Theory of Caregiver Effectiveness Model by Carol E. Smith 1991
The Theorist’s Background and Their Experiences Impacts on the Theory Development
The theory of caregiver effectiveness model was developed by Professor Carol E. Smith. Throughout her career, Smith was demonstrating a lot of interest in researching and writing about the roles that caregivers play in patients recovery and in facilitating their ability to take responsibility for their own health (Burns, Grove, & Gray, 2015). Smith always believed in effective care as a vital aspect of health care that plays a pivotal role in patients health. There are several articles that Smith has written to express her opinions regarding the subject of caregiving. Her articles were published in several journals including the Journal of External and Parental Nutrition, Journal of Patient Education and Counseling and the Journal of Medical Informatics. Her teaching areas include research project in nursing and health informatics (Burns et al., 2015). Smith played a significant role in the development of valuable concepts and theories that are used to guide the nursing profession along with her wide-scale research on the subject of care-giving; thus, she can be considered an authority in the given subject.
Smiths insights into the aspect of caregiving are relied on as a basis upon which health care providers make discussions on what it takes to provide effective care. She highlighted several concepts that she believed to have the capacity of influencing the quality of care that patients can get both at home and in health care facilities. One of her main publications is Multidisciplinary Group Clinic Appointments: The Home Management of Health Failure Trial. This article is rich in information about the approaches and measures that can be taken in the home environment to provide quality care to patients with heart failure. She also wrote about the complex home care by analyzing how economic factors influence the quality of family-based care (Burns et al., 2015). Based on the articles, it is clear that Smith is a reliable author on the subject of patient care. It is due to her knowledge of the determinants of quality caregiving and her understanding of the essence of quality caregiving that Smith chose to develop the theory of caregiver effectiveness model to provide guidelines on effective caregiving. Smith developed and tested a model of caregiving effectiveness that is still believed to be one of the most reliable theories of care giving. Since its development, the theory of caregiver effectiveness model has been refined into a midrange theory (Burns et al., 2015).
References for the Original Work of the Theorist and Other Authors Writing about the Selected Theory
In the initial model by Smith, variables like caregiver maturity, social support, family economic status, preparedness and the levelof social support were given a priority as the main variables that highly impacted on the outcomes of quality caregiving. The theory was developed after a close examination of caregivers of those patients who were receiving lifelong mechanical ventilation or the caregivers who were offering continuous intravenous therapy that is meant to support patients with heart failure. Smith also gained a lot of experience on the subject of quality caregiving by observing total parenteral nutrition. In response to the short falls of the observed caregiving experiences, Smith had chosen to develop a theory that she believed would facilitate provision of quality care (Family Caregiver Alliance FCA, 2010). She used qualitative and quantitative methodologies and applied established instruments in developing, refining and testing the theory of the caregiver effectiveness model. Based on Smiths experience in the subject, both as a researcher and tutor and as a result of the passion that she had on the subject, Smiths theory of caregiver effectiveness model is regarded as the most robust theory that has ever been developed by a nurse.
According to Family Caregiver Alliance FCA (2010), the results of past analyses of the theory show that variables that are suggested by Smith are effective in explaining the variance between a caregiver and patients quality of life. The findings that formed the basis upon which Smiths theory was developed had a significant influence on the nursing knowledge with regards to caregivers desire to help and the occurrence of mutual interactions hence having much impact on home care practice as a whole. Smith believed that the provision of effective care to family members and the loved ones, who primarily rely on technology for survival, would help to improve the condition of the patients for them to be able to get back to their routine lifestyles, and take part in family activities. Smiths theory was also developed with an aim of reducing health care costs based on the belief that effective caregiving helps to reduce the costs of health care provision that normally puts a big strain on the governments (Family Caregiver Alliance FCA, 2010).
