Date of Award

11-2024

Embargo Period

12-5-2024

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD) in Nursing Science

Department

Nursing

College

College of Nursing

First Advisor

Teresa Kelechi

Second Advisor

Michelle Nichols

Third Advisor

Katherine Sterba

Abstract

Purpose:

This dissertation study aimed to enhance understanding of informal caregiver wellbeing by exploring the presence of mental fatigue, the relationships among mental fatigue, self-care, and informal oncology caregiver quality of life (QOL), and determining whether differences exist in self-care engagement and QOL between caregivers who report high and low levels mental fatigue.

Problem:

Healthcare is becoming increasingly reliant on informal caregivers for the management and care of individuals with serious illnesses such as cancer. Previous research has shown that informal caregivers routinely experience many negative effects as a result of providing care including decreased mental health and QOL and increased mental fatigue. Due to the impact of mental fatigue on cognitive functioning, many caregivers rely on self-care activities to manage its effects however caregivers also report that mental fatigue interferes with their ability to engage in self-care. An inability to properly cope and recover from mental fatigue pose a direct threat to patient health outcomes and safety.

Aims:

Aim 1: Determine the prevalence of mental fatigue among a sample (N=204) of informal caregivers of individuals receiving cancer treatment in an outpatient oncology treatment center measured with the Mental Fatigue Scale (MFS).

Aim 2: Examine the relationship between mental fatigue, self-care, and caregiver quality of life in informal oncology caregivers measured with the MFS, Clinical Mindful Self-Care Scale (MSCS-C), and Caregiver Quality of Life Index-Cancer (CQOL-C).

Aim 3: Expand the understanding of mental fatigue’s impact on self-care and QOL through individual interviews of informal oncology caregivers with high (N=15) and low (N=15) levels of mental fatigue.

Exploratory Aim: Explore informal caregiver perceptions of caregiving, measured with the Appraisal of Caregiving Scale (ACS), and caregiver appraisal’s relationship to mental fatigue, self-care, and QOL.

Design:

This dissertation used a cross-sectional, convergent parallel, mixed methods design, guided by the Transactional Theory of Stress and Coping (TTSC).

Findings:

There were 66.8% participants who scored in the high mental fatigue group. T-tests revealed lower QOL and self-care engagement and higher threat appraisal in caregivers with high mental fatigue compared to those with low mental fatigue. MANOVA revealed a significant association of mental fatigue with self-care and QOL combined and multiple significant correlations were noted among mental fatigue, self-care, QOL, and appraisal of threat, stress and benefit. Four inductive themes (and subthemes) were identified among interviewed caregivers including: 1) caregiver perception of the experience (positive and negative), 2) lack of boundaries (identity, goals, and relationships), 3) resources (used and requested), and 4) self-care while caregiving (physical, mental, emotional, and other). Integration of quantitative and qualitative data revealed a previously unidentified, probable relationship between mental fatigue and reappraisal that impacts the caregiving experience.

Conclusions:

Mental fatigue is prevalent among informal oncology caregivers with the potential to negatively affect patient care and outcomes. We hypothesize that mental fatigue is both affected by and affects the reappraisal process and coping mechanisms used by caregivers. Longitudinal studies are needed to test for cause-effect relationships among mental-fatigue, self-care, and QOL but the associations noted in the results highlight specific areas to target when developing interventions to address caregiver stress and burden. Specifically, healthcare providers should focus their efforts on creating and providing effective caregiver resources while emphasizing the importance of maintaining boundaries and engaging in appropriate self-care activities.

Rights

Copyright is held by the author. All rights reserved.

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