Provision Of Person-centred Care Research Articles

Role of medicines management in preventing falls in older people.

Falls are common in older people and are a cause of preventable morbidity and mortality. As well as causing injury, falls can result in pain, distress, loss of confidence, loss of independence and increased mortality. Older people are more likely to visit an emergency department following a fall, therefore these incidents place a high burden on these patients and their carers, as well as on healthcare systems. Appropriate risk assessment accompanied by multifactorial falls prevention interventions can reduce the risk of falls. Assessments should include a medication review because various medicines, sometimes referred to as 'falls risk increasing drugs', can precipitate or contribute to falls. This article examines some of the medicines in this group that can contribute to falls, serious injuries and fractures in older people. It also discusses the importance of medicines management as part of falls risk assessment and prevention interventions.

Demonstrating empathy when communicating with older people.

Empathy is an integral aspect of communication with older people and is central to person-centred care. As part of the provision of person-centred care, empathy supports effective communication, producing positive effects such as increased emotional well-being, increased adherence to treatment plans, reduced pain levels and improved wound healing. Empathy involves attempting to understand the other person's perspective and feelings and communicate that understanding back to them. Empathic communication can help older people feel that they are being listened to and valued as partners in healthcare relationships. This article focuses on why it is important to demonstrate empathy when communicating with older people and how this can be achieved. It explains the origin of the concept of empathy in nursing and provides different ways of characterising empathy. It explores barriers to empathic communication in older people nursing and identifies verbal and non-verbal communication skills that nurses can use to enhance their empathy. Finally, it explains the importance for nurses to develop self-awareness and undertake self-care to preserve their capacity to demonstrate empathy towards older people.

Implications of COVID-19 on the Loneliness of Older Adults in Residential Care Homes.

With little understandings on the loneliness of older adults in residential care homes structured by social contact restrictions, the provision of person-centered care was jeopardized during the pandemic. This study employed hermeneutic phenomenology to explore the lived experiences of loneliness of this population during a 5-month period of the COVID-19 pandemic. We conducted unstructured face-to-face interviews with 15 older adults living in seven residential care homes. Thematic analysis was guided by Van Manen's approach. The essence of loneliness was uncovered as "A deprived sense of self-significance in a familiar world contributes to older adult's disconnection with prior commitments." A sub-theme "From collapse to dissolution of self-understanding" revealed how COVID-19 structured their loneliness. Another sub-theme, "Restoring meanings by establishing connections with entities" illustrated the ways to mitigate loneliness during the pandemic. Activities fostering alternative self-interpretation are important to protect older adults against loneliness.

Short Communication: Opportunities and Challenges for Early Person-Centered Care for Older Patients in Emergency Settings.

The provision of person-centered care (PCC) for older adults in emergency settings is important. This short communication explores the complexity of providing comprehensive PCC for older adults in emergency settings, based on a synthesis of existing literature and empirical data from a small-scale case study on the potential of improving patient engagement in a Danish emergency department (ED). Our findings highlight overall positive attitudes towards PCC, as patient engagement is perceived as important and feasible during the waiting hours that older patients experience. However, the key challenges include barriers in organizational structures and cross-sectoral care coordination. We conclude that staff education, optimized care coordination across sectors, and increased involvement of geriatric nurses may enhance the provision of PCC for older, complex adults in EDs. We further conclude that future research into the feasibility and effects of structured approaches for providing PCC in EDs is needed, including exploration of organizational models for PCC.

Engaging People and Co-Producing Research with Persons and Communities to Foster Person-Centred Care: A Meta-Synthesis.

Introduction: Engagement and co-production in healthcare research and innovation are crucial for delivering person-centred interventions in underserved communities, but the knowledge of effective strategies to target this population is still vague, limiting the provision of person-centred care. Our research aimed to identify essential knowledge to foster engagement and co-production. Materials and Methods: A meta-synthesis research design was used to compile existing qualitative research papers on health communication, engagement, and empowerment in vulnerable groups in high-income countries (HICs) from 2008 to 2018. A total of 23 papers were selected and analysed. Results: ‘Design and recruitment’ and ‘engagement and co-production’ thematic areas are presented considering the factors related to researcher–communities attunement and the strategical plans for conducting research. The insights are discussed in light of the literature. Long-term alliances, sustainable structures, and strengthened bonds are critical factors for producing real long-term change, empowering persons and communities, and paving the way to person-centred care. Conclusions: The enhancement of the recruitment, involvement, and empowerment of traditionally disengaged communities and individuals depends on the awareness and analysis of social determinants, power differentials and specific tactics, and the capacity of researchers and individuals to apply all these principles in real-world practice.

