James W. Gladstone

Exploring the Relationships Between Families and Staff Caring for Residents in Long-Term Care Facilities: Family Members' Perspectives

The purpose of this qualitative study was to learn more about the relationships that families develop with staff who work in the facilities in which their relatives live. Data were collected through participant observation in two long-term care facilities and through personal interviews with 61 family members. Five types of relationships emerged from the data, including relationships that were “collegial,” “professional,” “friendship,” “distant,” and “tense”. Several factors appeared to be associated with positive relationships developed between families and staff, including contact with purpose, shared experiences, and issues of trust. Families also reported a number of benefits from developing positive relationships with staff.

The Development of Relationships Between Families and Staff in Long-term Care Facilities: Nurses' Perspectives

The objective of this study was to explore the way in which relationships develop between family members and staff working in long-term care facilities. In-depth, qualitative interviews were conducted with 17 registered nurses. Data were analysed inductively using the constant comparative method. Findings showed that RNs perceive their relationships with families to develop in four stages: the “initial greeting,” sizing up,” “making a tentative decision,” and “reaching a final decision”. Several contextual factors were associated with the way in which relationships developed, including structural factors, family recognition of staff efforts, open communication, and professional identity. Findings suggest that relationships can best be understood from an interpretive perspective and that an analysis of family-staff relationships should consider the influence of social power.

Ways That Families Engage with Staff in Long-Term Care Facilities*

Le but de cette étude qualitative était d’analyser les styles d’engagement auxquels les familles ont recours avec le personnel des établissements de soins prolongés. Des données ont été recueillies lors d’entrevues personnelles avec 35 membres de familles. Cinq styles d’engagement ont été dégagés: positif, négatif, péremptoire, prudent et limité. Les facteurs associés à ces divers styles ont aussi été déterminés. Les possibilités de leur mise en pratique font l’objet de discussion. The purpose of this qualitative study was to explore styles of engagement used by families with staff in long-term care facilities. Data were gathered through personal interviews with 35 family members. Five styles of engagement were identified: positive, negative, peremptory, cautious, and limited. Factors associated with these different styles were also identified. Implications for practice are discussed.

Could We Hold Hands?: Older Lesbian and Gay Couples' Perceptions of Long-Term Care Homes and Home Care

RÉSUMÉ: Cette étude qualitative décrit les attentes, les préoccupations et les besoins en matière de services de soins de longue durée et de soins à domicile de 12 couples de lesbiennes et de gais plus âgés qui habitent au Canada. Nos résultats reflètent quatre grands thèmes: la discrimination, l’identité, les dépenses d’énergie, et les soins nuancés. Discrimination a été caractérisée par des préoccupations concernant une discrimination déguisée; perte d’amortisseurs sociaux lorsque l’on vieillit; diminution de la capacité de plaider pour soi-même et l’autre conjoint. Les questions d’identité ont inclus le risque prévu sur la divulgation de son identité sexuelle; l’importance centrale d’être identifié comme un partenaire dans une relation couplée; et l’importance d’avoir accès à des groupes de référence constitués d’autres aînés gais. Nous concluons que les partenaires sont accablés par le travail émotionnel de dépenser de l’énergie à cacher une partie de leur identité, l’évaluation de leurs environnements de discrimination et d’apaiser autres. Les participants suggèrent que les soins nuancéssont nécessaires, ce qui implique sentir à l’aise avec les fournisseurs de soins de santé; ayant fournisseurs sentir à l’aise avec eux; et une dualité de nécessité entre vouloir être considéré comme le même, tout en même temps également reconnu comme unique. Ces thèmes informent ententes de services de soins et de soins à domicile à long terme pour les couples lesbiens et gais plus âgés. This qualitative study describes expectations, concerns, and needs regarding long-term care (LTC) homes and home care services of 12 older lesbian and gay couples living in Canada. Our findings reflect four major themes: discrimination, identity, expenditure of energy, and nuanced care. Discrimination involved concerns about covert discrimination; loss of social buffers as one ages; and diminished ability to advocate for oneself and one’s partner. Identity involved anticipated risk over disclosing one’s sexual identity; the importance of being identified within a coupled relationship; and the importance of access to reference groups of other gay seniors. We conclude that partners were burdened by the emotional effort expended to hide parts of their identity, assess their environments for discrimination, and to placate others. Nuanced care involved a mutual level of comfort experienced by participants and their health care providers. These themes inform understandings of LTC homes and home care services for lesbian and gay older couples.