Lost in Transition: Community-Dwelling Partners' Stories of Losing a Spouse to Cognitive Decline and Long-Term Care Facilities.

This qualitative narrative study presents three stories told by older community-dwelling partners to spouses moving into long-term care facilities because of cognitive decline. Applying Alvesson and Kärreman's mystery method to these stories reveals that when spouses' caring needs increase, care partners must take on increasing loads of practical work and responsibilities. These partners become lost in the transitions between care work, extended family, and attending to their couplehood. When their spouses move into long-term care, living apart presents new challenges of care and couplehood, each day presenting new and unforeseen tasks to manage. Our findings suggest that if couplehood is to be maintained, well-established habits and work division between the spousal partners are both drivers and barriers. It necessitates agency, creativity from the community-dwelling partner, as well as a supportive extended family and sufficient economic resources. More knowledge is required regarding the interdependent expectations between the next-of-kin, long-term care residents, and caregiving staff members.

Cisan and Malahang: Indigenous Older Adults' Voices on Active Aging - Findings from a Qualitative Study in Taiwan.

The Taiwan Government follows the policy of active aging to prevent frailty. However, the current services lack cultural safety toward the Indigenous peoples and would benefit from a broader perspective on what active aging may entail. In this research, we study local perceptions of active aging among older Indigenous Tayal taking part in a local day club. The study identifies two formal activities that foster active aging: (a) information meetings about health and illness and (b) physical activities. In addition, two informal activities highlighted by the participants themselves were identified as necessary for promoting healthy and active aging: Cisan and Malahang. While Cisan means "social care," Malahang means "interrelational care practices." In conclusion, we argue for the relevance of listening to Indigenous older adults' voices to develop long-term care services adapted to their cultural values, linguistic competence, and cosmology.

Challenging Behaviors as a Relational Phenomenon: Findings From a Qualitative Study in a Nursing Home in Norway.

Challenging behaviors are common in nursing homes. Drawing on rich qualitative data from fieldwork and in-depth interviews with staff in a nursing home in Norway, we will explore (a) how challenging behaviors unfolded, and (b) how such incidents were handled and talked about among staff. Our data is presented firstly through Anna's story as an introduction to discussing: (1) the problem of contrasting approaches to avoid challenging behaviors and (2) the importance of knowing the resident. Christopher's story then works as an introduction to discuss (3) the importance of understanding how to prioritize, (4) the importance of caring with connection and concern, and (5) the importance of sharing success stories among staff. In conclusion we argue that we should develop a more flexible organizational culture and a staffing practice in which care workers are empowered to use their discretion and thus to care for the residents with more connection and sensitivity than is currently the case.

Indigenous Sami Family Caregivers' Experiences With Accessing and Collaborating With Municipal Health and Care Services.

Previous research has indicated that Indigenous Sami families in Norway use public home-based care services less often than their non-Sami peers. Based on qualitative interviews with Sami family caregivers, we explore what they experience as barriers to accessing public care services for older adults living with dementia, and how they experience collaborating with care services providers. Through a reflexive thematic approach, we identified that rather than a cultural norm of "taking care of one's own," the underuse of public care services among Sami families were related to several intertwined circumstances. The Sami family caregivers reported barriers to accessing public care, such as lack of familiarity with the services and cultural and language concerns and the legacy of history, and drivers for continuing family care, such as blurred distribution of responsibility, lack of continuity of care, and culturally unsafe caring environments and marginalizing practices.

"All I expect is that they accept that I am a Sami" an analysis of experiences of healthcare encounters and expectations for future care services among older South Sami in Norway.

The aim of this study first aims to forward our empirical knowledge of how older Sami experience healthcare encounters in Norway and what they expect in terms of future care services, and second, to forward our understanding of how more culturally safe services could be offered to the Sami population, 30 years after they were officially recognised as an Indigenous People. A qualitative interpretative and constructivist research design was used. 12 older South Sami were interviewed about their experiences with healthcare encounters, and their expectations for future care services. The results showed that the participants sometimes felt deprioritised and misunderstood by healthcare professionals. Moreover, they sometimes experienced that healthcare professionals had little or no knowledge about Sami history, culture and cosmology. They worried that they would not be accepted for being Sami if one day they would have to move into a nursing home. To conclude, the participants of this study are situated in a colonising context characterised by personal and collective experiences of accumulated discrimination that have taken place over many generations. The concepts of health equity and accumulated discrimination provide useful insights in the further development of culturally safe services for Indigenous Peoples in Norway and beyond.

