Introduction

Communication between older persons and nursing assistants is important in providing high-quality, person-centred home care. While previous research has reported on older persons' emotional concerns during home care conversations, there is a need to gain an in-depth understanding of emotional concerns' role in such conversations and how to support the older persons' comfort and well-being. Therefore, this study aimed to explore the nature and focus of emotional communication between older persons and nursing assistants in home care.

Methods

A descriptive qualitative design using observational data from 83 audio-recorded home care visits was used to identify and analyse sequences of distressing emotional communication, analysed through thematic analysis.

Results

In this study, four themes were described illustrating how emotional communication between older persons and nursing assistants during home care visits creates opportunities for empathy: (1) recognising empathic opportunities, (2) identifying subtle and vague signs of emotional distress, (3) expressing needs for emotional support, and (4) striving to restore comfort in challenging conversations.

Conclusions

Conversations about older persons' emotions and worries can be complex. The findings indicate a fine line between meaningfulness and discomfort in emotional sequences. Expressions of emotional distress provide empathic opportunities that call for attentiveness and sensitivity from nursing assistants, implying a need for education and training in person-centred communication.

Implications for Practice

Emotional communication acknowledging empathic opportunities enhances person-centred care by promoting trust, comfort, and well-being. Ultimately, emotional communication reinforces the importance of empathy in home care and creates space for emotional interactions, leading to more supportive relationships.

Background: Enhancing communication in everyday nursing conversations is essential for promoting person-centred care and preserving the dignity of older persons. This qualitative study was performed to gain an in-depth understanding of the nursing assistants’ person-centred communication skills and their communication style. The aim was to explore the communication styles of nursing assistants during home care visits to older persons.

Methods: This deductive qualitative study was based on observational data gathered with audio recordings of naturally occurring communication between nursing assistants and older persons during home care visits. Data collection was part of an educational intervention study for in-home nursing assistants and took place from March to December 2022. Data were analysed with a method for deductive qualitative content analysis. The deductive analysis was guided by the framework developed by Bottorff and Morse, and the communication styles identified in the current study, doing more, doing with, doing for, and doing tasks.

Findings: A total of 70 audio recording home care visits, including 39 nursing assistants and 37 older persons were included. Based on conversations during these visits, four distinct communication styles employed by NAs in their everyday interactions with older persons were described in depth with focus on communication patterns observed. The different styles included nuances of communication ranging from being more relational and collaborative to more task-oriented interactions. A pattern of doing too much was also observed.

Conclusions: The communication styles used influenced the degree of person-centredness. Nurse assistants’ communication styles can vary during conversations and appear to reflect individual traits. The emotional demands of home care work may require more recognition and support from policymakers and managers. Strengthening person-centred communication and care for older persons requires both training and organizational support.

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. 

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.

Background: In this study, the focus is on how to support the competence development needed for nursing assistants in home care. Home care services for older persons can be challenging concerning the nature of the interpersonal interaction and communication needed to care for and respond to the diverse needs of older people who seek to live well in our communities. This implies a need to offer more person-centred care (PCC) to older persons. However, there is a lack of knowledge on how to develop such competence. We, therefore, developed A Person-centred CommunicaTION (ACTION) programme, which is a web-based educational intervention aimed at supporting competence development for nursing assistants. The research objective is to evaluate the ACTION programme with respect to participants’ responses to and the effect of the intervention. Methods: A multicentre case–control study with pre- and post-assessments was designed. The ACTION programme will be implemented at home care units, in two different geographic areas in Sweden. A total of 300 nursing assistants will be recruited: 150 for the intervention group and 150 for the control group. We will evaluate the impact measures and the process. Pre- and post-assessments will be performed with data collected via a) audio recordings of communication, b) a questionnaire on self-efficacy communication skills, PCC, empathy and job satisfaction, c) user data, evaluation forms, field notes and observations, and d) interviews. The data will be analysed with descriptive and analytic statistics and/or qualitative methods for meanings. Discussion: This study has the potential to contribute to the evidence supporting competence development required to offer person-centred and quality home care to older persons and to meet upcoming needs for flexible and easily accessible competence development. Trial registration: ISRCTN64890826. Registered 10 January 2022, https://www.isrctn.com/ISRCTN64890826 

Aim

To explore nursing assistants' (NAs') experiences of developing communication skills while participating in an educational intervention on person-centred communication.

Design

A descriptive qualitative study was conducted.

Methods

Data were collected from interviews and written assignments before, during and after an educational intervention on person-centred communication targeting NAs in home care services. The data were analysed using a phenomenological approach. A total of 25 NAs participated in the study.

