One of the major concomitants of human aging is the increasing risk of physiological and psychological dysfunctions. A consequence of such dysfunctions is the loss of fully independent functioning and the resultant need for the provisions of formal and informal systems of caregiving. Whether or not such systems can provide effective support for the frail and disabled older person is affected greatly by a variety of social structural variables as well as individual behaviors that mediate favorable or adverse outcomes. Caregiving families emerged in the 1980s as a frequent topic in the media, in discussions of public policy and long-term care, and especially in social and behavioral research. This attention reflects the central role played by informal caregivers. With the dramatic growth of the older population and the increasing number of people who require care, families remain the first, most reliable, and most acceptable source of assistance. Furthermore, informal caregivers often facilitate the linkages with formal providers, such as physicians, hospitals, community long-term care services, and nursing homes. The attention to family caregivers has usually highlighted the stressfulness or burdensome nature of some types of care. Both the popular and the research literature have frequently emphasized one type of caregiving situation (e.g., a daughter caught between the demands of two generations, of providing care to someone with Alzheimer's disease). But families, care arrangements, and the context of caregiving vary greatly. Even the degree to which families find similar events or problems stressful can differ consider- ably, both in baseline comparisons and over time. The examination of informal care systems focuses on three issues that address variability in family caregiving: (a) culture and its influence on inter-generational relationships and caregiving, (b) comparisons of caregiving across disabilities, and (c) changes in caregivers' experiences over time just as defined in the book.
Reviews of the Chapter
One of the most sought after health care service nowadays is care-giving. It cannot be denied that there are many families, health care facilities and individuals that are employing health care workers more particularly caregivers. The main reason for this is the fact that there are many people that are requiring the services. Health care is a vital service that daily touches the lives of millions of Americans at significant and vulnerable times: birth, illness, and death. In recent decades, technology, pharmaceuticals, and know-how have substantially improved how care is delivered and the prospects for recovery. American markets for innovation in pharmaceuticals and medical devices are second to none. The miracles of modern medicine have become almost commonplace. At its best, American health care is the best in the world. Notwithstanding these extraordinary achievements, the cost, quality, and accessibility of American health care have become major legislative and policy issues. Substantial increases in the cost of health care have placed considerable stress on federal, state, and household budgets, as well as the employment-based health insurance system. Health care quality varies widely, even after controlling for cost, source of payment, and patient preference. With this, caregiver has become even more in-demand in terms of health care provisions.
Although they are not exhaustive of the variety of caregiving situations or experiences, these topics explore major dimensions of the caregiving situation that are often neglected. Although caregiving is typically studied at one point in time, it involves an ongoing process in which relationships, responsibilities, stressors, and stress may change over time. The advantage of longitudinal studies is demonstrated by Schulz and his colleagues, who examine patterns of change in depression among caregivers assisting someone with Alzheimer's disease. In this regard, it cannot be denied that there is a need for caregivers to secure health promotions.
Smyer considers issues in the measurement of change, including inter- and intra-individual patterns of change and stability. Most of us, most of the time, try to take ethics seriously and are troubled when we fall short of what we think we ought to do. But, at the same time, our ideas and feelings are unfocused, and that, of course, increases our sense of discomfort. Morality just doesn’t seem to do the work it’s supposed to do when we need it most. Of course, this doesn’t stop us from naming villains and heroes and boasting of our own sense of virtue. In fact, our boasts grow louder just when their dependability becomes more questionable. In this setting, philosophers, preachers, and pundits only add to the moral noise around us. And, to be sure, denial in one form or another is always an available strategy. Dissonance then pervades the ordinary moral situation and not simply moments of crisis. To be sure, we get by often enough to avoid moral insanity. But our anger at others and our increasing alienation from others betray a certain cynicism and reveal our insecurities. Moral discomfort grows. We are, as John Dewey reminded us some decades ago, still afflicted by a “quest for certainty,” and nowhere more than in the moral life. Disappointed in that search, as we must be, we scarcely know how to grasp, let alone decide between, conflicting and conflicted demands like “be successful” and “be cooperative,” be “loving” and “be competitive,” be “honest” and be popular. In our public lives, too, we reach moral dead ends, and with greater and greater frequency these days. The endless debates about “big” issues like abortion and affirmative action are a metaphor for what is happening.
Consequently, moral silences show up everywhere especially among the caregiver. The disappearance from the moral agenda of issues of social justice confirms our retreat to moral indifference. The turn inward to self-help strategies and the conversion of intimacy into technique confirm our moral blindness. The relief with which we seize upon this or that moral fad on the one hand and the rapidity with which we surrender to a fundamentalist temptation on the other reveal our moral uncertainties. Civil discourse fails, and communities fragment into separated enclaves. Our institutions are torn between traditionalists and modernists. Thus the interminable arguments in the university about the “canon.” We become propagandists more than scholars, choosing up sides in answer to the question: What is the basis of teaching and learning? Is it “Western” or “global,” patriarchal or feminist, classic or contemporary, and on and on. Thus, too, the nostalgia for the family of yesterday where every person knew his or her place—if it ever really existed—and for “family values” where the moral rules were clear and dependable. Everywhere we look, there are signs of the failures of moral common sense. In recent years, the importance of caring for and nurturing the young has moved from the private concern of families to the public agenda. This has been due in part to some of the failures of child-rearing within the family, as shown in instances of abuse, neglect, and incest. Other symptoms that also may be related to the stresses inherent in contemporary parenting are latch-key children, delinquency, adolescent suicide, and substance abuse among children and adolescents.
