festival of international conferences on caregiving, disability, aging and technology - growing...
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Festival of International Conferences on Caregiving, Disability, Aging and Technology - Growing Older
with a DisabilityFICCDAT 2011
June 5th – June 8th, 2011
Lynn Jansen RN, PhD (c), Dr. Carol McWilliam, RN, EdD Dr. Dorothy Forbes, RN, PhD, Dr Cheryl Forchuk, RN, PhD
• Background and Significance• Problem Statement• Research Question• Methodology and Methods• Findings• Implications
46% of elderly home care recipients experience urinary incontinence (UI) (Du Moulin et al. 2004).
Principal cause of long term care admissions & breakdown of caregiver arrangements.
Can be managed conservatively, however caregiver & care recipient health undermined; annual in-home Canadian costs of $2.6 billion.
Caregivers often lack experiential knowledge of continence promotion and UI management (Jansen & Forbes, 2006).
a process the creation, enactment and
application of knowledge informed by pre-existing personal
knowledge, practice and preferred sources of information
social interaction
(CIHR, 2009; Nutley, Walter & Davis, 2003).
Limited knowledge of:
Caregivers’ experiences of KT, specifically for UI management between and among home care providers and home care recipients.
Hermeneutic interpretive phenomenology• Discovery and understanding
Sampling Strategyo Maximum variationo Ultimately 4 caregivers
(theme saturation)o Appropriatenesso Adequacy
Family Caregivers’ Experience of UI KT as a ongoing dynamic relational process of Working Together/Not Working Together
Data collection: semi-structured in-depth interviews
Analysis: immersion and crystallizationAuthenticity and Credibility:
audio-taping, transcription reflexivity, memos member checking field notes, peer review
Compromising
Appreciating Understanding Encouraging Knowledge-seeking ListeningTrusting
Not Compromising Not Appreciating Not Understanding Impeding Knowledge Seeking Not listening Not Trusting
Compromising We ... compromise – it is not always our ideas that we implement. We should always be open to change to some else’s [provider’s] idea.
Not CompromisingI said ... “I would teach everyone how to do.” It was really frustrating to me that everyone had their own way of doing [and persisted despite teaching efforts]. I just backed off, so we were not ... working together.
It’s like a mirror ... I know you [provider] appreciate what I do as a caregiver, and I appreciate you. It mirrors back and is like an exchange. You go away and I go away, and everyone is happy – I feel good about myself and you feel good because you helped me to learn.
It was hard to follow what they were trying to teach me … they did not appreciate that I knew what worked.
Understand the other’s perspective – then you [care recipient/provider dyad] can talk and do anything together.
I don’t think that they understood how his [care recipient] condition … had deteriorated … and what help and information I needed [for in-home care].
• Respect• Expectations• Sensitivity• Patience• Self Expectations• Inability to Communicate Knowledge Needs• Authoritative Stance
Working Together/Not Working Together
Personal Attributes
They [providers] looked at me as if to say, “What do you want to know?” I didn’t know what I wanted to know. I just wanted some help … I felt like they didn’t understand. I mean, it was my fault too, because I didn’t know how to tell them.
Continuity/Discontinuity Consistency/Inconsistency Time/Inadequate Time for Developing Working Relationship
Working Together
/Not Working Together
Attributes
Home Care
Time is important to consider what has to be done. If you don’t agree right away [with learning and teaching approach] … just think about it and come back to it after some thought.
Findings suggest the importance of: Social interactions, in particular,
family caregivers’ and providers’ working relationships to create UI KT.
Relational practice to create KT given insights regarding professional boundary setting, power differentials, & opportunities for knowledge exchange between caregivers & providers.
Health professional education for client-centred interactive learning approaches rather than providers’ traditional didactic approaches.
Future interpretive research to construct substantive theory of how knowledge is socially created, integrated, & enacted to manage UI and in-home care.
Ultimately, increased understanding of caregivers’ experience of KT may:◦ Evolve social interaction KT interventions
& health promotion approaches for family caregivers & older adults
◦ Create policy-level information exchange to promote understanding of caregiver issues & policy to support caregiver/provider working relationships
◦ Decrease UI costs & long-term care admissions.
Questions?
Lynn Jansen RN, PhD(c)Doctoral Nursing CandidateArthur Labatt Family School of NursingUniversity of Western OntarioLondon, Ontario [email protected]
Acknowledgements: SSHRC Doctoral Fellowship, UWO Thesis Award, OGS, Canadian Nurses’ Foundation Doctoral Scholarship, Alzheimer Society of Canada, CNF, Nursing Care Partnership of Canadian Health Services Research Foundation, CIHR Institute of Aging, & CIHR Institute of Gender and Health, CIHR (TUTOR)