ESTABLISHING PARTNERSHIPS WITH FAMILY CAREGIVERS: Local and Cosmopolitan Knowledge

Abstract

1. The concepts of local and cosmopolitan knowledge may be used by gerontological nurses in creating partnerships with family caregivers to frail older people. 2. Local knowledge is the understanding and skills that the family brings to the caregiving situation; cosmopolitan knowledge is the understanding and skills that the gerontological nurse brings to the situation. 3. Four nursing interventions are guided by the conceptualization of local and cosmopolitan knowledge: acknowledging and affirming local knowledge when it is adequate; developing or enhancing local knowledge when it is inadequate; assisting family caregivers to apply local knowledge to problem solving; and blending local and cosmopolitan knowledge.

Working with family carers: towards a partnership approach

“…[48][49][50][51][52] There is little professional input at this time and carers are rarely fully prepared, either physically or psychologically, for their role, frequently lacking the necessary knowledge and skills. 46,[53][54][55][56] Subsequently, carers develop expertise largely by a process of trial and error, a situation which has been described as 'flailing about'. 46 Carers have a particular need for information which is often not met 57 and, according to Strauss et al,58 they are at the 'bottom of the institutional hierarchy of information'.…”

“…This is unfortunate, as there is evidence to suggest that carers who are adequately prepared for their role in terms of possessing the relevant knowledge and skills not only provide better care, but also have improved physical and emotional health. 54,61 This lack of attention to carers' needs is largely attributable to the fact that carers occupy an ambiguous position in the welfare system, with assessment being based on a number of implicit and ill-defined models. 42 The most common model is to see the carer as a resource, when the rationale for interventions is to maintain carers in their role.…”

“…79 Allen 79 argues that because both professionals and carers claim to possess expert knowledge of the patients' needs, tensions can arise. Rather than conflict, what is required is recognition of differing forms of expertise, with Harvath et al 54 suggesting a balance between what they call 'local' and 'cosmopolitan' knowledge. Local knowledge refers to a carers' unique insight into the experiential world of the patient, with cosmopolitan knowledge representing expertise of a more technical and general nature, usually held by professionals.…”

“…However, a skilful blending of the two is essential to ensure optimum care. 54 Achieving this synthesis requires a different way of working, a fact which is increasingly recognized in a range of disciplines. For example, the therapy literature has paid growing attention in recent years to the interaction between therapists and family carers, with a number of useful models emerging.…”

Negotiating the role of expert carers on an adult hospital ward

“…Drawing on Harvath et al (1994), Nolan et al (1996) contrast the local knowledge of family carers with the global and generic knowledge of formal carers. Harvath et al suggest that it is the skilful blending of the local knowledge of family caregivers with the generic knowledge of formal carers which results in the most profitable interaction between carers and service providers.…”