Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-20T17:44:43.649Z Has data issue: false hasContentIssue false
  • English
  • Français

The need for flexibility when negotiating professional boundaries in the context of home care, dementia and end of life

Published online by Cambridge University Press:  10 April 2018

RUTH ABRAMS ,
TUSHNA VANDREVALA ,
KRITIKA SAMSI  and
JILL MANTHORPE
RUTH ABRAMS*
Affiliation:
School of Social and Behavioural Sciences, Faculty of Arts & Social Sciences, Kingston University, UK.
TUSHNA VANDREVALA
Affiliation:
School of Social and Behavioural Sciences, Faculty of Arts & Social Sciences, Kingston University, UK.
KRITIKA SAMSI
Affiliation:
Social Care Workforce Research Unit, King's College London, UK.
JILL MANTHORPE
Affiliation:
Social Care Workforce Research Unit, King's College London, UK.
*
Address for correspondence: Ruth Abrams, School of Social and Behavioural Sciences, Faculty of Arts & Social Sciences, Kingston University, Penrhyn Road, Kingston upon Thames KT1 2EE, UK E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Professional boundaries may help care staff to clarify their role, manage risk and safeguard vulnerable clients. Yet there is a scarcity of evidence on how professional boundaries are negotiated in a non-clinical environment (e.g. the home) by the home-care workforce in the context of complex care needs (e.g. dementia, end-of-life care). Through analysis of semi-structured interviews, we investigated the experiences of home-care workers (N = 30) and their managers (N = 13) working for a range of home-care services in the South-East and London regions of England in 2016–17. Findings from this study indicate that home-care workers and their managers have clear perceptions of job role boundaries, yet these are modified in dementia care, particularly at end of life which routinely requires adaptability and flexibility. As a lone worker in a client's home, there may be challenges relating to safeguarding and risk to both clients and workers. The working environment exacerbates this, particularly during end-of-life care where emotional attachments to both clients and their family may affect the maintenance of professional boundaries. There is a need to adopt context-specific, flexible and inclusive attitudes to professional boundaries, which reconceptualise these to include relational care and atypical workplace conventions. Pre-set boundaries which safeguard clients and workers through psychological contracts may help to alleviate to some extent the pressure of the emotional labour undertaken by home-care workers.

