Delivery Of Person-centred Care Research Articles

"Things That You Thought Mattered, None of That Matters": A Qualitative Exploration of Family Caregiver Values following Left Ventricular Assist Device Implantation.

Intentional exploration, or elicitation, of patient and family values-who/what matters most-is critical to the delivery of person-centered care, yet the values elicitation experiences of family caregivers have been understudied. Understanding caregiver experiences discussing, reflecting upon, and acting on their values is critical to optimizing health decisions after left ventricular assist device (LVAD) implantation. The aim of this study was to explore the values elicitation experiences of family caregivers of individuals with an LVAD in the postimplantation period. This was a qualitative descriptive study of LVAD caregivers recruited from an outpatient clinic in the southeast United States. After completing one-on-one semistructured interviews, participants' transcripts were analyzed using thematic analysis. Interviewed caregivers (n = 21) were 27 to 76 years old, with 67% African American, 76% female, 76% urban-dwelling, and 62% a spouse/partner. LVAD implantation was an impactful experience prompting caregiver reevaluation of their values; these values became instrumental to navigating decisions and managing stressors from their caregiving role. Three broad themes of caregiver values elicitation experiences emerged: (1) caregivers leverage their values for strength and guidance in navigating their caregiving role, (2) LVAD implantation prompts (re)evaluation of relationships and priorities, and (3) caregivers convey their goals and priorities when deemed relevant to patient care. Having a care recipient undergo LVAD implantation prompted caregivers to reevaluate their values, which were used to navigate caregiving decisions and stressors. Findings highlight the need for healthcare professionals to engage and support caregivers after LVAD implantation.

Preferences and Quality of Life in Nursing Home Residents: A Mixed Methods Study.

Delivery of person-centered care (PCC) is the standard in nursing homes (NHs) and demonstrates a positive impact on resident quality of life (QOL). PCC inherently recognizes and prioritizes resident preferences; however, preferences, and their degree of importance among residents, demonstrate a variable relationship with QOL that remains underexplored. Therefore, the current study examined the association between preferences and QOL among NH residents. A mixed methods study incorporating surveys was conducted among 144 residents, with semi-structured follow-up interviews with 11 residents. Findings confirm a variable relationship between resident preferences and QOL. Higher order preferences not captured within the preference assessment may influence QOL. High numbers of unimportant and can't do/no choice preferences were linked to resident acclimatization to the NH. QOL was at risk if care was not consistent with preferences. In-depth assessments and robust measures of preferences and QOL should be integrated into care delivery and future research. [Journal of Gerontological Nursing, 50(5), 7-13.].

“They seemed to be like cogs working in different directions”: a longitudinal qualitative study on Long COVID healthcare services in the United Kingdom from a person-centred lens

BackgroundThe COVID-19 pandemic has presented significant challenges to the already over-stretched healthcare system in the United Kingdom (UK). These challenges are particularly pronounced for people living with the novel condition of Long COVID (LC) as they often face persistent and fluctuating symptoms, encountering prolonged uncertainty when seeking medical support. Despite a growing understanding of the healthcare challenges associated with LC, existing qualitative studies have predominantly focused on individual experiences rather than examining the structural aspects of healthcare.MethodsA longitudinal qualitative study with 80 participants and 12 healthcare practitioners was conducted in the UK to explore the healthcare experiences of those with LC. In total, 178 interviews (with attrition) were collected across two rounds, from November 2021 to March 2022, and from June to October 2022.ResultsEmbracing a person-centred framework that recognises and nurtures interconnected individual, relational, and existential needs, we investigated healthcare experiences related to LC across primary, secondary, and specialist integrated care. Using this perspective, we identified three overarching themes. Theme 1 addresses the persistent hurdle of accessing primary care as the initial point of contact for LC healthcare; Theme 2 underscores the complexity of navigating secondary care; and Theme 3 encapsulates the distinctive challenges of developing LC integrated care. These themes are interlinked, as people with LC often had to navigate or struggle between the various systems, with practitioners seeking to collaborate across the breadth of their professional responsibilities.ConclusionFrom a person-centred approach, we were able to identify the needs of those affected by lasting LC symptoms and comprehend how health services intricately influence these needs. The focus on healthcare systems also captures the nuanced impact that continuing healthcare struggles can have on people’s identity. As such, our findings provide evidence to inform a more effective and sustainable delivery of person-centred care for people with LC across various healthcare settings and over time.

