Relationships between patients, informal caregivers and health professionals in care homes
- Correspondence to Michael Bauer
Australian Centre for Evidence Based Aged Care, La Trobe University, Melbourne Campus, Bundoora, Victoria 3086, Australia;
Implications for nursing practice
■ Care delivery in the home creates a unique and potentially challenging set of relational issues for the nurse, client and informal carer.
■ The communication skills, values, attitudes and behaviours of the nurse are influential in determining the dynamic of the nurse-client-informal carer relationship in the home.
Implications for nursing research
■ Further research is needed to examine the views of stakeholders on the factors that influence nurse-client-informal carer relationships in the home-care setting.
■ Further research is needed to examine the success of interventions to promote positive relationships among stakeholders in the home-care setting.
Care provision in the home is becoming increasingly common. To date, there is little available research which examines the home as workplace and the impact home care can have on interpersonal relationships between the visiting health professional, client and informal care giver. To address this gap in knowledge, Lindahl et al synthesise the findings of a range of research-based papers which describe the dynamics of the nurse-client, or nurse-client-informal carer relationship and in so doing present a new interpretation and conceptualisation of relationships in this context.
The aim of this metasynthesis of the research literature was to describe and interpret the relationship between ‘patients, informal caregivers and health professionals involved in the home-care context’. According to the authors, a metasynthesis is an ‘integrated interpretation of qualitative research findings, which is more substantive than the results from each individual investigation’. Studies selected for inclusion in the metasynthesis were original peer reviewed research articles published in English or Swedish during 1992–2005 that met the authors' inclusion criteria and the aims of the study. Studies on psychiatric, maternity and midwifery care were excluded; as were papers about children's health promotion and childrens' primary healthcare. Thirteen articles from the USA, Canada, the UK and Sweden were selected for inclusion and analysis. All studies included used a qualitative research design. The process of analysis is not described in any detail by the authors but entailed a form of inductive thematic analysis.1
Three main themes were derived; ‘from privacy to public’, ‘being there’ and ‘home care as co-creation’. These and the subthemes which are described, present the ‘interpreted meanings of home as the place and space for care’ and the changed interpersonal relationships brought about by home care. ‘From privacy to public’ portrays the changes in the meaning of ‘home’ when what is normally a private domain, is transformed into a public space. What it means to the nurse, client and informal carer to ‘be there for each other’ in a home-care relationship, is characterised by ‘being there’. The third theme, ‘home care as co-creation’, represents the various processes involved in the shaping of home-care relations. The somewhat abstract notion of a ‘professional friendship’ which the authors describe as a ‘response to patients and their informal caregivers’ needs', was found to be the key to understanding home care.
While the applicability of the authors' interpretations is limited due to the small number of studies on which the findings are based, the article provides some insights into how home care is constructed by nurses, clients and informal carers (family) and in so doing, highlights some of the factors which can influence the professional relationship in the home-care context. A systematic review of the literature would arguably have formed the basis for a more robust analysis of this topic and it is not clear why the authors did not choose this approach. Nevertheless, many of their findings are consistent with studies conducted in institutional settings that highlight the importance of communication, trust, involvement in decision making and information exchange to the establishment and maintenance of good relationships with informal carers.2
Lindahl et al further highlight the need for more research which considers the perspective of the nurse, informal carer and client triad. How pertinent would the findings have also been to nursing home care and personnel? These terms were part of the initial search strategy, but presumably studies in this setting were either not found or excluded.
The concept of ‘professional friendship’ as the nexus between the healthcare professional and the home-care client and informal carer is not well explicated. A discussion of professional friendship in light of the writings of Aristotle as indicated in the abstract is not evident. This embryonic notion is in need of further development to become meaningful. The strength of this article lies in its ability to raise awareness among nurses about how easily the traditional hospital-based medical model of care can shape the home-care context and lead to a loss of privacy, power and control for the client and their family.