Caregiving Heuristics

Abstract

Improving practice depends on accurate understandings of practitioner knowledge, which are not easily attained, partly because practitioners unevenly apply formal theory and also rely on reflective processes and power bases that are significantly different from those of researchers. Focusing on residential care managers’ subjective experience of their own knowledge and clinical decisions, this study examines their application of theories, their beliefs and practices, challenges they faced, and factors managers described as related with good and poor client outcomes. Uninterested in formal theory and evidence-based practice models, the managers demonstrated a patterned, action-oriented, value-based ‘knowledge-in-action’ (per Floersch) we termed caregiving heuristics. Managers combined multiple interventions from diverse models to attain the best possible outcomes, using a strategy defined by Brandstatter, Hutchinson, and Gigerenzer as the priority heuristic. They creatively developed guidelines (at various levels of explication) for their decision-making. Unique to each practitioner, caregiving heuristics could be compared; elements were commonly held by managers. From these managers’s caregiving heuristics, guidelines for residential care management were distilled and included emphasizing compassion, providing supportive relationships so clients experience themselves as partners in their change process, developing clients’ strengths, and creating a community that restores clients’ dignity and provides psychological and material resources.