Showing papers in "Journal of Nursing Scholarship in 1997"

Therapeutic Use of Companion Animals in Health Care

Abstract: Purpose: To explore research that lends credibility to the therapeutic use of animals in health care. By integrating research from other disciplines and applying it to nursing, the art of nursing is fostered through the creative application of knowledge to practice. Significance: Positive physiological and psychological benefits have been linked to the presence of companion animals. For example, researchers suggest that decreases in blood pressure, heart rates, and stress levels, as well as increases in emotional well-being and social interaction are benefits of the human-animal bond. Conclusions: Compiling what has been learned in earlier scientific studies provides direction for future research in nursing to enhance nursing knowledge and expand nursing theory to improve care. Further investigation is necessary to clarify the concepts of animal assisted therapy (AAT) to build a body of useful knowledge for practice.

The University of Texas Medical Branch at Galveston

Abstract: Amount of Services Provided to County Amount of Services Billed to County Reimbursement Received from County 003 Angelina County 23,534.53 8,001.74 5,894.58 020 Angleton Danbury Hospital District 591,640.05 200,270.40 198,621.80 004 Aransas County 121,246.03 41,129.99 20,163.79 008 Austin County 20,843.35 7,076.36 6,860.09 036 Bayside Community Hospital District 68,542.58 23,126.24 2,576.64 013 Bee County 89,127.19 30,299.82 15,915.94 020 Brazoria County 2,570,424.97 871,276.36 675,009.00 031 Cameron County 2,141,441.04 721,065.80 350,477.74 036 Chambers County 139,765.87 47,391.33 29,459.88 045 Colorado County 69,245.42 23,529.86 7,006.26 084 Galveston County 5,105,570.18 1,737,953.26 1,136,533.68 100 Hardin County 471,215.71 159,899.66 93,492.90 111 Hood County 1,273.00 432.82 72.80 121 Jasper County 389,712.75 129,637.12 87,008.96 123 Jefferson County 1,652,299.33 578,304.77 533,556.82 146 Liberty County 211,594.17 73,161.81 58,531.85 170 Montgomery County 252,233.69 83,993.82 83,684.79 174 Nacogdoches Hospital District 51,228.79 17,411.56 14,833.73 176 Newton County 40,391.37 13,575.67 14,712.49 182 Palo Pinto County 13,032.88 4,431.18 4,431.18 187 Polk County 460,566.83 155,726.37 131,468.49 202 Sabine Hospital District 28,044.17 9,529.50 9,495.24 203 San Augustine Hospital District 56,208.51 18,946.06 14,091.02 204 San Jacinto County 111,097.80 37,549.66 31,326.46 207 Schleicher Hospital District 47,283.98 15,788.42 15,445.54 210 Shelby County 50,250.27 17,072.41 6,488.83 020 Sweeny Hospital District 325,923.75 110,588.34 82,648.64 229 Tyler Hospital District 3,496.06 1,182.72 1,182.72 236 Walker Hospital District 937,122.02 318,060.15 289,418.67 241 West Wharton Hospital District 80,009.52 26,939.93 5,270.32 241 Wharton County 146,555.25 49,439.07 43,085.50

Transcultural Nursing Research to Transform Nursing Education and practice: 40 Years

Abstract: In this article, an overview of some major trends, philosophical perspectives, and theoretical perspectives are presented, along with selected transcultural nursing research findings, primarily from the theory of culture care using the ethnonursing research method. A substantial body of transcultural nursing knowledge with health or well being outcomes has been forthcoming since transcultural nursing was launched in the 1950s. The author contends that transcultural nursing knowledge of Western and non-Western cultures is urgently needed to meet health needs in a multicultural world. Some misconceptions and reflections are offered to advance transcultural nursing research, education, and practice. For "newcomers" to transcultural nursing, some basic readings are recommended.

Balancing Engagement and Detachment in Caregiving

Abstract: Purpose: To investigate how caregivers balance engagement with detachment to cope with cumulative demands and losses. Design: Qualitative, descriptive. Population, formal and informal caregivers in the United States. A sample of 14 was studied between 1992 and 1994. Methods: Data were collected in open-ended interviews, then were coded and analyzed using grounded-theory methods. Credibility and fittingness were established. Results: Caregivers who balance engagement and detachment can affect outcomes without needing to control outcomes. Such caregivers are pragmatic and make conscious choices based on their emotional needs. They set and maintain limits and boundaries and are able to monitor the balancing process while recognizing the importance of practicing self-care. Conclusions: The longer and more intense a caregiver's involvement, the more important it is to learn to balance engagement and detachment. Caregivers may need to learn effective balancing skills.

