1.1 Developing your understanding of relational care

In the activities below you will hear from a resident in a care home (Activity 1), two members of care home staff (Activity 2) and a care home manager (Activity 3) about what relational care means to them.

Activity 1 Relational care in a resident’s own words: Nina’s story

Timing: AIlow 15 minutes

Watch the video of Nina and her daughter Kay talking about living in a care home and think about the following questions. Note down your thoughts in the box below.

• What relationships does Nina have in the care home?
• What do they mean to her?
• How do these relationships support her?

Download this video clip.Video player: Video 1

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Transcript: Video 1 Nina and Kay

KAY:

Hi, my name is Kay. And this is my mom, Nina. And we're here in Ballyholme, Abbeyfield and Wesley. And mom's going to tell you a little bit about why she's here and how she feels about it. And do you like the fact that you don't need to cook anymore, or your laundry, or things like that?

NINA:

That is a real blessing, that all meals are provided, even break time, the tea and the coffee are brought up on a trolley for us. And we can all sit around and chat. Everybody is very, very friendly and caring here. The only time it's quiet is at meal time when we're chewing our meal. But in between courses or waiting for the tea to be poured, the chat starts up again. And people are very, very friendly here.

KAY:

Yeah. On that note, obviously everybody was strangers at the beginning. And you've lived here now for, my goodness, 15 months? Now you've been here.

NINA:

Wow.

KAY:

How are your relationships with people here now?

NINA:

Oh, very good. Even the new ones in, we've had three, four new ones since I came in. And once again, they're all very chatty and nice. And Maureen, that sits next to me at the table at meal times, she is very helpful. Because she knows there are things, you know when there's a tea bag left in the cup of tea, I have-- there's another thing. John brought me.

KAY:

Oh, the tea bag squeezer.

NINA:

Tea bag squeezer. But with the arthritis in my hand, I couldn't manage it. And I apologised to him and said, John, I think I'm going to have to give these back to you because I can't manage them. And Maureen says, oh no, you don't. I'll manage it for you.

KAY:

And that's what we love.

NINA:

And she takes the tongs and the cup over, squeezes it out for me. And there, everybody is very, very helpful.

End transcript: Video 1 Nina and Kay

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Video 1 Nina and Kay

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Discussion

Nina emphasises the importance of her relationships with other residents to her happiness at the care home in which she is living. She also mentions how some of the other residents help her with things that she is no longer able to do for herself.

Activity 2 Phil and Jacqui’s stories

Timing: Allow 20 minutes

In Video 2, Jacqui, a member of the care team, and Phil, the head gardener at a well-established home called Nightingale Hammerson chat about relational care. Read the questions below and, as you watch Jacqui and Phil chatting, make a note of your answers to the questions in the box provided.

• What relationships do they have in the care home?
• Why are these relationships important and to whom?
• What do they do to keep these relationships going on a daily basis?
• What are the challenges?

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Transcript: Video 2 Phil and Jacqui

[TEXT ON SCREEN: What relationships do you have with different people in the care home where you work?]

JACQUI:

I see my residents most days and will be either supporting them to get to activities, talking to them about activities, or actually leading activities with them. And then relatives when they're when they're in the home, yeah, we talk and and I email relatives as well because I can't plan engagement without knowing what it is that gives them sense of well-being and what works for them. So you know, my role is to understand their needs, but also the day to day experiences that they're having. If they're unhappy because something's gone wrong with their care or their illness has progressed, then they're not going to be able to do engagement. So if I'm not there to see them, to see what's happening, how they're feeling, then I won't know-- I won't be able to help them engage and to have those.

And also, it's about being-- we kind of-- I think of us as a kind of family. If you don't see people, you don't know how they are. I can't support them. That contact's important. It's two-way.

And it's about-- encouragement to attend things can be the hardest part, actually helping people to get to the things. Because they might be feeling low or they don't feel they want to get up or they might feel, oh, I don't want to ask for help. So if I go and see them, if they're in their rooms or waiting, I can find out what's happening, what they need.

We talk about it a lot about care and about institutions and relationships. And for me, it is about getting to know people and we do become a Nightingale family. We're a group of staff and residents in one area of the home on Ronson floor. I get to know those residents really well. I spend time with them. I spend time liaising with their families.

And it is caring. It's not a cold, clinical, you know, process. You get to know people. You're there to care for them. You're there to help them. And so, yeah, and you're there for the emotional needs.

So it's really important that I can respond to that and give them emotional support. Because without that, all the other stuff doesn't mean anything if they don't feel connected. And it's about the connections between residents as well, helping them to make friends, relationships with volunteers, really important, and people are coming in regularly. And I think we do get to feel like a family. And at the times when things are good, that's what it feels like; sharing meals together, discussing how we feel together, supporting each other, sorting out problems for each other.

That contact with people each day, that's really important to me. That's what gives me a sense of well-being and seeing good results from the work that I do. We have people that are upset, so they're dealing with physical things or with dementias, and yeah, there has to be some boundaries. So you know, I also get a satisfaction from being able to do that.

And people die. So I'm not I can't be immune to feelings of sadness when we lose people and how that affects me and also other residents. We want to be able to express that we miss someone. And also, we share that with the family, share part of their grief.

