Applying Reed's Self-Transcendence Theory to Support Family Members of Nursing Home Residents Living With Dementia: A Critical Appraisal and Adaptation

Background: With the global aging population, the number of individuals living with dementia is increasing and raising the demand for supportive care, particularly in nursing homes (NHs). While family members of individuals with dementia often provide care, individuals with advanced stages of dementia require specialized care in NHs. The transition to NH care creates unique stressors for families, yet it can also foster personal growth and resilience among them. Existing research primarily focuses on stress and coping models that do not fully capture the positive aspects of caregiving, such as meaning and personal growth. This paper explores Reed's Theory of Self-Transcendence (ST) as a lens for understanding the positive dimensions of family caregiving in NH settings. Methods: Using Parse's criteria, we critically evaluated ST theory, adapting it to better reflect the experiences of families of NH residents with advanced dementia. Our evaluation confirms that ST is a strong framework, but its application in NH caregiving requires expansion to include ecological and relational factors that influence the caregiving experience. Theoretical Framework: We propose an adaptation that integrates concepts such as trust in NH staff, communication quality, shared decision-making, personhood, and caregiver burden, offering a more comprehensive understanding of family involvement in NH care. The adaptation we propose emphasizes the transformative potential of family caregiving, moving beyond stress-based models to acknowledge resilience and emotional adaptation. By connecting theory to real-world application, this work offers strategies to enhance family engagement, emotional well-being, and care quality in NHs. Conclusions: Future empirical research will test this revised framework and examine how these factors impact caregiver stress, well-being, and engagement. The findings will inform evidence-based nursing interventions and policies that view family members as essential partners in dementia care. Ultimately, integrating ST and stress perspectives provides a more nuanced, person-centered approach to supporting families in NH settings.