The family does not exist in isolation, but is embedded in a societal context, and changes in this context have many implications for the quality of caregiving within the family. For example, the dramatic influx in recent years of mothers of young children and infants into the work force has led to reliance on alternative caregiving, in day care centers, day care homes, or other informal arrangements. The individual family's main concern is finding adequate child-care, but looked at from a broader perspective, this movement toward supplementary parenting has broadened the societal definition of who may be a caregiver, and has drawn in a variety of other persons into what previously had been a more private, family realm.
These changes have increased the flexibility of parents' options but at the same time have increased the risks that children may not receive optimal care. For example, there is no clear consensus among parents or professionals concerning the qualities necessary for good caregiving, nor do we have an acceptable system of evaluating or monitoring outside-the-home care. While alternative caregiving can pose risks for the child, it must be recognized that where the home provides a less than adequate environment for the child's development, supplemental care can be beneficial. These changes within the family and within society have raised the question of how to define caregiving toward the child. The term, "care-giving," which appeared in the preface of Lewis and Rosenblum's 1974 edited volume, The Effect of the Infant on the Caregiver, expanded the notion of caretaking to include a broader range of competencies and behaviors related to child care.Following Bell's ( 1968) call to examine multidirectional effects in the parent- child interaction, Lewis and Rosenblum focused on the infant's contribution to its own care. Subsequently, Bronfenbrenner's ecological framework ( 1979), Belsky's triadic analysis of family interaction ( 1981) and Garbarino's ( 1982) concept of sociocultural risk factors in child maltreatment have been influential in calling attention to a broader range of influences on caregiving. In addition to the influences of the child and the social context, there is a growing amount of evidence suggesting that experiences during the caregiver's childhood may affect the caregiving ompetencies of adults. Moreover, research on the development of pro-social behavior and empathy shows that even from an early age, children are aware of some of the needs of both peers and children younger than themselves, and that often they can act sensitively to respond to those needs when encouraged by adults to perform child-care tasks. In addition, this approach calls our attention to nurturing experiences not directly related to child-care, which may nonetheless affect an individual's developing capacity and willingness to nurture young children or others in need. Such experiences might include caring for pets, or empathic responses toward peers.A developmental perspective on nurturance views the individual's personal history as an important determinant of his or her nurturing ability. However, just as caregiving by parents has been shown to be affected by the marital relationship and other aspects of the family context, the child's capacity and willingness to nurture also is affected by family context variables. Finally, the wider societal and cultural milieu can be expected to influence the conditions under which children are exposed to opportunities and incentives to nurture others.
Part I of this volume focuses on the developing child's responses to infants and younger children as possible precursors of later nurturance. The research studies outlined in this section provide detailed descriptions of the range of responses of children of different ages to the young. In addition, they call attention to person and situational variables -- such as gender, sibling status, adult encouragement, and the infant's own responses to the child -- that appear to modify children's behavior during child-infant interaction. Part II extends the developmental course of nurturance by examining early parenting and its determinants. In addition, cultural contexts and biological influences are examined for their potential impact on the developmental course of nurturance. Each part contains an overview detailing the contributions of each chapter. The chapters in Part I all focus upon the early development of children's positive responses to those younger than themselves, both within and outside the family. There are chapters that tackles, "Nurturance in the home: A longitudinal study of sibling interaction," by Pelletier-Stiefel and colleagues examines positive, caring responses between siblings in a longitudinal study of spontaneous sibling interactions in the home. Using the rich data base this investigation has generated, the authors address the possible influence of age, birth order, sex composition of the sibling pair, and interval on the expression of sibling nurturance. They also demonstrate the complex, reciprocal influences operating over time that suggest that sibling interactions may be an important context for developing nurturant responses. Moreover,t, "Young children's responses to babies: Do they foreshadow differences between maternal and paternal styles?" by Berman looks at children's responses toward infants and younger children outside the family context. In a review of literature on the determinants of responsiveness toward unfamiliar babies, the effects of age, gender, and situation are examined in an effort to explain how caregiving toward infants becomes integrated into the sex-role identity of individuals as they develop Melson, and Mistry re-examine evidence for sex differences in children's responsiveness toward infants and suggest that the concept of nurturance be broadened in several ways. First, they argue that nurturance can be thought of as including a variety of behaviors designed to foster the developmental potential of others. Second, they propose that individuals may choose a variety of individuals or objects to nurture. Thus, nurturance is conceptualized as a capacity developed by both males and females but often actualized in behavior in differing ways. Finally, Melson, Fogel, and Mistry, in another chapter, "The study of nurturant interactions: From the infant's perspective," document evidence that infants themselves contribute in important ways to their own nurturance. Using data on encounters between young children and unfamiliar infants, they demonstrate how varying characteristics of babies -- their age, gender, and appearance -- have differential effects on even preschoolage children. Moreover, behavioral analysis of infants with older children is used to show how infants signal their needs to children and attempt to draw them into interaction and maintain their interest. Taken as a whole, these chapters illustrate the complex nature of children's interactions with infants and younger children both within and outside the family. Both person and situational variables appear to interact in determining even short-term responsiveness to the young and when interactions are part of ongoing relationships, as they are among siblings, the developmental history of the relationship also becomes important.
