Dimensions of nursing home care: perspectives of patients, family members, and care providers

Abstract

Conflict among care participants in the nursing home setting concerning the expectations for care-giving and care-seeking behavior has been well-documented. The question explored in this study is whether substantial differences exist among nurses', nurses' aides', patients' and family members' interpretations of the meaning of care, care requirements, and distress states that influence decision-making and care-seeking behaviors. A related question addresses whether other factors within the nursing home environment, such as the organizational structure of nurses' work and the functional model of care delivery influence the cultural models of care of care participants. The fit between a formal model of care, the self-care deficit nursing theory, and the actual cognition of care of patients, family members, nurses, and nurses' aides is also examined. A critical hermeneutic approach frames the ethnographic and ethnosemantic methods used to collect terms and attributes of care and to relate these to the context in which care takes place. Resulting care models are presented and compared using both taxonomic and spatial representations of data from multiple sources. The effects gender and other roles have on the particular configuration of care each participant holds in mind are compared. Critical examination of the meaning of these findings for the improvement of nursing home care is presented. A relatively consistent model of care was found to hold among three different groups of consultants from five nursing homes. Two dimensions, a home/hospital dimension, and a generalized/specialized knowledge dimension defined the spatial configuration of terms and attributes.