Title: International Association of Gerontology and Geriatrics – European Region
Ward-Griffin, C., Brown, J. Keefe, J., Martin-Matthews, A., Kerr, M., & St-Amant, O. (April 14-17 2011). Nurses caring for elderly relatives: Exploring the impacts of double duty caregiving. VII European Congress IAGG-ER: Healthy Active Aging for All Europeans 'II', Bologna, Italy.

Nurses Caring for Elderly Relatives: Exploring the Impact of Double Duty Caregiving

Background: Double duty caregiving (DDC) is the provision of care to elderly relatives by practicing health professionals. Because health professionals are located at the juncture of public and private domains of caregiving they have unique caregiving experiences. And yet, few studies have investigated the impact of DDC, particularly to what degree health professionals negotiate their professional and personal caring boundaries.

Objectives: The objectives of this presentation are to: 1) compare the health, well-being and caregiver burnout between DDCs and non-DDCs; and 2) examine the caregiving experiences of DDC.

Methods: The purpose of this sequential mixed methods study was to examine how and to what degree DDC affects the health of Canadian, female and male RNs caring for elderly relatives. Phase I: Using a cross-sectional survey design, our stratified sample of 1424 RNs randomly selected from provincial college memberships completed mailed or web surveys. Phase II: Using grounded theory to further investigate the dimensions of the DDC, we conducted repeat in-depth telephone interviews with a purposeful sample if 50 male and female DDCs, investigating how workplace and/or government policies may shape the health effects of DDC.

Results: By using both quantitative and qualitative approaches, our findings have made visible what has been "invisible"- caregiving at the juncture of professional and personal caregiving domains. DDCs report lower health outcomes compared to non-DDCs. Further, female DDCs experience higher levels of exhaustion compared to male DDCs. Qualitative findings also suggest that DDCs, with limited tangible resources and high expectations to provide familial care, takes a toll on their health.

Discussion: Developing a more comprehensive understanding of DDC and how it influences the health and well-being of health professionals, is particularly urgent given the aging population, an aging health care workforce, and an increasing shortage of health care professionals. Study findings revealed that the provision of care at home and at work tended to result in negative health effects for RNs, which warrants further investigation. Ultimately, study findings will lead to policy recommendations that will promote the health of DDCs, their relatives and their patients.

Title: ISIH In Sickness & Health
Ward-Griffin, C., Keefe, J., Martin-Matthews, A., Brown, J. B., Kerr, M., & St-Amant, O. (May 4-6 2011). Nurses Caring for Elderly Relatives: Examining the Care Work of Double Duty Caregivers. ISIH In Sickness & Health: An International Community of Scholars and Researchers, Odense, Denmark.

Nurses Caring for Elderly Relatives: Examining the Care Work of Double Duty Caregivers

Background: Double duty caregivers (DDCs) are those individuals who provide care both at home and at work. Current conceptualizations of paid and unpaid care work tend to assume that these two domains are distinct, subsequently little is known about the health effects of the blurring of boundaries between familial and professional caregiving.

Purpose: Guided by a critical feminist perspective, the purpose of this sequential mixed-methods study was to examine how and to what degree DDC affects the health of Canadian, female and male RNs caring for elderly relatives.

Methods: Phase I - Using a cross-sectional survey design, 1424 RNs were randomly selected from provincial college memberships who completed mailed or web surveys. Phase II - Using grounded theory, repeat in-depth telephone interviews were conducted with a purposeful sample if 50 male and female DDCs.

Results: DDCs reported lower health outcomes compared to non-DDCs. Further, female DDCs experience higher levels of exhaustion compared to male DDCs. Qualitative findings also suggest that DDCs professionalize their familial care, especially those with high expectations and limited resources, taking a toll on their health. Conclusion: Study findings revealed that the provision of care at home and at work tended to result in negative health effects for RNs, which warrants further investigation. Developing a more comprehensive understanding of DDC and how it influences the health and well-being of health professionals, is particularly urgent given the aging population, an aging health care workforce, and an increasing shortage of health care professionals

Title: 24th Annual Sigma Theta Tau Research Conference St-Amant, O., Ward-Griffin, C., Brown, J. B., Kerr, M., Sutherland, N. (May 6 2011). Policy and practice implications for double duty caregivers: A critical structural health promotion approach. 24th Annual Research Conference: Promoting Excellence in Nursing Practice through Research, London, Ontario.

