Behind the Mask: Recognising the Person in Relatives of Nursing Home Residents-A Qualitative Meta-Synthesis

BACKGROUND: Relatives of nursing home residents are deeply involved in care relationships that extend far beyond visiting routines. However, their broader personhood is often overlooked, with existing research focusing on functional roles. This meta-synthesis aims to explore how relatives experience "being relative" within institutional long-term care, highlighting the complexity of their identity beyond institutional expectations.

METHODS: We conducted a qualitative meta-synthesis of 59 per-reviewed studies using Thomas and Harden's thematic synthesis approach. We systematically searched four databases (MEDLINE, CINAHL, Emcare, and PsycInfo) from inception to 17. In January 2024 and conducted citation tracking. Grounded in a social constructionist perspective, we conceptualised "being relative" as a relational identity co-constructed through everyday interactions with staff in an institutional context.

RESULTS: Four interconnected themes characterise relatives: (i) Managing Ambiguity (navigating emotional complexity between gratitude and criticism), (ii) Fluid and Overlapping Roles (continuously shifting between advocacy, observation, and mediation), (iii) Dynamic Relationship Development (evolving connections with staff through recognition and challenge cycles), and (iv) Negotiating Care Responsibility (ongoing adaptation of involvement patterns). These themes form a cyclical model illustrating how relatives continuously navigate between institutional expectations and authentic experiences. Rather than inhabiting static roles, relatives engage in dynamic positioning processes, constantly adapting and reinterpreting their place within care settings.

CONCLUSIONS: "Being relative" represents a dynamic process of continuous adaptation and meaning-making within institutional constraints, extending beyond functional role assignments. Our cyclical model challenges reductionist approaches and emphasises the need for person-centred care that recognises relatives as whole persons with complex identities and emotional needs. By acknowledging the person behind the institutional "mask," care facilities can improve relatives' experiences, enhance care quality for residents, and increase staff satisfaction-demonstrating the potential of truly person-centred approaches in long-term care.