Teaching Relational Care for Health Inequalities: Evaluating the Impact of a Program for Community Nurses and Midwives in Primary Care

INTRODUCTION: Internationally, nurses need to learn and develop relational skills that enable them to engage therapeutically with patients. Relational skills are crucial in contexts of socioeconomic deprivation, where patients face high levels of adversity, inequality, and poor health. They are defined as the interpersonal skills needed to bring about clinical change, while also enhancing staff well-being and support. Educators continue to grapple with how best to design and deliver educational programs that enhance relational skills in the nursing workforce. We report on a realist evaluation of a psychodynamically informed relational care educational program for primary care nurses, identifying outcomes, impacts, and mechanisms of change. METHODS: Mixed methods with a prospective cohort, within a realist evaluation framework. Predefined outcomes were assessed at pre, mid, post, and 3-month follow-up, using validated measures (Professional Quality of Life V and Therapeutic Relationship Assessment Scale-Nursing). The context and mechanisms through which outcomes were realized, and impacts were investigated through multiple data sources over the course of the program. RESULTS: Statistically significant increases were observed in compassion satisfaction, self-awareness, and knowledge. Reductions were observed in burnout and secondary traumatic stress. Empathy toward service users increased. Participants reported multiple well-being and patient-focused impacts associated with program engagement. Early indicators suggest these were sustained over time. DISCUSSION: Results highlight the value and impact of psychodynamically informed, relationally focused education approaches for staff working with service users experiencing high levels of health inequality and multimorbidities. A pedagogical model for effective delivery is presented. Future research should test the theory of change and outcomes under experimental conditions and long-term follow-up of outcomes.