Older persons' expressed worries during nursing care at home: Do health complexity and nature of nursing care in the visit matter?

OBJECTIVE: Older persons receiving home care express more cues and concerns compared to other clinical contexts. Increased health condition complexity requires a corresponding increase in nursing competence. The aim of this study was to explore how complexity of older persons' health and nature of the visit influenced their expressed worries. METHODS: In this cross-sectional explorative study, we analysed older persons' expressed worries (n = 508) identified by the Verona Coding Definitions of Emotional Sequences (VR-CoDES) in 129 audio-recorded home care visits with older persons (≥65 years), collected in 3 city districts and 1 rural area in Norway. RESULTS: Expressed worries of 45 older persons were included in the analysis: 18 had low health complexity, 5 moderate and 22 high health complexity. The nature of the visit affected the number of expressed worries, health complexity did not. Most of the worries were expressed during basic nursing care visits and/or medication administration. CONCLUSION: Findings suggest that home visit type may influence the older persons' expressed worries. The complexity of the older persons' health condition seems to have little impact on the expressed worries. PRACTICE IMPLICATIONS: Knowledge about communication in different complexity of visits is important when planning care for older persons.

Emotional communication in home care: A comparison between Norway and Sweden.

OBJECTIVE: Given the free movement of workers across countries, knowledge regarding communication differences between countries is imperative. In this study, we explored and compared the supportive responses of nursing staff to older persons' emotions in home care in Norway and Sweden. METHODS: The study had an observational, cross-sectional, comparative design, which included 383 audio-recorded home-care visits. Communication was coded using Verona Coding Definitions of Emotional Sequences. Worries and responses were categorised with regard to reference, communicative function and level of person-centredness. Standard statistical tests were used to analyse the data. RESULTS: The Swedish nursing staff provided space for further disclosure of worry more frequently than the Norwegian nursing staff (75.0 % versus 60.2 %, χ2 = 20.758, p < 0.01). In all, 65 % of the responses were supportive. Multiple logistic regression analyses showed that highly person-centred responses were independently associated with worries phrasing an emotion, OR (95 % CI) 3.282 (1.524-7.067). CONCLUSION: The level of person-centredness was associated with the way in which older persons expressed their distress. The Swedish nursing staff provided opportunities for further disclosure of worries more frequently than the Norwegian nursing staff. PRACTICE IMPLICATIONS: Findings of intercultural differences should be incorporated into the training of nursing staff.

Nursing staff's responses to thematic content of patients' expressed worries: observing communication in home care visits.

BACKGROUND: The aim of the study was to explore the thematic content of older persons' expressed worries in home care visits, and how nursing staff respond to different thematic contents. METHODS: The study had a descriptive, observational design, including 195 audio-recorded Norwegian home care visits with 33 nursing staff and 48 older persons. In all, 638 patient cues/concerns (worries) and subsequent nursing staff's responses were identified using Verona Coding Definitions of Emotional Sequences. A novel thematic coding scheme was used to label the thematic content of the cues/concerns. The nursing staff's responses were grouped based on communicative function as emotion-focused, content-focused or ignoring/blocking the cue/concern. Group difference was analysed using Pearson's chi-squared test, Fisher's exact test, and adjusted residuals. RESULTS: The theme of worries was associated with elicitation of the cue/concern, either elicited by the nursing staff or spontaneously expressed by the patient (Chi-square, p< 0.001). "Ageing and bodily impairment" was the most common theme (66%) and was equally elicited by patients and nursing staff. Worries about "Relationships with others" (9%), "Health care-related issues" (15%) and "Life narratives and value issues" (9%) were mainly elicited by nursing staff. The nursing staff response was associated with the theme of worries (p˂0.001). For the sub-themes of "Ageing and bodily impairment", Coping with existential challenges received more frequently emotion-focused responses (adjusted residuals: 3.2) and Expression of pain felt in the moment were more frequently ignored/blocked (adjusted residuals: 4.0, Fisher's exact test, p< 0.001). For the sub-themes of "Relationships with others", Being a burden more frequently received a content-focused response (adjusted residuals: 2.8), while Losing social ties more frequently received an emotion-focused response (adjusted residuals: 3.1, Fisher's exact test, p = 0.009). CONCLUSION: "Ageing and bodily impairment" was the most common theme and more frequently elicited by the older persons than other themes. Emotionally focused nursing staff responses were most common when addressing existential challenges and fear of losing social ties. Whereas nursing staff showed a tendency to ignore patients' spontaneous expressions of pain. Further research should explore the influence of nursing staff's responses on quality of care and patient satisfaction.

The use of supportive communication when responding to older people's emotional distress in home care - An observational study.