Reaching consensus on the definition of person-centred handover practices in emergency departments: A modified online Delphi.

To reach consensus on the definition and attributes of 'person-centred handover practices' in emergency departments. Handover practices between emergency care practitioners and healthcare professionals in emergency departments are important and should be conducted meticulously. Person-centred handover practices may enhance the delivery of person-centred care in emergency departments. A three-round online Delphi survey. Nine experts participated in a three round Delphi survey. The expert panel comprised experts from nine countries. Quantitative data were descriptively analysed, and qualitative data were thematically analysed. A consensus of 80% had to be reached before an attribute and definition could be accepted. Experts reached a consensus of 79% in round one, 95% in round two and 95% in round three. A final set of six attributes were agreed upon and the final concept definition was formulated. Person-centred handover practices have not been implemented in emergency departments. Yet, person-centred handover practices may enhance the delivery of person-centred care, which has multiple benefits for patients and healthcare practitioners. Person-centred care is not generally implemented in emergency departments. Person-centred handover practices can lead to person-centred care. Handover practices in emergency departments are a high-risk activity. Despite numerous calls to standardise and improve handover practices, they remain a problem. Developing a standardised definition could be a first step towards implementing person-centred handover practices in emergency departments. The study adhered to the relevant EQUATOR reporting guidelines: Guidance on Conducting and Reporting Delphi Studies (CREDES) checklist. Improve handover practices and patient care. Improve person-centred care in emergency departments. Emergency care practitioners and nurses experienced in handover practices and/or person-centred care, working in clinical and academic fields, participated in the study by sharing their expert knowledge during each of the Delphi rounds.

Staff perspectives on the feasibility of the person-centered care assessment tool (PCC-at) in HIV treatment settings in Ghana: a mixed-methods study

Person-centered care (PCC) aims to improve client’s experiences in HIV care while advancing outcomes. This study team developed the PCC assessment tool (PCC-AT) to assess PCC service performance in HIV treatment settings in Ghana. Study objectives aimed to describe the range of PCC-AT scores within and across study facilities and examine the feasibility of PCC-AT implementation in diverse HIV treatment settings. The PCC-AT was piloted at five health facilities providing HIV services among 37 staff. Immediately following each pilot, focus group discussions (FGDs) were conducted to gather feasibility data. Thematic qualitative analysis was conducted on translated FGD transcripts. Across facilities, providers scored highest in the staffing domain, followed by service provision, and direct client support. Time required to implement the PCC-AT averaged 62 minutes. Providers described the tool as well-structured, user-friendly, relevant, reflective of the core PCC delivery elements, and useful in elucidating actions to improve PCC service delivery across domains. The PCC-AT holds potential to strengthen activities that support clients’ broader clinical, mental and psychosocial wellbeing by offering friendly services that attend to each client’s holistic needs while contributing progress towards epidemic control.

Reinforcing the humanity in healthcare: The Glasgow Consensus Statement on effective communication in clinical encounters

Contemporary healthcare is characterized by multidisciplinary teamwork across a vast array of primary, secondary and tertiary services, augmented by progressively more technology and data. While these developments aim to improve care, they have also created obstacles and new challenges for both patients and health professionals. Indeed, the increasingly fragmented and transactional nature of clinical encounters can dehumanize the care experience across disciplines and specialties. Effective communication plays a pivotal role in reinforcing the humanity of healthcare through the delivery of person-centered care – compassionate, collaborative care that focuses on the needs of each patient as a whole person. After convening at the International Conference on Communication in Healthcare (Glasgow, 2022), an interdisciplinary group of researchers, educators and health professionals worked together to develop a framework for effective communication that both acknowledges critical challenges in contemporary health services and reinforces the humanity of healthcare. The Glasgow Consensus Statement is intended to function as a useful international touchstone for the training and practice of health professionals, fully recognizing and respecting that different countries are at different stages when it comes to teaching, assessment and policy. It also provides a vocabulary for monitoring the impact of system-level challenges. While effective communication may not change the structure of healthcare, it can improve the process if health professionals are supported in infusing the system with their own innate humanity and applying the framework offered within this consensus statement to reinforce the humanity in everyday practice.

