Concept Of Person-centred Care Research Articles

Exploring the Inclusion of Person-Centered Care Domains in Stroke Transitions of Care Interventions: A Scientific Statement From the American Heart Association.

Health care teams along the stroke recovery continuum have a responsibility to support care transitions and return to the community. Ideally, individualized care will consider patient and family preferences, best available evidence, and health care professional input. Person-centered care can improve patient-practitioner interactions through shared decision-making in which health professionals and institutions are sensitive to those for whom they provide care. However, it is unclear how the concepts of person-centered care have been described in reports of stroke transitional care interventions. A secondary analysis of a systematic review and meta-analysis was undertaken. We retrieved all included articles (n=17) and evaluated the extent to which each intervention explicitly addressed 7 domains of person-centered care: alignment of care with patients' values, preferences, and needs; coordination of care; information and education; physical comfort; emotional support; family and friend involvement; and smooth transition and continuity of care. Most of the articles included some aspects of person-centeredness; we found that certain domains were not addressed in the descriptions of transitional care interventions, and no articles mentioned all 7 domains of person-centered care. We identified 3 implications for practice and research: (1) delineating person-centered care components when reporting interventions, (2) elucidating social and cultural factors relevant to the study sample and intervention, and (3) clearly describing the role of family and nonmedical support in the intervention. There is still room for greater consistency in the reporting of person-centeredness in stroke transitions of care interventions, despite a long-standing definition and conceptualization of person-centered care in academic and clinically focused literature.

PERSON-CENTERED CARE: SETTING THE INTERNATIONAL SCENE FROM A CONCEPTUAL PERSPECTIVE

Abstract Over 142 million older persons worldwide need assistance with meeting basic needs, often requiring some level of long-term support and services. Person-centered care (PCC) is internationally recognized as an essential strategy for achieving high quality care and quality of life for older adults who need long-term care. Rather than focusing only on disease management or preventing morbidity, PCC results in positive outcomes for older people and their caregivers by focusing care on the whole person in their unique environment and aligning care with what is holistically meaningful to older people. Although PCC has become the gold standard for care of older adults, its widespread implementation has led to theoretical, conceptual, and practical inconsistencies that make it challenging to compare or evaluate its application or effectiveness globally. This is particularly problematic given our understanding of PCC is largely derived from research and practice in western cultures. Despite positive outcomes, the wide spectrum of person-centered interventions introduces variation which has made global comparisons difficult and ability to identify needs for cultural adaptation largely absent. To be able to compare PCC internationally, and reflect on potential needs for cultural adaptation, more conceptual clarity of the concept of PCC, its measurement, and implementation is needed. The purpose of this presentation is to review the use, value, and implementation of PCC concepts in international literature and present possible future directions for extending PCC to be more culturally inclusive for a global older adult population.

Holistic Approach for Cancer Patients: Integration of Therapeutic Gardens and Person Centered Care (Literature Review)

The concept of Person Centered Care (PCC) is a revolutionary approach in the world of health care that emerged from a strong argumentative foundation. PCC firmly recognizes that patients are not simply passive objects in the care process, but have the unique potential to be actively involved in managing their own health. This is based on deep psychological theories, one of which is the "self-efficacy" theory put forward by Albert Bandura. The Ecological Health Model is an approach that views a person's health from a more comprehensive and scientific perspective. This model explains that a person's health is not only influenced by physical factors, but also by a number of complex and interrelated social, psychological and environmental factors. In this understanding of health, socioeconomic conditions, social support, physical environment, and psychological factors all play an important role. A holistic approach to cancer patients that combines therapeutic gardens and person-centered care can provide substantial benefits. However, it requires active participation from patients, designers, healthcare professionals, and perhaps family members, to create a space that is truly healing and meets the unique needs of each individual on their healing journey.

The Role of the Surveyor in Discharge Planning for Patient Safety

This article reviews the critical process of patient discharge from hospitals and its challenges, with a focus on the length of stay (LOS) as an indicator of therapeutic success and treatment costs. Emphasis is placed on the importance of accurate diagnosis, appropriate discharge planning, and the prevention of readmissions to the hospital. Utilising the Calgary Family System Theory (CSFT) and the concept of Person-Centered Care (PCC), this piece underscores the significance of an individualised approach, patient involvement in decision-making, effective communication, and multidisciplinary collaboration in the discharge process. Thus, effective discharge planning can enhance the quality of patient care and reduce the economic burden associated with patient readmissions.

