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Coping and Subjective Burden in Caregivers of Older Relatives

Today, many studies have been commissioned to examine various issues affecting the quality of nursing care and to help enhance the delivery of professional care to patients. Since these researches yield a massive amount of literature, it is becoming increasingly difficult for healthcare givers to synthesize and use this literature to support their service delivery. However, health caregivers can utilize meta-synthesis approaches to gain insights into the findings and results of such studies (Del-Pino-Casado, Frı´as-Osuna, Palomino-Moral & Pancorbo-Hidalgo, 2011). This critique seeks to offer an insightful review of the meta-synthesis titled, “Coping and subjective burden in caregivers of older relatives: a quantitative systematic review.”

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The critique will utilize the worksheet of appraisal established by Nursing 608 online resources. This review will provide a critical appraisal of the strengths and weaknesses of the quantitative study based on the meta-synthesis tool kit provided. The validity and reliability of the results shall also be appraised. Other essential areas will include a critique of the research strategy, research questions, methods of data collection, sample study, and the limitations of the study. Lastly, the critique will provide an appraisal of the implications of the research to the nursing field.

Research Question

The research conducted by Del-Pino-Casado, Frı´as-Osuna, Palomino-Moral & Pancorbo-Hidalgo (2011) presented the research question in the title of the study and the abstract. The researchers detailed the introduction giving a firm background on the process of informal caregivers providing care to disabled old people. From the study, the researchers identified the focus group as the family members of the disabled old people and the old people, and provision of care (Del-Pino-Casado, Frı´as-Osuna, Palomino-Moral & Pancorbo-Hidalgo, 2011).

The study identified the expected results of the study as the effects of subjective burden in the informal caregivers to old and disabled people of their families. This shows that the study was objective from the onset and gives a clear direction on the expectations of the reader (Polit & Beck, 2012). The research aimed at gaining new insights as to the effects of care provided by informal caregivers (Del-Pino-Casado, Frı´as-Osuna, Palomino-Moral & Pancorbo-Hidalgo, 2011).

Search Strategy

In researching quantitative studies, the researchers’ search strategy was the effects of coping strategies in informal caregivers to old disabled people. The study utilized several electronic databases such as Elsevier, EBSCO, PubMed, MEDLINE, OVOID, and Scopus. According to the article, the researchers did not have time limitations when they were searching for these studies. They also used search terms or keywords to find their relevant studies.

These keywords included caregiver, supporter, burden, strain, coping or cope and care. The search included materials up to 2010. The strategy adopted was open open-ended, which was meant to maximize their search for all relevant studies (Del-Pino-Casado, Frı´as-Osuna, Palomino-Moral & Pancorbo-Hidalgo, 2011). Apart from this, the researchers used manual searches to find other relevant additional resources from psychological, nursing, and medical journals. The strength of the search is that it also included references in the papers that were selected (Tricco, Straus & Moher, 2011). These papers were inclusive of those published between 1990 and January 2010 (Del-Pino-Casado, Frı´as-Osuna, Palomino-Moral & Pancorbo-Hidalgo, 2011).

The study identified clear inclusion criteria adopted in selecting the research papers. The criteria were only original studies related to caregivers. Papers included were those mentioning subjective burden as a measurement or variable (Del-Pino-Casado, Frı´as-Osuna, Palomino-Moral & Pancorbo-Hidalgo, 2011). The review failed to indicate the total number of papers used in providing an analysis of the literature.

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The sample of the study

The researchers’ sample was systematically selected. The sample met the selection criteria. The criteria for inclusion of the sample were clearly stated and were adequate for their review. After the appraisal of the papers, the researchers utilized ten reports (papers) between 1990 up to 2010 (Del-Pino-Casado, Frı´as-Osuna, Palomino-Moral & Pancorbo-Hidalgo, 2011). The reports included care-recipients staying at home and suffering from cognitive impairments.

