Grandparent Caregivers Dissertation 100 pages

Grandparent Caregivers

Societal Antecedents as Predictors of Resilience, Caregiving/Parenting Stress and Coping Strategies in Custodial and Non-Custodial Grandmothers of African-American or African Decent

The past three decades have seen a break from the traditional nuclear family roles. During this time, society has witnessed a dramatic increase in the number of children being raised by their grandparents. Many grandparents assume the role of primary caregiver for their grandchildren and/or childcare provider because of the impact of numerous societal antecedents which cause the parent or parents to be absent from the home. These societal antecedents include child abandonment, and/or neglect, parental employment obligations, parental education endeavors, and parental military obligations. These represent the key reasons for grandparents assuming the care of grandchildren. This comes at a time of life when they might have dreams of a more leisurely life with fewer responsibilities, but they find themselves once again, as primary caregivers of children. According to Ross and Aday (2006), many of the grandparents that assume the role of custodial grandparent or childcare provider are women of African decent.

The purpose of this predictive correlational study was to examine the relationship among societal antecedents (child abandonment and/or neglect, parental employment obligations, parental education endeavors, and parental military obligations), coping skills, and resilience in custodial grandparents. Custodial grandparents are defined as those providing shelter and primary care of the grandchild. It also includes non-custodial grandparents or occasional caregivers, grandparents who do not have primary responsibility of their grandchild but provide temporary childcare (8 — 30 or more hours a week). A convenience sample consisting of custodial and non-custodial grandmothers, of African decent, in three Louisiana parishes were recruited as participants.

Four instruments were used to measure the variables under study:

Grandmother’s Demographic Data Profile, The Parenting Stress Index, The Resilience Scale (RS-14), and Ways of Coping Questionnaire. Descriptive statistics were used for each variable in an effort to organize and examine the data from various viewpoints. Statistical methods of analysis included hypothesis testing (Z test) and multiple regression analysis. The IBM SPSS 18 (Statistical Packages for the Social Sciences) statistical package was used for all data analysis.

That study is important, as understanding the impact that the mentioned societal antecedents (child abandonment and/or neglect, parental employment obligations, parental education endeavors, and parental military obligations), have on the grandmothers’ resilience, coping strategies and stress manifestation will provide nurses with the necessary information for developing appropriate educational and nursing interventions. This will help to decrease risks associated with the unanticipated role of parenting or caregiving of a grandchild on African-American grandmothers. This research will add to the body of knowledge on resilience and the coping skills utilized by grandmothers of African decent who are primary care providers of their grandchildren. The study will also address whether societal antecedents are predictors of the grandparent’s resilience and their capacity for coping and handling stress associated with those responsibilities. The results of this research will broaden the scope of holistic nursing care to grandparents who provide childcare for their grandchildren and will allow them to help Grandparents build better coping skills in light of their new family responsibilities. .

CHAPTER I

INTRODUCTION

According to a survey by the American Association of Retired Persons, (AARP), 31% of adults in the United States are grandparents (Stritof & Stritof, 2009). Of that number, 8% are providing day care on a regular basis, and 3% are rearing a grandchild (Stritof & Stritof, 2009). Two and a half million grandparent-caregivers are primarily responsible for the basic care of one or more of their co-resident grandchildren (American Community Survey, U.S. Bureau of the Census, 2007). These grandparents represent about 40% of all grandparents whose grandchildren live with them (American Community Survey, U.S. Bureau of the Census, 2007). The 2008 United State Census reports the number of children living with a grandparent in 2008 as 6.6 million. These children comprise 9% of all children in the United States (Families and Living Arrangements: 2008). This is a significant of the total number of children residing with their grandparents rather than their natural parents.

When compared with other states, Louisiana ranks as the state with the fourth largest percentage of children living with grandchildren in the country (http://www.lagrg.org). In addition, according to the United States Census Bureau, 67,058 grandparents in Louisiana report they were responsible for their grandchildren who are currently living with them. Of these, 57% are African-American, 2% are Hispanic/Latino, and 38% are white. A large percentage, (34%) of grandparents caring for their grandchildren, in Louisiana, are doing it without the children’s parents present (www.aarp.org/families/grandparents/; http://factfinder.census.gov). Additionally studies confirm that 72% of the grandparent-caregivers are under the age of 60; and 30% live in poverty (http://www.census.gov/population/www/cen2000/phc-t17.html). This places a significant hardship on the grandparents.

The situations under which grandparent-caregivers care for their children are differ and many different family scenarios exist. Many grandmothers assist their own children in caring for their grandchildren. One example is noncustodial grandmothers who help to ease the financial burden of childcare of the parents, many grandmothers care for grandchildren while parents are at work. Grandmothers might also care for grandchildren in the evenings and on weekends, allowing the parents to run errands or go to the movies. Parents benefit by knowing that their children are in loving hands, and grandparents reap the benefits additional closeness with their grandchildren, which they might not have had otherwise. The United States Census Bureau reports that grandparents provide childcare for almost a quarter (23%) of children under the age of five (AARP, 2006). Nearly 30% of these children are reported to have been cared for on a regular basis by a grandparent while their mother worked outside of the home during 2005. The number of children cited by the United States Census Bureau is even higher for young children who live only with their fathers. Of these children, grandparents provide childcare for more than a third (34%). Noncustodial grandparents are not technically raising their grandchildren, but they are doing important childrearing work. Grandparents are one of the most frequent sources of childcare provision by relatives when mother and/or fathers work.

The phenomenon of custodial grandparents has become a common occurrence across many different racial and economic groups. According to the U.S. Census Bureau, the grandparent household are broken into racial groups. Of these grandparent households, 1.7% are American Indian or Alaskan Native; 2.8% are Asian; 15.6% are Hispanic/Latino; 36.3% of these grandparents are African-American; and 40.9% are white (U.S. Census Bureau, Current Population Survey 2008. Internet Release Date: January 2009. http://www.census.gov/population). Studies also have suggested that African-Americans have a high likelihood of being grandchild caregivers just under white grandparents. Nearly 77% of them are women (Fuller-Thompson, Minkler & Driver, 1997). In addition to their increased likelihood of becoming grandparent caregivers, they are more likely to provide extensive care to their grandchildren. African-American grandmothers are likely to provide extensive, rather than occasional care 9.2% of the time, while white grandparents are likely to provide extensive care 2.3% of the time (Prunchno, 1999). Extensive care is defined as more than 30 hours of care per week or more than 90 nights per year (Minkler & Fuller-Thompson, 2001). This means that African-American grandparents are involved to a greater extent in the parenting role than other races.

The importance of understanding the role of the grandparent as a caregiver for their grandchildren cannot be overemphasized. The last three decades has seen a dramatic increase in the number of children who are being raised by their grandparents, either as custodial caregivers, or as noncustodial caregivers. The type of role that they are asked to play varies according to the situation, Many grandparents assume the role of primary caregiver for their grandchildren and/or childcare provider because of the impact of societal antecedents, which cause the parent or parents to be absent. These reason include child abandonment, and/or neglect (Minkler, Roe, & Price, 1992; Seamon, 1992), parental employment obligations, parental education endeavors, and parental military obligations. Becoming the care provider of grandchildren poses a challenge for grandparents today. Making the decision to help with the day-to-day needs of their grandchild whether for a few hours a day or on a more permanent basis is a life-changing decision for everyone involved. It means that these grandparents must dedicate their life to raising a child at a time when they might have dreams of a more leisurely life with fewer responsibilities (Minkler & Roe, 1993).

Although assuming the unexpected role of parenting or caring for grandchildren is stressful, many grandparents placed in this position demonstrate resilience in meeting the daily needs of the children and themselves (Burton, 1996). Grandparents placed in the caregiver role are under many different stresses. There are changes resulting from the natural aging process, economic stress, and societal stress. They also face many psychological, social and personal challenges. Aside from these stresses, simply watching children can be stressful, especially for grandparents who work other jobs. In keeping childcare arrangements, working grandparent caregivers face many of the same challenges as the biological parents. It is not always easy to keep childcare arrangements running smoothly and problems may arise from time to time. .

In addition to these stresses, familial stresses might occur. For instance, Grandparents and parents may have different views about raising children. Parents’ expectations of grandparents may exceed their resources. Grandchildren may not always obey or comply with grandparents’ rules. Grandparents may not like the role of strict disciplinarian when discipline is required. Differing opinions regarding discipline may cause friction between the parents and grandparents. These stresses can affect the children and their ability to adjust to the new situation. Familial stresses make the adjustment difficult for everyone. Familial problems are oftentimes difficult to resolve.

As the number of aging grandmothers who are experiencing the adversity stemming from assuming primary parental roles continues to increase, resilience in this population has become an area of academic importance. How well grandmothers cope with the stress of their added caregiving or parenting responsibilities and their need for social support is suspected to be related to how well they use their psychological and physical capacity to overcome adversity. Past clinical research studies explored resiliency in grandparent caregivers. These studies used a number of research instruments. Caregiver burden instruments, studied responses of custodial grandparents and highlighted the negative impact of parenting responsibilities on the ageing population (Dowdell, 1995; Joslin & Brouard, 1994; Kelley, 1993; Minkler, Roe, & Price, 1992). It was found that many studies made the assumption that caring for a disabled relative was similar to caring for grandchildren. However, this is an erroneous assumption and the two roles are quite different in many respects (Burton, 1992; Strawbridge, Wallhagen, Shema, & Kaplan, 1997), Therefore, studies that involve grandparents caring for disabled relatives cannot be extrapolated into the study population.

A high number of African-American grandparents assume the role of childcare giver (Ross & Aday, 2006). These grandparents share living quarters with their grandchildren. It is assumed that the large number of grandchildren reported in the Census 2000, being raised solely by grandparents without parental involvement, might have been under-reported. Grandparents often do not reveal that although one or both parents “live” in the home, they are seldom there and play little or no role in parenting (Hackworth, 1998; Butler & Zakari, 2005). Grandparents sometimes find themselves back in the role of parenting their adult children and their grandchildren at the same time.

Grandparents who live in a separate residence from the grandchildren’s home have reported having regular contact with their grandchildren, including occasional babysitting or childcare (Musil & Standing, 2005). According to Baydar and Brooks-Gunn (1998), the 1987 — 88 data from the National Survey of Families and Households revealed that 43% of grandparents provided childcare for their grandchildren at least once a month. Similarly, Bass and Caro’s (1996) research found that 32% of grandparents provided care for a grandchild, at least one hour a week. Of those grandparents providing care, 13.6 hours constituted the average time per week devoted to caring for a grandchild (Bass & Caro, 1996). National data indicates that grandparent caregivers are often women (77%; Fuller-Thomson & Driver, 1997; Engstrom, 2008), suggesting that grandmothers are more likely than grandfathers to be grandparent caregivers. Custodial grandparents are more likely to be African-American than noncustodial grandparents (Fuller-Thomson et al., 1997).

Research indicates that the number of grandparents who provide some level of caregiving for their grandchildren represents a major portion of the population. Understanding how these grandparents cope will play and important role in developing programs to help those grandparents who have not been able to cope with the stresses of their newly defined role. This research will play an important role in helping researchers, clinicians, and those cast into the role of grandparent caregiver to understand how to develop better programs for helping the grandparent caregiver adjust to their daily stresses associated with the parenting role.

Problem Statement

Since 1990, the number of grandparents that have accepted childcare or primary parental responsibility because their children are not capable of providing the necessary parenting for their children has dramatically increased (Butler & Zakari, 2005). The literature presents the causes or societal antecedents, which lead to grandparents becoming custodial parents (Hayslip, Shore, Henderson, Lambert, 1998; Ross & Aday, 2006). As previously stated, these societal antecedents include child abandonment and/or neglect, parental employment obligations, parental education endeavors, and parental military obligations. These issues have caused many grandparents to become temporary or permanent caregivers of their grandchildren. This responsibility can require a long-range care strategy and grandparents may need a high level of resilience and particular coping strategies to sustain them as they meet the increased demands at this time in their lives. This study will address the problem of how these grandparents develop resiliency and coping strategies.

No one knows exactly how many grandparents provide childcare for their grandchildren. However, previous research studies can provide us with a few clues. However, as discussed earlier the numbers are staggering and growing continually. Hirshorn (1998) points out, such activities as routinely getting young children ready for school in the mornings, providing full-time childcare for pre-schoolers, or serving as a custodial parent to children whose parents are unwilling or unable to provide care take the grandparent out of traditional older-generation roles and into roles typically assumed by a child’s parents. They take on a role that is typically for someone younger than themselves.

Thompson and Minkler, (2001), conducted a study that provided a profile of American grandparents who are in the role of providing extensive secondary childcare to their grandchildren. The study compared and contrasted this population group with those who are not providing such care along a variety of social and demographic dimensions. In another study, secondary analysis of 3,260 grandparent respondents in the 1992-94 National Survey of Families and Households (NSFH) was conducted. The study compared several different grandparent-caregiver scenarios. They are: (1) custodial caregivers (grandparents with primary responsibility for raising a grandchild for 6 + months), (2) extensive caregivers (grandparents who reported providing at least 30 hours of child care a week and/or cared for at least 90 nights per year, (3) intermediate caregivers (grandparents providing child care for 10-29 hours a week and/or had their grandchild stay overnight without his or her parents for 7 to 89 nights), (4) occasional caregivers (grandparents providing between 1 and 9 hours of child care in an average week and/or had a grandchild stay overnight without his or her parents 1 — 6 days in the past year, and (5) non-caregivers (grandparents providing no babysitting during an average week and, in the past year, had not had a grandchild stay overnight without his or her parents (Thompson & Minkler, 2001). The results of the study demonstrate that close to 7% of all grandparents provided extensive caregiving, as did 14.9% of those who had provided any grandchild care in the last month. Extensive caregivers most closely resembled custodial caregivers and had least in common with those grandparents who never provided childcare (Thompson & Minkler, 2001). The role of grandparent-caregiver differs and has a significant impact on the need to define these roles more closely, as well as the affects that they have on the lives of grandparents and their older years.

There was a relatively small amount of research on resilience found in the nursing literature. Since the mid to late 1980s, nursing’s major contribution to understanding resilience has been in the context of health, rather than coping skills (Peterson & Bredow, 2004). The Committee on Future Direction for Behavioral and Social Sciences, recently recognized resilience as a research priority for the National Institutes of Health (Singer, 2001; Peterson & Bredow, 2004). Historically, resilience was frequently studied in children and adolescents and characterized by attributes that usually were identified as positive. Recent studies on resilience in adults that were found in nursing literature, have centered on traits of resilience in older women. This population is beginning to receive the academic attention that it deserves.

Studies, especially those that view resilience as a trait, indicate it is difficult to discern the role and order of resilience-related concepts, such as coping, hope, or mastery (Peterson & Bredow, 2004). These concepts have alternatively been viewed as antecedent and protective factors or as outcomes of resilience (Petersen & Bredow, 2004). However, a limited number of nursing studies have explored the impact of societal antecedents on resilience, coping skills, and stress manifestation in custodial and non-custodial grandparents (Kadner, 1989; Haase, 2004). This study will address the problem of determining the impact of societal antecedents on resilience, coping skills, and the manifestation of stress in custodial and non-custodial parents.

Purpose

The purpose of this predictive correlational study is to examine the relationship between societal antecedents such as child abandonment and/or neglect, parental employment obligations, parental education endeavors, and parental military obligations, coping strategies, and resilience in custodial grandparents and non-custodial grandparents. The purpose of the study will be to fill in gaps in knowledge regarding resiliency and coping skills in both custodial and non-custodial grandparent caregivers of African-American or African decent. The purpose will be center on the ability to predict what factors are most important in the development of resilience and coping skills among this group of women in order to develop programs targeted towards helping grandparent caregivers develop the resilience and coping skills needed to allow everyone to thrive in their newly acquired roles.

Significance of the Study to Nursing

Nurses must often provide care to grandparent caregivers. Care may be provided for conditions that are related to the stresses of their role, or they may be for conditions that are entirely unrelated. Either way, nurses must have an understanding of the impact that the role of grandparent caregiver has on their immediate condition and on their ability to remain healthy in the future. Understanding the affects of societal antecedents and their affect on the reasons why grandparents were thrust into the role of caregiver and on their health is necessary in order for nurses to provide the best care possible for grandparent caregivers.

Nurses must understand how these societal antecedents affect the grandparent’s resilience, coping skills, and stress management skills. Understanding how the both their role as grandparent caregivers and their societal antecedents that led to their position affects the amount of stress in their lives and the various affects of stress on their health and well-being is paramount to the ability of the nurse to deliver the best possible care to this growing demographic group. This understanding will provide nurses with the necessary information for developing appropriate interventions to decrease the risks associated with assuming the role of parenting during a phase of life in which they had not anticipated raising children or providing childcare.

