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J Korean Gerontol Nurs > Volume 25(2):2023 > Article
Heo and Kim: Family caregivers’ perceived value of caring for older patient: A hybrid model of concept analysis



The purpose of this study was to define and clarify the concept of the family caregivers’ perceived value of caring for older patients.


The hybrid model of Schwartz-Barcott and Kim was used to perform the concept analysis of perceived value of caring. Concept analysis was conducted in three phases: the theoretical phase, fieldwork phase, and final analysis phase.


The perceived value of caring was found to have four dimensions and nine attributes. The providing care dimension consisted of two attributes—care behavior and care attitude—and the goals and expectation dimension included three attributes—social norms, family norms, and personal norms. The other two dimensions consisted of two attributes each: a belief in usefulness and a belief in meaning in the building beliefs dimension and life expansion and insight into the future in the suffering sublimation dimension. Finally, perceived value of caring can be defined as the personal belief that behavior or attitude of providing physical, mental, and social services to those in need of care is usefulness and important based on one’s goals and criteria, and with the personal effort of sublimating suffering that arises from care.


Based on the study findings, it is suggested that the use of the perceived value of caring should expand in nursing phenomena.


Care has contributed to life from birth to death for all ages and countries. Care is a key concept in nursing. Looking at the concept of care, Watson defined it as someone’s dedication to maintaining personal dignity or integrity, and Leininger described care as a universal phenomenon, essential to human survival [1], emphasizing that it is as much about the caregiver as the receiver. Adler [2] stated that care affects the physiological and psychological state of human beings based on reciprocal relationships in the field of medical science, while emphasizing relationship-building and ethical aspects in the field of education [3]. In economics, care refers to the provision of services to fulfil individuals’ basic physical and psychological needs that enable them to function at the level of socially acceptable abilities, comfort, and safety [4]. The elements included in the definition of care are the maintenance of human dignity, the commitment of caregiver, ethical aspects, individual dedication, and social effects. In the concept of care, care-receiver and caregiver exist. According to Noddings [3], care has a different meaning depending on the care-receiver and caregiver.
It is no exaggeration to say that care-receivers are all people. Primary and important care receivers are those who cannot lead their daily lives independently, including vulnerable populations with diseases or disabilities, such as minors and older adults [5]. In South Korea, along with the increase in the older population, the prevalence of geriatric diseases, such as dementia, stroke, and Parkinson’s disease, are rapidly increasing. The older people are attracting attention as the most vulnerable population of the total population [6]. In addition to changes in the demographic structure due to the increase in the older population compared to the total population, care for older adults within the family, which was taken for granted, is facing changes due to the change in the role of women and the younger generation-centered family view [7]. As care of older adults in the aging society has emerged as a policy issue, Korea has introduced social security systems such as the long-term care insurance system for the elderly and customized care services for older adults in vulnerable communities to ease the burden of supporting older adults [8].
Despite these governmental interventions in the care of older adults, in Korea where family dependence is high, families are not free from the primary responsibility of caring for vulnerable older adults. In addition, due to the expansion of the elderly care system, there is room for secondary problems, such as the misconception that the care burden of older adults’ family has been reduced compared to the actuality [7], the mismatch between institutions and family roles [9], and family conflicts due to inappropriate role understanding [10]. In the absence of a term to define what they experience and feel about the family caregiver’s care, which has been taken for granted, defining a new concept of perceived value of caring and identifying its attributes may help understand the older patient’s family caregiver.
For the understanding of perceived value to be synthesized with care in this study, perceived value as defined in the means-end theory of Zeithaml [11] in the marketing field can be presented. In this theory, perceived value is the customer’s assessment of price, quality, and usefulness, not just the price of the product. In a theory of consumption by Sheth et al. [12], perceived value is defined as a type of behavioral decision by consumers.
On the other hand, perceived value has been introduced in recent studies [12] as a term perceived value of work and reported to be related to job confidence and satisfaction [13] and competence [13,14] and is a factor that explains the growth and development of organizations [14]. Perceived value of work is a psychological state experienced by an individual through work that is accompanied by a cognitive appraisal of the importance of one’s work and a positive response to one’s perceived presence in the organization. Perceived value of work is a term that deals with the use of professionals’ work, and in nursing, it has been reported as a related factor in the nursing competence of clinical nurses [15].
Synthesized term such as perceived value of work can be used to express an extended meaning beyond the simple sum of each of these terms. These synthesized terms provide insight for synthesizing care and perceived value [16]. The meaning of perceived value of caring is expected to become clear through the specific experiences of individuals who have experienced care, such as older patient’s family caregivers.
The process of defining terms is essential for the utilization of synthesized term, and concept analysis is a reasonable method for term definition [17]. Compared to Walker and Avant’s concept analysis [16], which can be helpful when there are many cases presented through preceding studies, Schwartz-Barcott and Kim’s concept analysis [17] is a hybrid model that integrates multidimensional literature analysis of concepts and practical observations when a phenomenon exists, but no term exists. Perceived value of caring is a synthesized term with care and perceived value. On the other hand, it can be seen as a newly derived term that goes beyond a synthesized term in that it is something that the older patient’s family caregiver has experienced and thought about, but it has not been used as a term. Considering that the preceding studies using this term have not been conducted and there is no definition, perceived value of caring is appropriate for concept analysis through the hybrid model of Schwartz-Barcott and Kim [17]. In the case of the synthesized term, spiritual distress, which is already used in nursing, Schwartz-Barcott and Kim’s model attempted concept analysis, defined the term, and developed a measurement tool [18].
Therefore, in this study, the concept of perceived value of caring for older patients among family caregivers was analyzed using the hybrid model of Schwartz-Barcott and Kim [17]. Through concept analysis of this term, its attributes were identified and the meaning was clarified to expand its use in nursing phenomena. Thus, the purpose of this study was to present a definition of perceived value of caring in older patients’ family caregivers by identifying the dimensions and attributes of perceived value of caring through concept analysis using a hybrid model [17]. The specific objectives were to find antecedents, dimensions, and attributes of perceived value of caring through a literature review and derive a tentative definition for the theoretical phase, identify the dimensions, attributes, and indicators of perceived value of caring in the fieldwork phase, and integrate the results of the theoretical phase and the fieldwork phase to define the perceived value of caring of the family caregiver.


