Fostering a Trusting Relationship With Family in Dementia Special Care Units: A Participatory Action Research Project

Aim: To explore experiences of nursing home staff in implementing self-designed interventions to foster trusting relationships with family in practice. Design: This qualitative study used a Participatory Action Research approach. Methods: Data collection included focus groups (n = 15), interviews (n = 28) and observations (n = 5). A holistic narrative approach was used for data analysis, resulting in co-constructed narratives representing experiences of nursing home staff in implementing four different interventions in five Dutch dementia special care units in nursing homes. The data collection period began in August 2021 and ended in April 2022. Results: Nursing home staff implemented self-designed interventions to foster trusting relationships with family, including initiating informal conversations, sharing residents’ ‘happy’ moments, discussing mutual expectations, and being more aware of families’ emotional burdens. Identified facilitators emphasise the importance of reciprocity, familiarity, transparency, realistic goal setting and empathy. Identified barriers are related to moral uncertainty in balancing competing demands, conflicting social norms, prioritising hands-on care tasks over family contact and lack of courage to act. Conclusion: Nursing home staff conclude that their interventions contribute positively to building and maintaining a trusting relationship with families. Implications for the Profession and/or Patient Care: Sharing the narratives of nursing home staff with peers would support them in implementing interventions to foster trust. Regular Moral Case Deliberations can be used to address moral uncertainty. Collective dialogue among nursing home staff can be useful in establishing new social norms that prioritise family involvement. Conversation skills training can empower nursing home staff. Impact: Trust between nursing home staff and families can be improved by implementing the conducted interventions. Reporting Method: This report adheres to the standards for reporting qualitative research (COREQ). Patient or Public Contribution: No patient or public contribution.