Experience_of_Being_the_Spouse_Cohabitant_of_a_Person_with_Bipolar_Affective_Disorder__a_Cumulative_Process_over_Time

Running header: Experience of being the spouse/cohabitant Experience Of Being The Spouse/Cohabitant Of A Person With Bipolar Affective Disorder: A Cumulative Process Over Time Christina Gibson Morales Grand Canyon University: NRS 433V Introduction to Nursing Research July 15, 2011   Experience Of Being The Spouse/Cohabitant Of A Person With Bipolar Affective Disorder: A Cumulative Process Over Time Bipolar affective disorder (BPD) is a mood disorder characterized by swings in affect and activity from mania and hyperactivity to depression with decreased need for sleep. The married manic’s spouse is confronted with a myriad of symptoms that produce shock, fear, anger and grief among other burdens, the worst of which can involve suicide threats and attempts. During periods of crisis, the patient with BPD is the nurse’s first priority. Between hospitalizations, however, the most important caregiver is many times the spouse/cohabitant. Family-focused care, therefore, becomes a more effective approach than short-term crisis management. This paper reviews a qualitative research study whose purpose was to answer, “what are the experiences of spouses/cohabitants who over time live with a partner who has bipolar affective disorder'” The answers revealed a three-step process spouses’/cohabitants’ experience when mastering skills used to cope with their partner’s BPD. The following is the full article citation: Tranvag, O; Kristoffersen, K. (2008). Experience of being the spouse/cohabitant of a person with bipolar affective disorder: a cumulative process over time. Scandinavian Journal of Caring Sciences, 22, 5-18. Literature Review The authors thoroughly reference previous works, in the introduction and the discussion section, which define BPD and it’s effect on families and caregivers. Previous literature discusses families as they accept living with BPD, but lacks discussion of consistent patterns of spouses’/cohabitants’ burdens over time and how they learn to master the unexpected challenges accompanying BPD. Although nursing practice is not directly studied, applications for improved family education and family-focused care are derived from concepts discovered in this research (Tranvag & Kristoffersen, 2008). Study design The study design is identified as two-fold. A descriptive phenomenological approach was used for interviewing participants. Interviewers bracketed their own “beliefs and opinions about the phenomenon under study” (Polit & Tatano Beck, 2010) so as “to understand the other’s experience as they experience it, [maintaining a] phenomenological naïve attitude” (Tranvag & Kristoffersen, 2008). The second part of the research utilized a hermeneutic approach to interpret interview transcripts, in which the researcher made use of his/her own conscious phenomenological pre-understandings to interpret the interview transcripts. An underlying theme throughout the researchers’ article is the concept of the German word gestalt, “a configuration or whole, an entity which is more than the sum of its parts” (Wiley, 2004). Gestalt therapy theory dictates that “people’s insight, and the meaning they derive from experiences, are crucial for how the experiences are perceived. Each experience influences the whole, the whole influences the individual experiences and the whole amounts to more than the sum of its parts” (Tranvag & Kristoffersen, 2008). Complete gestalts represent equilibrium. If crisis/hospitalization is perceived as an unbearable burden, this is an incomplete gestalt and the spouse experiences imbalance. The healthcare team, through support, openness and education can form parts of a complete gestalt, alleviating some of the burdens associated with BPD and helping lend balance to the family. The researchers depth of understanding lent to the topic of spouses’/cohabitants’ experiences with BPD is profound. Fourteen illness-related experiences are explored as well as how these integrate into a three-step continuum of the illness-related experiences. The question posed of what do partners of BPD patients experience is thoroughly examined and re-examined revealing an apparent gestalt pattern of experience, perception (understanding) and mastery leading to equilibrium. These experiences are seen through the participants’ eyes, at their vantage point and understood through their own words. Methods and Sampling This study employed video/audio-taped interviews consisting of participants’ responses to open-ended questions that were later transcribed in their entirety. The process for purposeful selection was to only recruit spouses/cohabitants who live with the partner diagnosed with BPD, experiencing at least two critical episodes leading to the hospitalization of the individual with BPD. Psychiatric