Facilitating involvement of residents' Next-of-kin in long-term care facilities - the relatives perspectives.

Background. Increase in demand for long-term care in the population and at the same time reduction in the supply of qualified workforce in healthcare challenges the nursing home service. The services will need to rely more on volunteers and a close collaboration with family members in the future. Studies have shown that residents’ next-of-kin often have roles as advocates for nursing home residents and contribute with practical help and social support. However, family members report varying experiences with the collaboration and their role in the nursing home community, and cooperation with residents’ family members might be inadequate. It is essential that nursing homes and other long-term care facilities are developed from the understanding of what actually creates a good service, and care quality from the family’s perspective is just one piece of the nursing home experience that must be understood in order for optimal value in care to be realized. Person-centered care in nursing homes have been found to give positive outcomes for both the resident and next-of-kin. Collaboration with families is an important part of a person-centered care and may increase the quality of care. The aim of this study was to explore how the residents’ next-of-kin experienced the collaboration with the nursing home health care workers, and how their contribution to the nursing home community could be facilitated in order to develop person-centered care. Method. Qualitative methodology was used. Sixteen family members of residents in two nursing homes was purposely sampled, and they were interviewed once in three different focus groups. The transcribed text was analyzed by coding and categorizing. Results. The findings indicate that the family members had mixed feelings toward the nursing home and the role as next-of-kin. They felt a relief when the needs of their loved ones were taken care of, and had great confidence in the service when everything went well. However, they often felt insecurity when they experienced that quality of service was not good enough. This led to increased time spent in the nursing home and follow-up on care. The next-of-kin experienced their role either as a contributing family member, or as a guest and outsider, depending on how staff included them and level of care quality in the nursing home. From the family members’ perspective, three domains emerged that served as important markers of high quality of care: resident contentment, suitability of staff, and environmental context. Conclusion. In order to provide the best value in nursing care, the interdependence between strengthening and supporting families and provide care that is person-centered and promotes residents’ health, should be attended to by all staff members and management. The family perspective on quality of care offer a framework that may be useful to nursing leadership at all levels of the nursing home organization to identify locally important quality of care strengths as well as markers of poor care.