RESEARCH TO PRACTICE
Interpersonal Complexity
Medvene L., Grosch K., and Swink, N. (2006). Interpersonal complexity: a cognitive component of person-centered care. The Gerontologist, 46, 2, 220-227.
One of the key components of person-centered care is the relationship between a caregiver and a nursing home resident. Knowing residents, their personalities and individual needs helps staff be more responsive to those needs. This in turn leads to better outcomes for residents and caregivers. This study examines the staff’s cognitive skill in perceiving residents, which is the basis for flexible policies that give residents choices. The core of the interpersonal level of any successful person-centered model is caregivers’ relationship skills: communication skills (to get personal information from residents), cognitive skills (to see how this information can be translated into caregiving tasks), and behavioral skills (to perform these skills). This study focuses on the cognitive element, the ability people have to describe other people. The cognitive skill is very decisive in working with residents. When a staff member’s knowledge of a resident is correct, a resident’s needs have a better chance of being met adequately.
Many studies indicate that people with a higher level of interpersonal cognitive ability better understand the perspectives of others, demonstrate more empathy, and are more able to explain others’ behaviors. This research was based on certified nurse aides’ participation, as the focus of the study was a resident-centered model and the importance of aides’ cognitive skill in knowing the residents with whom they worked. The research demonstrated that the participants’ degrees of the skill were not affected by their gender, age, or level of education.
The study showed that when aides knew they were assigned to a particular resident (“social motivation”) it affected how well they described the resident. For aides with a strong interpersonal cognitive skill the degree to which they liked or did not like a resident did not affect their description. However, staff with a lesser ability were influenced whether they liked a resident or not. This suggests that residents should be introduced by staff who have more experience in working with them and residents should be described to new hires in a positive light.
The study advocates using experienced CNAs to demonstrate to new hires how biographical and personal information about residents can be used to help the CNA be an effective caregiver. Knowing information about a resident can assist staff with a resident during uncomfortable caring tasks. It can also cue staff about how to behave around a certain resident.
Can interpersonal cognitive skill be learned? Some studies imply that the skill requires intensive work over at least half a year. It must be based on repeated role plays, observations, and opportunities for reflection and feedback. The researchers caution that there is not enough data to support the association between the excellence of a staff member and his or her cognitive skill. They plan to study the effectiveness of using videotaped residents’ biographies to improve the degree to which individual needs are met.
Implications: The accurate perception of who a resident is and what his or her needs are is the core of a good relationship between staff and a resident. The resident-centered model is based on staff’s responsiveness to a resident’s needs and wants. Being assigned to the same residents creates an ideal environment for staff to get to know residents really well.
Newly hired staff should be thoroughly trained by staff who have known a resident for a longer time. Introducing a resident in a positive light should help a new staff member want to get to know him or her better. New hires should have the opportunity to discuss their perception of residents with more experienced staff to compare their experiences. All staff should develop their interpersonal cognitive skill through role playing and mutual feedback. When staff know their residents very well, the residents have a better chance of receiving a high quality care.