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Original Article

Effect of the Family Resilience Reinforcement Program for Family Caregivers of the Elderly with Dementia

Miran Bang1, Oksoo Kim2
Korean Journal of Adult Nursing 2016;28(1):71-82.
Published online: February 29, 2016

1School of Nursing, Kyungdong University, Wonju

2College of Nursing, Ewha Womans University, Seoul, Korea

Corresponding author: Bang, Miran Department of Nursing, Kyungdong University, 815 Gyeonhwon-ro, Munmak, Wonju 220-804, Korea. Tel: +82-33-738-1407, Fax: +82-33-738-1449, E-mail: bmr@kduniv.ac.kr
• Received: November 3, 2015   • Accepted: January 31, 2016

Copyright © 2016 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The purpose of this study was to investigate the effect of Family Resilience Reinforcement Program (FRRP) for family caregivers of the elderly with dementia on the family resilience, caregiver burden, family adaptation, perceived health status and depression.
  • Methods
    FRRP was implemented for 60 minutes each time, once a week, for 8 weeks. According to 3 factors of Walsh's Family resilience theory, FRRP was organized and specified as redefining ‘belief system’ in 1 to 2 sessions, figuring out one's own ‘organizational pattern’ in 3 to 5 sessions, enhancing ‘communication process’ in 6 to 8 sessions. A total of 46 family caregivers were assigned into either the experimental group with FRRP or the control group. Data were collected from February 18 to April 12, 2013 at the dementia support centers, and the data of 36 participants were finally analyzed.
  • Results
    The experimental group reported statistically significant differences in family resilience (p=.002), caregiver burden (p=.012), family adaptation (p<.001), and perceived health status (p=.002) compared to those in the control group. No significant difference was found between the two groups in depression.
  • Conclusion
    In the light of these results, FRRP is considered to decrease caregiver burden and to influence family resilience, family adaptation and perceived health status positively. The developed FRRP is considered to be an efficient nursing intervention for strengthening family resilience of the given population. It warrants future research expanding the range of target population to those caregivers of the patients with other chronic conditions.
  • Key Words: Dementia; Resilience; Family; Caregivers
Figure 1.
Flow diagram of family resilience reinforcement program.
kjan-28-71f1.jpg
Table 1.
Contents of the Family Resilience Reinforcement Program
Unit Session Topic Contents (min)
Orientation   The program orientation Show the purpose, contents, and agenda of the program
Understand the rules of the program
Explain the manuals and sign the agreement form
Introduce the participants and make the nicknames
Pretest
Belief system 1 Dementia and family Lesson (20 min): Dementia and family
Group activity (40 min):
Express one's perception about dementia patients
Introduce family members
Recognize the roles of the individual family members
2 Find strengths in the difficult times Lesson (20 min): what is family resilience?
Group activity (40 min):
Find the strengths in the family
Discuss successful and unsuccessful cases in overcoming difficulties
Organizational pattern 3 Being a happy partner Lesson (20 min): How to attend on dementia patients
Group activity (40 min): laughter therapy
Stress management of dementia patient's family: Laughter therapy
4 Enhance family cohesion Lesson (20 min): Family rules
Group activity (40 min):
Identify family rules
Make functional family rules
Enhance family interaction through the analysis of a genogram
5 Utilizing the family resources Lesson (20 min): Utilize dementia-related resources available in the community
Group activity (40 min):
Find the resources available in the family
Find the resources available in society
Establish a support group
Communication process 6 Observe family communication Lesson (20 min): what is communication?
Group activity (40 min):
Identify the communication types of the family members
Identify the improvements in communication
7 Improve communication skills Lesson (20 min): Effective communication
Group activity (40 min):
A clear and open communication method
Reflective listening
Practice effective communication methods
8 Problem solving through cooperation Lesson (20 min): An effective problem solving method
Group activity (40 min):
Apply a 6 step problem solving method
Wrap up   The end of the program The program evaluation
Award a certificate
Write a letter to the dementia patient
Posttest
Table 2.
Demographic Characteristics of the Participants (N=36)
Variables Characteristics Categories Exp. (n=18) Cont. (n=18) x2 or t or U p
n (%) or M±SD n (%) or M±SD
Family caregivers Age (year)   62.8±13.29 61.7±12.19 0.25 .805
         
