Pao-Feng Tsai

Access Type

Open Access Dissertation

Date of Award


Degree Type


Degree Name




First Advisor

Dr. Mary Jirovec


A theory of caregiver stress derived from Roy Adaptation Model was developed to examine the relationships among stimuli, coping mechanism and adaptive modes. The theory hypothesized that objective burden in caregiving would be the most important stimulus that leaded to perceived caregiver stress. Higher perceived caregiver stress would result in ineffective responses (poor health function, lower self-esteem/mastery, role enjoyment, and marital satisfaction, and less ability to reciprocate). These adaptive modes should be interrelated. In addition, this study also examined the role of depression and the function of contextual stimuli in the model. However, statistical analysis did not support the initial RAM-derived theory. The primary model was modified by reevaluating the relations among constructs in empirical data using structural equation modeling. The robustness of the final data-derived model was further partially cross-validated with another sample and was further simplify. The findings showed that (a) Objective burden in care giving and perceived caregiver stress were not the most important determinants of their outcomes in the context of chronic caregiving; (b) Perceived caregiver stress and depression were related yet distinct concepts in predicting caregivers' outcomes; (c) Depression was the most easily aroused outcome of perceived caregiver stress; (d) Contextual stimuli did not have either the main effect on perceived caregiver stress or a moderated effect on the relation between objective burden in caregiving and perceived caregiver stress. Instead, they influenced caregivers' outcomes directly; (e) Gender was the only residual stimulus that was found to predict perceived caregiver stress. Residual stimuli in this study played more important roles in predicting focal stimuli, contextual stimuli, depression, and adaptive modes; and (f) There were no causal relationships among adaptive modes; instead, adaptive modes were either predicted by depression, contextual stimuli, or residual stimuli. The results provide valuable insights to the RAM as well as caregiving knowledge. It also pointed out the importance of using secondary data analysis and structural equation model in nursing research.