Ethics statement: This study was approved by the Institutional Review Board (IRB) of Inje University (IRB No. INJE 2022-08-011-001). Informed consent was obtained from the participants.
This study was a concept analysis study using the hybrid model of Schwartz-Barcott and Kim [17] to define perceived value of caring, and it was conducted in three phases: the theoretical phase, fieldwork phase, and final analysis phase.

1. Theoretical Phase

1) Selection of a Perceived Value of Caring Concept

Assuming that care has various meanings depending on who the caregiver and care-receiver are [3], reexamining care in a concrete situation between an older patient who desperately needs care and his/her family caregiver helps us to understand this concept more realistically. Therefore, by synthesizing the concepts of care and perceived value, we would like to expand the concept of perceived value of caring into a new concept that families who provide care have been experiencing but that has not been covered as a term.

2) Searching the Literature

In this study, the concept and attributes of ‘care’ and ‘perceived value’ were identified through literature review. By setting ‘care’ or ‘caring,’ ‘caregiver,’ ‘value,’ ‘caring value,’ ‘caring worth,’ and ‘perceived value’ as search terms, academic journals and dissertations were searched for in Korean Academic Information, DBpia, National Assembly Library, MEDLINE, CINAHL, Embase, and Google Scholar without limiting the search period. As for international literature, 32,028 international and 5,257 domestic literatures were searched through search engines, of which 343 international and 53 domestic documents were selected, excluding duplicates. Excluding the literature where the definition of the concept was unclear or not directly related to the attributes and components, a final 17 international and 18 domestics were analyzed. All the literature were academic journal papers, of which 13 were related to care and 12 were associated with perceived value (Supplementary Table 1).

