Developing relationships in long term care environments: the contribution of staff

Abstract

The aim of this study was to consider how relationships in care homes influence the experience of older people, their families and staff. The main objective reported in this paper considers how these relationships are developed and the contribution that staff make to this process through the routines of care. Relationships have been found to be integral to experiences of residents, families and staff in care homes but little is known about how these relationships develop. Few studies consider relationships in care homes as their main focus and there is a dearth of studies that consider relationships from the perspective of residents, families and staff within the same care home. The study employed a constructivist design where the different perspectives held by participants were explored and shared to develop a joint construction of how relationships influenced their experiences. Data were collected from three care homes in England over two years between 2003-2005. Participant observation and interviews enabled a hermeneutic circle to be created between residents, families and staff. Data collection and analysis were conducted concurrently using a constant comparative method. Staff adopted three approaches to care delivery and these influenced the type of relationships that were developed between residents, families and staff. The three approaches were described as individualised task-centred, resident-centred and relationship-centred. This study progresses our understanding of the development of relationships between staff, residents and families in care homes by considering how the staff may support or constrain these relationships through their approach to care delivery. These findings have implications for developing practice in care homes to improve the experience of older people and their families by encouraging staff to develop a relationship-based approach to care routines.