Aboriginal and Torres Strait Islander patients' cancer care pathways in Queensland: Insights from health professionals.

To identify points for improvements within the health system where Aboriginal and Torres Strait Islander cancer patients may experience a lack of continuity in their cancer care. The optimal care pathway for Aboriginal and Torres Strait Islander people with cancer (OCP) framework was utilised as a tool in this work. Semi-structured interviews were conducted with health professionals at the primary health care (PHC) and hospital setting. Data were categorised into six steps using the OCP framework. This study identified multiple time-points in the cancer pathways that could be strengthened to increase the continuity of cancer care for these patients. In addition, the provision of person-centred care and adequate education tailored to patients' and health professionals' needs can help minimise the likelihood of patients experiencing a lack of continuity in their cancer care. Participants were recruited from an urban hospital (n=9) and from six Aboriginal Community Controlled Health Services (n=17) across geographical locations in Queensland. The provision of culturally competent care, effective communication, coordination and collaboration between services along the cancer pathway from prevention and early diagnosis through to end-of-life care were highlighted as important to enhance care continuity for Indigenous Australians. The implementation of recommendations outlined in the OCP framework may help with improving cancer care continuity for Indigenous patients with cancer. Aboriginal and Torres Strait Islander people can sometimes find cancer care pathways complex and difficult to navigate. This study identified points in the cancer pathways that could be strengthened to increase the continuity of cancer care for these patients which could potentially lead to improved outcomes.

How staff characteristics influence residential care facility staff\u2019s attitude toward person-centered care and informal care

BackgroundStaff members, and their attitudes, are crucial for providing person-centered care in residential care facilities for people with dementia. However, the literature on the attitudes of nursing staff regarding person-centered care is limited. The objective of this study is to explore the association between staff characteristics (age, education level, years of work experience and function, i.e., care or welfare) and staff attitudes toward perceived person-centered care provision and including informal caregivers in the caregiving process in residential care facilities.MethodsA convenience sample of 68 care staff – nurses and nurse assistants - welfare staff members – activity counselors, hostesses, and living room caretakers - of two residential care facilities filled out a questionnaire. Staff attitudes regarding perceived person-centered care were measured with the Person-centered Care Assessment Tool (P-CAT). Staff attitudes regarding informal care provision were measured with the Attitudes Toward Families Checklist (AFC). Multiple linear regression analysis explored the association between variables age, work experience, education, and function (care or welfare).ResultsA higher age of staff was associated with a more negative attitude toward perceived person-centered care and informal care provision. Welfare staff had a more negative attitude toward the inclusion of informal caregivers than care staff. The perceived person-centered care provision of the care and welfare staff was both positive. Work experience and education were not associated with perceived person-centered care provision or informal care provision.ConclusionThis study is one of the first to provide insight into the association between staff characteristics and their attitude toward their perceived person-centered care provision and informal care provision. A higher age of both the care and welfare staff was associated with a more negative attitude toward their perceived person-centered care and informal care provision. Welfare staff had a less positive attitude toward informal care provision. Additionally, future studies, also observational studies and interview studies, are necessary to collect evidence on the reasons for negative attitudes of older staff members towards PCC and informal care giving, to be able to adequately target these reasons by implementing interventions that eliminate or reduce these negative attitudes.

