This review critically examines the current state of the science on the concept of family caregiver-care receiver mutuality, summarizes accomplishments and gaps and identifies directions for future theory development and research. Mutuality between family caregivers and care receivers is of increasing interest to researchers. However, no analysis of the current state of the science of this important concept has been published. Our literature search revealed 34 research articles that met inclusion criteria. The studies were assessed in terms of conceptualization of mutuality, instrument development, populations studied, research designs and methods and findings. Significant scientific progress during the past 30 years includes the development of clear definitions and new instruments, expansion of research beyond the clinical populations in which mutuality was first studied, the use of a variety of research designs, and increasingly sophisticated methods of data analysis. Growing evidence suggests that mutuality is associated with caregiver emotional health outcomes and may decrease over time in the context of chronic illness. Directions for future research include development of new theoretical frameworks grounded in relational theory, development of theory on the dynamics of mutuality over time, exploration of mutuality in diverse cultures and populations, and intervention studies aimed at enhancing mutuality.

This study confirmed the effectiveness of the flipped classroom as a measure of active learning by applying a quantitative approach. But, regarding the significance of the initial contribution of flipped learning in the discipline of nursing science, carrying out a more authentic experimental study could justify the impact of flipped learning pedagogy.

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Patients who undergo coronary artery bypass graft (CABG) surgery are often dependent on spouses or family members for care during their recovery. The purpose of this study was to examine changes over time in spousal caregivers of coronary artery bypass graft (CABG) patients in caregiving demand and caregiving difficulty and to identify the key demands and difficulties at each time point. Spouses (n=34) of CABG patients comprised the sample. Caregiving demand and caregiving difficulty were measured using the Caregiving Burden Scale at three time points (baseline [early hospital discharge] and 3 and 6months later) and analyzed using repeated measures analysis of variance. Mean scores of each item were used to identify the top four caregiving demands and difficulties at each time point. There was a significant decrease over time in caregiving demands (F [1.696]=13.62, p<0.001) and caregiving difficulties (F [1.613]=4.52, p=0.02). The most demanding and/or difficult caregiving activities at all time points were providing social support, managing behavior problems, taking on additional household tasks, and monitoring symptoms. Early in recovery, providing transportation was a top ranked demand and difficulty. Later in recovery (3 and 6months), managing finances became a top ranked demand and difficulty. In conclusion, caregiving demands and difficulties declined significantly over six months for the caregivers in this study. These results indicate that caregiving demands and difficulties change over time and ongoing assessments of spouses and family members are needed to help them manage the caregiving situation.

Purpose Compared to non-caregivers, caregivers have higher rates of depressive symptoms, caregiver strain, less mutuality, and health care visits. However, few investigators have examined family caregivers after coronary artery bypass surgery. The purpose of this study was to examine differences in caregiving difficulties, mutuality (i.e., open communication; avoiding sad thoughts), and depressive symptoms based on low verses high caregiving demands among spousal caregivers. Design A descriptive, comparative design was used to examine 33 spousal caregivers of CAB surgery patients (16 in low and 17 in high caregiving demand groups). Methods Measures included: Caregiving Burden Scale, Mutuality and Interpersonal Sensitivity Scale, and Patient Health Questionnaire-9. Groups were compared using Mann-Whitney U statistics. Findings It was found that caregivers with high caregiving demands reported more caregiving difficulties and more open communication about the surgery compared to caregivers with low demands. Conclusion Caregivers with greater caregiving demands may need additional support to assist them with the caregiving situation.