Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)



Research Advisor

Carolyn Graff, Ph.D., RN


Ruthbeth Finerman, Ph.D. Pamela Hinds, Ph.D., RN Satish Kedia, Ph.D, RN Mona Wicks, Ph.D., RN


African Americans, caregivers, case study, grandparents, custodial grandparents, qualitative study


Data from the U.S. Census Bureau’s 2005-2007 American Community Survey show that there are 11,436 grandparents in Shelby County, Tennessee, who are responsible for grandchildren. In Memphis only, there are 9,213 grandparents who are responsible for their grandchildren (U.S. Census Bureau, 2000). The Child Welfare League of America (CWLA) 2003 report (2003) showed that 42% of Tennessee grandparents who were responsible for grandchildren who are living with them live in households where the children’s parents are not present. Casper and Bryson (1998) noted that grandparent-headed households are more prevalent in African American communities and are at high risk for poverty. Circumstances surrounding grandparents’ assuming the role of parent include grandparents’ sense of responsibility, parents’ neglect of the grandchild’s needs, sexual abuse of the child by a parent, parents’ need to work, parents’ need for a break, economic problems, inadequate housing, and teenage pregnancy (CWLA, 2003; Kennedy & Keeney, 1988; Minkler & Fuller-Thompson, 1999; Poe, 1992; Ruiz, 2000; Tompkins, 2007). In addition, the authors noted other circumstances for the parents of these grandchildren, including drug-addiction or alcohol problems, incarceration, divorce, inadequate parenting skills, and health problems such as AIDS or physical disability, mental illness, and parent death.

The purpose of this qualitative case study was to describe the symbiotic caregiving of African American custodial grandparents (i.e., grandmothers) and their grandchildren. Symbiotic caregiving will be defined as two way caregiving activities and experiences that exist between both grandparents and grandchildren or between custodial grandparents and their grandchildren. It is a reverse and reciprocal relationship where grandparents, especially custodial grandparents feel a sense of responsibility and attachment to their grandchildren and vice versa.

The sample was 18 African American grandmothers ages 65-85 years and 18 grandchildren ages 8-17 years. The sample was recruited through the Shelby County Relative Caregiver Program in Memphis, TN. The findings show that different circumstances led to grandparents assuming caregiving for their custodial grandchildren. Some of these circumstances are related to the instability of the grandparents’ biological children. These biological parents most times are not involved in their children’s lives and do not help with rearing their children. Harper and Hardesty (2001) described the grandparent/grandchild relationship as puervitic. The term puervitic is used in the context to show that grandparents are raising their grandchildren without assistance from their own biological children. Caregiving activities performed by grandchildren include both instrumental and emotional tasks. Grandparents saw the activities of their grandchild as a way to prepare the grandchildren for adult roles, while the grandchildren assumed their roles in order to help with their grandparents’ physical inability. Grandparents’ caregiving activities included daily rearing of their grandchildren, ensuring that their grandchildren have adequate nutrition, education, health care and moral support.

Both members of the dyad had a different perception of their roles as caregiver to each other. Grandparents envisioned themselves as parents helping to mold their grandchildren as they would with their own children. In contrast, the grandchildren saw their own roles as helping their grandmother, who was the only person who cared about them when other people around them did not. Financial stress was one of the major concerns of the grandparents. They echoed the sentiments of other grandparents in the literature that grandparents need financial rescue to raise their grandchildren effectively. The results indicated that the grandparents and their grandchildren form a close and reciprocal relationship, much as a filial relationship that exists between parents and their children.

The implication for nursing and research includes the need to recognize that custodial grandchildren are part of their grandparents’ lives. The grandchildren may need to be incorporated into the care and welfare of their grandparents as they may be the only individuals available to help some grandparents. With researchers acknowledging the existence and importance of grandchildren as caregivers, more research studies should focus on understanding the grandparent-grandchild dyad.




Two year embargo expired May 2011

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