Triadic relationships in home care nursing: an integrative review of the views and experiences of older couples and nurses

Background
The need for long-term home care for older people with chronic health conditions is rising, and family members are bearing the brunt of this care work. Caring for a partner is a common scenario. Caregiving partners are often of advanced age themselves and have limiting health conditions of their own. Nurses need to consider the specific characteristics of partner caregiving to provide relationship-centred care. This review aims to analyse perceptions of the triadic relationship between older persons with long-term care needs, their caregiving partners and nurses and to identify approaches that can be supportive approaches that can help couples to cope with at-home care situations.
Methods
This integrative review following the method outlined by Whittemore and Knafl focuses on qualitative and mixed methods studies. A systematic search in the PubMed and CINAHL databases served to identify studies dealing with experiences and perceptions of triadic care arrangements in home-based care from the perspectives of nurses, care recipients and caregiving partners. Eight studies met the inclusion criteria and investigated perceptions of the triadic relationship between nurses providing home care and older couples. They were analysed using thematic analysis.
Results
The results show that triadic relationships in home-based care are shaped by social dynamics, role conflicts and barriers to communication. Although many couples are initially reluctant to integrate nursing professionals into home caregiving, mutual trust can develop when personnel continuity is given and sustained relationship work is performed. Clear communication, clarity on the distribution of tasks and proactive knowledge sharing by nurses facilitate cooperation. Caregiving partners desire support with self-care to preserve their ability to continue in their caregiving roles in the long term.
Conclusions
Understanding the dynamics of triadic relationships in nursing care and the care situation in couple relationships enables nurses to provide more targeted support to older couples. Proactive communication, role clarity and continuity of care can reduce the burden shouldered by caregiving partners and improve care quality. Further research focusing on strategies for strengthening relationship-centred interventions in home-based care is desirable.