The sibling relationship, a unique blend of friendship and parenting, has been viewed as fostering the development of both positive, nurturant behaviors and negative, rivalrous behaviors. In this chapter, the attention is on the former, and on the factors that may be related to nurturance between siblings. Within the framework of their play together, siblings have the unique opportunity to "try out" parenting behaviors. Although young children are limited in heir abilities to perform caretaking acts which resemble those of parenting, they nevertheless are able to give positive, supportive care, such as helping and physical affection, which may be the rudiments of later adult-like caretaking behavior. Attitudes of helpfulness, as well as particular nurturant behaviors, could also be fostered, or not, in sibling relationships. This chapter describes nurturance in siblings as examined in a longitudinal study of sibling interaction in the home. The previous previous papers have described general patterns of prosocial, agonistic and imitative interaction ac- cording to the variables of sex composition of the dyad, the age-spacing or interval between siblings, and the age of the individual child (older or younger child within the dyad).
Here the focus on nurturance in relation to these same variables. It has been examined more closely the prosocial category of behavior, and in particular, a subset of nurturant, prosocial acts.A renewed interest in recent years in family functioning and in social developpractical standpoint, sibling research may have implications for family planning, such as the choice of age-spacing between children. Research into sibling in teraction should also lead to a better understanding of the role of other children in a child's development. Piaget's theoretical view of declining egocentrism as a function of interaction with other children might have implications for the sibling relationship and for nurturance in particular. As children learn to take the per- spective of other children and to respond to the emotional needs of others, we might expect to see an increase in nurturant behavior. Likewise, the role of siblings must be considered when examining birth order differences. It is increasingly recognized that parental treatment is not the only mediator of such differences. In order to describe nurturance in siblings, we first must be able to distinguish nurturant behaviors from other forms of interaction in our observations.
The traditional connotation of nurturance involves caring for someone needier, in most cases, younger. In reference to siblings, that would limit consideration to the older child's nurturance toward the younger sibling. However, as Bryant (1982) points out in a review, both the older and younger child may play a part in sibling caretaking. Similarly, our observations revealed helping, teaching, and comforting behaviors by the older siblings as well as sharing and affectionate behaviors by both younger and older siblings. These behaviors demonstrate the mutual caring and concern of both siblings. Of course, it is possible that a number of characteristics of our sample may have made for more equal nurturance between older and younger siblings than in other kinds of families. The younger children in his study were not infants. The youngest siblings were 18- months-old and it is possible that a child of this age would not elicit as much nurturant behavior by the older child, as an infant sibling would. The age of the older child may also be important -- perhaps the older children in this study were not old enough to give "real" care. In addition, this study is limited to two-child families. There is evidence that children may be more nurturant in larger families. Finally, in our families, older children were not assigned caretaking roles. Therefore, in families different from the kind we observed, even more extensive caretaking activities might be seen. However, we did not limit our definition of nurturance to physical caretaking; we chose to define it to include prosocial behaviors that have elements of psychological nurturance -- behaviors such as comforting, praising, giving, sharing, co-operating, helping, and physical affection. To set the stage for the analyses of these nurturant behaviors, we briefly review how they may relate to variables such as sex and age according to the existing literature. A variety of types of evidence suggest that female siblings, particularly older ones, should be especially nurturant in their interactions with their brothers and sisters. For instance, it is more common for girls, than for boys, to be assigned caretaking roles with younger siblings. Barry, Brown, and Child found that girls were expected to be more reasonable and nurturant than were boys.
With all the foregoing, it cannot be denied that caregiving is something that should be given attention to in terms of the selection process and of the manner of choosing who will take care of the patients or of the infants. There is an important thing that must and should considered and that is to make sure that the caregivers are knowledgeable of the proper health care provision. This is important because of the fact that it can worsen the health situation of a person or would probably give more problems later on. The competency and the assurance that the caregivers are certified in their own respected field is one of the things that should be considered. Without competence, it will be difficult to understand the health situation of the patients and the proper nourishment necessary for the improvement and development of the person being taken cared of.