Perspectives Unifying Symptom Interpretation

Abstract: Purpose: To introduce the symptom interpretation model (SIM) and facilitate understanding symptoms from an intrapersonal perspective. Determining an individual’s interpretation of symptoms is critical to understanding the resulting decisions. Organizing Construct: SIM is based on an illness representation model, knowledge structures theory, and propositions about reasoning. Individuals name and assign meaning to environmental stimuli. Based on this interpretation, behaviors are selected for symptom management. Methods: Theory derivation was used to develop SIM for understanding comparisons of known and new symptoms in a behavioral outcomes context. Conclusions: Symptom familiarity reinforces patterns about symptom management. SIM enriches understanding of symptom experiences. Comprehensive assessment, including the intraindividual perspective, is essential to successful symptom management. IMAGE: JOURNAL OF NURSING SCHOLARSHIP, 1997; 29(2), 175-1 81.01 997, SIGMATHETATAU INTERNATIONAL.

Analysis of the Concept of Mutuality

Abstract: Purpose Mutuality is explored as an interaction style for providers and clients that encourages accountability. Significance Accountability by both providers and clients is necessary to manage health care costs and outcomes. Organizing framework Walker and Avant's method of concept analysis. Scope Literature from 1930 to 1996. Mutuality is compared to autonomy, reciprocity, consumerism, negotiation, participation, collaboration, and paternalism. Conclusions Mutuality is shown to balance power and respect, and to promote productive provider-client communication. This interaction style for partnership relationships fosters positive and lasting health care outcomes. Implications Nurses are challenged to develop the skill of eliciting give and take, and creative, mutual exchanges.

(Ir)reconcilable differences? The debate concerning nursing and technology.

Abstract: Purpose: To review and critique the debate concerning nursing and technology. Technology has been considered both at one at odds with nursing. Organizing Construct: Mitcham's (1994) concepts of technological optimism and romanticism. Source: Nursing literature since 1960. Methods: Historical analysis. Findings: Technological optimists in nursing have viewed technology as an extension of and as readily assimilable into humanistic nursing practice, and nursing as socially advantaged by technology. Technological romantics have viewed technology as irreconcilable with nursing culture, as an expression of masculine culture, and as recirculating existing gender and social inequalities. Conclusions: Both optimists and romantics essentialize technology and nursing, treating the two as singular and fixed entities. The (ir)reconcilability of nursing and technology may be a function of how devices are used by people in different contexts, or of the (ir)reconcilability of views of technology in nursing.

Literature review of social support and caregiver burden, 1980 to 1995.

Abstract: Purpose: To critique social support and caregiver burden studies for (a) explication of constructs, (b) associations between constructs, (c) statistical conclusion validity, and (d) generalizability. Social support moderates caregiver burden, yet studies using different conceptualizations raise questions about validity. Framework and Scope: Cooper's (1984) methodology for an integrated literature review was used to examine 50 studies (1980-1995) involving adult caregivers of older family members. Findings: Inadequate explication of social support, potential spuriousness and reverse causation, threats to statistical conclusion validity, and lack of generalizability were found. Conclusions and Implications: Progress has been made in caregiving and social support research, yet many problems remain. Future research should include multiple measures of support, controls for spuriousness and reverse causation, valid and reliable instruments, and samples of diverse populations.

Rules outside the rules for administration of medication: a study in New South Wales, Australia.

Abstract: Purpose: To improve understanding of how nurses define or redefine medication error. Design: Qualitative descriptive. Methods: This 18-week ethnomethodological study in one hospital used participant observation, documentary analysis, and validation criteria. Ethnomethodology is useful for making clearer the every-day, taken-for-granted understandings and practices of people as they make sense of their world. It hinges on the use of tacitly held knowledge in practical situations. Findings: Nurses adopted practices and embodied logic to accomplish tasks. They created criteria to decide when incidents were “real errors” and used institutional rules to create order. Conclusions: The findings provide a body of tacitly held knowledge about medication error that is shared among clinical nurses and redefines medication error using six criteria. The study calls into question the way institutions seek to identify, document, and reduce medication errors by nurses and the validity of nursing research based on reported error rates.

