Zegwaard MI, Aartsen MJ, Grypdonck MHF and Cuijpers P
Background: Literature has shown the serious impact of severe mental illness on the daily life of caregivers. We
studied reported caregiver support practices by mental health nurses for use in the development of a nursing
intervention. We aimed to explore current caregiver support practices by mental health nurses.
Methods: Twenty-one participants completed semi-structured interviews, and 17 participants attended two focus
groups. All interviews were audio-taped, transcribed and coded for qualitative analysis.
Results: The diversity in caregiver support could best be described by three prototypes: the tolerator, the preventer
and the concerner, representing three approaches of involvement with caregivers. At one end of the spectrum are
mental health nurses (MHN) who are essentially only concerned with the wellbeing of the care recipient and see
the caregiver as a potential impediment in reaching the client’s goals. We call these the tolerators. At the other end
of the spectrum are the MHNs who see the caregiver and the care recipient as inextricably connected with each
other. In these cases the MHN directs her/his intervention towards both the informal caregiver and the care
recipient. We call these the concerners. In the middle position are MHNs who realize that caregivers are important
agents in the achievement of the client’s goals, and therefore consider preventing them from becoming
overburdened as an important goal. We call these the preventers.
Conclusions: Based on the extent to which the MHNs believe that the informal caregiver plays a necessary role in
the client’s support system, and the degree to which they feel responsible for the caregiver’s wellbeing, three
MHN prototypes can be distinguished. These prototypes determine how the nurses’ vision directs their
understanding of their role and responsibilities and the content of their behaviour. This implies that a change in
behaviour needs to be preceded by a change in vision. Therefore, promoting family support cannot be achieved