Gender Male 0 (0.0) 3 (16.7)   .229
Female 18 (100.0) 15 (83.3)    
Religion Yes 14 (77.8) 17 (94.4)   .338
No 4 (22.2) 1 (5.6)    
Family relation to patient Spouse 10 (55.6) 11 (61.1) 2.70† .791
Daughter 2 (11.1) 3 (16.7)    
Son 0 (0.0) 1 (5.6)    
Daughter-in-law 5 (27.8) 3 (16.7)    
Grandchildren 1 (5.6) 0 (0.0)    
Income (10,000 won) ≤100 6 (33.3) 7 (38.9) 3.63† .508
101~200 7 (38.9) 3 (16.7)    
201~300 2 (11.1) 4 (22.2)    
301~400 1 (5.6) 3 (16.7)    
≥401 2 (11.1) 1 (5.6)    
Care costs (10,000 won) ≤10 5 (27.8) 2 (11.1) 6.85† .187
11~30 6 (33.3) 5 (27.8)    
31~50 7 (38.9) 5 (27.8)    
51~70 0 (0.0) 3 (16.7)    
71~90 0 (0.0) 2 (11.1)    
≥91 0 (0.0) 1 (5.6)    
Period of caregiving (month)   50.4±50.08 56.7±31.55 -0.45 .658
Caregiving time (hour/day)   17.3±6.90 18.1±8.61 -0.28 .783
Elderly with dementia Age (year) 81.3±7.68 75.1±8.49 2.29 .029
Period of dementia diagnosis (month) 40.8±44.97 54.3±30.19 -1.06 .298
Living with spouse Yes 10 (55.6) 14 (77.8) 2.00 .289
  No 8 (44.4) 4 (22.2)    
Taking medicine Yes 17 (94.4) 18 (100.0)   .999
  No 1 (5.6) 0 (0.0)    
Family resilience   182.56±21.30 183.78±17.07 155.00‡ .833
Caregiver burden   88.00±25.34 88.17±16.80 -0.02 .982
Family adaptation   26.33±5.01 27.06±3.44 129.50‡ .308
Perceived health status   2.17±1.04 2.44±0.62 123.00‡ .226
Depression   17.94±9.86 17.89±9.66 0.02 .986

Exp.=experimental group (n=18); Cont.=control group (n=18);

†Fisher's exact test;

‡Mann-Whitney U-test.

