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The Key to Me: Seniors' Perceptions of Relationship-Building with In-Home Service Providers

  • Thomas W. Gantert (a1), Carol L. McWilliam (a1), Catherine Ward-Griffin (a1) and Natalie J. Allen (a1)


Changing demographics and hospital downsizing have placed increasing demands on the home care sector. Many of those receiving in-home care are seniors whose chronic conditions require a collaborative approach. Both providers' paternalistic orientations toward senior clients and seniors' passivity within provider–client interactions have the potential to undermine relationship building. While the former has been documented, how seniors perceive relationship building within the home has received little attention. The purpose of this study was to explore seniors' perspectives on relationship building with in-home providers, focusing particularly on the facilitators of and barriers to this experience. Applying interpretive phenomenology, in-depth interviews were conducted with a purposeful sample of senior clients and an immersion/crystallization analysis strategy was used to elicit the findings. Findings revealed that seniors perceived relationship building as a dynamic process that encompassed facilitators and barriers at both individual and contextual levels. The interpretive findings afford several insights into building provider–client relationships within the in-home context.

Les données démographiques changeantes et les compressions imposées aux hôpitaux ont exercé de plus en plus de pressions sur le secteur des soins à domicile. Bon nombre des personnes recevant des soins à domicile sont des aînés dont l'état chronique exige une méthode concertée. Les orientations paternalistes des deux fournisseurs envers les clients âgés et la passivité des aînés lors des interactions fournisseur-client pourraient nuire à l'établissement de relations productives. Bien que ces orientations aient été documentées, la façon dont les aînés perçoivent l'établissement de bonnes relations à domicile a reçu peu d'attention. Le but de la présente étude était d'évaluer la façon dont les aînés voient l'établissement des relations avec les fournisseurs de soins à domicile, en mettant l'accent sur les facilitateurs de cette expérience et les obstacles afférents. En ayant recours à la phénoménologie interprétative, nous avons effectué des entrevues approfondies auprès d'un échantillon ciblé de clients âgés, et utilisé une stratégie d'analyse par immersion et cristallisation pour obtenir des résultats. Les résultats ont révélé que les aînés percevaient l'établissement de relations comme un processus dynamique qui englobait les facilitateurs et les obstacles au niveau tant individuel que contextuel. Les résultats interprétatifs donnent une meilleure idée de la façon de procéder pour établir des liens fournisseur-client dans le contexte des personnes à domicile.


Corresponding author

Requests for offprints should be sent to:/Les demandes de tirés-à-part doivent être adressées à: Thomas W. Gantert, R.N., Ph.D, School of Nursing, Faculty of Health Sciences, HSA H131, University of Western Ontario, London, ON N6A 5C1, (


