The Reconceptualized Uncertainty in Illness Theory (RUIT) was used to investigate antecedents to, appraisals of, and ways of coping with stressful caregiving. Four focus groups with caregivers (8 males and 16 females) of relatives with dementia were conducted; 15 cared for their parents and the remainder cared for their spouses. They were recruited from an adult care center and other community settings in a metropolitan area in New England. The discussions were audiotaped and transcribed verbatim. Two researchers independently coded the transcripts. Thematic analysis was structured according to the RUIT. The study is unique in its application to caregivers as opposed to patients and to all of the elements of the RUIT. Caregivers experience uncertainty in similar ways to patients with life-altering illness. Symptom severity--lack of personal boundaries, repetitive and aggressive behaviors, and the need for constant care--was the most frequent source of stress. The appraisals were mostly negative and included feelings of resentment, a lack of support from family members, financial strains, and loss of freedom. Self-improvement and self-care were important aspects of coping. Spirituality and humor were other coping skills that respondents used. Not all respondents said they were coping and some also reported that support from health care providers was not always helpful. Nurses can help improve coping by explaining the factors that contribute to caregiver strain and uncertainty, and by assisting caregivers to anticipate the effects of the caregiving role.
Although this symposium has treated the subject of the Bill of Rights in the welfare state primarily within the context of American constitutional law, it is instructive and appropriate to compare the American experience with the experiences of other liberal democratic welfare states. Indeed, if a symposium on this subject had been held in 1991 at a university anywhere except in the United States, its approach almost certainly would have been cross-national from beginning to end. Most of the participants, no doubt, would have been invited to explore how some countries-for example
Over the two years it took them to draft the 1948 Universal Declaration of Human Rights, the eighteen members of the U.N.'s first Human Rights Commission had surprisingly few discussions of why human beings have rights or why some rights are universal.' After the horrors of two world wars, the need for a minimal common standard of decency seemed evident. One of the first tasks assigned to the new Commission chaired by Eleanor Roosevelt was the preparation of an "international bill of rights." The Commissioners, in haste to complete their work before the deepening Cold War made its acceptance by the General Assembly impossible, left the problem of foundations for another day. At the Commission's first session in January 1947, China's Peng-chun Chang and Lebanon's Charles Malik did try to initiate a discussion of the premises on which such a document might be based. 2 Chang was a Confucian philosopher and educator who had done postgraduate work with John Dewey, and Malik was a philosopher of science who had studied with Alfred North Whitehead and Martin Heidegger. Their suggestions precipitated the Commission's first argument. The Yugoslav, French and English delegates began to wrangle over the relation between man and society. Several other Commissioners became impatient with that sort of discussion. They just wanted to get on with the business at hand. After a time, India's Hansa Mehta broke in. She was one of two women on the Commission, a pioneering human rights activist, a crusader against British colonialism, and an advocate for women's equality. She said, "We are here to affirm faith in fundamental human rights. Whether the human person comes first or the society, I do not think we should discuss that problem now. We do not need to enter into this maze of ideology. '3 Charles Malik, who had been literally called out of his Beirut classroom and pressed into public service by the government of newly independent 1. For details of the framing of the Universal Declaration, see Mary Ann Glendon, Rights from Wrongs (forthcoming, Random House). 2. Human Rights Commission, First Session, Summary Records (E/CN.4/SR.7 p. 4).
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