It takes three to tango: An ethnography of triadic involvement of residents, families and nurses in long‐term dementia care

Abstract

BackgroundResearchers often stress the necessity and challenge of integrating the positionings of residents, family members and nurses in order to realize each actor's involvement in long‐term dementia care. Yet most studies approach user and family involvement separately.AimTo explain how productive involvement in care provision is accomplished in triadic relationships between residents, family members and nurses.MethodsAn ethnographic study of identity work, conducted between 2014 and 2016 in a Dutch nursing home.FindingsWe identify four ideal‐typical identity positionings performed by nurses through daily activities. The findings reveal how their identity positionings were inseparable from those of the residents and family members as they formed triads. Congruent, or ‘matching’, identity positionings set the stage for productive involvement. Our systematic analysis of participants' identity work shows how—through embedded rights and responsibilities—their positionings inherently shaped and formed the triadic types and degrees of involvement observed within these relationships.Discussion and conclusionThis study both unravels and juxtaposes the interrelatedness of, and differences between, the concepts of user and family involvement. Accordingly, our findings display how residents, family members and nurses—while continuously entangled in triadic relationships—can use their identity positionings to accomplish a variety of involvement activities. To mirror and optimize the implementation of user and family involvement, we propose a rights‐based and relational framework based on our findings.Patient or public contributionConversations with and observations of residents; feedback session with the Clients' Council.

Reimagining Family Involvement in Residential Long-Term Care

“…39,40 Ethnographic and other studies have also explored how the care "triad" consisting of nursing staff, residents, and family members are effectively navigated to enhance the care provided to residents with dementia. 41,42 Additional research has examined family members' perceptions of communication and interactions with staff in NHs. Positive family members' perceptions of the NH are associated with family engagement on the part of facility staff, including "demonstrations of care" that go beyond routine service delivery (ie, "informal contacts"), individualized and responsive care, and communication with family members.…”

Disruptions in Relational Continuity: The Impact of Pandemic Public Health Measures on Families in Long-Term Care

“…Such disconnect has been noted elsewhere; for example, Puurveen and colleagues (2019) noted how, prepandemic, family participation in care conferences was frequently viewed as tokenistic, tempering family caregivers’ ability to advocate for their relative’s care. The experiences of study participants demonstrate the primarily performative nature of family-inclusive care philosophies (see also Hoek et al, 2021 ; Holmgren et al., 2014 ; Koster & Nies, 2022 ) as they were swiftly denied and/or limited in their access to their relatives. With minimal opportunities to advocate for themselves and their relative, participants were left feeling aggrieved and betrayed.…”

Different views on collaboration between older persons, informal caregivers and care professionals

“…In care triads, care provision is seen as a communal effort. Each partner's perspective on collaboration shapes the dynamics within these care triads 7 . Understanding these views is crucial for navigating the complexities of care triads.…”

“…The workload can also be relieved by transferring care tasks from care professionals to informal caregivers when an older person moves to a care organization. Next to reducing workload, informal care provision is thought to enable more person‐centred care since informal caregivers are more aware of older person's preferences 1,5,7 . In addition, informal caregivers possess greater flexibility to align with these preferences, as they are less constrained by time limitations, organizational structures or formal protocols.…”