There are other researchers who have tried to develop theories to explain effective caregiving. A number of midrange caregiving theories have been developed with different authors writing about the subject. Bower developed one of the theories that are suggested to have given viable and highly important insights into the subject of family caregiving. In the model that Bower (1987) presented, the act of caregiving is understood as being supervisory, protective, anticipatory and preventive (Family Caregiver Alliance FCA, 2010). Bower is considered to be one of the first nursing researchers that gave a systematic identification of the functions of caregiving that went beyond the hands-on physical care that was traditionally believed to be what caregiving entails. The model by Bower was developed after taking time to observe children who were involved in the provision of care to their ageing parents. Family Caregiver Alliance FCA (2010) state that Bowers model is highly used in the discussion on caregiving despite the fact that the model has not been tested in order to establish whether or not it can be applied in other caregiving environments.
Roy also sought to add some insights into the aspect of caregiving; hence he developed the theory of caregiving stress (Hayasi, Leff, DeCherrie, & Soriano, 2016). The variables that are discussed by Roy have a lot of similarities with those that are discussed in Smiths theory to the extent that the theories can be perceived as complementing each other. Roy addresses the subject of caregiving from different perspectives. The aspects that Roy investigated in his theory are interrelated with Smiths variables, including; social support given to patients and the elderly members of a family, demographic characteristics, the challenges that are associated with caregiving and the social roles that the caregivers and the general community need to play in order to facilitate effective caregiving. Hayasi et al. (2016) state that Roys caregiving model was developed based on an understanding that caregivers undergo a lot of stress as their attempt to care for their disabled family members.
Roy attempted to develop a theory to explain caregiving based on his adaptation model as he intended to use the theory as a basis to facilitate his understanding of the manner in which caregivers relate. He also investigated the challenges that they encounter when providing care to relatives who are suffering from chronic diseases. Roy discusses the stress that is associated with caregiving to patients with chronic diseases in an objective way. In his analysis of caregiving and the challenges involved, Roy assumes that caregivers are able to respond to changes in the environment. He suggests that caregivers have certain perceptions of situations that determine their response to environmental stimuli and that they have a high adaptation capacity. Roy means that despite the challenges that are associated with care-giving, the providers of such services are capable of adjusting appropriately to environmental demands especially if they have the necessary motivation to provide effective care. The motivation is derived from motivational factors like social support that make caregivers feel that they are appreciated and their efforts are not in vain. When the environment is not conducive, it means that caregivers will be working under restrictive environments hence they are unable to provide effective care to their patients. Based on this argument, it is clear that Roy advocates for the provision of an enabling environment in terms of such aspects as social support and economic assistance as a means of facilitating the understanding of effective caregiving principles (Hayasi et al., 2016).
In his discussion of caregiving, Roy introduces the idea of the input section. He suggests that the input section consists of the objective burden that serves as the focal stimulus in the caregivers situation implying that it is revealed in the duties that are associated with the provision of care to people with chronic conditions (Hayasi et al., 2016). The responsibilities can at times be so much involving that Roy argues that effective care provision is highly dependent on the caregivers ability to cope with the challenges that might arise. The responsibilities, according to Roy, can have unfavorable implications for the caregiver. The implications are referred to as contextual stimuli and Roy suggests that they include the challenges related to peoples interpersonal relationships and financial challenges among others. Roy argues that caregiving is a stressful process and the caregivers who have not successfully overcome the stressful events experience higher levels of stress in comparison with those who have managed to deal with the stressful events (Hayasi et al., 2016).
In Smiths effective caregiving model, a number of challenges are sighted as the reasons why some caregivers do not offer satisfactory care. Smith suggested that such stressful experiences or events need to be monitored or that caregivers should receive social support to enable them resolve stressful events that can have negative implications on the quality of care that they provide. Therefore, both Smith and Roy have provided useful insights into the subject of quality caregiving by pointing out issues that can impede the provision of effective care. Based on the ideas that are suggested by the two authors, it becomes clear that the environment under which caregiving takes place has a significant impact on the outcomes of the caregiving experience. If there are several challenges in the environment in which care is provided, it is vital to take measures in order to resolve the challenges so as to ensure quality caregiving (McEwe& Wills, 2011).
Other researchers have conceptually studied caregiving but they have not developed theoretical models. The concepts that were discussed by Smith and Roy clearly emphasize the factors that can impede quality caregiving. The concepts are vital for all caregivers as they give suggestions on the aspects like the care environment and the societal factors that can have undesired impacts on the quality of caregiving.
