2.4.1 Defining roles, relationships, boundaries and participation between older people and nurses working within the primary care setting: An ethnographic study (25)

Julie McGarry, Lecturer, School of Nursing, Nottingham University, Derby, United Kingdom

Abstract:

Background:

There has been a marked shift in the location of nursing care to the home setting (Department of Health, 2006), which alongside changing demography strongly indicates that older people will be key recipients of care in this context. Nursing within the home encompasses both the physical and the social dimension within which caring takes place. However, the ‘home’ has received little research attention (Luker et al, 2000) and is largely beyond the public-professional gaze. Therefore, the relational qualities of care in this environment remain opaque. This presents a picture of a changing landscape of care for older people, and one which is relatively uncharted.

Aims:

Aims of the research To explore how nurses and older people negotiate relationships and experience care in the home and to examine the impact of this on the way care is provided.

Methods:

An ethnographic approach: participant observation and semi-structured interviews with thirteen older patients and sixteen community nurses within one Primary Care Trust over a period of one year. Data analysis was supported by an analytical framework (Ritchie & Lewis, 2003).

Findings:

Three themes emerged from the data and, alongside the implications for practice, form the focus of the presentation:

the location of care
the nature of nurse-patient relationships
the meaning of health and illness Discussion and implications for practice

The themes offer an account of the ways in which roles and relationships are constructed, negotiated and experienced by nurses and older people within the home and demonstrate that relationships between nurses and older people in this environment are multi-faceted. They also illuminate the pivotal position of the concept of ‘boundaries’ and boundary construction within relationships from different perspectives. This research makes a wider contribution to our knowledge of the complexity of nurse-older patient relationships within the community setting and illuminates the day to day realities of district nursing practice and the multiple dimensions which underpin how care is provided and experienced in the home.

Biography:

Julie McGarry is currently employed as a Lecturer in the School of Nursing, University of Nottingham with main areas of teaching and research interests in health and social care of older people, user and carer experience and participation issues, and primary care. Julie has a background in health services research and has undertaken a number of research studies including informal caring in later life, the management of pain in older people and social constructions of community. She has recently completed doctoral study at the University of Nottingham, School of Nursing (Doctor of Health Science) exploring the nature of professional and lay boundaries within primary care provision for older people.