title: Mental health nurses' support to caregivers of older adults with severe mental illness: a qualitative study.
abstract: BACKGROUND
  Literature has shown the serious impact of severe mental illness on the daily life of caregivers. We studied reported caregiver support practices by mental health nurses for use in the development of a nursing intervention. We aimed to explore current caregiver support practices by mental health nurses.
  
  
  METHODS
  Twenty-one participants completed semi-structured interviews, and 17 participants attended two focus groups. All interviews were audio-taped, transcribed and coded for qualitative analysis.
  
  
  RESULTS
  The diversity in caregiver support could best be described by three prototypes: the tolerator, the preventer and the concerner, representing three approaches of involvement with caregivers. At one end of the spectrum are mental health nurses (MHN) who are essentially only concerned with the wellbeing of the care recipient and see the caregiver as a potential impediment in reaching the client's goals. We call these the tolerators. At the other end of the spectrum are the MHNs who see the caregiver and the care recipient as inextricably connected with each other. In these cases the MHN directs her/his intervention towards both the informal caregiver and the care recipient. We call these the concerners. In the middle position are MHNs who realize that caregivers are important agents in the achievement of the client's goals, and therefore consider preventing them from becoming overburdened as an important goal. We call these the preventers.
  
  
  CONCLUSIONS
  Based on the extent to which the MHNs believe that the informal caregiver plays a necessary role in the client's support system, and the degree to which they feel responsible for the caregiver's wellbeing, three MHN prototypes can be distinguished. These prototypes determine how the nurses' vision directs their understanding of their role and responsibilities and the content of their behaviour. This implies that a change in behaviour needs to be preceded by a change in vision. Therefore, promoting family support cannot be achieved by one-size-fits-all-programmes.
authors.affiliation: Altrecht Mental Health Care, Gedachtengang 1, 3705 WH Zeist, The Netherlands.
authors.forename: Marian I
authors.initials: MI
authors.lastname: Zegwaard
authors.affiliation: Faculty of Social Sciences, VU-University Amsterdam, de Boelelaan 1081, 1081 HV Amsterdam, The Netherlands.
authors.forename: Marja J
authors.initials: MJ
authors.lastname: Aartsen
authors.affiliation: Faculty of Nursing Science, Ghent University, St. Pietersnieuwstraat 33, B-9000 Ghent, Belgium.
authors.forename: Mieke H F
authors.initials: MH
authors.lastname: Grypdonck
authors.affiliation: Faculty of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
keywords: Caregiver support; Mental health nurses; Nursing practice; Older adults; Severe mental illness