The focus of this research will be on the African-American and African populations. It will focus on grandmothers, as opposed to grandfathers. The reason for this is that this population is more prevalent than grandfathers assuming the role of parenting grandchildren. Traditionally, grandmothers provide most of the childcare tasks, such as bathing, changing diapers and the feeding of children. That is not to minimize the role of grandfathers, but in reality, it is the grandmother who will take on the greatest share of childcare responsibilities. The African-American and African population was chosen as the target for this research based on research that indicates that grandmother childcare providers are more likely than other racial groups to provide extensive, rather than limited childcare services for their grandchildren.

This research will add to the body of knowledge on resilience and the coping strategies utilized by African-American and African grandmothers who provide for the care of their grandchildren. It is expected that many of the findings of the research will be able to be applied to other demographic groups of grandmothers providing care for their grandchildren, but the focus of the study will be on the African-American and African populations. Cultural factors might limit the applicability of the study results to other demographic groups, but further research that is beyond the scope of this study will have to be conducted to determine if this is the case.

This research takes a two-fold approach to understanding the affects of care for grandchildren on African-American and African grandmothers. It will address which previously specified societal antecedents have been the greatest contributors causing grandparents to become temporary or permanent caregivers of their grandchildren. The study will also address whether societal antecedents are predictive of the grandmother’s resilience and their capacity for coping and handling stress. Understanding how these factors affect the ability of grandmother caregivers to cope with the stresses of the role will allow nurses to develop screening techniques to help determine grandmother caregivers who might be at an increased risk of developing stress related illnesses or conditions related to their new, unexpected role.

The ability to identify grandmothers who might be currently undergoing stress related problems associated with the caregiving role, or who might be at risk for developing stress related problems in the future, will allow the nurse better to understand how stress and coping skills are related to their condition. This is the case whether the root cause of the condition is directly related to stresses associated with the caregiving role or whether it is unrelated. Even if the grandmother caregiver is being treated for a condition that is seemingly unrelated to the stresses associated with the caregiving role, stresses might still have an impact on their ability to heal from the condition or the prevention of a relapse in the future.

Understanding how the societal factors associated with grandmothers in the caregiving role affect resiliency and coping strategies, as well as their uses as predictors for those who might be at increased risk for coping-related problems will help nurses to integrate strategies into their treatment plan to address these issues. This understanding might also help nurses to understand the root causes of their problems, or how all of the factors associated with the patient’s conditions are interrelated.

Grandmother caregiver stress has been measured in few studies (Musil, 1998). Most research on grandparent caregivers focuses on primary, custodial grandmothers that provide care until children reach adulthood (Kelly, 1993; Pruchno, 1999; Musil & Ahmad, 2002). Little has been done regarding grandmothers who provide non-custodial care for their grandmother or those who only provide temporary or limited care for their grandchildren. It is suspected that differences will exist between custodial and non-custodial grandmothers due to the increased amount and duration of care involved in custodial care of the grandchildren, Therefore, research needs to address both custodial and non-custodial grandmothers. This research will allow nurses to understand how differences in the type and duration of care provided by the grandmother affects resiliency and their ability to cope with the caregiving role.

The results of this research will broaden the scope of holistic nursing care to grandmothers of African-American or African decent who provide childcare for their grandchildren. It will provide nurses with several different perspectives and aspects of how societal antecedents affect the ability and stress level of African-American and African grandmothers in caring for their grandchildren. It will aid in nurses’ understanding how the stresses of caring for grandchildren affect both the quality of life and health of grandmothers thrust into the caregiving role for their grandchildren.

Research Hypotheses

Understanding the role of grandmothers of African-American and African decent who have been thrust into the role of caregiver for their grandchildren has many aspects. In order to gain a better understanding of the processes and factors that affect their ability to do so, this study will explore the following hypotheses.

Ho1

No empirically significant relationship exists among both custodial and noncustodial grandmothers of African-American or African decent in their coping strategies, level of resilience, caregiving/parenting stress, and selected demographic variables such as the age of the grandmother, economic status of the grandmother, educational level of the grandmother, age of the grandchild/grandchildren, number of grandchildren requiring custodial care, or the health status of the grandchild.

HA 1

An empirically significant relationship exists among both custodial and noncustodial grandmothers of African-American or African decent in their coping strategies, level of resilience, caregiving/parenting stress, and selected demographic variables such as the age of the grandmother, economic status of the grandmother, educational level of the grandmother, age of the grandchild/grandchildren, number of grandchildren requiring custodial care, or the health status of the grandchild.

HO 2.

No empirically significant difference exists between custodial and non-custodial grandmothers of African-American or African decent in terms

of caregiving/parenting stress, coping strategies, and level of resilience.

HA2

An empirically significant difference exists between custodial and non-custodial grandmothers of African-American or African decent in terms of caregiving/parenting stress, coping strategies, and caregiver resilience.

HO3

Societal antecedents (child abandonment and/or neglect, parental employment obligations, parental education endeavors, and parental military obligations) are not predictive of caregiving/parenting stress, coping strategies, and level of resilience in both custodial and non-custodial grandmothers of African-American or African decent.

HA3

Societal antecedents (child abandonment and/or neglect, parental employment obligations, parental education endeavors, and parental military obligations) are predictive of caregiving/parenting stress, coping strategies, and level of resilience in both custodial and non-custodial grandmothers of African-American or African decent.

For each of these research hypotheses, the independent variables will be complex. On a basic level, the independent variables will be the role of the grandmothers as caregivers of their grandchildren on some level. However, differences will exist in the level of care that these grandmothers provide for their children, the circumstances that led to them becoming caregivers of their grandchildren, the level of support that they have from others in their role, and other circumstantial factors, such as economics, age, general health etc. All of the study participants will be of African-American or African decent, which will also serve as an independent variable. The reason for this is that cultural factors might be present that would affect the results of the study. Allowing this racial factor to serve as an independent variable will allow the research to determine if any cultural or societal factors exist in this group that might affect their ability to manage or cope with the stresses of being a grandparent caregiver.

All of the various differences in the grandmothers could be considered as separate independent variables. However, treatment of these factors as such would make analysis cumbersome and results confusing. Therefore, these subcategories will be addressed via the research questions in order to gain a better understanding of how these individual factors affect the results of the study. The study will consider only two independent variables, that fact that the grandparents are caregivers of their grandchildren and that they are of African-American or African decent.

The study will address three interrelated factors that will serve as the dependent variables of the study. The levels of resilience, coping strategies and caregiving/parenting stress present in the grandmothers will be considered to be the three dependent variables in the study. These variables will be measured through a number of scales that will be described further in the methodology section of the study. The responses to these scales will help to determine how the levels of resilience, coping strategies and caregiving/parenting stress relate to the independent variables of being a grandparent caregiver and how being culturally African-American or African decent affect the dependent variables. Several research questions will be used to help distinguish the affects and relationships of these various factors.

Research Questions

The three primary research hypotheses will serve as the guiding problems to be resolved in the research study. However, the purpose of the study is to help provide nurses with the information that they need to be able to apply the information gathered to their daily interactions with grandmother caregivers. Therefore, many different facets of the research problem will be explored through the use of research questions. The research questions will be addressed through various portions of the scales used in the research study. These research questions will be helpful in the development of questions that can be asked of patients to determine their risk for developing stress related conditions associated with their role as grandmother caregiver for their grandchildren.

Five categorical methods of coping have been developed and will be utilized in the Ways of Coping Questionnaire. This questionnaire will help to answer the following set of research questions.

1. Which coping strategy is used most frequently in by both custodial and non-custodial grandmother caregiver/parents?

2. Which coping strategy is used the least by both custodial and non-custodial grandmother caregiver/parents?

3. What are the second, third and fourth most used strategies for coping among both custodial and non-custodial grandmother caregiver/parents?

The resiliency scale measures the feeling of adequacy and ability to cope among both custodial and non-custodial grandmother caregiver/parents. Use of this scale could also be translated into the amount of self-efficacy (perceived ability to be successful in a particular task) of the grandmother caregiver. This scale not only addresses the amount of resiliency in the grandmother, but it addresses the most common factors that determine their ability to be resilient in the given situation. These factors were the result of research the authors of the scale, Wagnild & Young (1987). The scale is devised so that the responses can be totaled to provide a resiliency score, with the higher scores corresponding to higher levels of resiliency. For the purposes of this research study, the resiliency scale will be used to address the following research questions.

4. Do custodial or non-custodial grandparents have higher resiliency scores?

5. Does the societal factor that led to their role as grandparent caregiver have an effect on resiliency scores?

6. What are the most frequent factors reported as the key resiliency factors among grandmothers in the study?

7. Are their differences in demographic groups in terms of resiliency? If so, what are they?

8. Is there a difference in resiliency between older and categorically younger grandmothers in the caregiver role?

9. Does health status of the grandmother have an affect on their resiliency?

10. Does the health status of the grandchild/grandchildren have an affect on the resiliency of the grandmother?

The resiliency scale will play a pivotal role in the ability of nurses to recognize grandmother caregivers who are at risk for the affects of stresses associated with poor resiliency in various groups.

The parenting stress scale of the study will be the final scale used in the conduct of this study. This questionnaire is important as it asks for the first response that comes to mind. Respondents are not supposed to think about the answers. Spontaneous answers will be the most likely to provide the most accurate level of stress. Grandmothers will not be as likely to ‘put on a good face’ due to societal pressures and role expectations. The parental stress scale will not only allow the researcher to determine the level of stress in various categories of grandmother caregivers, it will allow them to identify the most common causes of stress among the various groups. The following research questions will be derived from this research instrument.

11. How do grandmother expectations of their experience, as compared to their actual experiences with the child relate to the amount of stress that they are experiencing?

12. How do these expectations relate to their resiliency?

13. How do these expectations relate to their coping skills?

14. How do grandmother’s perceptions of how their child behaves, as compared to how other children act influence their level of stress?

15. How do grandmother’s perceptions of how their child behaves, as compared to how other children act influence their level of resiliency?

16. How do grandmother’s perceptions of how their child behaves, as compared to how other children act influence their coping skills?

17. How do the number of stressful events in the immediate family over the last 12 months affect the grandmother’s stress level?

18. How do the number of stressful events in the immediate family over the last 12 months affect the grandmother’s resiliency?

19. How do the number of stressful events in the immediate family over the last 12 months affect the grandmother’s coping skills?

Addressing these 19 questions, along with the three primary hypotheses will allow the researcher to paint a picture of how societal factors are related to the grandmother caregiver’s coping skills, resiliency and parental stress. The purpose of these research questions is to provide the nurse with guidance that will help them to recognize the factors that lead to problems in the ability to cope with the stresses of becoming a grandmother caregiver.

This research asks the respondent about a number of demographic factors that can be used to further explore how these factors affect the grandparent caregiver. Each of these demographic categories has the potential to represent a separate research question. However, this list would quickly become lengthy and cumbersome. Therefore, the questions will remain limited to those addressed in this section of the study. However, categorical comparisons will be made during the data analysis and discussion portion of the study. This approach will allow the researcher to narrow the affects of various factors on the ability of grandparents to cope with the additional stresses associated with becoming a grandparent caregiver.

Theoretical Framework

Grandmother caregivers constantly face stressful demands, both from internal and external sources, necessitating the use of coping strategies to adapt to their newly acquired parenting situations. Sister Callista Roy’s Adaptive Model focuses on human adaptive system responses and environmental stimuli (Roy & Andrews, 1999; Roy, 1971). Roy’s work will provide the central theoretical framework upon which this research study is based.

For Roy, human beings are holistic, comprised of a series of adaptive systems that are constantly changing in concert with a constantly changing environment. This constant reciprocal interaction causes life for human beings to never be the same, but instead representing a world of constant change and new challenges to overcome (Roy & Andrews, 1999; Fawcett, 2005). Problems in adaptation arise when the human adaptive system is unable to cope with or respond to stimuli from the internal and external environments in a manner that maintains the integrity of the system (Roy, 1989; Roy & Andrews, 1999; Fawcett, 2005). Roy’s definition of adaptation reflects the relationship of human beings to their environment in conjunction with social and cultural contexts. The environment is described as all conditions, circumstances, and influences that surround and affect the development and behavior of individuals and groups as adaptive systems, with particular consideration of mutuality of personal and earth resources (Roy & Andrews, 1999; Fawcett, 2005).

Environment is both physical and social (Roy & Andrews, 1999; Fawcett, 2005). This is an important issue in the context of this research study, as the group selected are African-American and of African decent. Social and cultural influences might have an impact on the responses of the respondents, as the research by Sister Roy suggests. Humans never act in isolation, but are influenced by the environment and in turn they affect the environment also (Roy & Andrews, 1999; Fawcett, 2005). This means that the relationship of human beings with their environment is reciprocal where each has an influence on the other. This research will have to consider the reciprocal affects of social and cultural contexts of this research group.

The roots of Roy’s Adaptation Model lie in her personal and professional background (Andrew & Roy, 1991a; Fawcett, 2005). Roy explained that she immediately became interested in resilience of young children while working as a young pediatric staff nurse in the recovery process. The resilience exhibited by these children exhibited to both their disease and other changes that were a result of hospitalization caused her to begin to view persons as having both innate and acquired abilities to deal with a changing environment. Later, she articulated her belief using the concept of adaptation. Human adaptation is a complex topic and until Roy’s work, little was known about the process of human adaptation.

Roy used a deductive approach to develop her concept of adaptation and the factors that influence a person’s level of adaptation and ability to adapt. Initially, Roy drew heavily from Helson’s (1964) work on adaptation and the notion that adaptation is a pooled effect of multiple influences, which he called focal, contextual, and residual stimuli (Roy, 1977; Fawcett, 2005). Later, Roy drew from more contemporary views of science and the relationship of a person and their environment (Fawcett, 2005).

Roy’s ideas of coping are also closely tied to the work of Coelho, Hamburg, and Adams, 1974; Lazarus, Averill, and Opton, 1974 (Fawcett, 2005). According to this model, increased force, or tension, derives from strains within the adaptive system (internal strains) or from the environment that impinges on the system (external strains) (Roy, 1989; Fawcett, 2005). Tension is created by the focal, contextual, and residual stimuli from both the internal and external environments (Roy, 1989; Fawcett, 2005).

Innovator dynamism involves personal cognitive and emotional strategies for change to higher levels of potential (Fawcett, 2005). Humans derive both short-term and long-term strategies that will allow them to reach higher levels of potential through the adaptive process. According to Roy & Andrews (1999) a person’s emotions and defenses are used to seek relief from anxiety to make affective appraisal and attachments to the stimuli (Fawcett, 2005). Adaptive responses are behaviors that appropriately meet the goals of adaptation. Ineffective responses refers to behaviors that do not contribute to integrity of the human system. The balance of these two factors allows people to decide whether or not to increase or decrease efforts to cope with the stimuli (Roy & Andrews, 1999; Fawcett, 2005). The goal of the adaptive process is to maximize the integrity of the human system.

Another important and useful element of Roy’s Adaptation Model is the inclusion of the Role Function Mode. Here she discusses behavior as it pertains to roles in human systems. The Role Function Mode for the individual focuses on the roles that the individual occupies in society (Fawcett, 2005). Role, in this case, refers to the functioning unit of society and is defined as a set of expectations about how a person occupying one position behaves toward a person occupying another position within that society (Fawcett, 2005). The basic underlying need is social integrity, the need to know who one is in relation to others so that one can act accordingly and avoid stress (Roy & Andrews, 1999; Fawcett, 2005). Roy identifies and defines seven sub-dimensions of the Role Function Mode. They are: primary role, secondary role, tertiary role, instrumental behavior, expressive behavior, role-taking, and integrating roles. The Role Function Mode as described by Roy is very useful in describing the grandparent role and traditional expectations of that role, as well as those of the parent and the child.

Roy & Andrews (1999), identify the primary function of the Role Function Mode as that ascribed by age, sex, and developmental stage responsible for the determination of the majority of behaviors engaged in by the person during a particular growth period of life. The Secondary Role is defined as the role that a person assumes to complete the task associated with a developmental stage and primary role (Roy & Andrews, 1999). The Tertiary Role is the role freely chosen by the person, temporary in nature, and often associated with the accomplishment of a minor task in a person’s current development (Roy & Andrews, 1999). Instrumental Behavior is goal-oriented behavior and consists of role activities the person performs (Roy & Andrews, 1999). Expressive Behavior is described as the feelings and attitudes held by the person about role performance (Roy & Andrews, 1999). Role Taking is the process of looking at or anticipating another person’s behavior by viewing it within a role attributed to the other. While at the same time, basing one’s own interaction on a judgment about the other’s role and focusing on the meaning that the acts have to both persons in a role interaction (Roy & Andrews, 1999). The seventh sub-dimension, Integrating Roles, is the process of managing different roles and their expectations (Roy & Andrews, 1999).