3) Dealing With Meaning and Measurement

Dealing with meaning and measurement in Schwartz-Barcott and Kim’s hybrid model is a phase to clarify concepts by identifying different or similar concepts [17]. In this study, caregiving satisfaction [19] and perceived value of work [13] were selected to confirm similarities and differences with perceived value of caring.

4) Choosing a Working Definition

Based on the dimensions and attributes identified through the literature review, a tentative definition of older patient’s family caregiver’s perceived value of caring was derived at the theoretical phase.

2. Fieldwork Phase

The fieldwork phase confirms that the definition and attributes of perceived value of caring derived from the theoretical phase are observed in the field or whether other attributes exist. In the fieldwork phase, although it is proposed to describe the field, negotiate, select cases, and collect data, due to the impossibility of participatory observation of perceived value of caring and the refusal of older patients to participate in field visits, individual interviews were conducted at a location of the study participants’ choice.

1) Ethical Considerations and Preparation of the Researcher

This research was approved by the institutional ethics committee of Inje University (No: 2022-08-011-001) for the fieldwork phase. The researchers explained the purpose and methods of the study to the participants before the interview that the contents of the interview will be used only for the study, kept secure, and disposed of after a certain time after data analysis, and obtained voluntary consent.
One researcher in this study studied the health of older adults for more than 30 years and published qualitative studies in domestic and international journals. Another researcher in this study, while taking qualitative study methodology, got trained in in-depth interviews and meaningful thematic derivation. Also, as the supervisor of the long-term care center for older adults, the researcher continuously consults older patients’ family caregivers.
Validity of the study was secured according to the four criteria suggested by Guba and Lincoln [20]. First, the true value secures internal validity, and for this, older patient’s family caregivers were selected as study participants. Regarding applicability, external validity was achieved by collecting data until it was determined that there was a saturation point where no new meaning was found in the statements of study participants. In addition, they were peer-verified by two older patient’s family caregivers who did not participate in the study to confirm that their experience and the results of the study matched. Regarding consistency, two researchers analyzed the original data through discussion until an agreement was reached to ensure reliability, and consistency was secured by evaluating the study results by a nursing science professor with abundant qualitative study experience. By securing neutrality, the researcher wrote a study journal from the beginning to the end of the study and made a phenomenological return to exclude her good understanding, assumptions, and prejudices.

2) Data Collection and Study Questions

The data collection period for the fieldwork stage was from December 15 to 25, 2022. The study participants were 10 older patients’ family caregivers at home who understood the purpose of the study and agreed to participate in the study. Recruitment of study participants was conducted as follows. In stage 1, the researcher visited the long-term care center for older adults and dementia center in Busan Metropolitan City, explained the purpose, methods, and ethical aspects of the study, and obtained the list of older patient’s family caregivers who agreed to participate in the study. In stage 2, the researcher confirmed their participation from the study participants over the phone. In stage 3, the participants were interviewed at a place of their choice (cafe, home) after receiving the consent. The interviews were conducted until the content of interviews reached saturation, and each study participants were interviewed 1 to 2 times, taking 30 to 100 minutes per interview. The interviews were recorded with the permission of the study participants. Study participants were explained that even if they agreed to participate in the study, they could withdraw at any time and would not be penalized for doing so.
There were ten study participants, two men and eight women. The average age was 56.7 years, with seven participants being aged between 51 to 60. Eight participants were high school graduates, and nine were married. The most common relationship to older patients was two daughters-in-law, followed by two daughters, two sons, and one spouse. There were one man and nine older women patients. The average age of older patients was 86.3 years, with five patients being aged 81 to 90 years. The duration of care ranged from 7 months to 6 years.
Interviews were conducted using a semi-structured questionnaire, asking questions such as, ‘① Do you have experience caring for older adults?’ ‘② What do you think care is?’ ‘③ What kind of care did the study subjects experience (are experiencing)?’ ‘④ How do you feel while providing care?’, and ‘⑤ Why did you take care of the elderly family at home instead of in a facility?’

