title: How family carers engage with technical health procedures in the home: a grounded theory study.
abstract: OBJECTIVE
  To explore the experiences of family carers who manage technical health procedures at home and describe their learning process.
  
  
  METHODS
  A qualitative study using grounded theory.
  
  
  METHODS
  New Zealand family carers (21 women, 5 men) who managed technical health procedures such as enteral feeding, peritoneal dialysis, tracheostomy care, a central venous line or urinary catheter. In addition, 15 health professionals involved in teaching carers were interviewed.
  
  
  METHODS
  Semistructured interviews were coded soon after completion and preliminary analysis influenced subsequent interviews. Additional data were compared with existing material and as analysis proceeded, initial codes were grouped into higher order concepts until a core concept was described. Interviewing continued until no new ideas emerged and concepts were well defined.
  
  
  RESULTS
  The response of carers to the role of managing technical health procedures in the home is presented in terms of five dispositions: (1) Embracing care, (2) Resisting, (3) Reluctant acceptance, (4) Relinquishing and (5) Being overwhelmed. These dispositions were not static and carers commonly changed between them. Embracing care included cognitive understanding of the purpose and benefits of a procedure; accepting a 'technical' solution; practical management; and an emotional response. Accepting embrace is primarily motivated by perceived benefits for the recipient. It may also be driven by a lack of alternatives. Resisting or reluctant acceptance results from a lack of understanding about the procedure or willingness to manage it. Carers need adequate support to avoid becoming overwhelmed, and there are times when it is appropriate to encourage them to relinquish care for the sake of their own needs.
  
  
  CONCLUSIONS
  The concept of embracing care encourages health professionals to extend their attention beyond simply the practical aspects of technical procedures to assessing and addressing carers' emotional and behavioural responses to health technology during the training process.
authors.affiliation: Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand.
authors.forename: Janet
authors.initials: J
authors.lastname: McDonald
authors.affiliation: Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand.
authors.forename: Eileen
authors.initials: E
authors.lastname: McKinlay
authors.affiliation: Department of Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: Sally
authors.initials: S
authors.lastname: Keeling
authors.affiliation: Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand.
authors.forename: William
authors.initials: W
authors.lastname: Levack
mesh_terms: D001291:Attitude of Health Personnel; D001294:Attitude to Health; D017028:Caregivers / Q000193:education / Q000523:psychology* / Q000592:standards; D002405:Catheterization, Central Venous; D004750:Enteral Nutrition; D005260:Female; D066296:Grounded Theory; D006701:Home Nursing / Q000523:psychology* / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009042:Motivation; D009520:New Zealand; D010530:Peritoneal Dialysis; D011182:Postoperative Care; D012380:Role; D013663:Teaching; D014140:Tracheotomy / Q000534:rehabilitation; D014546:Urinary Catheterization
keywords: Carer or caregiver; Family or informal care; New Zealand; QUALITATIVE RESEARCH: Grounded theory; Technical health care or Complex care; Technology dependence