Policy and Practice Implications for Double Duty Caregivers: A Critical Structural Health Promotion Approach.

Background: Double duty caregivers (DDCs), healthcare professionals who provide care at home and at work, are often called upon to fill the systemic gaps in healthcare services for seniors. And yet, there are few policies and practices to support or even acknowledge the care work provided by DDCs in Ontario.

Purpose: This study aimed to examine the context of double duty caregiving and ultimately the health effects for DDCs and their families. The purpose of this presentation is to illuminate those policy and practice opportunities that promote health for DDCs in Ontario.

Methods: A sequential mixed-method approach was employed to test the relationship between double duty caregiving and health as well as shed light on those enacted processes of being a 'professional' and 'personal' caregiver. Phase I: A stratified sample of 849 RNs was randomly selected from an Ontario membership list. Male and female RNs completed a mailed survey, including health, well-being and burnout measures. Phase II: Further, data were also collected by completing repeated in-depth telephone interviews for a purposeful sample of 20 male and female RNs in Ontario.

Findings: DDCs in the Making It Work Prototype reported better health outcomes than DDCs in the Working to Manage or Living on the Edge Prototype (p value < 0.001). Further, DDCs in the Making It Work Prototype were more likely to have flexible scheduling in their workplace (?2= 7.308; df=1; p= 0.009). As well, based on the Phase II interviews, DDCs within this prototype described the support they received within the workplace as ultimately translating into a health enhancing personal caregiving experiences. Discussion: It is imperative to shed light on those policies and practices that contribute to the positive health outcomes for DDCs and identify opportunities for change that will enhance health for all Ontario DDCs.

Title: FICCDAT Conference Ward-Griffin, C., Keefe, J., Martin-Matthews, A., Brown, J.B., Kerr, M., St-Amant, O. (June 5-8 2011). Negotiating the boundaries between professional and familial care work. FICCDAT Conference, Mississauga, Ontario.

Negotiating the Boundaries between Professional and Familial Care Work

Background: Although the prevalence of double duty caregiving (DDC), defined here as the provision of care to elderly relatives by practicing health professionals, is currently unknown, research has shown that approximately 30-50% of the working population provides care to older relatives. Few studies have examined the health effects of DDC or how double duty caregivers (DDCs) negotiate their professional and personal caring boundaries. The objectives of this presentation are to: 1) compare the health, well-being and caregiver burnout between male and female DDCs and non-DDCs; and 2) examine the caregiving experiences of male and female DDCs.

Methods: The purpose of this sequential mixed methods study was to examine how and to what degree DDC affects the health of Canadian, female and male RNs caring for elderly relatives. Phase I: Using a cross-sectional survey design, our stratified sample of 1424 RNs randomly selected from provincial college memberships completed mailed or web surveys. The hypothesized DDC model was tested using Structural Equation Modelling procedures Phase II: Using grounded theory to further investigate the dimensions of the DDC, we conducted repeat in-depth telephone interviews with a purposeful sample if 50 male and female DDCs, investigating how workplace and/or government policies may shape the health effects of DDC.

Results: By using both quantitative and qualitative approaches, our findings have made visible what has been "invisible"- the negotiation of professional and familial care boundaries. In general, DDCs report lower health outcomes compared to non-DDCs. Further, female DDCs experience higher levels of exhaustion compared to male DDCs. Qualitative findings also suggest that DDCs, with limited tangible supports, experience poor health. Two major themes emerged: Professionalizing Familial Care and Striving for Balance. In particular, six strategies including assessing, advising, advocating, consulting, coordinating and collaborating, were used by DDCs which professionalized the care they provided in the familial care domain. Subsequently as expectations rose and resources dwindled, participants reported that double duty caregiving took a toll on their health.

