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Table 2 Summary of studies included

From: Determinants of the quality of care relationships in long-term care - a systematic review

Authors (year) Aim Data collection Study population Perspective 1 Client group 2 Determinants described (level)
Abma et al. (2009) To understand tensions in the care relationship between professional and client due to different expectations from a care ethics perspective. open interviews 3 women with multiple sclerosis, chosen out of 15 case studies. The women were receiving care in both inpatient and outpatient settings and reported their experiences with these settings. One case study about a client Jane living in a nursing home was relevant for our study. C D Client: - Attitude (acceptance of situation & complaining or not)
Professional: - Attitude (respectful) - Encouragement (encouraging autonomy of client) - Focus on individual client - Take time - Professional competences (technical competences)
Between client and professional: - Equality
Contextual: - Time
Ahlström & Wadensten (2009) To explore the encounters in greater depth in close care relationships between personal assistants and disabled people of working age, as well as the prerequisites for and obstacles to the success of such encounters. open interviews 32 personal assistants who worked for 32 people with serious neurological diseases living at home. P D Client: -
Professional: - Attitude (respectful) - Availability (flexibility)- Encouragement (helpful, being positive &encouraging autonomy of client) - Extra effort (take initiative) - Focus on individual client - Take time
Between client and professional: - Closeness versus professional distance (professional attitude & informal relationship or friendship) - Reciprocity (personal chemistry) - Trust
Other: - Family
Andersen & Spiers (2016) Exploring the complexities of care, working environments, and knowledge, skills, and efforts of care aides who work in nursing homes. individual or paired interviews 22 care aides caring for nursing homes residents P O Client: - Abilities - Attitude (open to professional) - Emotional state - Previous life experience
Professional: - Attitude (open to client) - Emotional investment or caring - Extra effort (doing more than expected) - Focus on individual client - Professional competences (experience and timing) - Take time - Working in a team
Between client and professional: - Continuity (development of relationship)
Context: - Hierarchy - Time (workload)
Other: - Family
Bäck-Pettersson et al. (2014) To describe patients’ experiences of supportive conversation as long-term treatment in a psychiatric outpatient context. focus group interview 6 female patients receiving mental healthcare in an outpatient setting for more than 2.5 years. Clients with: emotional unstable personality disorder (n = 1), severe depression, without symptoms of psychosis (n = 1), dysthymia (n = 1), general anxiety disorder (n = 1), and bipolar disorder (n = 2). The contact was mostly a qualified nurse. C M Client: - Ask for help
Professional: - Attitude (respectful) - Availability - Dependable (confidentiality) Encouragement (creating roles outside of being patient and being helpful) - Extra effort - Focus on individual client - Listen - Professional competences (technical competences)
Between client and professional: - Closeness versus professional distance (informal relationship or friendship) - Continuity (development of the relationship) - Equality (collaboration) - Social interaction (open communication)
Bangerter et al. (2016) Exploring the specific way that a person defines eight key care preferences. Individual interviews 337 Cognitively capable nursing home residents recruited from 35 Nursing Homes. C O Client: -
Professional: - Attitude (friendly and kind, respectful, etiquettes) - Emotional investment or caring - Focus on individual client (interest, genuine concern for client) - Listen - Professional competences (communication) - Take time
Between client and professional: - Closeness versus professional distance (professional attitude) - Equality - Reciprocity - Social interaction (use of touch)
Context: -
Berggren & Gunnarsson (2010) To describe the characteristics of the Swedish Personligt Ombud (personal ombudsman; PO) through actual experiences of the service users and more particularly what they find to be significant and helpful features of their relationships with their PO. open-ended interviews 23 clients with severe mental health impairment. They all had extensive experience of psychiatric care and social services, none of the participants had been admitted to hospital care during the past two years. These clients received short-term individual support from a PO in an outpatient setting. C M Client: - Client in lead
Professional: - Attitude (non-judgemental) - Availability - Encouragement (helpful or being supportive, encouraging autonomy of client) - Extra effort (doing more than expected) - Focus on individual client - Professional competences
Between client and professional: - Closeness versus professional distance (informal relationship or friendship, professional boundaries, professional distance, being part of a community) - Equality - Reciprocity
Contextual: -
Bourgeault et al. (2010) To examine the role of immigrant care workers in the home and long-term care sectors in Canada, with a particular focus on the relationships with older adults and the implications for quality of care. semi-structured interviews 77 immigrant care workers, 24 employers, 29 current and future care recipients (older adults) living in nursing home or at home. C & P O Client: - Attitude (open to professional)
Professional: - Availability (flexibility) - Dependable - Emotional investment or caring - Focus on individual client - Listen - Professional competences (aware of cultural differences, technical competences) - Take time - Working in a team.
