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Promoting gentleness in health and social care

The key characteristics of employee gentleness can be described as taking a 'soft and slow' approach that combines guidance care behaviours - to direct the care process and achieve care objectives - and relational care behaviours which maintain and develop the relationship with the client.

These are among the key findings of a major piece of research by Alliance MBS into what it means to be gentle when caring in a professional role.

As Professor David Holman, Professor of Organisational Psychology at Alliance MBS, explained: “We want to develop our understanding of what it means to be gentle, and to understand how organisations can support it. To do this we observed practice over a few months and interviewed staff, patients and residents at a hospice day care centre and two care homes in the North West.”

The study found that the most important aspect of being gentle was taking a ‘soft and slow’ approach. This included a wide range of behaviours such as: speaking in a soft and quiet manner; softly touching hands or the lower arm; keeping an open posture (i.e. not crossing arms); sitting or crouching down to talk with clients; generally not rushing care delivery or decisions.

Professor Holman added that when guiding people, three things seemed most important. Firstly, friendly enquiry helps build a detailed understanding of who clients are and their needs. Secondly, offering support was essential and focused on giving people advice, assistance and encouragement. And thirdly, managing emotions was crucial. “Employees sought to manage clients’ emotions and feelings by reducing negative emotions such as anxiety, worry, fear and guilt, and by promoting positive emotions like calmness, contentment, happiness and comfort.”

The study found that being gentle helped with three particular aspects of care.

Firstly it helped ensure that clients and caregivers could discuss and disclose complicated, and at times emotional, topics. Secondly, being gentle helped with persuading clients to do a particular task such as eating, getting out of bed, or taking medicine. And thirdly, a gentle approach could give comfort when clients were upset or in pain.

Low workloads, few interruptions and high staffing levels are all factors that make it easier for care workers to spend extended and uninterrupted time ‘being gentle’ with clients.  Professor Holman said issues around workload and staff were especially evident at the hospice where staff-client ratios were low (1:1 or 2:1) and where staff had few interruptions and the pace of work was deliberately slow.

However, in care homes workload was high and interruptions far more frequent. “In this context, job discretion and support from colleagues and managers became all the more important for fostering gentleness, as they enable employees to ‘carve out’ the time to be gentle. Likewise, engaging in what we call knowledge-based practices, such as debriefing and handover meetings, was especially important when workload was high as this helped employees to develop close working relationships, agree on supportive solutions to client needs, and to focus on where gentleness might be most important.”

The report authors believe there are several ways that health and social care organisations can now help staff take a gentle approach to the care that they provide:

  • Sharing a belief in a person-centred care approach with other employees
  • Allowing staff discretion to decide what tasks to do when, and for how long so that client needs can be met
  • Having supportive colleagues and managers who will redistribute care/other tasks when caregivers need to spend extra time with clients
  • Sharing knowledge of clients at handovers and team meetings
  • Low workloads and few interruptions to allow caregivers to spend extended and uninterrupted time with clients

The report authors are now in the process of piloting a training course on employee gentleness that employees can use as part of continuing professional development, and which will be piloted between May and October this year.