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Background: People experiencing homelessness have some of the highest morbidity rates and lowest age of mortality in Canada yet face many barriers to care, in particular the attitudes of healthcare providers. Objectives: In this critical ethnographic study, power within client–provider relationships in health care with people experiencing homelessness is explored. Methods: Multiple qualitative methods of document analysis, participant observation, interviews, and focus groups were used with both clients and providers in a community clinic for people experiencing homelessness. Data analysis involved individual and team thematic analysis, guided by Lather's (2007, Getting lost: Feminist efforts towards a double(d) science. Albany, NY: SUNY Press)Lather, P. A. (2007). Getting lost: Feminist efforts towards a double(d) science. Albany, NY: SUNY Press. [Google Scholar] criteria for validity. Results: Caregiving relationships involve a negotiation of power based on the many differences of social location between clients and providers. Both clinic policies and personal practices influence the ways power is asserted, taken, or shared. Conclusions: In discussing the implications for addressing power relations in caregiving relationships, it is highlighted that most work in this area has focused on educating health professionals to assist them to relate in more appropriate ways. More needs to be done to actively address the power differentials inherent in caregiving with people experiencing homelessness, for which the concept of ‘solidarity’ is presented as offering some promise.

Intimate partner violence (IPV) is the most common form of gender-based violence affecting Canadian women. Women often seek help from shelters to deal with IPV and its consequences. These shelters function within a broader context that shapes how services are delivered. This study was undertaken to better understand how structural factors including policies shape shelter service delivery and reveal systemic and structural complexities that influence those services and women's ability to rebuild their lives. This feminist qualitative study combined in-depth interviews and focus groups with 37 staff and 4 executive directors from 4 shelters in Ontario, Canada, and included critical discourse analysis of salient policy texts. The findings illuminate the complexity of the structural challenges faced by abused women and the shelters that support them. Systemic impediments were shown to determine how shelters support abused women, the obstacles women face moving forward, and the extent and availability of their options. Future research should include policy evaluation of policy written and enacted, cost analysis examining the actual costs of delivering shelter services and supporting women after leaving, examination of potential alternatives to the identified structural challenges, and investigation of system coordination of services and support for abused women.

RÉSUMÉCette étude a exploré la signification d’une relation positive client-infirmière pour les personnes âgées atteintes de maladies chroniques qui reçoivent les soins à domicile. Pour les besoins de cette étude phénoménologique, huit participants âgés de 65 à 86 ont été sélectionnés à partir du Sud-Ouest Centre communautaire d’accès aux soins [or retain as Southwest Community Care Access Centre (SW-CCAC)]? à London, Ontario. Des données narratives ont été recueillies par des entrevues en profondeur capturé sur cassette audio, tout en utilisant un guide d’entretien semi-structuré. L’analyse et l’interprétation des entrevues ont révélé que le sens d’une relation client-infirmière positive de ces personnes âgées englobait deux tendances de sens: avoir de confort, et étant relié au sein de cette relation. Ces deux modèles ont été contextualisés par être une personne âgée avec une maladie chronique et ont été socialement construits à travers l’expérience d’avoir créé un rapport positif. Bien que des recherches supplémentaires sont nécessaires, les connaissances acquises ajouter à ce que l’on sait déjà au sujet de la théorie et la pratique de la promotion de la santé relationnelle pour les personnes âgées vivant avec des maladies chroniques et recevant les soins à domicile.

The multiple relationships involved in home-based end-of-life care have received little systematic analysis. As part of a focused ethnographic study examining client–caregiver–provider relational care experiences within the sociocultural context of home-based end-of-life care, this article describes the provision of end-of-life care to older adults with advanced cancer from the perspective of family caregivers. Data were collected through in-depth interviews ( n = 16) with 4 family caregivers and participant observations in each of the 4 households over a 6- to 8-month period. Family caregiving in home-based end-of-life care was portrayed in this study as 3 dialectical relational care experiences: (1) prioritizing care recipient needs–ignoring own needs, (2) feeling connected–feeling isolated, and (3) juggling to manage–struggling to survive. Study findings suggest that the sociocultural context of end-of-life care is not conducive to quality care and provide several insights for future directions in nursing practice, policy, and research.