Interprofessional Collaboration to Support Person-centered Care: Implementation of an Integrated Surgical Pathway for Complex Foot and Ankle Patients

Introduction: Traditionally foot and ankle patients have high medical and social complexities that require additional support and care navigation following surgery to improve transitions out of hospital into the community for recovery at home. We explored implementation of an integrated surgical pathway that included an interprofessional, centralized intake model for surgical consult, pre-operative mobility assessment to assess post-operative supports and potential barriers to successful discharge home, and creation of a partnership with transitional care, while providing person-centered care to improve patient experience and surgical recovery. 
 Aims, Objectives and Methodology: Our objective was to develop and implement an integrated surgical pathway for complex foot and ankle patients to support seamless transitions in care from acute to recovery at home following surgery. 
 A working group was formed with members spanning operational and clinical roles across the care continuum including: physiotherapist practitioner, surgeon administrative support, clinical managers, inpatient physiotherapists, social work, nurse practitioners and transitional care program managers. A 2-hour process mapping session was conducted outlining the current state surgical pathway and potential barriers to successful discharge were identified. Standard care path guidelines were developed with decision tree clinical resources to assist the care team in facilitating referrals to transitional care pre-operatively to ensure seamless transition for the patient after surgery. 
 Highlights and Key Findings: The patient population supported by this integrated pathway were those with complex foot and ankle surgical procedures including: ankle and midfoot fusion, ligament reconstruction, ankle osteotomy, total ankle replacement and triple arthrodesis. Fairly equal distribution was seen between male and female (48% and 52% respectively), and the average age was 54 years. The addition of an interprofessional consult offered more robust patient education, pre and post surgical planning and expectation setting. A pre-op mobility assessment optimized post-operative care coordination. This was illustrated by a reduction in the acute length of stay from an average of 8.2 days in 19/20 to 3.4 days in 20/21. From 2018 to 2022 the discharge disposition of this patient cohort remained consistent with the majority of patients (66%) supported to return home with outpatient physiotherapy, 24% of patients were discharged home with homecare services coordinated and a small proportion (<10%) were transferred to a transitional care, inpatient or residential care facility. Qualitative report from patient's revealed that supports provided eased anxiety and improved post-operative transitions home for recovery.
 Conclusions: Implementation of an integrated surgical pathway for complex foot and ankle patients that maximize pre-operative care planning and leveraging existing community partnerships, both in-home and institutional; enable the delivery of person-centred care, facilitating seamless transitions from acute care to community for patients while optimizing hospital resource utilization.
 Implications for applicability/transferability, sustainability and limitations: Expansion of collaborative integrated models that support additional orthopedic surgical patient populations from hospital to recovery within the community are critical in providing person-centered care. Sustainability of these models will rely on securing the resources required for pre-surgical patient education, expectation setting and care and resource planning for seamless post-operative transitions. 

THE MOVING FORWARD NURSING HOME COALITION: A CALL TO ACTION TO SUPPORT NURSING HOME REFORM

Abstract The Moving Forward Nursing Home Quality Coalition advances the goals outlined by the 2022 National Academies of Sciences, Engineering, and Medicine (NASEM) report aimed at improving nursing home (NH) quality. Over two years, Coalition committee members – along with a network of national leaders, nursing home residents, and the general public – will develop, test and promote action plans that will improve the way the United States finances, delivers, and regulates care in Nursing Homes. The Coalition is comprised of a steering committee and working committees that align with and advance the seven NASEM goals including; 1) advancing delivery of person-centered care; 2) ensuring a well-prepared and compensated workforce; 3) increasing financial transparency and accountability; 4) creating a rational and robust financing system; 5) designing more effective and responsive quality assurance; 6) expanding quality measurement and continuous quality improvement; and 7) adopting health information technology. Coalition committees have engaged in three of four phases of their two-year work plan including convening stakeholders to prioritize and develop action plans to test and promote change. Throughout the work, committee collaboration has ensured action plans are refined and expanded in synergistic ways to shape state and national policy. This presentation will provide an overview of the broader Coalition work and give context for the other presentations which provide an example of collaborative work leading to proposed recommendations for critical policy and regulatory change around person-centered care planning.