Roy’s definitions of the seven sub-dimensions can be used to illustrate the grandparent parenting phenomena. Couples get married and have children (Primary Role) and assume the parenting role (Secondary Role). When their children become parents and have children, the couple becomes grandparents (Primary Role, Noncustodial grandparents). During times of family crisis or societal antecedents, grandmothers assume custodial care of their grandchildren (Tertiary Role) and perform parenting behavior (Instrumental Behavior).

Many grandmothers accept the additional role of custodial grandmother without thought of personal and family impact (Expressive Behavior) since grandmothers face many positive and negative stimuli when deciding whether to take on the additional responsibilities of caring for a grandchild and doing the caregiving role. Grandmothers’ responses, by the way of biological, psychological, sociological or biopsychosocial actions, are the body’s way to maintain stability physically, psychologically and emotionally.

The role of parenting as idealized and demonstrated by custodial grandmothers exemplified by Roy’s Role-Taking sub-dimension. Successful combination of the traditional role of grandparents and the parental role (custodial grandparent) can be characterized by the resilience demonstrated by the custodial grandparent (Integrating Roles).

Using Roy’s Adaptive System and Adaptation Model, the predictive relation of the concept of stimuli (Societal Antecedents) to the concepts of coping ability (individual coping strategies), adaptive modes (demographic variables, psychological integrity, and parenting), and behavior (caregiving stress and resilience) is depicted in Figure 1.

Figure 1. Theoretical Adaptation Model: Human Adaptive System of Grandmothers of African-American

or African Decent

Human Adaptive System

INTERNAL ENVIRONMENT

Input

Grandmother

Output

External Stimuli

Human Adaptive System

Behavior

EXTERNAL ENVIRONMENT

Assumptions

Assumptions and limitations associated with the proposed study

The diagram illustrates that Societal Antecedents act as input into the Human Adaptive System (Grandmother of African-American or African decent) and that they are processed by the coping processes (cognator and regulator), prompting the need to develop coping skills. The output is represented as behavior (coping strategies), in the form adaptive responses (resilience) and ineffective responses (caregiving/parenting stress) for each component of the four interrelated adaptive modes (demographic variables, psychological integrity, parenting). Adaptive Responses (resilience) promotes the integrity of the Human Adaptive System. Grandmothers of African-American or African decent are depicted by the arrows that remain within the adaptive area. Ineffective responses (caregiving/parenting stress), which do not contribute to the integrity of the human adaptive system (grandmother), are depicted by the arrow that extends beyond the adaptive area. The responses act as feedback, which is further input for the Human Adaptive Model (Grandmother of African-American or African decent).

The specific relational propositions of the researcher’s model are listed below. Using Roy’s original relational propositions as a guide, the concepts related to grandmother in parental roles, caregiving stress, coping skills and resilience have been linked in the following theoretical framework.

A. Societal antecedents from the internal and external environment (through the senses) act as inputs to the grandmother’s adaptive system and influence the selection of coping strategies. This information is channeled automatically in the appropriate manner and an automatic, unconscious response is produced (behavior). Based on the grandmother’s demographic variables, psychological integrity, physiological integrity, parenting skills, and coping strategies adaptive measures are employed to prevent or reduce stress while parenting grandchildren. A successful coping response in the grandmother produces resilience while an unsuccessful response gives rise to caregiver stress when grandmothers of African-American or African decent are faced with the challenges posed by societal antecedents responsible for affecting the care of a grandchild. The responses then enter the system, as feedback, which is further input for resilience or caregiver stress.

B. Societal antecedents from the internal and external environment, as perceived through the senses, act as inputs to the grandmother’s adaptive system and coping strategy. This information is channeled automatically in the appropriate manner and an automatic, unconscious response is produced. Based on the grandmother’s demographic variables (age, income, education) and current psychological integrity, coping strategies are employed, while at the same time, measures are sought to prevent or reduce stress. A successful coping response produces resilience while an unsuccessful response gives rise to caregiving/parenting stress when grandmothers of African-American or African decent are faced with challenges posed by societal antecedents responsible for care of a grandchild. The linked responses then act as feedback, which is further input for resilience or coping stress.

C. Societal antecedents act as inputs to the cognator subsystem.

D. Societal antecedents and the capacity to adapt serve as input to determine how grandmothers of African-American or African decent provide primary care to a grandchild. Processing of this input through coping skills results in resilience.

E. Grandmothers of African-American or African decent must sense changes in the environment and make adaptations in their functioning in order to accommodate parenting role requirements.

F. The extent of the grandmother’s ability to cope when faced

with societal antecedents, affects the grandmother’s ability to respond positively in the situation (resilience) thus preventing or reducing caregiver stress.

G. Changing societal antecedents stimulate grandmothers to make adaptive responses. For grandmothers, of African-American or African decent with caregiver responsibilities, life is never the same. It is constantly changing and presenting new challenges to which they must use their coping mechanisms to adapt. The grandmother has the ability to make new responses to these changing conditions. As societal antecedents change, the grandparent has the opportunity to continue to grow, to develop, and to enhance the meaning of the additional parenting role and life. The ability to grow during adversity is a key characteristic of resilience.

H. The characteristics of the grandmother’s resilience, the societal antecedents that influence the adequacy of coping strategies and the level of caregiving/parenting stress experienced determine the adequacy of their parenting skills.

I. The characteristics of societal antecedents, demographic variables, psychological integrity, and parenting skills influence resilience and caregiving/parenting stress in grandmothers of African-American or African decent providing care for a grandchild.

J. Grandmothers are described, by Roy and in this research, as adaptive systems constantly growing and developing within a changing society. Resilience for grandmothers of African-American or African decent providing care to grandchildren can be described as a reflection of these interactions.

K. The goal of nursing is the promotion of the overall integrity of grandmothers of African-American or African decent providing care for a grandchild, thereby contributing to their resilience, psychological integrity, quality of parenting, and quality of life.

L. The general goal of nursing intervention is to maintain and enhance adaptive behavior (coping strategies) and to change ineffective behavior response (caregiving/parenting stress) to increase adaptation (resilience) in grandmothers of African-American or African decent providing care to grandchildren.

M. It is the nurse’s role to promote adaptation in societal situations affecting grandmothers’ coping strategies, psychological integrity, and quality in the care of grandchildren, and the enhancement of the interactions of grandmothers with societal antecedents, thereby promoting resilience and reducing caregiving/parenting stress in grandmothers of African-American or African decent providing care to grandchildren.

These principles will form the guiding theoretical framework for conduct of the study. The theoretical framework relies heavily on the work of Sister Roys and her many associates. The framework of Roys was found to be an excellent match for the conduct of this research. The theoretical framework for this research study was derived by applying the purpose and research assumptions associated with this research to the framework provided by the work of Roys.

Assumptions

The nature of research makes it necessary to make assumptions that can affect the conduct of the research and the conclusions that are drawn from it. The accuracy of these assumptions will largely determine the ability to draw conclusions from the research. For the purposes of this study, the following assumptions are made:

1. Custodial and non-custodial grandmothers will readily answer the questions on the study questionnaires.

2. Custodial and non-custodial grandmothers use specific ways of coping.

3. Custodial and non-custodial grandmothers will accurately report their age, and other demographic data.

4. Custodial grandmothers will accurately state the social antecedents that lead to providing primary care for their grandchildren.

5. Custodial grandmothers will provide accurate information about their contacts with their grandchildren.

6. Non-custodial grandmothers will provide accurate information about their contacts with their grandchildren.

7. Societal antecedents can influence how custodial grandmothers experience stress, use coping strategies, and demonstrate resilience, and these will be able to be measured using the research methodology.

Limitations

As certain assumptions must be made in the conduct of every research study, certain factors may limit the ability of the research to draw conclusions or to apply the results of the study to the sample population or to similar population. The following limitations will apply to this study.

1. The investigator’s reliance on self-report data of individuals in three parishes in Louisiana.

2. The study group does not represent a random sample. It will be a convenience sample.

3. The participants will not be a randomly selected sample of grandmothers experiencing a specific level of stress or resilience.

All of these limitations will affect the study in different ways. The reliance on self-report data might limit the reliability of the research study. One of the key drawbacks of self-report data is that the respondent must be able to accurately asses their own state. The accuracy of self-concept is difficult to assess and could affect the results of the study. The inability to obtain a random sample could affect the ability to generalize the study results, thus limiting the external validity of the study.

Theoretical Definitions

The following definitions will apply to this research study and will serve as the key theoretical definitions of the study, as derived from the literature.

Age — Grandmothers are 30 years of age and above (U.S. Census Bureau 2000).

Caregiving Stress — Physiological (physical), psychological (mental), or emotional pressures related to care giving responsibilities (Miller — Keane, 2003).

Coping

– Constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person. (Lazarus & Folkman, 1984).

Custodial grandparents — African-American, African decent, or black grandmother who assumes physical and financial responsibility for a grandchild, who is age 12

or under and who lives in the grandparent’s home (Hayslip, Shore, et al., 1998).

Grandchildren — Children, age 12 and under, who are not the natural biological children of the persons, but who might be of biological or court appointed derivation from their own children (Hayslip, Shore, et al., 1998).

Non-custodial Grandparent — African-American, African decent, or black grandmothers, whose grandchildren are in the care and custody of their parents and who live separately from the grandparent. It also refers to grandparents provide daycare and/or babysitting care for their grandchildren (Hayslip, Shore, et al., 1998).

Parenting Stress — The negative mental response grandparents ascribe to themselves and/or their grandchildren, created by a series of appraisals made by each grandparent in the context of his or her level of commitment to the parent role

(Abidin, 1992) and the disparity between the apparent demands of parenting and the existing resources to fulfill those demands (Abidin, 1995).

Resilience — A personality characteristic that moderates the negative effects of stress and promotes adaptation (Wagnild & Young, 1990.1993).

Social Antecedents — Circumstances leading up to, and reasons for becoming part of a grandparent-headed household. These include child abandonment and/or neglect, parental employment obligations, parental education endeavors, and parental military obligations.

Operational Definitions

The follow parameters will be used to define the parameters of this research study. They might or might not coincide with the theoretical definitions used in this study.

Age — self-reported years since birth as reported on the demographic information questionnaire.

Caregiving Stress for the purpose of this study this is the Total Stress (TS) score obtained on the Parenting Stress Index (PSI). Parents (in this instance grandmothers that are in the parenting role) who obtain a TS score above a raw score of 90 (at or above the 90th

percentile) are defined as experiencing clinically significant levels of stress (Abidin,

1995). According to Abidin (1995), the TS score provides an “indication of the overall level of parenting stress an individual is experiencing.” The component stresses associated with the Parental Distress (PD) subscale are “impaired sense of parenting competence, stresses associated with the restrictions placed on other life roles, conflict with the child’s/grandchild’s other parent, lack of social support, and presence of depression (Abidin, 1995). This study will use a raw score of 90 or above on the Parenting Stress Index as the criteria for determining that a grandmother is experiencing caregiving stress.

Coping is the score obtained from grandmother’s reported responses on the modified version of the Ways of Coping Questionnaire (Lazarus & Folkman, 1988).

Custodial grandmother — Female grandparent with primary custody and responsibility for the grandchild or grandchildren. This will be limited to grandparent homes in East Baton Rouge, Lafayette, and St. Landry parishes in Louisiana.

Grandmother of African decent — Female grandparent, who identifies herself as being of African-American, African decent, or black.

Non-custodial grandmother — Female grandparent without primary custody or responsibility of the grandchild or grandchildren but who provides temporary childcare (8 — 30 or more hours a week) to assist parents during the stated societal antecedents. This grandparent lives in the same Louisiana parish/city where the grandchildren lives and provides day care activities on a regular basis to their grandchild. This will be limited to homes in East Baton Rouge, Lafayette and St. Landry parishes in Louisiana.

Parenting Stress is the negative mental response grandmothers ascribe to themselves and/or their grandchild or child. It is created by a series of appraisals made by each grandmother in the context of her level of commitment to the parent role, as measured using the Parent Stress Index (PSI) (Abidin, 1992). There is also a total stress index, including a health scale. This instrument was also used by Nunn (2002) in her study examining the health perceptions and parenting stressors of parenting for African- American grandparents.

Resilience is the score on the Resilience Scale reflecting the measure of internal resources and of the positive contribution an individual brings to a difficult life event (Wagnild & Young, 1990,1993).

Societal Antecedents are self-reported responses obtained on the Grandparent Demographic

Profile Form used to collect demographic data about grandmother and grandchildren.

They include child abandonment and/or neglect, parental employment obligations, parental education endeavors, and parental military obligations.

Summary

Grandmothers assuming the non-custodial child day-care activities or custodial care of a grandchild due to societal antecedents in times of limited social and financial resources calls for increased attention to the need for positive coping strategies to be used by grandmothers. A pivotal need has been addressed for developing a better understanding of coping strategies of grandmothers employed during societal antecedents. There is a need to better understand resiliency in grandmothers with stressful life events.

These events may stem from caregiver stress, family problems (either in immediate or extended family members), and personal stressors which lead to enhanced resilience or a lack of resilience in grandmothers of African-American or African decent. The earlier these characteristics are recognized, the better treatment is available. Recognition of resilience in this specific population will lead to the establishment of multi-dimensional health care intervention plans targeted at the custodial and non-custodial grandmother’s ability to regain earlier levels of function through increased resilience.

CHAPTER II

REVIEW OF LITERATURE

The purpose of this predictive correlational study is to examine the relationship between societal antecedents (child abandonment and/or neglect, parental employment obligations, parental education endeavors, and parental military obligations), coping strategies, and resilience grandmother caregivers of African-American or African decent. The study will examine both custodial and non-custodial grandmothers. Custodial grandparents are defined as those providing shelter and primary care of the grandchild. Non-custodial grandparents are defined as grandparents who do not have primary legal and financial responsibility of their grandchild but provide temporary childcare (8 — 30 or more hours a week) of African-American or African decent. An adaptation of Sister Callista Roy’s Adaptation Model was used as the theoretical framework that will guide this study.

In order to understand what has been done in this area of research in the past, as literature review of academic sources will be conducted. Sources for materials to be included in this review will include journals and other credible sources of information. The literature will help the researcher to understand the individual subtopics within their larger area of research and to identify gaps in the current body of knowledge. The research will explore several areas that are relevant to the research topic. The literature review is divided into four sections: Antecedents to grandmothers parenting grandchildren, grandmother stress, coping strategies utilized by custodial and non-custodial grandmothers, and resilience of custodial and non-custodial grandmothers. The following reflects the results of this literature review.

Antecedents to Grandmothers Parenting Grandchildren

Antecedents to the need for grandmothers to assume the primary caregiver role parallels societal trends. Studies suggest that several antecedents lead to children being raised by grandmothers include: child abandonment and/or neglect, parental employment obligations, parental education endeavors, and parental military obligations (Seamon 1992, Kelly 1993, Minkler & Roe 1993, Dressel & Barnhill 1994, Jendrek 1994, Dowdell, 1995; Musil 1998, Pruchno, 1999; Sands & Goldberg-Glen, 2000; Grinstead, Leder, Jensen and Bond, 2003; Ross & Aday, 2006). While grandparent parenting occurs in many races and socio-economic levels, African-American grandparents are disproportionately represented, due to the impact of substance abuse such as crack cocaine and incarcerations on children and grandchildren (Minkler & Roe, 1996; Joslin & Brouard, 1995; Minkler & Roe, 1994). The likelihood of stress and distress increases when parenting a grandchild is coupled with the parenthood of a cocaine abuser (Turpin, 1993). Additional stress related to substance abuse and incarceration of the grandparent’s children is well documented in the literature examined.

Jendrek (1993) conducted a study based on a screening and in-depth interview of 114 grandparents who provided daily care to their grandchildren in or near Butler County, Ohio. The sample was primarily white (96%) and female (97%). Respondents ranged in age from 41 to 71 years; the mean age was approximately 56 years at the time of the in-depth interview. More than half (55%) of the sample was not currently employed outside the home; 29% worked full-time and 16% worked part-time. The respondents’ educational level ranged from completion of the seventh grade to the completion of several Master’s degrees. The mean educational level of the group was approximately 1 year of college. The grandparents in the study said they had between 1 and 24 grandchildren; the median number was 3. Three major categories of grandparent care roles emerged from the data: custodial, living with the grandchild, and day-care roles. These categories were used to reflect the key categories in the current research study also.

