Client-caregiver-nurse interaction in a home care setting

There is a dearth of knowledge related to the nature of interaction involving client-caregiver-nurse triads in home care and its impact on client care decision-making. This descriptive study investigated the interactive behaviors of elderly clients, their caregivers, and nurses during admission visits for home health care within Kim\u27s theoretical framework of collaborative decision-making in nursing. A field study combining participant observation and audio-recording of twelve home visits was carried out to address the nature of participation in decision-making by and of coalition formation among the elderly clients, caregivers, and nurses. The qualitative data from the home visits obtained through field notes and audio-recordings were supplemented by the quantitative data obtained from questionnaires completed by all participants regarding the participants\u27 attitudes on collaboration and their perceptions of the visits. The qualitative data were analyzed by content analysis with the aid of THE ETHNOGRAPH. The twelve home visits depicted a varied nature of the client-caregiver-nurse relationships, many different processes used by the nurses in proceeding with the visits, different decisions considered and the different collaborative, non-collaborative, and coalition forming interactions. Of 267 decision situations identified during the visits for 41 different types of decisions, 40 percent of them were made collaboratively. Of these nearly half were triad collaborative decision-making situations. Eight situations were found to be coalition-forming instances for decision-making. The way decisions were made depended on the characteristics of the participants as well as on the type of decisions and the context of decision-making. The participants\u27 verbal behaviors in collaborative decision-making situations reflected openness for and willingness to provide information, allowances for other\u27s opinions, approval, flexibility, and acceptance of final decisions. The participants\u27 verbal behaviors identified during coalition formation were similar to the verbal behaviors found in collaborative decision-making but also included giving alternatives, supporting a coalition-partner\u27s point of view, giving support for one\u27s own view, and providing mediator type statements. The findings expanded the understanding of the theoretical relationships among triad characteristics, triad participation in decision-making, coalition formation, and client outcomes in a home care setting. More descriptive studies with larger samples are recommended to further expand the understanding of client-caregiver-nurse collaboration