Providing palliative care in the home presents a variety of challenges for nurses and other care providers. As part of a focused ethnographic study examining client/caregiver/care-provider relationships within the socio-cultural context of home-based palliative care, this paper describes the provision of palliative care to Canadian seniors with advanced cancer from the perspective of nurses. Data were collected through in-depth interviews (n=19) with three palliative care nurses and participant observations in four households over a six-to-eight-month period. Home-based palliative care nursing was depicted in this study as a dialectical experience, revealing three relational practice patterns: making time-forfeiting time, connecting-withdrawing, and enabling-disabling. Nurses attempted to negotiate the tensions between these opposing approaches to palliative care. Study findings suggest that the socio-cultural context of palliative care is not conducive to high-quality palliative care and provide several insights related to future directions for practice, policy, and research.

Aim. To elicit an in-depth understanding of the sources of power and how power is exercised within client–nurse relationships in home-based palliative care. Background. As in all social relations, power is present within client–nurse relationships. Although much research has focused on interpersonal relationships in nursing, the concept of power within the client–nurse relationship in palliative care settings has not been extensively investigated. Methods. Applying a critical lens, secondary qualitative data analysis was conducted. Seventeen nurse and 16 client transcripts from a primary study were selected for secondary data analysis. These 33 transcripts afforded theme saturation, which allowed for both commonalities and differences to be identified. Data analysis involved analytic coding. Results. Study findings help make explicit the underlying power present in the context of home-based palliative care and how this power is used and potentially abused. In analysing the sources and exercise of power, the linkage between macro and micro levels of power is made explicit, as nurses functioned within a hierarchy of power. The findings suggest that educational/occupational status continues to be a source of power for nurses within the relationship. However, nurses also experience powerlessness within the home care context. For clients, being able to control one's own life is a source of power, but this power is over-shadowed by the powerlessness experienced in relationships with nurses. The exercise of power by clients and nurses creates experiences of both liberation and domination. Conclusions. Nurses who are willing to reflect on and change those disempowering aspects of the client-nurse relationship, including a harmful hierarchy, will ultimately be successful in the health promotion of clients in home-based palliative care. Additionally, it should be recognized that nurses work within a specific health system context and, therefore, their practice is influenced by policies and funding models implemented at various levels of the health care system. Relevance to clinical practice. The insights gained through this investigation may assist nurses and other health professionals in reflecting on and improving practices and policies within home-based palliative care and within home care in general.

The purpose of this study was to investigate the influence of personality, confidence, health, and well-being on engagement in daily activities in 199 seniors (mean age 79 years) who were fallers or feared falling. Personality, particularly extroversion, was a major determinant of engagement in activities outside the house (p < 0.001). Within the house, confidence significantly influenced independence and was associated with formal home care provision (p < 0.001). Confidence was influenced by fear (p < 0.001), subjective health (p < 0.001), and personality (p < 0.01). An older adult's personality significantly influences the impact of falling and fear of falling on their lifestyle.

Evidence suggests that intergenerational caregiving between mothers and daughters will become increasingly common, and yet, we know very little about the specific relationships between adult daughters and their mothers with dementia. Guided by socialist-feminist theory and a life-course perspective, 15 mother-adult daughter dyads participated in two individual, semistructured interviews. Data analysis revealed four dynamic types of mother-daughter relationships: custodial, combative, cooperative, and cohesive. Custodial and cooperative relationships mainly focused on the provision of and receipt of tasks, whereas combative and cohesive are emotion focused. At the same time, custodial and combative relationships are based on deficits compared with strength based cohesive and cooperative relationships. In addition, certain contextual factors, such as expectations of care and levels of support, shaped the development of these relationships. Moreover, study findings highlight a number of implications for practice, policy, and research necessary to support individuals with dementia and their families.