BACKGROUND: Responding to older people's distress by acknowledging or encouraging further discussion of emotions is central to supportive, person-centred communication, and may enhance home care outcomes and thereby promote healthy aging. This observational study describes nursing staff's responses to older people's emotional distress, and identify factors that encourage further emotional disclosure. METHODS: Audio-recorded home care visits in Norway (n = 196), including 48 older people and 33 nursing staff, were analysed with the Verona Coding Definitions of Emotional Sequences, identifying expressions of emotional distress and subsequent provider responses. The inter-rater reliability (two coders), Cohen's kappa, was >0.6. Sum categories of emotional distress were constructed: a) verbal and non-verbal expressions referring to emotion, b) references to unpleasant states/circumstances, and c) contextual hints of emotion. A binary variable was constructed based on the VR response codes, differentiating between emotion-focused responses and responses that distanced emotion. Fisher's exact test was used to analyse group differences and determined variables included in a multivariate logistic regression analysis to identify factors promoting emotion-focused responses. RESULTS: Older people's expressions of emotional distress (n = 635) comprised 63 explicit concerns and 572 cues. Forty-eight per cent of nursing staff responses (n = 638) were emotion-focused. Emotion-focused responses were observed more frequently when nursing staff elicited the expression of emotional distress from the patients (54%) than when patients expressed their emotional distress on their own initiative (39%). Expressions with reference to emotion most often received emotion-focused responses (60%), whereas references to unpleasant states or circumstances and contextual hints of emotion most often received non-emotion-focused responses (59%). In a multivariate logistic model, nursing staff's elicitation of the emotional expression (vs patients initiating it) and patients' expression with a reference to an emotion (vs reference to unpleasant states or contextual hints) were both explanatory variables for emotion-focused responses. CONCLUSIONS: Emotion-focused responses were promoted when nursing staff elicited the emotional expression, and when the patient expression referred to an emotion. Staff responded most often by acknowledging the distress and using moderately person-centred supportive communication. More research is needed to establish generalizability of the findings and whether older people deem such responses supportive.

Characteristics of communication with older people in home care: A qualitative analysis of audio recordings of home care visits.

AIMS AND OBJECTIVES: To describe the characteristics of communication practice in home care visits between older people (over 65 years old) and nurse assistants and to discuss the findings from a person-centered perspective. BACKGROUND: The older population is increasing worldwide, along with the need for healthcare services in the person's home. To achieve a high-quality care, person-centered communication is crucial. DESIGN: A descriptive design with a qualitative inductive approach was used. METHOD: Fifteen audio recordings of naturally occurring conversations between 12 nurse assistants and 13 older people in Norway were analysed by qualitative content analysis. RESULTS: Four categories were revealed through analysis: (i) supporting older people's connection to everyday life; (ii) supporting older people's involvement in their own care; (iii) attention to older people's bodily and existential needs; and (iv) the impact of continuity and predictability on older people's well-being. CONCLUSIONS: The communication between the older people and the nurse assistants during home care visits was mainly task-oriented, but also related to the person. The older people were involved in the tasks to be carried out and humour was part of the communication. Greater attention was paid to bodily than existential needs. The communication was connected with the older people's everyday life in several ways. Time frames and interruptions concern the older people; hearing and speech impairments were a challenge to communication. To enhance person-centred communication, further studies are needed, especially intervention studies for healthcare professionals and students. RELEVANCE TO CLINICAL PRACTICE: Being responsive to older people's subjective experiences is important in meeting their needs in home care. Communication that addresses the need for trust and predictability is important for older people. Responding to existential needs require more attention. The home care setting has an impact on communication.

Older persons' worries expressed during home care visits: Exploring the content of cues and concerns identified by the Verona coding definitions of emotional sequences.

OBJECTIVE: Little is known about how older persons in home care express their concerns. Emotional cues and concerns can be identified by the Verona coding definitions of emotional sequences (VR-CoDES), but the method gives no insight into what causes the distress and the emotions involved. The aims of this study are to explore (1) older persons' worries and (2) the content of these expressions. METHODS: An observational exploratory two-step approach was used to investigate audiotaped recordings from 38 Norwegian home care visits with older persons and nurse assistants. First, 206 cues and concerns were identified using VR-CoDES. Second, the content and context of these expressions were analysed inductively. RESULTS: Four main categories emerged: worries about relationships with others, worries about health care-related issues, worries about aging and bodily impairment, and life narratives and value issues, with several subcategories showing the causes of worry and emotions involved. CONCLUSION: The two-step approach provides an in-depth knowledge of older persons' worries, causes of worries, and their related emotions. PRACTICE IMPLICATIONS: The subcategories described in a language close to the experience can be useful in practice development and communication training for students and health care providers.

A cross-sectional study on person-centred communication in the care of older people: the COMHOME study protocol.

INTRODUCTION: This paper presents an international cross-sectional study on person-centred communication with older people receiving healthcare (COMHOME). Person-centred care relies on effective communication, but few studies have explored this with a specific focus on older people. The main aim of the COMHOME study is to generate knowledge on person-centred communication with older people (>65 years) in home healthcare services, radiographic and optometric practice. METHODS AND ANALYSIS: This study will explore the communication between care providers and older persons in home care services. Home healthcare visits will be audiorecorded (n=500) in Norway, the Netherlands and Sweden. Analyses will be performed with the Verona Coding Definitions for Emotional Sequences (VR-CoDES), the Roter Interaction Analysis System (RIAS) and qualitative methods. The content of the communication, communicative challenging situations as well as empathy, power distance, decision-making, preservation of dignity and respect will be explored. In Norway, an additional 100 encounters, 50 in optometric practice (video recorded) and 50 in radiographic practice (audiorecorded), will be analysed. Furthermore, healthcare providers' self-reported communication skills, empathy, mindfulness and emotional intelligence in relation to observed person-centred communication skills will be assessed using well-established standardised instruments. ETHICS AND DISSEMINATION: Depending on national legislation, approval of either the central ethical committees (eg, nation or university), the national data protection officials or the local ethical committees (eg, units of home healthcare) was obtained. Study findings will be disseminated widely through peer-reviewed publications and conference presentations. The research findings will add knowledge to improve services provided to this vulnerable group of patients. Additionally, the findings will underpin a training programme for healthcare students and care providers focusing on communication with older people.