It gives me-- it's not-- yeah, it's a sense of having a place in society. My working life has not contributed to anyone in terms of wealth. I've not produced a thing. I don't make things. I don't-- but I've given something to other people that I hope on the whole is useful.

PHIL:

I'm the head gardener here. And we also do intergenerational with the children and residents. So most of them are through coming to the garden club or just even in the garden because they come out and chat to me that way.

It's an open group. They just come along as and when they feel like it. But also, when they're in the garden and having a walk in the sunshine, they always have a chat to me. Obviously, everybody knows me here, I'm the gardener. So yes. So if there's any plant that they don't know, it's always like, oh, what's this? And obviously, the family as well. So you know, when they're pushing residents around, they'll always have a chat and ask about plants and fruit.

JACQUI:

There's never enough time to give people the time that they want. We're very lucky to have a wonderful group of volunteers who can give time, but there's always-- you know, people always need more time. We all need more time to spend with other people.

And yeah, the communication within an organisation can be challenging. To talk in more depth about individuals, to share our experiences, to share our knowledge. Again, that's time. Time to sit and talk, and you know, in a more meaningful way about what we could do to support. Lots of just trying to respond to the current issues. So that's always a challenge.

It is about consistency. So if people are coming in, like volunteers, we need to know what the commitment is. Yeah, consistency. People tend to thrive on knowing who's come in and who's there and who how they can-- how they can have consistency. Trust, building up trust. Takes a lot of time.

PHIL:

I think rather than the residents just staying in their rooms, they come out, they want to do things, which is why we do all the different activities for them, from honey making, spinning. You know, we do demonstrations for the residents, the children, the families come along, all the regular ones that come to the garden with the family. So they now all know me and they're asking me questions, and what's the plant. They buy the honey as well because we do have the honey for sale here.

French lady, she's blind. So she comes to garden club. So I always buy her herbs so she has the sensory smell. And then when we go on gardening trips. We did one to Kensington Park recently because I used to work there. Go through the park and pick everything so she smells it.

Until two years ago, so we never had any blind people. So obviously, it was a visual, from spring bulbs and plants that were flowering. But now with Colette here, we kind of do the sensory side as well.

As they get older, it's more of a supporting them while we're doing gardening. And obviously, they used to be able to walk around the garden. Now they're obviously either in a wheelchair or they're being supported by someone, so maybe they don't get around the whole garden as they used to. Which is why we've put a lot of herbs on the arts and crafts terrace so that if they do come down and with support, they can just sit out there and enjoy the herbs and flowers rather than they can't get to the whole garden like they used to.

So it's more of a supporting role as they get older, rather than just going, you can't come to gardening club. You can't do nothing anymore. It's like, well, you know, you can pick the flowers, you pick what you want, and I'll plant them and then you take them out of the pots. And so it's changing as they get older.

We do intergenerational with residents and children once a month and then with the residents once a week during growing times. So they're getting the residents down. I'm preparing everything ready for that activity. I can come up with a project idea and go to Alistair, who's head of activities, obviously, see if he's got any budgets. But same with the bees. You know, come up with that idea, we went through with the CEO, people come up with a donation.

I think with myself, I kind of do it because I think when I get older I would want someone to, wherever I am, to do some gardening with me. So I think it's such an important idea. Because they do then come out with what they used to do when they-- before they come to the care home. You know, oh, with my husband, we planted this. And so it kind of gives them memories from when they used to be able to do gardening, and then they tell us about their grandchildren. And so it takes their mind off things. You know, they're going back and then obviously discussing things. So it's not just all about the care home.

End transcript: Video 2 Phil and Jacqui

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Video 2 Phil and Jacqui

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Discussion

Both Jacqui and Phil talk about the importance of the relationships they have with the residents and their families. Whilst Jacqui also refers to the value of relationships with volunteers, Phil talks about the relationship with the community in terms of bringing children in to engage in shared activities with the residents. It is clear that Jacqui and Phil invest a lot of time in connecting with residents and getting to know them as individuals, and their needs, experiences and emotions. They obviously feel a sense of self-fulfilment in then adapting and planning what they do to support the residents for whom they care, which in turn enhances their wellbeing and makes them feel valued. Jacqui emphasises the mutuality of relationships – likening them to those in a family – particularly those relationships between residents and between staff and residents. However, she does make the point that it is sometimes necessary to set boundaries and having enough time to develop and sustain relationships is an ongoing issue.

Activity 3 A care home manager’s reflections on relational care

Timing: Allow 15 minutes

You will now hear from Asa – a manager in an Anchor group care home – about what relational care means to him. As in Activities 1 and 2, keep in mind the questions below and put your thoughts in the box provided.

• What kinds of relationships does Asa mention as being important for delivering good quality care?
• Does he see himself as a giver of care or a giver and receiver of care? How does this happen?

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Transcript: Video 3 Asa

ASA JOHNSON:

Hello. My name is Asa Johnson. I'm the service improvement manager for Anchor, who are a care home provider. And my role is to look at ways in which we can really develop and enhance that experience for our residents across 'activities' - which I'm sure we'll talk about in a moment - food, nutrition, the environment they live in, and dementia care practise.