3) Data Analysis

For data analysis in this study, Giorgi’s phenomenological analysis method [21] was used. Looking specifically at the contents of this study, first, to grasp the overall meaning of the data, the researcher transcribed the interview contents of the study participants, and then read the entire text repeatedly to understand the participants’ experiences. Second, to reflect the meaning of the experience of older patient’s family as it is, the transcript was read repeatedly, and at the same time, the task of distinguishing various semantic units described by the participant was repeated. Third, the linguistic expressions of the study participants were converted into academic terms. Finally, the components were integrated into a general structure based on the converted semantic units. The analysis was completed by repeatedly reading the interviews to construct a general structure that described the components and their relationships to the participants’ experiences.

3. Final Analysis Phase

In the final analysis phase, the definition, properties, and indicators of perceived value of caring were derived by analyzing the tentative definition and properties confirmed in the theoretical phase and the analysis data in the fieldwork phase.


1. Theoretical Phase

In the literature review for this study, 13 articles were related to definitions, attributes, and components of care, and 12 articles were related to definitions, attributes, and components of perceived value. The dimensions and attributes for the definitions of care and perceived value were analyzed based on these articles (Supplementary Table 2).

1) Definition of Care

(1) Dictionary definition of care

The standard Korean dictionary defines care as to provide something what is needed with interest [22]. The Oxford dictionary defines it as “the process of protecting someone or something and providing what the person or thing needs” [23].

(2) Definition of care based on the nursing science

In nursing science, Orem explained the function of care in the self-care deficit theory of nursing as providing and teaching a self-care environment for those who need help with self-care. According to Watson’s theory of human care, the caregiver influences treatment by establishing a relationship with the care-receiver. In Leininger’s theory of transcultural care diversity and universality, care supports patients to change their health and life patterns and ways [1]. In the above theory, care is intended to change the response and behavior of the care-receiver, i.e., the patient in need of care, and does not focus on elements of the caregiver side, such as motivation to provide care and health perception.
Eriksson uses the theory of caritative care and the multidimensional health model to explain motivation for care and care based on health perceptions from the caregiver’s perspective [24,25]. Considering care as alleviating human suffering and providing comfort, Eriksson [24] proposed compassion for human beings, the caritas motive which is the concept of love, and the ethical motive which is the respect of human dignity, as motives that should precede care. Through the multidimensional health model, she also explained the perception of health dimension: health as behavior, health as being, and health as becoming [25].
Eriksson [24] and Herberts and Eriksson [25] described the caregiver’s care while stating the contribution of care to health and life from the perspective of the person who needs the care. In this theory, the attributes of caregiver’s care are recognition of the caregiver’s health level care based on motivation, relationship between caregiver and receiver, and discovering the meaning of care in negative situations.

2) Definition of Perceived Value

(1) Dictionary definition of perceived value

The researcher was unable to find a term of perceived value in the standard Korean dictionary. However, the concept of value could be found. In the standard Korean dictionary, value is defined as usefulness of things [22]. In the Oxford dictionary, perceived value is defined as the price of a product determined by how much the customer wants and needs it rather than the price of the product itself [23].

(2) Definition of perceived value in nursing science

In the Korean Declaration of Nurse Ethics [26], the ethical value of nurses is presented as responsibility and respect for the defense of human dignity and human rights. This means that caregivers should respect mental, spiritual, and social areas, including the physical areas of care-receivers, and continue to pay attention to uncomfortable areas.
In nursing science, the concept of caregiving satisfaction was introduced as a concept similar to perceived caring [19]. Caregiving satisfaction gives positive meaning to the sense of reward, sense of achievement, psychological reward, and role experienced through care in human relationships.