Table 3.
Differences in Family resilience, Caregiver burden, Family Adaptation, Perceived Health Status, and Depression after the Intervention Between the Two Groups (N=36)
Variables Groups Pretest Posttest t or Z (p) Difference t or U (p)
M±SD M±SD M±SD
Family resilience Exp. 182.56±21.30 191.50±20.68 -2.55 (.004)† 8.94±16.64 70.50 (.002)‡
Cont. 183.78±17.07 179.11±14.89 -1.66 (.051)† -4.67±13.53  
Belief system Exp. 54.72±6.42 57.33±6.27 -1.62 (.062) 2.61±6.84 2.09 (.022)
Cont. 53.61±5.75 52.11±5.51 1.34 (.100) -1.50±4.77  
Organizational pattern Exp. 73.11±9.00 76.17±8.99 -2.41 (.014) 3.06±5.37 2.95 (.003)
Cont. 73.28±7.41 70.94±6.35 1.77 (.048) -2.33±5.59  
Communication process Exp. 54.72±7.58 58.00±6.76 -2.10 (.017) 3.28±6.67 101.00 (.027)
Cont. 56.89±5.63 56.06±4.99 -0.91 (.191) -0.83±4.54  
Caregiver burden Exp. 88.00±25.34 82.50±22.77 2.38 (.015) -5.50±9.80 -2.37 (.012)
Cont. 88.17±16.80 92.89±24.50 -1.30 (.106) 4.72±15.47  
Social activity restriction Exp. 18.94±6.39 18.39±5.56 0.44 (.332) -0.56±5.32 150.50 (.361)
Cont. 20.50±5.27 20.11±5.11 0.31 (.380) -0.39±5.32  
Negative change of elderly-caregiver relationship Exp. 25.06±7.50 22.28±6.09 2.98 (.004) -2.78±3.95 93.00 (.014)
Cont. 22.33±4.83 23.17±6.02 -0.80 (.218) 0.83±4.44  
Negative change of family relationship Exp. 14.00±4.26 14.17±3.96 -0.24 (.407) 0.17±2.96 160.00 (.478)
Cont. 14.22±3.57 15.28±6.30 -0.90 (.192) 1.06±5.00  
Psychological burden Exp. 11.67±5.03 9.78±5.15 -3.04 (.001) -1.89±2.08 -3.31 (.002)
Cont. 10.72±3.97 12.83±5.31 -1.67 (.050) 2.11±4.69  
Financial and job-related burden Exp. 8.50±3.81 8.56±3.88 -0.12 (.451) 0.06±1.89 116.50 (.068)
Cont. 9.50±2.85 10.44±3.43 -1.96 (.033) 0.94±2.04  
Health-related burden Exp. 9.83±3.26 9.33±2.89 -1.30 (.118) -0.50±1.47 -0.76 (.226)
Cont. 10.89±3.01 11.06±3.23 -0.11 (.467) 0.17±3.42  
Family adaptation Exp. 26.33±5.01 29.72±5.04 -2.93 (.001)† 3.39±4.06 40.00 (＜.001)‡
Cont. 27.06±3.44 24.83±3.30 -2.40 (.007)† -2.22±3.34  
Perceived health status Exp. 2.17±1.04 3.06±0.94 -2.89 (.002)† 0.89±0.90 78.00 (.002)‡
Cont. 2.44±0.62 2.44±0.62 0.00 (.999)† 0.00±0.59  
Depression Exp. 17.94±9.86 15.83±11.24 1.26 (.113) -2.11±7.12 -0.79 (.218)
Cont. 17.89±9.66 18.00±6.97 -0.05 (.481) 0.11±9.59  

Exp.=experimental group (n=18); Cont.=control group (n=18);

†Wilcoxon Signed Rank test;

‡Mann-Whitney U-test.

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    DOI: https://doi.org/10.7475/kjan.2016.28.1.71
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    • Citation for the content below
    Effect of the Family Resilience Reinforcement Program for Family Caregivers of the Elderly with Dementia
    Korean J Adult Nurs. 2016;28(1):71-82.   Published online February 29, 2016
    DOI: https://doi.org/10.7475/kjan.2016.28.1.71
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    Effect of the Family Resilience Reinforcement Program for Family Caregivers of the Elderly with Dementia
    Image
    Figure 1. Flow diagram of family resilience reinforcement program.

    Figure 1.

    Effect of the Family Resilience Reinforcement Program for Family Caregivers of the Elderly with Dementia

    Contents of the Family Resilience Reinforcement Program

    Unit Session Topic Contents (min)
    Orientation   The program orientation Show the purpose, contents, and agenda of the program
    Understand the rules of the program
    Explain the manuals and sign the agreement form
    Introduce the participants and make the nicknames
    Pretest
    Belief system 1 Dementia and family Lesson (20 min): Dementia and family
    Group activity (40 min):
    Express one's perception about dementia patients
    Introduce family members
    Recognize the roles of the individual family members
    2 Find strengths in the difficult times Lesson (20 min): what is family resilience?
    Group activity (40 min):
    Find the strengths in the family
    Discuss successful and unsuccessful cases in overcoming difficulties
    Organizational pattern 3 Being a happy partner Lesson (20 min): How to attend on dementia patients
    Group activity (40 min): laughter therapy
    Stress management of dementia patient's family: Laughter therapy
    4 Enhance family cohesion Lesson (20 min): Family rules
    Group activity (40 min):
    Identify family rules
    Make functional family rules
    Enhance family interaction through the analysis of a genogram
    5 Utilizing the family resources Lesson (20 min): Utilize dementia-related resources available in the community
    Group activity (40 min):
    Find the resources available in the family
    Find the resources available in society
    Establish a support group
    Communication process 6 Observe family communication Lesson (20 min): what is communication?
    Group activity (40 min):
    Identify the communication types of the family members
    Identify the improvements in communication
    7 Improve communication skills Lesson (20 min): Effective communication
    Group activity (40 min):
    A clear and open communication method
    Reflective listening
    Practice effective communication methods
    8 Problem solving through cooperation Lesson (20 min): An effective problem solving method
    Group activity (40 min):
    Apply a 6 step problem solving method
    Wrap up   The end of the program The program evaluation
    Award a certificate
    Write a letter to the dementia patient
    Posttest