The screening interview briefly examined grandparents’ temporal access to grandchildren and their degree of involvement with their grandchildren (Jendrek, 1993). The interview contained both subjective and objective assessments of the types and amount of care provided by the grandparent. In addition to the screening interview, an in-depth interview blended quantitative and qualitative methods to produce a more complete picture of grandparents who provide care to grandchildren. Focusing on one grandchild, the in-depth interview contained six sections (Jendrek, 1993). One section gathered information about the type of care currently provided by the grandparent (adoption, legal custody, temporary custody, guardianship, living with the grandchild but no legal relationship to that grandchild, and daycare) and the type of care, if any, provided previously by the grandparent. Using both open and closed- ended questions, a second section examined why grandparents provide regular care to grandchildren.

A third section focused on the decision to provide care and on whether pressures were exerted on them from an outside source to provide that care. A fourth section concerned grandparents’ employment experiences, with emphasis on whether providing care influenced either employment or retirement decisions. Grandparents’ leisure activities and the effect that providing care to a grandchild may have had on their lifestyle was the focus of a fifth section, which also used both open- and closed-ended questions. Grandparents’ use of service providers (social service agencies, medical practitioners, and lawyers) constituted the sixth section. Questions pertaining to grandparents’ feelings and concerns about providing care to a grandchild were interspersed throughout the interview (Jendrek, 1993). The overall aims, were to gather comparative information via the closed-ended questions and to allow the grandparents’ own words to help interpret and exemplify the findings. This combination of hybrid quantitative/qualitative research methodology has the advantage of providing both precise answers to research questions, while allowing the research expand on the results in a way that enhances their ability to apply the results or real-world situations.

Where more than one grandchild could serve as the focus grandchild, Jendrek randomly selected the focus grandchild from the screening interview data, using a table of random numbers. The screening interviews were conducted over the telephone and were not taped. Each screening interview lasted approximately one-half hour. In-depth interviews ranged in length from one-half hour to three and a half hours, depending on the type of care being provided by the grandparent.

Findings from the study revealed, that at least half of the total sample reported a change on 9 of the 20 lifestyle items. Jendrek (1993) reported that the three leading issues mentioned by a majority of the sample resulting in a change in the direction were: an increased need to alter routines and plans (79%), having more of a purpose for living (55.4%), and feeling more physically tired (55.0%) A majority of the sample population reported changes in the direction on less on three items: having less privacy (58.6%), having less time for oneself (58.0%), and having less time to get everything done (53.6%) (Jendrek, 1993). At least half of the custodial grandparents reported change, either increasing or decreasing, on 13 of the 20 items while, at least half of the day-care grandparents reported change on only 3 of the 20 items (Jendrek, 1993).

Jendrek’s research supports the hypothesis of this research study in that custodial grandparents caring for grandchildren are more likely to experience parental stress than non-custodial grandparents. Clearly the lifestyle of custodial grandparents undergoes the greatest change as was reflected by the fact that differences in change based on the type of care were statistically significant for 11 of the 20 items. Custodial grandparents reported the most change on 10 of these items. Day-care grandparents reported the least change on all statistically significant items (Jendrek, 1993). Jendrek’s research provides clear support for the inclusion of a related hypothesis in this research study.

Jendrek (1993) summarized her findings, concluding that custodial grandparents’ attempt to provide a stable environment for their grandchildren in the event that their own children are drug- and alcohol-addicted. She found that grandparents, especially day-care grandparents, attempt to provide their grandchildren with a stable day-care environment when parents work and day-care costs are prohibitive (Jendrek, 1993). The grandparents’ strength in the face of adversity, and their ability to cope with social antecedents led them to become custodial grandparents, apparently because they felt that they must (Jendrek, 1993).

The study by Jendrek provides several important perspectives that apply to the research study at hand. The first is that grandparents feel a sense of responsibility that goes beyond their own needs and wants, when it comes to their grandchildren. Jendrek did not explore or identify the root cause of this feeling of responsibility, but the fact that it was there was apparent. Grandparents were willing to put aside their own needs and expose themselves to hardship in many areas of their lives as a result of their feeling of responsibility to parent their grandchild. It is not known if this sense of responsibility is a result of internal, external familial, or societal pressures. Determining the reasons why grandparents choose to step in and parent their grandchildren in the face of societal antecedents represents a gap in the current body of knowledge.

Jendrek’s research makes this gap in literature apparent, but does not explore it further. The need to explore where this feeling of responsibility to help beyond one’s own personal concerns is apparent. It is suspected that social and cultural differences might exist between different demographic groups, but further research will have to be undertaken to explore this facet of the grandparent caregiver phenomenon. Grandparents feel the need to make great sacrifices for their grandchildren, yet the reasons for their decision are unknown. This creates a need for further research into these reasons. However, the scope of the current research will only allow the researchers to briefly touch on them.

Caregiving/Grandparenting Stress

An examination of the topic of caregiving/parenting stress in grandparents supports the need to conduct further studies into the reasons behind grandparent decisions to parent their grandchildren. Research supports the supposition that cultural and societal factors play an important role in these decisions. Although Hagestad and Neugarten (1985) note that “American society does not have formal norms regarding such interdependencies” of grandparents and grandchildren: informal expectations do exist (Jendrek, 1993).

In the normal societal pattern, one first becomes a parent and raises children. The children then form their own nuclear families, bearing and raising their own children. Grandparents remain free of parenting responsibilities in relation to grandchildren, except for the occasional visit or holiday stay. This is how American society defines the progression from child to grandparent and defines the expected relationships within this system. This societal pattern is violated when the grandparent assumes a parenting role for the third generation (Jandrek, 1993).

This upset in the natural order of roles produces stress in the lives of the grandparents. It violates their preconceived expectations about what life after parenting was complete. Stress may be created by this dramatic change in the grandparent’s life expectations and in the ability of their peers to provide social support (Hagestad & Neugarten, 1985). That is, grandparents who have been rehearsing expected grandparent roles suddenly find that they cannot play the role in the anticipated manner, causing them strain. Anytime our expectations are not met, it creates stress in our lives. The grandparent’s traditional support networks of friends and family may be unable to help because they are no longer simultaneously experiencing similar circumstances (Hagestad & Neugarten, 1985; Seltzer, 1976). Thus grandparents experiencing social antecedents of grandparents parenting grandchildren may find that they need to readjust their roles and support groups. However, these support groups might not be readily available as their peers move on to live out the traditional grandparenting role. The lack of a peer group support network may make them feel cut off from their support group. This lack of support, coupled with the changes in expectations can combine to create a considerable amount of stress in the grandparent’s lives.

A body of empirical literature has emerged suggesting that grandparents raising grandchildren, regardless of racial status, are negatively affected by their caregiving responsibilities. These negative impacts include psychological stress, social and economic well-being, and physical health (Burton, 1992; Minkler, Roe, & Price, 1992; Kelley, 1993; Minkler & Roe, 1993; Dowdell, 1995; Kelley & Damato, 1995; Roe, Minkler, Saunders, & Fuller-Thomson, 1996; Minkler, Fuller-Thomson, & Driver, 1997; Musil, 1998; Burnette, 1999a; Minkler & Fuller-Thomson, 1999; Whitley, Kelley, & Sipe 2001). According to these studies, grandparents have reported increased anxiety and depression since assuming primary parenting roles; others report an increase in smoking and alcohol consumption and an exacerbation of pre-existing physical illnesses such as arthritis and angina.

Studies also demonstrate that the enormous responsibility accompanying the revival of the parenting role can be overwhelming for an older person who has less energy (Shore 1990, Bower & Myers 1999). Slightly one third of African-American grandmothers in the Minkler, Roe, and Price (1992) study (N = 72) indicated that their health had worsened since beginning caregiving. Many of these African-American grandmothers attributed the change to the demands of their caregiving responsibilities (Minkler et al. 1992). African-American grandmothers raising their grandchildren reported feeling overwhelmed, unable to keep up with the grandchild’s activities, suffering from financial burdens, and lacking the time to take care of their own needs (Burton & Merriweather-de Vries 1992, Bowers & Myers 1999). Further review of the literature shows that some of the African-American grandmothers who took primary care of their grandchildren because of the parent’s addiction to cocaine experience great stress due to the multitude of family problems (Bower & Myers 1999)

It is not surprising that grandmothers experience increased stress and increased physical and mental problems associated with stress. However, studies also found that grandmothers may down play their health problems to protect grandchildren or because of fear that the children might end up in foster care. Minkler (1993) suggests that grandmothers may inflate their self-reported health status in order “to protect the children in their care and their authority to care for them.” It is not known whether the motivations for these decisions are internal or external. They represent a tremendous willingness to engage in self-sacrifice on the part of the grandmother, regardless of the reasons behind it.

Nunn (2002) conducted a study examining the health perceptions and parenting stressors of 31 custodial African-American grandparents in Detroit, Michigan. The objectives of the study were similar to those of this study. They were to examine the antecedents to grandparents becoming parents to their grandchildren, the grandparents’ perception of their health status, and their assessment of parenting stress. A researcher-designed Demographic Questionnaire, the Short-Form 36 Health survey, and the Parenting Stress Index (PSI) were used to collect data on grandparent ages, education, marital status, background information on grandchildren, and antecedents to grandparent parenting, the grandparents’ perception of own health status, and to reveal stresses in the Parent and Child domains. Results indicated that the grandparents parented minor grandchildren because of biological parent neglect/abuse, abandonment, mental illness, substance abuse, teen mother, or the death of a parent (Nunn, 2002). While most grandparents considered their health to be satisfactory, the grandparents, with ages ranging thirty to sixty reported a greater number of health concerns. Nunn noted these contradiction to earlier studies and added that the reason was unclear. Older grandparents had fewer health complaints, which Nunn explained may be a result of years of learned coping skills. The Total Parenting Stress scores identified by the PSI were less than the Life Stress scores (Nunn, 2002). The current research study will shed light on these contradictions and will provide greater depth to the topics covered in this research study.

Literature that describes the impact of raising grandchildren on the health of grandparents also links caregiving stress and mediators of stress. Mediators such as support systems, coping mechanisms and empowerment have been recognized as being of particular interest to health care providers (Grinstead, Leder, Jensen and Bond 2003). Grinstead et al. (2003), after a critical review of research literature on the health of grandparents raising grandchildren, found relatively few studies that addressed the health of grandparents as the central concern. Information about health status, according to this review of the literature, often appeared as secondary or incidental findings. However, the health of the grandparents should be a particular concern, as these issues can affect the care that they are able to provide their grandchildren.

Few studies have critically examined physical and mental health consequences in grandparents raising grandchildren. Few studies that included qualitative contextual data about housing and their home environment have been conducted as well. Butler & Zakari, (2005), conducted a descriptive study of the physical and emotional health of grandparents raising grandchildren and the extent to which caring for their grandchildren affected the grandparent’s health. Both quantitative and qualitative data were collected, through the use of an interview process, using a sample of 17 custodial grandparents who lived within a three state metropolitan area during a 1-year period. Data collected included physical and mental health status and health problems, level of health, level of stress, economic difficulties, family and social supports. The study provided useful information related to predictors of assumption of care, and the problems involved in raising grandchildren. Results of the study reflected wide variations in physical and mental health status. However, most participants tended to score high on parental stress-particularly in the child domain (Butler & Zakari, 2005). Disruption of social activities, financial problems, and alterations in family relationships were of significant concern (Butler & Zakari, 2005). This study reflects a need to delve deeper in the ability to develop better coping skills and resiliency in these circumstances. It supports the need for the current research study and its application to the nursing field.

Musil and Standing, (2005), studied the daily lives of grandmothers, and the differences in daily stresses based on their caregiving status to grandchildren. The stresses of 64 grandmothers living in northeast Ohio, grouped by caregiver status (grandmothers raising grandchildren, grandmothers living in multigeneration homes, non-caregivers to grandchildren) were recorded in three-week diaries and examined. The results of the study found that grandmothers raising grandchildren reported more stress related to grandchildren’s routines, activities, and school progress. They also reflected greater pressure and difficult interactions with grandchildren. The diary entries of grandmothers in multigenerational homes reflected their supplemental role in childcare, and sometimes stressful interactions with other family members. Grandmothers with no routine caregiving for grandchildren reported more involvement with those outside the immediate family. Many general concerns about the well-being of the family represent commonalities in grandmothers despite differences in current caregiving roles for grandchildren (Musil & Standing, 2005). This study supports the impact of enormous stresses for those who must regularly care for their grandchildren. The need to reduce these stresses is apparent in the responses of this and other studies previously examined.

In 2007, Standing, Musil, and Warner conducted a qualitative study, using a phenomenological approach, to learn how grandmothers perceive the change in their caregiving roles for grandchildren and changes in their household composition. Analysis of a semi-structured telephone interview with 26 custodial grandmothers identified several common themes. These themes included mixed feelings, changes in personal freedom, flexibility with unpredictable changes, spirituality as strength, commitment to grandchildren, and role transformation. The focus of this study was to explore the meanings grandmothers attached to the major changes in daily responsibilities, her views of herself, and her role in the family.

The presence of key stresses in the lives of grandparents who are thrust into the role of caregivers for their grandchildren is the primary premise behind the conduct of this research study. The body of literature examined confirms that both custodial and non-custodial grandmothers of grandchildren experience stresses that stem from many sources. Some of these sources of stress are internal, while others are external. The most common theme that was found in the literature is that these grandparents did not experience only one type of stress at a time. They experienced multiple sources of stress, all of which had an additive affect on their well-being. Parental stresses in grandparents had many negative affects on them. These included mental strain and physical health concerns.

The most important finding of this group of literature is that the stress of caring for grandchildren has a detrimental affect on the grandparents. The mental and physical affects of stress manifest in many ways. This group of studies highlights the importance of this study and the ability to identify ways to help increase coping strategies and resiliency in grandparents who are caring for grandchildren. The presence of mental and physical conditions that were already in existence in the grandparents before they took on the role of parents is of particular concern to the nursing profession. This suggests that nurses already have contact with these grandparents as a result of existing physical and mental illnesses.

The research highlights the importance of the nurse in alleviating stress that is a result of the parenting role in grandparents. This body of research indicates that even if the grandparents are not already involved with the health care profession due to existing physical conditions, it is probable that they will need healthcare services in the future due to the detrimental affects of stress caused by their new role as parents. Nurses could play a key role in identifying grandparents who are in need of services to help them cope with and develop resilience that result from their new role as parents. The ability of nurses to identify grandparents in need of their services and the ability to integrate treatment related to the stresses of parenting could play a pivotal role in the quality of life for grandparents who must perform the parenting role. This section of research studies highlights the need for the current research study.

Stressors and Protective Factors of Custodial and Non-custodial Grandparents

At present, no social model exists for the new family structure that is emerging for grandparents. The new nuclear family may consist of a Grandmother, a Grandfather and the children. Appropriate models of behavior may not exist for many contemporary grandparents who raise their grandchildren. These grandparents must define for themselves the nature of the new parental role with which they must cope (Rosow, 1985). Individuals have no control over when they become grandparents or their geographical proximity to their grandchildren. They are typically not in control of the antecedents that lead them to fall into the role either. Their new role can come quite unexpectedly or quickly.

Previous research by Burton (1992) has indicated that custodial grandparents derive many rewards from their parental roles. However, this is mixed with the stresses that go along with it as well. Burton’s research was one of few to explore the advantages and rewards that go along with parenting the grandchildren. Reading the current body of literature could give one the perception that grandparents in the caregiver role give up a life of bliss for a life of stress and hard labor, but that is certainly not the case. The focus of this research, and of the body of research in general is on solving the problems associated with this new role. For some grandparents, the problems might be great, but underneath it all, they love their grandchildren and want to care for them.

The focus of the nursing profession tends to be oriented towards finding the solutions to problems. This leads to a tendency to focus almost entirely on the problems. Afterall, without problems, there would be little need for nurses in the first place. However, focusing only on the problems can lead to a myopic view of the situation being addressed. In this case focusing on the stresses and reasons for the stresses associated with grandmother caregiving of their grandchildren will help nurses to identify and help patients learn to cope with these stresses and the affects of these stresses. However, Burton’s research reminds us to look to the positive affects on grandmothers who parent grandchildren. By looking at the positive affects, nurses might be able to identify protective factors that help grandparents combat the negative effects of the stresses of the situation.

The ability to cope with stress is combination of stress factors and protective factors. The formula is different for everyone, both in the stresses that are present and the protective factors that are present. Perception also plays an important role in the balance between stress and protective factors. What is stressful for one person might not be stressful at all for another. This literature review has revealed a number of clearly identifiable stress factors associated with grandmothers who must assume the role of primary caregiver for their grandchildren. However, equal attention needs to be paid to any positive effects as well. Within these positive affects, the nurse might be able to find protective factors that could be leveraged to help the patient better cope with the new stresses in their life.

