# Through the Burden: A Model of Self-Transcendence in in Family Caregivers of NH Residents

## TL;DR

This study explores how family caregivers of nursing home residents with dementia can find meaning and adapt through caregiving, despite emotional burdens.

## Contribution

The study applies Reed’s Self-Transcendence Theory to show how family-centered care reduces burden and fosters personal growth in caregivers.

## Key findings

- Perception of family-centered care significantly reduces caregiver burden.
- Lower burden is linked to higher self-transcendence in caregivers.
- Family-centered care indirectly promotes self-transcendence through reduced burden.

## Abstract

Family caregivers of nursing home (NH) residents with advanced dementia often experience high emotional and logistical burden. While most models emphasize stress and coping, fewer address meaning-making and personal growth. This study applies Reed’s Self-Transcendence (ST) Theory to explore how caregiving may foster adaptation and meaning after placement.

To examine whether perceptions of family-centered care predict caregiver burden and ST.

Using a cross-sectional survey of 232 family caregivers of NH residents with advanced dementia, we examined the relationships between “Perception of Family-Centered Care” (basic care, symptom management, communication, trust, shared decision-making, and recognition of personhood), in NH staff, burden, and ST.

Structural equation modeling revealed that Perception of Family-Centered Care significantly predicted lower caregiver burden (β = –.611, p < .001). In turn, lower burden was associated with higher ST (β = –.52, p = .002). The direct path from Perception of Family-Centered Care to ST was nonsignificant (β = –.154, p = .218). However, the indirect effect from Perception of Family-Centered Care to ST through caregiver burden was significant (β = .67, 95% CI [.214 – 2.253], p = .000), indicating full mediation.

Findings highlight the transformative nature of family caregiving in the NH setting. Recognizing family caregiving as a dynamic, transformative process can guide interventions that help family caregivers move through the burden-transcend toward meaning and connection. NH policies should consider integrating structured communication, family engagement, and decision-making support to reduce burden while fostering resilience, meaning-making, and role adaptation.