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Home care communication: moving beyond the surface
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.ORCID iD: 0000-0002-5685-8669
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

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

Place, publisher, year, edition, pages
Västerås: Mälardalen University , 2019.
Series
Mälardalen University Press Dissertations, ISSN 1651-4238 ; 288
Keywords [en]
communication, home care services, nursing staff, older persons, person-centred care, RIAS, VR-CoDES
National Category
Medical and Health Sciences
Research subject
Care Sciences
Identifiers
URN: urn:nbn:se:mdh:diva-42862ISBN: 978-91-7485-424-4 (print)OAI: oai:DiVA.org:mdh-42862DiVA, id: diva2:1295591
Public defence
2019-05-10, Beta, Mälardalens högskola, Västerås, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2019-03-12 Created: 2019-03-12 Last updated: 2019-05-08Bibliographically approved
List of papers
1. Older persons' expressions of emotional cues and concerns during home care visits. Application of the Verona coding definitions of emotional sequences (VR-CoDES) in home care
Open this publication in new window or tab >>Older persons' expressions of emotional cues and concerns during home care visits. Application of the Verona coding definitions of emotional sequences (VR-CoDES) in home care
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2017 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 100, no 2, p. 276-282Article in journal (Refereed) Published
Abstract [en]

Objective: This study aims to a) explore to what extent older persons express emotional cues and concerns during home care visits; b) describe what cues and concerns these older persons expressed, and c) explore who initiated these cues and concerns. Methods: A descriptive and cross-sectional study was conducted. Data consisted of 188 audio recorded home care visits with older persons and registered nurses or nurse assistants, coded with the Verona coding definitions on emotional sequences (VR-CoDES). Results: Emotional expressions of cues and concerns occurred in 95 (51%) of the 188 recorded home care visits. Most frequent were implicit expressions of cues (n = 292) rather than explicit concerns (n = 24). Utterances with hints to hidden concerns (63,9%, n = 202) were most prevalent, followed by vague or unspecific expressions of emotional worries (15,8%, n = 50). Most of these were elicited by the nursing staff (63%, n = 200). Conclusion: Emotional needs expressed by the older persons receiving home care were mainly communicated implicitly. To be attentive to such vaguely expressed emotions may demand nursing staff to be sensitive and open. Practice implications: The VR-CoDES can be applied on audio recorded home care visits to analyse verbal and emotional communication, and may allow comparative research. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2017
Keywords
Patient-provider communication, Concern, Cue, Home care, Nursing
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-35123 (URN)10.1016/j.pec.2016.09.009 (DOI)000396886000013 ()27692492 (PubMedID)2-s2.0-84999029525 (Scopus ID)
Available from: 2017-04-06 Created: 2017-04-06 Last updated: 2019-03-12Bibliographically approved
2. Registered Nurses' and nurse assistants' responses to older persons' expressions of emotional needs in home care
Open this publication in new window or tab >>Registered Nurses' and nurse assistants' responses to older persons' expressions of emotional needs in home care
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2017 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, no 12, p. 2923-2932Article in journal (Refereed) Published
Abstract [en]

Aim: This study aims to explore nurse assistants' and Registered Nurses' responses to older persons' expressions of emotional needs during home care visits. Background: Communication is a central aspect of care. Older persons might express different emotions and needs during home care visits and such expressions can be challenging to respond to. Little is known about communication in home care or nursing staff responses to older persons' expressed emotional needs. Design: Descriptive, cross-sectional design on nursing staff responses to older persons' negative emotions in home care. Methods: Collected data consisted of audio recordings of home care visits between older persons and nursing staff. Data were collected between August 2014-November 2015. The nursing staff responses to older persons' negative emotions in the communication were analysed with the Verona Coding Definitions of Emotional Sequences (VR-CoDES). Results: The nursing staff most often give non-explicit responses, providing space for further disclosure of older persons' expressed negative emotions. Such responses were more frequent if the nursing staff had elicited the older persons' expressions of a negative emotion than if such expressions were elicited by the older persons themselves. Most frequent types of responses were backchannel, active invitation or information advice. Conclusion: The nursing staff responses were mainly non-explicit responses providing space for older persons to tell more about their experiences. Such responses can be discussed in terms of person-centred communication and is important for the comfort of emotional concerns.

Place, publisher, year, edition, pages
WILEY, 2017
Keywords
communication, emotions, home care, nursing, nursing staff, older persons, person-centred, responses, VR-CoDES
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-37619 (URN)10.1111/jan.13356 (DOI)000418365200014 ()28586520 (PubMedID)2-s2.0-85021736037 (Scopus ID)
Available from: 2018-01-05 Created: 2018-01-05 Last updated: 2019-03-12Bibliographically approved
3. Emotional communication with older people: A cross-sectional study of home care
Open this publication in new window or tab >>Emotional communication with older people: A cross-sectional study of home care
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(English)In: Nursing and Health Sciences, ISSN 1442-2018, article id NHS12611Article in journal (Refereed) Accepted
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-42881 (URN)10.1111/nhs.12611 (DOI)000486246900015 ()
Available from: 2019-03-07 Created: 2019-03-07 Last updated: 2019-10-03Bibliographically approved
4. A positive tone and socio-emotional talk: Exploring person-centered aspects of home care communication
Open this publication in new window or tab >>A positive tone and socio-emotional talk: Exploring person-centered aspects of home care communication
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(English)Manuscript (preprint) (Other academic)
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-42894 (URN)
Available from: 2019-03-12 Created: 2019-03-12 Last updated: 2019-03-12Bibliographically approved

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Höglander, Jessica

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