Guilt experienced by caregivers to individuals with dementia: A concept analysis

AimTo create a comprehensive understanding and definition of guilt in caregivers of individuals with dementia. Through this concept analysis, we hope to empower nurses to more accurately identify guilt in caregivers and tailor interventions to specifically reduce these symptoms of guilt. BackgroundIndividuals with dementia are often cared for by relatives, friends and neighbours. Many caregivers express feelings of guilt, increasing the risk of depression and psychological burden. In turn, this impacts their availability to render care. DesignConcept analysis according to Walker and Avant (Strategies for theory construction in nursing. Boston, MA: Prentice Hall; 2011). MethodA literature search was completed utilising the following databases Cumulative Index to Nursing and Allied Health, PubMed, PsycINFO and Google Scholar for the years 2003-2017. Common definitions and lay usage were also considered. ResultsThe identified critical attributes of guilt experienced by caregivers to individuals with dementia include the following: (a) The expectation of a moral responsibility to care for the individual with dementia; (b) a negative, subjective appraisal of one's own caregiving performance, including neglecting other roles and responsibilities and self-neglect; and (c) a sense of transgression or violation of a moral standard as a caregiver to the individual with dementia. These defining attributes were then applied in three cases: model, borderline and contrary. Pertinent antecedents and consequences to the concept of guilt in caregivers to individuals with dementia were identified. DiscussionAs a result of the guilt, the caregiver may experience poor mental and physical health, symptoms of anxiety and depression, and a greater sense of caregiver burden. ConclusionA new, comprehensive conceptual definition of guilt in caregivers to individuals with dementia is described. Implications for practiceA conceptual definition of guilt in caregivers of individuals with dementia allows nurses to assess and identify caregivers at risk for, or currently experiencing, guilt and help direct caregivers to appropriate interventions and supportive services.