Tug of War Over Power: A Case Study on the Development of Professional–Informal Caregiver Tensions in Residential Dementia Care

Effective collaboration between professional and informal caregivers is essential in residential dementia care, but often disrupted by relational tensions. This 2-year case study explores how these tensions emerge and develop. Using visual and inductive analysis of qualitative data, we study a strained professional–informal caregiver relationship in a Dutch residential dementia care facility, focusing on the personal, relational, and organizational factors that shape it. Findings indicate that divergent conceptualizations of good care, rooted in distinct ethical frameworks, lead to relational tensions between professional and informal caregivers. These tensions tend to escalate through a series of interrelated dynamics that ultimately result in a tug of war over power, which triggers a downward spiral in the relationship. Organizational processes such as pseudo-participation and unintentional support for distancing practices further entrench these dynamics. Professional and informal caregivers are prompted to work around rather than resolve the conflict. Set within a Dutch residential dementia care context, the study offers broader implications for similar care settings globally. It advocates a shift from person-centered care to relational care, emphasizing multidirectionality to address power asymmetries. Key implications include promoting relational care as the moral standard, implementing organizational changes to support relational care and embedding moral skills into nursing education.