Keywords

professional boundarieshome careend of lifedementiaemotional labourpsychological contractsqualitative research
Type
Article
Information
Ageing & Society , Volume 39 , Issue 9 , September 2019 , pp. 1976 - 1995
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Arnold, J., Randall, R., Patterson, F., Silvester, J., Robertson, I., Cooper, C., Burnes, B., Harris, D. and Axtell, C. 2016. Work Psychology: Understanding Human Behaviour in the Workplace. Pearson, London.Google Scholar
Austin, W., Bergum, V., Nuttgens, S. and Peternelj-Taylor, C. 2006. A re-visioning of boundaries in professional helping relationships: exploring other metaphors. Ethics and Behaviour, 16, 2, 77–94.Google Scholar
Barken, R. 2017. ‘Independence’ among older people receiving support at home: the meaning of daily care practices. Ageing & Society. 39, 3, 518–40.Google Scholar
Berta, W., Laporte, A., Deber, R., Baumann, A. and Gamble, B. 2013. The evolving role of health care aides in the long-term care and home and community care sectors in Canada. Human Resources for Health, 11, 25, 1–6.Google Scholar
Bjerregaard, J., Haslam, A. S., Mewse, A. and Morton, T. 2017. The shared experience of caring: a study of care-worker's motivations and identifications at work. Ageing & Society, 37, 1, 113–38.Google Scholar
British Association for Social Workers 2012. The Code of Ethics for Social Work, Statement of Principles. British Association for Social Workers, Birmingham, UK.Google Scholar
Butler, S. 2009. Women still taking care: the experiences of older home care workers. Journal of Gerontological Social Work, 52, 3, 277–93.Google Scholar
Carberry, C. 2001. Privileged position: preparing nurses to work in the community. Nursing Inquiry, 8, 2, 82–9.Google Scholar
Care Quality Commission (CQC) 2013. Not Just a Number. Home Care Inspection Programme. CQC, London.Google Scholar
Care Quality Commission (CQC) 2017. The State of Adult Social Care Services 2014 to 2017. Findings from CQC's Initial Programme of Comprehensive Inspections in Adult Social Care. CQC, London.Google Scholar
Cooper, F. 2012. Professional Boundaries in Social Work and Social Care: A Practical Guide to Understanding, Maintaining and Managing Your Professional Boundaries. Jessica Kingsley Publishers, London.Google Scholar
D'Astous, V., Abrams, R., Vandrevala, T., Sami, K. and Manthorpe, J. 2017. Gaps in understanding the experiences of homecare workers providing care for people with dementia up to the end of life: a systematic review. Dementia. Published online 30 March 2017, doi:10.1177/1471301217699354 .Google Scholar
De Witt, L. and Ploeg, J. 2016. Caring for older people living alone with dementia: healthcare professionals’ experiences. Dementia, 15, 2, 221–38.Google Scholar
Devlin, M. and McIlfatrick, S. 2010. Providing palliative and end-of-life care in the community: the role of the home-care worker. International Journal of Palliative Nursing, 16, 4, 195–203.Google Scholar
Department of Health 2013. Improving Care for People at the End of Their Life. Department of Health, London.Google Scholar
Exley, C. and Allen, D. 2007. A critical examination of home care: end of life care as an illustrative case. Social Science and Medicine, 65, 11, 2317–27.Google Scholar
Health and Care Professions Council 2017. Standards of Proficiency: Social Workers in England. Health and Care Professions Council, London.Google Scholar
Herber, O. R. and Johnston, B. M. 2013. The role of healthcare support workers in providing palliative and end-of-life care in the community: a systematic literature review. Health and Social Care in the Community, 21, 3, 225–35.Google Scholar
Hill, R. C., Dempster, M., Donnelly, M. and McCorry, N. K. 2016. Improving the wellbeing of staff who work in palliative care settings: a systematic review of psychosocial interventions. Palliative Medicine, 30, 9, 825–33.Google Scholar
Hochschild, A. R. 1983. The Managed Heart: Commercialization of Human Feeling. University of California Press, Berkeley, California.Google Scholar
Jeon, Y. H., Govett, J., Low, L. F., Chenoweth, L., McNeil, G., Hoolahan, A., Brodaty, H. and O'Conner, D. 2013. Care planning practices for behavioural and psychological symptoms of dementia in residential aged care: a pilot of an education toolkit informed by the Aged Care Funding Instrument. Contemporary Nurse, 44, 2, 156–69.Google Scholar
Lovatt, M., Nanton, V., Roberts, J., Ingleton, C., Noble, B., Pitt, E., Seers, K. and Munday, D. 2015. The provision of emotional labour by health care assistants caring for dying cancer patients in the community: a qualitative study into the experiences of health care assistants and bereaved family carers. International Journal of Nursing Studies, 52, 1, 271–9.Google Scholar
MacNaughton, K., Chreim, S. and Bourgeault, I. L. 2013. Role construction and boundaries in interprofessional primary health care teams: a qualitative study. BMC Health Services Research, 13, 486, 1–13.Google Scholar
McGarry, J. 2010. Relationships between nurses and older people within the home: exploring the boundaries of care. International Journal of Older People Nursing, 5, 4, 265–73.Google Scholar
Moriarty, J., Rutter, D., Ross, P. and Holmes, P. 2012. End of Life Care for People with Dementia Living in Care Homes. Social Care Institute for Excellence, London.Google Scholar
O'Leary, P., Tsui, M. S. and Ruch, G. 2013. The boundaries of the social work relationship revisited: towards a connected, inclusive and dynamic conceptualisation. British Journal of Social Work, 43, 1, 135–53.Google Scholar
Ong, P., Rickles, J., Matthias, R. and Benjamin, A. E. 2002. California Caregivers: Final Labour Market Analysis. California Employment Development Department, Los Angeles.Google Scholar
Powell, A. E. and Davies, H. T. O. 2012. The struggle to improve patient care in the face of professional boundaries. Social Science and Medicine, 75, 5, 807–14.Google Scholar
Reamer, F. G. 2003. Boundary issues in social work: managing dual relationships. Social Work, 48, 1, 121–33.Google Scholar
Reimer-Kirkham, S., Sawatzky, R., Roberts, D., Cochrane, M. and Stajduhar, K. 2016. ‘Close to’ a palliative approach: nurses’ and care aides descriptions of caring for people with advancing chronic life-limiting conditions. Journal of Clinical Nursing, 25, 15/16, 2189–99.Google Scholar
Ritchie, J. and Spencer, L. 1993 Qualitative data analysis for applied policy research. In Bryman, A. and Burgess, R. (eds), Analysing Qualitative Data. Routledge, London, 173–94.Google Scholar
Skills for Care 2016. The State of the Adult Social Care Sector and Workforce in England. Skills for Care, London.Google Scholar
Sudbery, J. 2002. Key features of therapeutic social work: the use of relationship. Journal of Social Work Practice, 16, 2, 149–62.Google Scholar
World Health Organization 2012. Dementia: A Public Health Priority. World Health Organization, London.Google Scholar