task centred approach case study

Social Work Practice pp 115–132 Cite as

Task-centred Practice

Veronica Coulshed &
Joan Orme

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Part of the book series: Practical Social Work ((PSWS))

Task-centred practice, also known as brief therapy, short-term or contract work has had a significant impact on both social work practice and the organisation of services. As the various names suggest, it is focused work which is time-limited and offers approaches to problem-solving which take into account the needs of individuals to bring about change in their situations, and the requirements of agencies that work is targeted and effective. As we will see in the account of the development of the method, its introduction challenged some of the principles of casework. In doing this it recognised that the person with the problems also had the means to resolve them, and that social work intervention should become more of a partnership. In this way task-centred casework can be seen to be at the beginning of attempts to empower users of social work services. It offers an optimistic approach which moves the focus away from the person as the problem, to practical and positive ways of dealing with difficult situations.

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Coulshed, V., Orme, J. (1998). Task-centred Practice. In: Social Work Practice. Practical Social Work. Palgrave, London. https://doi.org/10.1007/978-1-349-14748-9_7

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Task Centred Casework

This multimedia learning object provides an introduction to the "task-centred" model of social work intervention. This model was based on the work of Sigmund Freud and the psychoanalysts. Psychoanalytic social work emphasised relationship-focused intervention with the professional adopting the role of the 'expert'.

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In This Article Expand or collapse the "in this article" section Brief Therapies in Social Work: Task-Centered Model and Solution-Focused Therapy

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Task-Centered Organization
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Brief Therapies in Social Work: Task-Centered Model and Solution-Focused Therapy by Cynthia Franklin , Krystallynne Mikle LAST REVIEWED: 06 May 2015 LAST MODIFIED: 30 September 2013 DOI: 10.1093/obo/9780195389678-0188

Brief therapies serve as evidenced-based practices that place a strong emphasis on effective, time-limited treatments that aid in resolving clients’ presenting problems. The resources presented in this article summarize for professionals and educators the abundant literature evaluating brief therapies within social work practice. Brief therapies have appeared in many different schools of psychotherapy, and several approaches have also evolved within social work practice, but two approaches—the task-centered model and solution-focused brief therapy (SFBT)—stand out as being grounded in research and have also gained international acclaim as important interventions for implementation and further study. These two approaches are the focus of this bibliography. The task-centered model and SFBT were developed by social work practitioners and researchers for the purposes of making clinical practice more effective, and they share a common bond in hoping to improve the services delivered to clients. Since the development of the task-centered and solution-focused approaches, brief therapies have become essential to the work of all types of psychotherapists and clinicians, and many of the principles and practices of brief therapy that are a part of the task-centered and solution-focused approaches are now essential to psychotherapy training. Clinical social workers practicing from the perspective of the task-centered model and SFBT approaches work from several brief therapy assumptions. The first regards the client/therapist relationship. The best way to help clients is to work within a collaborative relationship to discover options for coping and new behavior that may also lead to specific tasks and solutions for change that are identified by the client. Second is the assumption that change can happen quickly and can be lasting. Third, focus on the past may not be as helpful to most clients as a focus on the present and the future. The fourth regards a pragmatic perspective about where the change occurs. The best approach to practice is pragmatic, and effective practitioners recognize that what happens in a client’s life is more important than what happens in a social worker’s office. The fifth assumption is that change can happen more quickly and be maintained when practitioners utilize the strengths and resources that exist within the client and his or her environment. The next assumption is that a small change made by clients may cause significant and major life changes. The seventh assumption is associated with creating goals. It is important to focus on small, concrete goal construction and helping the client move toward small steps to achieve those goals. The next regards change. Change is viewed as hard work and involves focused effort and commitment from the client and social worker. There will be homework assignments and following through on tasks. Also, it is assumed that it is important to establish and maintain a clear treatment focus (often considered the most important element in brief treatment). Parsimony is also considered to be a guiding principle (i.e., given two equally effective treatments, the one requiring less investment of time and energy is preferable). Last, it is assumed that without evidence to the contrary, the client’s stated problem is taken as the valid focus of treatment. The task-centered model and SFBT have developed a strong empirical base, and both approaches operate from a goal-oriented and strengths perspective. Both approaches have numerous applications and have successfully been used with many different types of clients and practice settings. Both approaches have also been expanded to applications in macro social work that focus on work within management- and community-based practices. For related Oxford Bibliographies entries, see Task-Centered Practice and Solution-Focused Therapy .

Task-Centered Model Literature

The task-centered model is an empirically grounded approach to social work practice that appeared in the mid-1960s at Columbia University and was developed in response to research reports that indicated social work was not effective with clients. William J. Reid was the chief researcher who helped develop this model, and he integrated many therapeutic perspectives to create the task-centered approach, including ideas from behavioral therapies. The task-centered model evolved out of the psychodynamic practice and uses a brief, problem-solving approach to help clients resolve presenting problems. The task-centered model is currently used in clinical social work and group work and may also be applied to other types of social work practice.

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Practice Model: Task Centred

Outline, espoused values, basic characteristics, strengths and limitations; initial, middle and terminal phases of practice approach in detail

This page has three sections:

Background Material that provides the context for the topic

A suggested Practice Approach

A list of Supporting Material / References

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Background Material

Task-centred social work is a way of working with clients to achieve their goals and alleviate immediate problems. The problems can include one or more of the following: interpersonal conflict; dissatisfaction in social relations; relations in formal organizations; difficulty in role performance; problems of social transition; reactive emotional distress; and/or inadequate resources. The key to identifying problems is that the client must express a desire to work on the problem either independently or in collaboration with the social worker.

The basic process of the approach includes identifying the problem(s) as perceived by the client, exploring the problem(s) in detail, selecting the problem that is causing the client the most distress as the target for intervention, defining a goal which removes or diminishes the problem, establishing tasks for both the client and social worker that moves the client towards the goal, and evaluating the end work. Evaluation explores whether the client has reached the desired goal and whether the problem has been removed or diminished.

The following values are inherent in the task-centred approach and are particularly useful for social work (Doel, 1991).

1. Partnership and empowerment The relationship between the client and social worker is one of partnership and collaboration. The client should specify problems from her or his perspective and establish goals that are personally meaningful. Inequalities in the sense of power, roles or responsibility, these need to be made explicit in order to create a true partnership.

2. Clients are the best authority on their problems Clients should describe the problem from their perspective and establish personally meaningful goals. At times external sources may define the problem.

3. Builds on people’s strengths rather than their deficits Social workers should identify each person’s strengths and resources

4. Provide help rather than treatment The social worker’s responsibility is to acknowledge and make explicit this power imbalance while seeking to work collaboratively with the parents to reach their goals as well as those mandated by the courts.

Basic Characteristics

1. Focus on Client-Acknowledged Problems The focus of service is on resolving specific problems that clients explicitly acknowledge as being of concern to them (problems-in-living).

2. Planned Brevity Service is short-term, 6 to 12 weekly sessions within a 4-month period.

3. Collaborative Relationship Relationships with clients emphasize a caring but collaborative effort. Client and practitioner contract explicitly about the target problems to be worked on, goals, and duration. The practitioner’s role includes structuring sessions for collaborative problem-solving work and occasionally carrying out tasks on behalf of clients.

4. Structure The intervention program is structured into well-defined sequences of activities that focus on resolving target problems. The middle phases include systematic task planning and implementation activities.

Several strengths include the following:

The task-centred approach is a generic approach in the sense that it can be applied to a variety of problems / difficulties .