Person-centered medicine and psychiatry – Emerging perspectives

Person-centered medicine is dedicated to the promotion of health as a state of physical, mental, socio-cultural and spiritual wellbeing as well as to the reduction of disease, and founded on mutual respect for the dignity and responsibility of each individual person. The concept of person centered care has evolved over the years and the main focus has been on moving further away from biological reductionism that has plagued western medicine. In the recent years, a critical evaluation of the current practices in psychiatry and the emerging lived experience research has helped garner momentum to the narratives around person centered care. In times of psycho-social adversity, and especially when health resources are inadequate, Person Centered Medicine offers a ray of hope. The article will look into some of the emerging perspectives in person centered care.

Barriers and facilitators for coherent rehabilitation among people with inflammatory arthritis – a qualitative interview study

BackgroundPeople with chronic diseases have contact with several different professionals across hospital wards, municipality services and general practice and often experience lack of coherence. The purpose was to explore perceived barriers and facilitators to coherent rehabilitation pathways for health care users with inflammatory arthritis and how coherence can be improved.MethodsSemi-structured individual interviews were conducted before a planned inpatient rehabilitation stay, 2-3 weeks and 4-6 months after discharge. Thematic reflexive analysis guided the analysis of data. Concepts of person-centred care, complex adaptive systems and integrated care were applied in the interpretations.ResultsIn all, 11 participants with IA were included. There was one overarching theme, The importance of a person-centred approach, illuminating the significance of professionals who respect healthcare user’ preferences. To use a person-centred approach, demands professionals who are interested in exploring the persons own values, preferences and experiences and incorporate these when planning care and rehabilitation.Connected to the overarching theme, three sub-themes were derived; 1) Experiences of empowerment and dis-empowerment, covering that most want to be in control and act themselves, but felt overwhelmed and lost energy and they tended to give up; 2) Experiences of communication and coordination, encompass how people feel forced to take on coordination and communication tasks themselves although they do not always feel qualified for this. Some asked for a coordination person and 3) Facing everyday life after discharge, covering how initiatives taken by professionals were not always experienced as helpful after discharge. Some gave up and some tried to find alternative paths themselves.ConclusionProfessionals taking a person-centred approach facilitated coherent rehabilitation pathways. This encompassed care with respect for individual needs and professionals who empowered patients to self-management. Furthermore, to be aware that interprofessional communication and coordination need to take place both between professional within the same department, between departments and between professionals in different sectors.After discharge, some patients were challenged in their everyday life when trying to follow the advice from the professionals. Professionals, who do not use a person-centred approach, hinder coherence. Patients thus feel compelled to take on communication and coordination tasks.

Vagueness and variety in person-centred care

Person-centred care is a cornerstone of contemporary health policy, research and practice. However, many researchers and practitioners worry that it lacks a ‘clear definition and method of measurement,’ and that this creates problems for the implementation of person-centred care and limits understanding of its benefits. In this paper we urge caution about this concern and resist calls for a clear, settled definition and measurement approach. We develop a philosophical and conceptual analysis which is grounded in the body of literature concerning the theory and practice of person-centred care. We consider a range of influential definitional frameworks of person-centred care, highlighting their differences and showing that they do not correspond to a clearly circumscribed and consistent underlying concept. We argue that a degree of indeterminacy and vagueness should not be seen as a problem with the concept of person-centred care; these are features of a rich and contested concept which exists prior to and outside of practical and technical operational definitions and applications. We defend the value of operating with multiple accounts of person-centred care, arguing that what counts as being person-centred can vary across different care contexts, in relation to different patient groups, and as a reflection of different, defensible ethical perspectives. Although the idea of a single, agreed definition is attractive and may seem to be a practical or even necessary step towards meaningful and coordinated action, we argue that this is only the case in a qualified sense. Comprehensive attempts to narrow down the concept in this way should be resisted, as they risk undermining what it is that makes person-centredness a valuable concept in healthcare.

