Communication Behaviors in Nursing Homes in South‑East Iran: An Ethnographic Study

Sedigheh Khodabandeh‑Shahraki, Farokh Abazari, Batool Pouraboli, Nahid Dehghan‑Nayeri


Background: Because of the increasing number of the elderly, the need for care in aged nursing homes (NHs) is increasing. As a cultural perspective toward care is new, it is very important to understand the communication behavior of the elderly in various cultures. This study aimed to explore the communication behaviors among the elderly in NHs in Kerman, Iran.

Materials and Methods: This ethnographic focused study was conducted on 25 staff members and 8 residents in two NHs in 2015. Data were collected through observation of the participants, field notes, and semi‑structured deep interviews in Kerman. Cuba and Lincoln method was used to ensure the trustworthiness of the data. The collected data were analyzed through content analysis.

Results: By analyzing primary codes, 3 categories and 8 subcategories were extracted through content analysis including fluctuation in communication (task‑oriented communication, avoidance of communication, and establishment of effective communication), artificial collaboration (fake friendships, jealousy, and its consequences, and cooperation in concealing error), and lack of collaboration among team members (fragmented teamwork, extreme working conditions, and physical burnout among the elderly).

Conclusions: The results of this study indicate that communication problems between caregivers and the elderly are high. Thus, it is necessary that people who care for elderly indiviuals are trained regarding special communication strategies and skills, and they are not influenced by fatigue and burnout resulting from caring.


Behavior, communication, Iran, nursing homes, qualitative research

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Cagle JG, Unroe KT, Bunting M, Bernard BL, Miller SC. Caring for dying patients in the nursing home: Voices from frontline nursing home staff. J Pain Symptom Manage 2017;53:198‑207.

Iran’s Population Dynamics and Demographic Window of Opportunity [Internet]. Stanford University. 2017. Available from: https://iranian‑ publications/irans_population_dynamics_and_demographic_ window_of_opportunity_1.pdf. [Last cited on 2018 Dec 15].

Cagle JG, Unroe KT, Bunting M, Bernard BL, Miller SC. The experience of older people living independently in Singapore. Int Nurs Rev 2015;62:525‑35.

Lee MK. Disability and quality of life in community‑dwelling elderly cancer survivors: Case‑control study in the Korean population. Eur J Oncol Nurs 2016;24:22‑8.

Dobbs D, Baker T, Carrion IV, Vongxaiburana E, Hyer K. Certified nursing assistants’ perspectives of nursing home residents’ pain experience: Communication patterns, cultural context, and the role of empathy. Pain Manag Nurs 2014;15:87‑96.

Sprangers S, Dijkstra K, Romijn‑Luijten A. Communication skills training in a nursing home: Effects of a brief intervention on residents and nursing aides. Clin Interv Aging 2015;10:311‑9.

Williams KN, Ilten TB, Bower H. Meeting communication needs: Topics of talk in the nursing home. J Psychosoc Nurs Ment Health Serv 2005;43:38‑45.

Babaei S, Taleghani F, Keyvanara M. Contextual facilitators and s Iranian Journal of Nursing and Midwifery Research ¦ Volume 24 ¦ Issue 2 ¦ March-April 2019 143 maintaining of compassion‑based care: An ethnographic study. Iran J Nurs Midwifery Res 2017;22:91‑6.

Dellefield ME, Castle NG, McGilton KS, Spilsbury K. The relationship between registered nurses and nursing home quality: An integrative review (2008‑2014). Nurs Econ 2015;33:95‑108.

Towsley GL, Hirschman KB, Madden C. Conversations about end of life: Perspectives of nursing home residents, family, and staff. J Palliat Med 2015;18:421‑8.

Sundler AJ, Eide H, van Dulmen S, Holmstrom IK. Communicative challenges in the home care of older persons ‑ a qualitative exploration. J Adv Nurs 2016;72:2435‑44.

Chan EA, Wong F, Cheung MY, Lam W. Patients’ perceptions of their experiences with nurse‑patient communication in oncology settings: A focused ethnographic study. PLoS One 2018;13:e0199183.

Khodabandehshahraki S, Pouraboli B, Dehghan Nayeri N. Challenges in caring for the elderly in Iran: A systematic review. Ethiop Med J 2018;56:189‑95.

Higginbottom G, Pillay JJ, Boadu NY. Guidance on performing focused ethnographies with an emphasis on healthcare research. Qual Rep 2013;18:1‑6.

Holloway I, Wheeler S. Qualitative Research in Nursing and Healthcare. 3th ed. USA: John Wiley & Sons; 2015.

Spradley JP. Participant Observation. 1th ed. USA: Holt, Rinehart and Winston; 1980.

Kornbluh M. Combatting challenges to establishing trustworthiness in qualitative research. Qual Res Psychol 2015;12:397‑414.

Haugan G. The relationship between nurse‑patient interaction and meaning‑in‑life in cognitively intact nursing home patients. J Adv Nurs 2014;70:107‑20.

Brandburg GL, Symes L, Mastel‑Smith B, Hersch G, Walsh T. Resident strategies for making a life in a nursing home: A qualitative study. J Adv Nurs 2013;69:862‑74.

Randall EW, Clissett PC. What are the relative merits of interventions used to reduce the occurrences of disruptive vocalisation in persons with dementia? ‑ a systematic review. Int J Older People Nurs 2016;11:4‑17.

Laging B, Kenny A, Bauer M, Nay R. Rencognition and assessment of resident’ deterioration in the nursing home setting: A critical ethnography. J Clin Nurs 2018;27:1452‑63.

Figueredo‑Borda N, Zabalegui‑Yarnoz A. Long‑term care of the elderly in Uruguay. J Transcult Nurs 2015;26:178‑84.

Zandiyeh Z, Zare E, Mehrabi T, Shiri M. The effect of need‑oriented educational intervention on the general health of the elderly. Iran J Nurs Midwifery Res 2017;22:51‑6.

Abdolrahimi M, Ghiyasvandian S, Zakerimoghadam M, Ebadi A. Iranian nursing student–patient health communication in medical surgical wards. Iran J Nurs Midwifery Res 2018;23:136‑42.

Yektatalab S, Sharif F, Kaveh MH, Fallahi Khoshknab M, Petramfar P. Living with and caring for patients with Alzheimer’s disease in nursing homes. J Caring Sci 2013:187‑95.

Babaei S, Taleghani F, Kayvanara M. Compassionate behaviours of clinical nurses in Iran: An ethnographic study. Int Nurs Rev 2016;63:388‑94.

Wilkinson H, Whittington R, Perry L, Eames C. Does formulation of service users’ difficulties improve empathy in forensic mental health services? J Forensic Psychol Res Pract 2017;17:157‑78.

Cleary M, Walter G, Halcomb E, Lopez V. An examination of envy and jealousy in nursing academia. Nurse Res 2016;23:14‑9.

Ericson‑Lidman E, Strandberg G. Learning to deal constructively with troubled conscience related to care providers’ perceptions of deficient teamwork in residential care of older people‑a participatory action research study. Scand J Caring Sci 2015;29:215‑24.

Tyler DA, Parker VA. Nursing home culture, teamwork, and culture change. J Res Nurs 2011;16:37‑49.

Blanca Gutiérrez J, Linares Abad M, Grande Gascón M, Aranda Marín D. The personal relationships that are established by residents of a nursing home. Enfermería Global 2012;28:13‑22.


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