Exploring the Use of Explanatory Models in Nursing Research and Practice

Abstract: Purpose: To address the lack of information in nursing for delivering culturally appropriate care and provide a framework for nurses to incorporate diverse beliefs and health needs into research and practice. People interpret and react to health and illness events within a cultural system. However, the nursing literature contains little about how to elicit cultural beliefs. Organizing Framework: Use of Kleinman's (1980) concept of explanatory models (EMs) is explored first, by describing the concept as it was developed by Kleinman, and second, by illustrating how it was used in three research studies conducted between 1990 and 1994. Method: Individual in-depth interviews were conducted with community-based convenience samples. Data were analyzed using content analysis. Explanatory models were explored with healthy people, with people following illness, and with people having a condition with potential health risks, to illustrate their usefulness in nursing research and practice. Conclusions: The findings provide a beginning understanding of the complex linkages between beliefs and actions and demonstrate the versatility and usefulness of EMs for nursing research and practice. Assessing models offers one means for researchers and clinicians to explore health beliefs and the linkages between beliefs and behaviors.

Nurse-expressed empathy, patient outcomes, and development of a middle-range theory

Abstract: Purpose: To demonstrate how a middle-range theory was developed and tested through research that examined relationships between nurse-expressed empathy and two patient outcomes: patient-perceived empathy and patient distress. Significance: Nurse-patient relationships are the basis for all nursing care and empathy is an important aspect of these relationships. Research is needed, however, to determine the patient outcomes that are related to the empathy of nurses. Organizing Framework: Orlando's (I 96 1, 1972) nursing model. Scope: 140 subjects, 70 staff RNs and 70 patients from hospital medical-surgical acute care units. Each nurse-subject completed two measures of nurse-expressed empathy and each patient-subject completed a measure of perceived empathy and two measures of distress. Findings: Negative relationships were found between nurse-expressed empathy and patient distress (r = -.71, p < .001), and between patient-perceived empathy and patient distress (r = -.71, p < .007). A moderate positive relationship was found between nurse-expressed empathy and patient-perceived empathy (r = .35 to .47, p < .05). Conclusions: A model can be tested when propositions theoretically linked to the model are empirically tested. This study's findings demonstrated support for relationships proposed in Orlando's model.

Historical Methodology for Nursing Research

Abstract: Purpose: To describe the basic tenets of historical research methodology, with emphasis on researching nursing history. Aims: To introduce students and researchers to historical research, through substantive guidelines for library and archival research, and definitions of primary and secondary sources. To discuss ethical considerations—particularly those provoked by recent scholarly interest in the history of ordinary people. To explore issues of external and internal criticism. To discuss analysis, synthesis, and presentation of historical findings. Conclusions: Historical research, as a type of scholarly inquiry, requires attention to methodology to uncover and interpret findings for nursing.,/p>

Nursing Science in the Global Community

Abstract: Knowledge development and research are generally embedded in cultural values and perspectives. This article examines the development of knowledge in nursing in a global context and addresses the degree to which Western values and the social environment in the United States shape nursing theory development. Three perspectives illustrate the influence of US values and contextual factors. Questions are raised about the relevance of knowledge to other cultural or national contexts. Recommendations are made for nursing inquiry that makes knowledge more applicable to the global community.

Readability of Advance Directive Documents

Abstract: Purpose: To assess the readability of advance directive documents. Design: Descriptive. Sample: Convenience, 10 advance directive documents from various sources. Methods: Advance directive documents were electronically scanned in 1994 then evaluated using three readability formulas: Flesch-Kincaid Grade Level, Flesch Reading Score, and Gunning's Fog Index. Findings: The average readability (in schoolgrade levels) of the 10 documents was 11.3 using the Flesch-Kincaid Grade Level and 18.2 using the Gunning's Fog Index. Conclusions: All documents were above reading levels usually recommended for patients. Clinical Implications: Patients must be able to read and understand advance directive documents before signing them. Refinement of the documents is recommended to support patient understanding and autonomy in end-of-life care.

Pain in frail, elderly women after surgery.

