Relational Care and Long-Term Care Home Transitions: Enabling and Constraining Practices

Care planning in long-term residential care is currently determined mostly by institutional practices whereby decisions about staffing, care delivery, and accountability are made using traditional biomedically focused models. These structures also reflect the influences of neoliberal health care reforms, which began to dominate health care delivery and practices starting in the mid-1990s, creating tensions for nurses between quality of care and the corporatization of health care. A consequence is that long-term care (LTC) care planning and delivery does not emphasize relationships between residents, their family members, and staff as much as it does the biomedical (physical, clinical) aspects of care. Highlighting care as a relationship promotes the uniqueness of individuals. The concern, then, is that relational care (also referred to as relationship-centered care or relationship-focused care) is not being enabled for staff, families, and residents, particularly during transitions. Person-centered (resident-centered) initiatives in LTC have been underway for many years with the intent to improve quality of life and care of residents. In spite of this person-centered notion, long-term residential care homes (LTCHs) are challenged to deliver care that is relational. Transitioning into LTC has been shown to be a stressful and uncertain time for residents and families and a demanding time for staff. Current research lacks experiential data from residents themselves and also about how staff experience this process. Therefore, looking more closely at the specific ways that residents, families, and staff experience transitions will aid in identifying what is currently happening in this area and what could make it better. A qualitative case study design, using purposeful sampling with semi-structured interviews, was used to gather data from various stakeholders in one LTCH. In this thesis I use a critical paradigm and feminist political economy approach to explore what residents, families, and staff identify as the current challenges during transitions into LTC and what would improve this process to further reinforce care as a relationship. This research will contribute to nursing by acknowledging the importance of the nexus of relationships involved in LTCHs and how relational care can offer constructive strategies to address the tensions involved in care quality, accountability, and work conditions so often experienced during transitions.