Samarbeid mellom helsepersonell og pårørende i hverdagsrehabilitering - En studie av helsepersonell og barns erfaringer

Abstract

Norsk sammendrag Despite the fact that the next of kin (adult children) are considered an important resource for older adults living at home, there has been little systematization in the collaboration between them and the health professionals and next of kin (adult children) in the health and care services when older adults need rehabilitation. The functional decline in older adults can affect other family members and the family occupations they do together. Accordingly, there is a need to develop a better understanding of the collaboration between health professionals and next of kin in reablement. Next of kin may have different needs and knowledge regarding their parents, and some of this knowledge may be useful to improve the quality of reablement services for both older adults and their next of kin. The purpose of this thesis is to contribute to knowledge about collaborations between next of kin and health professionals from their different perspectives. The thesis also aims to contribute to knowledge regarding adult children’s experiences of family occupations when older parents experience a decline in function. The thesis has a cross-sectional design and uses a constructivist grounded theory (CGT) approach. This approach was chosen because it provides the opportunity to explore the ongoing social process and see how participants construct meaning through interaction and managing specific situations. The thesis is based on two empirical samples. The first sample consisted of 49 health professionals. The data were constructed through ten focus group discussions. The second sample consisted of adult children of older adults who had participated in reablement. A total of 15 next of kin participated (14 adult children and one daughter-in-law), and in-depth individual interviews were conducted to collect data. The data material was analysed based on strategies from constructivist grounded theory. The results are presented in three articles. The findings show how the different actors make different assessments of older adults’ needs, and this affects possible collaboration. Healthcare professionals (Article 1) experienced that next of kin could be a resource for the older adults, but it was not always necessary to involve them. The children (Article 2) pointed out that collaboration was first and foremost about collaboration within the family, with parents, siblings and the latter possibly with reablement. Findings (Article 3) showed how the children gradually performed more of the physical aspects in the family occupations, and the children faced ambivalence about doing more without being asked by the parents. The children experienced being in a situation of constant preparedness in relation to the needs of their parents. The construction of the substantive theory «iceberg of family occupations» can provide a deeper insight into how children experience the dynamics of family occupations and how these occupations are in constant change when parents have a functional impairment. This knowledge may also be relevant to other health professionals who encounter older adults living at home. The thesis concludes that collaboration arises in everyday meetings between the professional (health personnel) and the family (the children). However, it is unclear what the collaboration will consist of and who is responsible for initiating it. The children want to have a plan in advance and to know whom they can contact if needed. There is a need to nuance who is next of kin in further studies and to continue to construct knowledge about their relationship with those they are related to. This applies to both the perspective of the next of kin and the perspective of the older adults who participate in reablement.

English summary Despite the fact that the next of kin (adult children) are considered an important resource for older adults living at home, there has been little systematization in the collaboration between them and the health professionals and next of kin (adult children) in the health and care services when older adults need rehabilitation. The functional decline in older adults can affect other family members and the family occupations they do together. Accordingly, there is a need to develop a better understanding of the collaboration between health professionals and next of kin in reablement. Next of kin may have different needs and knowledge regarding their parents, and some of this knowledge may be useful to improve the quality of reablement services for both older adults and their next of kin. The purpose of this thesis is to contribute to knowledge about collaborations between next of kin and health professionals from their different perspectives. The thesis also aims to contribute to knowledge regarding adult children’s experiences of family occupations when older parents experience a decline in function. The thesis has a cross-sectional design and uses a constructivist grounded theory (CGT) approach. This approach was chosen because it provides the opportunity to explore the ongoing social process and see how participants construct meaning through interaction and managing specific situations. The thesis is based on two empirical samples. The first sample consisted of 49 health professionals. The data were constructed through ten focus group discussions. The second sample consisted of adult children of older adults who had participated in reablement. A total of 15 next of kin participated (14 adult children and one daughter-in-law), and in-depth individual interviews were conducted to collect data. The data material was analysed based on strategies from constructivist grounded theory. The results are presented in three articles. The findings show how the different actors make different assessments of older adults’ needs, and this affects possible collaboration. Healthcare professionals (Article 1) experienced that next of kin could be a resource for the older adults, but it was not always necessary to involve them. The children (Article 2) pointed out that collaboration was first and foremost about collaboration within the family, with parents, siblings and the latter possibly with reablement. Findings (Article 3) showed how the children gradually performed more of the physical aspects in the family occupations, and the children faced ambivalence about doing more without being asked by the parents. The children experienced being in a situation of constant preparedness in relation to the needs of their parents. The construction of the substantive theory «iceberg of family occupations» can provide a deeper insight into how children experience the dynamics of family occupations and how these occupations are in constant change when parents have a functional impairment. This knowledge may also be relevant to other health professionals who encounter older adults living at home. The thesis concludes that collaboration arises in everyday meetings between the professional (health personnel) and the family (the children). However, it is unclear what the collaboration will consist of and who is responsible for initiating it. The children want to have a plan in advance and to know whom they can contact if needed. There is a need to nuance who is next of kin in further studies and to continue to construct knowledge about their relationship with those they are related to. This applies to both the perspective of the next of kin and the perspective of the older adults who participate in reablement.