Short summary

The aim of this qualitative study is to explore the significance of relatives' competencies in their contact with health professionals in relation to acutely-admitted older people. The study involves relatives' contact with health professionals in hospital, primary care and general practice. Three selected phases of the acute admission of older people guide the study: 1) The period of the emergency admission, 2) the emergency hospitalization on an emergency ward, and 3) the follow-up, here limited to the first month after discharge from hospital.

Rationale

"At the forefront of older people's care" is collaboration between the municipalities of Haderslev, Tønder, Aabenraa and Sønderborg in the southern part of Jutland, the general practitioners in these municipalities, the Hospital of Southern Jutland and research groups at the University of Southern Denmark (SDU). 

The overall aim of "At the forefront of older people's care" is to develop and implement actions, in relation to older citizens, their relatives and health professionals, that will create healthier lives for older people, can increase the capacities of older people and their quality of life as well as reduce or delay the number of hospitalizations. 

The first phase of the project consists of three PhD programs in which the perspectives of health professionals, older people and relatives are highlighted separately. These PhD programs will contribute to the achievement of the overall aim of the project.

The development in Denmark towards increased involvement of patients and relatives is a natural extension of the increasingly prevalent incentives around self-management and taking personal responsibility. There is a broad political desire that individual citizens should be more responsible for their own lives. A recent study of Danish relatives' experiences, roles, attitudes, expectations and wishes shows that many relatives of admitted patients already play an important role in hospitalization. Qualitative studies have shown that there is room for improvement regarding relatives' interactions with the Danish Health Service. The results of national as well as international qualitative studies show that relatives can find it difficult to fulfil their roles.

Contact between relatives and health professionals

With the increased focus on involvement of relatives, and the resulting rights and duties of relatives, changes naturally follow in their contact with health professionals, where distribution of power and the distribution of responsibility between the two parties are actualized. Research also shows that relatives who seek involvement are highly dependent on constructive and safe cooperation with the health professionals. Health professionals generally have a positive attitude towards the involvement of relatives, albeit their feelings are characterized by some degree of ambivalence. Health professionals can experience relatives as a demanding resource, because contact with relatives takes time in a clinical practice characterized by resource shortages and demands for high efficiency. Qualitative studies of the relationship between relatives and health professionals show that some relatives have more difficulties in their contact with health professionals than others. For example, health professionals feel challenged by relatives who do not follow the unwritten rules in the ward or ask critical questions. Relatives who are experienced as demanding by the health professionals risk being excluded from contact with them and deprived of the opportunity to be involved in the care and treatment of the patient. Older citizens who are hospitalized in an acute ward can be particularly dependent on whether they have resourceful relatives who can be heard by the health professionals and will be actively involved in their care and treatment.

The increased demands for citizens to take personal responsibility in relation to health and illness can have a particular impact on citizens who do not possess the required competencies to navigate the healthcare system and thus meet the requirements for involvement. Katrin Hjort, Professor at the Department for the Study of Culture at the University of Southern Denmark (SDU), describes how the requirements for citizens' client competencies are increased in the light of the modernization of the public sector. Hjort indicates that the transition from the welfare state to the competition state causes changed governance strategies that reinforce social inequality, as the demands on citizens' client competencies are increased. According to Hjort, resources for action, negotiation and buying power are increasingly decisive for ´negotiations for welfare´ and to get ´access to care´. Hjort describes how the client's competencies are defined by their affective, cognitive, social and economic resources. According to Hjort, these client competencies determine whether the individual citizen can successfully navigate, for example, the health service. Hjort's interpretation of the concept of client competencies is theoretically based, and it therefore seems relevant to investigate whether it is possible to identify these competencies in the relatives of admitted older citizens. Hjort's competence concept uses a broad definition of the 'client' that allows the client competence concept to be used in relation to both the patient and the relative. The concepts used in the PhD study are inspired by Hjort's theoretical definition of client competencies. 

Aim

The aim of this study is to explore the significance of relatives' client competencies in their contact with health professionals in relation to elderly patients' acute hospital admissions. 

How do the relatives' client competencies play a role in the acute care of older citizens, and what is the significance of these client competencies for contact between healthcare professionals and the older citizens´ relatives?

The study concerns the periods before (14 days before), during and the first month after an acute hospital admission. The assumption is that the relative significance of relatives' client competencies could differ in the three periods, and that the consequences for the elderly citizen will vary depending on the period. 

Description of the cohort

Relatives of older people who are acute hospitalized

Both men and women

Adults

Speaks and understand danish

Data and biological material

Qualitative interviews

Observation studies

Collaborating researchers and departments

Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, King Christian X's Rheumatic Hospital, Focused Research Unit in Rheumatic

• Professor Jette Primdahl

University College South Denmark (UC SYD)

• Head of Research Keld Thorgård, PhD

The Unit of Health Promotion Research, Faculty of Health Sciences. University of Southern Denmark

• Professor Pernille Tanggaard Andersen

User Perspectives, IST, University of Southern Denmark (SDU)

• Associate Professor Tine Mechlenborg Kristiansen, PhD

Hospital of Southern Jutland, IRS, University of Southern Denmark (SDU)

• Associate Professor Christian Backer Mogensen, PhD

Publications associated with the project

Elisabeth Häggström PhD, RNT, Annica Kihlgren PhD, RN, Mona Kihlgren PhD, RN, Venke Sörlie PhD, RNT