The nurse often cannot eliminate the stresses that create mental health and physical health concerns in grandmothers who must assume the role of caregiver for their grandchildren. These factors are often outside of the role and scope of the relationship between the nurse and the patient. The nurse is supposed to help the patient find ways to cope with the stresses in their life, regardless of the sources of their stress. Examining protective factors in the patient’s life can play an important role in helping the patient to develop a plan for dealing with the stresses in their life. Therefore, more academic attention needs to be placed identifying protective factors in the lives of grandmothers who must care for their grandchildren. Focusing on the positive will go much farther in this case than focusing on the negative.

As far as nurses are concerned, one can look at stresses and protective factors as two sides of a coin. On one side, identifying stresses can help nurses to identify those who are at risk for health problems related to the stresses related to the caregiving role for their grandchildren. However, this can only go so far in identifying those who are risk for developing problems in this area. Simply knowing what stresses created the problems in the grandparents lives can help the nurse to identify them but it cannot help to resolve their problems in many cases. The nurse simply has little control over the stresses in the patient’s life, neither does the patient in many cases. There are simply too many things in life that cannot be controlled. Therefore, the nurse must turn elsewhere to search for answers in helping the patient.

Once the nurse has used stresses to identify patients who are in need of help, they must turn their focus to finding ways to help them. This is where the identification of the positive effects of caregiving can be helpful. The nurse can help the grandmother focus on the good and to rely on their own protective factors to help reduce or overcome the stresses in their life. The study by Burton might seem to be insignificant in light of a majority of the information found in the literature review, but it brings up a very important and understated point in light of the other literature that was found. It is apparent that if nurses are to play an important role in helping grandmothers overcome the stresses associated with the care of their grandchildren, they will need more information on the positive protective factors that can help them accomplish this goal. More academic attention needs to be directed towards protective factors and the positive affects of caring for grandchildren so that they can be used to develop effective coping strategies and treatment plans. This obvious gap in the current body of literature might have been missed had it not been for Burton’s research.

This position is also supported by other researchers in the area of stress and the mediation of stress. Literature that describes the impact of raising grandchildren on the health of grandparents connects caregiving stress and the mediators of stress. Mediators such as support systems, coping mechanisms and empowerment are recognized as being of particular interest to health care providers (Grinstead, Leder, Jensen and Bond 2003). Grinstead et al. (2003) after critical review of research literature on the health of grandparents raising grandchildren, found relatively few studies that addressed the health of grandparents as the central concern.

Information about health status, according to this review of the literature, often appeared as secondary or incidental findings. However, the health of the grandparents needs to be a primary concern for researchers in this area. Their health not only affects their future, it has an impact on their quality of their relationship and on the quality of life of their grandchildren as well. Healthy grandparents will be able to do a better job of parenting for their grandchildren.

Given the tragic circumstances under which custodial grandparenting is required, the difficulties experienced by the involved grandchildren may, in many ways, exacerbate those adjustments associated with the need for middle aged and older grandparent to assume parenting roles. For example, it is quite clear that the impact of divorce, abuse, or living with a parent who is abusing drugs can be quite negative for many children in both short- and long-term consequences (Hayslip, Shore, Henderson, Lambert, 1998). Coping with such stress and difficulties may heighten the grandparents’ sense of role confusion and isolation from their age peers. In addition, it might further interfere with the grandparents’ relationship with grandchildren for whom the grandparents are not providing care (Emick & Hayslip, 1996).

Once again, this brings up an important factor in the literature review. The focus of research revolves around the new nuclear family that is formed when grandparents begin to care for their grandchildren. However, research often forgets that there may be other grandchildren in the family who will not be cared for by the grandparents. This children might experience a number of affects, such as feeling jealous, or that their ability to have as relationship with their grandparents has been hindered. They might view the children being cared for by the grandparents in a different light than they did before the change in circumstances. Yet, these problems have not been addressed in literature on this subject.

Moreover, a grandchild’s problems linked to his or her parents’ divorce could further complicate the grandchild’s adjustment to being cared for by grandparents (Hayslip et al., 1998). Grandchildren’s difficulties may also interfere with the grandparents’ lifestyle, leaving them little time for one another, requiring everyday routines to be altered, and making future plans they have made less certain (Jendrek, 1994). Different grandchildren affect grandparental feelings and perceptions in different ways (Thomas, 1990; Hayslip et al., 1998). This topic has not been adequately addressed in the literature, and it might be a taboo subject, but it will have an effect on the grandparent’s adjustment to their role. It is unlikely that this topic could be addressed effectively in a research setting because it is unlikely that grandparents would be willing to admit favoritism towards one or more of their grandchildren. Although this might be a factor in reducing stress, it is not a topic that could be included in a nursing intervention for the same reason.

Hayslip et al. (1998) conducted a comparative study of three groups of grandparents in order to examine the extent to which personal, role-specific, and grandchild-relationship as sources of distress were experienced. Custodial grandparents were in a nontraditional role, while attempting to separate grandparental role demands from child-specific problems as the source of such distress. Studying custodial grandparents in this manner, would permit a clearer view of the unique stresses and demands of this new role apart from the stresses associated with problems experienced by the grandchildren (Hayslip et al., 1998).

Participants in this study were 193 male and female grandparents from Dallas-Fort Worth area of Texas. Volunteers were recruited by a variety of methods to ensure a reasonable representative sample of both custodial and traditional (non-custodial) grandparents. Both clinic and self-help groups were approached as potential sources of custodial grandparents due to a high incidence of family trauma that often leads them to become custodial grandparents (Hayslip et al., 1998). Senior centers, older adults’ organizations, and newspaper announcements identified both custodial and traditional (non-custodial) parents. When a couple was parenting, only one member of the couple was permitted to volunteer.

Hayslip et al. piloted an initial version of the questionnaire, with 10 elderly participants to determine any difficulties inherent in self-administration. Based upon the results of the pilot study of the questionnaire, several changes were made to make the questionnaire more concise and clear. Revised questionnaires were subsequently distributed in person by the second author (Shore) to each participant, and then returned by the participant to a contact person at the participant’s referral point (e.g., clinic, support group, senior center) (Hayslip et al., 1998).

An overview of the analyses of the study revealed the value of differentiating between the demands of reassuming the parental role in middle and later life and the difficulties particular to the grandchild being raised as sources of stress in the lives of custodial grandparents. This distinction is especially significant in light of the circumstances (antecedents) that led the grandparent to become a custodial grandparent. The study results indicate that aspects of psychological distress or well-being, role satisfaction, relationship quality, and, to a certain extent, some dimensions of grandparental meaning are affected negatively by the resumption of the parental role, especially when the child being cared for evidences a variety of difficulties with which the grandparent must cope (Hayslip et al., 1998). This reminds us that it is dangerous to over generalize and that the experiences of grandparents differ. Nurses must remain sensitive to this fact when caring for this special group.

The sense of satisfaction associated with the obligation to one’s parental responsibilities is also reflected in this study; all but 11 of the 101 custodial grandparents indicated that if they had it to do over, they would assume responsibility for their grandchild again (Hayslip et al., 1998). On the other hand, 41% of the custodial grandparents indicated that if someone else could be found who was completely acceptable to them as a surrogate parent, they would allow that person to assume the care of their grandchild (Hayslip, Shore, Henderson, and Lambert, 1998). Thus, they were experiencing some ambivalence about their parental roles, reflecting the stresses of raising grandchildren (Hayslip, Shore, Henderson, and Lambert, 1998). This ambivalence might increase the stresses that they associate with their new parental role.

The findings also suggest that women receive more social support, which reflects the relative difficulties that women in the study faced in raising their grandchildren and the importance of social support in resolving them (Hayslip et al., 1998). Women are more likely than men to assume the bulk of custodial grandparenting responsibilities (Bengtson et al., 1990). Despite reporting more support, women are nevertheless affected differentially by the presence or absence of problem grandchildren (Hayslip et al., 1998). This is especially important given the crisis-like circumstances under which custodial grandparenting comes about (Emick & Hayslip, 1996; Minkler et al., 1992). Nurses need to be aware, as do future researchers, about the increased risk of stress and health problems associated with grandmothers, as opposed to grandfathers, assuming the parenting role for their grandchildren. The stresses are likely to be much greater for grandmothers, as they take on the greatest portion of responsibility when a crisis occurs. They must no only cope with the crisis, they must take on a majority of the parenting responsibilities as well.

This body of research found that assuming the role of parent by a grandparent introduces an incredible amount of stress into their lives. They must cope with many changes, for which many were not prepared. This section of research found that the circumstances under which grandparents become parents can occur quite suddenly, with little preparation. Several major gaps in the research were identified, not the least of which is the need to study protective factors and the positive affects of grandparents assuming the parental role. Research also need to focus on the affects of the changes on other family members, such as grandchildren not living with the grandparents. The affects of the changes on these family members can also have an affect on grandparent stress and the ability to cop with parenting their grandchildren.

One of the most important findings of this portion of the literature review is that the relationship of the grandparent with the child is important in the ability of the grandparent to cope. Having a child who misbehaves or who has other problems adds to the stress experienced for the grandparent caring for them. Research need to focus on separating factors that are associated with a particular child from those that are general factors associated with the stress of caring for grandchildren. This factor will have to be considered in drawing the conclusions of this research study as well. Particular factors associated with a child who misbehaves or has other difficulties could represent a confounding variable in the study. The issue of child behavior and child-specific stress was accounted for in the research instruments used in this study through certain questions. This portion of the literature review will play an important role in identifying potential sources of bias in the current study and in the direction of future research in this area.

Coping Strategies of Custodial and Non-custodial Grandparents

Thus far, prior research studies conducted on African-American grandparents as custodians of grandchildren have not expanded to describe the overall coping resources employed by these grandparents and how they facilitate their psychological well-being (Moore & Miller, 2007). More recently, research studies have begun to identify coping resources that are central to enhancing the psychological well-being of African-American grandparents who are raising grandchildren (Musil, Schrader, & Mutikani, 2000). Coping resources generally refer to behavioral or cognitive attempts to manage demands perceived as challenging life events (Lazarus & Folkman, 1984). Results of contemporary empirical studies indicated that coping resources such as intergenerational solidarity, informal social support, and spirituality have a major impact on enhancing the psychological well-being of African-American grandparents who are raising grandchildren (Musil, Schrader, & Mutikani, 2000).

Using secondary data analysis, Minkler and Fuller-Thomson (1999) compared the functional and self-rated health of grandparents raising grandchildren with that of non-custodial grandparents. They found that custodial grandparents were more likely to have limitations in four activities of daily living compared to non-custodial (Minkler & Fuller-Thomson, 1999). One might recall that this issue was also raised the prior studies that compared custodial to noncustodial grandparents raising their grandchildren. It was found that custodial grandparents had more responsibilities and that they had higher levels of stress when compared to noncustodial grandparents. It would appear from these research results that custodial grandparents represent an increased risk for stress when compared to noncustodial grandparents and that they should receive special attention from the nursing community due to these increased risks.

Research findings presented in several studies recognized that the task of parenting is a highly complex one and that it often must be performed within very demanding situations, with limited personal resources. When one considers these factors in relation to a child who by virtue of some mental or physical attributes may be exceedingly difficult to manage, grandparents can experience even greater stress in the care of that child (Abidin, 1990). These studies show that custodial grandparents tend to experience worsened emotional and physical health caused by parenting and/or observing the deterioration of an adult child on drugs (Minkler et al., 1992). They also experience increased financial obligations (Kelley, 1993), an increased lack of instrumental and emotional support (Burton, 1992), and increased role conflict (Burnette, 1999b).

According to Abidin (1990), parenting stress refers to the stress of a parent’s experiences, that is a function of certain salient child characteristics, parental characteristics, and situational variables that are directly related to the role of being a parent. It is apparent that drug use by the child increases these stresses by many fold. Drug use by the child must be considered by the nurse in the determination of stress levels that might affect the grandparent caring for a grandchild under these circumstances.

Holroyd and Lazarus (1982) elaborated on the potential pathways by which coping with stressful situation may affect health. They reported: (1) coping strategies may influence health by affecting how often and how long neuroendocrine stress response occurs; (2) As a secondary gain, illness in itself may become a stable coping response; (3) Coping behaviors selected may be ones that are injurious to health, for example, smoking or drug use; and (4) Choice of coping strategies may directly affect an existing health problem, for example, taking needed medication as directed. Findings from the California-based Grandmother Caregiver Study, Miller (1991) reported declining health after becoming surrogate parents. Other studies have found changes in social behaviors, such as an increase in cigarette smoking and alcohol consumption (Burton 1992, Minkler & Roe 1996, Minkler, Roe, & Price 1992). Understanding the mechanisms that lead to decreased health outcomes under prolonged stress are an important factor for the nursing student.

In 2002, Musil and Ahmad investigated a comparative study of the health of grandmothers according to caregiver status. In a cross-sectional study, stress, coping, social support, and health were compared in 86 custodial grandmothers, 85 partial/supplemental caregiver grandmothers in multigenerational homes, and 112 noncustodial grandmothers. The study had two main purposes: (a) to compare stress, health, coping, and support between custodial grandmothers, partial/supplemental caregiver grandmothers, and noncustodial grandmothers and (b) to test whether coping and support affect the mental and physical health of custodial and partial/supplemental caregiver grandmothers and if these effects are primary, moderating, or mediating (Musil & Ahmad, 2002). Data collection included mailed questionnaires that incorporated measures of stress, health, support, and coping.

The study revealed that custodial grandmothers reported worse self-assessed health, but partial/supplemental caregiver grandmothers reported a tendency toward more depression and more instrumental support (Musil & Ahmad, 2002). According to the modified Ways of Coping Checklist (Lazarus & Folkman, 1984), non-custodial grandmothers reported the least stress and less active and avoidant coping. Coping and subjective support added to the variance of depression and self-rated health (Musil & Ahmad, 2002). These studies support the idea that stress is different for custodial and noncustodial grandmothers and that stress affects them in many different ways.

Ross & Aday (2006) conducted a study of 50 custodial African-American grandparents who resided in Harris County, Texas. The specific objectives were to (a) determine the degree of stress in African-American grandparents who are raising their grandchildren, (b) identify coping strategies utilized, and (c) identify the importance of the characteristics of the caregivers and the caregiving situation itself and specific coping strategies that influence the degree of stress (Ross & Aday, 2006).

The sample consisted of grandchildren 12 years of age or younger living with their grandparents in January and February 2001. The principal investigator conducted structured interviews at senior centers and churches where the grandparent caregivers were affiliated. Five interviews were conducted in the home of the grandparent due to weather conditions or transportation problems. Interviews lasted approximately 40 minutes (Ross & Aday, 2006).

A convenience sample comprising 50 African-American grandparents who met the inclusion criteria was recruited. In all, 42 grandmothers, 4 great-grandmothers, and 4 grandfathers participated. Participants identified other grandparents; therefore, snowball sampling was utilized in obtaining some of the respondents.

Instruments used in the study included the Parenting Stress Index/Short Form (PSI/SF) and the Ways of coping Questionnaire 9 WCQ-Shortened Version. The PSI/SF is a 36-item derivative of the PSI/full-length test, that can be used to generate a score for Total Stress (TS) and three subscales: Parental Distress (PD), Parent-Child Dysfunctional Interaction (PCDI) and Difficult Child (DC). Reported coefficient alpha and test-retest reliability ranges for TS were .84 to .95 and .68 to .92 for the subscales (Abidin, 1995; Musil, 1998). For this study, Cronbach’s alphas for the PSI/SF were .95 for TS and .86 to .92 for the subscales (Ross & Aday, 2006).

The Ways of Coping Questionnaire — Shortened Version (Lazarus & Folkman, 1984) used by Judge (1998) consisting of 24 items that tap coping strategies associated with ordinary stressful events in day-to-day lives was utilized. Scores were calculated by summing the ratings for each subscale. The shortened version was used in this study to reduce respondent burden. Cronbach’s alphas for the WCQ subscales were self-control (? = .76), accepting responsibility (? = .71), positive appraisal (? = .69), confrontive coping (? =.64), seeking social support (? = .63), distancing (? = .61), escape avoidance (? = .40), and planned problem solving (? = .37). With the exception of escape avoidance and planned problem solving, the subscales were marginally significant (Ross & Aday, 2006).

The Parenting Stress Index (PSI) and the Ways of Coping Questionnaire, 94% reported a clinically significant level of stress. Indeed, 92% were experiencing clinically significant levels of stress (> 90th percentile) according to the PSI developed by Abidin (Ross & Aday, 2006). These study findings reflected that coping strategies were significantly correlated with less stress including accepting responsibility, confrontive coping, self-control, and a positive clinically significant level of stress. Coping strategies significantly correlated with less stress included accepting responsibility, confrontive coping, self-control, positive reappraisal, planned problem solving, and distancing. These factors will be helpful in the design and comparative findings of the current research study. These finding support the rationale for the design of this study and its usefulness in developing strategies to help nurses design effective case plans and treatment strategies.