The reports were based on separate studies, which guaranteed reliability since it eliminated the selection bias. The sources included were primary detailing quantitative inquiries. The samples were derived from experiences of family members who gave informal care to old disabled members of the family (Del-Pino-Casado, Frı´as-Osuna, Palomino-Moral & Pancorbo-Hidalgo, 2011).

Of the total sample, 68 studies were related to subjective burden of the caregiver. Of the 68 studies, 67 studies were published in English and only one was published in Spanish. Out of 67 studies, 43 studies were excluded because of failure to meet the criterion of inclusion as established by the researchers.

After a thorough appraisal, only 25 studies met the comprehensive inclusion criteria However, only 10 studies qualified as the final sample after passing the quality test.

Quality Appraisal

The foregoing discussion details the methods, which the researchers used to appraise the quality of the selected studies for inclusion. Using the quality methodology provided by the Agency for Healthcare Research and Quality, two judges assessed and approved the evaluation tool. (Del-Pino-Casado, Frı´as-Osuna, Palomino-Moral & Pancorbo-Hidalgo, 2011) noted that the systematic review of was used to summarize the information obtained from the existing literature using the model suggested by Roe. In addition, the researchers referenced the work of Cooper and Cant and the reporting standards of PRISMA (Tricco, Straus & Moher, 2011).

The review materials were sufficient to give insights into the research phenomenon beforehand. Not only did the researchers assess the concepts of subjective burden, but also other meaningful terms that could help gain understanding of the topic. However, they formed categories using the derived concepts. All these were subjected to validity tests using the original reports (Del-Pino-Casado, Frı´as-Osuna, Palomino-Moral & Pancorbo-Hidalgo, 2011).

Data Extraction

The data extraction process undertaken by (Del-Pino-Casado, Frı´as-Osuna, Palomino-Moral & Pancorbo-Hidalgo, 2011) was adequate for the purposes of review of the meta-synthesis. The researchers utilized a meta-synthesis method in analyzing the findings of the quantitative primary studies. All the procedures for evaluation and selection of the samples proved to be valid and accurate in providing a thorough analysis of the results.

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The sources and the magnitude of the data were clearly documented. The researchers obtained their sample data from primary studies published between 1990 and 2010. They utilized relevant search strategies to ensure that all sources are used.

The sample of the study used was in form of reports, abstracts, and included various data collection methods. Although the study offered a comprehensive evaluation of the sample used, the researchers did not give specific details about the sample collected. They only mentioned that they were family members, informal, or homecare givers for old people. Because of this exclusion of sample details, the reader is denied an opportunity to understand the nature and characteristics of the selected participants (Tricco, Straus & Moher, 2011). The researchers took conscious steps to enhance the integrity of the data collected.

However, there is no clear indication as to how many people were used to provide for extraction of the information needed. However, the researchers indicate the information collected was carefully grouped into categories. They indicate that primary studies were checked by two judges using the model proposed by Roe, which enabled them to arrive at the final sample of 10 studies. From the above discussion, it is clear that the researchers utilized proper techniques to enhance the reliability of data.

Data Analysis

The review of the article shows that (Del-Pino-Casado, Frı´as-Osuna, Palomino-Moral & Pancorbo-Hidalgo (2011) succeeded in compiling all necessary primary studies that could provide a comprehensive review of the literature. The studies offered a detailed examination of the effects of subjective burden on family members who gave care to old disabled people. The researchers effectively pooled all relevant themes and linked relevant information (Tricco, Straus & Moher, 2011).

Using valid grounded theories and established frameworks, (Del-Pino-Casado, Frı´as-Osuna, Palomino-Moral & Pancorbo-Hidalgo (2011) managed to find similarities in the findings of various studies that were selected as samples. The researchers utilized summaries to detail findings of the studies that they selected for purpose of critical review of literature.