Creating Conditions for Professional Development through a Trauma-Informed and Restorative Practice.

Professionals in social work and nursing meet people who, due to trauma, struggle with self-regulation of emotions and social behavior. Caring for trauma survivors requires connection and compassion. Previous research has indicated that many professionals, some with their own trauma histories, do not feel sufficiently equipped to practice self-care or cope with challenging communication. To address how insecurity and trauma are rooted in deeper individual and structural causes of social injustice, social workers and nursing students (N = 29) were invited to participate in action research and a restorative circle process. The aim was to provide professionals the opportunity to challenge and reflect upon their own practices by introducing them to a trauma-informed and restorative practice based on the importance of building emotional safety and connection. The findings suggest that given time and space for reflection in a setting characterized by equality and safety, professionals can develop increased (a) self-awareness and compassion, (b) emotional safety and tolerance of stress in challenging communication, (c) trauma understanding, and (d) personal growth. A change to a more restorative and trauma-informed practice could lead to increased interpersonal competence and well-being among professionals and clients.

Maintaining or letting go of couplehood: Perspectives of older male spousal dementia caregivers.

Despite the negative implications for their own health, spouses continue to support each other and maintain their couplehood for as long as possible, including when one of them develops a severe illness. However, with some exceptions, the experiences of older male spousal caregivers have been largely overlooked, and our knowledge of the relational aspects of spousal dementia care is scarce. To respond to this knowledge gap, this article explores the following research questions: How do older male spousal caregivers of wives with dementia talk about changes in their couplehood? What transitions or phases in the relationship can be identified as the caring process evolves and the wife's health continues to deteriorate? To answer these questions, we analyse in-depth interviews with eight purposefully selected men aged 67-92 years old from Iceland and Norway. Our findings reveal that the participants felt that they were gradually losing their couplehood in the sense that they lost their shared everyday life routines, intimacy, joint activities, meaningful communication, and dreams and hopes for the future. Four phases of the dementia caring process were identified: the denial phase, the battle phase, the new reality phase and the redefinition phase. We hope that our findings spur more research on relational challenges as experienced by spouses caring for partners with cognitive decline. In conclusion, we argue that interdisciplinary clinical guidelines for a couple-centred approach in elder care should be developed to urge professional care providers to pay attention to the various changes and challenges that dementia couples undergo to meet not only the health and care needs of dementia patients but also those of their spouses.

'We are All Interdependent'. A Study of Relationships Between Migrant Live-In Carers and Employers in Taiwan.

For the past three decades, to meet the increasing need for long-term care, the Taiwanese government's primary approach has been to import migrant care workers. In this article, we analyse qualitative interview data produced in an Indigenous community. Drawing on Kittay's feminist dependency theory, we explore the interrelationships and collaborative efforts between live-in carers and their employers. Three types of relationships were identified: 'unsupportive relationships', where the live-in carer was treated as a servant; 'supportive relationships', where the live-in carer was treated as a care worker; and 'semi-supportive relationships', where the live-in carer was treated as a carer-servant. In conclusion, the article sheds light on how the live-in carer arrangement could be practised in ways that allow live-in carers and thereby their care recipients to thrive.

Being connected to nature, reindeer, and family: findings from a photovoice study on well-being among older South Sámi people.

In this paper, we examine the perceptions of well-being among older South Sámi people with various experiences from reindeer herding by use of a method called photovoice. Eleven participants, including six men and five women aged 67-84 years, agreed to take photos of situations, things, or persons that made them feel a sense of well-being. When the researcher collected the photos, the participants were invited to tell their stories related to each photo. In the thematic analysis of the photos, three main themes emerged: a) well-being through connection to nature, b) well-being through connection to the reindeer, and c) well-being through connection to the family. In conclusion, we argue that if healthcare professionals are to enhance the well-being of care receivers - in this case older people with South Sami background from reindeer-herding families - they must consider the care receiver's life story and what constitutes well-being for the individual person.

"This Life is Normal for Me": A Study of Everyday Life Experiences and Coping Strategies of Live-in Carers in Taiwan.

