Care Relationships Between Support Staff and Adults With a Learning Disability in Long-Term Social Care Residential Settings in the United Kingdom: A Systematic Literature Review

Context: Research exploring care relationships between support staff (e.g., support workers) and adults with a learning disability in long-term social care residential settings in the United Kingdom is relatively neglected. This has potential theoretical and care practice implications.

Objectives: This study sought to synthesise relevant literature, expand knowledge, and identify directions for future research. We investigated five questions about care relationships and what makes them positive, exploring definitions of care relationships, relational practices and processes, barriers and facilitators to good care relationships, the impact of relationships, and restoration of disrupted relationships.

Methods: Following protocol registration in PROSPERO, a systematic literature review was conducted in June–July 2021. The review was informed by official guidelines and focused on the United Kingdom, covering 41 years of relevant work. Twelve databases and five websites were searched, and experts were contacted. Forty-five reports were included and synthesised using the narrative synthesis framework.

Findings: Definitions of care relationships revolved around friendship, equality, professionalism, and power. Practices and processes underlying positive relationships included knowing the person, setting boundaries, and shifting power dynamics. Barriers to positive care relationships included staff interactional patterns, attributions, and staff dilemmas, whilst facilitators included receiving training and using communication tools. Good care relationships were key to effective support and ways to restore disrupted relationships included receiving input from systemic therapy.

Limitations: Literature was limited for certain review questions and more extensive for others. Only a few reports addressed care relationships as such with the rest focusing on communication or interactions. Time constraints prevented us from including more kinds of reports. The voice of residents was limited.

Implications: We hope that this review contributes to and expands knowledge around care relationships and shapes directions for future research. Findings can be used by support staff, service managers, residents, trainers, advocates, regulators, and researchers.