Background: One of the fundamental rules of the ‘Relationship Based Care' (RBC) nursing model is to establish an approach to the patients and their families based on their central role; this is the answer to the need to relate with the patients/caregivers, to understand their needs and expectations in order to apply an advanced nursing personalised care (Koloroutis, 2004; Hebda & Patton, 2012; Hedges, Nichols, & Filoteo, 2012). The implementation of this model led to remarkable results in terms of quality of care, of health and therefore led to a reduction of health assistance costs as well (Hedges et al., 2012). A good relationship and effective communication are linked to a high quality of care and a safer environment for patients (Burt, Berry, & Quackenbush, 2015). The RBC nursing care model has never been implemented in Italy in any field.
Aim: To evaluate whether or not the application of the RBC care model to the paediatric field could reduce the anxiety of the caregiver, enhance the quality of the nursing care as perceived by the caregiver, and boost the satisfaction about their performance for nurses.
Methods:
Study design: Randomized control trial. Participants: All caregivers of the patients that were admitted to the Units 2° and 3° of the Women's and Children's Health Department, Padua University Hospital, fluent in both written and spoken Italian, that declared themselves ready to take part to the study. The study included also all nurses of the Units that carried out the model care. Radomization: Patients belonging to the same group (case or control group) were admitted to the same rooms. Then the rooms - equipped with an equal number of beds - were randomized. In order to ensure a balance, a permutated block randomization was applied. The case group received the “Take 5 Minutes” (T5M) treatment, while the control group received the standard care. Treatment: During the stay of the patients in the Units, nurses applied the T5M treatment, that consisted of dedicating some time to the relationship with the caregiver in order to achieve a more effective collaboration, applying some specific communication strategies. Primary outcome: ‘The Hospital Anxiety and Depression Scale' (HADS) (Costantini, Musso, Viterbori et al., 1999) for the caregiver treated with the T5M treatment. Secondary outcomes: ‘Caring Behaviors Inventory' (CBI) (Tomietto, Papastavrou, Efstathiou, Palese, 2014), filled in by the caregiver that received the T5M treatment. The questionnaire ‘Fulfillment in the Workplace' (Cortese 2007), given to the nurses at the beginning and at the end of the study. Statistical analysis: the Mann- Whitney test, two-way ANOVA with pairwise comparisons, regression lines and Pearson’s r. Ethical aspects: The research was approved by the Ethical Committee for the Clinical Trials (prot. N 3567/AO/15) of the University Hospital of Padua, Italy.
Results: In the experimental group data showed a lower level of anxiety and depression (p 0.001) and highlighted that the effect of the T5M was proportional to the seriousness of caregivers’ anxiety and depression. The quality of nursing care was perceived as better in the experimental group, especially for the items “Presence”, “Respect” and “Attention”. The item “Competence” was perceived at the same level for the baseline, experimental and control groups, highlighting that the professional competence was perceived as good in any case. The nurse job satisfaction before and after the implementation of the RBC model remained at the same level.
Discussion: In scientific literature there are no comparable studies on RBC model with these methodological characteristics. The findings of this research are comparable with other studies for the improvement of perceived quality of nursing care (Winsett & Hauck, 2011) and patients’ satisfaction with health care (Carabetta et al., 2013; Faber 2013; Hedges et al., 2012). The nurse job satisfaction didn’t show any changes, not consistent with other studies (Winsett & Hauck, 2011; Faber, 2013; Hedges et al., 2012)
Conclusion: The caregivers who received the T5M treatment, consistent with the RBC model, showed a lower level of anxiety and depression, and a better perceived quality of nursing care. In particular, the T5M treatment showed more strength on those caregivers who had a higher level of anxiety and depression at the hospital admission. These findings have important implications for clinical practice: they show that it’s affordable to improve nursing care without raising costs for the health care organizations and that the RBC is compatible with the standard nursing care plan. Further research is needed to develop this model care in other settings