The influence of nursing home managers\u2019 leadership on person-centred care and stress of conscience: A cross-sectional study

BackgroundLeadership and stress are common concepts in nursing, and this study explores empirically the connection between leadership and stress of conscience in the context of aged care practice. Previous literature has shown that when staff are unable to carry out their ethical liabilities towards the residents, feelings of guilt may occur among staff, which may be an expression of stress of conscience. Although leadership has been described as crucial for staff’s work perceptions of stress as well as for person-centred practices, the influence of nursing home managers’ leadership on stress of conscience among staff and person-centred practices is still not fully explored. This study attempts to address that knowledge gap by exploring the relationship between leadership, person-centred care, and stress of conscience.MethodsThis study was based on a cross-sectional national survey of 2985 staff and their managers in 190 nursing homes throughout Sweden. Descriptive statistics and regression modelling were used to explore associations.ResultsLeadership was associated with a higher degree of person-centred care and less stress of conscience. A higher degree of person-centred care was also associated with less stress of conscience. The results also showed that leadership as well as person-centred care were individually associated with lower levels of stress of conscience when adjusting for potential confounders.ConclusionNursing home managers’ leadership was significantly associated with less staff stress of conscience and more person-centred care. This indicates that a leadership most prominently characterised by coaching and giving feedback, relying on staff and handling conflicts constructively, experimenting with new ideas, and controlling work individually can contribute to less staff stress as well as higher degree of person-centred care provision.

Person centred care provision and care planning in chronic kidney disease: which outcomes matter? A systematic review and thematic synthesis of qualitative studies

Rationale & ObjectiveExplore priorities related to outcomes and barriers of adults with chronic kidney disease (CKD) regarding person centred care and care planning.Study designSystematic review of qualitative studies.Search Strategy & SourcesIn July 2018 six bibliographic databases, and reference lists of included articles were searched for qualitative studies that included adults with CKD stages 1–5, not on dialysis or conservative management, without a previous kidney transplantation.Analytical ApproachThree independent reviewers extracted and inductively coded data using thematic synthesis. Reporting quality was assessed using the COREQ and the review reported according to PRISMA and ENTREQ statements.ResultsForty-six studies involving 1493 participants were eligible. The period after diagnosis of CKD is characterized by feelings of uncertainty, social isolation, financial burden, resentment and fear of the unknown. Patients show interest in ways to return to normality and remain in control of their health in order to avoid further deterioration of kidney function. However, necessary information is often unavailable or incomprehensible. Although patients and healthcare professionals share the predominant interest of whether or not dialysis or transplantation is necessary, patients value many more outcomes that are often unrecognized by their healthcare professionals. We identified 4 themes with 6 subthemes that summarize these findings: ‘pursuing normality and control’ (‘pursuing normality’; ‘a search for knowledge’); ‘prioritizing outcomes’ (‘reaching kidney failure’; ‘experienced health’; ‘social life’; ‘work and economic productivity’); ‘predicting the future’; and ‘realising what matters’. Reporting quality was moderate for most included studies.LimitationsExclusion of non-English articles.ConclusionsThe realisation that patients’ priorities do not match those of the healthcare professionals, in combination with the prognostic ambiguity, confirms fatalistic perceptions of not being in control when living with CKD. These insights may contribute to greater understanding of patients’ perspectives and a more person-centred approach in healthcare prioritization and care planning within CKD care.

Health care providers' experiences with delivering person centred care in an Integrated Care Program for thoracic surgery patients in Ontario, Canada

PurposeThe purpose of this study is to understand health care providers' experiences with delivering a novel Integrated Care (IC) Program that co-ordinates hospital-based clinical services and home care for thoracic surgery patients, including perceptions on the provision of person-centred care and quality of work life.Design/methodology/approachThe authors conducted a process evaluation using qualitative methods to understand provider experiences in the Integrated Care (IC) Program and to identify areas for programme improvement. Study data were collected using a focus group with thoracic surgeons, open-ended survey with home care providers, and semi-structured interviews with lead thoracic surgeons and IC leads, who are nurses serving as the primary point of contact for one consistent care team. Data were analysed using thematic analysis.FindingsThe IC Program was successful in supporting a partnership between health care providers and patients and caregivers to deliver a comprehensive and person-centred care experience. Informational continuity between providers was facilitated by IC leads and improved over time with greater professional integration and adaptation to the new care delivery processes. Differential impacts were found on quality of work life for providers in the IC Program.Originality/valueThis study describes provider experiences with delivering integrated and person-centred care across the hospital to home continuum, which can inform future integrated care initiatives.

