Carers’ ambivalence in conflict situations with older persons

Abstract

The aim of this study was to illuminate the meaning of professional carers' experiences in caring situations when a conflict of interest arises with the older person receiving care. The findings reveal the complexity of the carers' ambivalence when facing a conflict of interest, weighing up between the older persons' right to self-determination and external demands. The carers are alone in their ambivalence, and the conclusion is that they need help and support to be more present in the encounter. The implication for this study is to focus on care as a person-centered practice and to focus on people as interdependent on support carers to maintain older people's right to self-determination in the relationship.

Factors influencing older people′s experiences of participation in autonomous decisions concerning their daily care in their own homes: a review of the literature

“…Knowledge and experience can help a caregiver to do right in various situations, but there are no easy solutions for these ethical dilemmas (Frilund et al ., ). Carers are on their own in their ambivalence and want support to be more present in the encounter (Breitholtz et al ., ; Frilund et al ., ). It is argued that carers’ ability to act ethically increases if there is an ongoing dialogue between carers (Frilund et al ., ).…”

“…Carers’ perception of what constitutes correct care is based on professional considerations that do not necessarily accord with older peoples wishes and needs. At the heart of this dilemma is the question of which consideration should be given more weight: older person's autonomy or what is in the older persons′ best interest based on a professional perspective (Fjordside & Morville, ; Beauchamp & Childress, ; Breitholtz et al ., ; Frilund et al ., ; Janssen et al ., ). This dilemma is comparable to the issue of decision‐making in relation to treatment of the older ill person.…”

“…This gap can be explained by the influence of external factors on the relationship between the older people and the carer. The carer experiences a conflict of interest balancing the older person's rights to self‐determination against external demands (Vik & Eide, ; Breitholtz et al ., ; Frilund et al ., ; Josse‐Eklund et al ., ). This review and other studies indicate that the home‐care system could benefit from focusing on carers’ scope for a more relational, reflective approach to help instead of focusing on administrative factors (Goethals et al ., ; Mullen, ; Vik & Eide, ; Breitholtz et al ., ; Josse‐Eklund et al ., ).…”

Characteristics of communication with older people in home care: A qualitative analysis of audio recordings of home care visits

“…The objectives of home care are mainly to improve quality of life and maintain independence through various actions as well as assessment of the person's needs to enable him/ her to live at home (Genet et al, 2011;Thom e et al, 2003). Moreover, both emotional aspects (Devik, Enmarker, & Hellzen, 2013) and conflict of interests can be challenging and influence the interaction and caregiving in the home (Breitholtz, Snellman, & Fagerberg, 2013;Sundler, H€ oglander, et al, 2016). Older people express concerns during home care visits (Hafskjold et al, 2016;Sundler, Eide, Dulmen, & Holmstr€ om, 2016).…”

Registered Nurses’ and nurse assistants’ responses to older persons’ expressions of emotional needs in home care

“…Home care services are often organizationally driven and experienced by older persons as being based on routines, where individual needs and resources may not be included (Turjamaa, Hartikainen, Kangasniemi, & Pietil€ a, 2014). Nursing staff can be restricted by working conditions, routines, and time boundaries, where they are trying to strike a balance between the older person's needs and the decisions and procedures required by the organization (Breitholtz, Snellman, & Fagerberg, 2013). Older persons' need to talk or receive emotional support becomes difficult to satisfy when the time needed for caring is restricted.…”