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Therapeutic interpersonal relationships are the primary component of all health care interactions that facilitate the development of positive clinician-patient experiences. Therapeutic interpersonal relationships have the capacity to transform and enrich the patients' experiences. Consequently, with an increasing necessity to focus on patient-centered care, it is imperative for health care professionals to therapeutically engage with patients to improve health-related outcomes. Studies were identified through an electronic search, using the PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases of peer-reviewed research, limited to the English language with search terms developed to reflect therapeutic interpersonal relationships between health care professionals and patients in the acute care setting. This study found that therapeutic listening, responding to patient emotions and unmet needs, and patient centeredness were key characteristics of strategies for improving therapeutic interpersonal relationships.

The care of older persons is facing several challenges, especially as care tasks are becoming increasingly rationalized with less opportunity for relational engagement between nurse assistants and older persons. Evidence suggests this engagement is needed to promote well-being and satisfaction among the older persons with whom they work. The aim of this study was to explore how care, in the context of worker perspectives, is understood and experienced in home or residential care facilities. Focus-group interviews were conducted with experienced nursing assistants (n = 14) working in urban municipalities in Sweden. Data were analyzed using reflexive thematic analysis. The main theme: \"This work is more than a checklist of tasks, it's like simultaneous mind puzzles\", exposes the shortcomings of a \"task and time\" oriented care system while expecting individualized relational care practices. Three subthemes emerged: \"It's about responsibility, not remuneration\", \"Knowing them is part of the job\" and \"We do a lot that is not our job\". Participants expressed working responsibly day-to-day to find solutions to meet the needs of older persons. Tensions experienced between task and relational care orientations align to variation in understandings of care. These subthemes highlight that their work requires being context-sensitive to adapt in the moment, much like trying to solve mind puzzles. Increased rationalization of care, while expecting focus on relational aspects, sets nursing assistants in a challenging position. This paradox negatively affects the health of nursing assistants by creating unsustainable work. Without recognition of the required cognitive engagement in problem solving that is part of their work, the challenges of retention, sick leave and burnout are unlikely to be addressed. To ensure coordinated continuative care for older persons, nursing assistants need time and agency to enact relational practices that facilitate doing their work's dynamic care puzzles.

This article proposes a new typology between professional and voluntary care, thus seeking to understand why attempts to establish clear boundaries between them often end in ambiguity and frustration. We argue that because both forms of care represent their own unique and paradoxical ways of combining formal and relational care principles, any attempt to fix the boundaries between them and create the sense of a predictable world usually proves challenging. As such, we show that the two different care practices, in fact, have severe difficulties drawing their boundaries on their own terms. Finally, we consider how these insights might enhance efforts to manage collaborations between professional and voluntary care delivery.

The concept of dignity is core to community district nursing practice, yet it is profoundly complex with multiple meanings and interpretations. Dignity does not exist absolutely, but, rather, becomes socially (de)constructed through and within social interactions between nurses and older adult patients in relational aspects of care. It is a concept, however, which has, to date, received little attention in the context of the community nursing care of older adults. Previous research into dignity in health care has often focused on care within institutional environments, very little, however, explores the variety of ways in which dignity is operationalised in community settings where district nursing care is conducted ‘behind closed doors’, largely free from the external gaze. This means dignity (or the lack of it) may go unobserved in community settings. Drawing on observational and interview data, this paper highlights the significance of dignity for older adults receiving nursing care in their own homes. We will demonstrate, in particular, how dignity manifests within the relational aspects of district nursing care delivery and how tasks involving bodywork can be critical to the ways in which dignity is both promoted and undermined. We will further highlight how micro-articulations in caring relationships fundamentally shape the ‘dignity encounter’ through a consideration of the routine and, arguably, mundane aspects of community district nursing care in the home.

Background The implementation of a data-driven approach within the health care system happens in a rapid pace; including in the eldercare sector. Within Swedish eldercare, data-driven health approach is not yet widely implemented. In the specific context of long-term care for older adults, quality of care is as much determined by how social care is being performed as it is by what kind medical care that is provided. In particular, relational aspects have been proven to have a crucial influence on the experience of quality of care for the actors involved. Drawing on ethnographic material collected at a Swedish nursing home, this paper explores in what way the relational aspects of care could potentially become affected by the increased use of a data-driven health approach. Methods An ethnographic approach was adopted in order to investigate the daily care work at a long-term care facility as it unfolded. Fieldwork was conducted at a somatic ward in a Swedish long-term care facility over 4 months (86 h in total), utilizing the methods of participant observation, informal interviews and document analysis. The material was analyzed iteratively throughout the entire research process adopting thematic analysis. Results Viewing our ethnographic material through an observational lense problematising the policy discourse around data-driven health approach, two propositions were developed. First, we propose that relational knowledge risk becoming less influential in shaping everyday care, when moving to a data-driven health approach. Second, we propose that quality of care risk becoming more directed on quality of medical care at the expense of quality of life. Conclusion While the implementation of data-driven health approach within long-term care for older adults is not yet widespread, the general development within health care points towards a situation in which this will become reality. Our study highlights the importance of taking the relational aspects of care into consideration, both during the planning and implementation phase of this process. By doing this, the introduction of a data-driven health approach could serve to heighten the quality of care in a way which supports both quality of medical care and quality of life.