Vagueness and variety in person-centred care.

Person-centred care is a cornerstone of contemporary health policy, research and practice. However, many researchers and practitioners worry that it lacks a 'clear definition and method of measurement,' and that this creates problems for the implementation of person-centred care and limits understanding of its benefits. In this paper we urge caution about this concern and resist calls for a clear, settled definition and measurement approach. We develop a philosophical and conceptual analysis which is grounded in the body of literature concerning the theory and practice of person-centred care. We consider a range of influential definitional frameworks of person-centred care, highlighting their differences and showing that they do not correspond to a clearly circumscribed and consistent underlying concept. We argue that a degree of indeterminacy and vagueness should not be seen as a problem with the concept of person-centred care; these are features of a rich and contested concept which exists prior to and outside of practical and technical operational definitions and applications. We defend the value of operating with multiple accounts of person-centred care, arguing that what counts as being person-centred can vary across different care contexts, in relation to different patient groups, and as a reflection of different, defensible ethical perspectives. Although the idea of a single, agreed definition is attractive and may seem to be a practical or even necessary step towards meaningful and coordinated action, we argue that this is only the case in a qualified sense. Comprehensive attempts to narrow down the concept in this way should be resisted, as they risk undermining what it is that makes person-centredness a valuable concept in healthcare.

Increasing person-centeredness in psychosis inpatient care: staff experiences from the Person-Centered Psychosis Care (PCPC) project

BackgroundInterventions to increase person-centeredness in hospital care for persons with psychotic illness are needed. Changing care delivery is however a complex venture, requiring staff to reconsider their mindsets and ways of working. A multidisciplinary educational intervention for hospital staff at four wards was launched to increase person-centeredness in the care of patients with schizophrenia and similar psychoses. This study aims to explore staff experiences of working to increase person-centeredness.MethodsA heterogenic sample of staff (n = 23) from all participating wards were recruited for six focus group interviews. Semi-structured questions covered staff perceptions of person-centered care and the process of increasing person-centeredness. Transcribed data was analyzed using thematic analysis according to Braun and Clarke.ResultsStaff viewed person-centered care as an approach rather than a method. They described central aspects of person-centered care, such as recognizing the patient as a capable person who can participate in her/his care. Statements further showed how these core features were put into practice. Changes related to the intervention were presented in terms of evolving patient and staff roles, improved contact with patients, more flexible care routines, and a more positive ward climate. Neither psychotic symptoms nor involuntary status were considered barriers for person-centered care, but organizational factors beyond staff control seemed to impact on implementation.ConclusionsAfter implementation, participants displayed good understanding of the core concepts of person-centered care in both thinking and action. They attributed several improvements in the care milieu to an increased level of person-centeredness. Psychotic behavior and involuntary treatment did not present major barriers to person-centered care. Findings suggest person-centered care is feasible in the psychosis inpatient setting and could improve quality of care.Trial registrationThe study is part of a larger study evaluating the intervention Person-Centered Psychosis Care (PCPC). It was registered retrospectively at clinicaltrials.gov, identifier NCT03182283.

A study of reminiscence activities program on dementia behavioral problems care for long-term care older adults in Taiwan

ABSTRACT The concept of person-centered care has been incorporated through various healthcare interventions to enhance mental health-related outcomes and ensure the quality of care delivered to individuals living with dementia. Reminiscence therapy (RT) is a popular therapeutic intervention for individuals with dementia. The purpose of this study is to evaluate intervention effects of group RT on symptoms of agitation in individuals with dementia. We employed a quasi-experimental repeated measures study design. The participants included 80 older adults with dementia, residing in two long-term care facilities in Taiwan. The participants received a 120-minute group RT session once per week for 10 weeks. Outcomes were measured 1 week pre- and post-intervention. It was observed that participation in group RT significantly improved agitated behavior of individuals with dementia across time periods. The designed RT program showed promising effects regarding improving the agitated behavior of older adults with dementia living in long-term care homes. Incorporating RT activities into clinical social work practice may help long‐term care to evolve in a more diverse and innovative direction.

