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Placing a spouse in a care home for older people: (re)-constructing roles and relationships
Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Linköping University, Faculty of Health Sciences.
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis explores the process of placing a spouse in a care home for older people from the perspectives of the key actors involved. Due to the lack of previous studies in this area in Sweden and the desire to generate new insights that have the potential to inform practice developments a grounded theory methodology was adopted.

Data were collected using semi-structured interviews (70 in total) with spouses, adult children, community based staff and staff in care homes. Analyses of these data suggested that placement is best interpreted as a temporal experience comprising four stages: making the decision, making the move, adjusting to the move and reorientation. Each of the key actors offered differing insights into the way that the process as a whole was experienced with it emerging that in the initial two phases the primacy focus was on the practical and instrumental aspects of the move, with the emotional consequences being largely overlooked. This is a key issue as spouses were usually unprepared for the sense of separation and loss that the placement caused. Subsequently, spouses placed particular importance on maintaining their sense of involvement with their partner by a variety of 'keeping' activities. However, children and staff in care homes shared varying degrees of 'awareness' which influenced the way that relationships were forged.

Based on a synthesis of the data the core category and basic social process that emerged was termed '(re)-constructing roles and relationships'. This highlights the subtle and dynamic way that placement unfolds and reinforces the importance of understanding the process from multiple perspectives. In addition to providing new theoretical insights the thesis identifies a number of ways in which the placement process could be improved and suggests the need for more open and explicit discussion of a number of aspects, particularly the ways in which expectations of roles and relationships change over time. Thls is essential if spouses are to be better prepared and supported both for the sense of separation from their partner and for the need to integrate into the care home setting.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2001. , 71 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 710
Keyword [en]
family carers, care home placement, partnership, adult children, community staff, nursing staff, carer support, grounded theory
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-28076Local ID: 12840ISBN: 91-7373-148-X (print)OAI: oai:DiVA.org:liu-28076DiVA: diva2:248627
Public defence
2001-12-13, Berzeliussalen, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-11-09Bibliographically approved
List of papers
1. 'I don't have any other choice': spouses' experiences of placing a partner in a care home for older people in Sweden
Open this publication in new window or tab >>'I don't have any other choice': spouses' experiences of placing a partner in a care home for older people in Sweden
2000 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 32, no 5, 1178-1186 p.Article in journal (Refereed) Published
Abstract [en]

The main aim of this paper is to consider the experiences of Swedish spouses who have placed a partner in a care home for older people. Data were gathered from semi-structural interviews with 14 spouses (11 wives and 3 husbands) who had been involved in a care home placement within the previous 6 months. The results reported here are from the first component of a larger grounded theory study, the aim of which is to explore, describe and understand the experience of care home placement from a variety of perspectives and to identify the implications for policy and practice in Sweden. The focus here is on the experience of spouses, relating to the decision-making process, the move into care and subsequent contact with the care home. Four themes emerged from the data – making the decision, making the move, adjusting to the move and reorientation. The results show a lack of planning for the elder person’s entry to a care home, and professional dominance of this stage of the process. The largely ambivalent emotional responses to the move that spouses experience and the difficulties in initiating and sustaining relationships with staff in the home are discussed in the light of previous research.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27024 (URN)10.1046/j.1365-2648.2000.01588.x (DOI)11668 (Local ID)11668 (Archive number)11668 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-03Bibliographically approved
2. Placing a spouse in a care home: the importance of keeping
Open this publication in new window or tab >>Placing a spouse in a care home: the importance of keeping
2001 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 10, no 3, 406-416 p.Article in journal (Refereed) Published
Abstract [en]

• Despite a universal policy of community care, the number of frail older people entering care homes is likely to increase in the future.

• There have been relatively few studies exploring the experience of spouses who have placed a partner in care.

• Due to a lack of preparation, the placement process is often ad hoc, with little attention being given to spouses’ emotional reactions or their efforts to maintain their relationship with their partner.

• The relationship between care home staff and families is often superficial and strained.

• There is a need for more proactive efforts to facilitate a partnership between care home staff and families.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27028 (URN)10.1046/j.1365-2702.2001.00497.x (DOI)11672 (Local ID)11672 (Archive number)11672 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-03Bibliographically approved
3. Moving into a care home: the role of adult children in the placement process
Open this publication in new window or tab >>Moving into a care home: the role of adult children in the placement process
2002 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 39, no 3, 353-362 p.Article in journal (Refereed) Published
Abstract [en]

Admission of an older person to a care home is widely recognised as a very stressful period for the family and one which, despite community care policy, is likely to be an increasingly common experience. Although there is a growing research base in this area, there have been few studies on the role of adult children in supporting their parents during this difficult transition. This paper reports on the third stage of a grounded theory study conducted in Sweden which explored the part played by adult children in the placement process. Data were collected from 13 adult children using in-depth semi-structured interviews and the results are compared with themes previously derived from interviews with 26 spouse carers. The analysis reveals important overlaps and differences and suggests the need for further research exploring the dynamics of the placement process.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27025 (URN)10.1016/S0020-7489(01)00033-5 (DOI)11669 (Local ID)11669 (Archive number)11669 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-03Bibliographically approved
4. The role of community staff in care home placement in Sweden
Open this publication in new window or tab >>The role of community staff in care home placement in Sweden
2002 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 11, no 4, 488-497 p.Article in journal (Refereed) Published
Abstract [en]

• The role of community staff in placing a relative in a care home is a relatively unexplored area of practice.

•  Interviews with a variety of community staff in Sweden suggest that they play a significant role in helping family carers, particularly spouses, research the decision about the need for placement.

•  This role can include recognition that placement is required (seeing the need), initiating and sustaining discussions about placement (sowing the seed and nurturing the seed) and legitimating the decision.

•  However, once the decision has been made relatively little attention is given to the emotional consequences of the move and attention is focused largely on instrumental aspects.

•  Despite showing sensitivity in the decision-making phase, community staff could do more to help carers deal with the guilt they experience and to initiate contact with the care home.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27933 (URN)10.1046/j.1365-2702.2002.00619.x (DOI)12694 (Local ID)12694 (Archive number)12694 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-03Bibliographically approved
5. 'Entering a New World': empathic awareness as the key to positive family/staff relationships in care homes
Open this publication in new window or tab >>'Entering a New World': empathic awareness as the key to positive family/staff relationships in care homes
2002 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 39, no 5, 507-515 p.Article in journal (Refereed) Published
Abstract [en]

Despite an almost universal policy of community care, placing a relative in a care home will be an increasingly common event as population ageing continues. Studies suggest that most families wish to remain involved in care following placement but that they often experience difficulties in establishing relationships with staff. This paper reports on the fifth phase of a Swedish study exploring the experience of placement from a temporal perspective and including the views of all the key actors (relatives, staff in the community, staff in care homes). The focus here is placed on the perceptions of care home staff and their perceived role in relation to spouses who have recently placed a partner. The study adopted a grounded theory approach and data were collected from in-depth interviews with 16 staff members of varying grades and positions. Analysis of the data suggested 3 levels of awareness amongst staff: empathic awareness, guarded awareness and limited awareness. The characteristics of empathic awareness are outlined and its implications briefly considered.

Keyword
Care home placement, Family carers, Grounded theory, Partnership, Staff perceptions
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-46840 (URN)10.1016/S0020-7489(01)00056-6 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2012-09-03Bibliographically approved

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