No abstract

As suggested by the results, it can be concluded that high-quality caring relationships contribute to the need fulfillment of residents and their well-being. The quality of caring relationships is thus an important topic for further research. The field may especially benefit from longitudinal studies and studies that use observations of the caring relationship in addition to self-reports.

Quality of life and wellbeing in nursing homes are becoming more important in research and practice. One of the main influences on residents' wellbeing is the interaction with their professional care-givers. The purpose of this study was to explore to what extent care-givers support the residents' needs of relatedness, autonomy and competence, and how this need support is related to wellbeing. Residents and their professional care-givers of four nursing homes in the Netherlands participated in an observational and questionnaire study. Three video-observations of each resident (with different care-givers) were made during morning care. Additional data were collected by means of questionnaires. The results show that the needs of residents were, on average, moderately fulfilled during care interactions. More need support by care-givers was related to higher resident wellbeing. Care-givers provided more need support to residents with stronger functional impairments. More need support was provided by highereducated care-givers and care-givers in higher job functions. The results show the importance of need support for situational wellbeing, but the contribution to the general subjective wellbeing of residents remains unclear. Further (longitudinal) research is needed to investigate changes in wellbeing over time. Possible differences between subjective ratings and observations of need support and wellbeing should be taken into account.

This article demonstrates the value of a Buberian approach to relationships between professional caregivers and residents in nursing homes. Extant research on relationships between professional caregivers and residents typically distinguishes between task-centered and person-centered communication yet tends to privilege either the perspective of professionals or residents. To address this issue, we develop an approach that addresses the co-construction of I-It and I-Thou relationships, based on Martin Buber's social existentialist philosophy. In turn, we show the merit of this approach by using it to analyze interactional data from an observational study on morning care in Dutch nursing homes. As these examples illustrate, our analytical perspective is useful because it highlights how different caregiver-resident relationships are co-created and unfold over time. Thus, by revealing how these relationships are worked out in everyday interactions through subtle shifts between task-centered and person-centered communicative practices, this article offers important insights for improving the quality of care in nursing homes.

Self-reports in nursing homes generally show highly satisfied residents, whereas observational studies provide more nuanced results. In this study, which is based on self-determination theory, the perspective of nursing home residents (self-reports) is compared to the perspective of trained "neutral" observers (video-observations). The experiences of physically frail older residents are measured with regard to the fulfillment of their needs for relatedness, autonomy, and competence. Self-reports of need fulfillment , and of 36 residents (64 % female, mean age 80 years) were compared with observer ratings of resident need fulfillment during the latter caregiving episode. Furthermore, it was investigated which measure relates best to residents' self-reported well-being. The results show that residents rate their need fulfillment higher than observers. There is weak to moderate agreement between resident and observer ratings. Furthermore, only residents' self-reported need fulfillment is related with self-reported well-being. Different explanations are provided, including the "barrier of happiness," the use of cognitive strategies, a change in identity and existing power relations. There seems to be a paradox in caregiving: Residents and their needs should be central, but because residents might adapt their needs and wishes it is hard to assess these. Suggestions for practical applications are given.