“A becoming in the meeting”: the interpretations of competence in home care from the perspectives of older people and registered nurses – a meta-ethnography

Figures & data

Table 1. Inclusion and exclusion criteria.

Inclusion Criteria Perspectives of older people, aged 65 years and over, living in and receiving care in their own homes Perspectives of government-employed registered nurses working in home care for older persons in their own homes that is paid for by taxes Peer-reviewed original qualitative research studies Date of publication: 2011–2021 English language

Exclusion criteria Care for older people taking place at nursing homes, day care centres, hospitals or short rehabilitation programmes Quantitative studies Mixed methods studies

Figure 1. PRISMA flowchart of the literature search.

Table 2. List of included studies with study characteristics and metaphors/themes.

Corbett and Williams (2014). Striking a professional balance: interactions between nurses and their older rural patients. Aim: To explore the nature and value of the relationship between older adults in chronic pain living in rural areas, and their health and social care providers. Participants: Both RN’s (4) and older people (10) Setting: home care visits in rural areas of Wales Method: Qualitative Interviews and qualitative data analysis Themes: Social and emotional connectedness through a familiar face Normal conversation Having time	Haex, R., Thoma‐Lürken, T., Beurskens, A. Haex et al. (2020). How do clients and (In)formal caregivers experience quality of home care? A qualitative approach. Aim: To explore and understand the views of clients and formal and informal caregivers about the experienced quality of home care for older people. Participants: Both RN’s (4) and older people (6) Setting: Dutch home care Method: A descriptive qualitative study using content analysis Themes: Familiar carers to provide personal care needs Having a connection Attentiveness
Hupkens, S., Goumans, M., Derkx, P., & Hupkens et al. (2020). Nurse’s attunement to patient’s meaning in life—a qualitative study of experiences of Dutch adults ageing in place. Aim: To explore the experiences of older adults who receive home nursing, in terms of nurses’ attunement to patients’ MiL Participants: Older people (24) Setting: home nursing patients in The Netherlands. Method: Gadamerian hermeneutic phenomenological design with semi-structured interviews and interpretative phenomenological analysis. Themes: Technical skills vs. personalized care Attentiveness Knowing the nurse A special connection	Sæterstrand and Rudolfsson (2019). Using a Reflective Attitude when Meeting Older Chronically Ill Patients’ Care Needs in Home Care Nursing. Aim: To describe what nurses take into account in order to meet the care needs of older chronically ill patients in home care nursing. Participants: Registered nurses (14) Setting: Four different home care units in two municipalities in Norway Method: Semi-structured interviews and qualitative content analysis Themes: Knowing the patient Listening Making time
Turpin et al. (2012). The meaning of a positive client-nurse relationship for senior home care clients with chronic disease. Aim: This study explored the meaning of a positive client-nurse relationship for seniors with chronic disease receiving in-home care. Participants: Older people (8) Setting: Home care in London, Ontario, Canada. Method: Phenomenological study Themes: A personal aspect (not just a clinical problem) Knowing the nurse Taking time	Choe et al. (2015). Ethical concerns of visiting nurses caring for older people in the community. Aim: The purpose of this study was to explore the ethical concerns that visiting nurses experience when caring for vulnerable older people living in a community. Participants: Registered nurses (13) Setting: 13 visiting nurses in a South Korean community. Method: In-depth interviews and qualitative thematic analysis Themes: Time pressure (due to administrative practices) Knowing the patient
Sundler et al. (2020). Attributes of person‐centred communication: A qualitative exploration of communication with older persons in home health care. Aim: The aim of this study was to explore attributes of person‐centred communication between nurses and older persons being cared for in their home. Participants: Both RN’s (11) and older people (37) Setting: Home care in Sweden Method: A descriptive study with a qualitative approach and qualitative thematic analysis. Themes: Recognizing the person and being familiar Asking questions and listening	Tønnessen et al. (2011). Rationing home-based nursing care: professional ethical implications. Aim: The purpose of this study was to investigate nurses’ decisions about priorities in home-based nursing care. Participants: Registered nurses (17) Setting: Home care in Norway. Method: Qualitative research interviews. The interviews were analysed and interpreted according to a hermeneutic methodology. Themes: Caring despite time pressure Attention to individual care needs

Figure 2. Example of data extraction table.

Table 3. Reducing themes into relevant categories.

