title: An extra care community's perceived priorities for 'whole system' relationships: a Q-methodological study.
abstract: Health and social care settings worldwide need to sustainably improve the quality of relationships across communities or 'whole systems'. This research informs the development of a relational framework based on stakeholder perspectives. It is grounded in an action research project with practitioners, and draws on a previous literature review, to present the underpinning elements of quality relationships as statements, organised under the headings of integrity, respect, fairness, compassion and trust. Using Q methodology, 27 participants, comprising a range of stakeholders (staff, residents, family and service providers), rank-ordered 48 statements based on perceptions of the importance of differing aspects of relationships. By-person factor analysis was used to create five factors or viewpoints by comparing and contrasting using the composite rankings alongside interview data collected for each participant. The first view 'Altogether now' prioritises compassionate engagement. Second, 'Respect is a two-way street' emphasises the need for reciprocal respect and recognition of history. The factor labelled 'Free spirits' posits the dominant view of freedom. The fourth view 'Families … strengths and challenges' focuses on the necessary and complex involvement of families and finally, 'Helping hands' emphasises the role of relationships in increasing previously low expectations of social integration for previously isolated residents. The different views that exist on the composition of quality relationships can be used to help extra care communities to understand and utilise relationships as a powerful and effective resource.
authors.affiliation: School of Healthcare, University of Leeds, Leeds, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Grimshaw
authors.affiliation: School of Healthcare, University of Leeds, Leeds, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: McGowan
authors.affiliation: School of Healthcare, University of Leeds, Leeds, UK.
authors.forename: Elaine
authors.initials: E
authors.lastname: McNichol
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D003695:Delivery of Health Care; D004645:Empathy; D005163:Factor Analysis, Statistical; D005260:Female; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006801:Humans; D007398:Interpersonal Relations; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D012112:Residential Facilities; D000073597:Stakeholder Participation; D035502:Trust; D006113:United Kingdom
keywords: Q methodology; action research; ageing; extra care housing; health and social care; relationships