Characteristics of communication with older people in home care: A qualitative analysis of audio recordings of home care visits

Older persons' experiences of care encounters in their home: A multiple-case study

AIM

To explore and describe older persons' unique experiences of care encounters with home care nurses in a real-life context.

BACKGROUND

The increasing number of older persons in society contributes to increases in age-related impairments compromising their quality of life. Future care consists of "hospitals at home" where care encounters occur in a person's private domain, partly becoming a clinical workplace. Scant research has focused on how older persons experience care encounters with home care nurses and needs to be highlighted.

DESIGN

Multiple-case study.

METHODS

The cases relied on replication logic and five purposive sampled older persons were interviewed. Data were analysed using qualitative content analysis and differences within and between cases were explored and findings across the cases were replicated.

FINDINGS

The cross-analysis emerged in three categories: "Nursing routine rules the care encounters", "Lack of knowledge and information" and "Dependency on support from others".

CONCLUSIONS

Our research has found that older persons face challenges while receiving home care, including limited engagement in their care and the need for enhanced support. Implementing person-centred care in homes poses ethical challenges that require careful consideration. Home care nurses should prioritise understanding each patient individually, recognising them beyond their patient role, which necessitates more thorough and time-sensitive care encounters.

REPORTING METHOD

Findings were reported using COREQ guidelines.

PATIENT OR PUBLIC CONTRIBUTION

Patients were interviewed and contributed with data for this study.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

This study emphasises the need to prioritise individualised care in home settings and listen to the voices of older individuals to enhance quality.

Nurses' experiences of using the Integrated Palliative care Outcome Scale with patients in specialized palliative care-A qualitative focus group study

AIM

To explore nurses' experiences of using the Integrated Palliative care Outcome Scale (IPOS) as a communication tool in specialized palliative care.

DESIGN

This study employed a qualitative inductive approach. The Standards for Reporting Qualitative Research were followed for reporting.

METHODS

Five focus groups were conducted with nurses from four specialized palliative care units, and the discussions were analysed with quality content analysis.

RESULTS

Using IPOS for communication with the patient gave an opportunity to understand the patient's care needs and to let these care needs guide care interventions. Prerequisites in terms of relation, atmosphere, skills and flexibility were needed to establish an interactive communication. It was challenging to communicate about issues that evoked emotional reactions in the patient. There was a balancing act between the use of a structured scale and overcoming communication challenges. Nonetheless, when the two complemented each other, IPOS was a useful tool for nurses to promote person-centred care.

Empathy and Attitude upon An Aged Body: Aged Simulation Suit Among Undergraduate Physiotherapy Students

Background and Purpose: When empathy and attitude levels of health professionals are high, patient compliance and satisfaction are increased. The purpose of this study was to assess the empathy and attitude levels of undergraduate physiotherapy students towards older people before and after wearing the aged simulation suit by performing pre-defined related scenarios. Methods: The aged simulation suit was put on 63 students to complete the pre-defined scenarios, which included reading, eating, walking, and sitting to determine the experiences and emotions of students via semi-structured questions and interviews. The empathy and attitude levels were evaluated using the Jefferson Scale of Empathy-Health Professions Students (JSE-HPS) version and Kogan's Attitudes Towards Old People (KAOP) scales at baseline and immediately after performed scenarios. Results: The scores of the JSE-HPS and its sub-scales, including "perspective-taking" (p=0.000) and "compassionate care" (p=0.008), were significantly improved, while "standing in patient's shoes" was significantly decreased after the intervention (p=0.005). KAOP positive items were found to be higher compared to the baseline results (p=0.040). Besides, 87.1% of the students stated that their behavior towards older people would change positively. Conclusion: Using aged simulation suits may be an effective educational technique that positively contributes to undergraduate physiotherapy students' attitudes and empathy.

Older persons' expressed worries during nursing care at home: Do health complexity and nature of nursing care in the visit matter?

OBJECTIVE

Older persons receiving home care express more cues and concerns compared to other clinical contexts. Increased health condition complexity requires a corresponding increase in nursing competence. The aim of this study was to explore how complexity of older persons' health and nature of the visit influenced their expressed worries.

METHODS

In this cross-sectional explorative study, we analysed older persons' expressed worries (n = 508) identified by the Verona Coding Definitions of Emotional Sequences (VR-CoDES) in 129 audio-recorded home care visits with older persons (≥65 years), collected in 3 city districts and 1 rural area in Norway.

