi-angle family assessment.3.In the context of Chinese culture,the family resilience of the disabled elderly has different characteristics in the aspects of the family belief system,family organizational patterns and family communication process.The understanding of the connotation and generation process of family resilience needs to be combined with the specific background culture and time stage.4.This study preliminarily constructed an intervention model to improve the family resilience of the disabled elderly,and clarified the intervention entry points and social support strategies to improve the resilience of such families.The intervention model in this study is scientific and practicable for clinical work.It could guide nursing staff how to integrate the new perspective of family resilience into family nursing practice.Suggestions:1.A new perspective on family and family resilience of the disabled elderly should be considered.2.Strengthen the research on the concept and connotation of family resilience.3.Strengthen cooperation and promote the interdisciplinary integration of research on family resilience of disabled elderly.4.Actively explore the community and family nursing practice model centered on the improvement of family resilience.Innovation points1.Innovation of research perspective.First of all,previous studies on the caring of the disabled elderly have focused on family care burden and negative experience.This study focuses on strength and resources from the perspective of positive psychology,and explores the characteristics,abilities and processes of the disabled elderly family to adapt and grow after experiencing difficulties.Secondly,this study takes the family as the research object,and discusses the influencing factors,relationship interaction and generation mechanism of the family in the process of coping with disability events from the perspective of family resilience.In the construction of intervention model,it extended from hospitals to families and communities,which changes the nursing mode of only focusing on the disabled elderly under the biomedical model,emphasizes the interaction and potential transformation of individual-family-environment relationship,which provides a new idea for follow-up related research and nursing intervention.2.The expansion of the research content and the enrichment of the research theory of the family resilience of the disabled elderly based on China’s cultural background.The results of this study reveal the influencing factors of family resilience of the disabled elderly under the cultural background of China,as well as the family resilience representation in the aspects of belief system,organizational model and communication process,four stage characteristics and four family resilience patterns.From the perspective of nursing specialty,it is proposed to integrate the family resilience theory with community nursing and family nursing.The intervention model of family resilience improvement for disabled elderly with Chinese cultural background has been constructed,which has enriched and expanded the application space and applicable objects of family resilience research.Conceptions for making further study1.Due to the limitation of resources and manpower,this study mainly focuses on the families with disabled elderly in the communities of Tangshan.It does not include the families with disabled elderly in remote rural areas into the scope of investigation.As a result,it lacks a comparative study of the resilience of urban and rural families with disabled elderly.2.This study just demonstrates the rationality and scientificity of the model,and the effect of intervention needs to be further verified through practical cases.