Enhancing relationships between care providers and residents in long-term care. Designing a model of care.

Research in three different areas was examined and several conclusions can be drawn. Continuity of care provider is critical to understanding the resident and to developing relationships with the resident over time (Patchner, 1987; Teresi et al., 1993a). The teaching of interactional skills is not enough; the care provider must be engaged in some way, such as learning about the person through life stories (Best, 1998; Caris-Verhallen et al., 2000; Coker et al., 1998; Heliker, 1999; McCallion et al., 1999; Pietrukowicz & Johnson, 1991; Williams & Tappen, 1999). If care providers are called to enhance relationships with residents, they too must be supported in their work environments (Hallberg & Norberg, 1993; Montegar et al., 1977; Kovach & Krejci, 1998). Finally, research confirmed positive secondary resident and care provider outcomes can be achieved following the development of holding relationships. Overall, preliminary empirical support for the capacities of the care provider--reliability, empathy, continuity--and for the requirement for support were established from a review of the literature. However, no intervention studies were found that incorporated the complete set of theoretical variables. Testing the combined influence of these variables, as conceptualized by Winnicott's (1970) theory of relationships, and the manner in which they affect the holding relationship for residents, and subsequently secondary care provider and resident outcomes, is essential to assess the usefulness of this theory to relationship building in LTC. Caregiving relationships involve all kinds of social interaction during the course of which the patient's sense of self-worth can either be enhanced or thwarted (Agich, 1990). Therefore, a milieu should be developed to accentuate care provider-resident relationships and lead to a systematic and encompassing framework of positive expectations on the part of all nursing personnel involved. A model of care focusing on relationships may be one means to this end.