Between client and professional: - Closeness versus professional distance (informal relationship or friendship, professional relationship) - Social interaction (language barriers)
Contextual: - Setting - Time (workload, lack of backup)
Broer, et al. (2010) To explore how mental healthcare professionals initiate, improve, and maintain client autonomy while improving other aspects of quality of care. observations from conferences about projects of care professionals and interviews Care professionals providing long-term mental healthcare to clients (unspecified amount and without further specification of occupation) P M Client: -
Professional: - Availability - Encouragement (being positive, creating roles outside of being patient, encouraging autonomy of client) - Focus on individual client
Between client and professional: - Closeness versus professional distance (informal relationship or friendship) - Equality (collaboration)
Contextual: -
Cook & Brown-Wilson (2010) To describe residents’ narratives of their experiences of interacting with staff and making suggestions for practice development. Observations and interviews This article draws on two studies: one included 53 older people, the other one included 16 older nursing home residents, 25 staff and 18 family members. C, P & F O Client: - Abilities - Attitude (open to professional) - Client in lead - Previous life experiences
Professional: - Attitude (respectful) - Dependable - Extra effort - Focus on individual client - Task-centered - Take time
Between client and professional: Closeness versus professional distance (informal relationship or friendship, being part of a community) - Continuity (development of relationship, perceiving stability in the relationship) - Reciprocity - Social interaction (open communication) - Trust
Contextual: - Time
Day et al. (2017) To explore consumer concerns, issues and preferences relating to HCPs before the introduction of CDC on the 1 July 2015. in-depth interviews Five older people, four women and one man, aged 81 to 90 years participated in the study. Of the five participants, four lived alone and one lived with family. Four participants were receiving HCP services and one was on the waiting list for services. C O Client: - Client in lead
Professional: - Focus on individual client (interest, genuine concern for client) - Listen - Take time - Professional competences (communication)
Between client and professional: Closeness versus professional distance (informal relationship or friendship) - Continuity (development of relationship) - Reciprocity - Trust
Contextual: - Time (workload)
Denhov & Topor (2012) Exploring the components of helping relationships and the characteristics of helping professionals as described by users who are in various stages of recovery while still undergoing some form of psychiatric care. open interviews 71 severely mentally ill users of psychiatric care in Sweden, receiving care in both inpatient and outpatient settings. Clients received care from psychotherapists, doctors, social workers or case managers. C M Client: -
Professional: - Take time - Attitude (friendly and kind, non-judgemental) Availability - Dependable - Emotional investment or caring - Encouragement (being supportive) - Extra effort (doing more than expected) - Focus on individual client - Listen - Professional competences (timing)
Between client and professional: - Closeness versus professional distance (informal relationship or friendship, professional boundaries) - Continuity (development of relationship) - Continuity (perceiving stability in the relationship) - Reciprocity (personal chemistry) - Social interaction - Trust
Contextual: -
Dziopa & Ahern (2009) To explore the attributes of a therapeutic relationship in mental health nursing to determine if there are different ways mental health nurses develop therapeutic relationships. interviews and Q-sorting 6 mental health nurses were interviewed, thereafter 10 inpatient mental health nurses completed the Q-sorting assignment. P M Client: -
Professional: - Attitude (non-judgemental, open to client, respectful) - Encouragement (helpful) - Focus on individual client - Professional competences
Between client and professional: - Closeness versus professional distance (professional boundaries) - Continuity - Equality - Social interaction (open communication) - Trust
Contextual: -
Eriksen, et al. (2013) To reveal and express knowledge about the meanings of recognition of clients’ personhood and intrinsic value as human beings, based on mental health workers’ lived experiences of long-term relationships with clients. multi-stage focus groups 8 mental health workers providing outpatient mental healthcare, all qualified nurses. P M Client: -
Professional: - Attitude (non-judgemental, open to client, respectful) - Encouragement - Professional competences
Between client and professional: - Closeness versus professional distance (professional distance)
Contextual: -