Nursing students’ learning about person-centred dementia care in a nursing home: A qualitative study

It is unclear to what extent nursing students are able to apply person-centred care in practice, despite a mixture of educational support approaches. The aim of this study was to explore nursing students’ experiences of learning about person-centred dementia care after they participated in an adopted education programme in a nursing home. The education programme presented the main concepts of person-centred care. A qualitative explorative design was chosen where 32 bachelor-level nursing students participated in seven focus groups. The study is reported according to the COREQ checklist. Qualitative thematic content analysis revealed two main themes: care culture in the nursing home as joyful and inclusive, and the nursing student role as ambivalent and challenging. The nursing home management, staff members and patients, together with the programme, seemed to enhance students’ learning about person-centred dementia care.

Person-centred care in speech-language therapy research and practice for adults: A scoping review.

Person-centred care (PCC) has shown positive effects in various health-care settings and therefore is desirable in clinical work. However, as PCC is still being developed, the literature reflects a heterogeneous use of both terminology and conceptualisation. This lack of consistency hinders the implementation or adaptation of PCC in general and in select fields of practice such as speech-language therapy (SLT). To describe how the concept of PCC manifests in current speech and language therapy research and practice for adult patients. Searches for published literature were conducted in five databases (PubMed, Scopus, CINAHL, Psych INFO, and Linguistics and Language Behaviour Abstracts) using search terms related to PCC and SLT. Records were included if they involved an adult population, were written in English, and focused on PCC and SLT irrespective of year of publication. A total of 134 records published 1996-2020 were included in this review. Many of these records were discussion papers that described how speech-language therapists (SLTs) can or should work in a person-centred way. The search did not find any records that explore the implementation, effects, or patients' views of person-centred SLT. This literature review revealed that person-centred SLT practice mainly relates to the International Classification of Functioning, Disability, and Health framework, and the Life Participation Approach to Aphasia. Studies incorporating exploration of proposed clinical routines of PCC demonstrate specific context-dependant aspects including barriers to eliciting a patient narrative, involving patient and family members, and documenting SLT. This study provides information that can be used to implement person-centred care in SLT education, clinical practice, and research by providing an inventory of the current knowledge and the existing gaps. PCC has shown positive effects and is currently being implemented in various health-care settings worldwide. This study provides an account of the current state in research and practice on how PCC for adults is described, discussed, and evaluated. While related concepts such as family-centred care have mainly been explored within paediatrics, little is known about how PCC manifests in SLT for adults. Our results show that PCC is presently being discussed and valued in SLT although obstacles exist, and few studies explore whether current practice is person centred and the potential effects of such practice. WHAT ARE THE POTENTIAL OR ACTUAL CLINICAL IMPLICATIONS OF THIS WORK?: This study provides clinicians, researchers, and policymakers' guidance on what aspects to consider when working to implement person-centred SLT for adults.

Key Intervention Categories to Provide Person-Centered Dementia Care: A Systematic Review of Person-Centered Interventions.

Background:Person-centered care (PCC) is an important concept in many countries’ national guidelines and dementia plans. Key intervention categories, i.e., a taxonomy of person-centered (PC)-interventions, to provide person-centered dementia care, are difficult to identify from literature.Objective:This systematic review aimed to identify and categorize published PC-interventions into key intervention categories to guide the provision of person-centered dementia care.Methods:Conduct of this systematic review followed Cochrane guidelines. A search of the dimensions ‘Dementia’, ‘Person-Centered Care’, and ‘Intervention’ combined was performed in PubMed, EMBASE, and Web of Science. Study selection was based on 2-stage screening against eligibility criteria, limited to controlled study designs. Information about interventions and outcomes was extracted into an “Effects Table”. The identified PC-interventions were categorized in intervention categories to provide person-centered dementia care.Results:Searches identified 1,806 records. 19 studies were included. These covered a range of psychosocial interventions, oftentimes multi-component interventions, which followed heterogeneous approaches. Studies were conducted in long-term care/hospital settings. Nine key intervention categories were identified: social contact, physical activities, cognitive training, sensory enhancement, daily living assistance, life history oriented emotional support, training and support for professional caregivers, environmental adjustments, and care organization.Conclusion:Our findings provide a current overview of published PC-interventions in dementia, which followed heterogeneous approaches under the PCC-concept. The heterogeneity made it challenging to identify a well-defined concept of PCC and common key intervention categories. An effectiveness-evaluation of “PC” - including “relationship-centered”-interventions may be valuable, to assess whether an explicit focus on relationships around PCC-interventions yields an added benefit.PROSPERO-ID: CRD42021225084.