Clustering themes into relevant categories Taking/making time Having time (Corbett & Williams, 2014; RN & OP) Making time (Sæterstrand T. M., & Rudolfsson, G. 2019, RN) Caring despite time pressure (Tønnessen et al., 2011, RN) Taking time (Turpin et al., 2012, OP) Time pressure due to administrative practices (Choe et al., 2015, RN) Knowing the patient/knowing the nurse Social and emotional connectedness through a familiar face (Corbett,, & Williams, 2014; RN & OP) Familiar carers to provide personal care needs (Haex et al., 2020, RN & OP) Knowing the nurse (Hupkens et al., 2020, OP) Knowing the nurse (Sæterstrand T. M., & Rudolfsson, G. 201; Choe at a;., 2015, RN)9, RN) Recognising the person and being familiar (Sundler et al., 2020, RN & OP) Knowing the nurse (Turpin et al., 2012, OP) Seeing the person, not just the patient The normal conversation (Corbett & Williams, 2014; RN & OP) Attentiveness (Haex et al., 2020, RN & OP) Technical skills vs. personalised care (Hupkens et al., 2020, OP) Attentiveness (Hupkens et al., 2020 , OP) Attention to individual care needs (Tønnessen et al., 2011, RN) A personal aspect – not just a clinical problem (Turpin et al., 2012, OP) Interpretations of connectedness Having a connection (Haex et al., 2020, RN & OP) A special connection (Hupkens et al., 2020 OP) Listening (Sæterstrand & Rudolfsson, G. 2019, RN) Asking questions and listening (Sundler et al., 2020, RN & OP)

Figure 3. Primary data synthesis of the primary author interpretations.

Figure 4. Example of a translation table – older people’s perspectives.

Table 4. Examples of third-order themes.

Third-order themes: Older people studies (interpretation of competence in home care)	Third-order themes: Registered nurses studies (interpretation of competence in home care)
Feeling prioritised/feeling important to someoneImportance of knowing and trusting each otherGetting recognized as a human beingMeaning something to someone Importance of knowing and trusting each other Getting recognized as a human being Meaning something to someone	Making/prioritizing timeBeing familiar/showing interestSeeing/acknowledging the whole person Being familiar/showing interest Seeing/acknowledging the whole person

Figure 5. Example of a synthesis process.

Figure 6. Example of a line-of-argument synthesis developed.

Figure 7. “A becoming in the meeting”.

Corbett, S., & Williams, F. (2014). Striking a professional balance: Interactions between nurses and their older rural patients. British Journal of Community Nursing, 19(4), 162–167. https://doi.org/10.12968/bjcn.2014.19.4.162

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Haex, R., Thoma‐Lürken, T., Beurskens, A. J. H. M., & Zwakhalen, S. M. G. (2020). How do clients and (in)formal caregivers experience quality of home care? A qualitative approach. Journal of Advanced Nursing, 76(1), 264–274. https://doi.org/10.1111/jan.14234

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Hupkens, S., Goumans, M., Derkx, P., & Machielse, A. (2020). Nurse’s attunement to patient’s meaning in life – a qualitative study of experiences of Dutch adults ageing in place. BMC Nursing, 19(1), 1–13. https://doi.org/10.1186/s12912-020-00431-z

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Sæterstrand, T. M., & Rudolfsson, G. (2019). Using a reflective attitude when meeting older chronically ill patients’ care needs in home care nursing. International Journal of Caring Sciences, 12(2), 666–673. https://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=138636054&site=ehost-live

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Turpin, L. J., McWilliam, C. L., & Ward-Griffin, C. (2012). The meaning of a positive client-nurse relationship for senior home care clients with chronic disease. Canadian Journal on Aging/La Revue Canadienne du Vieillissement, 31(4), 457–469. https://doi.org/10.1017/S0714980812000311

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Choe, K., Kim, K., & Lee, K.-S. (2015). Ethical concerns of visiting nurses caring for older people in the community. Nursing Ethics, 22(6), 700–710. https://doi.org/10.1177/0969733014542676

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Sundler, A. J., Hjertberg, F., Keri, H., & Holmström, I. K. (2020). Attributes of person‐centred communication: A qualitative exploration of communication with older persons in home health care. International Journal of Older People Nursing, 15(1). https://doi.org/10.1111/opn.12284

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Tønnessen, S., Nortvedt, P., & Førde, R. (2011). Rationing home-based nursing care: Professional ethical implications. Nursing Ethics, 18(3), 386–396. https://doi.org/10.1177/0969733011398099

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