Health Care and Health PromotionAn exploration of how positive emotions are expressed by older people and nurse assistants in homecare visits
Introduction
The communication in a clinical encounter could be viewed as a value chain by which the relationship and providers’ empathy as well as positive reappraisal of concerns contribute to coping and wellbeing [1]. Extensive focus has been devoted to the exploration of patientś expressions of concerns and worries and healthcare providerś responses; and the Verona Coding of Emotional Sequences has been an important tool in the last decade [2]. By focusing on negative emotions, there is also the possibility that we amplify them. Positive emotions are associated with health and longevity [3], social connectedness [4], and with flourishing mental health [5], [6]. We know that good feelings alter peoplés mindset by widening their scope of attention promoting behavioral flexibility [7]; whereas, negative emotions narrow people’s attention and limit behavioral responses [8]. While the expression of both positive and negative emotion is normal and adaptive, to achieve quality health care, it seems necessary to focus also on the positive emotions.
The structure of homecare visits is quite different from the consultation with a physician; the visit has a beginning and an end, but the communication is accompanying the goal of helping with activities of daily life (ADL) and nursing care, some of the communication being task focused but also socio-emotional and informal. In this paper, we want to explore the possible value of communication of positive emotion in these visits. Earlier analysis of the communication in these visits shows that the communications is mainly task-oriented, that more focus is paid to physical than existential needs [9], and that responding to worries, solving disagreements and relating to existential issues are challenging [10]. The older peopleś worries are related to relationships with others, health care related issues, aging and bodily impairment aspects including existential worries [11].
Affect is described as higher order categories of positive and negative emotions producing changes in peoples‘ thoughts, actions and physiological responses. Positive emotions include pleasant or desirable situational responses, and increase well-being in the moment by triggering upward spirals of cognitions and actions improving the capacity to cope with adversities experienced in the course of daily living. Thus, being able to mobilize positive emotions is an important part of resilience. Positive emotions have an impact not only because they may reduce negative emotions, but most of all because it triggers a multitude of benefits on a cognitive as well as on a physiological level. Though they are situational, positive emotions can serve an adaptive function that lead to enduring personal resources [12].
We now know that positive emotions, or good feelings, alter peoplés mindset and bodily systems, and predict a variety of meaningful outcomes. What we dońt know, is how positive emotions are being expressed by patients and health care providers in consultations. The aim of this study is to identify positive emotions expressed by older people and nurse assistants to discuss the function of these in the visits.
Section snippets
Design and sample
The study is a pilot study. Six transcribed audiotaped visits from the COMHOME study [13] were analyzed. The study was approved by the Norwegian social science data registry (NSD) and supported by the Research Council of Norway, grant no. 226537 (PraksisVEL). As this was a pilot study, all six visits were coded in consensus by HE and LH. We then calculated descriptive simple statistics.
Expression of positive emotion
Expressions of positive emotion were coded using a system developed by Terrill, Ellington et al. [14] (under
Results
Descriptive numbers of older peoples and NAs expressions of positive emotions in the visits were summed up. See Table 2.
In total, we found 114 expressions of positive emotions in the six homecare visits, giving a mean of 19 expressions per consultation (range 4–36). The consultations varied in length from 2 min 27 s to 32 min 25 s (M = 17 min 49 s). Nurse assistants‘ expressed more positive emotions (N = 71, 62.3%) than did patients (N = 43, 37.7%). We found expressions in six out of the seven categories (
Discussion
Home health is expanding to meet the increasing aging population. This care is typically being provided by Nursing Assistants (NA). Often the goal of care is to sustain patients’ independence while they remain in the comfort of their home. Additionally, home health saves costs compared to hospitalization or a skilled nursing facility. It is therefore important for nursing assistant care to support patients’ physical health and prevent decline while also promoting their emotional strength and
Conclusion
We agree with Finset and Mjaaland in that positive reappraisal of the patient is an important part of a consultation. However, not merely the concerns and negative emotions needs validation. The praise and support given by NAs, also seemed effective in contribute to fostering relationships and maintaining patient resilience. Thus, we claim that emotional talk in communication also should include positive emotions. Teaching health care providers about the importance of expressions of positive
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