    Demographic Characteristics of the Participants (N=36)

    Variables Characteristics Categories Exp. (n=18) Cont. (n=18) x2 or t or U p
    n (%) or M±SD n (%) or M±SD
    Family caregivers Age (year)   62.8±13.29 61.7±12.19 0.25 .805
             
    Gender Male 0 (0.0) 3 (16.7)   .229
    Female 18 (100.0) 15 (83.3)    
    Religion Yes 14 (77.8) 17 (94.4)   .338
    No 4 (22.2) 1 (5.6)    
    Family relation to patient Spouse 10 (55.6) 11 (61.1) 2.70† .791
    Daughter 2 (11.1) 3 (16.7)    
    Son 0 (0.0) 1 (5.6)    
    Daughter-in-law 5 (27.8) 3 (16.7)    
    Grandchildren 1 (5.6) 0 (0.0)    
    Income (10,000 won) ≤100 6 (33.3) 7 (38.9) 3.63† .508
    101~200 7 (38.9) 3 (16.7)    
    201~300 2 (11.1) 4 (22.2)    
    301~400 1 (5.6) 3 (16.7)    
    ≥401 2 (11.1) 1 (5.6)    
    Care costs (10,000 won) ≤10 5 (27.8) 2 (11.1) 6.85† .187
    11~30 6 (33.3) 5 (27.8)    
    31~50 7 (38.9) 5 (27.8)    
    51~70 0 (0.0) 3 (16.7)    
    71~90 0 (0.0) 2 (11.1)    
    ≥91 0 (0.0) 1 (5.6)    
    Period of caregiving (month)   50.4±50.08 56.7±31.55 -0.45 .658
    Caregiving time (hour/day)   17.3±6.90 18.1±8.61 -0.28 .783
    Elderly with dementia Age (year) 81.3±7.68 75.1±8.49 2.29 .029
    Period of dementia diagnosis (month) 40.8±44.97 54.3±30.19 -1.06 .298
    Living with spouse Yes 10 (55.6) 14 (77.8) 2.00 .289
      No 8 (44.4) 4 (22.2)    
    Taking medicine Yes 17 (94.4) 18 (100.0)   .999
      No 1 (5.6) 0 (0.0)    
    Family resilience   182.56±21.30 183.78±17.07 155.00‡ .833
    Caregiver burden   88.00±25.34 88.17±16.80 -0.02 .982
    Family adaptation   26.33±5.01 27.06±3.44 129.50‡ .308
    Perceived health status   2.17±1.04 2.44±0.62 123.00‡ .226
    Depression   17.94±9.86 17.89±9.66 0.02 .986

    Exp.=experimental group (n=18); Cont.=control group (n=18);

    †Fisher's exact test;

    ‡Mann-Whitney U-test.