The task-centred approach can be easily used in combination with other theories and methods and across many settings. For example, a social worker may begin by utilizing motivational interviewing with a client who is ambivalent about making a change and then switch to task-centred social work when the client is ready to work towards alleviating the identified problem.

The approach is empowering in that the social worker and client enter into a partnership where the client identifies the problem, specifies a goal and participates in small tasks that lead to reaching the goal. The social worker and client equally participate in this process, are both accountable and are able to receive feedback about their work together.

The approach has continually been subjected to research and has been found to be a cost-effective method of working. The approach incorporates aspects of social systems theory and therefore, although clients define the problems and goals, they do not have to be the focus of intervention and the problem does not necessarily have to reside with them.

The limitations of the approach include the following:

The task-centred approach may not be appropriate for all clients . For instance, the approach requires that the client make links between problems, tasks and goals (that is, actions and consequences), yet some clients may experience limitations or difficulties to this type of thought.

The task-centred approach may be difficult to implement if the client is mandated to work with you.

Practice Approach

Supporting Material

(available on request)

Teater, B. K. (2010). Introduction to applying social work theories and nethods . Berkshire: McGraw-Hill Education. Retrieved from http://ebookcentral.proquest.com/lib/une/detail.action?docID=771427

Fortune, A. E. & Reid, W. J. (2011). Task-centered social work. In F. Turner (Ed.), Social work treatment: Interlocking theoretical approaches (5th ed.), (pp. 513-532). Oxford, England: Oxford University Press.

Phases of the model

There are several clearly identifiable phases in the application of the task-centered model:

Firstly, the social worker helps the service user articulate the specific problems as the service user sees them. In this phase active listening is important.
Secondly, the social worker assists the service user to break down and detail the problem areas, redefining these where necessary. Distressed or anxious service users sometimes cannot 'see the wood for the trees'.
Finally the social worker encourages the service user to prioritise the problems according to the service user's own views. Sometimes an external constraint (for example the threat of eviction) is most pressing, but otherwise the priority depends on the urgency as perceived by the service user.

Using the task-centered approach the social worker and service user will work in parnership to:

Identify outcomes
Agree a contract
Review and evaluate progress

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What is Task Centered Therapy in Social Work In The United States?

What is Task-Centered Practice in Social Work?

Task-Centered Practice in Social Work is an active, direct, and easily measurable way to focus on actionable solutions to specific problems. It’s one thing to recognize and appreciate the socioeconomic factors contributing to a client’s issues.

However, using this information to determine the best practice model for the client is one of the most significant challenges for social workers. Sometimes, it’s more appropriate to reinforce a client’s support structures and let the problems resolve passively. However, in task-centered practice (TCP), the social worker’s approach is more direct.

The task-centered practice focuses on actionable solutions to specific problems. It is active, direct, and easily measurable. Present in many disciplines, this method was first adapted to social work in the 1970s by two practitioners from the Chicago School of Social Service Administration, William Reid and Laura Epstein.

Their process is taught in schools worldwide, though often as a part of other practice models. Since TCP is adaptable, practitioners use it “accidentally” to address specific client problems. The anatomy of this model is as straightforward as the name implies. It identifies the client’s issues, outlines goals, creates and executes a task-centered plan, and evaluates the results.

Identify the Target Problem

The problem(s) that clients present may vary greatly depending on the social work practice setting, the region and population served, and several other factors. Regardless of the environment, social workers must rely on a range of methods, including intake assessments, counseling sessions, psychotherapy, and more, to determine the target problem or problems.

In many cases, clients may be unaware, hesitant to explain, or dishonest about their problems, significantly if it could threaten their parental custody and job status. Social workers must have systems in place to make their clients feel supported and protected, which encourages greater transparency in stage one of the TCP model.

Let’s say that the client has met with their social worker at a private addiction counseling center, and through assessments and private counseling, the two have agreed on two target problems:

Prescription opioid addiction
Potential bipolar disorder (undiagnosed)

We will follow this case study throughout the remaining steps. The target problems have been identified. So, now it is time for the social worker and the client to delineate specific goals in the task-centered practice model.

Set Goals Collaboratively

We have already identified the target problems. Therefore the goals may seem obvious in this case. For example, quitting prescription opioids and seeking an evaluation for bipolar disorder would be the solution.

However, these goals need to be detailed to serve as a proper foundation for the next step. In this step, you create and execute a task-centered action plan. Simply stating that one wants to run a marathon, for example, doesn’t help a person to formulate a workout and diet plan for that first week of training.

The social worker should personalize the client’s goals. This way, every step motivates the client as they progress towards a realistic and vividly detailed outcome. This is also an ideal opportunity to give the client control which is a key component to self-motivating behaviors. When clients can choose their own goals, they are more invested in working towards them.

Create and Execute a Task-Centered Action Plan

The task-centered action plan is a reflection of the goals of the client. If the goals are the “what,” then the task-centered action plan is the “how.” Given our current case, the action plan could reasonably consist of the following steps:

Identify and eliminate client-specific triggers for opioid abuse.
Introduce safer, legal methods of pain control and stress/anxiety management.
Start a mood diary on client strengths and review with the social worker to assess possible bipolar symptoms.
Eliminate any roadblocks preventing a psychiatric evaluation like no insurance, high copay, no in-network providers in the area and other small tasks.
Refer client to mental health specialist for possible diagnosis and case management.
reactive emotional distress
receive feedback

Generally, the TCP model involves a series of eight or more sessions between the social worker and client carried out for at least six months. Throughout this time, the client and social worker will assess the client’s progress toward the broader goals stated above by checking off the action steps stated just above.

One of the most significant advantages of the TCP model is making appropriate adjustments in response to any unexpected developments. If the client, in this case, reported that the mood diary only worsened their negative thought patterns and mood swings, for example, the social worker may need to pivot to another form of self-assessment or eliminate the step.

Evaluate the Results

First, the client must meet the agreed-upon number of visits and time limit for the task-centered plan. Then the social worker can evaluate its effectiveness.

Then, like a patient being discharged from a medical facility, if the client needs more care, it is up to the provider to delineate the nature of this care and refer the client or patient when appropriate.

Assess the Remaining Needs

The assessment should not be undertaken from a “pass-fail” perspective. This evaluation style does not adequately reflect the client’s unique set of challenges. For example, a client with an opioid addiction may depend on sugary snacks. It may even worsen their health. This isn’t a failure to address the original addiction but an unintended consequence that needs to be addressed.

By documenting and reporting the results of a TCP plan, social workers support a constantly growing knowledge base. And then others in their profession can follow. TCP is an evidence-based practice by social workers and other practitioners. Its use lets others in the field assess the effectiveness of the many interventions and techniques.

Applications of Task Centered Model

In summary, the task centered model is one of the most broadly applicable techniques for social work available across the social work umbrella. This method doesn’t differentiate between problems like joblessness, mental health issues, unplanned pregnancy, and criminal rehab. Instead, it offers a systematic, evidence-based approach for solving any set of problems.

Clients and social workers cooperate to identify issues, set goals, develop an action plan and evaluate the results. Additionally, individuals can adjust to the flexible structure. Social workers use task centered model in every conceivable environment, including hospitals, schools, mental health facilities, and private practices.

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Social Work: An Introduction

Student resources, case studies / activities.

Case study with Activity

Having read about the five stages of task-centred work, consider the following case study and the action points at each stage. You may need to refer back to the chapter to refresh your understanding of the task-centred approach. You might find it helpful to undertake this activity with a small group of fellow students so that you can share and discuss your understanding.

