Objective: Quality of life for residents in long-term care has been linked with meaningful relationships with health care aides (HCA) who care for them. Despite the mounting evidence of the need for a meaningful relationship between HCA and resident, no intervention studies were found that specifically addressed methods for HCAs to build or enhance these relationships in long term care. This study was intended to fill this gap by investigating the effects of a relationship enhancing program of care (REPC) based on a relationship theory by Winnicott (1970) on residents, family members and on HCAs. The aim of the REPC was to enhance the way HCAs relate to their residents since it was proposed that meaningful interactions lead to close connections.
Design: A quasi-experimental design was used to evaluate the REPC.
Population/Setting/Sample/Year: During 2000, 40 residents, 39 family members and 19 HCAs participated in the REPC on 2 long-term care units (1 intervention and 1 comparison).
Concepts/Variables Studied: The influence of the relationship enhancing program of care on the relational care provided by HCAs from the perspective of the resident, family member and from the HCAs’ relational behaviors. The influence of the REPC on close relationships between HCAs and residents was also investigated.
Intervention: The three components of the intervention involved (a) a continuity of careprovider model in which the HCAs have control over which residents are assigned to them, (b) the acquisition of the empathic and reliability skills and knowledge required by the HCAs from their nursing supervisors to assist them in maintaining effective relational care. The intervention is founded on Winnicott’s (1970) theory and on empirical evidence. The intervention took seven months to complete.
Method: Data from the participants were collected at baseline and at 4 months post intervention. Repeated measures ANOVA were used to examine changes in outcomes.
Findings: Results indicated that following the intervention residents perceived changes in the relational care provided to them by their HCAs, F(1,38)=6.5, p=.014. Family members also perceived changes in the relational care provided to their relatives, F(1,37)=8.81, p=.005. Finally, the quality of the HCAs’ interactions improved F(1,41)=4.2, p=.046. No differences were found in the perceptions of close HCA-resident relationships.
Conclusions: Providing continuity of staff, ensuring HCAs have effective relational skills, and supporting them for their efforts, can have a positive effect on HCAs’ ability to provide effective relational care to residents. Providing effective relational care does not necessarily lead to close HCA-resident relationships.
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