    Differences in Family resilience, Caregiver burden, Family Adaptation, Perceived Health Status, and Depression after the Intervention Between the Two Groups (N=36)

    Variables Groups Pretest Posttest t or Z (p) Difference t or U (p)
    M±SD M±SD M±SD
    Family resilience Exp. 182.56±21.30 191.50±20.68 -2.55 (.004)† 8.94±16.64 70.50 (.002)‡
    Cont. 183.78±17.07 179.11±14.89 -1.66 (.051)† -4.67±13.53  
    Belief system Exp. 54.72±6.42 57.33±6.27 -1.62 (.062) 2.61±6.84 2.09 (.022)
    Cont. 53.61±5.75 52.11±5.51 1.34 (.100) -1.50±4.77  
    Organizational pattern Exp. 73.11±9.00 76.17±8.99 -2.41 (.014) 3.06±5.37 2.95 (.003)
    Cont. 73.28±7.41 70.94±6.35 1.77 (.048) -2.33±5.59  
    Communication process Exp. 54.72±7.58 58.00±6.76 -2.10 (.017) 3.28±6.67 101.00 (.027)
    Cont. 56.89±5.63 56.06±4.99 -0.91 (.191) -0.83±4.54  
    Caregiver burden Exp. 88.00±25.34 82.50±22.77 2.38 (.015) -5.50±9.80 -2.37 (.012)
    Cont. 88.17±16.80 92.89±24.50 -1.30 (.106) 4.72±15.47  
    Social activity restriction Exp. 18.94±6.39 18.39±5.56 0.44 (.332) -0.56±5.32 150.50 (.361)
    Cont. 20.50±5.27 20.11±5.11 0.31 (.380) -0.39±5.32  
    Negative change of elderly-caregiver relationship Exp. 25.06±7.50 22.28±6.09 2.98 (.004) -2.78±3.95 93.00 (.014)
    Cont. 22.33±4.83 23.17±6.02 -0.80 (.218) 0.83±4.44  
    Negative change of family relationship Exp. 14.00±4.26 14.17±3.96 -0.24 (.407) 0.17±2.96 160.00 (.478)
    Cont. 14.22±3.57 15.28±6.30 -0.90 (.192) 1.06±5.00  
    Psychological burden Exp. 11.67±5.03 9.78±5.15 -3.04 (.001) -1.89±2.08 -3.31 (.002)
    Cont. 10.72±3.97 12.83±5.31 -1.67 (.050) 2.11±4.69  
    Financial and job-related burden Exp. 8.50±3.81 8.56±3.88 -0.12 (.451) 0.06±1.89 116.50 (.068)
    Cont. 9.50±2.85 10.44±3.43 -1.96 (.033) 0.94±2.04  
    Health-related burden Exp. 9.83±3.26 9.33±2.89 -1.30 (.118) -0.50±1.47 -0.76 (.226)
    Cont. 10.89±3.01 11.06±3.23 -0.11 (.467) 0.17±3.42  
    Family adaptation Exp. 26.33±5.01 29.72±5.04 -2.93 (.001)† 3.39±4.06 40.00 (＜.001)‡
    Cont. 27.06±3.44 24.83±3.30 -2.40 (.007)† -2.22±3.34  
    Perceived health status Exp. 2.17±1.04 3.06±0.94 -2.89 (.002)† 0.89±0.90 78.00 (.002)‡
    Cont. 2.44±0.62 2.44±0.62 0.00 (.999)† 0.00±0.59  
    Depression Exp. 17.94±9.86 15.83±11.24 1.26 (.113) -2.11±7.12 -0.79 (.218)
    Cont. 17.89±9.66 18.00±6.97 -0.05 (.481) 0.11±9.59  

    Exp.=experimental group (n=18); Cont.=control group (n=18);

    †Wilcoxon Signed Rank test;

    ‡Mann-Whitney U-test.
    Table 1. Contents of the Family Resilience Reinforcement Program

    Table 2. Demographic Characteristics of the Participants (N=36)

    Exp.=experimental group (n=18); Cont.=control group (n=18);

    Fisher's exact test;

    Mann-Whitney U-test.

    Table 3. Differences in Family resilience, Caregiver burden, Family Adaptation, Perceived Health Status, and Depression after the Intervention Between the Two Groups (N=36)

    Exp.=experimental group (n=18); Cont.=control group (n=18);

    Wilcoxon Signed Rank test;

    Mann-Whitney U-test.

    Table 1.

    Table 2.

    Table 3.

    Korean J Adult Nurs : Korean Journal of Adult Nursing

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