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Being perceived as a ‘visitor’ in the nursing staff’s working arena: the involvement of relatives in daily caring activities in nursing homes in an urban community in Sweden
Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.ORCID-id: 0000-0002-8551-3264
Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
Röda Korsets Högskola.ORCID-id: 0000-0002-0335-3472
2013 (engelsk)Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, nr 3, s. 677-685Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background

It is both complex and difficult for relatives when a loved one moves into a nursing home and many relatives are not prepared for the realities these new situations entail. Little attention has been paid to scrutinising the involvement of relatives in patient care, particularly in relation to the structures and routines of nursing homes or to the staff's reasoning concerning their involvement.

Aim

To describe, from a gender perspective, how nursing staff's routines and reasoning act to condition the involvement of relatives in nursing homes.

Methods

Focused ethnographic fieldwork was conducted in a medium-sized urban community in central Sweden in three different nursing homes.

Results

The nursing staff assigns a certain code of conduct to all relatives they perceived as ‘visitors’ in their working arena. This code of conduct was related to the routines and subcultures existing among the nursing staff and stemmed from a division of labour; the underlying concept of ‘visitor’ predetermined the potential for relatives' involvement. This involvement is explicitly related to the general gendered characteristics that exist in the nursing staff's perception of the relatives.

Discussion

The study's limitations are primarily concerned with shortcomings associated with a research presence during the fieldwork. The discussion focuses on the dimensions of power structures observed in the nursing home routines and the staff's reasoning based on their gendered assumptions. We argue that it is important to develop mechanisms that provide opportunities for nursing staff in elderly care to reflect on these structures without downplaying the excellent care they provide. We stress the importance of further exploring these issues concerning relatives and their involvement in nursing homes to facilitate the transition from informal caregiver to ‘visitor’.

sted, utgiver, år, opplag, sider
Oxford: Wiley-Blackwell, 2013. Vol. 27, nr 3, s. 677-685
Emneord [en]
nursing home staff, relatives, involvement, ethnography, power structure, gender perspective
HSV kategori
Identifikatorer
URN: urn:nbn:se:rkh:diva-453DOI: 10.1111/j.1471-6712.2012.01077.xPubMedID: 23003575OAI: oai:DiVA.org:rkh-453DiVA, id: diva2:563510
Tilgjengelig fra: 2012-10-30 Laget: 2012-10-30 Sist oppdatert: 2017-12-07bibliografisk kontrollert
Inngår i avhandling
1. Conditions for relatives' involvement in nursing homes
Åpne denne publikasjonen i ny fane eller vindu >>Conditions for relatives' involvement in nursing homes
2015 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

The overall aim of this thesis was to describe and analyse how the involvement of relatives is conditioned in nursing homes from different critical perspectives. Gender perspectives, discourse analysis and intersectional theory are applied, based on social constructionist ontology. The thesis comprises three qualitative papers and data are based on ethnographically-focused fieldwork in three municipal nursing homes in the form of formal/informal interviews, participating observations and the analysis of documents.

Based on gender perspectives, the routines and reasonings among nursing staff were studied and thematically analysed in relation to how these conditioned the involvement of relatives in the daily caring activities (I). In the second study (II), the nursing staff were interviewed in groups to describe, discursively analyse and identify the biopolitical meaning in the "involvement discourse" that was collectively constructed in the speech of the nursing staff concerning the involvement of relatives. In the last study (III), interviews with relatives were thematically analysed in the context of intersectional theory about their involvement in the nursing homes.

The findings show that the conditions for relatives’ involvement were dynamic and constantly in re-negotiation, but also conservative and inflexible. This placed relatives in both privileged and unprivileged social positions in the nursing homes, which were relevant for their involvement. The relatives were considered to be "visitors", which conditioned the characteristics and levels of involvement in the care of the residents and was linked to gendered notions of the division of labor, both within the groups of relatives and between nursing staff and relatives (I). The involvement of relatives was conditioned by the biopolitics of an "involvement discourse" that prevailed in the nursing homes. This built upon family-oriented rhetorics and metaphors that upheld and legitimised notions about relatives. The relatives were considered to be members of the "old" family in relation to the "new" family represented by the nursing staff (II). The relatives described how they were positioned in a betweenship, squeezed between different competing social musts from the older family members, the nursing homes as institutions and the nursing staff (III).

Inverting the prevailing picture of the involvement of relatives would make it possible to consider the nursing staff as pedagogical, professional and caring "visitors" in the nursing homes for the benefit of the residents and their relatives. This could be achieved through a constructive change management which emphasises the learning of nursing staff, their responsibility and the emotions of relatives, along with a focus on alternative notions of involvement, where relatives are included in the development of quality of care in Swedish nursing homes.

sted, utgiver, år, opplag, sider
Karolinska Institutet, 2015. s. 62
Emneord
discourse analysis, focused ethnography, focus group interviews, gender perspectives, intersectionality, involvement, nursing homes, nursing staff, participant observations, qualitative interviews, relatives, social constructionism and thematic analysis
HSV kategori
Identifikatorer
urn:nbn:se:rkh:diva-1858 (URN)978-91-7549-872-0 (ISBN)
Disputas
2015-05-26, H3 Blå, Alfred Nobels Allé 23, Huddinge, 13:00
Opponent
Veileder
Tilgjengelig fra: 2015-05-26 Laget: 2015-05-25 Sist oppdatert: 2015-08-04bibliografisk kontrollert

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