A FRAMEWORK OF SUPPORT: THE NURSING HOME PERSON-CENTERED OPTIONS COUNSELING CERTIFICATION PROGRAM

Abstract Person-centered initiatives and approaches are the cornerstone of best practices when it comes to supporting older adults and persons living with dementia. Lack of person-centered care has been associated with higher medical costs and negative health outcomes, particularly in low-resource communities. Implementing person-centered care may help to address disparities and improve care outcomes in these communities, although it is often unclear which approaches are most appropriate. The Person-Centered Options Counseling Certification program attempts to address this gap via a mentoring program and competency framework. Developed and piloted in rural New Hampshire, this framework helps professionals and organizations evaluate the approaches that works best for them, while creating fidelity for ongoing support through a rigorous mentorship program. The framework shows promise of being cost effective, an important consideration for many low-resource communities. Professionals can attain knowledge, skills, and abilities without incurring higher education costs and agencies can utilize pre-developed instructional materials. Pilot data was collected to evaluate the program and demonstrated that professionals found the educational training delivered within the framework was relevant to their community and increased their knowledge about person-centered care, although some expressed hesitancy when applying the skills learned with individuals. Professionals who completed both the training and participated in the mentorship program reported a high level of competency, satisfaction, and confidence in delivering person-centered care. The use of this framework may support staff retention in low-resource communities and approaches can be tailored across different environments to facilitate the delivery of person-centered care.

PACE AND FFS MEDICARE OUTCOMES BEFORE AND DURING COVID-19: A PROPENSITY SCORE MATCHED ANALYSIS

Abstract We compared outcomes of Program of All-Inclusive Care for the Elderly (PACE) participants and fee-for-service (FFS) Medicare, dually eligible individuals using a retrospective cohort study with propensity score matching on demographic, socioeconomic, and participant-specific acuity level variables. PACE participants in 132 PACE centers nationwide who were dually eligible, enrolled during the study period, and did not have end-stage renal disease were included. Over 80% of eligible PACE participants were matched with FFS beneficiaries during each period, bringing many covariates closer between groups. We assessed differences during each period using Wilcoxon signed rank test and over time using differences-in-differences analyses. PACE participants spent significantly more time in the community and less time in nursing homes and hospitals (all p< 0.01). PACE participants had fewer COVID-19 diagnoses and hospitalizations per member per month (all p< 0.01). Due to the blinding of data, we could not determine definitively which performed better in limiting severe pressure ulcers. However, the results indicate PACE performed better when the mean assumption for blinded data is used. For all-cause mortality, PACE participants continued to perform better than FFS both before and during the pandemic (all p< 0.01), but the rates were closer during the pandemic periods. The flexibility in the PACE model and its person-centered care delivery approach may have contributed to the positive outcomes compared to FFS before and during the pandemic. We should consider how best to leverage the PACE model of care to support older adults to remain in their homes and avoid institutional settings.

Exploring the Experiences of Pharmacists with Drug Shortages in the UK

Abstract Introduction Drugs can become short in supply for many reasons including increased demand and reduced production1. Drug shortages have the potential to impact patients and pharmacists. A recent study reported pharmacists spending up to 11 hours per week dealing with drug shortages2. However, the overall impact of experiencing and dealing with drug shortages on pharmacists and patients has not been fully investigated, particularly within community pharmacy, an area of practice that has been struggling with drug shortages. Aim To highlight the challenges pharmacists face and the constraints within the current system when dealing with drug shortages. Methods The study was reviewed and received ethical approval. This was a survey study involving practising community pharmacists in the UK. Pharmacists were invited through social media and professional networks to complete a validated online survey during the period of September to December 2021. Survey data was analysed using descriptive statistics. Results 100 responses were received from 11 regions in the UK. Eighty three percent of the respondents were experiencing drug shortages 3 or more times per week and more than 70% spent 1-3 hours per week dealing with them. The majority of the respondents (93%, n = 93) indicated that drug shortages were a problem for them and sixty one (n = 100) respondents reported that they had worsened since the start of the pandemic. In addition, sixty five (n = 100) respondents believed that drug shortages had had an impact on patient care. How the respondents dealt with prescriptions for drugs that were in shortage varied with a third (34%) responding they would contact the prescriber and suggest an alternative. The respondents suggested ways for improving the management of drug shortages including giving pharmacists more legal power to change prescriptions, increasing the number of Serious Shortage Protocols (SSPs) and providing early and transparent communications. Discussion/Conclusion Spending time dealing with drug shortages impacts on the pharmacists’ workloads and quality of patient care. There was a variation between how respondents indicated they dealt with drug shortages. Patients should be able to obtain their medicine(s) and pharmacists need to respond in a way that ensures delivery of person-centred care. How pharmacists deal with shortages and why they do this needs further exploration. Some respondents suggested ways to help manage drug shortages. An increase in number of SSP’s may not be the best approach as they can be inflexible and time consuming. Initiatives such as more legal powers have received attention by the Royal Pharmaceutical Society (RPS) who believes an amendment in law to allow pharmacists to make minor changes to prescriptions affected by drug shortages would improve patient access to medicines and reduce the burden on the healthcare system. This comes at a time when community pharmacists are under pressure to offer services such as minor ailments, blood pressure checks and contraception. Despite the survey being undertaken over a year ago and the small sample size, drug shortages continue to be an issue that impacts community pharmacists, which requires further investigation.

