Alzheimer-type dementia (AD) is an insidious pervasive debilitating disorder that destroys the affected person's capacity for self-care. In this grounded theory study, we explored the reciprocal process of becoming strangers in which eastern Canadian family caregivers and care recipients with AD interact on a continuum from intimacy to alienation through dimensions of dawning, holding on and letting go. The findings illuminate the experiences of family members who struggle on a daily basis with their commitment to the person they knew and their increasing detachment from the stranger that person has become. With the increasing emphasis on home care, these findings offer insights for individual care and health policy development.

Health care restructuring during the 1990s resulted in major changes in the way nurses' work is defined and implemented. The adoption of the baccalaureate degree as basic preparation for entry into nursing has further complicated the lives of nurses. The purpose of this qualitative study is to explore the impact of health care reforms and changing educational requirements on nurses in New Brunswick, Canada. Sixty-three nurses representing different practice settings were interviewed and three focus groups were held with the nurses that were interviewed. Study findings indicate that nurses' practice has changed as a result of the reforms. Nurses give less direct care to patients and have taken on a greater administrative role. The requirement of a baccalaureate degree for entry to practice has placed a strain on working relationships between older and younger nurses, accentuating differences in working knowledge and work ethic among these groups.

The findings of this grounded theory study of Eastern Canadian family caregiving for persons with Alzheimer's disease (AD) provide additional evidence that the presence of both formal and informal social support often fails to make caregiving easier. At family, community, and professional levels, caregiver perception of the helpfulness of support in meeting needs emerged as the indicator of whether support is connected or disconnected. In this paper, we demonstrate and discuss the impact of connected and disconnected support on caregiver progression on the continuum from intimacy to alienation in the process of becoming strangers, the basic social process identified in the study. Implications for further research and practice are discussed.

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