nurses identified couples that fulfilled the inclusion criteria, and patients were then approached for informed consent to invite their partner to participate in the study. Their partner was approached once signed consent was obtained. Willing partners also signed informed consent. Eight couples, ranging from 6 to 51 years of cohabitation, participated in the study. The last two participants did not supply “perspectives to the study that had not already emerged; this was regarded as saturation” (Tranvag & Kristoffersen, 2008). The Regional Committee of Medical Research Ethics, Norway and the management of two psychiatric hospitals granted permission for this research study beforehand. Data Collection Clear and complete description of the lives of spouses/cohabitants of BPD patients was seen in the fourteen categories: fear, accusations, self-doubt, being overlooked by health personnel, stigmatization, uncertainty and powerlessness, loneliness, anger/despair, the persistent threat, own health problems, and loss/grief. These were illustrated through narrative quotes from participants. Assumptions/biases General assumptions about the experience of living with a person with BPD were voiced in this article, including that the symptoms of BPD are perceived as burdens, and that some of nurses’ reactions towards spouses/cohabitants can increase instead of alleviate the weight of the burdens. These are fair assumptions, and at the very least the first of those two assumptions are well documented in previous literature; both are supported by the results of this research. Data analysis Content analysis followed inductive methods, so as to increase “former knowledge about the phenomena” (Elo, 2007). One hundred sixty pages of conversation were transcribed from the completely taped interviews. A detailed explanation in included in this article explaining the following five steps used for data analysis: First, a naïve reading was followed by the identification of meaning units. Meaning units were condensed and subthemes formulated. The subthemes were reintegrated into the original context leading to a total understanding of the text and formulation of themes that expressed the essence of couples’ experiences. Findings The findings were consistent with the reflective data. The fourteen different thematic experiences were summarized and illustrated with one to three participant quotes, lending to the credibility of the data. Three major aspects emerged characterizing these fourteen experiences: experiences create pre-understanding of future occurrences; pre-understanding affected the perception of subsequent occurrences; pre-understanding also affected the ability to master subsequent crisis. Trustworthiness Guba and Lincoln proposed four criteria for establishing qualitative research trustworthiness: credibility, transferability, dependability and confirmability (Trochim, 2006). During the participants’ second interviews, a written presentation of participants’ descriptive statements along with the interviewers’ interpretation was provided to the participants, with the opportunity to express their reaction to the interpretations, lending credibility to the study. Transferability was noted in the authors stating documenting that ten of the fourteen themes that emerged had already been observed in previous research. A larger pool of peers for examination could have better supported dependability. Confirmability, “the extent to which the findings of a study are shaped by the respondents and not researcher bias, motivation or interest”, (Cohen & Crabtree, 2006) is supported by 100% transcription of recorded interviews. Conclusions The fourteen common spouse/cohabitant experiences revealed three characteristics of acquiring a complete gestalt and inner balance: critical experiences lead to pre-understanding utilized to cope with subsequent ordeals; pre-understanding affects spouses’ perception of subsequent events; positive perception of experiences leads to successful coping needed to adjust to living with a patient with BPD. Nurses who understand this process can help to lighten the burdens carried by spouses/cohabitants who deal with their partner’s BPD symptoms. Nurses who provide empathy and information to spouses/cohabitants ensure that they do not perceive that they are overlooked or turned away. Sharing knowledge can dissipate feelings of powerlessness. Health-promotion can assist cohabitants that experience their own health problems secondary to the stress of their spouses’ BPD. Further research is needed to clarify universal needs of families; specific needs of individuals in families, and the cumulative process that spouses/cohabitants experience so that holistic nursing interventions can be developed. Emphasis should be placed on cohabitants deriving insight, perspective and understanding to master burdens and crises.