Person-centred caregiver singing for people living with dementia in South Africa: A mixed methods evaluation of acceptability, feasibility, and professional caregivers' experiences.

Dementia care in South Africa faces challenges including a paucity of published research, a prevalent medical model in healthcare, and inadequate caregiver training. Music is a meaningful psychosocial intervention in dementia care, yet its application is not always safe and effective. A training protocol was codesigned to enhance caregivers' delivery of person-centred care through attuned, live singing. This study explored the acceptability and caregivers' experiences of a person-centred caregiver singing (PCCS) protocol in South Africa. A PCCS workshop was applied at seven aged care homes in Cape Town, South Africa. Forty-one formal caregivers adhered to inclusion criteria and consented to attend one workshop on PCCS. Mixed methods data collection was obtained from questionnaires containing a Likert scale and written reflections. Quantitative data were analysed through nonparametric tests and narrative descriptions, and qualitative data through thematic content analysis. Findings were integrated deductively using seven components of acceptability. Findings converged to show caregivers' positive experiences, highlighting observed improvements in residents' wellbeing, caregivers' capabilities, empathic connection, and person-centred care beyond the one-on-one. Caregivers' limited song repertoire and residents' unpredictability hindered implementation, however, the skills acquired appeared useful and applicable. Integration of findings suggests the acceptability of PCCS as caregivers experienced PCCS as a helpful, easy-to-implement intervention that contributes to their delivery of person-centred care. Further research focused on caregiver self-efficacy, empathy, and caregivers' own personhood is needed as well as determining the most effective strategies to ensure maximum uptake and sustainability in the sector. Formal caregivers participated in this study, both attending the training and implementing the singing protocol with residents in their care at their respective care homes. The people living with dementia residing at the care home were recipients of the singing protocol but not included as participants in the research.

Older Adults and Their Families' Online Reviews of Urban Nursing Homes in China.

Social media has made online care facility reviews popular. By analyzing online reviews of nursing homes (NHs), managers and designers can acquire insight into the perceptions of the older adults and their families. This study aims to help improve the care and environment of NHs. This study employed a mixed-methods approach to analyze online NH reviews. An inductive thematic analysis was utilized to identify and develop themes, followed by a detailed content analysis using Jieba, a Python-based program. Also, a regression analysis was conducted between the sentiment level of each subtheme and the final star ratings. Online reviews of NHs could be classified into 6 main themes, 18 subthemes, and 53 initial themes. Among the main themes, "service quality" received the most reviews, followed by "physical space environment." Of the 53 initial themes, "attitude and caring" received the most feedback, followed by "general impression of the space environment," and "meals and nutrition." Regression analysis using 18 subthemes revealed that, except for the "facility scale," all 17 subthemes were significantly connected with the final star rating. "Personal and property security" had the highest regression coefficients, followed by "service attitude" and "space." Online reviews provide a valuable supplement to conventional NH quality assessment criteria, enhancing person-centered care delivery. Based on the findings, recommendations for NH management and design are proposed to improve care quality, environment, and satisfaction for older adults and families.

Integration of Person-Centered Narratives Into the Electronic Health Record.

