Date of Award


Degree Type


Degree Name

Doctor of Philosophy in Nursing



First Advisor

Donna Schwartz-Barcott


More than 1.4 million Americans reside in long term care facilities across the United States. Social and professional relationships are an integral component of everyday life within these environments. Few studies have systematically examined positive relationships that exist between residents and nursing assistants in long term care. A focused ethnography of a nursing home, one known for the quality of life experienced by its residents and located in the northeastern United States, was used to examine the nature of (1) interactions (2) positive relationships (their development and maintenance) between residents and nursing assistants, and (3) supportive environmental factors. Peace House (a pseudonym) was one of 30 nonprofit, continuing care facilities operated in the US by an order of Catholic Nuns committed to the care of the elderly poor. Participant observation took place primarily in public spaces over a four-week period. Interviews were conducted with ten Caucasian, English speaking and cognitively alert residents, including 9 women, 1 man and ranging in age from 74 to 103 and residing on a skilled nursing unit. Schatzman and Strauss’s fieldwork notation system was used to record and analyze data. Semi-structured taped interviews were transcribed, read and re-read and analyzed in relation to general themes. Credibility and trustworthiness were enhanced by member check and expert review of transcripts and findings.

Overall, interactions in public spaces were resident-to-resident, social in nature, and initiated primarily by residents. On skilled units interactions were primarily initiated by staff to resident but controlled by the resident. Residents interviewed had at least one positive relationship with a direct caregiver, but differentiated as, specific, non-specific, or distant. The presence, or lack, of close familial relationships did not influence the forming of close personal relationships between residents and nursing assistants. Most of the residents were unable to describe how these relationships developed and were maintained over time due to memory lapses surrounding the initial period of transition. A number of public spaces and social and work opportunities existed that facilitated social interaction. The sisters and staff members supported positive relationships by allowing the residents to be themselves. Knowledge of individual resident preferences was communicated effectively among the staff, enabling residents to decide with whom and how they wished to establish a relationship. Implications from this study include expanding Kim’s (2000) conception of the nurse-client domain to encompass interactions that are prolonged and sustained over time, increasing research on transition periods into long term care and the importance of acknowledged individuality.



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