Relatives risk being overlooked
A nurse is in a hospital corridor, in the process of finding a bed pan. She is busy and has a number of patients to see before she finishes her shift. A relative comes and tries to catch the nurse's attention and says: "I'm really worried about my mother."
Such a situation is not optimal for either the nurse or the relative, because the nurse is busy and is therefore unable to provide the best possible response. But these kinds of meetings take place daily in Danish hospitals.
Based on her research, PhD fellow Camilla Bernild has shown how to improve relatives’ opportunities to be heard and to receive information about a patient’s condition.
»In the hospital, where you are busy treating the patient, the relatives can be perceived as a kind of ‘invisible background noise’ and I think it is important to conduct research that focuses on what is not so obvious. My research shows that introducing a structured consultation process would put a stop to the conversations in the corridors. The nurse can refer to the fact that there is a consultation, where the relative can ask questions says,« Camilla Bernild.
In her PhD thesis, she has researched the cooperation between nurses and relatives in connection with the hospitalization of elderly patients for hip fractures. The study was conducted at the orthopaedic surgery department at Hillerød Hospital.
Gender still plays a key role, and there is a gender imbalance among the relatives. The gender roles are culturally embedded in us.
Relatives have been an overlooked group, and it wasn’t until 2014 that an association for relatives was established in Denmark. Bernild's research shows that the group is overlooked in Denmark, but is important for the patients.
»The relatives are a means of achieving better patient care, and they help and relieve the pressure on both the patients and the healthcare system. The more a relative is involved in the patient’s care the better,« says Camilla Bernild.
Relatives’ working life comes under pressure
Before the existence of the welfare state, it was the family who had to take care of sick and elderly family members, and it was primarily a task for women. Then the welfare state was introduced, Caring for the elderly and children was professionalized and institutionalized, and the women entered the labour market. This meant that the family was no longer required or able to take care of their sick and elderly family members.
But we can now see that there is once again an attempt to try and push some of these tasks back into the home and especially back to the women, explains Camilla Bernild.
»Although women have entered the labour market, it is still primarily the women who deal with the care tasks, for example as relatives,« says Camilla Bernild, who also finds that the rights of the relatives have not really been addressed by society.
Being relatives puts pressure on their everyday and working lives. There are no measures to remedy this. You cannot get a day off work just because your grandmother is sick. You can get leave for serious illness, but the conditions are not very good, says Camilla Bernild.
Various studies across Europe indicate that most of the relatives visiting the hospitals are women. In Bernild's studies, the relatives are often the daughter or daughter-in-law, and they are usually aged between 50 and 70.
»Gender still plays a key role, and there is a gender imbalance among the relatives. The gender roles are culturally embedded in us. My study also shows that the women want to help and provide care. It is often meaningful and rewarding for them, but it can nevertheless put pressure on their everyday life,« says Camilla Bernild.
New system creates greater security
Through Camilla Bernild's PhD research project, she tested systematic discharge consultations at the orthopaedic surgery department at Hillerød Hospital, where the relatives are given the opportunity to ask questions and receive a leaflet with information. It was an important focus point for the researcher to involve the people who work with the patients on a daily basis. Since Camilla Bernild completed her study, the consultations have been introduced as a permanent element in the department.
»Now the relatives receive information about the process and they have the opportunity to express their concerns. This is a change from the earlier situation, where it was the relatives’ own responsibility to request a consultation. This initiative means that the healthcare system also involves the more vulnerable relatives, who might not have had the resources to seek out a consultation themselves,« explains Camilla Bernild.
The healthcare professionals and their relatives may have slightly different interests, because for the relatives it is the time after hospitalization that is in focus, while the health professionals are more concerned with the patient's situation here and now during their hospitalization. A consultation can help to establish a shared understanding and reassure the relatives about the discharge, which may otherwise be a major source of anxiety.
»Anxiety levels can increase for the relatives during the transitions. 'What do the healthcare professionals think? Are they just sending her home?' These are some of the concerns of the relatives,« says Camilla Bernild.
The researcher hopes that more attention will be given to the role of the relatives.
»Relatives play a very important role in our healthcare system and my hope for the future is therefore that the relatives will have more rights in relation to the labour market, and that there will be more places where relatives can meet and share their concerns with people who are in the same situation,« says Camilla Bernild.
Camilla Bernild is a PhD student at the Department of People and Technology in the subject Interdisciplinary Studies in Health Promotion and Health Strategies, where she also teaches.
Facts:
In her PhD thesis, Camilla Bernild has researched the cooperation between nurses and relatives in connection with the hospitalization of elderly patients for hip fractures.
In this connection, she has monitored relatives during their hospitalization and for two weeks after their discharge.
She has had dialogue meetings with the nurses, and she has participated in discharge consultations.
Camilla Bernild has also reviewed a number of medical records and concludes from this review that the relatives do not receive very much attention in this regard. The concerns of the relatives are only mentioned in 6% of the patients' records. As part of her research, she has conducted a consultation process at the orthopaedic surgery department at Hillerød Hospital.
Published in Rubrik #13, 2018.