Background: Communication between older persons and nursing staff is an important component in the provision of person-centered home care. However, there is a lack of research on how to implement person-centered communication in home care settings. Aim: The overall aim of the thesis was to explore the communication between older persons and nursing assistants (NAs) in home care, as well as to implement and evaluate an educational intervention on person-centered communication.  

Methods: The thesis consist of four studies combining qualitative and quantitative approaches. Study I explore emotional communication during home care visits. Data was collected by audio-recordings and analyzed by using VR-CoDES and thematic analysis based on descriptive phenomenology. Study II was a process evaluation of the implementation, where multiple data was gathered and analyzed by mixed methods. Study III explore the NAs’ experiences of developing communication skills. Data collection consisted of interviews and written assignments, analyzed using a phenomenological approach. Study IV explore the feasibility of evaluating the intervention by using a self-efficacy questionnaire and measuring job satisfaction, analyzed descriptively and statistically. 

Main results: Emotional communication during home care visits can create empathic opportunities for meaningfulness and trust, at the same time as it can be challenging, requiring courage, time, and communication skills. The intervention, aimed at supporting the NAs to develop communication skills, was implemented through a web-based educational program. The program format offered flexibility and accessibility for the NAs. The education contributed to insights on strengths and weaknesses in the NAs communication through reflection, and they obtained strategies on how to communicate in challenging situations. Organizational barriers challenged the implementation process and program completion. The NAs ratings of communication skills before and after the intervention showed tendencies towards improvement. There was no difference in their estimate of job satisfaction before and after intervention.    

Conclusion: Emotional communication is a complex and dynamic phenomenon, requiring NAs being equipped with a repertoire of communication skills that can guide them to manage different situations in home care. Key factors for successful implementation of educational interventions were identified: the possibility to adapt and modify the implementation to the context, and organizational prerequisites that support the implementation process and the participants’ learning. Educational interventions, together with support from the organization, can enable NAs to flourish in their communication with older persons through words and beyond.