Carole A. Robinson

Health Care Relationships Revisited

It is time to revisit our beliefs about health care relationships. Although these relationships have long been recognized as influential to illness experience and patient satisfaction with care, they have been construed as background to the more important work of intervening to elicit change. However, according to five families who participated in a grounded theory study designed to explore the process and outcomes of nursing care, health care relationships are pivotal to change. The nurses relational stance of curous listener, compassionate stranger nonjudgmental collaborator, and mirror for family strengths is a significant intervention that invites healing.

Family Nursing Interventions: What Families Say Makes a Difference

Within the nursing offamilies, assessment skills have become more and more sophisticated. However, our ability to intervene in relation to the family problems that are identified has lagged behind. There is growing awareness that it is time to attend to what we do that helps healfamily suffering. This article reports on the interventions that one group offamilies identified and described as making a difference that matters in living with a chronic condition. Thesefamilies experienced difficulty managing a members chronic condition and sought assistance in an outpatient nursing clinic. The interventions were illuminated through a grounded theory study designed to explore both the process and outcomes of family nursing interventions. From the family perspective, the intervention process involved two stages: (a) creating the circumstancesfor change and (b) moving beyond and overcoming problems. Examples are given of specific interventions thatfamiliesfound useful within the intervention process.

Issues in Rural Palliative Care: Views from the Countryside.

CONTEXT Growing concern exists among health professionals over the dilemma of providing necessary health care for Canadas aging population. Hospice palliative services are an essential need in both urban and rural settings. Rural communities, in particular, are vulnerable to receiving inadequate services due to their geographic isolation. PURPOSE To better understand experiences and issues related to rural palliative care. METHODS Focus groups were held for health professionals, family members and volunteers in 3 rural British Columbia communities. A coding schema was developed and the data were then thematically analyzed using a constant comparison technique. FINDINGS Three themes in rural palliative care were established: nature of palliative health care services, nature of rural relationships, and competencies required for rural palliative care. Findings indicated that the diversity in rural communities requires tailored approaches to palliative care that consider the geographic, cultural and health aspects of residents in order to optimize care. CONCLUSION Tailored approaches to palliative care developed in conjunction with rural communities are needed in order to optimize care.

Gender relations and health research: a review of current practices

IntroductionThe importance of gender in understanding health practices and illness experiences is increasingly recognized, and key to this work is a better understanding of the application of gender relations. The influence of masculinities and femininities, and the interplay within and between them manifests within relations and interactions among couples, family members and peers to influence health behaviours and outcomes.MethodsTo explore how conceptualizations of gender relations have been integrated in health research a scoping review of the existing literature was conducted. The key terms gender relations, gender interactions, relations gender, partner communication, femininities and masculinities were used to search online databases.ResultsThrough analysis of this literature we identified two main ways gender relations were integrated in health research: a) as emergent findings; and b) as a basis for research design. In the latter, gender relations are included in conceptual frameworks, guide data collection and are used to direct data analysis.ConclusionsCurrent uses of gender relations are typically positioned within intimate heterosexual couples whereby single narratives (i.e., either men or women) are used to explore the influence and/or impact of intimate partner gender relations on health and illness issues. Recommendations for advancing gender relations and health research are discussed. This research has the potential to reduce gender inequities in health.

The male face of caregiving: a scoping review of men caring for a person with dementia

The purpose of this scoping review was to examine the empirical evidence published since 2007 on men as family caregivers of persons with dementia. Searches were conducted on Academic Search Complete, Ageline, CINAHL, Embase, Medline, PsychINFO, Social Work Abstracts, and Web of Science using database-specific controlled (i.e., MeSH terms) vocabulary related to dementia, men, and caregiving. Studies published in English between 2007 and 2012 that provided evidence of the experiences of male family caregivers of persons with dementia were included in the review. A total of 30 articles were selected for inclusion. Studies were grouped into three major themes for review: men’s experiences of caregiving, relational factors, and outcomes of caregiving. The reviewed studies build on and support previous findings related to stress, burden, accessing services, and the importance of relational factors to men’s caregiving experiences. However, there is a need for a framework that explains these findings in relation to masculinities. Such a framework would provide the necessary unifying context for a more powerful explanatory account. Furthermore, there appears to be the potential for great benefit in fully linking men’s caregiver research to men’s health issues as a means to articulate strategies to sustain the health and well-being of men caregivers. This seems especially relevant in light of the closing gender gap in life expectancy, which will ultimately see many men providing direct care to their partners.