RESULTS

Expressed worries of 45 older persons were included in the analysis: 18 had low health complexity, 5 moderate and 22 high health complexity. The nature of the visit affected the number of expressed worries, health complexity did not. Most of the worries were expressed during basic nursing care visits and/or medication administration.

CONCLUSION

Findings suggest that home visit type may influence the older persons' expressed worries. The complexity of the older persons' health condition seems to have little impact on the expressed worries.

PRACTICE IMPLICATIONS

Knowledge about communication in different complexity of visits is important when planning care for older persons.

Person-centered dementia care in home care services - highly recommended but still challenging to obtain: a qualitative interview study

BACKGROUND

Dementia is one of the main causes of disability and dependence in older people, and people with dementia need comprehensive healthcare services, preferably in their own homes. A well-organized home care service designed for people with dementia is necessary to meet their needs for health- and social care. Therefore, it is important to gain knowledge about how people with dementia experience the home care service and if the service responds to their wishes and needs. The aim of this study was to explore the experience of home care services among people with dementia, to understand the continuity in services, how the service was adapted to people with dementia, and how the patient experienced person-centered care and shared decision-making.

METHODS

We used a qualitative, exploratory design based on a phenomenological-hermeneutic approach and performed individual in-depth interviews with persons with dementia. A convenience sample of 12 persons with moderate to severe degrees of dementia from four Norwegian municipalities participated in the study. The interviews were conducted in February 2019.

RESULTS

The findings identified that the participants appreciated the possibility to stay safely in their own homes and mostly experienced good support from staff. They expressed various views and understanding of the service and experienced limited opportunities for user involvement and individualized, tailored service. The overall theme summarizing the findings was: "It is difficult for people with dementia to understand and influence home care services, but the services facilitate the possibility to stay at home and feel safe with support from staff."

CONCLUSION

The participants did not fully understand the organization of the care and support they received from the home care services, but they adapted to the service without asking for changes based on their needs or desires. Although person-centered care is recommended both nationally and internationally, the participants experienced little inclusion in defining the service they received, and it was perceived as unclear how they could participate in shared decision-making.

Person-centred communication in long-term care with older people: a scoping review

Purpose

Interpersonal skills are increasingly important tools in long-term care with older people, especially against the backdrop of loneliness affecting older people and expectations for a person-centred, joined-up approach. However, the term is used as a composite and its definition lacks shape and focus. In existing literature, participants appear to be selected on the basis of specific illnesses rather than age. Better understanding of the features of everyday communication processes associated with person-centred care can lead to improvements in policy and practice.

Design/methodology/approach

A scoping review examined communication features associated with person-centred care for older adults. This identified the extent and nature of literature. Several databases were searched; after screening and hand-searching, 31 were included. Findings were analysed for patterns and contradictions, against the objectives of person-centred and integrated care.

Findings

Emotional intelligence and the ability to employ various communication styles are crucial skills of person-centred communication. Such approaches can have positive effects on the well-being of older people.

Research limitations/implications

Some studies' validity was weakened by methodological designs being founded on value judgements.

Practical implications

Using personalised greetings alongside verbal and non-verbal prompts to keep residents emotionally connected during personal care is considered good practice. Stimulating feedback from people using services and their relatives is important.

Originality/value

The role of communication is highlighted in many professional guidance documents on person-centred and integrated care, but the process of implementation is decentralised to individual employers and workers. This paper draws on the findings of contemporary literature, grounded in naturalistic data, with implications for practice and policy.

A client-centered approach in home care for older persons - an integrative review

OBJECTIVE

To describe and synthesize client-centered care and service in home care for older persons.

METHODS

The study was an integrative review using the guidelines for literature reviews by the Joanna Briggs Institute. The research process followed the Whittemore and Knafl framework and PRISMA toolkit in the selection of eligible articles. The CINAHL, Medline, Scopus, Web of Science and Social Sciences abstracts were searched for articles published between January 2007 and May 2020 according to previously designed search strategies. In total, 24 articles were deemed relevant for an analysis using a thematic analysis.

RESULTS

The analysis resulted in four themes with sub-themes which revealed that client-centered care and service in home care consist of: 1) Clients' involvement in their own care; self-care, decision-making, satisfactory daily life, 2) Family members' and care partners' participation in care; family members' and care partners' commitment to care, family members' and care partners' competence in care, 3) Communication and co-operation; communication models, empowerment, partnership, and 4) Evidence-based service competence; delivery and organization of services, implementation of services, versatile clinical skills, quality outcomes and personnel wellbeing.