Significance: Research on DDC informs two key policy challenges: the contribution of family caregivers and the investment in healthy work environments with the aim of retaining a strong health care workforce. Ultimately, study findings will assist with the development and refinement of policies to promote the health of DDCs. Developing a more comprehensive understanding of DDC and how it influences the health and well-being of health professionals is particularly urgent given the aging population, an aging workforce and increasing shortage of health care professionals.

Title: The 10th International Family Nursing Conference Ward-Griffin, C., Keefe, J., Martin-Matthews, A., Brown, J.B., Kerr, M., St-Amant, O. (June 25-27 2011). Professionalizing familial care: Nurses caring for elderly relatives. The 10th International Family Nursing Conference, Kyoto, Japan.

Professionalizing Familial Care: Nurses Caring for Elderly Relatives

Background: Current conceptualizations of paid and unpaid care work tend to depict these two domains as distinct, subsequently little is known about the health effects of the blurring of boundaries between familial and nursing care. Purpose: The purpose of this sequential mixed-methods study (cross-sectional survey and constructivist grounded theory) was to examine how and to what caring at home and at work (double duty caregiving-DDC) affects health. This presentation will focus on phase two of the study.

Methods: Guided by a critical feminist perspective, we sought to better understand how expectations of familial care and the resources to provide that care shaped the health of double duty caregivers (DDCs). Using a purposive sample selected from Phase I, repeated in-depth telephone interviews with 50 Canadian male and female nurses caring for elderly relatives were conducted.

Results: Data analysis revealed that DDCs tended to professionalize their familial care. Embedded within two overarching processes, setting limits and making connections, six sub-processes emerged: assessing, advising, advocating, collaborating, coordinating and consulting. Each of these strategies assisted DDCs to respond to familial care expectations and care resources. For those DDCs with high expectations and limited resources, the boundaries between professional and personal care domains blurred, taking a toll on their health.

Conclusions: Study findings revealed that being the "family nurse" often resulted in negative health effects. Developing a more comprehensive understanding of DDC and how it influences the health of nurses will inform the refinement and development of policies and practices that will promote health of DDCs.

Title: International Philosophy of Nursing Society Ward-Griffin, C., Keefe, J., Martin-Matthews, A., Brown, J.B., Kerr, M., St-Amant, O. (September 2010). Re-thinking care work for double duty caregivers: Using constructivist grounded theory to examine the health effects of DDC. Philosophizing Social Justice in Nursing: The 14th International Philosophy of Nursing Conference, Vancouver, British Columbia, Canada.

Re-thinking care work for double duty caregivers: Using constructivist grounded theory to examine the health effects of DDC

Double duty caregivers (DDCs) are those individuals who provide care both at home and at work. Building on our previous qualitative research that revealed a dramatic blurring or erosion of boundaries between familial and professional caregiving amongst health professionals resulted in negative health effects, this study aimed to examine the context of double duty caregiving and ultimately the health effects for DDCs and their families. A constructivist grounded theory approach was employed to shed light on those enacted processes made real through performed actions of DDC and consequently how the duality of being a formal/informal caregiver shapes health for nurses and their elderly relatives. Data were collected by completing repeated in-depth telephone interviews for a purposeful sample of 50 male and female RNs in Ontario, Nova Scotia and British Columbia. Data analysis revealed that DDCs simultaneously enacted a position of privilege and oppression. The knowledge and skill of caregiving positioned some nurses as the 'expert' in familial care, while others were expected to provide care and lacked sufficient resources to support their elderly relative. Neo-liberal ideologies related to 'care work' (the emphasis on caregiving as labor) have shaped the blurring of boundaries between professional and familial care and assumed that such domains are easily separable. The findings from this research study suggest the need for a philosophical shift in how care work is conceptualized for nurses and family caregivers.

