Care quality
Relational care:environment, engagement and enterprise
Care expert Jenny Kartupelis MBE discusses the findings of her latest book, Making Relational Care Work for Older People - based on some 150 in-depth interviews over a period of five years – including practical advice for enhancing care outcomes through the physical environment
It is fully accepted that the surroundings in which people live and work in a care home will have a profound effect on their wellbeing. However, fresh approaches to what works and why, are continually unfolding, being tested and developed. My new book published last October, Making Relational Care Work for Older People, offers a conceptual theory based on numerous interviews in seven different care home groups, as well as practical, evidence-based models for environmental changes that benefit residents, managers and staff.1 Over the last five years, I interviewed some 150 older people, care staff and providers of residential homes - as well as community projects - to analyse and better understand what constitutes good practice, and why it matters. This has led to the development of the theory of ‘relational care’ - the idea that a care setting that is effectively a network of
mutual support and acceptance will have the best outcomes.
Changing times
In the past, particularly the first half of the previous century, nursing and care homes were run on lines that allowed them to function primarily as entities where - with some exceptions of course - rules and systems were in place basically to serve the organisation. The dreaded pall of the workhouse still hung over the idea of being ‘put in a home’. More enlightened times brought the change to person-centred care. While there is no universally accepted definition, it does place the emphasis on the older adult as an individual whose wishes and needs should be the guiding principle in care decisions.
That is admirable but there can be an inadvertent downside: a failure to recognise that every individual occupies
a unique place in relation to friends, family, carers, their community and society. While being alone can be a relief at times, humans are born to be interdependent, and very few thrive in situations of isolation or loneliness. Humans are creatures of interaction that need to give as well as receive, to be recognised as having an intrinsic value, rather than as a collection of needs and demands to be met by others. Understanding this leads to favouring the type of care based on relationships. We are looking at the model of a family. Of course, not all families are ideal, and some can be downright dysfunctional. Yet the family that enables its members to feel supported, valued and provides company at, for example, mealtimes - but also honours the need for privacy - is an excellent reference point. During my research, this theory was borne out time and again by the comments of interviewees about what really matters to them.
Principles of relational care One of the underlying principles of relational care is that everyday tasks like personal hygiene, selection of clothes, service of meals - as well as activities like singing, craft or exercise - should be carried out as part of the caring interaction.
Carers told me things like “Someone getting washed and dressed, maybe, that should be an enjoyable, interactive time” and “I join in completely”. One regional manager meanwhile told me “It was hard to break that…task-oriented culture. But that doesn’t provide emotional support to
residents...it doesn’t build relationships”. If tasks are ‘blended’ with
conversation and an affectionate touch, older people feel less ‘done to’ and more that they are partners in their own wellbeing. That means more time may have to be allocated to tasks, but possibly less time to crisis management,
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www.thecarehomeenvironment.com • January 2021
©Hallmark Care Homes
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