The components of personal passports for people living with dementia in an acute healthcare setting: an integrative review.

To explore the components of personal passports for people living with dementia in an acute healthcare setting. Globally, supporting people with dementia poses a prominent health and social care challenge. Importance for people with dementia in an acute healthcare setting includes social relationships and communication with healthcare staff. A personal passport is an international initiative designed to support the personhood of the person living with dementia. This integrative review is based on the methodology of Whittmore and Knafl (2005). The Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist were adhered to. A database search of PubMed, MEDLINE, CINAHL, Scopus and EBSCO databases was systematically performed. This integrative review identified nine research studies on the components of personal passports that met the inclusion and exclusion criteria. A constant comparative method of data analysis identified five key pivotal themes: person-centredness, communication, family/carer involvement, education and leadership. The use of personal passports supports the provision of person-centred care for people living with dementia through enhancing the well-being of both the person and their families/caregivers. Personal passports are an important document and should be determined by the person with dementia, their care needs and the caregiver's role in meeting these needs.

Exploring Leadership, Stress of Conscience, and Person-Centered Care in Nursing Homes

On a daily basis, many care situations contain difficult issues and challenges for care providers. Stress of conscience, such as feelings of guilt, can be experienced by staff when not fulfilling ethical obligations to the residents. Although leadership has been advocated as a key component for staff work perceptions as well as for person-centred care, the impact of nursing home managers’ leadership on levels of stress of conscience among staff and the extent to which person-centred care (PCC) is provided is yet to be explored. Thus, the aim was to explore the relationship between leadership, stress of conscience and PCC as perceived by staff. The study was based on a cross-sectional national survey of 3084 staff and their managers in 189 nursing homes throughout Sweden. Descriptive statistics and regression modelling were used to explore associations. The preliminary results showed that leadership was negatively associated to stress of conscience and positively associated to PCC. PCC were negatively associated to stress of conscience. Additional findings will be presented. This indicates that nursing home managers’ leadership seem to beneficially impact staff work situation in terms of stress of conscience and person-centred care provision.

Professional consensus on orthodontic risks: What orthodontists should tell their patients

Effective communication of risk is a requisite for valid consent, shared decision-making, and the provision of person-centered care. No agreed standard for the content of discussions with patients about the risks of orthodontic treatment exists. This study aimed to produce a professional consensus recommendation about the risks that should be discussed with patients as part of consent for orthodontic treatment. A serial cross-sectional survey design using a modified electronic Delphi technique was used. Two survey rounds were conducted nationally in the United Kingdom using a custom-made online system. The risks used as the prespecified items scored in the Delphi exercise were identified through a structured literature review. Orthodontists scored treatment risks on a 1-9 scale (1=not important, 9=critical to discuss with patients). The consensus that a risk should be discussed as part of consent was predefined as ≥70% orthodontists scoring risk as 7-9 and<15% scoring 1-3. The electronic Delphi was completed by 237 orthodontists who reached a professional consensus that 10 risks should be discussed as part of consent for orthodontic treatment; demineralization, relapse, resorption, pain, gingivitis, ulceration, appliances breaking, failed tooth movements, treatment duration, and consequences of no treatment. A professional orthodontic consensus has been reached that 10 key risks should be discussed with patients as part of consent for orthodontic treatment. The information in this evidence base should be tailored to patients' individual needs and delivered as part of a continuing risk communication process.

Finding the Person in Electronic Health Records. A Mixed-Methods Analysis of Person-Centered Content and Language

ABSTRACT The co-creation and sharing of documentation of person-centered care is important, but challenging in clinical practice. Online access to health records is considered essential to increase patient participation and empowerment in person-centered care provision. The aims of this study were (1) to identify the extent of person-centered content in medical inpatient records and discharge letters; (2) to describe the characteristics of the language and rhetoric used in discharge letters. This was a concurrent, mixed-methods study involving a deductive, quantitative analysis of person-centered content in 69 Patient Accessible Electronic Health Records from patients with pituitary tumors, and an iterative, qualitative language analysis of a nested sample of 57 discharge letters. Both the content and language of inpatient records were mostly patient-centered. Records were concerned with the documentation of symptoms and medical and care interventions. There was little person-centered documentation of patients’ preferences, wishes and needs, and shared decision-making. In the discharge letters, written for the patients, some physicians had attempted to write in a person-centered way, using plain language and a narrative. However, most wrote in a style that was reflective of their discourse community, using abbreviations and medical terms. Established norms for documentation in healthcare are a barrier to person-centered documentation. Patients’ needs and preferences about documentation should be explored to increase understanding of how person-centered documentation can be achieved in clinical practice.

