title: Caring about caring: developing a model to implement compassionate relationship centred care in an older people care setting.
abstract: OBJECTIVE
  This study actively involved older people, staff and relatives in agreeing a definition of compassionate relationship-centred care and identifying strategies to promote such care in acute hospital settings for older people. It was a major component of a three year programme (the Leadership in Compassionate Care Programme, LCCP) seeking to integrate compassionate care across practice and educational environments.
  
  
  BACKGROUND
  Compassionate caring and promoting dignity are key priorities for policy, practice and research worldwide, being central to the quality of care for patients and families, and job satisfaction for staff. Therapeutic relationships are essential to achieving excellence in care but little is known about how to develop and sustain such relationships in a culture that increasingly focuses on throughput and rapid turnover.
  
  
  METHODS
  The study used appreciative inquiry and a range of methods including participant observation, interviews, story telling and group discussions to actively engage older people, relatives and staff. A process of immersion crystallization was used to analyze data with staff as co-analysts.
  
  
  RESULTS
  The study adds considerably to the conceptualization of compassionate, relationship-centred care and provides a model to aid staff deliver such care in practice, based on 'appreciative caring conversations' that enable all parties to gain two forms of 'person and relational knowledge' about 'who people are and what matters to them' and 'how people feel about their experience'. Such knowledge enables staff, patients and carers to 'work together to shape the way things are done'. The study generated a model called the 7 'C's that captures in detail the factors necessary to promote 'appreciative caring conversations'.
  
  
  CONCLUSIONS
  The study demonstrates that engaging in 'appreciative caring conversations' promotes compassionate, relationship-centred care but that these conversations involve practitioners taking risks. Such 'relational practices' must therefore be valued and accorded status. Staff require appropriate support, facilitation and strong leadership if these practices are to flourish.
authors: Health and Social Sciences, Hamilton Campus, Caird Building (Room 2.3), Almada Street, Hamilton ML3 0JB, United Kingdom. belinda.dewar@uws.ac.uk
authors: Belinda
authors: B
authors: Dewar
authors: Mike
authors: M
authors: Nolan
mesh_terms: D000368:Aged; D004645:Empathy; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D007857:Leadership; D018802:Patient-Centered Care; D006113:United Kingdom
keywords: Appreciative inquiry; Caring; Caring conversations; Compassion; Older people; Relationship-centred care