[TEXT ON SCREEN: What does relational care actually mean to you in your role?]

I see relational care as really day-to-day interactions that we all have as human beings, both family, friends, acquaintances, people you might bump into in the street or in the shop. It's just about having that human contact and building up those relationships with people and really making sure that what we do is in line with what the person receiving care wants and vice versa. So it's working together, rather than having this hierarchy of caregiver and care receiver.

[TEXT ON SCREEN: What would you say relational care feels like both for those giving and receiving?]

I think relational care very much feels like those interactions going somewhere and being meaningful. So when the person that's providing the support and the care and the person that's receiving that support are actually working together to achieve those everyday life goals and actually the care is very much built around what that person's experience is and what that experience that they want-- how they want that experience to be.

[TEXT ON SCREEN: So would you say it involves everyone in a care setting?]

Absolutely. You have to bring everybody together. Everybody has to work on this. No matter what their role in that care home may be, how often they may be working in that care home, everybody really has to live and breathe that relational care ethos and really see it as a community of people coming together to make sure that the experience of the people that are receiving that care is the best it possibly can be and is very much in line with how that person expects to live their life.

[TEXT ON SCREEN: What difference do you think relational care makes to everybody in the care setting?]

I think people coming together and having this experience together and letting their personalities shine through their life experiences, their day-to-day goings-on actually, A, builds on that community feel within that care setting, and the person who's giving that care, actually they're bringing themselves to work every single day. It's not about being driven by task. It's about being driven by people and you, as a person, and the person receiving that care as a person. So it's just about being more human with each other. And really, relational care-- the framework and the guidance that's been provided-- is absolutely fantastic.

But if we really look at it, it's not radical. It's everyday life. Outside of the care sector, what relational care talks about is the norm, whereas sometimes, within the care sector and in particular in dementia care, what is seen as radical is just the norm everywhere else. And it's almost about understanding that and taking a step back and thinking, let's get out of this care bubble for a moment and really think about what we're trying to achieve here. I'm not saying it's easy, but it's not radical. And I think that's the kind of mentality we have to go into this with. Actually, it's just about being human with each other.

[TEXT ON SCREEN: So if somebody was thinking about adopting relational care, what would you say to them?]

First of all, don't overthink it. Really look at it as a framework for everyday life. And break it down into manageable chunks. Look at-- across the whole home-- if it's in a care home setting across the whole home, in those different areas, whether it's through the lifestyle, the wellness, the activity, the engagement, the living life piece-- what does that look like-- that formalised plan and programme of clubs and experiences-- for residents? The food and nutrition, how is that driven by residents, but also by the people that are producing that food and serving that food? The environment-- does the environment really feel like a place that people can call home? And what I call home may be very, very different to what you call home. It's about having those conversations.

Really break it down into manageable chunks and look at how it can weave across the whole home. And don't look at people's individual role, but look at people's individual personality and skill to determine how this is driven because, actually, there may be some areas that somebody would work on that perhaps traditionally didn't work in that department, if you like, within the care home. So somebody that maybe doesn't work in the catering team would have a really good understanding around how to drive a great food experience for residents in that care home based on those relationships, having those conversations. So utilising people's skills, interests, hobbies, personalities, to really help this be achievable within your care setting.

End transcript: Video 3 Asa

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Video 3 Asa

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Discussion

Asa emphasises that relational care is very much based on the everyday human and family interactions in which we all engage. To this end, relational care means that everyone has a role and is valued; using their skills, everyone in a care setting should work together as a community in ensuring that the care environment and experience are meaningfully shaped by both residents and staff.

A key message that emerges from the videos in the three activities that you have just completed is that relational care is very much about creating a sense of ‘home’ in a care setting, in which all those who live and work there feel they are part of a family. The connectedness integral to being part of such a community involves mutually enjoyable and beneficial relationships in which all parties are both givers and receivers of care. However, it’s important to remember that not all families are happy all the time, and that relational care also means acknowledging and working with challenges.

Another key message is that within relational care each person is respected, and everyone works together to achieve ‘everyday life goals’. Relational care means that residents and staff are not defined by set roles but are enabled to use their skills, hobbies, interests and personalities in different ways to contribute to the relational care ethos.

All those in the videos talk about the importance of relationships. Some important points are made about the nature of these relationships, for example that they are two-way and need to be based on good communication and meaningful interaction. More specifically, relational care means that, while tasks and time are essential, they are part of the process of forming relationships, rather than impeding them. Older people in a care setting are also given opportunities to be involved in decisions and planning.

Jacqui and Phil also talk about the importance of relationships (including, importantly, inter-generational relationships) between the care setting and residents’ families, volunteers and the local community. Nina and Jacqui provide examples of the value of facilitating relationships between residents (e.g. through protected mealtimes) and how the friendships that they develop can lead to residents knowing and helping each other.

Up to this point in the course you have explored the concept of relational care. You have heard from people living and working in care settings about the significance of relational care and its benefits. So, how can this practice be developed, nurtured and supported in care settings? You will explore this in the following section.