Unifying Distinctions for Nursing Research with Persons and Families

This article presents a unifying conceptualization of nursing research with persons and families. A common language for both nursing practice and nursing research with persons and families is proposed that is intended to facilitate critical dialogue toward advancing the discipline of nursing.

On the road again: patient perspectives on commuting for palliative care.

OBJECTIVE The aim of this research project was to gain an understanding of the experiences of rural cancer patients who commute to an urban cancer center for palliative care. METHOD The study utilized a mixed method design. Fifteen individuals with a palliative designation participated in semi-structured interviews and filled out the Problems and Needs in Palliative Care Questionnaire. RESULTS Qualitative findings included three major themes: cultures of rural life and care, strategies for commuting, and the effects of commuting. Participants valued their rural lifestyles and gained significant support from their communities. Strategies included preparing for the trip with particular attention to pain management, making the most of time, and maintaining significant relationships. Establishing a routine helped to offset the anxiety of commuting. Commuting was costly but the quality of life and supportive relationships obtained through treatment were significant benefits. Questionnaire data suggested that participants were experiencing a number of problems but few indicated they desired more professional attention to those problems. SIGNIFICANCE OF RESULTS Rural lifestyles are often an important part of overall well-being and commuting for care is both costly and complex. Health care providers should assist individuals to weigh the relative contributions of staying in their rural locale versus commuting for care to their overall quality of life. Palliative-care individuals in this study indicated a number of ongoing problems but were not inclined to seek further assistance from health care providers in addressing those problems. Clinicians should actively inquire about problems and further research is needed to understand why patients are reluctant to seek help.

A home away from home: The meaning of home according to families of residents with dementia

This study sought to understand the ways in which family caregivers to institutionalized relatives with dementia perceived and experienced the relocation of their relative to a more home-like setting of care. Twenty-nine family members were interviewed through focus groups and individual interviews following the closing of two traditional care facilities and the subsequent migration of all residents to dementia cottages. Questions focused on the assessment and evaluation of quality of care. Results of this qualitative study pointed to the centrality of relationships in creating a truly homelike environment, in addition to what constitutes effective relational practice from the family perspective. We argue that the creation of a meaningful home for persons with dementia must encompass a relational orientation, both philosophically and in practice, that is inclusive of resident, staff, and family.

A Nontraditional Approach to Family Violence

Family violence has often been conceptualized as a linear phenomenon in which perpetrators commit acts intended to hurt victims. Intervention in these circumstances involves treating the perpetrator and the victim individually. In contrast, this article presents a Systemic Belief Approach to the situation of mutual family violence. A case example illustrates the influence of beliefs on the occurrence of violent acts between family members (in this case, sole-parent mother and adolescent daughter). Family systems nursing interventions such as reflective questions and reflecting teams are used to challenge the familys constraining beliefs, which enables the coevolution of facilitative beliefs that invite healing.

Supporting Rural Family Palliative Caregivers

There is urgent need to effectively support the well-being of rural palliative family caregivers (FCGs). A mixed method study was conducted with 23 FCGs. Data collection included completion of an assessment questionnaire and semistructured interviews. The most prevalent needs identified by questionnaire were caring for the patient’s pain, fatigue, body, and nourishment; FCG’s fatigue and need for respite. Yet few FCGs wanted more attention to these needs by healthcare providers. FCGs resisted considering their own personal needs. Instead, they focused on needs related to providing care including to be(come) a palliative caregiver, be skilled and know more, navigate competing wishes, needs, demands, and priorities, and for “an extra pair of hands.” Gaps in rural palliative services contributed to low expectations for assistance; reluctance to seek assistance was influenced by FCGs’ resourcefulness and independence. Findings suggest that supporting FCGs will most likely be successful when framed in relation to their caregiving role.