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Att mötas genom och bortom orden: Implementering av personcentrerad kommunikation inom vård och omsorg i hemmet
University of Borås, Faculty of Caring Science, Work Life and Social Welfare.ORCID iD: 000-0002-8379-7910
2023 (Swedish)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Through words and beyond : Implementation of person-centered communication in home care (English)
Abstract [en]

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. 

Place, publisher, year, edition, pages
Borås: Högskolan i Borås, 2023.
Series
Skrifter från Högskolan i Borås, ISSN 0280-381X ; 133
Keywords [en]
person-centered communication, home care, educational intervention, implementation
National Category
Nursing
Research subject
The Human Perspective in Care
Identifiers
URN: urn:nbn:se:hb:diva-28711ISBN: 978-91-89271-82-1 (print)ISBN: 978-91-89271-83-8 (electronic)OAI: oai:DiVA.org:hb-29368DiVA, id: diva2:1732217
Public defence
2023-03-10, Sparbankssalen, Allégatan 1, Borås, 13:00 (Swedish)
Opponent
Available from: 2023-01-30 Created: 2023-01-30 Last updated: 2023-01-30Bibliographically approved
List of papers
1. Process evaluation of the ACTION programme: a strategy for implementing person‐centred communication in home care
Open this publication in new window or tab >>Process evaluation of the ACTION programme: a strategy for implementing person‐centred communication in home care
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2021 (English)In: BMC Nursing, E-ISSN 1472-6955, Vol. 20, no 1, article id 56Article in journal (Refereed) Published
Abstract [en]

Background: There is currently a strong emphasis on person-centred care (PCC) and communication; however, little research has been conducted on how to implement person-centred communication in home care settings. Therefore, the ACTION (A person-centred CommunicaTION) programme, which is a web-based education programme focusing on person-centred communication developed for nurse assistants (NAs) providing home care for older persons, was implemented. This paper reports on the process evaluation conducted with the aim to describe and evaluate the implementation of the ACTION programme. Methods: A descriptive design with a mixed method approach was used. Twenty-seven NAs from two units in Sweden were recruited, and 23 of them were offered the educational intervention. Quantitative and qualitative data were collected from multiple sources before, during and after the implementation. Quantitative data were used to analyse demographics, attendance and participation, while qualitative data were used to evaluate experiences of the implementation and contextual factors influencing the implementation. Results: The evaluation showed a high degree of NA participation in the first five education modules, and a decrease in the three remaining modules. Overall, the NAs perceived the web format to be easy to use and appreciated the flexibility and accessibility. The content was described as important. Challenges included time constraints; the heavy workload; and a lack of interaction, space and equipment to complete the programme. Conclusions: The results suggest that web-based education seems to be an appropriate strategy in home care settings; however, areas for improvement were identified. Our findings show that participants appreciated the web-based learning format in terms of accessibility and flexibility, as well as the face-to-face group discussions. The critical importance of organizational support and available resources are highlighted, such as management involvement and local facilitation. In addition, the findings report on the implementation challenges specific to the dynamic home care context. Trial registration: This intervention was implemented with nursing assistants, and the evaluation only involved nursing staff. Patients were not part of this study. According to the ICMJE, registration was not necessary (). © 2021, The Author(s).

Place, publisher, year, edition, pages
Springer Nature, 2021
Keywords
Communication, Education, Home care, Implementation, Intervention, Nursing assistants, Older persons, Person‐centred, aged, article, demography, facilitation, human, learning, nursing assistant, nursing staff, quantitative analysis, Sweden, workload
National Category
Nursing
Research subject
The Human Perspective in Care
Identifiers
urn:nbn:se:hb:diva-25891 (URN)10.1186/s12912-021-00565-8 (DOI)000638121300001 ()2-s2.0-85104091353 (Scopus ID)
Available from: 2021-07-12 Created: 2021-07-12 Last updated: 2024-07-04
2. Communication in home care—A feasibility study of an educational intervention in self‐efficacy and job satisfaction
Open this publication in new window or tab >>Communication in home care—A feasibility study of an educational intervention in self‐efficacy and job satisfaction
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2023 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 10, no 3, p. 1375-1382Article in journal (Refereed) Published
Abstract [en]

Aim

To explore the feasibility of evaluating a novel educational intervention on person-centered communication for nursing assistants (NAs) in home care.

Design

A feasibility study with pre- and post-assessments.

Methods

Feasibility was assessed pre- and post-intervention, including evaluation of data collection procedures, completion rates and missing data in two questionnaires: Self-efficacy Questionnaire measuring communication skills and Measure of Job Satisfaction, analysed descriptively and statistically.

Results

The questionnaires were feasible and acceptable for the NAs to complete and understand. The pre- and post-assessments showed 83% and 61% completion rates, respectively, and a low proportion of missing data. Barriers for not participating in data collection were stress caused by staff shortages and high workload. Preliminary analysis of the questionnaires showed no significant difference pre- and post-intervention, even though an overall tendency of increased communication self-efficacy was observed. The NAs' self-efficacy ratings also revealed a ceiling effect.

 

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
communication, evaluation, feasibility, home care, intervention, job satisfaction, self-efficacy
National Category
Didactics
Research subject
The Human Perspective in Care
Identifiers
urn:nbn:se:hb:diva-28722 (URN)10.1002/nop2.1387 (DOI)000860296700001 ()2-s2.0-85138725712 (Scopus ID)
Funder
University of Borås
Note

Forskningsfinansering: Agneta Prytz-Folkes och Gösta Folkes Stiftelse

Available from: 2022-10-11 Created: 2022-10-11 Last updated: 2023-08-24Bibliographically approved

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