Recruiting migrant live-in carers has become the main strategy to address the rapid increase in the number of older persons with intensive care needs in many parts of the developed world. This is also the case in northern Taiwan, where this study took place. Thirteen live-in carers from Indonesia and the Philippines were interviewed in the fall of 2019. In this article, we discuss their two main coping strategies: a) "accepting destiny", which refers to carers accepting their life and viewing their role as a live-in carer as a job that allowed them to meet their parents' expectations of financial support; and b) "connecting to significant others", which is the most important way carers found motivation to keep going. However, despite their coping strategies, working as a live-in carer was experienced as a challenging and precarious lifestyle. In the conclusion, we discuss how professional social workers in collaboration with decision-makers and non-governmental organizations in Taiwan could contribute to fostering a system that would support live-in carers in ways that allow them, and the older persons they care for, to thrive.

Social care for older people - a blind spot in the Norwegian care system.

A growing number of older people in Norway receive care services at home. Public policy aims at promoting social safety, preventing social problems and providing recipients of care with the means to live an active and meaningful everyday life together with others. However, health-related services have long been prioritized at the expense of other care services. Our aims are to investigate how professional caregivers in Norwegian home care for older people relate their professional mandate to social care to assess what different professional positions regarding social care imply for realizing the ideal of integrated and person-centered care. Interviews with 16 professional caregivers are analyzed within the framework of positioning theory. A variety of discursive positions relating the own professional mandate to social care are identified. Findings suggest that the absence of common standards leaves it up to the individual caregiver if social care needs are met or not. Common standards for social care delivery and a more suitable skill mix among health and social care professionals are proposed.

Challenging the ethnic pyramid: Golden rules and organisational measures towards a more inclusive work environment.

AIM: To contribute to knowledge of how healthcare managers can promote connection and ethnic equality among staff in multicultural organisations. BACKGROUND: The increase in migrant care workers often leads to deskilling, discrimination, communication difficulties and harsh working conditions. METHODS: A constructivist grounded theory approach was used to examine the work experiences of healthcare workers in a strategically selected nursing home unit with minority and majority workers well balanced across positions. RESULTS: Three golden rules were identified: (a) take responsibility for the quality of care in the unit, (b) should engage in all aspects of the care work within scope of practice and (c) collaborate and help each other. Organisational measures supporting these norms were also identified. CONCLUSION: It is possible, by means of golden rules and organisational measures, to foster connection and cooperation among nursing home staff and to promote an inclusive work environment where the workers' skills and competences are recognized across educational and migration backgrounds. IMPLICATIONS FOR NURSING MANAGEMENT: Healthcare managers can contribute to challenge the ethnic pyramid often identified in multicultural institutions by implementing diversity-sensitive measures. This may increase the quality of care and the well-being of residents.

Staff perceptions of competence in a multicultural nursing home in Norway.

Nursing homes throughout the Western world are seeing a steady increase in migrant workers. Although migrant staff members' multicultural background may be perceived and used by management as a resource in the workplace, studies indicate that the qualifications and competencies of these workers are often underestimated. Numerous studies have examined and theorized on the challenges related to workplace diversity and the deskilling of migrant workers. However, our knowledge of how competence may be conceptualized in inclusive ways in diverse staff groups remains scarce. This study examines minority and majority staff members' perceptions of competence in a strategically selected multicultural nursing home unit in Norway with 15-20 years of experience in recruiting and including minority staff members to various levels of the organization. We performed a thematic analysis of in-depth interviews with 22 healthcare providers and found that in this nursing home unit, contrary to what has often been found in other organizations, competence was not primarily discussed as a matter of educational level or background, skin complexion or whether staff members spoke the majority language with a foreign accent. Rather, a competent care worker was perceived as a) having good professional knowledge on how to care for nursing home residents (regardless of the worker's educational level), b) either having the ability to speak well or working hard to improve one's skills in the majority language, c) exhibiting 'a genuine interest' in working in a nursing home despite the relatively harsh working conditions, and d) having the ability to prioritize to ensure that all tasks and duties were completed on each shift. Staff members' perceptions of competence were hence interrelated with educational, racial, linguistic and social dimensions, but in unexpected and transgressing ways, paving the way to ethnic equality among staff.