Eriksen et al. (2013) To describe service users’ understanding of being in relationships with professionals, and how these relationships may limit or enhance recovery. in-depth interviews 11 people with severe mental illnesses living at home and receiving community-based mental healthcare at least three times a week (unspecified type of care professionals). C M Client: - Abilities - Attitude (open to professional) - Client in lead
Professional: - Attitude (non-judgemental) -Availability - Dependable - Encouragement (helpful) - Focus on individual client - Listen
Between client and professional: - Equality - Reciprocity (sensing close contact and togetherness) - Social interaction (open communication)
Contextual: -
Forsgren et al. (2015) To explore how nurses experience their everyday interactions with nursing home residents, with a particular focus on interactions with residents with communicative disabilities. semi-structured interviews 8 nurses, 7 enrolled nurses and 1 nurse’s aide working at six nursing homes and providing care to nursing home residents with communicative disabilities. P O Client: - Abilities (communicative disability)
Professional:- Encouragement (being positive) - Focus on individual client - Professional competences – Task-centered
Between client and professional: - Continuity (development of relationship) - Equality (power) - Social interaction
Contextual: - Time
Huxley et al. (2009) Exploring what the worker did with and for the user, what the most important actions were, which made the greatest difference, what else could or should be done, and how could the local Support, Time and Recovery [31] service could be improved. semi-structured interviews STR workers, mental health service users receiving care in outpatient setting, and managers (unknown number) C & P M Client: - Attitude (open to professional) - Client in lead
Professional:- Attitude (non-judgemental, open to client, respectful) - Availability - Dependable (confidentiality) - Encouragement (encouraging autonomy of client) Focus on individual client - Listen - Professional competences (communication) - Take time
Between client and professional: - Closeness versus professional distance (informal relationship or friendship, being part of a community -), Continuity (development of relationship) - Reciprocity - Trust
Contextual: -
Jones & Moyle (2016) To explore the nature of relationships in edlerly care services from the perspective of staff. exploratory interviews 39 direct elderly care staff from 7 residential age care facilities and 12 outpatient community organisations .
Respondents were registered nurses, enrolled nurses, personal care workers, community care workers, allied health professionals, and occupational therapists
P O Client: -
Professional: - Task-centered
Between client and professional: - Closeness versus professional distance (professional boundaries)
Contextual: - Time
Other: - Family
Ljungberg et al. (2017) to investigate the experience-based knowledge of professionals in outpatient psychiatric services with regard to being personal in their relationships with users. Open interviews 21 professionals offering treatment in three units for outpatient psychiatric services targeting people with mental health problems who need extensive support. Respondents were 13 mental health care assistants, 4 nurses, 3 psychologists, 1 physiotherapist. P M Client: -
Professional: - Focus on individual client (interest, genuine concern for client) - Extra effort (doing more than expected)
Between client and professional: - Closeness versus professional distance (informal relationship or friendship, professional boundaries)
Contextual: - Setting
McCloughen et al. (2011) To identify whether consumers and nurses in a mental health rehabilitation setting shared common understandings, attitudes, values, and experiences of nurse–consumer collaboration. focus groups and a survey for consumers and a survey for nurses. Consumers of inpatient rehabilitation service of a public psychiatric hospital. The research setting comprised one locked and one open ward and five residential-type complexes. Consumers received less intensive support from nurses and were close to discharge into community accommodation. Three focus group were held with 13 consumers from four residential-type complexes and three focus groups were held with 13 nurses. Thereafter, surveys were completed by 34 nursing staff and 18 consumers. C & P M Client: - Abilities - Attitude (open to professional) - Strategic adapting behaviour
Professional: - Attitude (open to client, respectful) - Dependable - Focus on individual client - Listen - Professional competences (communication) - Working in a team
Between client and professional: - Equality (collaboration) - Social interaction (open communication) - Hierarchy - Trust
Contextual: - Hierarchy - Time (workload, lack of backup)
McGarry (2008) To provide a clear, in-depth account of the nature of the relationships between nurses and older people within the context of their own home, from the perspective of both nurses and older patients. semi-structured interviews 13 older patients who were receiving outpatient care from the district nursing service for more than 2 months.