The researchers established a fundamental basis to exhibit how informal caregivers took part in preparation of homecare services to old and disabled relatives. By reframing the categories of homecare giving and creating a linkage between cues and subcategories, the researchers attempted to develop meaningful themes to explain the phenomenon beforehand (Del-Pino-Casado, Frı´as-Osuna, Palomino-Moral & Pancorbo-Hidalgo (2011).

The review of the results shows that the researchers effectively gave a detailed account of the findings from primary studies. They indicated that these findings were consonant with their findings and that these results were well routed to the subject of the study. Since the study gave a detailed analysis of the sample data collected, the study offered accurate information obtained from the sources (Polit & Beck, 2012). These results enabled the researcher to provide a detailed interpretation of their methodology. Since samples were used adequately and that results are consistent with those obtained from primary sources, it can be concluded that the findings of the study were credible and valid (Polit & Beck, 2012; Lai, Teng & Lee, 2011).

Conclusions, Limitations, and Implications

The researchers set out to investigate the effects of subjective burden on family members who provide informal care to disabled old people. Therefore, they attempted to provide a comprehensive answer to this research question. They also attempted to find out the effect of reducing SB to the quality of informal care provided by family members. The researchers established a positive correlation between avoidance coping and subjective burden among informal caregivers of aged people with cognitive problems.

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Using their literature analysis and evaluation of the studies, the researchers managed to arrive at objective conclusions as to the validity, reliability and quality of the selected studies in a bid to provide a reasoned answer to the research question (Polit & Beck, 2012). The study found that reduction in subjective burden has a positive impact on the quality of informal homecare provided to old people suffering from cognitive impairment. They determined that reducing the burden could increase the efficacy of homecare and improve the health of informal caregivers.

They found that assistance from professional caregivers increases the effectiveness of the care given to these patients. The researchers further reveal that there is need to develop a collaborative understanding between informal and formal caregivers to reduce subjective burden and improve the patient family relationship. They found that interventions from professional nursing care and change of perception of informal caregivers has the effect on reducing subjective burden and increasing the quality of homecare (Polit & Beck, 2012; Lai, Teng & Lee, 2011). The researchers provide insightful recommendations as to the need to assist informal caregivers as they strive to take care of their loved ones.

In the discussion, the researchers detail the implications of the research findings to the nursing practice. The researchers noted that since the concept of family care is complex and dynamic, there is need for future research to gain understanding of the concept. The researchers suggest the need to conduct future research to identify effective coping among informal caregivers. They also suggest that attempts should be put in place to enhance the efficacy of nursing and care plans for homecare givers.

The study recommends that informal care giving should be driven by coping skills, including avoiding negative perceptions, positive reappraisal, and problem-solving skills.


The meta-synthesis review of the study provided comprehensive information on the significance of subjective burden in influencing the quality of homecare provided to people challenged with cognitive impairment. By appraising the researchers’ search strategy, validity of the data, and evaluating the implications of the study to the nursing practice, a professional caregiver is able to identify ways of leveraging informal caregivers to help them cope with challenges of providing care to old relatives with cognitive impairment (Polit & Beck, 2012).

With the above review, nursing care professionals will be able to understand and prepare well when attempting to assist family members who find themselves in difficult and demanding situations of providing care to old disabled members of their families.


Del-Pino-Casado, Frı´as-Osuna, Palomino-Moral & Pancorbo-Hidalgo. (2011). Coping and subjective burden in caregivers of older relatives: a quantitative systematic review, Journal of Advanced Nursing, 67(11), 2311–2322.

Lai N. M, Teng C. L., & Lee, M. L. (2011). Interpreting systematic reviews: are we ready to make our own conclusions? A cross-sectional study, BMC Med, 9(30).

Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice. Philadelphia: Williams & Wilkins.

Tricco, A. C., Straus, S. E., & Moher, D. (2011). How can we improve the interpretation of systematic reviews? BioMed Central, 9(31), 1-3.

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