JAMDA
Volume 9, Issue 1 , Pages 36-44, January 2008

The Emotional Context Facing Nursing Home Residents’ Families: A Call for Role Reinforcement Strategies from Nursing Homes and the Community

  • Mercedes Bern-Klug, PhD, MSW

      Affiliations

    • Corresponding Author InformationAddress correspondence to Mercedes Bern-Klug, PhD, MSW, Room 308 North Hall, School of Social Work, University of Iowa, Iowa City, IA 52242.

University of Iowa School of Social Work & The Aging Studies Program, Iowa City, IA.

published online 13 December 2007.

Objectives

Identify useful concepts related to the emotional context facing family members of nursing home residents. These concepts can be used in future studies to design and test interventions that benefit family caregivers.

Design

Secondary data analyses of qualitative ethnographic data.

Setting

Two nursing homes in a large Midwestern city; 8 months of data collection in each.

Participants

44 family members of nursing home residents whose health was considered, “declining.”

Measurements

Role theory was used to design and help interpret the findings. Data included transcripts of conversations between family members and researchers and were analyzed using a coding scheme developed for the secondary analysis.

Results

Comments about emotions related to the social role of family member were grouped into three categories: relief related to admission, stress, and decision making support/stress. Subcategories of stress include the role strain associated with “competing concerns” and the psychological pressures of 1) witnessing the decline of a loved one in a nursing home, and 2) guilt about placement. Decision-making was discussed as a challenge which family members did not want to face alone; support from the resident, health care professionals, and other family members was appreciated.

Conclusions

Family members may benefit from role reinforcement activities provided by nursing home staff and community members. All nursing home staff members (in particular social workers) and physicians are called upon to provide educationa and support regarding nursing home admissions, during the decline of the resident, and especially regarding medical decision-making. Community groups are asked to support the family member by offering assistance with concrete tasks (driving, visiting, etc.) and social support.

Keywords: Qualitative, ethnography, family, end-of-life, nursing home, role theory, chronic illness, older adult

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 Data analysis was supported by the John A. Hartford Social Work Initiative, Doctoral Dissertation Fellowship program, and a Social Work Leadership Award from the Soros Foundation’s, Project on Death in America. The original data were collected under the auspices of an NIH grant to principal investigator, Dr. Sarah Forbes (National Institutes of Health NINR R15NR04974). The author has no financial or other conflict of interest to report. I thank Dr. Sarah Forbes-Thompson for allowing the use of these data for my doctoral dissertation, from which this manuscript was developed. This paper was presented, in part, at the 2006 Annual Meeting of the American Academy of Hospice and Palliative Medicine “Nursing Home Family Member’s Emotional Support Needs.”

PII: S1525-8610(07)00361-1

doi:10.1016/j.jamda.2007.08.010

JAMDA
Volume 9, Issue 1 , Pages 36-44, January 2008

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