Linda (23 years old) has approached the duty worker at the local area social work office. Linda advises the worker that she is struggling to cope with all the demands that exist in her life. During the discussion, Linda presents the following information; Linda lives in a one bedroom flat with her son, Sam (2 years old). The property is in poor condition with internal damp, single glazing and inadequate heating. The father of Sam is John (29 years old). Linda and John separated when Linda was five months pregnant with Sam and since then John has provided little financial or practical support. Contact between John and Sam is sporadic at best. Linda has no family support following the death of her mother a year ago. Over the past few months Linda has faced increasing problems with debt and she has struggled to manage her benefit entitlement. Linda feels socially isolated within the local community and she has been unable to access external support either for Sam or herself.

Stage 1: Problem exploration Activity - Part 1

From the information provided, list the problems that exist for Linda. Consider how you would work with Linda in a manner that promotes her participation in this process.

Stage 2: Identifying priority problems and agreeing goals Activity - Part 2

Look again at the problems that you listed in Part 1. From Linda’s point of view, how might these problems be prioritised and why?
Identify some goals that Linda might want to work towards. In doing this you should consider whether goals identified by service users always align with those that social workers might identify?
Create a contract for the work that will be carried out with Linda. Remember to ensure that the contract contains the required information but is also written in a manner which ensures that it will be understood.

Stage 3: Identifying required tasks Activity Part 3.

Identify some tasks that could be undertaken in work with Linda. These tasks should be linked to the goals that you devised earlier.
Which tasks would best be completed by Linda? Are there any tasks that could be undertaken by the worker?

Stage 4: Carrying out and achieving the tasks Assume that work with Linda takes place; then consider stage 5.

Stage 5: Ending the work and evaluation Activity Part 4.

List some of the considerations that should be taken into account when working with Linda as you move into the termination phase.
What practical measures would you put in place to manage this phase in an effective manner?

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TASK-CENTERED APPROACH. This essay takes a social work case study as the basis for an analysis of the different approaches that must be taken when dealing with individuals in a social work setting

INTRODUCTION

This essay takes a social work case study as the basis for an analysis of the different approaches that must be taken when dealing with individuals in a social work setting. The essay focuses on a task-centered approach to solving the problems that arise in the context of the specific problem being discussed; this approach is preferred since it allows for a number of smaller goals to be set, and it is then possible to quantitatively and qualitatively assess the extent to which those goals have been met, and what measures (if any) must be taken in order to improve working standards in future. The case will also highlight the values, anti-discriminatory and anti oppressive practice that was involved in applying the task-centered approach which helped with the decision-making process.

The aim is to use the case of NG in order to better understand various aspects of social work, and to come up with a series of recommendations in terms of any improvements that might be necessary. At its most basic formulation, social work can be defined as “a social science that improves the lives of people and societies… and to promote social justice and the end of chronic social problems” (Wilson et al., 2008, p. 17). By studying the theory of social work, it’s possible for practitioners to gain a far better understanding of the ways in which social care practice can be used to enhance the lives of those who are in need of help. In order to be useful, however, such theory “must have a practical dimension that allows for the application of that theory in the real world” (Wilson et al., 2008, p. 36).

The International Federation of Social Workers (2000 in Beckett, 2006:5) provides the following definition:

‘The social work profession promotes social change, problem solving in human relationships and the empowerment and liberation of people to enhance well-being. Utilizing theories of human behaviour and social systems, social work intervenes at the points where people interact with their environments. Principles of human rights and social justice are fundamental to social work’

Payne (2005) suggests that social workers need to have ideas that try to explain why and how we should make our practice decisions. Social work theory, therefore, can be said to serve the functions of providing some explanation for the complexities observed in practice, help predict future behaviour, how the problem or condition could develop and what might be the effect of planned change (Coulshed & Orme, 2006).

Furthermore, social work theory provides guidance towards more effective practice (Coulshed & Orme, 2006). Payne (2005) informs that workers use theory within the politics of their daily practice to offer accountability to manager, politicians, clients and the public. In addition, he explains that theory does this by describing acceptable practice sufficiently to enable social work activities to be checked to see that they are appropriate.

Payne (2005) also highlights that because social work is practical action in a complex world, a theory or perspective must offer a model of explicit guidance and must be based on evidence about what is valid and effective and therefore suggesting that a model should be backed by explanatory theory.

CASE STUDY: NG

NG was a 65-year old man who had no history of severe health problems until, just after Christmas, he suffered a substantial fall at home and broke his hip in three places. Prior to this fall, NG was a socially and physically active individual, with many community interests and a series of active hobbies include bicycle riding, ballroom dancing and bowls. The fall was atypical, since it involved him tripping at the top of the stairs and falling all the way down. Since his wife was out at the time, he lay in agony for a few hours before she came home and called an ambulance.

In hospital, NG went through three operations. The first was to re-set the bone; the second was to fit a small metal grip; and the third was related to complications from the first two. Unfortunately, these operations drained NG’s strength to the point that, after three weeks, he developed pneumonia. For around three days, he was on a respirator and his wife was informed that he was not expected to make it through the night. Although he subsequently recovered, those who knew him said that he was ‘not the same man’ after leaving hospital: his activity levels had plummeted and he showed no inclination to leave the house, let alone resume a gentle version of his former activities. He claimed to be in no pain from his hip, although his wife and GP both believed that this was not true. Furthermore, he had begun to argue with his neighbours over trivial matters, and they were coming to view him as a nuisance, raising the possibility of an escalating feud.

When I first encountered NG, he was not very communicative. He has taken to using a wheelchair, although he is able to walk. It was difficult to reconcile this man with the description given by his wife of his lifestyle before the accident. Responses were monosyllabic at best, and it was clear that this was taking a substantial toll on his wife. His GP was of the opinion that NG was ‘feeling sorry for himself’, although a subsequent visit by a different GP resulted in a diagnosis of depression. Medication, in the form of Fluoxetine, was offered to NG, but he dismissed the idea, and the GP advised that there was little that could be done – if he refused to take the medication, that was his choice.

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It was clear that NG was suffering from the traumatic after-effects of his fall, and that this had affected him massively on an emotional level. Physically, although his hip was painful and stiff, he should have been able to resume a moderately active life; instead, he appeared to choose to drift into sedentary habits and to refuse to leave the house. The diagnosis of depression was accepted, and it was noted that NG’s personal hygiene was starting to slip. Furthermore, the effect on his wife was clear, and she appeared frail and distracted now that she was having to put up with NG’s low mood and occasional outbursts of anger. It was clear that a task-centered approach was the best option.

TASK-CENTERED APPROACH

Task-centered work originated wholly within social work, from a famous series of studies by Reid and Shyne (1969), Reid and Epstein (1972a, b) and Reid (1985) (Payne, 2005:99). Moreover Reid (1992:12 in Payne, 2005:99) acknowledges the influence of crisis intervention – which originated from mental health and formulated by Caplan (1965 in Payne, 2005) – on the development of task-centered work (Payne, 2005).

As Neil Thompson notes, “this approach not only means that it’s easier to track a subject’s development, it also forces them to face up to the realities of the problems that they are facing” (Thompson, 2005, p. 85). This can sometimes be a problem: if the individual refuses to acknowledge the problem(s), they will also likely refuse to accept the need generated by the tasks that are set. As Thompson goes on to point out, “it’s often the case that one of the hardest initial roles involves persuading the subject of the importance of setting out and then following the list of tasks” (Thompson, 2005, p. 96).