Care delivery that is not person-centered has been called discordant care . There has been a shift to incorporate more of a person's narrative into their individual healthcare treatment plan to reduce discordant care. Aligning with this shift in healthcare delivery, we developed a person-centered narrative intervention (PCNI) to address existing gaps in delivery of person-centered care. This study aimed to evaluate the feasibility of conducting a randomized study and describe the outcomes of PCNI to usual care on the following person (patient)-reported outcomes: perceptions of the quality of communication with their nurses and their psychosocial and existential well-being. This study's design was an Obesity-Related Behavioral Intervention Trials model Phase II proof-of-concept randomized study. The participants were people admitted to an acute care hospital diagnosed with heart failure and/or end-stage renal disease. Despite COVID-19 challenges, the PCNI was feasible in an acute care setting; it showed a moderate positive difference between conditions in the person's perception of their quality of communication and a small positive difference in their perception of feeling heard and understood. For our secondary outcomes of anxiety, depression, and psychosocial illness effect, there were small or no effects in the acute care setting. Using a person-centered narrative, such as the PCNI, can help inform delivery of care that incorporates a person's (patient's) beliefs, values, and preferences into their healthcare. This study used a pragmatic approach to evaluate the PCNI in real time in an acute care setting to assess patient-reported outcomes. These positive results in a small sample indicate the need for continued testing of the PCNI. These promising effects require further testing in a Phase III efficacy study within a larger randomized controlled clinical trial.

Who am I? Identity, person-centred care and dementia.

Identity is a central aspect of our lives. Who we believe ourselves to be has profound implications on how we interact with and interpret the world around us. People with dementia often experience stigma and suboptimal care because of a perception that they have 'lost their identity' as the cognitive symptoms associated with the condition progress. This notion is challenged by proponents of person-centred care who argue that a person's identity and worth are based on more than cognitive abilities. Person-centred care is a holistic approach that takes account of the entirety of a person's life and provides support that respects the individual and their self-identity. Since identity is vital to well-being, delivery of person-centred care must involve actively seeking a person's concept of self to tailor their care to meet all their needs. This article considers the importance of identity and personhood for people with dementia and their carers in the context of person-centred care. The article includes two case studies to illustrate these concepts in practice.

Developing a person-centred approach in dentistry beyond NHS recall intervals: a commentary.

Person-centred care (PCC) is acknowledged as a fundamental dimension of quality within health care and provides significant benefits for patients and clinicians. Models of PCC have primarily been developed from the medical literature, with limited consideration of their application within dentistry. The Personalised Care Institute was established to deliver education and training on PCC and is working with the Office of the Chief Dental Officer for England to develop resources on shared decision-making (SDM) to promote tailored recall intervals.This paper seeks to promote the value of PCC and SDM in delivering high-quality care but cautions against the use of generic models or training in view of the potential differences which may exist within dentistry, particularly general dental practice. The authors highlight the need to develop materials and training which are appropriate, contextualised and relevant to dentistry. The capacity and desire to deliver PCC is strongly influenced by the healthcare system which is in operation. The current units of dental activity (UDA) system operating in England would appear to act as a barrier to the delivery of PCC. Unless significant and rapid changes are introduced to the NHS Contract, UDA targets will continue to take precedence over PCC, SDM and tailored recall intervals.

Person-Centered Models for Cardiovascular Care: A Review of the Evidence: A Scientific Statement From the American Heart Association.

Cardiovascular disease remains the leading cause of death and disability in the United States and globally. Disease burden continues to escalate despite technological advances associated with improved life expectancy and quality of life. As a result, longer life is associated with multiple chronic cardiovascular conditions. Clinical guidelines provide recommendations without considering prevalent scenarios of multimorbidity and health system complexities that affect practical adoption. The diversity of personal preferences, cultures, and lifestyles that make up one's social and environmental context is often overlooked in ongoing care planning for symptom management and health behavior support, hindering adoption and compromising patient outcomes, particularly in groups at high risk. The purpose of this scientific statement was to describe the characteristics and reported outcomes in existing person-centered care delivery models for selected cardiovascular conditions. We conducted a scoping review using Ovid MEDLINE, Embase.com, Web of Science, CINAHL Complete, Cochrane Central Register of Controlled Trials through Ovid, and ClinicalTrials.gov from 2010 to 2022. A range of study designs with a defined aim to systematically evaluate care delivery models for selected cardiovascular conditions were included. Models were selected on the basis of their stated use of evidence-based guidelines, clinical decision support tools, systematic evaluation processes, and inclusion of the patient's perspective in defining the plan of care. Findings reflected variation in methodological approach, outcome measures, and care processes used across models. Evidence to support optimal care delivery models remains limited by inconsistencies in approach, variation in reimbursement, and inability of health systems to meet the needs of patients with chronic, complex cardiovascular conditions.

Qualitative evaluation of an integrated respiratory and palliative care service: patient, caregiver and general practitioner perspectives.