An important finding was that with increased years of caregiving, grandparents experienced less stress (Ross and Aday, 2006). It appears that with the passage of time, grandparents were better able to establish a routine and to adjust and cope with the demands of caregiving (Ross and Aday, 2000). In addition, it is possible that the grandparents accepted the likely reality that they would serve as primary caregivers for their grandchildren until the children became independent (Ross and Aday, 2000). The length of time spent in the caregiving position appears to be an important factor in the stress level of grandparents, but it was not addressed in other research studies.

This study found that the grandparent’s primary reason for caregiving was because of neglect of the grandchild related to parental substance abuse by one or both parents. This finding was consistent with the findings of Burton (192), Dowdell (1995), Kelley (1993), Minkler and Roe (1993), Musil (1998), and Pruchno (1999). It would seem that worry about both their children and grandchildren would be an added stress and burden (Ross and Aday, 2000).

Only one study was found that concentrated on the development of coping strategies used by the grandparents placed in the position of caring for their grandchildren. This factor will be the key focus of the current research study. It is important to understand the problems and factors that lead to the stress and there have been many studies that focus on finding these factors. However, the purpose of this study is to aid in the development of strategies for solving the problems related to stress. Therefore, this study will add to the body of knowledge that addressed the coping strategies that are already in use by grandparents and which ones have proven to be more effective.

It is apparent that much more emphasis has been placed on the identification of stress factors in the grandparents and very little has been placed on protective factors or the coping strategies that are already in use by them. Understanding which strategies are already in use by grandparents and which ones are effective and which ones are not will be a great aid in the development of helping them to develop better coping strategies. This was an important finding in this literature review.

Resilience of Custodial and Non-Custodial Grandparents

The study of resilience is relatively new in the field of psychology, with most research focusing on children (Garmezy, 1993; Rutter, 1987, 1993; Werner, 1984) until 15 to 20 years ago. However, it was only recently that the nursing profession began to recognize its potential contributions in diverse clinical contexts (Gillespie, Chaboyer, Wallis, 2007). Traditionally, health care interventions have used a model grounded in pathology, which emphasizes deficits and fixing problems (Wagnild, 2009). Focusing on concepts such as resilience redirects health care to recognize strengths and develop strategies to build on existing capabilities in African-American grandmothers. Resilience connotes inner strength, competence, optimism, flexibility, and the ability to cope effectively when faced with adversity (Wagnild, 2009). Resilience is the key to developing effective coping strategies in the research population.

Resilience is a process that can be developed at any time during one’s lifespan, and thus is not an inherent characteristic of personality (Gillespie et al., 2007). In the mid-nineties, Dyer and McGuiness (1996) undertook a conceptual analysis of resilience. Several limitations make Dyer’s and McGuiness’ concept analysis less applicable today (Gillespie et al., 2007). The age of this 1996 publication, more than a decade ago, affects its conceptualization, measurement and utility in explaining why some individuals are able to overcome adversity while others are not, and thereby form strategies that may build resilience (Gillespie et al., 2007). However, this pivotal work still forms the underpinnings of modern theories regarding resilience. Therefore, it is still worth mentioning in this literature review.

Another conceptual analysis of resilience was conducted by Gillespie et al., using the logical and systematic approach described by Walker and Avant (1995) to gain new insights about the resilience derived from a synthesis of the previous literature. The study had two purposes: (1) To identify current theoretical and operational definitions of the concept of resilience; and (2) To identify the constructs that are the defining attributes of resilience (Gillespie et al., 2007). From this analysis, a conceptual model of resilience suggests that the constructs of self-efficacy, hope and coping are defining characteristics of resilience (Gillespie et al., 2007). The development of resilience is based on the synergy shared between individuals, their environment and experiences.

In a qualitative study using a grounded theory approach, Wagnild and Young (1990) endeavored to describe the qualities that characterize elderly women who can adjust to major life loses. They offer two related definitions of resilience in older women: (1) A unique human phenomenon distinguished by the lived experience of rebound in health after loss in women late in life, and (2) the ability to adjust successfully to major life losses. The study consisted of twenty-four Caucasian women between 67 and 92 years old who had experienced losses, such as death of a loved one, loss of employment, loss of health, and losses associated with relocation.

Five overarching themes that emerged from data analysis were used to describe resiliency. The themes identified were: (a) equanimity — a balanced perspective of one’s life experience; (b) perseverance – persistence in spite of adversity, and a willingness to continue the struggle; (c) self-reliance — a belief in oneself and capabilities; (d) meaningfulness — the realization that life has a purpose and the value of one’s contributions; and (e) existential aloneness — the realization that each person’s life path is unique (Wagnild & Young 1990). The authors compared their findings to the available literature and noted its congruence.

Felten and Hall (2001) explored the concept of resilience in diverse women older than 85 and the proposed the basic elements of a middle range theory of resilience applicable for that group of older adults. Following Meleis’s approach of concept analysis, the conceptualization of resilience formed a foundation of inquiry to study how and why some women, older than 85, rebound after illness and others do not.

The topic of resilience is much like the topic of motivation. Consistent theoretical underpinnings based on research do exist and certain themes have emerged as a result. However, when one attempts to apply them to a particular case, they have a tendency to fail both in their predictive value and in their ability to identify and resolve problems. Nurses need to develop a system that is predictive and that can be applied to individual patient cases. This is perhaps the greatest challenge in this research that was identified in the literature on resiliency. Resiliency was found to be a highly individual reaction.

Just as with the study involving older women who had suffered losses late in life, some grandparents might adjust to caring for grandchildren, while others will not. The factors that were identified by (Wagnild & Young 1990) will be likely to have an impact on the ability of the grandmothers chosen for this study and their ability to cope with caring for their grandchildren under what could prove to be a highly stressful situation. Nurses can use these factors to determine who might be better able to cope, but many of these factors may require therapy in order to develop them. The most important factor found in this section of the study is that resiliency can be acquired later in life and that it is not a fixed personality trait. This means that resiliency can by built in grandmothers who are suddenly thrust into the role of caregiver.

Summary

In summary, the phenomena of grandparents becoming primary custodian of grandchildren has been studied both by quantitative and qualitative research methods. The societal reasons for this phenomenon have been studied and demographic characteristics of this population published by sociologists and nurses. Many of these studies report negative physiological and psychological affects of grandparents providing childcare to grandchildren. Studies about resilience and the impact of parenting stress are very limited.

Resilience studies, when found, are primarily of children, especially those children being cared for by grandparents and attending school. Resilience was evaluated by the child’s adjustment and performance in school. These studies might be helpful in identifying the factors that increase resilience, but they are hardly applicable to the study at hand.

Many researchers show that the grandmothers of African-American or African decent possess a major source of support in the African-American family network. These grandmothers are willing to raise their grandchildren, despite advancement in age, little financial support and limited social support. Studies that focus on the ways that grandmothers cope in different societal antecedents are impressive and support the ability of these grandmothers to learn to adjust to their new circumstances.

CHAPTER III

METHODOLOGY

The purpose of this predictive correlational study is to examine the relationship between societal antecedents (child abandonment and/or neglect, parental employment obligations, parental education endeavors, and parental military obligations), coping strategies, and resilience in African-American or African decent. It will examine both custodial grandmothers providing shelter and primary care to a grandchild and non-custodial grandmothers who do not have the primary responsibility of providing for a grandchild but who provide temporary childcare (8 — 30 or more hours a week) in three Louisiana parishes. An adaptation of Sister Calista Roy’s Adaptation Model will be used as the key theoretical framework to guide this study. According to Roy’s Adaptation Model, basic knowledge of human behavior is the understanding of how individuals adapt within their various life situations (Roy, 2009). Included in this chapter will be a discussion of the research hypotheses, sample, recruitment procedure and study design, setting, and study procedure and instrumentation. Also included in the discussion are the proposed methods for data analysis.

Rationale and the Research Hypotheses:

This study will use this research methodology to support the following hypotheses:

Ho1

No empirically significant relationship exists among both custodial and noncustodial grandmothers of African-American or African decent in their coping strategies, level of resilience, caregiving/parenting stress, and selected demographic variables such as the age of the grandmother, economic status of the grandmother, educational level of the grandmother, age of the grandchild/grandchildren, number of grandchildren requiring custodial care, or the health status of the grandchild.

HA 1

An empirically significant relationship exists among both custodial and noncustodial grandmothers of African-American or African decent in their coping strategies, level of resilience, caregiving/parenting stress, and selected demographic variables such as the age of the grandmother, economic status of the grandmother, educational level of the grandmother, age of the grandchild/grandchildren, number of grandchildren requiring custodial care, or the health status of the grandchild.

The inclusion of this research hypothesis is supported by the literature review. It was found that demographic factors had an impact on both the level of stress in the grandparents and in their ability to develop appropriate coping methods for the situation. This research hypothesis will be examined through comparison of the results of research instruments among various demographic groups identified via the research instruments.

HO 2.

No empirically significant difference exists between custodial and non-custodial grandmothers of African-American or African decent in terms

of caregiving/parenting stress, coping strategies, and level of resilience.

HA2

An empirically significant difference exists between custodial and non-custodial grandmothers of African-American or African decent in terms of caregiving/parenting stress, coping strategies, and caregiver resilience.

This hypothesis is not supported by the literature review. The rationale for this hypothesis stems from the supposition that the development of resiliency and coping strategies is the result of individual factors, rather than the outside factors that created the situation. The literature did support the fact that custodial grandparents have greater financial and parenting responsibilities and that they experience increased levels of stress. However, research on resiliency does not support that idea that that the amount of stress or the source of stress has to do with the development of resiliency. Instead, it indicates that any person can develop resiliency, if they are willing to develop an attitude that is conducive to doing so. Therefore, the ability to cope with stress and the development of resiliency is not expected to have to do with whether the grandparent is experiencing higher levels of stress as a custodial grandparent, but rather that they can develop resiliency with proper treatment and help.

HO3

Societal antecedents (child abandonment and/or neglect, parental employment obligations, parental education endeavors, and parental military obligations) are not predictive of caregiving/parenting stress, coping strategies, and level of resilience in both custodial and non-custodial grandmothers of African-American or African decent.

HA3

Societal antecedents (child abandonment and/or neglect, parental employment obligations, parental education endeavors, and parental military obligations) are predictive of caregiving/parenting stress, coping strategies, and level of resilience in both custodial and non-custodial grandmothers of African-American or African decent.

This research hypothesis is also supported by research that indicates that the amount or source of the stress is not a factor in the ability to develop coping strategies and resiliency. The source of stress was not found to be predictive of whether a person could cope with it or not. The person can develop coping strategies, regardless of they source of their stress. The literature review supports inclusion of this hypothesis in the research study.

The key method of exploration for these topics was found to involve the use of questionnaires, interviews and other survey instruments. These methods were found to produce excellent results in studies involving similar research hypotheses. These methods yielded consistent survey results in the studies that were examined. The use of questionnaires and interviews represents the major methodology used in the study of these and other research topics. Use of survey questionnaires has sufficient support for its use through the weight of evidence found in the literature review regarding the success of these methods. The use of a study design based on survey instruments is supported by a large number of historical research that has successfully employed this study method. Therefore, the use of surveys and questionnaires is thought to be an appropriate research design for the current research study.

Research Design

The purpose of a predictive design was to “examine casual relationships between variables and predict the level of the dependent variable from the independent variable” (Burns & Grove, 2009, p. 247). In a predictive correlational study design that examines casual relationships, the terms independent and dependent variables are appropriate (Burns & Grove, 2009). For the purposes of this study, the causal relationship under investigation is that of selected social antecedents (independent variables) and coping strategies, level of resilience, and caregiving/parenting stress (dependent variables) in custodial and non-custodial grandmothers living in three Louisiana Parishes.

No attempt was made to manipulate the variables under study. They were measured by the research instruments. This predictive correlational study predicted the level of resilience or caregiving/parenting stress resulting from societal antecedents and grandmothers coping skills while caring for their grandchildren. It was expected that coping skills and the societal antecedents would correlate with grandmother’s resilience and stress level and help in predicting psychological adaptation. A graphic representation of the study design is illustrated in Figure 2 Predictive Correlational Study Design.

Predictive Correlational Study Design

Figure 2. Predictive correlational study design depicting the causal relationship between selected societal antecedents, resilience, caregiving/parenting stress, and coping skills in custodial and non-custodial grandmothers of African-American or African decent.

Sample

The participants in this study consisted of 110 grandmothers of African-American or African decent, aged 50 years to 80 years. They were grandparents providing primary care or childcare/babysitting for one or more biological grandchildren. Grandmothers must have provided primary care for their grandchild (ren), within the previous year. A convenience sample of grandmothers providing childcare to grandchildren were recruited from churches, community centers, health care centers and grandparent organizations through fliers, word of mouth and referral by social and health care providers.

Word of mouth (networking/snowballing) by other study subjects assisted in the further identification of other grandmothers who met sample criteria. The sample size was determined by using a power analysis of 0.8 and ? Of 0.05. Power analysis is the capacity of the study to detect differences or relationships that actually exist in the population (Burns & Grove, 2007). The minimum acceptable level of power for a study is 0.8, or 80% (Cohen, 1988). The standard value for ?, established used by researchers is 0.05 (Polit & Beck, 2004).

Effect is the presence of the phenomenon examined in the study (Burns & Groves, 2007). One of the study research questions calls for the comparison of caregiving/parenting stress, caregiver coping strategies, and caregiver resilience for custodial grandmothers, and non-custodial grandmothers. In order to adequately answer this question effect size was crucial. The effect size tells the size of the difference between the groups or the strength of the relationship between two variables (Burns & groves, 2007). A medium effect size of 0.25 was used in the calculation of sample size needed.

Cohen (1977) recommended the use of statistical power analysis to determine optimal sample size. Power analyses are conducted to determine how large the sample should be to reduce the risk of a Type II error (Polite & Sherman, 1990). Based on Cohen’s formula used to determine a sample for multiple regression analysis and an effect size of 0.25, a sample of 100 is needed to yield a power of 0.80.

Tabachnick and Fidell (2001) and Newton and Rudestam (1999) suggest using the formula N ? 50 plus 8 times the number of independent variables for testing multiple correlations, and N ? 104 plus the number of independent variables for testing individual predictors. In this study, two variables were identified as predictors: 50 + (8)(2) = 66 for testing the multiple correlation and 104 + 2 = 106 for testing individual predictors. Using Cohen’s (1977) formula and the formula suggested by Tabachnick and Fidell (2001) and Newton and Rudestam (1999), it is determined that between 105 and 110 participants would be required to achieve a power of 0.80.

Human Subjects Protection

Prior to the initiation of this study, approval from Institutional Review Board (IRB) was obtained. Procedures for the protection of human subjects were followed throughout the study. Signed consents were stored, separate from questionnaires in a sealed envelope in a locked file drawer in the investigator’s office. In order to assure confidentiality of responses, questionnaires only contain codes, placed in sealed envelopes and locked in a locked file drawer. These consents and questionnaires will be kept for a period of five years then shredded and discarded. All data analysis will be stored in a password protected computer database. Information from this study will be presented only as group data. No information connecting individuals to their survey answers will be included in the final report of research findings.

Setting

The settings for the study were private areas in churches, senior centers, private homes, and public libraries East Baton Rouge and Lafayette parishes. These parishes are in 60-mile proximity along the I-10 corridor. According to The State of Grandfamilies in Louisiana, dated February 18, 2010, Louisiana has the fourth largest percentage of children living with grandparents in the country (www.lagrg.org). More than 2.5 million children nationwide are being raised by their grandparents without the biological parents present in the household. This is a noteworthy 55% increase since 1990.

Nearly ten percent of all children in Louisiana (117,859) live in grandparent-headed households of which nearly 65,000 of them live there without either parent present (The State of Grandfamilies in Louisiana Report Highlights, February 18, 2010). In Louisiana, 57% of theses grandparents are African-American, 38% Caucasian, and 2% Hispanic (U.S. Census, 2008). These grandparents are also significantly poorer with nearly 1:3 living in poverty. A closer review of the statistics show that there are 6,335 grandparents responsible for their grandchildren in East Baton Rouge parish (www.RaisingYourGrandchildren.com), 1,437 grandparents in St. Landry parish and 967 grandparents responsible for their grandchildren in Lafayette parish (U.S. Census Bureau Table DP-2, Profile Selected Social Characteristics: 2000).

Procedure

Upon receipt of IRB approval from Southern University, letters describing the study, along with a self-addressed stamped envelope were sent to Baton Rouge, Lafayette and St. Landry parishes’ Grandparent Parenting Grandchildren (GPG) organization. Letters describing the study were also mailed and hand delivered to select local pastors, senior centers, and owners of hair and nail salons in the three designated parishes. Telephone verification of receipt of letters was conducted. A request for an appointment to meet with the pastor/director/owner or designee to further discuss the study and arrange for collection of data occurred during the telephone verification process. Upon obtaining permission from the pastor/director/owner of the agency, fliers were posted notifying potential participants of the study (see Appendix B).

