Keeping dad safe : an autoethnography of double-duty caregiving in the context of risk as an advanced practice nurse in geriatrics caring for a hospitalized frail older adult parent

Abstract

Particular challenges emerge when children who are health professionals become caregivers for their older adult parents who are hospitalized. This double-duty caregiving involves performing multiple roles and can create tensions for formal and informal caregivers that may impact the care of the older adult. In my case double-duty caregiving meant positioning as a daughter of an older adult family member and as a clinical nurse specialist in geriatrics within a change in risk culture toward patient-and-family centered care. Using autoethnography informed by poststructural perspectives, I conducted a discourse analysis and identified subject positions produced through and by these discourses. I applied analytic and evocative autoethnographic methods to my data that included medical records of my dad from two separate hospital admissions, journal notes, memory, and emails. Additionally, I conducted semi-structured interviews with my dad, three siblings, and the health service director at the hospital where my dad was hospitalized. My double-duty caregiving experience is reflected in my autoethnography that applied historical perspectives of risk and the influence of risk culture on in-the-moment caregiving. I identified safety as a predominant discourse that I, my participants, and the health care providers who cared for my dad took up and performed in my experience of double-duty caregiving for my dad. Within the safety discourse were sub-discourses of competency/incompetency, surveillance, trust/mistrust, fear, and control. Through this process of discourse analysis, biomedical discourses were unveiled as the most dominant discourses that produced the culture of risk within the context of double-duty caregiving for my frail older adult parent, and the tension between biomedical discourses and patient-and-family centered care is revealed. This study is unique in using autoethnography to look at double-duty caregiving for an older adult parent within the context and culture of risk. This research supports other findings that enacting trust in relationships is complex when individuals not only position themselves in relation to multiple selves, but are positioned by others for a number of purposes. Future research into how best to shift the focus of risk imbued by biomedical discourses to a patient- and family-centred and team-based approach is essential.Health and Social Development, Faculty of (Okanagan)Nursing, School of (Okanagan)Graduat