Objectives Integrated respiratory and palliative care services for people with advanced lung disease provide disease-orientated care until the end of life, alongside symptom management and discussions about future care. This study aimed to explore patient, caregiver and general practitioner perspectives of an integrated respiratory and palliative care service, to understand which components of the service were considered valued and effective. Methods We approached patients, caregivers and general practitioners, to participate in semi-structured phone interviews. A grounded theory approach guided data collection and qualitative analysis. Results Between July and December 2019, 10 patients, eight caregivers and five general practitioners completed interviews. The overarching theme was that of valuing integrated care - the provision of disease-orientated care along with palliative care. Four other major themes emerged: Valuing communication and engagement between patient, caregiver and healthcare professionals - who spoke of 'growing this plan together'; the delivery of person-centred care - where physicians 'actually listen and you are not treated like a number'; the reality of action plan use in serious illness - while many found plans 'certainly' do help, others described when they were simply 'too ill to do the action plan'; and finally, divergent preferences for discussions about future care - while some patients felt this subject was 'better left alone', caregivers consistently reported their preference was to 'make a plan.' Conclusion Consumer perspectives highlight the service was valued for delivering personalised care with high communication standards. Similar services should appreciate the usefulness and limitations of action plan use in advanced lung disease, and be sensitive to potential diverging preferences of the patient and caregiver when discussing future care.

Development and acceptability of the person-centred observation and reflection tool for supporting staff and practice development in dementia care services.

Observational tools can support the understanding of the complex needs of older people with dementia and aid delivery of person-centred care. However, existing tools are complex and resource intensive to use. To develop and evaluate the acceptability and feasibility of a low-resource, observational tool to support staff reflection and practice development. Intervention development of the Person-Centred Observation and Reflection Tool (PORT) and acceptability and feasibility study, using surveys and focus groups in the UK, Norway and Spain. PORT was reported as easy, accessible and acceptable to use. The observation was identified as powerful for individual staff development and provided an evidence-based source for underpinning individualised care planning. Potential time challenges associated with implementation were identified. Initial evaluation indicates PORT is an acceptable and feasible tool for use in health and social care settings for older people. Further research is needed on implementation models and the impacts of PORT use. PORT may be a useful tool to support individual staff development in care settings and person-centred care planning for people with dementia.

Bedside nurses' perspective on the Fundamentals of Care framework and its application in clinical practice: A multi-site focus group interview study

BackgroundA changing nursing workforce and an increase in demands for care together with more complex care, raise arguments that leading and guiding nursing practice is more challenging than ever. Therefore, nurses need to have a shared agenda and a common language to show the importance of nursing care and the consequences of not addressing this in an appropriate way. In response to this the Fundamentals of Care framework was developed to also contribute to the delivery of person-centred care in an integrated way. However, to gain acceptance and applicability we need to ensure the framework's relevance to clinical practice from bedside nurses' perspectives. ObjectiveTo describe bedside nurses' perspectives on the Fundamentals of Care framework and how it can be applied in clinical practice. DesignA descriptive qualitative design informed by the Fundamentals of Care framework. Setting(s)The study was undertaken at seven hospitals in Sweden, Denmark and the Netherlands during 2019. ParticipantsA total sample of 53 registered nurses working at the bedside participated. Participants had a wide variety of clinical experience and represented a range of different nursing practice areas. MethodsTwelve focus group interviews were used to collect data and analysed with a deductive content analysis approach. ResultsBedside nurses perceived that the Fundamentals of Care framework was adequate, easy to understand and recognised as representative for the core of nursing care. The definition for fundamental care covered many aspects of nursing care, but was also perceived as too general and too idealistic in relation to the registered nurses' work. The participants recognised the elements within the framework, but appeared not to be using this to articulate their practice. Three main categories emerged for implications for clinical practice; guiding reflection on one's work; ensuring person-centred fundamental care and reinforcing nursing leadership. ConclusionsThe Fundamentals of Care framework is perceived by bedside nurses as a modern framework describing the core of nursing. The framework was recognised as having clinical relevance and provides bedside nurses with a common language to articulate the complexity of nursing practice. This knowledge is crucial for bedside nurses both in clinical practice and in leadership roles to be able to speak up for the need to integrate all dimensions of care to achieve person-centred fundamental care. Various activities for reflection, person-centred care and leadership to apply the framework in clinical practice were presented, together with minor suggestions for development of the framework. Tweetable abstractBedside nurses recognise their clinical practice within the Fundamentals of Care framework, showing the core of modern nursing.