16 community nurses (qualified district nurses, registered nurses and auxiliary nurses)
C & P O Client: - Previous life experiences - Attitude (doing as been told)
Professional: - Take time - Encouragement (encouraging autonomy of client)
Between client and professional: - Closeness versus professional distance (informal relationship or friendship, professional boundaries) - Equality
Contextual: - Setting - Time
McGilton & Boscart (2006) To analyse the perceptions of residents, family members and care providers with regard to close care provider–resident relationships in a LTC setting. semi-structured interviews 25 residents living in long-term care facilities receiving two or more hours of nursing care per day and their families (or a family member). 32 care providers (registered nurses, licensed practical nurses and healthcare aides). C, P & F O Client: - Abilities - Attitude (not interested, open to professional)
Professional: - Attitude (open to client) - Dependable - Extra effort (doing more than expected, take initiative) - Focus on individual client - Listen - Professional competences (technical competences) - Take time
Between client and professional: - Closeness versus professional distance (informal relationship or friendship) - Equality (dependency or power) - Reciprocity (personal chemistry) - Social interaction (having a sense of fun or humour, language barriers)
Contextual: - Time (workload)
Petriwskyj et al. (2015) To examine how client engagement is enacted within the context of a large Australian elderly care provider, Blue Care. interviews and focus groups 85 clients, including 43 clients of community-based services, 32 clients of residential services and 10 clients of retirement living.
94 staff (staff in administration, activities and hospitality, as well as chaplains, assistants in nursing, personal carers, clinical nursing and managers).
C & P O Client: - Client in lead - Previous life experiences
Professional: - Take time - Emotional investment - Encouragement - Extra effort (doing more than expected) - Focus on individual client - Understand - Professional competences (communication)
Between client and professional: - Continuity (development of relationship) - Equality (collaboration) - Equality (dependency, power) - Reciprocity - Trust
Contextual: -
Roberts & Bowers (2014) To develop a conceptual model that explains how residents develop relationships with peers and staff in nursing homes. unstructured interviews and field observations 15 cognitively intact nursing home residents from 2 nursing homes receiving care from staff (among others nurses) C O Client: - Attitude (acceptance of situation, open to professional) - Previous life experiences - Strategic adapting behaviour
Professional: - Attitude (friendly and kind) - Encouragement (encouraging autonomy of client) - Take time
Between client and professional: - Closeness versus professional distance (being part of a community) - Reciprocity - Social interaction (having a sense of fun, humour)
Contextual: - Time
Rugkåsa, et al. (2014) To investigate how influencing behaviours were conceptualized by professionals. structured interviews, in-depth interviews, focus groups 417 patients of community health services took part in structured interviews, 39 patients were additionally interviewed in depth.
48 care professionals (including nurses, psychiatrists, social workers, community support workers, occupational therapists, students and an office manager)
C & P M Client: -
Professional: - Attitude - Dependable - Encouragement - Extra effort (doing more than expected) - Focus on individual client (interest, genuine concern for client) - Listen - Professional competences (communication)
Between client and professional: - Closeness versus professional distance (professional relationship) - Continuity (development of relationship, perceiving stability in the relationship) - Equality (collaboration, dependency, power) - Reciprocity - Trust
Contextual: -
Scanlon (2006) To ascertain the nature and comprehension psychiatric nurses assign to the development of a therapeutic relationship. semi-structured interviews Six psychiatric nurses (client group not specified). P M Client: -
Professional: - Non-judgemental - Emotional investment or caring - Focus on individual client (interest, genuine concern for client) - Professional competences (communication, timing) - Working in a team
Between client and professional: - Closeness versus professional distance (professional boundaries) - Continuity (development of relationship) - Equality (dependency, power) - Reciprocity (sensing close contact and togetherness) - Social interaction (open communication, having a sense of fun or humour) - Trust
Contextual: - Time
Schroeder (2012) To give voice to the lived experiences of older adults with serious mental illness and their perceptions of the healthcare provider relationship open interviews 8 older adults with a serious mental illness receiving outpatient care from healthcare providers such as a GP, psychiatrist or therapist. C O&M Client: -
Professional: - Attitude (Non-judgemental attitude, respectful) - Closeness versus professional distance (being part of a community) - Dependable - Emotional investment (caring) - Encouragement (creating roles outside of being patient, helpful or being supportive, encouraging autonomy of client) - Focus on individual client - Listen