However, once a task-centered approach has been decided upon, the collaborative nature of the task system can quickly improve the bond between the social worker and the subject. This bond is often tangible in terms of the benefits that it brings to the subject’s willingness to work towards the goals that have been set, and it’s been noted by a number of commentators that “if the social worker is forced to hand his or her role on to a colleague, the subject often gives up on the goals, since the tasks have become highly individualized and tailored to fit the specific relationship that has been established with the first social worker” (Trevithick, 2005, p. 7). It’s therefore important, where possible, to ensure a high degree of continuity in terms of the care provider.

Another advantage of the task-centered approach is that it is, by its nature, limited in terms of time, this means that goals are set with specific deadlines by which they are expected to be complete (Coulshed & Orme, 2006:156). Obviously these goals should be realistic, since no-one will benefit if the work is rushed, but it has nevertheless been shown in a number of studies that it’s very important to generate a feeling that the deadlines set for specific tasks are important and should not, if possible, be missed. As Juliette Oko notes, “deadlines allow for a feeling of steady progress… and of a cumulative improvement over a specified period of time” (Oko, 2008, p. 217). Marsh (2002) argues that the purpose of this practice is to move from agreed problems to agreed goals in a set period of time, however negotiation is needed to achieve and establish the agreement.

The task-centered approach is central to the General Social Care Council (GSSC)’s Code of Practice, which states that regular progress markers should be established in order to ensure that a subject’s treatment is moving in the right direction. The code also encourages social workers to look beyond their initial point of contact and to identify any related areas of concern; in terms of NG, this was particularly relevant because of the behaviour of his wife, who seemed to be suffering because of her husband’s new attitude. Ultimately, a task-centered approach encourages accountability of practice and ensures that social workers keep their clients moving in the right direction and retaining the essential markers of professional practice. Despite criticism that a task-centered approach encourages “a managerial and dogmatic approach that fails to take into account the individual needs of each subject” (Payne, 2005, p. 7), the approach remains at the forefront of social work theory.

INTERVENTION

In assessing NG’s needs, I first went through his file in order to better understand the facts surrounding his traumatic fall and hospital stay. The picture that emerged of NG was that of an active man who was enjoying his retirement (he worked as a secondary school teacher until taking early retirement at the age of 63) until the unfortunate accident that resulted in his fall. It was clear that the fall was in no way a result of his age, and that a similar accident and subsequent injury could have occurred to anyone, of any age. However, NG’s age clearly complicated his recovery, and left him prone to the pneumonia that almost killed him and that clearly took a heavy psychological toll. I consulted his GP, who advised me on the nature of NG’s apparent depression, and suggested that getting through to him on a verbal level might prove hard; he suggested that NG was faking a sudden loss of hearing in order to avoid having to acknowledge attempts to talk to him.

On meeting NG for the first time, it was immediately apparent how difficult it would be getting through to him. For the first hour of the first visit, NG barely acknowledged my presence, and communicated only once or twice with his wife, AG, and this communication was at best in the form of small grunts of acceptance or refusal. I sat with NG and AG for over an hour, engaging his wife in conversation and regularly attempting to engage NG and bring him into the casual conversation that we were having. This approach failed, and eventually AG and I decided that I should try to talk to him alone. Once AG was gone, I introduced myself more formally to NG and explained exactly who I was and what I was doing there. It was extremely difficult to engage with NG on any of the levels prescribed by Chris Trotter, who suggests that “all clients will eventually show some willingness to engage, and it’s up to the social worker to interpret what few signals there might be in order to understand how the client is sending signals relating to the way in which he or she is willing to engage” (Trotter, 2006, p. 17). In other words, Trotter believes that clients will send signals, sometimes very subtle, to indicate how he or she might be willing to engage. However, on this first visit to NG, no such signal was detected.

Since I had been forewarned by the GP and AG that NG might become angry if pushed too hard, I had already decided that it might be necessary to wait until my second visit to fully engage with him. Therefore, after half an hour of talking to him alone, I began to explain clearly and simply what my role was and how I was going to help him. Trotter argues that “by explaining such matters in clinical detail, it might seem scary to the patient, but it might also be encouraging for him or her to realise that there are strong formalized methods of dealing with the problem, and will stress the professionalism and education of the social worker” (Trotter, 2006, p. 37). I explained to NG exactly when I would be returning and what I planned to do, and then I left after briefly giving the same information to his wife, AG, in the kitchen, where NG couldn’t hear us. I also let her know that I was there for her as much as for her husband, and indicated that on my next visit I would seek to spend some time talking to her about how she was coping. She seemed pleased and encouraged by this idea.

On my second visit, I was surprised to find that NG acknowledged my presence in a manner that had been completely lacking before. It had been a week, and he was now willing to vocalize his concerns about the plan I’d explained; he said that he felt it was ‘too much effort’ and that there were other people who would benefit more from my time. I explained that I was there to help him and his wife, and that I would be able to help him return to a more active lifestyle. NG complained that this was pointless; however I was fairly quickly able to encourage him to leave his wheelchair and walk to the garden with me. Once out there, away from AG, I was able to get NG to tell me about the accident and his time in hospital, although he was noticeably reluctant to talk about his life before the accident. It was apparent that, since he and AG had no children, he considered AG to be the entirety of his support network, and that he was therefore reluctant to leave the house without her.

I was eventually able to persuade NG and AG to take a number of short trips out of the house, and it was apparent that these lightened NG’s mood. He was still insistent that AG should accompany us at all times, but was gradually willing and able to walk further distances. After three visits, AG told me that she and NG had settled into a habit of taking a short walk every morning to a local café. I encouraged NG to extend this to occasional trips to the shops, and he agreed that he would work towards accomplishing this task. We also set out a number of other aims, and agreed that when the summer season started he would return to the bowls club and rejoin his friends there. This gave NG both a short term and a long term goal and ensured that he would continue to work on the small, incremental steps that were necessary in order to encourage him to return to a semblance of his former, active life.

In dealing with NG and AG, my role was focused on restoring his confidence in his own ability to ‘get about’, and showing him that while AG was his support network, he could consider his friends at the bowls club as an additional part of that network. NG began to offer his own thoughts on this subject, and began to agree with me when I suggested that he didn’t need to take AG with him every time he went out. I felt that the long term goal of returning to the bowls club was particularly important, since it was apparent very early that he had given up hope of returning to this important social site; the idea that he might be able to return seemed to be a very strong motivating factor, and I credit this with persuading him to take the smaller steps such as going to the café and to the shops.

APPLICATION OF THE APPROACH TO THE CASE STUDY

The task-centered approach is based on a standardized framework that nevertheless allows for significant flexibility in terms of the ways in which the approach can be applied to individual patients. Doel and Marsh (1992 in Doel 2002) highlight that i n task- centered work, the priority is to identify areas that the service user is finding a problem and wants change with the intention to get as many of the problems out in the open and in brief form, so that the range of difficulties can be seen.

Neil Thompson suggests that one of the most important aspects of the task-centered approach is the point of entry, i.e. the moment that the social worker first meets the patient, having read the relevant files (Thompson, 2005). As noted above, my initial meeting with NG was difficult, since he resolutely refused to communicate with either his wife or me. Once our relationship had improved over several weeks, I asked NG about this initial problem, and he claimed that it was because he didn’t know me and therefore preferred to ‘keep myself to myself’, and he also apologized for being rude. Obviously it’s unlikely that this simple explanation covers the entirety of the emotions that he was feeling at that time; nevertheless, his attempt to articulate his problems fits in, broadly, with Thompson’s suggestion that it is best for the social worker to try to enter into dialogue as soon as possible in relation to the various problems that are causing the communication problem (Thompson, 2005).

