Realtionships RNs & Fams LTCF

Relationships Between RNs and Families

Relationships Between RNs and Families in Long-Term Care Facilities

The relationship between families of residents in long-term care facilities and nursing staff is a crucial element of care provision and can significantly effect patient outcomes. Communication with families with regard to both social/emotional and medical needs of patients is often left to RNs in long-term care making these communications an absolutely crucial aspect of the patient and families' overall experience in long-term care. Research on this subject is limited, as the topic has been only anecdotally explored, excluding a few key research works. This work discusses the current literature dealing with this issue in an attempt to help develop a clearer understanding of the issue and explore the various facets and points-of-view of it to develop evidence-based practice decisions and protocols to foster and support positive relationships between the two groups.

Introduction

In many ways and for many people long-term care facilities become the last home a person might ever know. Though, there is a stress in some institutions on rehabilitation and/or temporary family respite type services this is not the general rule, as most patients in nursing homes are referred to by all as residents, because they live in the care facility and may likely do so until they die. If the particular long-term care facility that an individual lives in is a good one, with loving, patient and competent staff as well as a positive physical environment this fact is not a harsh reality, if none or some of these things are missing then the situation may be completely the opposite and rest in a poor quality end of life.

The nature of care provider-resident relationships in long-term care is crucial to the quality of life of residents. Clinical observations and anecdotal evidence suggest that close relationships exist between residents and care providers. However, research exploring how these relationships are defined and measured is only in an early stage of development. (McGilton & Boscart, 2007, p. 2149)

Long-term care staff then has a significant psycho-social role to play in a person's life and the overall feel of the facility (depending on the outlook of the administration and/or owner of the place) might be goal oriented toward creating an atmosphere that is homey and comfortable, while still maintaining the facility as an institution that has institutional standards and must meet everyone's needs to its best ability.

One aspect of geriatric and/or long-term nursing care that is infrequently studied, is the relationship between nurses (here specifically Registered Nurses) and families of residents of long-term care facilities, even though such relationships can seriously effect patient medical, physical and social needs outcomes, family comfort with leaving a loved one in the care of others and lastly the long-term psychological effects of the whole of the long-term care experience for the family and patient. (McGilton & Boscart, 2007, p. 2149) Though unskilled and other skilled staff members are in contact with family on a somewhat regular basis depending mostly on family involvement, the RN is the staff member, within the facility that is most likely to experience direct family contact, with regard to medical and social issues pertaining to the patient. It is most often the role of the RN to receive questions and report care and even social issues to the family when the need arises. This work will explore various aspects of the relationship between RNs and families in the long-term care setting and discuss issues regarding the effect and development of such relationships, with regard to how such relationships can assist or detract from the experience of long-term care for the family and by proxy the patient. This work will serve as a preliminary review of literature for the development of a defined set of research questions.

Review of Literature

As a result of the immaturity of the research base on this issue coupled with the fact that most information on the subject is limited to anecdotal and qualitative research this work will begin with an analysis of a comprehensive research article that describes relationships between all staff and families of long-term care residents. The work is demonstrative of the fact that in the long-term care setting, and likely other health care settings perception from differing point-of-view determine both perception and the real relationships experienced by both staff and families in this situation. According to the article;

Care providers perceived the closeness of relationships by the degree of reciprocity they experienced with their residents and by their emotional connection with them. Residents defined close relationships with care providers based on the care providers' caring attitude and behaviours. Family determined the closeness of relationships between their relatives and care providers according to the positive effects of the care providers' behaviours on their relatives' well being. In addition, care providers, residents and family accredited different factors as influencing the closeness of the care provider-resident relationship. (McGilton, & Boscart, 2007, 2149)

The differing points-of-view and expectations, if they were known by all parties, but especially by staff/nurse would likely sway and potentially guide future communications and actions toward patients and family members and create evidence-based practice solutions for the future. As is stated by McGilton and Boscart the results of this research, based on separate interviews among all parties, indicate that awareness of perception could "enhance resident care in long-term care facilities." (2149)

Again, the limitations of specific research on RN relationships dictates that the next article reviewed also have a broader focus, i.e. that of all staff as apposed to just RNs and residents themselves. The importance of the work to the immediate work is that in this work there is a significant emphasis, based on the early (non-specific) findings that staff-family relationships are undervalued and relatively unknown, and deserve significantly more consideration. The demographic surprises of the work indicated that staff members who were married reported more positive attitudes and perceptions of resident family members. Another demographic study indicates that staff in smaller facilities also reported far better relationships with residents and resident family, by proxy. Lastly, the work points out that staff who care for more residents with learning difficulties were more likely to report a better understanding of patients. The conclusion of the work is described by the authors, supporting the early statement of importance of this work to the work at hand is also significant.

The findings emphasize the need to consider elements of staff-family relationships when considering staff perceptions of residents. The results also imply that clinical interventions designed to enhance social relationships in nursing homes can be extended across the long-term care landscape to positively influence the staff-resident-family triad. (Gaugler, 2005, p. 377)

This work gives great credence to the idea that the nurse-family dynamic is an essential aspect of patient care in long-term care that needs to be better understood.

A third article, expressing research knowledge of staff does look directly at RNs and family in practice. The work reflects RN perceptions, as interviews were not conducted among families or patients in this study. The study indicates that there were three main research outcomes; 1. that "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." 2. "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." 3."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." (Gladstone & Wexler, 2002, p. 1710) the research results are significant and interesting in that they discuss an issue not yet raised in other research, and that being "social power" and authority. RNs tend to have a certain degree of professional recognition, that might not be afforded other staff in a nursing home, and this does seem to partly sway family perceptions of them, on an initial and a long-term basis. This in and of itself is a great insight in the development of relationships between families and RNs as either party might be unaware of the sway that this perception of "social power" has on the situation and may need to be either addressed and bridged or utilized to assist family and patient compliance.

The final peer reviewed article demonstrates a direct research base between RNs and family relationships in long-term care and may be looked at as a seminal work on the matter. The work looks at the relationship directly and addresses the perceptions of both groups through interviews.

Analysis of interview transcripts and fieldnotes revealed 4 types of family-nurse relationships -- conventional, competitive, collaborative, and "carative" -- each reflecting the roles of nurse and family, negotiating strategies, and consequences. (Ward-Griffin, Bol, Hay, Dashnay, 2003, p. 151)

The work again, contends that more research is needed but offers a variety of archetype relationships that can, when looked…