(3) Definition of perceived value in other disciplines

The means-end theory of perceived value in economics defines perceived value as evaluations based on customers’ perceptions of price, quality, and utility, including evaluations of the actual price or quality of a product [11]. In marketing, Sheth et al. [12] classified five categories in a theory of consumption: functional value, emotional value, social value, epistemic value, and conditional value, and confirmed that consumers’ product selection is determined according to this category. In psychology, value was defined as the relative importance of goals that individuals want. Humanistic psychologists have a desire to believe that their lives and what they do are meaningful, which they call perceived value [13].
As a result of examining perceived value in nursing science and other disciplines, perceived value can be defined as beliefs and goals created by reflecting various perspectives, such as individual functional value, emotional value, social value, epistemic value, situational evaluation and experience, and ethical standards, while being based on the usefulness pursued by society or organization, that is, utility. The attributes of perceived value identified above are based on human dignity, usefulness, goals and expectations of utility, and individual evaluation.

(4) Concepts related to perceived value of caring

There is caregiving satisfaction as a perceived value of caring-related concept [19]. Perceived value of caring is a more comprehensive concept than caregiving satisfaction, which is a positive experience in the care process. It is one’s goals and beliefs throughout life, including caregiving satisfaction. Comparing perceived value of caring with the psychological term, perceived value of work [13], it is similar in that it is evaluated as being useful to the organization through work or care. If the evaluation of the work is negative, work can be cut off by resignation or vacation, but there is a difference that taking care of a family member is not easy to be cut off even if it is negative.

3) Dimensions, Attributes, and Tentative Definitions of Perceived Value of Caring at the Theoretical Phase

Rubin and Babbie [27] proposed a two-dimensional configuration in which the dimension is the axis representing the concept and the attribute is a characteristic that a concept has. According to this proposal, the concept analysis of spiritual distress [18] that used a hybrid model was also defined as a method of first classifying into dimensions and deriving attributes for each dimension. Thus, a dimension is a category of a concept, and an attribute is an element included in a category. In this study, the attributes of care and perceived value identified in the literature review were integrated, and perceived value of caring was categorized into the dimensions of care provision, one’s goals and expectations, and personal beliefs. Attributes of the care-providing were behavior of providing services to care-receivers and attitude of providing services to care-receivers; one’s goals and expectations included the basis of one’s goals and expectations; and individual beliefs consisted of personal beliefs that are considered useful and important. The antecedents to perceived value of caring derived through the theoretical phase were the motivational care, human dignity base, relationship building between caregiver and receiver, health level perception, usefulness and expected usefulness, and individual evaluation. The result of perceived value of caring was belief formation based on personal goals and expectations when caring for older adults.
At the theoretical phase, a tentative definition based on the attributes of perceived value of caring is a personal belief that behaviors or attitudes that provide physical, mental, and social services to those in need of care are useful and important based on one’s goals and expectations.

2. Fieldwork Phase

In the fieldwork phase, perceived value of caring was categorized into four dimensions and nine attributes. The four dimensions were care provision, goals and expectation, belief formation, and effort of sublimating suffering. The nine attributes were service-providing behavior and service-providing attitude in care provision; social norms, family norms, and personal norms in goals and expectation; beliefs of usefulness and beliefs of meaning in belief formation; and life expansion and insight into the future in the effort of sublimating suffering.

1) Care Provision

(1) Service-providing behavior

Service-providing behavior is the act of taking over or providing care for behaviors that older patients cannot do for themselves in their daily lives.
“I have to do everything. Why? Because my mom can’t even go to the hair salon and I cut her hair with a pair of scissors. I cut her hair, bathe her, dress her, and she can’t do anything by herself” (Participant #2).

(2) Service-providing attitude

Service-providing attitude means being unable to forsake the demands of older patients due to family duty, repaying the favors received from older patients in the past, and pursuing self-confidence through care.
“I say I stop by her very often, but I have my own life. I want to hang up, but my mom keeps trying to call me. My brother or sister aren’t interested, so I have no choice but to do it” (Participant #8).