Abstract: Purpose: To describe the lived experience of postoperative pain in frail, elderly women. Design: Colaizzi's (1978) phenomenological approach. Sample, Method: 16 hospitalized women from ages 75 to 93, who had abdominal surgery. Unstructured, open-ended interviews were conducted in 1992. Findings: Three major themes emerged: the immediate reality of pain, security, and dealing with pain. The immediate reality of pain consisted of the feeling, awareness, and past imposing on the present. Security consisted of comfort and trust. Dealing with pain consisted of endurance, control, and self-discovery of strategies, the most predominant of which was being still to relieve pain. Conclusions: The frail elderly women in this study tended to endure pain and to trust nurses to provide pain-relief measures. Nurses should carefully assess pain and the desire of patients for control of pain-relief measures.

Roadblocks encountered in recruiting patients for a study of sleep disruption in Alzheimer's disease.

Abstract: Recruitment strategies and the roadblocks encountered in a clinical trial are described. A four-group, repeated measures design was used to test the effects of three sleep-related behavioral interventions on sleep disruption and related variables in Alzheimer's disease patients and their primary caregivers. Despite extensive recruitment efforts, enrollment did not meet expectations. Data analysis revealed three types of roadblocks to recruitment: caregiver resistance, provider resistance, and a mismatch of the disease characteristics with protocol requirements. Recommendations are made to help others solve recruitment problems.

National Delphi Study to Determine Competencies for Nursing Leadership in Public Health

Abstract: Purpose: To identify competencies needed by nurse leaders in public health programs. Design: Five-round national Delphi. Sample: Convenience sample of members of major public health nursing associations and nurse and non-nurse public health leaders in the USA. Methods: Mailed survey in 1994-7995 using a modified snowball technique based on a modification of the Pew Foundation health professions’competencies for Round I. Four additional rounds produced consensus. Findings: Initially, 62 competencies were identified. Factor analysis resulted in four factors: political competencies, business acumen, program leadership, and management capabilities; 57 competencies were clustered in the four groupings and accounted for 91.4% of the variance. Conclusions: Graduate schools in nursing and public health must prepare students with broad-based competencies from a variety of disciplines. Findings of this national survey provide a database for curriculum development and evaluation ofprograms to prepare nurse leaders for roles in public health-based delivery systems.

Peer review, authorship, ethics, and conflict of interest.

Abstract: Purpose To explore problems in peer review, authorship, ethics, and conflict of interest related to writing and publishing. Publishing and adhering to principles is critical as nurse researchers, educators, administrators, and practitioners participate in the development and dissemination of knowledge. Conclusions The quality and integrity of nursing publications are affected by peer review, author collaboration, and ethical conduct. Understanding the conflicts of interest inherent in each action and being committed to impartial review and meeting the requirements of authorship can ensure fewer difficulties for authors, publishers, and consumers.

Fathers' experience of their partners' antepartum bed rest.

Abstract: Purpose: To survey paternal worries, concerns, streses, or problems and the type of support received by men whose partners were prescribed antepartum bed rest at home, or in the hospital, or both. Design: Descriptive retrospective. A national subsmaple of 59 men whose mates were on pregnancy bed rest were randomly selected in 1995 from a nonrandom select sample of individuals who had contacted a bed-rest support group for information. Methods: The Paternal Bed Rest Questionnaire of open-ended questions designed to detail paternal concerns, stresses, and supports was mailed to fathers. Results: Major problems for fathers were assuming multiple roles, managing emotional responses, and caring for their partner. The major paternal worry was for the health of mate and fetus. Coping strategies included using tangible assistance; altering cognitive, behavioral, and emotional responses; and verbalizing worries. Fahers reported receiving little assistance from health care providers. Conclusions: Fathers experience extreme stress when pregnancy bed rest is prescribed for a mate. Family-centered care should include care of the partner whose mate is at high-risk. Interventions that ruduce paternal worry and provide emotional and tangible support are needed.

Comparison of Nursing Interventions Classification and Current Procedural Terminology Codes for Categorizing Nursing Activities

Abstract: Purpose: To compare the frequecy with which nursing activity terms could be be categorized using Nursing Interventions Classification (NIC) and Current Procedural Terminology (CPT) codes. Design: Descriptive. The sample was 201 patients with AIDS hospitalized 1989–1992 for pneumocystis carinii penumonia in three US medical centers. Methods: Nursing activity terms (n = 21, 366) wer collected from patient records, then were categorized using NIC and CPT codes. Results: Nursing activity terms were categorized into 80 NIC interventions across 22 classes and into 15 CPT codes. All terms in the data set were classifiable using the NIC system of the majority (60%) of the terms were classified by CPT codes. The most frequently used CPT code was “pulse oximetry.” Significantly (p >.0001) greater numbers of nursing activity terms could be categorized in the NIC system compared to the CPT system. Conclusions: Findings provide evidence that NIC is superior to CPT for categorized nursing activities in this study's population. The findings support the importance of discipline-specific classifications for categorized of health care interventions. Nursing-specific intervention classification systems such as NIC, the Omaha System, and the Home Health Care Classification are essential to defining the contribution of nursing to both quality and cost outcomes.