Results

The findings describe NAs' experiences concerning the communication skills needed for building relationships with older persons and handling emotionally challenging situations. The educational intervention increased their knowledge and awareness of the importance of communication skills and how such skills are developed and refined.

An educational intervention to improve communication skills in home care – a feasibility study

Background

An educational intervention focused on person-centred communication with older persons in home care was developed. Twenty-three nursing assistants (NAs) from two home care units were offered the intervention. This feasibility study was conducted to capture benefits and pit falls with study processes before large scale interventions, such as acceptability and appropriateness of evaluation methods.

Aim

To explore the feasibility of proposed methods for evaluating a novel educational intervention on person-centered communication for NAs in home care.

Method

Feasibility study with pre- and post-assessments, including evaluation of data collection procedures, completion rates, and missing data for two questionnaires: Self-efficacy Questionnaire measuring communication skills and Measure of Job Satisfaction. Descriptive and statistical analysis was conducted. 

Results

The results showed a completion rate of 83% and 61% in pre- and post-assessment respectively, and a low proportion of missing data. The questionnaires were feasible and acceptable for NAs to complete and understand. Stress due to staff shortages and high workload negatively affected NAs’ participation in data collection. Overall, NAs rated their communication skills as high with a tendency towards higher communication self-efficacy after the intervention, however, this difference was not statistically significant. Job satisfaction remained unchanged pre- and post-intervention.

Conclusion

Low follow-up rates suggest that the data collection procedures need refinement. Although the outcomes are preliminary at this point, they indicate a ceiling effect in NAs’ self-efficacy ratings. The ceiling effect limits possibilities for improvement and suggests that studies with a larger sample is needed.

Implications for caring in a changing world

In a changing world, where a rapid aging population challenges home care services, there is a need for innovative interventions that support and strengthen health care professionals’ communication skills, aiming at improving older persons’ well-being This study contributes with knowledge to the complexity of developing and evaluating complex interventions on communication in home care.

Background: 

The home care of older persons includes inter-personal interactions and communication needed to care for and respond to diverse needs of older people. Previous research has focused on emotional expressions of older persons and responses by nursing staff. Research on the meaning of the interaction in these sequences is sparse. Therefore, the aim of this study was to illuminate the meaning attached to sequences of emotional communication and the interaction during these sequences between older persons and nursing assistants during home care visits.

Methods: 

A descriptive observational design was used. The data consisted of 44 audio recordings of real-life conversations between older persons and nursing assistants during home care visits. A hermeneutic phenomenological analysis was conducted.

Findings: 

Preliminary results indicate sequences of emotional communication being a window of opportunities. The interaction that followed were linked to dual and sometimes incongruent meanings. Expressions being actively blocked or ignored could cause an increase of unpleasant emotions or distract away from negative feelings. Simultaneously, such conversations could both ease or add to the complexity of the interaction and communication. Conversations elaborating on the older persons’ emotions seemed to instill trust and create meaningfulness, at the same time as these situations contained unpleasant moments with sad or angry feelings. The risk for discomfort in these sequences could threaten the trust in the relationship.

Discussion: 

Conversations on older persons worries can be complex: the findings point to a fine line between meaningfulness and distress in these sequences. Unpleasant emotions call for attention and caution, these may need to be noticed at the same time as they cannot be forced out. 

Background: Communication is important for nurse assistants (NAs) when caring for older persons. There is limited research about how to improve the communication competence of NAs in home care. The aim was to describe NAs perception on learning in relation to an educational intervention on person-centred communication.

Methods: A qualitative descriptive study was conducted. Data consisted of four group interviews, five individual in-depth interviews and written reflection assignments from participants gathered during the web-based intervention. In total 23 NAs at two home care units participated. The data were analysed using a phenomenographic approach. This is a qualitative method for analysis developed from Nordic traditions of phenomenology. Phenomenography aims to describe individual perceptions of a certain phenomenon.

Preliminary findings points to the nurse assistants perceiving that the education supported their development of person-centred communication. They pointed out self-reflections as important for their learning as well as to get confirmation on what was already known. The NAs described that the intervention added to their knowledge and skills. Even though, there was more to learn and challenges that remained regarding communication in challenging situations such as caring for persons in end-of-life and supporting their relatives, caring for persons being aggressive or violent.

Preliminary implications of research: This study can provide knowledge on participants’ perspective on their learning process, which may be important to consider when conducting educational interventions in home care as well as other health care contexts.