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Conditions for relatives' involvement in nursing homes
Karolinska Institutet, Institutionen för neurobiologi, vårdvetenskap och samhälle.ORCID iD: 0000-0002-8551-3264
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Karolinska Institutet , 2015. , 62 p.
Keyword [en]
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
National Category
Nursing
Identifiers
URN: urn:nbn:se:rkh:diva-1858ISBN: 978-91-7549-872-0 (print)OAI: oai:DiVA.org:rkh-1858DiVA: diva2:814000
Public defence
2015-05-26, H3 Blå, Alfred Nobels Allé 23, Huddinge, 13:00
Opponent
Supervisors
Available from: 2015-05-26 Created: 2015-05-25 Last updated: 2015-08-04Bibliographically approved
List of papers
1. 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
Open this publication in new window or tab >>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
2013 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 3, 677-685 p.Article in journal (Refereed) 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’.

Place, publisher, year, edition, pages
Oxford: Wiley-Blackwell, 2013
Keyword
nursing home staff, relatives, involvement, ethnography, power structure, gender perspective
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-453 (URN)10.1111/j.1471-6712.2012.01077.x (DOI)23003575 (PubMedID)
Available from: 2012-10-30 Created: 2012-10-30 Last updated: 2017-05-23Bibliographically approved
2. Replicating the Family: The Biopolitics of Involvement Discourses Concerning Relatives in Nursing Home Institutions
Open this publication in new window or tab >>Replicating the Family: The Biopolitics of Involvement Discourses Concerning Relatives in Nursing Home Institutions
2014 (English)In: Aporia: The Nursing Journal, ISSN 1918-1345, Vol. 6, no 4, 19-29 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to describe the biopolitics of involvement discourses articulated by nursing staff concerning relatives in nursing home institutions, using a Foucault-inspired discourse analytical approach. Previous research has described how relatives have not been involved in nursing homes on their own terms. This is partly due to a lack of communication and knowledge, but it is also a consequence of an unclear organizational structure. Results from a discourse analysis of six focus group interviews with nursing staff show that the "involvement discourse" in nursing homes can be described as a "new" vs "old" family rhetoric. This rhetoric can be said to uphold, legitimize and provide different subject positions for both nursing staff and relatives concerning the conditions for involvement in nursing homes. As part of a "project of possibility" in elderly care, it may be possible to adopt a critical pedagogical approach among nursing staff in order to educate, strengthen and support them in reflecting on their professional norming and how it conditions the involvement of relatives.

Place, publisher, year, edition, pages
Brigham Young University, 2014
Keyword
discourse analysis, focus group interviews, involvement, nursing home, nursing staff
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-1399 (URN)
Available from: 2015-01-07 Created: 2015-01-07 Last updated: 2017-07-03Bibliographically approved
3. Intersectional perspectives on family involvement in nursing home care: rethinking relatives' position as a betweenship
Open this publication in new window or tab >>Intersectional perspectives on family involvement in nursing home care: rethinking relatives' position as a betweenship
2014 (English)In: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, Vol. 21, no 3, 227-237 p.Article in journal (Refereed) Published
Abstract [en]

This study seeks to understand, in the context of intersectional theory, the roles of family members in nursing home care. The unique social locus at which each person sits is the result of the intersection of gender, status, ethnicity and class; it is situational, shifting with the context of every encounter. A content analysis of 15 qualitative interviews with relatives of nursing home residents in Sweden was used to gain a perspective on the relationships between relatives and residents, relatives and the nursing home as an institution, and relatives and the nursing home staff. We sought to understand these relationships in terms of gendered notions of the family and the residents, which are handed down from generation to generation and thus condition who and how relatives should be involved in care, and the ways in which relationships change as care moves from home to nursing home. It requires knowledge and awareness that the nursing home culture is based on intersectional power structures in order for relatives to be involved in nursing home care in alternative and individual ways.

Place, publisher, year, edition, pages
John Wiley & Sons, 2014
Keyword
elder care, institutional care, intersectional perspective, involvement, nursing homes, nursing staff, power structure, relatives
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-704 (URN)10.1111/nin.12046 (DOI)23875545 (PubMedID)
Available from: 2013-08-20 Created: 2013-08-20 Last updated: 2017-05-23Bibliographically approved

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