Life, death, isolation, and compression stockings

Tanja Gustafsson. Tanja Gustafsson has a background as a district nurse at a primary healthcare centre. She began her studies towards a doctorate within the field of The Human Perspective in Care in the autumn of 2017. The purpose of her doctoral work is to, together with a research group at the university, develop, test, and evaluate an educational programme in communication for staff who care for the elderly in the home.

This training intervention includes 25 people from two different home care groups from one unit. The education is in eight parts, and has been specifically designed to be flexible and easily accessible, with all parts except one being web-based.

"For this group, the focus is usually more on the tasks, on the practicalities of what the staff are to do. It can be anything from cooking, cleaning, putting on compression stockings, or giving eye drops. But the meeting and relationship are at least as important to the people they care for," says Tanja Gustafsson.

Lack of communication

Sound recordings from home visits made in a previous international project involving researchers from Borås showed that there are shortcomings in the communication between elderly people cared for at home and the staff who care for them. The study showed that during the visit it is easy, as a healthcare professional, to fail to attend to the worries or concerns of elderly people and their need to talk about them.

"It may be due to many things. Individuals who care for the elderly at home have different educations and varied backgrounds. They can range from very young people coming straight from high school to experienced nurses," she explains.

Another obstacle to communication may be the language. It is important to speak slowly and use words and expressions that are familiar to those who receive care.

"Good communication increases the elderly's wellbeing, but also the staff's."

In a meeting room in a Western Swedish municipality, a group of healthcare professionals gathers. The sun shines through the patterned curtains. It is springtime, and outside, the magnolias have just started blooming. The door is open and a house cat from the geriatric care home, which is in the same building, curiously peeks in for a look before moving on.

Following the staff's learning

Pernilla Karlsson. On site, Pernilla Karlsson, Lecturer in Caring Science at the University of Borås, holds the part of the training where the staff receive supervision on site.

"I participate in the educational programme and follow the staff's learning," she says.

She writes questions that will be used as a jumping off point on the board while the day's five participants drop in and take their places around the table. Today it is about being guided and reflecting on the subject of communication.

Other themes for training sessions have been, for example, basic values and approaches, verbal and non-verbal communication, as well as listening and being fully present.

The group explains that the biggest benefit they have already seen is that they are receiving confirmation that they are doing the right thing in their work.

"Communication is the be-all and end-all in our job. This is a great training programme for those who are new. Unfortunately, there has not been so much new to those of us who have worked in elderly care for 20 years," says one of the participants.

It's about attitude

But they see how important communication is in the work.

"We can be the only one the elderly person sees all day. We get to hear about the latest doctor's visit, meet with the family with regard to health care at the end of life, but also be involved when, for example, there has been a death in the family. Our communication means a lot," says another.

The educational programme does not give any out-of-the-box answers for how to deal with difficult questions from older people. There are no "standard answers," but it's more about attitude: being able to listen actively and focus on the person who is receiving care, the visit, and not thinking about the next step in a busy schedule.

Tanja Gustafsson explains:

"We have let participants participate and influence the content. We discuss examples of difficult situations such as caring for those with dementia who are aggressive or crying, and provide tools for what you need to think about and how to deal with those situations. But each meeting is unique in that the people meeting have different needs and abilities."

The educational programme provides tools

She further explains that the work situation places demands on home care staff because of the fast pace and extensive help needed by those receiving care in the home. She believes that education can provide practical tools, but also give an understanding of how important the meeting and conversation are for the elderly person.

"We know that many who care for elderly in the home have a busy schedule, but short conversations can also do a lot, as the elderly then feel acknowledged. The important thing is to try to focus on just the current contact and making it as good as possible. And it's not always just about the verbal conversation; it’s as much about body language," she says.

To find out if the educational programme makes any difference, researchers have already collected 60 audio recordings from home visits with the staff team before the training started. Both short and long home visits have been recorded. All staff involved have also participated in a survey in which they, for example, evaluated their own ability to communicate and their job satisfaction. In addition, a group interview was conducted about their perceived expectations.

Following up on the training

After the training is completed, more data will be collected to see if the educational programme can be seen to make a difference; both the audio recordings and the survey will be repeated. The researchers will also conduct interviews about the staff's experiences of the educational programme.

"In addition to getting answers as to whether a training can improve communication, I also think it's important that we have focussed on the staff that conduct home visits. It's a group that has not been researched very much; they do an important job that may not have received so much attention," says Tanja Gustafsson.

Research Director for the project is Annelie Sundler, Associate Professor of Caring Science. Since 2013, she has been researching communication with older people who are cared for at home. She explains that this work began when she participated in an international research project involving Sweden, Norway, and the Netherlands working to study this kind of communication. Already in that phase an educational intervention was considered, but there was no research funding for it.

"I hope that through this project, we can show an example of how clinical research can be done on a staff training that is designed to suit the conditions of the setting, and that is easy to implement if it proves to be effective."

She is also part of an international network of communication researchers in health and medical care. Studies in other countries have shown that educational programmes can make healthcare professionals more secure in communicating and more responsive to patients' needs--it is thus possible to train up the communicative ability.

"Our research is a response to the social debate about efficiency, in which those who receive care can get stuck between a rock and a hard place. If staff do not have the time or skills to meet the needs of the elderly, this can increase their worry. I hope our study can take us a step towards making a difference for those who are being cared for. When the elderly feel acknowledged, feelings of security are promoted, and patients are more satisfied with the care they receive," says Annelie Sundler.

The research group

The research group consists of:

Tanja Gustafsson, doctoral student

Annelie Sundler, Associate Professor

Elisabeth Lindberg, Senior Lecturer

Hanna Maurin Söderholm, Senior Lecturer

Pernilla Karlsson, Lecturer


Text: Anna Kjellsson

Photo: Anna Sigge, Suss Wilén and Claudia van Zyl (Unsplash)

Illustration: Suss Wilén

Translation: Eva Medin