The emotional context facing nursing home residents' families: A call for role reinforcement strategies from nursing homes and the community

Objectives: Identify useful concepts related to the emotional context facing family members of nursing home residents. These concepts can be used in future studies to design and test interventions that benefit family caregivers. Design: Secondary data analyses of qualitative ethnographic data. Setting: Two nursing homes in a large Midwestern city; 8 months of data collection in each. Participants: 44 family members of nursing home residents whose health was considered, "declining." Measurements: Role theory was used to design and help interpret the findings. Data included transcripts of conversations between family members and researchers and were analyzed using a coding scheme developed for the secondary analysis. Results: Comments about emotions related to the social role of family member were grouped into three categories: relief related to admission, stress, and decision making support/stress. Subcategories of stress include the role strain associated with "competingconcerns" and the psychological pressures of 1) witnessing the decline of a loved one in a nursing home, and 2) guilt about placement. Decision-making was discussed as a challenge which family members did not want to face alone; support from the resident, health care professionals, and other family members was appreciated. Conclusions: Family members may benefit from role reinforcement activities provided by nursing home staff and community members. All nursing home staff members (in particular social workers) and physicians are called upon to provide educationa and support regarding nursing home admissions, during the decline of the resident, and especially regarding medical decision-making. Community groups are asked to support the family member by offering assistance with concrete tasks (driving, visiting, etc.) and social support.