Gentleness at work is an important part of professional care, but it has rarely been investigated or qualified – until now. David Holman, Professor of Organisational Psychology at Alliance Manchester Business School, discusses recent in-depth research on the topic.
High-quality care is important in all health and social care settings. While we know people value characteristics such as empathy and compassion when being cared for, there is actually very little written about what it means to be gentle when caring in a professional role. Also, with budgets under pressure and funding hard to come by, the time and space to administer care has become tougher than ever.
So, how exactly do we define gentleness? Along with a team funded by Alliance Manchester Business School, including Dr Clare Mumford, Dr Maurice Nagington and Professor Leo McCann, we’ve sought to answer the question in a qualitative research project entitled Employee Gentleness in Care Settings.
To collect data, we observed practice and interviewed staff, patients and residents at a hospice day care centre and two care homes in the North West of England. There were two main aims for the project: firstly, to develop an understanding of what employee gentleness is; and secondly, to understand how employee gentleness is fostered in organisations.
Across our investigations, we witnessed many examples of high-quality care. We found that gentleness is highly important to achieving person-centred care and developing therapeutic relationships.
Soft, slow and patient approach
A central characteristic of gentleness was a soft, slow and patient approach to caregiving that involved speaking in a soft and quiet manner, the use of soft touch, and generally not rushing care delivery or decisions. Gentle care was also characterised by a repertoire of ‘guidance’ and ‘relational’ behaviours.
Guidance behaviours were used to steer and deliver care without being too controlling and in a way that responds to patient need. They include friendly enquiries to discover client needs and personal preferences, providing support for practical tasks where needed, and emotion management to reduce negative emotions such as anxiety, and promote positive emotions, such as contentment.
Relational care behaviours help to build and maintain a close relationship with patients and clients and thus are an important part of the care process itself.
They comprised being attentive to client needs, demonstrating concern and compassion, providing validation of the client’s sense of self-worth, and non-judgmental acceptance. In sum, employee gentleness is a repertoire of guidance and relational care behaviours that are delivered in a soft, slow and patient way.
Where is gentleness most important?
The study found that being gentle helped with three particular aspects of care. First of all, it helped ensure that clients and caregivers could discuss and disclose complicated and, at times, emotional topics. Being gentle also helped with persuading clients to do a particular task such as eating, getting out of bed, or taking medicine. Finally, a gentle approach could give comfort when patients are upset or in pain.
We found that certain conditions are particularly conducive to promoting a gentle approach. Low workloads, high discretion, few interruptions and high staffing levels were all factors that made it easier for care-givers to spend extended and uninterrupted time ‘being gentle’ with clients.
However, as we’ve seen over recent years, due to factors such as an ageing population and greater need for care alongside pressurised funding budgets, these ideals are not easy to achieve.
The research found that the conditions in the hospice day care, with lower staff to client ratios, few interruptions and a deliberately slow pace of work, provided a far more conducive setting for employee gentleness. Conversely, issues around workload and staffing were especially evident in care homes.
Here, care staff had to be mindful of attending to the needs of more than one resident at a time. Multiple interruptions to their work, especially at times such as mealtimes, made it imperative to find ways to work together as a team, in order to provide gentle care where it was needed.
In this context, job discretion and support from colleagues and managers became all the more important for fostering gentleness, as they enabled 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 these helped employees to develop close working relationships, agree on supportive solutions to client needs, and to focus on where gentleness might be most important.
In developing our understanding of gentleness, it was soon evident that a soft and slow approach is a huge asset. It might be something as simple as holding a patient’s hand when they become distressed, but the pace and manner in which care is delivered is crucial.
The impact of body language
Body language makes a huge impact on the delivery of gentleness. Light touches can communicate empathy, while open body language, such as an attentive stance, demonstrates interest and being available to help a patient or resident.
Developing a good understanding of clients and their needs is, expectedly, central to caregiving. But this actually requires a great deal of empathy and friendly enquiry. To draw patients out of their shell and to create rapport in the hospice setting, for instance, open questions were used to create a greater understanding of the person, their complex needs and specific wants.
As one employee put it, “You just go very gently with it because we facilitate and provide a safe place but we don’t lead the discussions. We can ask questions but it’s not about our agenda.”
Other simple actions which were found to be helpful included speaking in a soft and quiet manner, softly touching the hands of people where staff knew that this would comfort them, being at the same level as the client, for example sitting or crouching when they were seated, during face-to-face conversations, and generally not rushing care delivery or decisions.
Providing assistance or resources to others is a fundamental part of care in any situation. Our research found that a specifically gentle approach to support involved advising and explaining. We found that employees went beyond providing just simple advice.
In the hospice, for example, much emphasis was placed on explaining information that was being given, helping the client to interpret the meaning of information for their own circumstances, and tailoring to each personal situation.
In the care homes, patience was another key feature of gentle ways that practical tasks such as walking, washing and feeding, could be supported. Being patient and fully attentive to the task that the resident was engaged in helped the person feel more in control and to retain dignity.
Manage the emotions
The emotional side of gentleness is another factor to consider. Gentle care-givers learn to recognise and offer support in the event of patient emotions such as anxiety, worry, fear and guilt. Emotion management techniques, to manage the employee’s own emotions as well as the client’s, aimed to promote positive emotions for the client such as calmness, contentment, happiness and comfort.
One interviewee, who captures the essence of the emotionally gentle approach, said, “I think we have to acknowledge her feeling, if it’s obvious. It’s the most important thing to acknowledge a feeling, whatever that feeling may be. You would just say, ‘It looks like that makes you sad’, or, you know, ‘You sound angry, is it making you angry, all of this?’ And it’s just a gentle probe, isn’t it?”
So what is the answer to ensuring gentleness?
Through our research, we arrived at a number of key takeaway messages which we would implore care-giving institutions to consider. These include:
- The importance of developing a shared belief in a person-centred care approach across the full team;
- 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 and other tasks when caregivers need to spend extra time with clients;
- Sharing knowledge of clients at handovers and team meetings;
- Low workloads with few interruptions to allow caregivers to spend extended and uninterrupted time with clients.
If these ideals can be met or strived for, then institutions can make strides toward delivering a higher quality of care which adopts a truly gentle approach.