Understanding consumer perceptions of frailty screening to inform knowledge translation and health service improvements.

Background and Objectivesdespite growing support for the clinical application of frailty, including regular frailty screening for older adults, little is known about how older adults perceive frailty screening. The purpose of this study was to examine older adults’ perspectives on frailty screening to inform knowledge translation and service improvements for older adults with frailty.Research Designinterpretive descriptive qualitative design.Participantsa total of 39 non-frail (18%), pre-frail (33%) and frail or very frail (49%) South Australian older adults aged 62–99 years, sampled from community, assisted living and residential aged care settings.Methodsseven focus groups were conducted and analysed by two independent investigators using inductive thematic analysis.Resultsthree themes were identified. First, older adults question the necessity and logic of an objective frailty measure. Second, older adults believe any efforts at frailty screening need to culminate in an action. Third, older adults emphasise that frailty screening needs to be conducted sensitively given negative perceptions of the term frailty and the potential adverse effects of frailty labelling.Discussion and Implicationsprevious screening experiences and underlying beliefs about the nature of frailty as inevitable shaped openness to, and acceptance of, frailty screening. Findings correspond with previous research illuminating the lack of public awareness of frailty and the nascent stage of frailty screening implementation. Incorporating consumer perspectives, along with perspectives of other stakeholder groups when considering implementing frailty screening, is likely to impact uptake and optimise suitability—important considerations in person-centred care provision.

Persoonsgerichte zorg voor personen met dementie in Vlaamse woonzorgcentra

Background Providing person centered care for elderly persons with dementia in residential care settings is challenging. Furthermore, little insight exists into how employees apply person centered care.Goal Map the provision of person centered care for elderly persons with dementia by employees in nursing homes in the Dutch speaking part of Belgium.Methods Eight interviews and two focus groups were conducted with 25 employees of six residential care settings. A descriptive research approach was applied in four phases.Results Three themes emerged from the data concerning employee experiences with person centered care: (1) organizational support; (2) team support and (3) employee mindset. As person centered actions within the current practice, two themes were identified: (4) care at the pace of the resident and (5) contact adapted to the residents' needs.Conclusion Five themes regarding person centered care were found. However, specific examples of how this care was provided in practice could not be provided or were mostly examples of basic care. Employees are often obstructed by task oriented care. Setting the wishes and needs of the residents as reference point, providing organizational support, and investing in training might facilitate person centered care in residential care settings.

Perceptions of hospital-based Registered Nurses of care and discharge planning for people who are homeless: A qualitative study

ABSTRACT Background Links among homelessness, poor health and frequent hospitalisation are familiar to health services worldwide. Despite this, limited research has explored hospital-based Registered Nurses’ perspectives of homelessness healthcare. Aim This study explored the perspectives of hospital-based Registered Nurses, regarding provision of person-centred care for people who are homeless. Methods Interviews were conducted with twelve Registered Nurses working in a tertiary metropolitan hospital. Interview transcripts were analysed using a deductive thematic approach guided by Deci and Ryan’s self-determination theory (SDT). Findings Five themes emerged regarding provision of person-centred care for people who are homeless. First, people who are homeless frequently access the hospital as a safe place. Second, nurses often perceive homeless health problems as multifaceted and difficult to manage. Third, stigma creates a barrier to the delivery of hospital-based homelessness healthcare. Fourth, it is important to provide people who are homeless with a sense of choice. Fifth, there is a lack of suitable discharge options and connection between the hospital and community services. Discussion If care pathways within a hospital are not designed to adequately address the complex needs of people who are homeless, they are vulnerable to frequent re-admissions and extended lengths of stay. A non-judgmental attitude and providing a sense of choice are important approaches for hospital-based Registered Nurses when working with people who are homeless. Conclusion Hospital-based homelessness healthcare presents many challenges. The perceptions of Registered Nurses provide insight into the daily experience of caring for people experiencing homelessness within a hospital setting.

