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Who cares? Tinkering with values in geriatric care by first-generation immigrant newcomers and established caregivers in a German residential home

Een Duits verzorgingstehuis nodigde recent aangekomen vluchtelingen uit die geïnteresseerd waren in werken in de ouderenzorg. Het doel van deze studie was om inzicht te krijgen in hoe gevestigde zorgverleners en eerstegeneratie immigranten nieuwkomers sleutelden aan waarden om de zorg voor mensen met dementie vorm te geven. Deze etnografische studie omvatte 200 uur observatie, 24 diepte-interviews en twee focusgroepinterviews met zes immigranten van de eerste generatie en zes gevestigde personeelsleden. De gevestigde zorgverleners en immigranten van de eerste generatie toonden zich bereid en in staat om te sleutelen aan situaties waarin verschillende waarden een rol speelden. Wanneer de werklast echter te zwaar wordt, kunnen medewerkers uit beide groepen gevoelens van machteloosheid, onverschilligheid en demotivatie ervaren. Institutionele beperkingen hebben een negatieve invloed op de interactie tussen gevestigde zorgverleners en immigranten van de eerste generatie die nieuwkomers zijn en beïnvloeden hun uitvoering van de zorg voor geriatrische bewoners met dementie. In dergelijke situaties wordt het cruciaal voor het personeel om een ondersteunende supervisor te hebben die hen kan helpen om te gaan met de dagelijkse stressfactoren van hun praktijk.

Perceived added value of a decision support App for formal caregivers in community‐based dementia care

Aims and objectives To gain insight into the perceived added value of a decision support App for district nurses and case managers intended to support a problem assessment and the provision of advices on possible solutions to facilitate ageing in place of people with dementia, and to investigate how they would implement the App in daily practice. Background District nurses and case managers play an important role in facilitating ageing in place of people with dementia (PwD). Detecting practical problems preventing PwD from living at home and advising on possible solutions is complex and challenging tasks for nurses and case managers. To support them with these tasks, a decision support App was developed. Methods A qualitative study using semi‐structured interviews was conducted. A photo‐elicitation method and an interview guide were used to structure the interviews. The data were analysed according to the principles of content analysis. Results In five interviews with seven district nurses and case managers, the added value was described in terms of five themes: (a) providing a broader/better overview of possible solutions; (b) providing a guideline/checklist for problem assessment and advice on solutions; (c) supporting an in‐depth problem assessment; (d) being a support tool for unexperienced case managers/district nurses; and (e) providing up‐to‐date information. The participants regarded the App as complementary to their current work procedure, which they would use in a flexible manner at different stages in the care continuum. Conclusions The participants valued both parts, the problem assessment and the overview of possible solutions. An important requisite for the usage would be that the content is continuously updated. Before implementation of the App can be recommended, an evaluation of its effectiveness regarding decision‐making should be conducted. Relevance to clinical practice This study underpins the need of nurses and case managers for decision support with regard to problem assessment and providing advices on possible solutions to facilitate ageing in place of PwD. There results also show the importance of listening to users experience and their perceived added value of decision support tools as this helps to explain the lack of statistically significant effects on quantitative outcome measure in contrast to a high willingness to use the App in a previous study.

The experiences of family caregivers who participated in a family involvement program after cancer surgery

Purpose: As recovery time after oncological surgery can be long, family caregivers often play an important role in the delivery of care after patients’ discharge. To prepare carers for this role, we developed a family involvement program (FIP) to enhance their active involvement in post-surgical oncology care during hospitalization. The purpose of this qualitative study was to explore family caregivers experience of participating in a FIP. Methods: We conducted semi-structured interviews with 12 family caregivers who participated in the family involvement program. The program is comprised of two main components (1) training and coaching of physicians and nurses; (2) active involvement of family caregivers in fundamental care activities. This active involvement included six activities. Data were analyzed using interpretative phenomenological analysis. Results: Family caregivers positively valued the program. Active participation in post-surgical care was experienced as an acceptable burden. The program gave participants the ability to simply be present (‘being there’) which was considered as essential and improved their understanding of care, although family caregivers sometimes experienced emotional moments. Active involvement strengthened existent relationship between the family caregiver and the patient. Participants thought clinical supervision. by nurses is important. Conclusions: Physical proximity appeared as an essential part of the family involvement program. It helped carers to feel they made a meaningful contribution to their loved ones’ wellbeing. Asking families to participate in fundamental care activities in post-surgical oncology care was acceptable, and not over-demanding for caregivers.

“It Is about How Kind They Are”

In recent years, Dutch authorities have attempted to shift from formal to informal care responsibilities to meet an increasing demand for care. There is a growing expectation that social and healthcare professionals will actively involve, support, and collaborate with partners, family members, and others who provide informal care. However, the practical implementation of such collaborations is not yet evident. In this qualitative study, 37 individual interviews and eight focus groups were conducted to explore the preferences of informal caregivers in the Netherlands regarding their collaboration with social and healthcare professionals. In recognition of the growing consensus that professionals should tailor their approach to caregivers’ individual circumstances, we adopted an intersectional approach to examine the relationship between caregivers’ social positions and preferences as well as the impact of systemic and power dynamics on these collaborations. The findings indicate that most of caregivers’ worries concerning collaborations are rooted in the organisational context of their interactions with professionals rather than the interactions themselves. Caregivers’ social positions do not necessarily lead to varying opinions regarding collaboration with professionals; however, caregivers do expect professionals to be aware of their social positions, as these positions shape the context within which informal care is provided and determine how easily caregivers can integrate care responsibilities into their lives. To enhance collaboration between caregivers and professionals in the short term, care organisations and social and healthcare educational programmes should encourage a professional mindset that recognises caregivers as equal partners in care. It is essential for professionals to acknowledge the caregiver’s role and devise strategies for arranging care together that build on the existing relationship between the caregiver and care recipient.

Informal caregivers’ judgements on sharing care with home care professionals from an intersectional perspective: the influence of personal and situational characteristics

Informal caregivers’ judgements on sharing care with home care professionals from an intersectional perspective: the influence of personal and situational characteristics

The European policy emphasis on providing informal care at home causes caregivers and home care professionals having more contact with each other, which makes it important for them to find satisfying ways to share care. Findings from the literature show that sharing care between caregivers and professionals can be improved. This study therefore examines to what degree and why caregivers’ judgements on sharing care with home care professionals vary. To improve our understanding of social inequities in caregiving experiences, the study adopts an intersectional perspective. We investigate how personal and situational characteristics attached to care judgements are interwoven. Using data of the Netherlands Institute for Social Research, we conducted bivariate and multivariate linear regression analysis (N = 292). We combined four survey questions into a 1–4 scale on ‘caregiver judgement’ (α = 0.69) and used caregivers’ personal (such as gender and health status) and situational characteristics (such as the care recipient's impairment and type of care) as determinants to discern whether these are related to the caregivers’ judgement. Using a multiplicative approach, we also examined the relationship between mutually constituting factors of the caregivers’ judgement. Adjusted for all characteristics, caregivers who provide care to a parent or child with a mental impairment and those aged between 45 and 64 years or with a paid job providing care to someone with a mental impairment are likely to judge sharing care more negatively. Also, men providing care with help from other caregivers and caregivers providing care because they like to do so who provide domestic help seem more likely to be less satisfied about sharing care. This knowledge is vital for professionals providing home care, because it clarifies differences in caregivers’ experiences and hence induce knowledge how to pay special attention to those who may experience less satisfaction while sharing care.