Adoption of the concept of person-centred care into discourse in Europe: a systematic literature review.

This study aims to describe how person-centred care, as a concept, has been adopted into discourse in 23 European countries in relation to their healthcare systems (Beveridge, Bismarck, out of pocket). A literature review inspired by the SPICE model, using both scientific studies (CINHAL, Medline, Scopus) and grey literature (Google), was conducted. A total of 1,194 documents from CINHAL (n=139), Medline (n=245), Scopus (n=493) and Google (n=317) were analysed for content and scope of person-centred care in each country. Countries were grouped based on healthcare systems. Results from descriptive statistics (percentage, range) revealed that person-centred care was most common in the United Kingdom (n=481, 40.3%), Sweden (n=231, 19.3%), the Netherlands (n=80, 6.7%), Northern Ireland (n=79, 6.6%) and Norway (n=61, 5.1%) compared with Poland (0.6%), Hungary (0.5%), Greece (0.4%), Latvia (0.4%) and Serbia (0%). Based on healthcare systems, seven out of ten countries with the Beveridge model used person-centred care backed by scientific literature (n=999), as opposed to the Bismarck model, which was mostly supported by grey literature (n=190). Adoption of the concept of person-centred care into discourse requires a systematic approach at the national (politicians), regional (guidelines) and local (specific healthcare settings) levels visualised by decision-making to establish a well-integrated phenomenon in Europe. Evidence-based knowledge as well as national regulations regarding person-centred care are important tools to motivate the adoption of person-centred care in clinical practice. This could be expressed by decision-making at the macro (law, mission) level, which guides the meso (policies) and micro (routines) levels to adopt the scope and content of person-centred care in clinical practice. However, healthcare systems (Beveridge, Bismarck and out-of-pocket) have different structures and missions owing to ethical approaches. The quality of healthcare supported by evidence-based knowledge enables the establishment of a well-integrated phenomenon in European healthcare. Our findings clarify those countries using the Beveridge healthcare model rank higher on accepting/adopting the concept of person-centered care in discourse. To adopt the concept of person-centred care in discourse requires a systematic approach at all levels in the organisation-from the national (politicians) and regional (guideline) to the local (specific healthcare settings) levels of healthcare.

The importance of person-centred care and how to achieve it

This article discusses the important concept of person-centred care and how this can be achieved. Following an introduction defining what is meant by this term and contrasting it with the term patient-centred care, the relevant and pertinent parts of the Nursing and Midwifery Council code will then be identified and discussed. The four principles of person-centred care will then be presented. The role of the support worker and nursing associate will be made clear in how the wishes and needs of patients can be gained. Self-awareness, emotional intelligence and communication will be discussed in relation to this. Finally, two potential barriers to the successful achievement of person-centred care will be identified.

Brief Admission for Patients with Self-Harm from the Perspective of Outpatient Healthcare Professionals

The aim of the study was to describe the role of brief-admission (BA) in treating high-risk patients with self-harm from the perspective of outpatient healthcare staff in Sweden. Ten outpatient healthcare professionals from three psychiatric clinics were interviewed. Data were analyzed using a conventional content analysis. The findings of this study help support the role of BA as an acute crisis management intervention, and describe how BA serves as a useful adjunct to outpatient treatment, especially for patients with complementarily psychotherapeutic interventions. The findings also suggest that implementing BA may increase treatment opportunities for outpatient staff and strengthen the concept of person-centered care.