CONCLUSIONS

According to the results, achieving client-centered care and service in home care requires the realization of all of the above aspects. The practice of nursing must better identify all dimensions of client-centered care and take these into account in the delivery of home care services. KEY POINTS Client-centeredness is a fundamental value and the basis of nursing and care in home care provided for older persons This paper: deepens and structures the concept of client-centered care in the context of home care. assists professionals to understand the factors behind client-centered care within the home care environment. provides deeper understanding of the roles of the older person, family members, and the service system in developing client-centered services in home care for older persons.

A systematic review on implementation of person-centered care interventions for older people in out-of-hospital settings

THE PURPOSE

of this study was to explore the content and essential components of implemented person-centered care in the out-of-hospital context for older people (65+).

METHOD

A systematic review was conducted, searching for published research in electronic databases: PubMed, CINAHL, Scopus, PsycInfo, Web of Science and Embase between 2017 and 2019. Original studies with both qualitative and quantitative methods were included and assessed according to the quality assessment tools EPHPP and CASP. The review was limited to studies published in English, Swedish, Danish, Norwegian and Spanish.

RESULTS

In total, 63 original articles were included from 1772 hits. The results of the final synthesis revealed the following four interrelated themes, which are crucial for implementing person-centered care: (1) Knowing and confirming the patient as a whole person; (2) Co-creating a tailored personal health plan; (3) Inter-professional teamwork and collaboration with and for the older person and his/her relatives; and (4) Building a person-centered foundation.

CONCLUSION

Approaching an interpersonal and inter-professional teamwork and consultation with focus on preventive and health promoting actions is a crucial prerequisite to co-create optimal health care practice with and for older people and their relatives in their unique context.

Striking a balance: Health care providers' experiences with home-based, patient-centered care for older people-A meta-synthesis of qualitative studies

OBJECTIVE

The aim of this article was to synthesize research findings about health care providers' experiences of patient-centered care in the home setting.

METHODS

This is a meta-synthesis of qualitative findings using the analytical method of meta-ethnography developed by Noblit and Hare. We performed a systematic literature search in seven databases and assessed potential studies against eligibility criteria and quality. Subsequently, 10 primary studies were included for analysis.

RESULTS

The core theme "being a balance artist" emerged from the synthesis, incorporating the participants' experiences when faced with conflicting and competing responsibilities and needs. Two subthemes-"balancing the older clients' needs against organizational demands" and "balancing the older clients' needs against professional standards"-further elaborated on this core theme.

CONCLUSION

Health care providers' experiences indicate that organizational factors play a crucial role in shaping the conditions for patient-centered care for older people in the home setting.

PRACTICE IMPLICATIONS

To motivate and facilitate health care providers to move to a more patient-centered practice, it is important to expand the values of patient-centered care beyond the clinical encounter into the organization.

Emotional communication with older people: A cross-sectional study of home care

The aim of this study was to explore the influence of characteristics of nurses and older people on emotional communication in home care settings. A generalized, linear, mixed model was used to analyze 188 audio-recorded home care visits coded with Verona Coding Definitions of Emotional Sequences. The results showed that most emotional distress was expressed by older females or with female nurses. The elicitation of an expression of emotional distress was influenced by the nurses' native language and profession. Older women aged 65-84 years were given the most space for emotional expression. We found that emotional communication was primarily influenced by sex for nurses and older people, with an impact on the frequency of expressions of and responses to emotional distress. Expressions of emotional distress by older males were less common and could risk being missed in communication. The results have implications for students' and health professionals' education in increasing their knowledge of and attentiveness to the impacts of their and others' characteristics and stereotypes on emotional communication with older people.

"It just happens". Care home residents' experiences and expectations of accessing GP care

BACKGROUND

Care homes provide personal care and support for older people who can no longer be supported in the community. As part of a larger study of integrated working between the NHS and care homes we asked older people how they accessed health care services. Our aim was to understand how older people resident in care homes access health services using the Andersen model of health care access.

METHODS

Case studies were conducted in six care homes with different socio-economic characteristics, size and ownership in three study sites. Residents in all care homes with capacity to participate were eligible for the study. Interviews explored how residents accessed NHS professionals. The Andersen model of health seeking behaviour was our analytic framework.

FINDINGS

Thirty-five participants were interviewed with an average of 4 different conditions. Expectations of their health and the effectiveness of services to mitigate their problems were low. Enabling factors were the use of intermediaries (usually staff, but also relatives) to seek access. Residents expected that care home staff would monitor changes in their health and seek appropriate help unprompted.