Between client and professional: - Closeness versus professional distance (informal relationship or friendship, professional distance) - Continuity (perceiving stability in the relationship) - Equality (dependency, power) - Trust
Contextual: -
Sellevold et al. (2013) To describe healthcare providers’ experience with the ethical challenges and possibilities in the relationship with patients suffering from dementia and their impact on quality care. in-depth narrative interviews 12 professionals from two different nursing homes providing care to clients suffering from dementia. 4 registered and 8 assistant nurses. P O Client: - Attitude (open to professional) – Emotional state
Professional: - Attitude (open to client) – Focus on individual client – Professional competences (communication)
Between client and professional: Equality (collaboration) – Reciprocity – Social interaction (use of touch, open communication) - Trust
Contextual: -
Shattell et al. (2006) To examine mentally ill patients’ experiences of what it is like to be understood. open interviews 20 mentally ill clients. Clients self-identified as having a mental illness. C M Client: -
Professional: - Take time – Attitude (non-judgmental, open to client, respectful) – Encouragement – Focus on individual client – Listen – Professional competences (communication)
Between client and professional: - Closeness versus professional distance – Continuity (development of relationship) – Equality – Social interaction (use of touch, open interaction)
Contextual: -
Shattell et al. (2007) To describe mental health service recipients’ experience of the therapeutic relationship. open interviews 20 mentally ill clients. Clients self-identified as having a mental illness. C M Client: -
Professional: - Attitude (non-judgmental, open to client) – Emotional investment – Encouragement (being positive, helpful) – Extra effort (doing more than expected) - Focus on individual client – Listen – Professional competences (communication) - Take time
Between client and professional: - Closeness versus professional distance – Continuity – Equality – Social interaction (use of touch)
Contextual: - Time
Westin & Danielson (2007) To illuminate and interpret the meaning of residents’ experiences of encounters with nurses in nursing homes. open interviews 12 residents from 3 nursing homes receiving care for at least 6 months. These residents received care from nurses. C O Client: -
Professional: - Attitude (respectful) – Encouragement (being positive, creating roles outside of being patient – Focus on individual client - Take time
Between client and professional: - Closeness versus professional distance (being part of a community) - Social interaction (having a sense of fun, humour, open communication)
Contextual: - Time
Brown Wilson (2009) To help understandi the factors that may be significant in forming relationships in care homes and how this may help the community’s development. participant observation, focus groups and interviews Interviews with 16 residents, 25 staff members and 18 family members. 8 focus groups of which 3 were held with residents, 2 with family members and 3 with staff members. 256 h of observation.
Many residents of one nursing had a degree of cognitive impairment and residents of another nursing home suffered from enduring mental health problems. Staff were unspecified.
C, P & F O Client: - Previous life experiences – Being part of a community
Professional: - Attitude (respectful) – Dependable – Focus on individual client – Listen – Task centered – Working in a team
Between client and professional: - Closeness versus professional distance (informal relationship or friendship) – Continuity – Reciprocity – Social interaction (having a sense of fun, humour)
Contextual: - Hierarchy – Setting – Time (workload)
Other: - family
Brown Wilson &. Davies (2009) How these relationships are developed and the contribution that staff make to this process through the routines of care. participant observation and interviews with residents 256 h of participant observation and interviews with 10 residents of three nursing homes, 25 staff members and 18 family members. Residents of the first nursing home had complex physical healthcare needs and some were cognitively impaired. Residents of the second nursing home had long-term mental health issues and complex healthcare needs. Residents of the third nursing home had complex health needs including mental health problems. Staff were unspecified. C, P & F O Client: - Previous life experiences
Professional: - Encouragement (creating roles outside of being patient) – Extra effort – Focus on individual client – Task centered – Take time
Between client and professional: - Continuity (development of relationship) – Closeness versus professional distance (being part of a community) - Reciprocity – Social interaction (having a sense of fun, humour, open communication)
Contextual: - Time (workload)
  1. 1. Included the perspective of client (C), professionals (P) or family (F)
  2. 2. Client group concerned: physically or mentally frail older adults (O), people with mental health problems (M), people with disabilities (D)