The Problems Addressed by the Theory
Family caregiving is an area that has attracted a lot of attention. Governments are concerned about the subject of effective caregiving so as not to increase the number of patients and the ageing population, which make it difficult for them to allocate adequate resources to quality health care. The challenge is made even worse due to the retirement of baby-boomers and an increase in the need to offer effective care to patients who are suffering from chronic illnesses. There are a number of patients who visit hospitals on a daily basis to seek medical attention. Health care facilities can hardly accommodate the population of health care seekers and they are forced to have some patients nursed at home. According to McEwen and Wills (2011), the effectiveness of home-based care is highly dependent on the competence with which patients are attended to while at home. It is due to this reason that governments and hospitals are showing a lot of concern about caregiver effectiveness. Nursing makes up the highest proportion of health professions and nurses often work with families of all social classes in all environments. Nurses play a crucial role in attending to physical, psychological, emotional and spiritual needs of patients. Nurses are commonly seen as offering compassionate bedside care to patients in the hospital setting. In the earlier days, nurses served widely by offering compassionate care to families at home before their roles were restricted to the hospital environment. The need for quality health care provision has resulted to another change in the current health care environment. Currently, nurses provide services to individuals, families, communities in different settings including homes. Nurses also serve families and patients, caregivers and care receivers irrespective of their age (McEwen & Wills, 2011).
Based on this understanding, it becomes absolutely clear that the development of such theories as Smiths theory of caregiver effectiveness model is a move in the right direction. It is because the theories provide guidelines on effective caregiving to the nursing professionals and to the general community. The theories highlight the impediments to effective caregiving and point to the role that the society should play in enabling the understanding of effective caregiving principles (McEwen & Wills, 2011).
Reasoning Used by the Theory
Smiths theory of caregiver effectiveness model uses inductive reasoning that begins with an incomplete set of observations before moving on to the most probable explanations. This type of reasoning is typical for medical diagnosis that uses sets of symptoms and finds out the reasoning that can relate a patients disease to the symptoms (McEwen & Wills, 2011). In case of the theory of caregiver effectiveness, Smith finds a relation between his variables and health care in an attempt to understand the factors that lead to effective caregiving. Smith relates quality caregiving to such variables as preparedness, family economic stability, social support and caregiver mutuality. In this way, the theory examines the roles played by the variables in determining the quality of caregiving. It begins with the incomplete set of observations regarding the inefficiencies in caregiving and then moves on to finding possible reasons behind the difficulties in the provision of effective caregiving.
Major Concepts of the Theory and the Way They Are Defined
The main concepts of the theory of caregiver effectiveness model are preparedness, social support, caregiver mutuality and economic stability. The concepts are also the variables that Smith has consistently used to explain the caregiver experiences and the challenges that are encountered in the provision of effective care. In the theory, the concept of preparedness is used to denote the psychological readiness of caregivers for their duties. With the use of the concept, the theorist implies that there is a need for caregivers to have psychological and physical preparedness for the caregiving role for them to succeed in providing effective care (McEwen & Wills, 2011). The concept mutuality is used to refer to willingness that caregivers should demonstrate before they start executing their duties. Economic stability refers to the financial well-being that is required in the caregiving environment to facilitate provision of effective care. Smith also discusses social support in a manner that suggests that effective caregiving heavily relies on the support that the caregiver receives from the community around the caregiving environment (McEwen & Wills, 2011).
Relationship among the Major Concepts
The major concepts that are discussed in Smiths theory have a causal relationship in that the concepts like social support, economic status and mutuality are highlighted as the determinants of the caregiving effectiveness. It means that the efforts that are targeted at enhancing caregiving effectiveness must address the main concepts that are perceived as the factors that influence the caregiving effectiveness (Meleis, 2012). For example, social support is related to the concept of effective caregiving in the sense that the availability of adequate social support motivates the caregiver hence leading to the effective caregiving. When caregivers are not given adequate support, they lack the will and motivation that are necessary for effective caregiving. In this way, effective caregiving is dependent on the concepts that denote the determining factors of the results of caregiving.