Few studies examine care as a relational process in long-term care, and still fewer describe the participation of residents with dementia. In this article, our objective was to understand the development of knowledge in this area by means of a meta-ethnography. Our search and selection process resulted in six eligible articles. Each documents a qualitative study of resident–staff interactions during care activities in a residential care setting, and includes participants with dementia. Tronto’s 4 Phases of Care were used to guide the identification of relational care practices within the articles selected. We identified five translatable concepts across the six studies: (1) doing with versus doing for, (2) staff responsiveness, (3) resident agency, (4) inclusive communication, and (5) time. In our new configuration of relational care, we combine these concepts to delineate an “interactive space” in which the agency of residents and initiative of staff are equally visible.

Due to its major impact on Dutch care homes for older people, the COVID-19 pandemic has presented care staff with unprecedented challenges. Studies investigating the experiences of care staff during the COVID-19 pandemic have shown its negative impact on their wellbeing. We aimed to supplement this knowledge by taking a narrative approach. We drew upon 424 personal narratives written by care staff during their work in a Dutch care home during the COVID-19 pandemic. Firstly, our results show that care staff have a relational-moral approach to good care. Residents’ wellbeing is their main focus, which they try to achieve through personal relationships within the triad of care staff–resident–significant others (SOs). Secondly, our results indicate that caregivers experience the COVID-19 mitigation measures as obstructions to relational-moral good care, as they limit residents’ wellbeing, damage the triadic care staff–residents–SOs relationship and leave no room for dialogue about good care. Thirdly, the results show that care staff experiences internal conflict when enforcing the mitigation measures, as the measures contrast with their relational-moral approach to care. We conclude that decisions about mitigation measures should be the result of a dialogic process on multiple levels so that a desired balance between practical good care and relational-moral good care can be determined.

This study assessed a) the impact of playing the Dignity board game on participants’ understanding of respectful maternal and newborn care and b) participants’ perceptions of how the game influenced their subsequent practice in Malawi and Zambia. Nurse-midwives’ poor understanding of respectful maternal and newborn care can lead to substandard practice; thus, effective education is pivotal. Used in several disciplines, game-based learning can facilitate skills acquisition and retention of knowledge. a quasi-experimental study, using mixed-methods of data collection. Data were collected between January and November 2020. Nurse-midwives (N = 122) and students (N = 115) were recruited from public hospitals and nursing schools. Completion of paper-based questionnaires, before and after game-playing, assessed knowledge of respectful care principles and perceptions around behaviours and practice. Face-to-face interviews (n = 18) explored perceived impact of engaging with the game in clinical practice. Paired and unpaired t-test were used to compare scores. Qualitative data were analysed and reported thematically. The study was completed by 215 (90.7 %) participants. Post-test scores improved significantly for both groups combined; from 25.91 (SD 3.73) pre-test to 28.07 (SD 3.46) post-test (paired t = 8.67, 95 % confidence interval 1.67–2.65), indicating an increased knowledge of respectful care principles. Nurse-midwives performed better than students, both before and after. In Malawi, the COVID pandemic prevented a third of nurse-midwives’ from completing post-game questionnaires. Qualitative findings indicate the game functioned as a refresher course and helped nurse-midwives to translate principles of respectful care into practice. It was also useful for self-reflection. The Dignity board game has the potential to enhance understanding and practice of respectful maternal and newborn care principles in low-resource settings. Integration into nursing and midwifery curricula and in-service training for students and healthcare workers should be considered.

Most direct residential aged care is provided by personal care assistants (PCAs), with western societies increasingly relying on culturally diverse aged care workers. In Australia and internationally, studies have reported that the level of training in both instrumental and relational care for PCAs is insufficient and inconsistent. This study evaluated the impact of The Little Things training program, designed for culturally diverse PCAs and students training to become PCAs. A modified Most Significant Change process, comprising a group-based qualitative analysis of narratives, was used to gain a rich understanding of the impacts and outcomes of the training. Narratives supplied by 29 PCAs and students were reviewed with aged care and training organization managers, who identified six themes: Increased confidence; Taking time; Building rapport and collaboration; Awareness of new skills; Seeing the whole person; and Positive impact on the resident. These themes reflected two key aims of The Little Things training: improving PCAs’ communication with residents and increasing PCAs’ confidence in communicating with residents. The study findings showed that The Little Things training program can improve the confidence of PCAs to communicate with aged care residents and may improve their capacity to form relationships.

The frail and homebound older adult populations currently experience difficulties accessing primary care in the medical office. Given this fundamental access to care problem, and the questionable care quality that arises when navigating a labyrinthine health-care system, these populations have typically been subject to inadequate primary care. To meet their needs better, growing research stresses the importance of providing comprehensive home-based primary care (HBPC), delivered by an inter-professional team of health-care providers. Family care-givers typically provide the majority of care within the home, yet their perceptions of HBPC remain under-researched. The purpose of this study was to explore unpaid care-givers' perceptions of and experiences with HBPC programmes in Toronto, Canada. We conducted qualitative inductive content analysis, using analytic procedures informed by grounded theory, to discover a number of themes regarding unpaid care-givers' understandings of HBPC. Findings suggest that, compared to the standard office-based care model, HBPC may better support unpaid care-givers, providing them assistance with system navigation and offering them the peace of mind that they are not alone, but have someone to call should the need arise. The implications of this research suggest that HBPC could be a model to help mitigate the discontinuities in care that patients with comorbid chronic conditions and their attendant unpaid care-givers experience when accessing fragmented health, home and social care systems.