Evid Based Nurs doi:10.1136/eb-2013-101596
  • Care of the older person
  • Quantitative study—other

A model to develop compassionate relationship-centred care between older people, relatives and staff identifies seven factors necessary to promote appreciative caring conversations

  1. Beth Mahler
  1. Centre for Nursing and Health Studies, Athabasca University, Alberta, Canada
  1. Correspondence to: Dr Beth Mahler, Centre for Nursing and Health Studies, Athabasca University, 1 University Drive, Athabasca, Alberta, Canada T9S 3A3; bethp{at}

Commentary on: [CrossRef][Medline]Google Scholar

Implications for practice and research

  • Two forms of knowledge (person and relational) facilitate staff, patient and family collaboration.

  • ‘Simple gestures’, provided in a spirit of sincerity, often positively change patients’ lives.


A longstanding concern regarding quality of care for older people in acute care hospital settings exists. The authors of this study point out the tension between efficient patient care activities, and development of therapeutic carer–patient relationships, a strain that may cause compassionate care to be lost. They established a link between thearpeutic relationships, quality of care and patient and staff satisfaction. Investigators sought to discover the dimensions of compassionate care in the context of older adult care and to uncover relational strategies that can be implemented by carers and relatives to achieve these dimensions.

The study is a component of a larger action research programme called the Leadership in Compassionate Care Programme, undertaken by Edinburgh Napier University and National Health Service Lothian.


Dewar and Nolan used a collaborative approach called appreciative inquiry to explore what participants value, rather than taking a more negative, problem-based focus. They also used action research, which focuses on practical change and involves multiple stakeholders, including patients, staff and relatives. Participants included a sample of staff comprising registered nurses, non-registered care staff, allied healthcare professionals and medical staff (n=35); patients (n=10) and families (n=12). A variety of data-gathering strategies were used, including participant observation, interview, storytelling with emotional touch points, photo elicitation and group discussion. Informal observations and discussions were recorded in field notes. Data analysis used immersion crystallisation and staff were involved as coanalysts. Owing to the emergent design, research ethics approval was renegotiated throughout the study.


The study resulted in conceptualisation of compassionate, relationship-centred care and development of a guiding practice model based on seven ‘C's. These model attributes, foundational to caring conversations, are courage, connecting emotionally, curiosity, collaborating, considering other perspectives, compromising and celebrating.

Dimensions of care were identified and illustrative stories provided. The dimensions are: ‘know who I am and what matters to me’, and ‘understanding how I feel’. Researchers identified two forms of knowledge (person and relational) that facilitated staff, patient and family collaboration to ‘get things done’. Knowledge and dimensions of care are gained through ‘appreciative caring conversations’.


Caring and compassion are considered essential in patient-centred care. Yet caring is a multifaceted, personalised and complex human interaction that is problematic to define. Articulating specific strategies that are experienced as compassion is challenging. Dewar and Nolan overcame these difficulties. They transform ‘care’ and ‘compassion’ from vague, overused terms to more tangible and achievable outcomes.

The seven Cs of caring conversations provide ways to communicate caring. For example, simply being curious and questioning can lead to enhanced patient–carer collaboration. Likewise, courage and risk-taking can enhance caring. The commonality in the seven Cs is that they are all ‘simple gestures’.1 Simple gestures are small caring acts, provided in a spirit of sincerity that often positively change patients’ lives.

The strength of this study is the illustrative stories. Stories are powerful teaching strategies. Reflective learning results from exposure to stories helping care professionals build empathy and explore their views of the human experience.2 Stories model effective behaviour demonstrating how to care. The memorable, well-written narratives are embedded with lessons that facilitate changes in attitudes and behaviours in readers. The authors illustrate dimensions and concepts effectively by weaving stories into their manuscript.

Dewar and Nolan link quality of care to staff satisfaction in a linear way. Considering the links between these concepts as cyclical rather than linear could extend this discussion. Such a caring-quality-caring spiral has been called the miracle circle.1

Finally, the methodology used is truly participative. The philosophical underpinnings of qualitative research are clearly upheld during data collection and analysis, including the involvement of study participants as coanalysts. By providing participants’ verbatim stories, readers are also invited to contribute a layer of analysis as they read the stories themselves.


  • Competing interests None.


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