Peer relationships were important to the experience of thriving in some, but not all, nursing home residents
Ms A Bergland, Lovisenberg Deaconal College, Oslo, Norway;
What are the perceptions of nursing home residents of the importance of peer relationships to the experience of thriving (defined as living life fully)?
Descriptive exploratory study based on a social-phenomenological research tradition.
26 residents (age 74–103 y, 20 women) who had lived in the nursing home for ⩾2 months and were mentally lucid.
Data were collected through participant observation (daily activities and organised social activities) and interviews with 16 residents. These data were analysed, and then 10 additional residents were interviewed to elaborate on preliminary findings.
12 residents had established a personal relationship with ⩾1 other resident. Peer relationships were important to thriving for some, but not all, residents. Thriving among residents involved in peer relationships. These residents had established relationships with only 1 or a few peers since many of the other residents had mental impairments. They actively sought each other out, visited each others’ rooms, and talked about their families, previous lives, and nursing home experiences. These relationships contributed to thriving by providing social support and opportunities for mutual exchanges of thoughts, experiences, and goods (eg, sweets from family members). Thriving in the absence of peer relationships. Of those residents who had not established peer relationships, some did not feel that such relationships were important to thriving. As one woman said, “Personally, I do not miss contact. I am used to being alone…As long as I have my people [family] who come to visit me, that is enough for me.” Other residents initially had expectations of socialising with other residents but soon realised that they could not interact with many of their fellow residents. They adapted by reducing their expectations. Thriving but expressing a wish for peer relationships. Still others who felt they were thriving without peer relationships wished for more and closer social contact with their peers. These residents regularly participated during mealtimes and organised social activities. Despite close physical contact with peers, they did not establish the meaningful contact they desired. Reasons for not establishing peer relationships included personal characteristics (eg, being reserved), impairments of peer residents (eg, hearing or mental impairments), and organisational issues (eg, not serving all residents at a table at the same time did not promote mealtime as a social event). Caregivers’ role as facilitators. For most residents who had established peer relationships, organised activities provided limited opportunities for positive interactions. Some caregivers were able to take on a facilitator role to promote active participation among residents who were not able to establish such relationships on their own. They brought together residents who had the potential to participate in conversations and initiated conversation by introducing themes of general interest to the group. They maintained the conversation by asking questions and introducing new themes at critical moments. Alternatively, organised activities that were led by caregivers who were poor facilitators could actually prohibit meaningful interactions among residents.
Peer relationships were important to thriving for some, but not all, nursing home residents. Participating in organised social activities did not necessarily help to establish peer relationships in residents who had an expressed wish for such relationships. Caregivers who mastered a facilitator role helped to bring together residents capable of interacting.
Bergland A, Kirkevold M. The significance of peer relationships to thriving in nursing homes. J Clin Nurs 2008;17:1295–302.
Source of funding: Teaching Nursing Home Project, Oslo County.
As Maslow classically illustrated,1 friendships and social networks are an essential part of the healthy human condition. Given this importance, nursing home staff can help to foster relationships between residents and, in doing so, can help to promote quality of life and ensure that the physical, functional, psychological, and social needs of residents are met. The study by Bergland and Kirkevold looked at the promotion of peer relationships in nursing homes from the perspectives of both residents and their caregivers.
A strength of the study is that data were collected using observations of nursing home life as well as interviews with residents. Observations highlighted the instrumental role of caregivers in facilitating peer relationships—a role not identified by residents. However, the purposive sample drawn requires consideration when interpreting the findings and could limit transferability. The study focused on the minority of residents who were mentally lucid and living among other residents with dementia and other cognitive disorders; most of the study participants were women. The influence of these participant characteristics on their experiences is not clear. For example, it would be useful to understand the influence of sex, condition, or length of time as a resident on peer relationships and thriving.
Individual preferences for social relationships are important regardless of setting, and so establishing peer relationships needs to be viewed as important by the individual. However, because individual preferences vary, caregivers are challenged to identify residents who want social contacts and those who need help to form relationships. Nurses should be able to understand, respond, and adapt to different resident characteristics and the nursing home environment. By engaging with residents who desire relationships, caregivers can promote a positive nursing home experience for their residents—an important determinant of a happy and dignified home life.