Three volunteer research assistants (RA) to assist with data collection were recruited (one from each of the three study parishes). RAs were nurses and teachers with a minimum of a bachelor degree. All RAs attended a three-hour training session in order to ensure consistency of data collection and recognition of the need for confidentiality and anonymity (see Appendix F). Contents of the training included the purpose, rationale, and procedure of the study.

In addition to reviewing the study with the RA, the investigator and the RA reviewed the four questionnaires verbatim. The investigator remained readily available, by cell phone to address any questions and/or situations that might occur. A daily phone debriefing schedule was established by investigator and individual research assistant at mutually agreed times; weekly team sessions that required all members of the research interview team presence in a public library in St. Landry Parish were formulated.

The daily debriefing and team meetings decreased or negated interviewer variance by: (a) assuring the RA established rapport with the participants; (b) assuring adherence to the interview procedure; (c) adhering to questions used for clarifying and probing; and (d) using the approved wordings or definitions for specific questions (Collins, et al., 1988). The RAs were required to sign a mandatory confidentiality statement that includes IRB and HIPPA regulations regarding confidentiality and the management of client’s data.

Each participant received an explanation about the study and were prescreened by the investigator or one of the research assistants using the research assistants’ procedure guide (Appendix C). The research assistants’ guide included questions based on inclusion and exclusion criteria.

Recruitment for the study was face-to-face, and by acknowledgement or endorsement by leaders of community agencies. Letters explaining the study (Appendix A) were given to every prospective participant and a consent form obtained from the participant prior to starting the interview. The consent form explained the purpose of the study, the benefits of the study, and the risks (see Appendix D). The consent form also informed participants how their privacy and confidentiality would be protected, the length of time required for completion of the questionnaires, and the voluntary nature of their participation and their right to withdraw at anytime without penalty.

Each potential participant who met the inclusion criteria and agreed to participate in the study was given an instrument package (see Appendix E). The instrument package included the consent form, demographic data profile, Parenting Stress Index/Short Form, 29 Item Ways of Coping Questionnaire, and Wagnild and Young 14- Item Resilience Scale. The participant signed and gave the consent to the investigator or research assistant. A copy of the consent form was also given to each participant. The researcher then set with the participant at a desk in a private designated area of the interview site for completion of the questionnaires. After each interview session, the researcher placed the consent and questionnaires in separate sealed envelopes. To protect the participant’s anonymity, the consent form envelope does not contain a code.

At the completion of the questionnaires, the participant received a five dollar ($5.00) Walmart® gift card as an incentive for participating in the study. The sealed envelopes containing completed questionnaires and consent forms were given to the primary investigator as soon as possible or during the weekly debriefing meetings. The primary investigator secured the consent forms and completed questionnaires in a locked file at the investigator’s office.

Instruments

Each participant received a packet (see Appendix E) containing a researcher developed demographic data profile, Parental Stress Index / Short Form, 29 Item Ways of Coping Questionnaire, and Wagnild and Young 14 Item Resilience Scale. The merits of each of these instruments will be discussed in subsequent sections.

Grandparent Demographic Data Profile

The Grandparent Demographic Data Profile was developed by the investigator and designed to collect descriptive information about the personal characteristics of the participants in order to describe the sample. According to Burns and Grove (2007), age, education, gender, ethnic origin (race), income, marital status, and employment status are common demographic variables examined in nursing research. In addition, the study demographic profile included the ages and number of grandchildren in primary or daycare, available social support, reason for role as caregiver (societal antecedent), type of childcare care being provided, and actual and anticipated length of childcare needs. These factors were suspected to be a factor in stress and coping methods. This method allowed them to be statistically separated for analysis of the affects of these factors.

Descriptive information was gathered to develop a profile of the grandparent. Because current literature suggests that both custodial grandparents and grandchildren are adversely affected emotionally and physically by circumstances leading to the placement of the grandchild with the grandparent, questions regarding grandparent and grandchild’s overall health were included. Recommendations resulting from a pilot study conducted by the investigator were incorporated into the revision of the demographic data profile.

Ways of Coping Questionnaire

In recent years, how individuals cope with stress, not the amount or source of the stress per se, influences their psychological well-being, social functioning, and somatic health. Despite increased interest in coping, empirical research has been limited until recently, by a lack of suitable assessment techniques (Lazarus & Folkman, 1984). The Ways of Coping Questionnaire was developed to provide researchers with a theoretically derived measure that could be used to explore the role of coping in the relationship between stress and adaptational outcomes (Lazarus & Folkman, 1984).

The Ways of Coping Questionnaire assesses thoughts and actions individuals use to cope with the stressful encounters of everyday living. It is derived from a cognitive phenomenological theory of stress and coping that is articulated in Stress, Appraisal, and Coping (Lazarus & Folkman, 1984) and elsewhere (e.g., Lazarus, 1981; Lazarus & Launier, 1978). It has been used in many studies and was found to be a reliable means to assess these factors.

The Ways of Coping Questionnaire has been used primarily as a research instrument in studies of the coping process. Researchers have used it to investigate the components and determinants of coping in a variety of studies. The Questionnaire is conceived as an evolving strategy for measurement rather than a test (Lazarus, 1981).

The Ways of Coping Questionnaire was used to identify the thoughts and actions of custodial and noncustodial African-American grandmothers who are providing or have provided primary or daycare/babysitting to their grandchild within the last 12 months. These grandmothers were asked about actions they had used to cope with a specific stressful encounter resulting from their parenting or caregiving experiences. Coping processes, not coping dispositions or styles, were identified.

The Ways of Coping Questionnaire is based on a definition of coping as the cognitive and behavioral efforts to manage specific external and/or internal demands appraised as taxing or exceeding the resources of the individual (Lazarus, 1981). According to Lazarus (1981), this definition has four key features: (1) it is process-oriented; (2) it speaks of management rather than mastery; (3) it makes no a priori judgment about the quality of coping processes; and (4) it implies a stress-based distinction between coping and automatic adaptive behaviors.

The Ways of Coping Questionnaire retains the broad range of cognitive and behavioral strategies that comprised the antecedent checklist. Items that were redundant and unclear were deleted or reworded, and several items, such as prayer, were added at the suggestion of subjects. Further, the response format was changed from a yes-no format to a 4-point Likert scale so that respondents could indicate the frequency with which they use each strategy. Research using the revised Ways of Coping Questionnaire was first reported in Folkman and Lazarus (1985).

The Ways of Coping Questionnaire has eight scales: (1) Confrontive Coping describes aggressive efforts to alter the situation and suggests some degree of hostility and risk-taking; (2) Distancing describes cognitive efforts to detach oneself and to minimize the significance of the situation; (3) Self-Controlling describes efforts to regulate one’s feelings and actions; (4) Seeking Social Support describes efforts to seek informational support, tangible support, and emotional support; (5) Accepting Responsibility acknowledges one’s own role in the problem with a concomitant theme of trying to put things right; (6) Escape-Avoidance describes wishful thinking and behavioral efforts to escape or avoid the problem. Items on this scale contrast with those on the Distancing scale, which suggest detachment; (7) Planful Problem Solving describes deliberate problem-focused efforts to alter the situation, coupled with an analytic approach to solving the problem; and (8) Positive Reappraisal describes efforts to create positive meaning by focusing on personal growth. It also has a religious dimension.

The 29 item version of the Ways of Coping Questionnaire can generally be completed in about ten minutes, although the time will vary with respondents (Folkman, Lazarus, 1988). Items on the Questionnaire are designed to be answered in relation to a specific stressful encounter. No single standardized method has been devised by the authors for eliciting it (Folkman, Lazarus, 1988). The Ways of Coping Questionnaire has been used as an interview protocol in one set of studies and as a self-administered assessment in another (Folkman, Lazarus, 1988). The method must be adapted to fit the needs of the specific study.

Although this questionnaire is self-administered, Folkman, Lazarus (1988) points out that an interview can be held before administration to help the subject reconstruct the focal encounter. Asking questions about the encounter, such as who was involved and what happened, helps assure that, when responding to the items, the individual is focusing on a specific encounter rather than on a generalized condition. The interview can range from a brief summary of the encounter to a full exploration of its content, depending on the purposes of the research. An interviewer can also check to make sure that all items were completed after the individual has completed the inventory. Studies have been conducted where subjects completed the original Ways of Coping Checklist both with and without the use of an interviewer (Folkman, 1979). Both were found to yield satisfactory study results.

There are two methods for scoring the Ways of Coping Questionnaire, raw and relative. The decision as to which set of scores to use depends on the information desired. Raw scores describe coping effort for each of the eight types of coping, whereas relative scores describe the proportion of effort represented by each type of coping. In both methods of scoring, individuals respond to each item on a 4-point Likert scale, indicating the frequency with which each strategy is used: 0 indicates “does not apply and/or not used,” 1 indicates “used somewhat,” 2 indicates “used quite a bit,” and 3 indicates “used a great deal.” Both scoring methods will be conducted in this study. This will provide the researcher the level of depth desired in this research study.

In the raw scoring the, raw scores are the sum of the subject’s responses to the items that comprise a given scale. This method, used in the majority of research, provides a summary of the extent to which each type of coping was used in a particular encounter. These are raw scores and not factor scores; responses are not differentially weighted according to factor loadings.

Relative scores, which were suggested by Peter Vitaliano (Vitaliano, Maiuro, Russo, & Becker, 1987), describe the contribution of each coping scale relative to all of the scales combined. A relative score for each scale is computed by (a) calculating the average item score for the items on a given scale by dividing the sum of the ratings on the scale by the number of items on that scale, (b) calculating the sum of the average item scores across all eight scales, and (c) dividing the average item score for a given scale by the sum of the average item scores across all eight scales. The relative score technique controls for the unequal numbers of items within the scales and for individual differences in response rates. The results of the study by Vitaliano, Maiuro, et al. (1987) on five scales (named by them as Problem-Focused Coping, Seeks Social Support, Blamed Self, Wishful Thinking, and Avoidance) indicated that the relative scores revealed relations among ways of coping that can be blurred with the raw score technique.

Reliability is evaluated by examining the internal consistency of the coping measures, estimated with Cronbach’s coefficient alpha (Lazarus, 1981). Internal consistency estimates of coping measures generally fall at the low end of the traditionally acceptable range. Billings and Moos (1981) point out, those who are constructing coping measures should attempt to minimize item redundancy within each coping category, resulting in groups of relatively independent clusters of coping strategies within each category. The use of one coping response may produce the desired effect, which lessens the need and probability that other coping responses from the same category will be used (Billing & Moos, 1981). The alpha coefficients for the eight scales are higher than the alphas reported for most other measures of coping processes (Billing & Moos, 1981).

The items on the Ways of Coping Questionnaire have face validity since the strategies described are those that individuals have reported using to cope with the demands of stressful situations. Evidence of construct validity is found in the results of the studies are consistent with theoretical predictions, namely, that: (1) coping consists of both problem-focused and emotion-focused strategies, and (2) coping is a process. That is, how people cope varies in relation to the demands and constraints of the context and also in relation to changes in those demands and constraints as an encounter unfolds. People use both problem-focused and emotion-focused types of coping in virtually every stressful encounter, formulations that define the coping process solely in terms of one or the other are inadequate (Folkman & Lazarus, 1980).

People vary their coping efforts according to their situational appraisal of control, what we call secondary appraisal. Problem-focused types of coping are more often used in encounters in which the outcome is appraised as being able to be change than in encounters that must be accepted, while emotion-focused types of coping are more often used in encounters that must be accepted than in encounters holding a possibility for change (Folkman & Lazarus, 1980, 1985; Folkman, Lazarus, Dunkel-Schetter, et al., 1986).

People also vary their coping efforts according to what is at stake in a given encounter, what we call primary appraisal. Individuals are apt to use more self-control, accept more responsibility, use more escape-avoidance, and seek less social support in encounters viewed as highly threatening to their self-esteem than they would in encounters that do not pose this threat (Folkman & Lazarus, 1980). The fact that people vary their coping to fit the possibilities for coping (secondary appraisal) and the nature of the threat (primary appraisal) in a given context is consistent with the premise that coping is determined by the relationship between the person and the environment, rather than by independent person or situation (Folkman & Lazarus, 1980). People also vary their coping as an encounter unfolds.

The findings of several studies provide clear support for the Ways of Coping

Questionnaire as a measure that captures (1) both problem-focused and emotion focused coping functions and (2) changes in coping both across different encounters and within a particular encounter. The construct validity of the Ways of Coping Questionnaire is thus supported to the extent that the findings are consistent with theoretical predictions (Folkman & Lazarus, 1980). This research instrument is considered to be an excellent choice for this research study.

Parenting Stress Index

The Parenting Stress Index (PSI) is a robust diagnostic tool that identifies stressful parent-child systems using a Likert scale. This 60-item self-report inventory measures both parent and child contributions to dyadic problems (Abidin, 1995). In addition to its composite score (total stress index), there are three subscales addressing parent distress, child difficulty, and parent-child dysfunctional interaction that assess experienced stress (Abidin, 1990). The PSI has been used successfully with different populations, including diverse cultures, and is expected to maintain its usefulness with various U.S. populations (Abidin, 1995; Butler & Zakari, 2005).

The development of the Parenting Stress Index (PSI) was guided by a number of assumptions. The first was that the instrument would be built on an existing knowledgebase. The second assumption was that the PSI would integrate the existing knowledge base with the clinical issues of identification and diagnosis of individual parent-child systems under stress. The third assumption was that stressors or sources of stress are additive (Selye, 1952, 1974; Rahe, 1974; Abidin, 1983). The fourth assumption was that stressors are multidimensional as to source and kind (Abidin, 1983). This led to the identification of three major source domains of stressors (Abidin, 1983): (a) child characteristics, (b) parent characteristics and (c) situational/demographic life stress. The kinds of stressors identified range from objective life events, such as death of a family member, to the parent’s judgment of the child’s activity level, and to the parent’s subjective feelings of being trapped by his or her parenting responsibilities (Abidin, 1983).

The Parenting Stress Index/Short Form (PSI/SF) is a 36-item instrument derived from the PSI/full-length test. The PSI/SF generates a score for Total Stress (TS) and three subscales: Parental Distress (PD), Parent-Child Dysfunctional Interaction (PCDI), and Difficult Child (DC). Parents who obtain a TS score above a raw score of 90 (at or above the 90th percentile) are experiencing clinically significant levels of stress (Abidin, 1995). Consequently, this measure will be used as the operational definition of stress in this study.

According to Abidin (1995), the TS score provides an “indication of the overall level of parenting stress an individual is experiencing.” The component stresses associated with the PD subscale are “impaired sense of parenting competence, stresses associated with the restrictions placed on other life roles, conflict with the child’s other parent, lack of social support, and presence of depression,” (Abidin, 1995). The PCDI subscale focuses on the (grand)parent’s “perception that his/her grandchild does not meet the (grand)parent’s expectations, and the interactions with his/her (grand)child are not reinforcing to him or her as a (grand)parent” (Abidin, 1995). The DC subscale focuses on “some of the basic behavioral characteristics of children that make them either easy or difficult to manage” (Abidin, 1995).

Reported coefficient alpha and test-retest reliability ranges for TS are .84 to .95 and .68 to .92 for the subscales (Abidin, 1995; Musil, 1998; Roggman, Moe, Hart, & Forthum, 1994). In the study of stress and coping of 50 African-American grandparents who were raising their grandchildren, conducted by Ross & Aday (2006) the PSI/SF was used and yielded Cronbach’s alphas of .95 for TS and .86 to .92 for the subscales. The parameters found for the use of this scale in similar studies supports its appropriateness as a research tool in the current research study.

Wagnild & Young Resilience Scale

Researchers have measured resilience in a variety of ways. The Resilience Scale is the earliest published instrument designed to measure resilience and is one of many options now available to quantify the multidimensional aspects of this concept.

Studies that identified Resilience Scale scores, sample descriptions, and tested relationships between the Resilience Scale and study variables have reported Cronbach’s alpha coefficients ranging from .72 to .94 supporting the internal consistency reliability of the Resilience Scale. Hypothesized relationships between the Resilience Scale and study variables (e.g., forgiveness, stress, anxiety, health promoting activities) have supportably strengthened the evidence for construct validity of the Resilience Scale. The Resilience Scale has performed as a reliable and valid tool to measure resilience and has been used with a wide range of study populations.