CONCLUSIONS

Care home residents may normalise their health care needs and frame services as unable to remediate these which may combine to disincline older care home residents to seek care. Care access was enabled using intermediaries -either staff or relatives-and the expectation that staff would proactively seek care when they observed new/changed needs. Residents may over-estimate the health-related knowledge of care home staff and their ability to initiate referrals to NHS professionals.

The effects of empathy skills training on nursing students' empathy and attitudes toward elderly people

BACKGROUND

Nursing students' empathy and positive attitudes toward elderly people could help provide improved elderly care in their future practice. This study aimed to investigate the effects of empathy skills training on nursing students' empathy and attitudes toward elderly people.

METHODS

This quasi-experimental study was conducted in Yasuj, Iran in 2014. The sample consisted of 63 students at Hazrat Zeinab Nursing and Midwifery School who were randomly divided into a control (n = 31) and an intervention group (n = 32). The intervention group attended an eight-hour workshop on empathy skills that was presented through lectures, demonstration, group discussions, scenarios, and questioning. The data were collected using the Persian versions of Kogan's Attitudes towards Old People Scale and Jefferson Scale of Physician Empathy-Health Professionals Version. Then, the data were entered into the SPSS software, version 19 and were analyzed using descriptive statistics, chi-square test, t-test, and repeated measures analysis of variance.

RESULTS

The results showed that the empathy skills training program had a significant impact on the students' mean scores of empathy and attitudes toward elderly people (p < 0.001). The intervention group's mean score of empathy increased from 77.8 (SD = 10.7) before the intervention to 86 (SD = 7.3) immediately after that and 85.2 (SD = 8.9) 2 months later. Their mean score of attitude also increased from 110.8 (SD = 10.9) before the intervention to 155.2 (SD = 23.4) immediately after the intervention and 158.6 (SD = 23.2) 2 months later. Additionally, the empathy and attitude scores of the intervention group were significantly higher than those for control group immediately and 2 months after the intervention.

CONCLUSIONS

Empathy skills training improved the nursing students' empathy and attitudes towards elderly people. Therefore, empathy training is recommended to be incorporated into the undergraduate nursing curriculum.

Nursing staff's responses to thematic content of patients' expressed worries: observing communication in home care visits

Background

The aim of the study was to explore the thematic content of older persons’ expressed worries in home care visits, and how nursing staff respond to different thematic contents.

Methods

The study had a descriptive, observational design, including 195 audio-recorded Norwegian home care visits with 33 nursing staff and 48 older persons. In all, 638 patient cues/concerns (worries) and subsequent nursing staff’s responses were identified using Verona Coding Definitions of Emotional Sequences. A novel thematic coding scheme was used to label the thematic content of the cues/concerns. The nursing staff’s responses were grouped based on communicative function as emotion-focused, content-focused or ignoring/blocking the cue/concern. Group difference was analysed using Pearson’s chi-squared test, Fisher’s exact test, and adjusted residuals.

Results

The theme of worries was associated with elicitation of the cue/concern, either elicited by the nursing staff or spontaneously expressed by the patient (Chi-square, p< 0.001). “Ageing and bodily impairment” was the most common theme (66%) and was equally elicited by patients and nursing staff. Worries about “Relationships with others” (9%), “Health care-related issues” (15%) and “Life narratives and value issues” (9%) were mainly elicited by nursing staff. The nursing staff response was associated with the theme of worries (p˂0.001). For the sub-themes of “Ageing and bodily impairment”, Coping with existential challenges received more frequently emotion-focused responses (adjusted residuals: 3.2) and Expression of pain felt in the moment were more frequently ignored/blocked (adjusted residuals: 4.0, Fisher’s exact test, p< 0.001). For the sub-themes of “Relationships with others”, Being a burden more frequently received a content-focused response (adjusted residuals: 2.8), while Losing social ties more frequently received an emotion-focused response (adjusted residuals: 3.1, Fisher’s exact test, p = 0.009).

Conclusion

“Ageing and bodily impairment” was the most common theme and more frequently elicited by the older persons than other themes. Emotionally focused nursing staff responses were most common when addressing existential challenges and fear of losing social ties. Whereas nursing staff showed a tendency to ignore patients’ spontaneous expressions of pain. Further research should explore the influence of nursing staff’s responses on quality of care and patient satisfaction.