Future of the Nudrse Labor Market According to Health Execudtives in High Managed-Care Areas of the United States

Abstract: PURPOSE To understand how the work environment of nurses is changing in states with high enrollment in health maintenance organizations (HMOs), the underlying forces driving change, and how these forces are expected to affect employment and earnings of nurses in the future. Financing and delivery systems that have developed in some states with high enrollment in HMOs are generally regarded as indicative of the future for all the United States. DESIGN Survey in 1995 of a convenience sample of 62 health executives in 11 states with high enrollment in HMOs. Executives included officials in state governments, state and metropolitan hospital associations, professional and nonprofessional nursing associations, state boards of nursing, community and public health, home health care, nursing homes, other non-acute care associations, and leading HMOs. METHODS Through structured telephone interviews, executives were asked about changes in nurse employment, earnings, collective bargaining, fringe benefits, nurses' roles, substitution of licensed practical nurses (LPNs) and aides for RNs, patient severity, quality of patient care, and expectations for nurse employment during the remainder of the decade. FINDINGS Executives perceive a mostly positive and fast-changing nurse labor market but they are concerned about the aging RN work force, possible development of an RN shortage, and linking quality of patient care to the provision of nursing services. They doubt the ability of nurse educators to respond quickly to the need to prepare nurses for rapidly changing employer requirements. CONCLUSIONS Public and private forces are causing rapid, profound changes in health care delivery and throughout the nurse labor market. These changes are most evident in the shift in employment of nurses from hospitals to home health. Despite anxiety associated with these changes, no evidence of an "employment disaster" exists in the views of health executives.

Policy Issues Associated With Analyzing Outcomes of Care

Abstract: Policy questions associated with the conduct of outcmes studies are addressed and outcomes management and outcomes research are differentiated. Multiple outcomes initiatives are being undertaken inthe United States, from the institutional to national and international levels. Nurses have had limited invlvement, thus far-althoughthe array of outcomes being examined is cnsiderable. Members of an American Academy of Nursing expert panelon quality health care discuss the environmental context and multiple focuses of outcomes analysis. they provide an overview of current activities, present the challenges confronting nursing in its pursuit of a quality assessment agenda, and make recommendations for increasing nurses' participation in quality initiatives.

Doctoral Education in Nursing for Practitioner Knowledge and for Academic Knowledge: The University of Adelaide, Australia

Abstract: Australian nursing has undergone rapid academization in the past 10 years and this radical change has tended to meld the somewhat different academic traditions of North America and Britain. The introduction of doctoral education in nursing in 1987 has led to a massive increase in scholarly activity and to the preparation of talented leaders. We concur with the view expressed by Henry (1997), "I am convinced that the problems we face in the nursing services would be much more creatively solved if the majority of our doctoral programs prepared young, energetic nurses, early in their career, for clinical practice, not for research and teaching" (p. 162).

Research and practice in an academic community nursing center.

Abstract: Purpose: To identify issues and describe strategies used in developing a successful program of clinical research focused on the vulnerale populations served by one urban academic nursing center. Academic community nursing centers provide ideal settings to implement programs of research. Understanding the challenges when integrating research into these practices and the strategies used is important. Setting and Scope: The University of Wisconsin-Milwaukee Silver Spring Community Nursing Center has provided primary health care services to a low-income urban population since 1987. A team of advanced practice nurse clinicians, community health nurses, and other health care professionals and community residents implemented a broad range of innovative, community-focused, clinical inteventions that are routinely studied throughan integrated program of nursing research. Their strategies for research implementation are analyzed. Conclusions and Implications: Factors affecting the integration of research into the center include (a) community mistrust, (b) the need for participatory recruitment strategies, and (c) the need for multiple data collection methods. Meeting these challenges requires that research agendas and methods are consonant with community goals. The inclusion of clinicians, other providers, and community residents as active members of research teams is critical to success. Reframing research and practice roles in terms of team effort that incorporates the community can strengthen research and practice-and benefit professionals and the populations they serve.

