We, not them and us – a utopia? Relatives and nursing home staffs views on and experiences with each other

The overall aim of the study was to explore and describe the views and experiences that the relatives of the elderly living in nursing homes and the home's staff had about each other.

A qualitative approach guided the methods used in the five studies. Tape-recorded, faceto-face interviews were conducted in four studies: studies I and III focused on the relatives' views of the staff-, studies IV and V focused on the staff's, RNs and LPNs views of the relatives. A non- participant observation was used in study II, which was based on group discussions between the relatives of nursing home residents and the home's staff. Data from the interviews and notes from the observations were transcribed verbatim. The text was subjected to a qualitative content analysis.

Findings. Almost all of the relatives said in the beginning of the interviews that the staff was nice. But usually they gave examples of situations that could be understood as questioning, disappointing and sometimes frustrating. Narratives that included negative views of the staff and their activities were often explained in a way that reduced personal criticism. Many relatives expressed that the staff seldom received credit for their difficult jobs. The relatives were generally satisfied with the physical care of the resident, but had many comments about the staff s abilities to attend to the resident's psychosocial care. Some relatives deliberately invested efforts to develop a positive relationship with the staff to advocate and monitor the resident's care. The relatives were uncertain about if and how the staff took advantage of their information about the resident, or if the information was passed on to other staff members. The relatives found it difficult to get adequate information, which contributed to feelings of uncertainty - a common theme in the relatives narrative (I-III).

In general the staff (registered nurses, RNs and licensed practical nurses, LPNs ) had positive attitudes about the relatives but also described them as rather demanding, taking up their time and sometimes trying their patience. The RNs recognised that the relatives were a part of their work; low- priority work that was not often rewarded by their peers and managers (IV). The staff viewed relatives differently regarding age and gender. The younger relatives were more knowledgeable and knew what they could ask for. They did not tolerate shortcomings like the older relatives. The women paid more attention to the practical matters than the men. Relatives were regarded as a resource for both the residents' psychosocial wellbeing and contributing to hands-on care, provided that the RNs were aware that the relatives knew what they were doing and did not risk harming themselves or the resident (IV). The LPNs restricted the relatives' involvement to care that did not hinder their work (V). There were doubts about whether or not relatives knew what kind of care could be expected in a nursing home setting. The relatives' wishes for the resident were sometimes interpreted as an expression of their own needs (IV). The staff thought that they knew some of the residents' needs and preferences better than the relatives did at the moment. The staff understood that the relatives could sense and take into consideration that they were under stress. The relatives were described as vague in their requests and questions. The staff explained that the relatives' awkward behaviour was understandable because they were going through a hard time.

Conclusions. The interactions and relationships between the relatives and staff are heavily dependent on how the communication between them develops. The findings in this thesis directly attend to the importance that the staff bears this in mind. Thereby measures should be taken to facilitate communication that has concordance between content and behaviour, leaving little room for uncertainty.

List of scientific papers

I. Hertzberg A, Ekman SL (1996). "How the relatives of elderly patients in institutional care perceive the staff. " Scand J Caring Sci 10(4): 205-11
https://pubmed.ncbi.nlm.nih.gov/9060774

II. Hertzberg A, Ekman SL (2000). ""We, not them and us?" Views on the relationships and interactions between staff and relatives of older people permanently living in nursing homes. " J Adv Nurs 31(3): 614-22
https://pubmed.ncbi.nlm.nih.gov/10718881

III. Hertzberg A, Ekman SL, Axelsson K (2001). "Staff activities and behaviour are the source of many feelings: relatives interactions and relationships with staff in nursing homes. " J Clin Nurs 10(3): 380-8
https://pubmed.ncbi.nlm.nih.gov/11820548

IV. Hertzberg A, Ekman SL, Axelsson K (2002). ""Relatives are a resource, but..." Registered nurses views and experiences of relatives of residents in nursing homes." (Submitted)

V. Hertzberg A, Ekman SL, Axelsson K (2002). "Licensed practical nurses views on and experiences with relatives of nursing home residents." (Manuscript)