ARCHIVED KNOWLEDGE TRANSLATION ACTIVITIES

Ward-Griffin, C., Keefe, J., Martin-Matthews, A., Kerr, M. & Brown, J.B., St-Amant, O. (December 2010). Examining the health effects of double duty caregiving: A constructivist grounded theory. 39th Annual Scientific and Educational Meeting of the Canadian Association on Gerontology: Spotlight on integration of knowledge and practice, Montreal, Quebec.

Ward-Griffin, C., Keefe, J., Martin-Matthews, A., Kerr, M., & Brown, J.B., St-Amant, O. (2010, July). Health Professionals Caring for Elderly Relatives: Promoting the Health of Doubly Duty Caregivers. 20th IUHPE World Conference on Health Promotion, Geneva, Switzerland.

Ward-Griffin, C., Keefe, J., Martin-Matthews, A., Kerr, M., & Brown, J.B., St-Amant, O. (2010, July). Health Professionals Caring for Elderly Relatives: Examining the Health Effects of Double Duty Caregiving. 5th International Carers Conference: New Frontiers in Caring: 2010 and beyond, Leeds, United Kingdom.

St-Amant, O., Ward-Griffin, C., McDonald, J., Anjos, P., Turpin, L., Tsang, T. (2010, April). Health Care Professional Caring for Elderly Relatives: Investigating the Health Effects of DDCs. 23rd Annual Research Conference: Promoting Excellence in Nursing Practice through Research, London, Ontario.

McDonald, J., Ward-Griffin, C. St-Amant, O., Turpin, L., Tsang, T., Anjos, A. P., & Aguilar, I. (2010, February). Nurse Family Caregivers: Exploring the Health Effects of Double Duty Caregiving. Aging, Rehabilitation & Geriatric Care Research/Faculty of Health Sciences Symposium: 'Bridging Collaborative Research Momentum in Aging, Rehabilitation & Geriatric Care'. London, Ontario.
McDonald, J., Ward-Griffin, C. St-Amant, O., Turpin, L., Tsang, T., Anjos, A. P., & Aguilar, I. (2010, March). Nurse Family Caregivers: Exploring the Health Effects of Double Duty Caregiving. Faculty of Health Sciences Research Day. London, Ontario.

Ward-Griffin, C., Keefe, J., Martin-Matthews, A., Kerr, M., & Brown, J.B., St-Amant, O. (2009, October). Health Professionals Caring for Elderly Relatives in an Aging Society: Building Partnerships Between Personal and Professional Policy Domains. 8th Elder Care Conference: Older People Deserve the Best, Registered Nurses' Association of Ontario, Toronto, Ontario.

Ward-Griffin, C., Keefe, J., Martin-Matthews, A., Kerr, M., & Brown, J.B., Oudshoorn, A. (2009, June). Providing care at home and at work: Investigating the impact of double duty caregiving on the health of nurses. The 9th International Family Nursing Conference. Reykjavik, Iceland.

Ward-Griffin, C., Keefe, J., Martin-Matthews, A., Kerr, M., & Brown, J.B, Oudshoorn, A. (2009, March). Investigating the impact of Double Duty Caregiving (DDC) on women's health. Looking Back Thinking Ahead: Using Research to Improve Policy and Practice in Women's Health. Halifax, Nova Scotia

Ward-Griffin, C., Keefe, J., Martin-Matthews, A., Kerr, M., & Brown, J.B., Oudshoorn, A. (2009, February). Nurses providing health care at home and at work: Investigating the impact of double duty caregiving. 2009 Canada Nurses Association: Nursing Leadership Conference, Toronto, Ontario.

OTHER KNOWLEDGE TRANSLATION ACTIVITIES

Dr. Catherine Ward-Griffin interviewed for Registered Nurse, November/December Issue, Registered Nurses Association of Ontario, sidebar article, 2009, p. 22.

Dr. Catherine Ward-Griffin with Judith Phillips, show entitled 'Family Caregivers Unite' on Voice America Variety channel, February 16th, 2010, hosted by Dr. Gordon Atherley. http://www.voiceamerica.com/voiceamerica/vepisode.aspx?aid=44495