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Anderson, G.F., & Hussey, P.S. (2000). Population aging: A comparison among industrialized countries. Health Affairs, 19, 191203.
Aronson, J. (2003). “You need them to know your ways”: Service users' views about valued dimensions of home care. Home Health Care Services Quarterly, 22(4), 8598.
Baltes, M.M. (1996). The many faces of dependency in old age. Cambridge: Cambridge University Press.
Bandura, A. (1999). A social cognitive theory of personality. In Pervin, L., & John, O. (Eds.), Handbook of personality (2nd ed., pp. 154196). New York: Guilford Press.
Barker, J.C. (2002). Neighbors, friends, and other nonkin caregivers of community-dwelling dependent elders. Journal of Gerontology, 57B(3), S158S167.
Benner, P.E., & Wrubel, J. (1989). The primacy of caring: Stress and coping in health and illness. Menlo Park, CA: Addison-Wesley.
Blumer, H. (1969). Symbolic interactionism: Perspective and method. Englewood Cliffs, NJ: Prentice-Hall.
Bowers, B., Esmond, S., & Jacobson, N. (2000). The relationship between staffing and quality in long-term care facilities: Exploring the views of nurse aides. Journal of Nursing Care Quality, 14(4), 5564.
Breeze, J.A., & Repper, J. (1998). Struggling for control: The care experiences of “difficult” patients in mental health services. Journal of Advanced Nursing, 28(6), 13011311.
Brown, D., McWilliam, C., & Ward-Griffin, C. (2006). Client-centred partnering in nursing. Journal of Advanced Nursing, 53(2), 160168.
Chant, S., Jenkinson, T., Randle, J., & Russell, G. (2002). Communication skills: Some problems in nursing education and practice. Journal of Clinical Nursing, 11(1), 1221.
Clark, P.G. (2002). Values and voices in teaching gerontology and geriatrics. Gerontologist, 42(3), 297303.
Cox, C.L., Kaeser, L., Montgomery, A.C., & Marion, L.H. (1991). Quality of life nursing care: An experimental trial in long-term care. Journal of Gerontological Nursing, 17(4), 611.
Coyte, P.C., & McKeever, P. (2001). Home care in Canada: Passing the buck. Canadian Journal of Nursing Research, 33(2), 1125.
Drew, N. (1986). Exclusion and confirmation: A phenomenology of patients' experiences with caregivers. Image: Journal of Nursing Scholarship, 18(2), 3943.
Erlen, J.A., & Jones, M. (1999). The patient no one liked. Orthopaedic Nursing, 18(4), 7679.
Fiscella, K., Meldrum, S., Franks, P., Shields, C.G., Duberstein, P., McDaniel, S.H., et al. (2004). Patient trust: Is it related to patient-centered behavior of primary care physicians? Medical Care, 42(11), 10491055.
Forchuk, C. (1994). The orientation phase of the nurse–client relationship: Testing Peplau's theory. Journal of Advanced Nursing Practice, 20(3), 532537.
Forchuk, C., & Reynolds, W. (2001). Clients' reflections on relationships with nurses: Comparisons from Canada and Scotland. Journal of Psychiatric and Mental Health Nursing, 8(1), 4551.
Forchuk, C., Westwell, J., Martin, M., Bamber Azzapardi, W., Kosterewa-Tolman, D., & Hux, M. (1998). Factors influencing movement of chronic psychiatric patients from the orientation to the working phase of the nurse–client relationship on an inpatient unit. Perspectives in Psychiatric Care, 34(1), 3644.
Grasser, C., & Craft, B.J. (2000). The blessing of giving: The importance of reciprocity to self-health care. Geriatric Nursing, 21(3), 138143.
Hackstaff, L., Davis, C., & Katz, L. (2004). The case for integrating behavior change, client-centered practice and other evidence-based models into geriatric care management. Social Work in Health Care, 38(3), 119.
Halpern, J. (2001). From detached concern to empathy: Humanizing medical practice. Oxford: University of Toronto Press.
Hochschild, A.R. (1983). The managed heart: Commercialisation of human feeling. Berkeley: University of California Press.
Kuzel, A.J., Like, R.C. (1991). Standards of trustworthiness for qualitative studies in primary care. In Norton, P.G., Stewart, M., Tudiver, F., Bass, M.J., & Dunn, E.V. (Eds.), Primary care research: Traditional and innovative approaches (pp. 138158). Newbury Park, CA: Sage.
McCabe, C. (2003). Nurse–patient communication: An exploration of patients' experiences. Journal of Clinical Nursing, 13(1), 4149.
McCann, T.V., & Baker, H. (2001). Mutual relating: Developing interpersonal relationships in the community. Journal of Advanced Nursing, 34(4), 530537.