Payne (2005) highlights the use of planning the tasks which is agreed between the social worker and service user. The plan used on this occasion was for both the worker and service user to share tasks to meet the agreed outcomes. However, as a worker I had to acknowledge the power differences between myself and NG (Beckett and Maynard, 2005).

In the subsequent meeting that followed as the second stage of the task-centered approach, goals needed to be agreed (Trevithick, 2005). This enabled NG to establish the goals and not to dwell on the problems. This also helped NG to identify and see the difference between the goals and problems. For example, using the task-centered approach made it possible to identify that the goal was to go out and the problems were to overcome the barriers and risks in between (Coulshed & Orme, 2006). This second stage enabled us to draw up a written agreement, which we would work towards. The planning and implementing involved NG and myself to put the written agreement into action. Moreover it required us both to monitor the progress and ensure that the outcome will be achieved (Doel, 2002; Trevithick, 2005).

I therefore made sure that, on my second visit to see NG, I explained to both him and AG how I felt we should progress, and it was notable that when I arrived for my third visit, expecting to take NG for his first trip to the shops, he and AG had already taken it upon themselves to go for a ‘trial run’ to a local café the day before. This is a clear example of the benefits of using specific tasks to plan an order of progress, since AG admitted that part of the pleasure of the trip came from the fact that they knew they were ‘racing ahead’ in terms of my plans for NG. While such haste might in some cases be harmful, in this case it seemed to help NG enormously.

According to Payne (2005) this helps the service user to see the importance of the task and gives them a framework to follow. Furthermore, doing this ensured that NG does not feel that he is left alone in the process. Payne (1996) suggests that being able to set goals and motivate the service user enables the worker to empower them.

It was clear from an early stage that the task-centered approach would be the most appropriate for NG, since it would allow him to build up his confidence by passing a series of personal goals. Oko argues the case for such an approach, suggesting that “a series of small victories will help the individual work up to the ultimate goal, which is hitting the main target” (Oko, 2008, p. 95). This clearly worked in the case of NG. Furthermore, the process allowed his wife to take part in the recovery of NG’s lifestyle, and a number of commentators, including Thompson, have noted that “it’s important to involve the family so that the social worker and patient relationship doesn’t become an isolated partnership that places recovery solely within a clinical domain… (and) therefore lead to a situation in which the social worker becomes the sole support for the individual” (Thompson, 2005, p. 47); in the case of NG it is clear that AG became a central part of his recovery process, thereby avoiding the potentially tricky situation that would have developed had I become the sole source of this support. It is therefore possible to say that the application of theory was extremely positive in this case, although it’s perhaps also notable that NG’s recovery was a little quicker than might otherwise have been the case.

It should be noted that although a time limit was imposed on the point at which NG was to achieve each of the various stages, these limits were imposed for his own benefit rather than simply because Age Concern’s work required such a limit. Time limits have a crucial role to play in a task-centered approach, since they “enable measured steps to be taken towards a clear goal, in a clear way” (Doel, 2002, p. 74), thereby making the social work process seem less nebulous and more like a real plan with a defined set of actions. I also felt that there was a sense of urgency in this case, since NG and AG’s life had been under a great deal of strain and it appeared that AG, in particular, was suffering a marked deterioration in her health as a result of the problems with her husband. Although it’s impossible to accurately measure such things, I am of the opinion that AG may not have been able to cope with this stress in the long term, and I felt that there would be real questions over the couple’s ability to remain living alone in their own home if the situation was not resolved as soon as possible.

The recovery of NG from his post-hospital state was remarkable and effective. When he was released from hospital, NG was depressed and, those who previously knew him described him as, ‘a different man’. The effect on both NG and his wife AG was obvious, and it was clear that this was a situation that needed to be addressed. Furthermore, the belligerence with his neighbours was causing social problems that had the potential to grow into full feuds. It was clear at the start that the situation could only be improved by prompt and careful application of social work principles, mainly the task-centered approach, in order to improve NG and AG’s situation and return them from a position of apparent mutual depression. As Oko notes, “some situations are best saved early on, as later intervention is almost impossible” (Oko, 2008, p. 106); this was one of those situations.

The task-centered approach worked since it allowed steps to be laid out in a clear manner that was both clinical and easy to understand. Although NG was mostly unresponsive when I set these steps out to him on the first visit, he later clearly exhibited signs of having understood and processed them. Furthermore, the task-centered approach was easy for AG to understand, and it was particularly good to see the way in which this husband and wife team approached the steps together. As Malcolm Payne has suggested, “the ideal situation is one in which the social worker becomes the facilitator for the individual’s action, rather than having to try to force them along a route” (Payne, 2005, p. 85); this is exactly what happened in the case of NG and AG. As Payne goes on to note, the task-centered approach is not based on finding “an immediate solution… (but on) determining how best an individual might be able to get his or her life back on track over the short and medium terms” (Payne, 2005, p. 94). This is precisely what happened with NG and AG.

BIBLIOGRAPHY

Beckett, C. & Maynard, A. (2005). Values and ethics in social work – An Introduction . London: Sage Publications.

Beckett, Chris. (2006). Essential Theory for Social Work Practice . London, New Delhi & Thousand Oaks: Sage Publications

Coulshed, V. & Orme, J. (2006). Social Work Practice (4 th ed) . Basingstoke: Palgrave Macmillan

Doel, M (2002). Task-Centered Work ’ in Adams, Robert & Lena Dominelli & Malcolm Payne (ed.s), Social Work: Themes, Issues and Critical Debates (2 nd ed)’. Basingstoke: Palgrave

General Social Care Council. (2002). The Codes of Practice for Social Workers and Employers . London: General Social Care Council.

Horne, Nigel (2006). What is Social Work? Context and Perspectives . London: Learning Matters

Marsh, P. (2005). Task Centred Work . In Davies M (Ed) The Blackwell Companion to Social Work (2 nd ed) . Oxford: Blackwell.

Oko, Juliette (2008). Understanding and Using Theory in Social Work . London: Routledge

Payne, Malcolm (2005 ). Modern Social Work Theory . Basingstoke: Palgrave

Thompson, Neil (2005). Understanding Social Work: Preparing for Practice . Basingstoke: Palgrave

Trevithick, Pamela (2005). Social Work Skills: A Practice Handbook . Maidenhead: Open University Press

Trotter, Chris (2006). Working with Involuntary Clients: A Guide to Practice . London, New Delhi & Thousand Oaks: Sage Publications

Wilson, Kate. & Gillian, Ruch. & Mark, Lymbery. & Andrew, Cooper. (2008). Social Work: An Introduction to Contemporary Practice . London: Routledge

TASK-CENTERED APPROACH. This essay takes a social work case study as the basis for an analysis of the different approaches that must be taken when dealing with individuals in a social work setting

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Scand J Prim Health Care
v.38(4); 2020

A client-centered approach in home care for older persons – an integrative review

Päivi sanerma.

a Department of Health Sciences, Faculty of Social sciences, University of Tampere, Tampere, Finland

b Hamk Smart Reseach Unit, Hamk University of Applied Sciences, Hämeenlinna, Finland

Sari Miettinen

c Information Services Unit, Research Unit, The Social Insurance Institution of Finland, Helsinki, Finland

Eija Paavilainen

Päivi Åstedt-kurki.

To describe and synthesize client-centered care and service in home care for older persons.