2) Goals and Expectations

(1) Social norms

Social norms refer to goals and expectations based on universal ethical norms in accordance with the needs of society. In Korea, the Welfare of the Elderly Act [28] defines caregivers as immediate family members and spouses (Article 1, paragraph 2), and states that family members should maintain the family system and practice filial piety (Article 4).
“Well, he’s my family, so I have to do it. Isn’t it natural in Korea? And if it wasn’t me, who would take care of that poor man” (Participant #1).

(2) Family norms

Family norms are reliance on family members and providing care to meet their expectations. It means that other families find stability because of me, relying on my family when there is limit of care available.
“My mother said she was in the early stage of dementia. It’s quite depressing and sad, but other family members are far away and my wife and I take care of her, so it would be helpful if I had family members helping us. It was depressing to think that I was alone” (Participant #4).

(3) Personal norms

Personal norms are to form different meaningful goals based on one’s relationship with older patients.
“I’ve decided to take care of my mother if she gets sick, so I do everything without saying anything to others. Sometimes it’s annoying, but I promised not to change the way I’ve chosen” (Participant #3).

3) Belief Formation

(1) Beliefs of usefulness

Beliefs of usefulness means the conviction that care is a useful behavior and a caregiver is a useful person.
“I think that I should cheer up while preparing meals for my mom. Because I’m here, my mom can stay with me without going to an institution” (Participant #2).

(2) Beliefs of meaning

Beliefs of meaning is to confirm that I, who provides care, am more important than before, and that I, as a caregiver, am recognized by others.
“My mom calls my younger brother and tells him not to worry about her because I care for her well, which means she knows what I am doing for her” (Participant #5).

4) Effort of Sublimating Suffering

(1) Life expansion

Life expansion means finding the strength in me that groans with the pain of a long illness and giving meaning to my life that is exhausted with care.
“I’m going crazy. She’s got dementia and depression together. I’m still with my mom, so I think I’m going to the house where she’s waiting for me. Even if it’s hard, I endure” (Participant #2).

(2) Insight into the future

Insight into the future is to discover the homogeneity between older patients and my life and prepare for my future by caring for older patients.
“My mother had a cerebral hemorrhage first and then dementia suddenly, so medicine was useless. I should take care of my health, too. I should take care of my mother and my health” (Participant #4).

3. Final Analysis Phase

In the final analysis phase, the results from the theoretical and fieldwork phase were comprehensively analyzed to identify the definition, attributes, and indicators of perceived value of caring. In the theoretical phase, three dimensions and five attributes were derived. In the fieldwork phase, four dimensions and nine attributes were identified.
In addition to the three dimensions identified in the theoretical phase, dimensions and attributes of the effort of sublimating suffering were additionally identified in the fieldwork phase. Also, the dimension of one’s goals and expectations were supplemented with three attributes in the fieldwork phase. Therefore, the dimension of one’s goals and expectations were changed to the dimension of goals and expectations derived from the fieldwork phase. In the final analysis phase, four dimensions, nine attributes, and 19 indicators were derived (Table 1).

1) Dimensions and Attributes of Perceived Value of Caring

Finally, perceived value of caring was divided into four dimensions: care-providing, goals and expectations, belief formation, and effort of sublimating suffering. The care-providing dimension included two attributes: service-providing behavior and service-providing attitude; and goals and expectations included three attributes: social norms, family norms, and personal norms. The belief formation dimension consisted of two attributes: beliefs of usefulness and beliefs of meaning; and the effort of sublimating suffering consisted of two attributes: life expansion and insight into the future.

2) Definition of Perceived Value of Caring

Based on the attributes identified in the theory and fieldwork phase, perceived value of caring can be defined as the personal belief that behavior or attitude of providing physical, mental, and social services to those in need of care is useful and important based on one’s goals and criteria, and with the personal effort of sublimating suffering that arises from care.


