Interactions and Relationships in Long Term Care: Photography and Narratives by Direct Care Workers

Abstract

The challenge of hiring and retaining well-trained caregivers for the growing numbers of elders in need of care is a global concern. This study was designed to understand the views of direct care workers and included 15 nurse aides and med techs working in an assisted living and special care assisted living community for people with dementia. Each participant was provided with a digital camera and asked to take photographs “to show what caregiving means to you.” Analysis is based on group discussions about the full set of photographs created by the direct care workers and individual written and oral narratives about four photographs chosen by each participant. The categories generated from these data represent the direct care workers’ perceptions of the approaches to quality caregiving and the relationships involved in doing their jobs well. By focusing on the essential relationships and interactions, rather than primarily on the required care, we can begin to imagine the caregiving experience in terms of a communal rather than an institutional experience. We can then productively turn our focus to the people involved rather than emphasize their roles as providers or recipients of care.

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Fig. 1
Photograph 1
Photograph 2
Photograph 3

Notes

  1. 1.

    Some of the participants worked both as Resident Assistants and med techs on different days or shifts, see Table 1.

  2. 2.

    Greenbriar is a two-story, private-pay assisted living community and Safe Harbor is its 60-bed sister community around the corner where care is provided for people with dementia in need of “special care.” Safe Harbor is one-story and divided into three units surrounding an inner Main Street.

  3. 3.

    Five additional direct care workers were later interviewed and included in the larger study. Photographs and narratives were created by the fifteen original participants in the study.

  4. 4.

    We have informed consent to include many residents of the two facilities in our research. The caregivers were directed to take photographs freely and that we would take care of the informed consent issues regarding use of the photographs. While all of the residents, staff and family members included in the full set of photographs have not given their informed consent, the photographs used as examples include only people for whom we have full consent.

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Acknowledgments

Thanks to my research assistants: Denise Bordeman, for her dedicated participation in the data collection and transcription and Jeena George for her assistance with data summary and qualitative analysis. I also thank the residents, family, and staff of Greenbriar and Safe Harbor, especially the skilled and dedicated direct care workers whose commitment to their work is portrayed here in their discussions of the photographs they created.

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Correspondence to Dena Shenk.

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Shenk, D. Interactions and Relationships in Long Term Care: Photography and Narratives by Direct Care Workers. Cult Med Psychiatry 36, 535–556 (2012). https://doi.org/10.1007/s11013-012-9269-8

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Keywords

  • Direct care workers
  • Caregiving
  • Photography
  • Narratives
  • Long term care