Client-Caregiver-Nurse Coalition Formation in Decision-Making Situatons during Home Visits

• Published in: Journal of advanced nursing Vol. 52; no. 3; pp. 291 - 299
• Main Author: Dalton, Joanne
• Format: Journal Article
• Language: English
• Published: 01.11.2005
• Subjects: Carers; Collaborative decision making; Home health care; Housebound elderly people; Nurse-Patient communication
• ISSN: 0309-2402

Aims. The purpose of this paper is to report the findings of an exploratory study designed to test a portion of the Theory of Collaborative Decision-Making in Nursing Practice for Triads by examining the relation between types of decisions & formation of coalitions during triadic interactions among older home healthcare clients, their caregivers & home healthcare nurses during seven admission visits for home health care. Background. Although home healthcare nurses include clients & family members in decision-making about care, few publications address the nature of interactions among triads of clients, caregivers & nurses in home health care & the association between decision-making & those interactions. Method. The data presented in this paper are a secondary analysis of data originally collected in 1994. The sample included 157 decision-making situations identified from interactions of seven triads of older home healthcare clients, their caregivers & nurses. Qualitative data were collected by participant observation & audio-recording of admission visit interactions among clients, caregivers & nurses. Content analysis, augmented by Ethnograph software, was used to analyse the data. Findings. Coalitions were evident in just eight of the 157 decision-making situations. All of the theoretically possible types of nursing care decisions (programme, operational control, agenda) were observed. Each coalition involved one nursing care decision; two coalitions formed in one triad. Seven coalitions formed between nurse & caregiver against client during two programme & five operational control decisions. One coalition formed between client & caregiver against nurse during an agenda decision. No coalitions formed between client & nurse against caregiver. Conclusions. Although the study sample was small, the findings expand understanding of the relation between types of decisions & formation of coalitions during triadic interactions in home health care, & provided empirical support for a portion of the Theory of Collaborative Decision-Making in Nursing Practice for Triads. 1 Table, 33 References. Adapted from the source document.