Home care communication : moving beyond the surface

Sammanfattning: Communication is an essential part of care and human interaction. While communication within care entails both task-focused and socio-emotional elements, nurses are sometimes perceived as too task-focused. When in need of care, older persons want to be perceived and treated as individuals – to feel involved. However, nurses might lack the prerequisites for establishing individualised home care, which is often based on daily tasks rather than on older persons’ needs and wishes. Despite the importance of communication in nurse-patient interactions, knowledge about daily communication within home care is scarce. Therefore, the overall aim of this thesis was to explore the naturally occurring communication between nursing staff and older persons during home care visits, with a focus on emotional distress and from a person-centred perspective.This thesis is an observational, cross-sectional study of the communication in 188 audio-recorded home care visits, and is part of the international COMHOME project. In Study I, older persons’ expressions of emotional distress were coded and analysed using the Verona Coding Definitions of Emotional Sequences [VR-CoDES]. The results showed that older persons often express emotional distress in the form of hints at emotional concerns, which were defined as cues. Explicit expressions of emotional distress, which were defined as concerns, were uncommon. The responses of nursing staff to older persons’ cues and concerns were coded and analysed in Study II using VR-CoDES. Nursing staff often responded by providing space rather than reducing it for further disclosure of older persons’ emotional distress. In Study III, the communication of emotional distress and participants’ characteristics were analysed using generalised linear mixed model [GLMM]. The results revealed that most cues and concerns were expressed by older females and to female nursing staff. Furthermore, elicitations of expressions of emotional distress were influenced by native language and profession, and responses that provided space were more often given to older females and to older persons aged 65-84 years. Home care communication between registered nurses and older persons was coded and analysed in Study IV using the Roter Interaction Analysis System [RIAS]. The results revealed a high degree of person-centred communication, especially during visits lasting 8-9 minutes, and that socio-emotional communication was more frequent than task-oriented communication.Home care communication contains important aspects of person-centred communication, with nursing staff providing space for the older person’s narrative; however, there are also challenges in the form of vague and implicit expressions of emotional distress. Keywords: communication; home care services; nursing staff; older persons; person-centred care; RIAS; VR-CoDES