The study was an integrative review using the guidelines for literature reviews by the Joanna Briggs Institute. The research process followed the Whittemore and Knafl framework and PRISMA toolkit in the selection of eligible articles. The CINAHL, Medline, Scopus, Web of Science and Social Sciences abstracts were searched for articles published between January 2007 and May 2020 according to previously designed search strategies. In total, 24 articles were deemed relevant for an analysis using a thematic analysis.

The analysis resulted in four themes with sub-themes which revealed that client-centered care and service in home care consist of: 1) Clients’ involvement in their own care; self-care, decision-making, satisfactory daily life, 2) Family members’ and care partners’ participation in care; family members’ and care partners’ commitment to care, family members’ and care partners’ competence in care, 3) Communication and co-operation; communication models, empowerment, partnership, and 4) Evidence-based service competence; delivery and organization of services, implementation of services, versatile clinical skills, quality outcomes and personnel wellbeing.

Conclusions

According to the results, achieving client-centered care and service in home care requires the realization of all of the above aspects. The practice of nursing must better identify all dimensions of client-centered care and take these into account in the delivery of home care services.

Client-centeredness is a fundamental value and the basis of nursing and care in home care provided for older persons
This paper:
deepens and structures the concept of client-centered care in the context of home care.
assists professionals to understand the factors behind client-centered care within the home care environment.
provides deeper understanding of the roles of the older person, family members, and the service system in developing client-centered services in home care for older persons.

Introduction

In the European Union, older persons expect to receive increasingly high quality integrated home care services [ 1 ]. The home care service structure is influenced by state service structures, regulations, financial aspects, and available workforce. The key pillars of the home care of the future will be seamless integration and coordination of services, high quality, utilization of technology and client-centered care [ 2–5 ].

Client-centered care has been defined as ‘an approach to practice established through the formation and fostering of therapeutic relationships between all care providers, patients and others significant to them in their lives. It is underpinned by values of respect for persons, individual right to self-determination, mutual respect and understanding’ [ 6 , 7 ]. Client-centered care is focused on care needs, involvement, autonomy and respect. It is an approach to plan, deliver, and evaluate health care that relies on a mutually beneficial partnership, is well-planned and implemented, and is measured and evaluated in interprofessional collaboration where the client has an up-to-date care and service plan [ 6 , 8–12 ]. When clients experience a high quality of care and service, at the same time, the client-centeredness of service tends to be on a high level [ 13 ]. Concepts related to client-centered care include person-centered care and patient-centered care. Similarities can also be found in the concepts of user or customer-oriented services [ 10 , 12 ].

From the value base and principles of nursing, home care is guided by the ethics of care, self-determination, continuity of care and family-centeredness. A positive client–nurse relationship benefits seniors in two ways: they feel both comfortable and safe in the relationship to which they are committed. Research results highlight the importance of client–nurse interpersonal interactions and communication, which promote comfort and connectedness [ 14–17 ].

In the client-centered care process, the goals of care are negotiated in cooperation with the client's family members [ 4 ]. Coordination of services and nursing, the competence of professionals and economical organization of work are important factors influencing client-centeredness and quality. The level of collaboration with family members appears to be directly proportional to the quality of care and services [ 18–20 ]. This research topic is important because client-centered care is an ethical and fundamental value of home care. It increases a high quality of care and involvement of clients and families and increases the well-being of personnel [ 13 ].

The aim of the current integrative literature review is to describe and synthesize client-centered care and service in the home care of older people. The review is guided by the following question: How is client-centered care defined with respect to the older person’s home care and what factors underlying client-centered care have been identified in earlier studies?

An integrative review is a method that allows the inclusion of diverse methodologies to provide a broad understanding about a particular phenomenon of interest. This integrative review followed the guidelines of the Joanna Briggs institute for a literature review. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) was utilized in the selection of eligible articles [ 21 , 22 ]. Quality assessment was performed using the JBI Critical Appraisal instruments depending on the study design [ 23 ] ( Tables 1–4 ).

Selected quantitative studies.

Selected qualitative studies.

Selected literature reviews.

Selected case studies.

Research strategy and selection criteria

This integrative review took into consideration all available studies exploring the description or definition of client/patient-centered care in home health care. The literature search was conducted on the 4 th of May 2020 using the electronic databases Medline, Scopus, Social Service Abstracts and Web of Science electronic databases. The search strategies used with the databases are presented in Appendix A and B . The second phase of the search process was conducted manually based on reference lists compiled from all eligible articles.

The correspondence author and an information specialist planned the search strategy. The information specialist and two researchers verified information retrieval independently. All studies concerning home care for older people aged over 65 and above using qualitative, quantitative and mixed methodologies were included in the review.

The following pre-agreed inclusion criteria were used in the selection process: a study concerning home care of older people aged 65, reporting the results of an empirical study or systematic review, has been peer reviewed, and full text is available. The information retrieval resulted in 742 articles. One of the selected articles dealt with medical home care involving the provision clinical treatment. Two additional articles were selected from material not included in the search results. Original articles were selected on the basis of their titles, summaries and full text.

Exclusion criteria were as follows: the study was concerned with care provided in a nursing home or home care for children or adolescents, patient discharge, adolescence or specific issues of a specific group, the article had been published in a language other than English, or full text was not available ( Figure 1 ).

An external file that holds a picture, illustration, etc.
Object name is IPRI_A_1841517_F0001_B.jpg

PRISMA flow diagram [ 22 ].

PRISMA screening and quality appraisal

This integrative review utilized the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA; Figure 1 ) [ 22 ].

The data search identified 742 articles, and additional searches of other sources identified further 2 articles. Firstly, the topics of the studies were assessed and duplicates removed. Subsequently, the remining articles ( n = 688) were screened by title and abstract for relevance, as a result of which non-relevant articles ( n = 504) were excluded. Full texts ( n = 188) were screened for eligibility based on the inclusion and exclusion criteria. After the PRISMA screening process, 24 studies were included in the review. Two researchers assessed the full texts and 24 were included for final analysis by consensus. The selected articles are described in Tables 1–4 .

The quality appraisal of the selected articles was carried out independently by the second reviewer and consensus was consequently reached. The quality assessment of the original studies ( n = 24) selected for the review was carried out by two researchers using the evaluation criteria of the Joanna Briggs Institute [ 24 ] and the double-blind method. The following evaluation lists defined by the Joanna Briggs Institute were used in the evaluation:

The JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies (7 articles), JBI Critical Appraisal Checklist for Quasi-Experimental Studies (non-randomized experimental studies; 1 article), JBI Critical Appraisal for Care Reports (1 article), JBI Critical Appraisal Checklist for Systematic Review and Research Synthesis (7 articles), JBI Critical Appraisal Checklist for Case Reports (1 article), JBI Critical Appraisal Checklist for qualitative Research (5 articles) and JBI Critical Appraisal Checklist for Text, Opinion papers (1 article) and JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data (1 article).

The scales have between 6 and 11 questions with the response alternatives yes, no, unclear or not applicable. Affirmative responses for at least half of the questions were required in order to select an original article for the review [ 24 ]. The articles selected to the data set met the quality evaluation criteria ( Appendix C–G ).

Data extraction and analysis

The data synthesis was implemented following the integrative review methodology by Whittemore and Knafl (2005). Details of the methods and outcomes organized, coded, categorized, and summarized based on their relevance to client-centered care were extracted from the primary sources. Thematical analysis was implemented by the correspondent author in data analysis by focusing on expressions of client-centeredness using the line-by-line analysis method [ 22 , 25 ]. Expressions were tabulated and coded. The list of codes was grouped into sub-themes and turned into categories with names characterizing their content. A concept map was generated from the relevant data. Analytical themes were defined and related to the outcomes of client centered care and the theoretical framework. After data comparison, concepts similar to one another were regrouped, condensed and refined. Finally, the concepts were contextualized based on the authors’ professional preconceptions as nursing teachers and researchers of health and social services. The selected studies were evaluated by four authors to assess the levels of credibility. All the remaining selected studies were found to be acceptable [ 21 , 23 ].