McCormack, B. (2001). Autonomy and the relationship between nurses and older people. Ageing and Society, 21, 417446.
McCormack, B. (2004). Person-centredness in gerontological nursing: An overview of the literature. Journal of Clinical Nursing, 13(3a), 3138.
McWilliam, C., Brown, J.B., Carmichael, J.L., & Lehman, J.M. (1994). A new perspective on threatened autonomy in elderly persons: The disempowering process. Social Science and Medicine, 38(2), 327338.
McWilliam, C., Coleman, S., Melito, C., Sweetland, D., Saidak, J., Smit, J., et al. (2003). Building empowering partnerships for interprofessional care. Journal of Interprofessional Care, 17(4), 363376.
McWilliam, C.L., Stewart, M., Brown, J.B., Desai, K., Coderre, P., & Galajda, J. (1999). Home-based health promotion for chronically ill older persons: Results from a randomized controlled trial of a critical reflection approach. Health Promotion International, 14(1), 2741.
McWilliam, C., Stewart, M., Brown, J.B., McNair, S., Desai, K., Patterson, M.L., et al. (1997). Creating empowering meaning: An interactive process of promoting health with chronically ill older Canadians. Health Promotion International, 12(2), 111123.
McWilliam, C., Ward-Griffin, C., Sweetland, D., Sutherland, C., & O'Halloran, L. (2001). The experience of empowerment in in-home service delivery. Home Health Care Services Quarterly, 20(4), 4971.
Merleau-Ponty, M. (1964). The phenomenology of perception. Smith, C. (Trans.). London: Routledge and Kegan Paul.
Mok, E., & Chiu, P. (2004). Nurse–patient relationships in palliative care. Journal of Advanced Nursing, 48(5), 475483.
Morse, J.M., Havens, G.A., & Wilson, S. (1997). The comforting interaction: Developing a model of nurse–patient relationship. Scholarly Inquiry for Nursing Practice: An International Journal, 11(4), 321343.
Muncey, T. (2002). Individual identity or deviant case. In Freshwater, D. (Ed.), Therapeutic nursing: Improving patient care through self awareness and reflection (pp. 162178). London: Sage.
Patton, M.Q. (2002). Qualitative research and evaluation methods (3 ed.). Thousand Oaks, CA: Sage.
Pearlin, L.I., LeBlanc, A.J. (2001). Bereavement and the loss of mattering. In Owens, T.J., Stryker, S., & Goodman, N. (Eds.), Extending self-esteem theory and research: Sociological and psychological currents (pp. 285300). New York: Cambridge University Press.
Peplau, H.E. (1952). Interpersonal relations in nursing. New York: Putman.
Registered Nurses Association of Ontario (2002). Client centred care. Toronto: Author.
Registered Nurses Association of Ontario (2006). Establishing therapeutic relationships. Toronto: Author.
Richardson, J. (2002). Health promotion in palliative care: The patients' perception of therapeutic interaction with the palliative nurse in the primary care setting. Journal of Advanced Nursing, 40(4), 432440.
Rogers, C.R. (1951). Client-centered therapy. Boston: Houghton Mifflin.
Romanow, R.J. (2002). Building on values: The future of health care in Canada. Retrieved 11 Oct. 2004 from
Rosenberg, M., & McCullough, B.C. (1981). Mattering: Inferred significance and mental health among adolescents. In Simmons, R.G. (Ed.), Research in community and mental health (pp. 163182). New York: JAI Press.
Rundqvist, E.M., & Severinsson, E.I. (1999). Caring relationships with patients suffering from dementia: An interview study. Journal of Advanced Nursing, 29(4), 800807.
Shattell, M. (2002). Eventually it'll be over: The dialectic between confinement and freedom in the phenomenal world of the hospitalized patient. In Thomas, S., & Pollio, H. (Eds.), Listening to patients: A phenomenological approach to nursing research and practice (pp. 214236). New York: Springer.
Spiegelberg, H. (1982). The phenomenological movement. Dordrecht, The Netherlands: Mortinus Nijhoff.
Statistics Canada (2005). Population projections of visible minority groups, Canada, provinces and regions, 2001–2017. Ottawa: Author.
Williams, A. (2001). A study of practicing nurses' perceptions and experiences of intimacy within the nurse–patient relationship. Journal of Advanced Nursing, 35(2), 188196.


The Key to Me: Seniors' Perceptions of Relationship-Building with In-Home Service Providers

  • Thomas W. Gantert (a1), Carol L. McWilliam (a1), Catherine Ward-Griffin (a1) and Natalie J. Allen (a1)


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