Given that care is for everyone across their life span, perceived value of caring of the family caregiver is a concept that can be applied to many disciplines, not just nursing science, but also to many other fields, including medicine, education, and sociology. It can be seen as a meaningful attempt to define perceived value of caring by focusing on the experience of a specific target, the family caregiver, from the care dealt with from the point of view of the care-receiver. In addition, beyond the synthesizing of the term care and perceived value, it refers to the individual’s goals, expectations, beliefs, including efforts to overcome difficulties and is also meaningful in that it derived a new term that did not exist before.
The process of synthesizing the term perceived value of caring in this study can be compared to synthesized terms, such as caregiving satisfaction [19] and perceived value of work [13]. The care duty fulfillment of caregiving satisfaction, which positively evaluates the experience of caring for older adults, and the reciprocity of care attribute is in line with the service-providing attitude attribute of this study; and the role performance’ dimension of care satisfaction is in line with the goals and expectations and belief formation dimensions of this study. The difference is that while caregiving satisfaction refers to the positive aspects of the family caregiver providing care, perceived value of caring includes efforts to address the negative aspects as well as the positive.
In this study, service-providing behavior and effort of sublimating suffering were derived as perceived value of caring categories differentiated from caregiving satisfaction [19]. The service-providing behavior attribute suggests what care is defined by the older patient’s family caregiver through doing behaviors instead of older patients in daily life and providing care for older patients in need of care.
Among the attributes derived from this study, the meaning differentiated from caregiving satisfaction [19] and perceived value of work [13] is effort of sublimating suffering. Through finding strength within myself who is groaning with the pain of long illness included in effort of sublimating suffering, giving meaning to my tired life through care, finding homogeneity in my life with older patients, and preparing my future by caring for older patients, it can be seen that perceived value of caring contributes to life expansion beyond the positive meaning of care satisfaction.
The attributes of perceived value of work [13], self-value perception and work value perception, are in line with belief of usefulness and belief of meaning in this study. It shows that people perceive themselves as useful through work or care and confirm that they are recognized by others and that they find usefulness and meaning through care just as they find fulfillment through work.
The category of perceived value of caring that differed from perceived value of work was effort of sublimating suffering. The value fulfillment emotion of perceived value of work means that the more one’s self-esteem and sense of achievement are satisfied through work, the more one’s usefulness is recognized in the organization, and when value fulfillment emotion is not satisfied, one can experience a sense of meaninglessness in life. On the other hand, the effort of sublimating suffering of perceived value of caring means giving meaning to one’s life and striving to find meaning and strength to prepare for the future along with negative experiences such as burden or burnout through care. Work can be separated from one’s life in time and place, and work can be separated from one’s life if it is not filled with positive elements. Care for older adults differs from perceived value of work in that it is part of one’s life, so rather than separation, one’s life is expanded by efforts to overcome negative situations, and one experiences insight into the future.
The effort of sublimating suffering of perceived value of caring is similar to the caregiver’s perception of the health dimension presented in Eriksson’s multidimensional health model [25]. Herberts and Eriksson [25] said that if the caregiver is aware of the health level and cares with motivation, he or she finds the meaning of life and gets his or her comfort even in negative situations such as stress and burden. In this study’s fieldwork phase, while taking care of one’s father for a long time, the caregiver’s efforts to overcome negative situations were confirmed by the father’s dedication to his family, the justification for compensation, and the experience of pursuing an understanding of others through care rather than focusing on negative situations.
In the care-providing dimension of this study, it was confirmed that service-providing behavior is the caregiver’s perception of care and behavior through the fieldwork phase. This closely aligned with the definition of nursing scientists who defined care as maintaining the wholeness of the individual, assisting in survival, alleviating human suffering, and preserving and protecting life and health [1].
Although elder care in Korea seems to be diverse, social norms, family norms, and individual caregiver’s goals and expectations consistently say that families should take care of older patients. According to social norms, it is a universal ethical norm [28] and a social demand that care for older adults belongs to the family. In relation to care for older adults, public assistance is being expanded and forms of care are being diversified, but it was once again confirmed that care through the family is still a major pillar of care for older adults.
Through the belief formation dimension of this study, the personal belief that caring for older adults is useful and important was confirmed. The fieldwork phase confirmed that care is hard work, but that individuals’ beliefs are built from the usefulness, presence, and recognition of caregivers from others. It can be interpreted in the same context as Pearlin and Schooler [10] which explained that personal coping rather than social support can prevent mental and physical health deterioration in the stress process model. This suggests that it is necessary to develop a program for individual belief formation of family caregivers.
The effort of sublimating suffering means trying to expand one’s life and looking at one’s future through caring for an older patient, by which to discover one’s strength among the negative emotions experienced while caring for older patients, give meaning to life through care, find homogeneity in the lives of older patients and family caregivers, and confirm the phenomenon of preparing for one’s future. Although the stress process model [10] also recognizes the stress of caring for older patients and explains that the family caregiver may have different consequences depending on how they cope and social support.
Perceived value of caring was a phenomenon that family caregivers of older patients felt and experienced, but did not have a defined term. In this study, dimension and attributes were identified by attempting to synthesize caring with perceived value through theoretical analysis and field analysis on the extension of care. Defining perceived value of caring in this study is significant because it provides a basis for expressing and measuring the meaning implicit in caregivers’ experiences.