As we found in the literature review, traditionally, health care interventions have used a model grounded in pathology, which emphasizes deficits and fixing problems. Focusing on concepts such as resilience redirects health care to recognize strengths and develop strategies to build on existing capabilities. Resilience connotes inner strength, competence, optimism, flexibility, and the ability to cope effectively when faced with adversity. Resilience is associated with numerous desired outcomes including physical health (Wagnild, 2007) and emotional health (Broyles, 2005). The importance of focusing on resilience was highlighed in the literature review and plays an important role in the design of the research methodology.

The Resilience Scale was published in 1993 (Wagnild & Young, 1993). The scale was based on (a) a 1987 qualitative study of older women who had adapted successfully following a major life event, and (b) a thorough review of the literature on resilience up to that time (Wagnild & Young, 1990). The initial Resilience Scale consisted of 50 items. Each was a verbatim statement from the initial study of 24 older women. After initial analysis, the scale was reduced to 25 items reflecting five characteristics of resilience and was initially available and pretested in 1988 (Wagnild & Young, 1990). Scores range from 25-175. After repeated applications of the Resilience Scale with a variety of samples, scores greater than145 indicated moderately high to high resilience, 125-145 indicated moderately low to moderate levels of resilience, and scores of 120 and below indicated low resilience.

The five characteristics of resilience (Wagnild & Young, 1993), which serve as the conceptual foundation for the Resilience Scale, are perseverance or the act of persistence despite adversity or discouragement, connoting a willingness to continue the struggle to reconstruct one’s life and remain involved in the midst of adversity. Perseverance is the ability to keep going despite setbacks.

Equanimity is a balanced perspective of life and experiences and might be viewed as sitting loose and taking what comes, thus moderating the extreme responses to adversity. Those with equanimity often have a sense of humor. Meaningfulness is the realization that life has a purpose and recognition that there is something for which to live. Those who are self-reliant believe in themselves. They recognize and rely on their personal strengths and capabilities and draw upon past successes to support and perhaps guide their actions. Finally, existential aloneness is the realization that each person is unique and that while some experiences can be shared, others must be faced alone. With existential aloneness comes a sense of uniqueness and perhaps freedom (Wagnild & Young, 1990, 1993).

Several small studies in the early 1990s provided the earliest reliability and validity data for the Resilience Scale including undergraduate and graduate students, caregivers of spouses with Alzheimer’s disease, first-time mothers returning to work, and residents in public housing (Wagnild & Young, 1993). Cronbach’s alpha coefficient was consistently acceptable and moderately high (.73 to .91). The early studies also demonstrated that the Resilience Scale was appropriate for younger individuals as well as middle-aged and older adults. Validity of the Resilience Scale was supported with hypothesized and statistically significant associations with morale, self-esteem, life satisfaction, depression, and perceived stress (Wagnild, 2009).

The reliability and validity of the Resilience Scale were tested further in a sample of 810 middle-aged and older adults, 48% of whom were male (Wagnild & Young, 1993). The measures of validity included depression, morale, and life satisfaction. As hypothesized, resilience was positively associated with morale and life satisfaction and negatively with depression. Internal consistency reliability continued to be acceptable (alpha coefficient = .91). Factor analysis indicated that the Resilience Scale has two major factors, which were named “acceptance of self and life” and “individual competence” (Wagnild & Young, 1993).

Humphrey (2003) studied 50 sheltered, battered women in order to identify strengths and expand our understanding of human responses to trauma. Humphrey found that battered women who scored higher on the Resilience Scale reported fewer symptoms of psychological and physical distress overall as compared to women who scored lower on the Resilience Scale. Participants included 20 African-American women, 11 European-American, 11 Hispanic, 5 Asian-American, 1 American Indian, and 2 mixed or not given. Less resilient women reported more depression, anxiety, somatization, obsessive- compulsive behavior, and interpersonal sensitivity than more resilient women (Wagnild, 2009).

Monteith and Ford-Gilboe (2002) studied the relationships between the mother’s resilience, family health work, and mother’s health promoting lifestyle practices in families with preschool children. They found that a mother’s resilience was related to family health work. Also, family health work and a mother’s resilience significantly predicted a mother’s health promoting lifestyle practices. Mothers who worked full-time had higher resilience scores than women who worked part-time. Resilience was most strongly associated with spiritual growth aspects of health promoting lifestyle practices (Wagnild, 2009).

Christopher (2000) studied the relationship of demographic variables, life satisfaction, and psychological well-being with resilience among 100 adult Irish immigrants to the United States with an average age of 31 years. Resilience was positively associated with psychological well-being. Resilience, fewer health care visits, and life satisfaction were the strongest predictors of well-being using hierarchical regression analyses (Wagnild, 2009).

March (2004) studied the relationships between life adversity and resilience in late life development. She found that Resilience Scale scores were significantly and positively correlated with morale. They were negatively associated with life stress and a number of stressful events and suggested that although life stresses lower resilience, resilience maintains its buffering effects on well-being. She also suggested that resilience alone could not explain the paradox of subjective well-being in late life and that other variables such as social support may also be significant (Wagnild, 2009).

Leppert, Gunzelmann, Schumacher, Strauss, and Brahler (2005) studied resilience as a protective personality characteristic in the elderly. Resilience was assessed as a protective personality factor for physical well-being. As resilience scores increased, subjective body complaints decreased. Resilience tended to be lower in women than in men. There appeared to be no age-related effects (Wagnild, 2009).

Wagnild (2007) interviewed 20 older women who resided in a frontier community to determine the relationships among resilience, health promoting behaviors, and self-reported health status. There were moderate correlations between resilience, health status, and health promoting behaviors. These women, who by definition were geographically isolated with few available health care resources, exemplified the characteristics of resilience in attaining a healthy old age.

The average Resilience Scale scores for the above studies were moderate to moderately high with most scores ranging from 140 to 148. Internal consistency of the Resilience Scale was consistently high in all of the studies (Cronbach’s alpha coefficient ranged from .85 to .94). The lowest reported coefficient in all studies utilizing the scale was .72. Therefore, the internal consistency reliability of the Resilience Scale is not only acceptable across sample populations, but also rather robust.

Instrument validity is defined as the extent to which an instrument measures what it is intended to measure (Wagnild, 2009). Construct validity is concerned with the extent to which a particular measure relates to other measures consistent with theoretically derived hypotheses concerning the concept being measured. Researchers in the studies reviewed for this study, hypothesized that if individuals are resilient, there would be positive correlations between Resilience Scale scores and psychological well-being, health promoting activities, purpose in life, sense of coherence, morale, and forgiveness (Wagnild, 2009). Researchers also hypothesized that Resilience Scale scores would be inversely associated with stress, depression, anxiety, loneliness, and hopelessness (Wagnild, 2009). These hypotheses were supported and statistically significant, strengthening support for the construct validity of the Resilience Scale (Wagnild, 2009).

There are many clinicians, researchers, and health care consumers who recognize the importance of psychological resilience (Wagnild, 2009). The evidence to date suggests that the Resilience Scale, as an instrument designed to measure resilience, is simple to use and is reliable (Wagnild, 2009). There is growing evidence that the Resilience Scale is a valid instrument for measuring resilience as well in a variety of populations (Wagnild, 2009). This research supports it use in the current research study.

Method for Data Analysis

A data codebook was developed for each instrument. Each questionnaire was coded to ensure that the investigator was able to credit the data to the correct participant. The IBM SPSS 18 (Statistical Packages for the Social Sciences) statistical package was used for all data analysis. Descriptive statistics (mean, standard deviation, range) was used for each variable in effort to organize and examine the data from various viewpoints. Multiple regression analysis was used to measure the relationship between the variables. Coping strategies was correlated to characteristics resilience. Research assistants helped with the inspection of data files for accuracy.

Data analysis included descriptive statistics, hypotheses testing (z test) and multiple regression analysis (see Table 1.). Descriptive statistics were utilized to present certain factual aspects of the study participants (Dempsey & Dempsey, 1992). Demographic variables or sample characteristics analyzed included the number of grandchildren in care, age of grandmother, socio-economic status of grandmother, ages and gender of grandchildren, length of caregiving, and the health status of the grandchild. This data aided in the prediction of when and under what conditions resilience exists.

Table 1. Research Hypothesis and Methods of Proposed Analysis

Null Hypothesis

Method of Analysis

Ho1 There is no relationship among custodial

Multiple Regression

and noncustodial grandmothers of African

American or African decent in their coping strategies, level of resilience, caregiving/parenting stress, and selected demographic variables (age of the grandmother, economic status of the grandmother, educational level of the grandmother, age of the grandchild/grandchildren, number of grandchildren requiring custodial care, and health status of the grandchild)

Ho2 There is a no difference among custodial and Z test non-custodial

grandmothers of African-American

or African decent caregiving/parenting stress, coping strategies, and level of resilience.

Ho3 Societal antecedents (child abandonment and/

Multiple Regression

or neglect, parental employment obligations, parental education endeavors, and parental military obligations) have no predictive effect on caregiving/parenting stress, coping strategies, and level of resilience in custodial and non-custodial

grandmothers of African-American

or African decent.

The chosen analysis methods for the hypotheses described in this table were derived from an examination of similar research questions in the literature review. The topics being addressed in this research study are similar to others that have been addressed in numerous studies that were found in the literature review. The similarities between these studies and the current study support the use of these research methods.

Although this research study is similar in many ways to studies that have been previously undertaken, the results of the study will be applied in a manner that is different from them, It will add to the body of research in this research area not by the methods used for data collection and analysis, but by how it applies this information to the topic. The use of this data analysis method for the research hypotheses is supported through the use of historical evidence highlighting the successful use of these methods in similar research studies.

Internal Validity

The use of four different research instruments complicates the discussion of internal validity in this research study. The first research instrument only collects demographic data. It is not expected that the internal validity of this instrument will play an important role in the internal validity of the study as a whole. This instrument will not be used to support the hypotheses. It’s purpose is to provide the categorical information needed for data analysis.

The three primary data collection instruments will play an important role in supporting either the hypotheses or the null hypotheses. Therefore, it is important to understand how the internal validity of each of them affects the internal validity of the research as a whole. An extensive discussion of the historical use and validity issues associated with each of the research instruments has already been undertaken previously in this chapter and does not need repeating.

The three primary research instruments used have proven to have sufficient internal validity for use in this research study. The research instruments only have internal validity that is similar to that already found in other studies if they are used in a similar manner as they were used in the study in which the internal validity was measures. It is believed that the circumstances of the study are similar enough to those in the original and subsequent studies in which the research instruments were used that they will have similar internal validity measures. This would lead to the conclusion that one would expect that the internal validity of the instruments, when used in this research study, would be similar to those in previous studies.

It was important to choose research instruments that had strong support for their use in this research study. The inclusion of one instrument that did not have strong support for its usage could have a negative impact on the validity of the study as a whole. In this case, all of the research instruments have been tested in a number of circumstances yielding consistently positive results. Historical usage of all three of the chosen instruments supports their use in the current research study. They are believed to have individual and combined results that support their ability to maintain their validity under the parameters of this research study.

External Validity

This research uses a sample population that is limited in scope. It uses women who are of African-American or African decent. In some places in the study, it was indicated that these women could be “black.” This term is broad and generally refers to those of African-American or African decent. The use of this racial characteristic in defining the parameters of the study group might limit the ability of the researcher to generalize the results of the study to other sample populations.

Cultural elements might exist within the sample population that may effect the ability to apply the results to the general population. In an earlier discussion, it was determined that the sample population size was sufficient to draw conclusions that applied to the entire population of grandparents who were raising their grandchildren, regardless of the circumstances that created the situation. However, the limitations of the sampling method and the narrowly defined target sample population have the potential to introduce biases in the sample population.

Many of the biases that might be inherent in the study population are a result of societal and cultural attitudes that are beyond the scope of this study. Familial characteristics and structures are often defined by cultural context. Although the sample population exists within the larger structure of the United States, many culturally defined groups exist within the general population. Those of African-American and African decent have a long history of culturally defined traditions, many of which have become integrated into the fabric of America to such an extent that they are no longer recognized as separate cultural traditions.

These cultural constructs might not be noticed as such, and they have the potential to go unnoticed in the interpretation of the research. It would be a mistake to assume that a culturally defined study group can be extrapolated to a larger, mix ethnicity population. The results of the study can only reliably be applied to the intended study population in this case. However, they might be able to be applied to other African-American and African groups in other parts of the country. The restriction of including only African-Americans and Africans in the study population might limit the external validity of the study. Further studies will be needed to determine if this is the case.

Summary

The research design of the study is a predictive correlational design. The relationship among societal antecedents, (child abandonment and/or neglect, parental employment obligations, parental education endeavors, and parental military obligations) coping skills, and resilience in custodial grandparents (those providing shelter and primary care of the grandchild) and non-custodial grandparents (grandparents who do not have primary responsibility of their grandchild but provide temporary childcare for 8 — 30 or more hours a week), of African-American or African decent, living in three Louisiana Parishes was examined. The settings for the study included churches, senior centers, private homes, and public libraries East Baton Rouge, Lafayette, and St. Landry parishes. Convenience and network or snowball sampling was utilized to obtain participants.

Approval of this study was obtained from the Institutional Review Board for Human Subject Protection. Permission was also obtained from appropriate administrators of churches, senior centers, private homes, and public libraries in East Baton Rouge, Lafayette, and St. Landry parishes prior to speaking with possible participants, distributing study fliers, posting signs advertising the study, and conducting interviews. Prior to data collection, written informed consent were obtained from each participant. Three prepared research assistants were trained to assist with data collection, which included completion of the instrument packet.

Four instruments were used to measure the variables under study: Grandparent Demographic Data Profile, The Parenting Stress Index / Short Form, The 14 Item Resilience Scale, and The 29 Item Ways of Coping Questionnaire. Descriptive statistics were used for each variable in effort to organize and examine the data from various viewpoints. Multiple regression analysis and hypotheses testing (Z test) were used to measure the relationship between the variables. The IBM SPSS 18 (Statistical Packages for the Social Sciences) statistical package was used for all data analysis.

The internal validity of the study instruments is demonstrated by their use in previous studies. All of the research instruments used, with the exception of the demographic information have been tested and utilized under a number of research scenarios. Their internal validity has been tested under a number of circumstances and sampling conditions. The three previously tested study instruments have been proven to have consistent reliability under the test conditions. They are considered to be excellent candidates for use in this research study. The amount of evidence that supports use of these research instruments for similar research topics is abundant. There were no studies found that did not support use of these research instruments for the study.

One of the key elements that led to the selection of these particular research instruments was based on the number of times that they were encountered in the literature review. There is overwhelming academic support for the use of these instruments. Much is known about their internal validity and their various advantages and disadvantages in various research situations. A careful examination of these factors, as was outlined in this chapter supports the use of the chosen research instruments in this study.

This study methodology is based on the application of the theoretical framework proposed by Roys in conjunction with the research that was discovered during the literature review. The chosen methodology has a large number of studies that support the use of similar research methodologies to explore similar research questions. The number of these studies that were found lends to support use of these research methods in the current research study. The rationale behind the methodology is supported by evidence found in the literature review. The instruments being used have a long history of use in many different sample populations, including some that are similar to the one being studies. Overwhelming evidence supports use of this research methodology and this study design for these research questions.

Theoretical Model: Grandparents caring for Grandchildren S.C. Haynes, 2010 Societal antecedents from the internal and external environment (through the senses) act as inputs to the grandmother’s adaptive system and coping strategies. This information is channeled automatically in the appropriate manner and an automatic, unconscious response is produced. Based on the African-American or African decent grandmother’s demographic variables, psychological integrity, physiological integrity, parenting skills, and coping ability adaptive measures are employed to prevent or reduce stress while caring for the grandchild. Successful coping response produces resilience while an unsuccessful response gives rise to caregiving/parenting stress when grandmother is faced with challenges posed by societal antecedents responsible for assuming care of a grandchild. The responses act as feedback, which is further input for resilience. Adapted with permission, from Callista Roy’s Adaptation Model .

Ineffective Response

(Caregiving / Parenting Stress)

Effective Adaptive Response

(Resilience)

Coping Process

Demographic Variables

Psychological Integrity

Physiological Integrity

Coping Skills

Parenting

Significant Others

Stress Levels

Societal Antecedents:

Neglect

Abandonment,

Parental employment obligations,

Parental educational obligations

Military obligations

Coping Strategies

Non-custodial Grandmother of African-American or African decent

Societal Antecedents

Child abandonment/neglect

Parental employment obligations

Parental education endeavors

Parental military obligations

Resilience

Caregiving/Parenting Stress

Coping Skills

Custodial Grandmother of African-American or African decent

Resilience

Societal Antecedents

Child abandonment/neglect

Parental employment obligations

Parental education endeavors

Parental military obligations

Caregiving/Parenting Stress

Coping Skills

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