Process of ambivalent normalisation: Experience of family caregivers of elders with mild cognitive impairment in Taiwan

Aims and objectives: To conceptualise the caregiving process in Taiwanese families caring for elders with mild cognitive impairment. Background: Family caregivers play an essential role in the lives of elders with mild cognitive impairment by dealing with their cognitive status and daily function. Little is known, however, about the development of the caregiving trajectory, particularly in Asian countries.Design and methods. Grounded theory methodology was used. Data were collected via in-depth interviews with 10 family caregivers of patients with mild cognitive impairment and living at home in northern Taiwan. Data were analysed by constant comparative analysis. Results: The process most used by family caregivers to adjust to conflicts and changes in relationships with elders with mild cognitive impairment was 'ambivalent normalisation'. This dynamic process included three components: subtle changes, optimistic appraisal and ambivalent anticipation. Family caregivers who had developed this process were more likely to adopt multiple effective behavioural approaches to avoid conflict in their daily life and to begin outlining future caregiving tasks. Conclusions: The process of ambivalent normalisation can sensitise healthcare providers to family caregivers' needs and provide a basis for developing frameworks for future substantive theory and possible future research. Relevance to clinical practice: This study's findings may help healthcare providers understand family caregivers' needs and effective patterns for taking care of elders with mild cognitive impairment. Interventions can be developed to facilitate family caregivers' awareness of the changes in their loved one in the initial stage of diagnosis and adopt multiple effective strategies to prevent conflicts in their lives. Healthcare providers can actively examine the cognitive function of older people in general outpatient departments, provide well-timed treatments and minimise caregiver burden.