What is it about?
Relatives of nursing home residents are often described in narrow ways, as visitors, caregivers, or decision-makers. But their experience of "being relative" inside institutional long-term care is far more complex. This qualitative meta-synthesis reviewed 59 studies from 14 countries, spanning more than three decades of qualitative research on relatives in nursing homes. We found that relatives navigate four interconnected patterns of experience: managing emotional ambiguity (holding gratitude and criticism simultaneously), shifting fluidly between overlapping roles such as advocate, observer, or mediator, building and losing relational connections with staff, and continuously negotiating what care responsibility should look like. These four dimensions form a cyclical model in which each shapes the next in an ongoing adaptive process. Rather than occupying fixed roles, relatives engage in continuous adaptation and meaning-making within institutional constraints. Recognising this, the person behind the institutional "mask" matters for how nursing homes design their approaches to family involvement.
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Why is it important?
Person-centred care in nursing homes has traditionally focused on residents and, occasionally, staff. Relatives have been quietly left out of this framework. Yet relatives shape care relationships every day, often invisibly. This paper matters for three reasons. First, it offers a comprehensive synthesis of what we know about relatives' experiences across three decades of qualitative research, a foundation that previous reviews focused on functional contributions could not provide. Second, it introduces a cyclical model that makes the dynamic, relational nature of "being a relative" visible and analytically tractable. Third, it turns theoretical recognition into concrete implications: for practice (reflective dialogue spaces, flexible role structures, designated contact persons), for research (assessment instruments that capture relational rather than static dimensions), and for theory (extending person-centred frameworks to include relatives systematically). If we want person-centred long-term care to be more than a slogan, the personhood behind the institutional mask needs to be seen. This paper offers the vocabulary and the model to do so.
Perspectives
This paper grew out of a broader research programme (BE-REAL) exploring what it means to be a relative inside institutional long-term care. As an Advanced Practice Nurse working in long-term care myself, I have seen how easily the person behind the "family member" role slips out of view, for staff, for institutions, and sometimes for relatives themselves. Synthesising 59 studies from around the world made clear that this is not a local observation but a shared pattern. What surprised me most was how consistently the same tensions surface across contexts: gratitude and criticism sitting side by side, the pull between advocating and preserving the relationship with staff, the quiet renegotiation of responsibility over time. These are not problems to be solved. They are the texture of being a relative in institutional care, and recognising this changes what person-centred practice can look like.
Rouven Brenner
Eastern Switzerland, University of Applied Sciences, School of Health, St. Gallen
Read the Original
This page is a summary of: Behind the Mask: Recognising the Person in Relatives of Nursing Home Residents—A Qualitative Meta‐Synthesis, Scandinavian Journal of Caring Sciences, July 2026, Wiley,
DOI: 10.1111/scs.70278.
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