Abstract

Change in the Canadian health care system is increasing family responsibility for caring in health and illness and this responsibility is primarily assumed by women. Traditional health research upon which these changes are based has provided an incomplete understanding of both women's health and women's caring and has failed to consider the contextual realities of women. The purpose of this research was to expand nursing knowledge of women's caring as a base for policy development and expansion of nursing roles. ;The grounded theory method was used from a feminist perspective to develop a substantive theory to explain the problematic aspects of caring within the existing social structure. Sources of data were selected using theoretical sampling beginning with interviews of mothers of young children. They included 21 women with diverse caring responsibilities, interviewed twice in individual or group interviews; participant observation at networking, self-help, and public information sessions; and 43 previously collected interviews with parents of children with middle ear disease, women caring for elders with Alzheimer's Disease, and women survivors of conjugal abuse. ;The analysis revealed that the competing and changing nature of caring demands are most problematic for women. Intervening environmental conditions named caring ideals, caring options, caring proximity, and caring rewards influence women's responses of caring demands. The two stage process, found to be used by women to manage caring demands, was named Precarious Ordering. In the first stage, women's connections with others become frayed in the process of responding reactively to competing and changing demands. Fraying connections are evident in struggles with caring work, relationships and helping systems; altered prospects for the future; and ambivalent feelings. In the second stage of the process, women become proactive using the interdependent processes of setting boundaries, negotiating, and repatterning care. These processes are strategies that are intuitively and consciously acquired and refined to limit demands, change intervening conditions, and improve management. The process of precarious ordering is recursive as each new set of competing demands or changed demands varies fraying connections and results in revision to these basic strategies with concomitant growth in perspectives, skills, or opportunities. ;The central process of Precarious Ordering demonstrates the power and resilience in women's responses to caring demands and indicates points of entry for nurses' caring. The model suggests not only individual solutions directed at improving women's abilities to manage but also social change to alter the ways the existing social structure creates and intensifies problems for women caring. In addition, research methodology in nursing is advanced by reflection on the process of implementing grounded theory from a feminist perspective