Advice from affected persons about living with human papillomavirus infection.

Abstract: Purpose: To describe the “advice or information” people who have had HPV for one year would give to the newly diagnosed. Design: Descriptive Population, Sample: The population was persons with HPV. A convenience sample of 61 women and 27 men, mean age 23.8 years, was recruited from 4 clinics in one midwestern U.S.A. city between 1990 and 1993. Methods: Participants answered an open-ended question about the advice and information they would give to newly diagnosed persons. Content analysis was done. Findings: Six major areas of advice were provided including keeping a balanced perspective, getting treatment, sexual behavior, knowledge, self-care, and other. A high percent of advice from women was to keep a balanced perspective on life. A high percent of the advice from men focused on sexual behavior. Conclusions: Advice covered a variety of topics touching on many aspects of daily life, not simply disease control and sexual behavior. Clinical Implications: Practitioners should carefully explore their clients’reactions to the diagnosis of HPV and address the sensitive emotional elements entailed.

Effects of Case Management on the Nursing Context-Perceived Quality of Care, Work Satisfaction, and Control Over Practice

Abstract: Purpose: To examine in 1995 the effects of case management on the context of nursing practice-perceived quality of care delivered, work satisfaction, and control over nursing practice-rather than the commonly studied effect on fiscal outcomes. Design: Prospective quasi-experimental. Sampled were nurses on four units at one community hospital where patients with DRG 107 (Coronary Artery Bypass Graft, with no cardiac catheterization) were traditionally hospitalized. Methods: Registered nurses on these units completed quality of care, satisfaction, and practice-control scales before and 1 year after implementation. Findings: Significant positive differences were found in several aspects of perceived quality of care for both staff nurses and case managers, with specific increases found in nurses' perceived ability to develop relationships with patients, ability to be therapeutic, and support for good care from the institutional structure and administration. A significant decrease in nurses' satisfaction with their pay and other rewards as well as respect from colleagues was found. Case managers were found to have significantly increased perceptions of control over their practice. Conclusions: Case management was found to have a primarily positive effect on nurses-staff and case managers alike. There were significant increases in several aspects of the nurses' perceptions of the quality of care delivered. Additionally, case managers were more satisfied with the administration, the respect they received, and their pay and rewards in the institution. Most strikingly, case managers perceived themselves to have more control over their practice. Some negative effects of the program were a decrease in satisfaction with the pay and rewards by the staff who were not case managers.

Managing health problems among homeless women with children in a transitional shelter.

Abstract: Purpose: To describe health problems among homeless women with children living in a transitional shelter, analyze how they managed various ailments and when and how they sought care. Design: Qualitative using grounded theory and dimensional analysis. Sample: During 1992 and 1993, data were gathered from a convenience sample of 13 Latina, 11 White, and 6 African American women (n=30) who lived in a transitional shelter in California, USA. Methods: In-depth, semi-structured interviews Findings: Despite many supportive services in transitional shelter, respondents had difficulty managing health problems. Typically, a woman reported she managed a health problem by overcoming it alone. Conclusions: The pattern of overcoming it alone existed years before transitional shelter life, and, in many instances, persisted during shelter years. Clinical Implications: Clinical nursing interventions that address shame, fear, lack of information, and eligibility for services could improve health outcomes among women and children living in transitional shelters.

Change and continuity in family caregiving practices with young mothers and their children

Abstract: Purpose: To examine how young mothers who gave birth during adolescence extended and developed caregiving practices within the context of family relationships, caregiving traditions, and life events. Design: Longitudinal, interpretive-phenomenological. A community-based sample in 1993 consisted of 13 of the 16 young mothers and 11 of the 18 grandparents who had participated in a 1988 study. Three male partners of the young mothers also participated in this 1993 study. Families resided in a Western metropolitan area in the United States. Methods: Life history accounts of the intervening years, stories of family routines, and recent coping episodes of parenting were elicited through in-depth interviews with the young mothers and their male partners; one interview was conducted with grandparents. Data were analyzed using the interpretive approach. Findings: Adversarial caregiving practices develop or change in the context of transformed family relationships. Conclusions: Life-course and parenting experiences of young mothers are not private and located in the self, but are developed in interaction with others. Family-centered interventions are needed that support the efforts of young mothers and grandparents to become responsive caregivers.