A Parallel Process of Staff-Family Distress in Long-Term Care: A Challenge to Collaboration

Area of Science:

• Gerontology
• Dementia Care
• Healthcare Communication

Background:

• Collaborative partnerships between staff, families, and residents are essential for supporting individuals with advanced dementia in long-term care (LTC).
• Relational tensions, particularly regarding care decisions, can impede effective collaboration in LTC settings.

Purpose of the Study:

• To explore the emotional experiences of families and healthcare staff during shared decision-making processes for individuals with advanced dementia residing in LTC homes.
• To understand the dynamics and challenges influencing collaborative partnerships in dementia care.

Main Methods:

• A qualitative interpretative description study was conducted in two Canadian LTC homes.
• Semistructured interviews were performed with 12 staff members and 16 family members.
• Data were analyzed using reflexive thematic analysis, employing both inductive and deductive approaches.

Main Results:

• A parallel process of trauma and grief, including distress, isolation, and feelings of devaluation, was identified, leading to distance between staff and families.
• A lack of time and space for reflection and validation contributed to a dynamic where staff and families perceived each other as adversaries.
• This dynamic created a push-and-pull cycle, hindering critical connections during shared decision-making.

Conclusions:

• Reflexive opportunities are vital in LTC homes to address emotional barriers and improve collaboration between staff and families.
• The findings propose a preliminary framework to aid staff in navigating difficult conversations and emotions.
• Fostering reflexive care can enhance connections, rather than obstruct them, in advanced dementia care settings.