Study characteristics

The original studies selected for the review had been published between 2007 and 2020 ( Table 1 ). The studies had been carried out in Sweden ( n = 5), USA ( n = 3), Norway ( n = 5), Canada ( n = 3), Netherlands ( n = 1), Belgium ( n = 1), New Zealand ( n = 1), Faroe Islands ( n = 1), UK ( n = 1), Spain [ 1 ], Northern Ireland ( n = 1) and Finland ( n = 1). The number of quantitative studies was 10 [ 1–10 ], qualitative studies 5 [ 11–14 , 26 ], literature reviews 7 [ 15–21 ] and case studies 2 [ 22 , 23 ].

Elements of client-centered care in home care

As a result of thematical analysis, the client-centered care in older people home care was structured according to four analytical themes; clients’ involvement, the participation of family members and care partners, communication and collaboration, and evidence-based service competence.

Clients’ involvement

In this review, the client’s involvement has been defined as self-care, decision making and satisfactory daily life. Clients’ involvement in their own care is at the core of client-centered home care [ 27–29 ].

Self-care. In home care, motivation and commitment to one’s own care strengthens the individual performance and resources of the older person [ 29–33 ]. Participation in care management increases the sense of involvement and wellbeing [ 29 , 34–37 ]. Motivation is influenced by personality [ 38 ], cultural background [ 39 ], cognitive abilities, age and resources to participate, marital status and positive guidance [ 35 ]. The client’s knowledge, need of services, values, beliefs, and cultural background are incorporated into the planning and delivery of care [ 33 , 37 , 39 ]. Active involvement in the setting of goals is evidently one of the essential steps towards empowering older people [ 24 , 29 , 30 , 35 , 37 , 38 ]. Participation in medication, care planning and scheduling, and goal setting increases the client’s sense of involvement [ 30–32 , 35–37 ]. Involvement increases the clients’ satisfaction with care. Clients have a negative attitude towards their possibilities for influencing their own care, in contexts such as scheduling home visits and the continuity of care [ 40–42 ].

Decision-making. Influence over decision-making regarding personal care goals, an individual care plan, and relationships with professionals increase the client’s health, quality of life and satisfaction with care [ 28 , 31 , 35 , 37 , 40 ]. A lack of participation in decisions is in contradiction with the clients’ psychological need to have an influence over decisions affecting their own lives [ 27 , 28 , 33 , 35 , 43 ]. Client involvement with care management helps older persons obtain decisions that are meaningful for them and which make the persons’ life worth living [ 28 , 34 , 36 , 43 ]. It also increases dignity and autonomy of the older person [ 33 , 39 ].

Satisfactory daily life. Paying attention to the clients’ emotional and psychological needs promotes mental wellbeing and a sense of involvement in their own life at home [ 34 , 40–42 ]. Clients need a meaningful daily life and their existential needs must been taken into account. There are no significant differences between men and women in this regard [ 33 , 44 ]. It is important that the older persons’ home and living environment enable them to live actively, and maintain social relationships and interactions, and that they are comfortable with their living environment [ 28 , 29 , 35 , 37 , 44 ]. Feeling safe, and living an inclusive and meaningful life is important at home, as this prevents the feeling of illness and, as a consequence, reduces unnecessary use of health services [ 32 , 35–37 , 45 ]. Social relationships and consideration of cultural and ethnic perspectives in care and service make the home care client’s everyday life meaningful. The support provided by an active life, social relationships and discussions can help older persons participate in social activities [ 28 , 33 , 35 , 37 , 40 ].

Family members’ and care partners’ participation

The analytical theme of family members’ and care partners’ participation is closely linked to the core of client care and is structured according to the descriptive themes of family and care partners’ commitment to care, and family and care partners’ competence of care.

Family members’ and care partners’ commitment to care . Family members’ level of satisfaction, trust and emotions influence their commitment to an older person’s care [ 35 , 37 , 46 , 47 ]. They need to be provided with a possibility to assess their own needs, burdens, experiences, hopes and fears. Often, family members feel that they are not getting the psychological support they need to commit to the care process [ 24 , 28 , 44 , 46 ]. Families often experience pain or difficult emotions related to their family member’s health or increasing need of treatment [ 24 , 27 , 28 , 32 , 44 ]. The opinions, values, beliefs, knowledge, cultural background and feelings of family members should be respected to ensure their commitment to treatment [ 33 , 39 ]. The older person’s health and goals of care are defined in partnership. Shared decision-making in the care process is important between the client, family members and home care professionals. Client-centered care represents a service feature which is a significant contributing factor to family members’ commitment to care [ 27 , 30 , 32 , 46 ].

Family members’ and care partners’ competence in care. Family members and care partners are often part of a therapeutic alliance, participate in the implementation of the client’s care, and allow a better response to critical symptoms and warning signs. Family members and care partners are familiar with the older person’s health situation and life circumstances, they ensure that decisions respect the older person’s wants, needs, preferences, and ensure the education and support of the client [ 30 , 31 , 46 ]. Thus, it is important to recognize their knowledge base of care, lifestyle and the communication pattern in the family. In client-centered care, collaboration, the therapeutic relationship, and team spirit, flexibility and negotiation need to be realized between client, family members, professionals and home care service providers [ 29 , 32 , 36 , 40 , 43 , 45 ].

Communication and collaboration

The analytical theme of communication and collaboration is structured around the following descriptive themes: communication models, empowerment and partnership.

Communication models. Clients and their family receive timely, complete, and accurate information to communicate effectively [ 27 , 39 , 42 , 46 ]. In the communication models of client-centered care, the following items were emphasized: active listening, recognition of content, active questioning and prompting, interpretation of tips and cues, handling unclear reactions and learning to apologize, respect and understand the client’s life. More attention needs to be paid to the client’s perspective and views [ 37 , 41–43 ]. The communication skills, empathy, mindfulness, showing interest in the client, and emotional intelligence and self-knowledge are significant characteristics of professionals [ 29 , 37 , 41 , 43 , 44 , 48 ]. Humor and a friendly approach can be used as a strategy to support older people’s connection to everyday life as well as a strategy in handling the challenges pertaining to continuity and predictability. During home visits, humor was adapted to the home care context while at the same time used with sufficient sensitivity when interacting with the infirm older person and her everyday life [ 31 , 33 , 37 , 43 ].

Empowerment. Professionals who make room for and listen to the client enable their clients to deal with their own emotions. When professionals ask their clients about care, clients will be open about their emotional needs. Mutual non-verbal communication differs from that occurring in a hospital. Silently listening to the patient or client can promote building a connection with the patient [ 24 , 32 , 42 , 45 , 46 ]. Knowing the client comprehensively, openness, sensitivity, sense of humor, understanding, empathy, emotional intelligence, supportive space and trust are significant parts of interaction. Sensitivity also involves understanding and processing negative emotions as well as knowing, which topic to avoid [ 33 , 41 , 43 , 45 , 46 , 48 ].

Clients show their feelings and especially their negative emotions as clues. The nurse should respond to and make room for these feelings in positive encounters [ 41 , 42 , 47 ]. Organization of services can negatively influence the fulfilment of emotional and psychological needs, especially if there are differences between the continuity of care and the client’s hopes and needs for the future [ 24 , 30 , 34 , 47 ].

