Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Janice B. Foust

Second Advisor

Priscilla Gazarian

Third Advisor

Lisa Sundean


The Caregiver Advise Record Enable (CARE) Act Law is legislation aimed to better partner and educate the patient’s informal caregiver(s) with the healthcare team during a hospitalization. Informal caregivers in the U.S. provide hours of caregiving and this has been found to decrease healthcare service utilization thereby cutting the overall U.S. cost of healthcare by billions of dollars. The CARE Act Law requires the hospital personnel offer the patient an opportunity to name a caregiver(s), document this name and contact information in the electronic health record (EHR) and educate this caregiver(s) on the tasks and aftercare needed by the patient when they return home after a hospitalization. Few studies have explored the implementation of the CARE Act Law in the highly contextual practices of an acute care hospital. Therefore, this research delves into and describes this complex social phenomenon (enablers and challenges) using Yin’s (2018) case study methodology and the Normalization Process Theory (NPT), an implementation science framework (May et al., 2018). The data sources analyzed in this study include state and hospital documents, nine in-depth hospital personnel interviews and journaling activity. The study findings are organized into ten (10) major themes that overlap across the domains of the NPT. The findings highlight two areas: (1) the complexity of involving informal caregivers in hospital healthcare practice(s) and (2) the major overarching theme of the electronic health record (EHR) as it was found to be an enabler and a challenge to the implementation of a hospital’s CARE Act Law Policy & Procedure (P&P). The findings from this study identify numerous practice and policy implications aimed to better engage and educate informal caregiver(s) and enhance their capacity to care for their family member after an acute care hospitalization.


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