Enacting the Nurse–Client Relationship: A Qualitative Study of Older Adults and Community Nurses in Long‐Term Community Care

Vollständiger Abstract

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ABSTRACT Introduction The foundation of nursing care is the nurse–client relationship. The Fundamentals of Care (FoC) Framework provides guidance on the core elements of this relationship: trust, focus, anticipate, know, and evaluate. A gap remains in understanding how older adults and nurses themselves engage with these relational elements in the context of long‐term community care. This may hinder nurses and their clients from collaborating in care practices. Aim To explore how older adults and nurses, through and within their ongoing relationship in community care, concretely enact and co‐construct the five elements of the nurse–client relationship and explore factors influencing this relationship. Design A qualitative descriptive research design was employed in 2022–2023, utilizing both individual and group interviews. Thirteen unique clients and relatives as informal care givers and 22 nurses participated. Results ‘Trust’ related to clients trusting the nurses' expertise and nurses enabling clients to feel confident and safe. ‘Focus’ was understood as a shared aim and actions towards maintaining independency and autonomy of clients. ‘Anticipate’ was characterized by nurses responding to clients' preferences and needs and clients and nurses making shared decisions regarding care. ‘Know’ was aimed at gaining a good understanding of clients' needs, which required clients to be open and committed to telling their needs, and nurses actively listening to their clients. Finally, ‘evaluate’, both formal and informal, revealed to be necessary to align and adjust care when necessary. Poor care coordination and continuity of care were contextual factors influencing the caring relationship. Conclusion We showed that nurses and clients in community care settings were engaged in a constructive relationship to collaborate for optimal nursing care. An empirical understanding was obtained about how the core elements of this relationship were put into practice. These elements develop over time, influenced by the nurse–client interaction and the specific context. Implications for the Profession and/or Patient Care This study highlights that both the client and the nurse have an active role in establishing the nurse–client relationship. Impact (Addressing) What problem did the study address? This study addressed how older adults and nurses themselves engage with the relational elements of trust, focus, anticipate, know, and evaluate in the context of long‐term community care. What were the main findings? An empirical understanding was obtained of how nurses and clients put these relational elements into practice. These elements evolve over time, influenced by nurse–client interactions and specific contexts. Where and on whom will the research have an impact? This research will impact community‐care nurses by offering them practical insights into establishing effective relationships with clients and engaging in dialogue about clients' responsibilities in shaping these relationships. Reporting Method We adhered to the Consolidated criteria for reporting qualitative research (Coreq) guidelines ( International Journal for Quality in Health Care , 2007, 19, 349). Patient or Public Contribution In the research team, two co‐researchers (J.A. and J.Z.) participated in the design of the study, data collection and analyses. These co‐researchers are older women with experiences in participating in qualitative research (collecting and analysing data) and community‐based nursing care (as informal care giver).