Partnership. The client-centered approach involves designing, implementing and evaluating client care based on mutual partnerships in collaboration with family members. Clarity when sharing information [ 27 , 28 , 33 , 43 , 45 , 47 ] facilitates collaboration. Listening to clients and encouraging them to explain about their lives, making genuine efforts to obtain feedback, and suggesting actions as responses to health changes contribute to building a relationship, and show compassion for older people’s concerns [ 32 , 33 , 48 ]. The decision-making process is simplified when there is a clear statement of what is possible and what is not [ 27 , 30 , 32 , 42 , 43 , 46 ]. To achieve this kind of communication, equality and co-operation, the family members involved in care provision may need training, information sources, support, encouragement and compassionate attitudes displayed in a variety of ways [ 24 , 30 , 31 , 43 , 46 ].

Evidence-based service competence

The analytical theme of home care service competence was structured as the delivery and organization of services, versatile clinical skills, implementation of services, and quality and safety outcomes.

Delivery and organization of services. In the delivery and organization of services [ 27 , 30–34 , 37 , 39 , 45 ] client-centered services are implemented in a highly coordinated, predictable, accessible, flexible and multidisciplinary manner in the provision of social and health care. Resource allocation and support within services also affect the organization of client-centered services, for example the need for small care teams [ 34 , 37 , 46 , 48 ], involving f a physician, geriatrician or a general practitioner in the provision of services, use of care technology in the delivery of services as well as the involvement of private and public sectors [ 39 ].

Implementation of services. In the implementation of services [ 24 , 31 , 32 , 34 , 35 , 37 , 39 , 40 , 44–46 , 48 ], client-centered care is related to the planning of care, scheduling of home visits, monitoring of care performance and outcomes, support of self-management and knowledge, effective professional communication, sensitivity, healthy culture and an evidence-based knowledge base. Identification of goals, ethics of care, task-orientation and continuity of care are important elements of implementation. Nurses have to achieve a balance between the fulfillment of the client’s needs and demands of organizations and professional standards [ 49 ].

Versatile clinical skills. Home care documentation is mostly concerned with medication. Home care professionals do not deal with issues more serious than respiratory problems, follow-up treatment, life cycle and health behaviors. The treatment they provide is primarily focused on the clients’ physical needs, whereas the clients’ other needs are not taken into account. The care and services are not based on the client’s individual life history and health status [ 40 ].

Significant client-centered clinical skills include the monitoring of the effects of medications, individual care design, clinical decision-support, communication skills, chronic care management and medication-related knowledge, documentation and disease management [ 24 , 28 , 29 , 39–41 , 45 ].

Client-centered service requires service needs assessment, development of clinical expertise, communication skills, empathy and interpretation of the client’s symptoms and signs. Client-centered work also requires changes in the working culture and reorganization of work shifts with different roles and specific ethical questions. Client-centered work increases the sense of staff capability and work satisfaction, work efficiency and commitment to work [ 28 , 35 , 36 , 39 , 45 , 47 ].

Quality outcomes and personnel wellbeing. The quality of home care services is achieved thorough the relationship between client, family members and professionals. Client-centered care can be a way to improve the quality of care, save costs and increase care satisfaction. Ideally, medical and care services for older persons should be better integrated in order to improve the availability of the services offered, the coordination of care and communication between providers in different service domains [ 29 , 32 , 37 ]. A lack of continuity and predictability poses a challenge and causes concern to the older person. Nurses’ visit schedules have also emerged as a major problem for home care clients [ 33 , 49 ].

The complexity of patient care and the need for co-operation and joint decision-making mean that there is a need for a focus on personal care and practical improvement of the patient experience [ 38 , 39 ]. Restructuring of improved service quality requires systematic political decision-making [ 27 , 32 , 49 ]. From the viewpoint of home care professionals, client-centered care and service increases the job satisfaction of personnel and create new roles for nurses [ 28 , 38 , 49 ].

The practical approach involves creating and promoting client-centeredness and therapeutic relationships between patients, nurses and other important people in their lives. It is supported by respect for individual persons’ values, right to self-determination, mutual respect and understanding [ 9 , 13 , 15 , 40 , 44 ].

The concept ‘client’ is related to caregivers and nurses in the home care context. The concept aims at improving the client’s health instead of being merely used for describing the context. It is realized at home, outside of the hospital. Home care clients need a wide range of help in their life situations. The concept is different from ‘patient’ which is functional and concentrates primarily on treating an illness [ 9 , 10 , 12 , 13 , 50 , 51 ].

(1) The category Client involvement describes the possibilities participate in self-care and the management of one’s own care process. The importance of shared decision-making has been described in several studies [ 13 , 20 , 26 ]. In the studies presented here, shared decision-making appears in the form of negotiations. This process influences commitment to care, functional capacity of self-care and satisfactory daily life. The client’s involvement seems to lie at the core of a successful home care process [ 6–8 , 20 , 40 ].

(2) The category Family members’ and care partners’ participation describes the therapeutic alliance of home care as well as the conditions and opportunities for participation in care [ 8 ]. In the past, several studies have noted that family members find it difficult in many ways to participate in the care process [ 11 ]. In the future, more attention should be paid to the competence, involvement and wellbeing of family members and care partners. From a family perspective, client-centered care is a partnership that takes into account capabilities, knowledge, opportunities and the feelings of family members [ 16 ].

(3) The category communication and collaboration describes the significance and individuality of interaction in home care. The use of communication should be purposeful, taking into account context, the goals of care and the various roles of nurses [ 13 , 50 , 51 ]. Communication has to be positive, involve giving emotional support and bearing in mind special characteristics of an old person in communication and in the interpretation of messages. Home care organizations should learn more about communicating with the clients [ 41 ].

Nurses need to be flexible in their different roles. Communication is at the core of achieving care goals, the objectives are to empower the client, family and care partners; and to create and strengthen partnerships [ 46 ]. Engagement in communication is also an important part of creating a sense of security in the client [ 13–15 , 17 , 50 , 52 ].

(4) The category of evidence-based service competence describes organizations and factors that underlie client-centeredness as well as the positive consequences and outcomes of client centered-care. In addition, client-centeredness is directly affected by political decision-making and funding models, service delivery and coordination, and the implementation planning and culture of organizations [ 38 , 52 , 53 ].

Limitations

Only English language sources were used. In addition, the results might have been influenced by differences in the meanings of concepts used in social and health care.

This review compiled research knowledge regarding client-centered care and its underlying factors. Client-centeredness in home care demands the client’s genuine involvement in self-care and decision-making in collaboration with family members and care partners. Communication is at the core of the care relationship, and competence development is essential given the context of home care and the individuality of the older person. In practice, evidence-based service organization expertise requires a significant change in service systems, organizational cultures and financial systems.

Appendix A. Search strategies in the databases medline and cinahl, social service abstracts, scopus and web of science.

Appendix b. search strategies in the databases social service abstracts, scopus and web of science., appendix c. quality assessment with jbi critical appraisal checklist for qualitative research..

Note Key: Y=Yes, N=No, U=Unclear, NA= Not applicable.

Appendix D. Quality assessment with JBI critical appraisal checklist for systematic reviews and research synthesis.

Appendix e. quality assessment with jbi critical appraisal checklist for case reports., appendix f. quality assessment with jbi critical appraisal checklist for analytical cross sectoral studies., appendix g. quality assessment with jbi critical appraisal checklist for quasi-experimental studies., disclosure statement.

No potential conflict of interest was reported by the author(s).

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