Conditions for relatives' involvement in nursing homes
Author: Holmgren, Jessica
Date: 2015-05-26
Location: Karolinska Institutet, hörsal H3 Blå, Alfred Nobels Allé 23, Huddinge
Time: 13.00
Department: Inst för neurobiologi, vårdvetenskap och samhälle / Dept of Neurobiology, Care Sciences and Society
Abstract
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.
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.
List of papers:
I. Holmgren, J., Emami, A., Eriksson, L. E., & Eriksson, H. (2013). 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. Scandinavian Journal of Caring Sciences, 27(3), 677-685.
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II. Holmgren, J., Emami, A., Eriksson, L. E., & Eriksson, H. (2014). Replicating the family – the biopolitics of involvement discourses concerning relatives in nursing home institutions. Aporia – The Nursing Journal, 6(4), 19-29.
III. Holmgren, J., Emami, A., Eriksson, L. E., & Eriksson, H. (2014). Intersectional perspectives on family involvement in nursing home care: rethinking relatives’ position as a betweenship. Nursing Inquiry, 21(3), 227-237.
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I. Holmgren, J., Emami, A., Eriksson, L. E., & Eriksson, H. (2013). 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. Scandinavian Journal of Caring Sciences, 27(3), 677-685.
Fulltext (DOI)
Pubmed
View record in Web of Science®
II. Holmgren, J., Emami, A., Eriksson, L. E., & Eriksson, H. (2014). Replicating the family – the biopolitics of involvement discourses concerning relatives in nursing home institutions. Aporia – The Nursing Journal, 6(4), 19-29.
III. Holmgren, J., Emami, A., Eriksson, L. E., & Eriksson, H. (2014). Intersectional perspectives on family involvement in nursing home care: rethinking relatives’ position as a betweenship. Nursing Inquiry, 21(3), 227-237.
Fulltext (DOI)
Pubmed
View record in Web of Science®
Institution: Karolinska Institutet
Supervisor: Eriksson, Henrik
Issue date: 2015-05-05
Rights:
Publication year: 2015
ISBN: 978-91-7549-872-0
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