Explicit and Implicit Assumptions Underlying the Theory
The theory is based on a number of assumptions. First, Smith assumed that effective caregiving is entirely influenced by environmental factors that can either serve to motivate or demotivate the caregiver. The theory mainly looks at the motivating factors that are related to the external environment without giving much consideration to the patient or care receiver as a source of inspiration for caregivers. According to the theory, it is the external forces that drive action. Caregivers derive their motivation from the support and appreciation that they get from the family members and friends of the care receiver (Meleis, 2012). The theory does not cover the intervening factors that can also have an influence on the quality of the care provided.
A Description of the Four Metaparadigm Concepts of Nursing
There are four metaparadigms of nursing, namely person, environment, health and nursing. Smiths theory of caregiver effectiveness model has addressed the four metaparadigms of nursing. With respect to person as the first metaparadigm, the theory makes reference to the patient, family or relatives and friends. The theory addresses the need for caregivers to nurture their patients, friends and family members. It is through effective nurturing that a caregiver can make a significant impact on a given patient. Nurturing of the person also involves understanding the demands of an individual patient. For nurses to succeed in handling the diverse characteristics of patients and families there is a need to have a personal drive for care provision. Nurses who are involved in nurturing patients must always focus on the patients wellbeing (Meleis, 2012).
The theory has also addressed health as a main metaparadigm. Health refers to the wellness of a patient. According to Smiths theory, effective caregiving can help to enhance patients wellness for their way to recovery to be made shorter. The theory talks about the economic factors that are blamed for poor access to health care among low income earners. Patients wellness heavily relies on the quality of care that they are given. Smiths theory also provides a mechanism by which patients can be empowered to continue with their treatment at home as they are monitored in that environment (Meleis, 2012). Environment is the final metaparadigm that Smiths theory has discussed. The theory identifies the environment as one of the main factors that limit the opportunities provided by the caregiver effectiveness model. Another metaparadigm that is addressed by the theory is nursing. Smith highlights the special skills that are necessary for nurse practitioners.
Clarity of the Theory
The theory has introduced and critically discussed vital aspects of caregiving in a manner that facilitates ease of understanding the role and effectiveness of caregivers. The manner in which the theory addresses concepts helps to enhance clarity by presenting a clear relationship between the concepts. Meanings are derived through inference so that people can easily understand the manner in which the concepts are presented. Lucidity is also a factor of nursing especially when it comes to caregiving. Terms are clearly defined by Smith to enhance ease of understanding so that people can associate themselves with the four metaparadigms. A discussion on a particular metaparadigm can help in understanding caregivers and how the metaparadigm influences their effectiveness in executing their caregiving role. Smith is also consistent in the way he presents his ideas on the main concepts and the interrelationship between these concepts.
How the Theory Would Guide Nursing Actions
Smiths theory of caregiver effectiveness is highly applicable in the nursing environment. The theory represents an essential referencing tool for nurse practitioners in the provision of services to patients. First, it stipulates the relationship that should exists between nurses and patients or patients family members and friends. The relationship should be based on mutuality and the theory guides nurses to understand that patients, family members and friends should be active participants in the caregiving practice (Talley & Travis, 2014). Based on the guidelines, the theory plays a significant role in determining the roles that nurse practitioners are to execute and how to do it in a manner that will ensure effective caregiving. The theory is also applicable to nursing as it addresses the issues related to home-based care. Nurses are actively involved in the assessment of patients that should be given home-based care either by their family members or the nurses themselves. Generally, the theory offers guidance to nurses on how to handle virtually all matters that pertain to caregiving.
Using thee Theory in the Area of Nursing Practice
As a nurse practitioner, I would make a lot of reference to the theory when making decisions on caregiving and when trying to understand the causes of some health complications in patients. For example, in case a patient who has been provided with home-based care reports signs that indicate worsening of his or her situation, I would look at the nature of care that is given to the patients and understand the factors that have contributed to the patients slow recovery. Having the knowledge would help me decide on the further plan of action that would be aimed at reducing the risks that the patient is subjected to. I would also use the theory as a supporting document when offering caregiving services. It would help me in preparation for the nursing responsibilities as it points to the essential steps that should be taken before performing the caregiving role. For example, I would apply the theorys suggestion on preparedness and mutuality to be adequately prepared for working with patients and families.