The purpose of this study was to investigate how family caregivers and nurses consider their mutual relationship and to develop a substantive theory on the relationship between formal and informal care. Interviews (n=88) with family caregivers, nurses and nurse managers have been conducted. Data collection and analysis were performed according to the grounded theory methodology. The relationship between formal and informal care is an encounter of two quite different perspectives that is focussed on the issue of how a particular amount of caregiving work is performed by means that are considered helpful. The perspectives of family caregivers and nurses on their relationship differ considerably, but both are engaged in a process of negotiating helpful action. While for family caregivers the proces is determined by the goal of facilitating work and care, the nurses’ everyday reality is focussed on shaping different realities in different households and with different people. How these different perspectives contribute to the negotiation process is influenced by interactive effects between nurses and family caregivers conceptualised as mutual dependency.

From the caregivers point of view the beginning of a caregiving situation is conceptualized by the context of Facing new life circumstances. For family caregivers the consequence out of this context is coming to terms with competing demands. Family caregivers engage in a process of Developing a fitting arrangement. In this process family caregivers apply strategies of managing caregiving. The strategies for managing caregiving are intended to develop a caregiving arrangement that allows for the goal off facilitating work and care.

From the nurses’ perspective becoming involved is an underlying condition of home care nursing. It is a prerequisite for the work of nurses in home care. Home care nursing is framed by three concepts: Framing home care nursing which conceptualises the context and which contains the legislative framework of home care nursing. Beside framing home care nursing, the nurses’ professional identity (Working in home care nursing) and the nurses’ personal identity (contributing one’s own personality) influence the nursing perspective. The interplay between the home care framework and the nurses’ professional and personal identity results in the consequence of the nurses feeling restricted in their practice. The core of the nurses’ perspective is the process of shaping different realities. The concept of feeling restricted influences the process of shaping different realities. According to their professional and personal identities nurses apply professional (matching order and reality) and personal (balancing closeness and distance) strategies to shape different realities. The goal of the process of home care nursing is keeping people at home.

The substantive theory adds to the understanding of the relationship between formal and informal care in home care. For nursing practice the substantive theory serves as a tool for evaluating existing practice and reconsider implicit professional assumptions in relation to an existing reality of family caregiving.