This study is a concept analysis study of perceived value of caring using a hybrid model. The results show that perceived value of caring is the personal belief that behavior or attitude of providing physical, mental, and social services to those in need of care is useful and important based on one’s goals and criteria, and with the personal effort of sublimating suffering that arises from care. By presenting a conceptual definition of perceived value of caring that is not clearly presented in Korea, this study will serve as a useful resource for the development of tools to measure care value and the development of programs based on perceived value of caring. By identifying the attributes of perceived value of caring and clarifying its meaning, it will be possible to expand its use in nursing phenomena.


Authors' contribution
Study conception and design acquisition - SHH and HRK; Data collection - SHH; Data analysis and interpretation - SHH and HRK; Drafting and critical revision of the manuscript - SHH and HRK
Conflict of interest
No existing or potential conflict of interest relevant to this article was reported.
This study was supported by Inje University fund (No. 0001201000500).
Data availability
Please contact the corresponding author for data availability.

Supplementary materials

Supplementary Table 1.

A Journal List of Literature Review

Supplementary Table 2.

Components of Theoretical of Perceived Value of Caring


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Table 1.
Components of Final Confirmed of Perceived Value of Caring
Dimension Attribute Indicator
Providing care Behavior of caring Substituting for the behaviors elderly patients cannot do in their daily lives
Providing care for sick elderly patients
Attitude of caring Unable to betray elderly patients’ demands for duties as a family member
Repaying elderly patients’ benefits received in the past
Seeking confidence through care for elderly patients
Goal and expectation Social norms Having goals and expectations according to society’s demands
Having goals and expectations according to universal ethical norms
Family norms Trying to live up to the expectations of the family
Keeping care, depending on the support of family
Personal norms Establishing goals and expectations faithful to the relationship between elderly patients and me
Establishing meaningful goals different from those before through caring in my life
Building beliefs Belief in usefulness Confirming that care for elderly patients is useful
Confirming my presence in care for elderly patients
Belief in meaning Confirming that I am a person who is more important than who I was before, now when I am caring for elderly patients
Confirming that as a caregiver, I am recognized by others
Suffering sublimation efforts Expansion of life Finding tenacity in me who suffers from pains of long care for the sick
Adding meaning to my exhausted life by caring
Insight into the future Finding homogeneity between elderly patients’ lives and my life
Preparing my future by caring for elderly patients
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