Performance management in primary healthcare: Nurses' experiences.

BackgroundThe use of the performance management (PM) system is highly contested by public servants in South Africa, although its value as essential to the appraisal and management of staff is undeniable.ObjectivesThe aim of this study was to explore nurses’ perceptions and experiences of the PM system at primary healthcare (PHC) facilities in relation to the current health system’s reforms.MethodAn exploratory, descriptive and qualitative design was utilised. Participants were selected through purposive sampling. A semi-structured interview tool was used to collect data from 18 nurses in four sub-districts of Dr. Kenneth Kaunda district in the North West province. Data were analysed through thematic analysis.ResultsThe findings of this study confirmed that PM is implemented to some extent. However, various loopholes in its implementation threaten the accuracy and transparency of the system and leave it vulnerable to perceived organisational injustice and unfairness, with the objectivity of the system questioned. The limitations of the current PM system revealed by this study include (1) the lack of alignment with current health system reforms towards comprehensive and integrated care that demands person-centred care; (2) the system’s usefulness for career progression, performance improvement and rewarding exceptional performance.ConclusionPerformance management is inadequately applied in PHC facilities at district level and needs to be realigned to include the appraisal of key attributes required for the current health system’s reforms towards comprehensive and integrated care, including the provision of person-centred care, which is central for responding adequately to South Africa’s changing disease profile towards multi-morbidity.

Meeting the needs of older people living in Australian residential aged care: A new conceptual model.

To report on the conceptualisation of a model for residential aged care in Australia. Three-stage approach involving initial model conceptualisation; extensive consultation with stakeholders to test and develop the model for feasibility and acceptability; and examination of whether the model addresses circumstances that arise in scenarios of organisational failure. A model consisting of five domains relevant to the experience of older adults living in residential aged care-health care; social inclusion; rights; personal care and re-ablement; and dementia management. This proposed model of residential aged care takes as its purpose the provision of person-centred care to older people with complex health issues, requiring end-of-life care, and/or living with dementia. This includes supporting dignity of risk and quality of life and enabling older adults to thrive.

Staff Engagement for Practice Change in Long-Term Care: Evaluating the Feasible and Sustainable Culture Change Initiative (FASCCI) Model

<strong>Context:</strong> Interventions aimed at increasing the provision of person-centred care in long-term care (LTC) homes, that do not address contextual and system issues, most often fail. Promoting positive change in LTC homes requires requires a multilevel, systems approach. <strong>Objectives:</strong> Evaluate the effectiveness of the Feasible and Sustainable Culture Change Initiative (FASCCI) model for improving the provision of person-centred mealtime practices in a LTC home. <strong>Methods:</strong> A single-group, time series design was used to assess the impact of the FASCCI model for change on outcome measures across four time periods (pre-intervention, 2-month, 4-month and 6-month follow-up). Differences in scores from baseline were assessed utilizing Wilcoxon signed-rank tests. Interviews (n = 21) were also conducted to examine treatment fidelity and to ascertain the study participants’ perceptions of the process for making improvements using the FASCCI model. <strong>Findings:</strong> We observed increases in care staff’s capacity to consistently provide relational and person-centred care during mealtimes. Mealtime environment scores started increasing immediately following the intervention, with statistically significant improvements in all mealtime environment scales by six-months, including: the physical environment (W = 55.00, p = 0.008); social environment (W = 55.00, p = 0.008); relationship-centred care (W = 45.00, p = 0.014); and overall quality of dining environment (W = 55.00, p = 0.010). Analysis of data from qualitative interviews demonstrated that use of the FASCCI model resulted in improved team leadership, communication, and collaborative decision-making. <strong>Limitations:</strong> Generalizability is limited due to the small sample size and use of convenience sampling methods. <strong>Implications:</strong> Outcomes indicate that the FASCCI model seems promising in its ability to improve PCC mealtime practices in LTC homes and is worthy of a larger scale study. The results further demonstrate the value of supportive team environments in quality dementia care.