Patients’ experiences of place and space after a relocation to evidence‐based designed forensic psychiatric hospitals

Forensic hospitals provide care for incarcerated patients who have committed a crime under the influence of serious mental illness. The care and (re)habilitation of the target group require highly competent staff and treatment strategies as well as purpose-built facilities that promote successful recovery. The aim of this study was to examine patients' experiences of place and space in new, purpose-built, evidence-based designed forensic psychiatric facilities in terms of supporting everydayness. A qualitative methodology was chosen. In total, 19 patients agreed to participate. Data were collected through photovoice (a combination of photographs and interviews) at three forensic hospitals, according to an evidence-based design and the concept of person-centred care in Sweden. The data were analysed through thematic content analysis. Four themes emerged from the data, revealing the patients' experiences of the new buildings: (i) having a private place, (ii) upholding one's sense of self, (iii) feelings of comfort and harmony, and (iv) remaining connected to one's life. The findings reveal that purpose-built environments can support everyday living and well-being and can create comfort. This is considered highly therapeutic by the patients. In conclusion, the findings of this study are of imperative importance in the design of health-promoting forensic hospitals.

A learning process towards person-centred care: A second-year follow-up of guideline implementation.

Research claims that 'learning by doing' creates new thinking, often leading to new practice. The aim was to explore and describe the staff learning process from the first to the second year when adopting person-centred care into clinical practice in a nursing home for persons with dementia. The data consisted of poster texts from staff and written notes by researchers obtained from the group discussions. The study involved 24 care units (200 staff). Content analysis was chosen as method to explore the learning process. The staff described the actions that they took during year 1 and year 2, in which five categories emerged, activities, environment, information, priorities and staff routines. With researchers' analysis the categories together created the learning process and formed a sub-theme. They further formed an overarching theme from simplicity to complexity and consensus. Staff changes year 1 pertained more to planning and doing, while year 2 changes constituted a larger complexity of person-centred care with reflection, collaborative learning and a mind-set change. Staff chose the development area, and the learning process was illuminated by the researchers. This underscores the value to visualise and verbalise the steps of change as well as include these steps in the design of an implementation process. The concept of person-centred care could be viewed on different levels. The findings may contribute to a more comprehensive understanding of staff learning process when implementation of person-centred care. Making staff's learning process visible can be a guide for improvement and change from a generic care towards person-centred care. The Regional Board of Research Ethics approved the study (Reg no. 2010/1234-31/5).

‘인간중심 돌봄’적인 측면에서의 치매친화환경지침 비교검토

Purpose: This study aims to examine how Person-Centered Care approach has affected the long-term elderly care facility design guidelines related to the dementia friendly environment, by examining the literature on ‘Person-Centered Care’ highlighted in research; to address the policy implications for dementia-friendly environment on basis of Person-centered approach. Method: The concept of Person-centered Care was defined, and the principles and the design features of Person-centered care were derived from literature review focused on person-centered Care and the design of environments for people with dementia highlighted in research. Based on the facts, this study examines how much Person-Centered Care approach affects the design guidelines for dementia-friendly environments by comparative review. Result: The result shows that the principles and design features of Person-centered Care influence on that of the selected design guidelines for dementia-friendly elderly care environments directly through comparative review. The viewpoint to dementia care environments has changed from person-centered care approach for dementia patients based on homelike environment to that expanded dementia patients’ families and staffs who take care of them, based on community. In Korea, the direction of dementia care policy is in the process of gradually changing from a medical approach to an expanded social and person-centered care approach. There is a strong need to establish the design guideline for dementia-friendly environments to apply the efficient change.

The experience of non-conveyance following emergency medical service triage from the perspective of patients and their relatives: A qualitative study

BackgroundAs many as 25% of all Dutch ambulance emergency service assignments result in non-conveyance of the patient to the hospital. Little is known about how patients and their relatives experience being left at home by an ambulance nurse after an acute request for medical help. AimTo gain insight into the experience of patients and their relatives with a high urgency request for ambulance assistance that results in non-conveyance, with the ultimate goal of offering adequate follow-up. MethodA qualitative design based on semi-structured interviews with fifteen patients and seven relatives, conducted between September and November 2018. ResultsFour themes emerged from the thematic analysis: Fear as the prominent emotion, four components of confidence in decision-making, different consequences and coping between patient and relative(s) over time and the perceived need for evaluation afterwards. ConclusionThe experience after non-conveyance has several phases in which fear, reassurance, confirmation (for relatives) and shame (for patients) follow each other throughout the care process. Complex interpersonal skills of ambulance nurses congruent with the concept of person-centred care can modulate this impact. These findings offer starting points for the optimisation of training programmes within the ambulance care sector.