Person-centered Healthcare Research Articles

#NavigatingHealth - Building a Global Movement Empowering Patients to Navigate Health Systems

Background: Whilst health reports talk about health systems shifts from reactive “one size fits all” to proactive personalised health care, the current reality is that health systems are challenging for patients and carers to navigate. Patients frequently experience gaps and barriers in healthcare. We talk about patient-centred care, but we do not have patient centred systems. The challenges are not new and patient navigation was extensively research by Professor Harold Freeman in the US over 30 years ago. 
 Audience: This presentation is for a multidisciplinary audience of patients, health professionals, policy managers and politicians focused on enabling patient-centred at a systems level. 
 Who did you involve and engage with? What was the approach and process undertaken? 
 Patients, professionals and policy makers in Australia and globally have been involved in what started as a national Community of Practice in Australia “Mind the Gap: #NavigatingHealth”. 
 The approach was tested for audience interest with a series of two webinars in September 2021 to set the scene of navigating health across a life journey of patient and provider experiences with a solutions focused approach on how to tackle the many challenges.
 Following the success and interest of the webinars and as part of a focused advocacy and change management approach we developed a bimonthly Community of Practice. This is open to all those in Australia. Our focus in the first year was to make visible the many solutions being developed to support patients and to develop an engaged participatory community and build connection. 
 Further to the success in the first year, we have now expanded the approach at a global level running our first global webinar in November 2022 with speakers from Australia, the United States of America, Canada and the United Kingdom providing a connected approach across a life journey. This included lived experience of patients as well as presentations from non-governmental, medical and government organisations interweaving micro, meso and macro approaches (for example included American Cancer Society, NHS England). 
 What is the learning for the international audience? Problems that patients face navigating health systems in countries are common and consistent. Collaborating across disease and functional areas both within and across countries allows the opportunity to take a “big-picture” view to take a systems focused approach. This allows the solutions being developed to be coalesced at a systems level, remove duplication and leverage resources to benefit both patients, providers and policy makers to focus on a person-centred value-based healthcare approach across a life journey. 
 What are the next steps? Our next steps are to consolidate the learnings and scale. Whilst our initial focus has been high income countries we will be expanding the approach in 2023 to low and middle income countries using the same methodology.

The effect of hospital volunteering on empathy in nursing and medical students

BackgroundEmpathic care benefits patients and healthcare providers. There is evidence of self-reported empathy decline among students in healthcare education. Hospital volunteering could assist undergraduate healthcare students to develop empathetic relationships with patients. AimThe study aimed to investigate the feasibility and effect of a hospital volunteering intervention on the empathy levels of undergraduate nursing and medical students. It further aimed to explore their experience of the intervention and determine student-identified areas for patient safety improvements. DesignPre–post-intervention study SettingA large outer metropolitan hospital in New South Wales, Australia. ParticipantsTwenty-nine (n = 29) undergraduate nursing and medical students from an Australian university. MethodsStudents had an introductory experience of volunteering at their local district hospital through participation in the ‘Volunteer Taster Program’. The Jefferson Scale of Empathy-Health Professions Student questionnaire was used to measure student empathy scores pre and post program. Responses to open-ended questions were thematically analysed to evaluate student experiences and identify student-reported areas for patient safety improvements. ResultsTwenty-nine students (18 nursing, 11 medical) completed the program. Students had statistically significant improvements in post-intervention mean empathy scores 112.03 (95% CI 107.56, 116.5) to 117.38 (95% CI 113.76, 121.00) p < 0.001. Subgroup analysis identified a larger increase in empathy scores among medical students than nursing students. The thematic analysis revealed potential program benefits, including new perspectives of the patient experience, improved confidence in patient communication, a stronger professional identity, and a rewarding experience. Identified patient safety issues included concerns for patients’ emotional and physical well-being, and patient communication. ConclusionsThe Volunteer Taster Program is feasible and enabled nursing and medical students to connect with patients outside the sphere of clinical education. It appears to increase empathy levels in undergraduate students and could assist them to deliver empathetic, person-centred healthcare.

Community perceptions of a biopsychosocial model of integrated care in the health center: the case of 4 health districts in South Kivu, Democratic Republic of Congo

SummaryBackgroundBiopsychosocial care is one of the approaches recommended in the health system by the WHO. Although efforts are being made on the provider side to implement it and integrate it into the health system, the community dynamic also remains to be taken into account for its support. The objective of this study is to understand the community's perceptions of the concept of integrated health care management according to the biopsychosocial approach (BPS) at the Health Center of a Health District and its evaluation in its implementation.MethodsThis cross-sectional study was done in six Health Areas belonging to four Health Districts in South Kivu, DRC. We conducted 15 semi-directive individual interviews with 9 respondents selected by convenience, including 6 members of the Development Committees of the Health Areas, with whom we conducted 12 interviews and 3 patients met in the health centers. The adapted Normalization MeAsure Development (NoMAD) tool, derived from the Theory of the Normalization Process of Complex Interventions, allowed us to collect data from November 2017 to February 2018, and then from November 2018 to February 2019. After data extraction and synthesis, we conducted a thematic analysis using the NoMAD tool to build a thematic framework. Six themes were grouped into three categories.ResultsInitially, community reports that the BPS approach of integrated care in the Health Centre is understood differently by providers; but then, through collective coordination and integrated leadership within the health care team, the approach becomes clearer. The community encouraged some practices identified as catalysts to help the approach, notably the development of financial autonomy and mutual support, to the detriment of those identified as barriers. According to the community, the BPS model has further strengthened the performance of health workers and should be expanded and sustained. ConclusionsThe results of our study show the importance of community dynamics in the care of biopsychosocial situations by providers. The barriers and catalysts to the mechanism, both community-based and professional, identified in our study should be considered in the process of integrating the biopsychosocial model of person-centered health care.

Development and psychometric evaluation of TEXP-Q: a questionnaire measuring transition and transfer experiences in emerging adults with type 1 diabetes

BackgroundDuring transition to adulthood and transfer to adult healthcare, emerging adults with chronic conditions are at risk of deteriorating disease control, well-being, and acute, as well as long-term complications. Despite an increasing call for person-centred healthcare services attuned to young peoples’ needs, few validated instruments exist pinpointing adolescents’ and emerging adults’ experiences of preparation for transition and transfer. Thus, the overarching purpose of this study was to develop a person-centred, clinically applicable instrument (Transitional care EXPeriences Questionnaire, TEXP-Q) adjustable to different chronic conditions, although the focus in the present study was Type 1 Diabetes. The specific aim was, therefore, to describe the development and psychometric evaluation of TEXP-Q in emerging adults with Type 1 Diabetes.MethodsInitial development of the TEXP-Q was inspired by existing research. Items were formulated in accordance with consensus recommendations for developing patient-reported measures, and extra consideration was taken to ensure person-centredness. Psychometric evaluation comprised two phases: In phase I, data from cognitive interviews, content validity indexing, and judgement of an expert panel provided information on face and content validity. In phase II, data from a cross-sectional study conducted at eight adult diabetes outpatient clinics in Sweden (n = 163) allowed for explorative factor analysis (EFA), as well as calculation of content validity, reliability and responsiveness.ResultsCombining results from cognitive interviews, content validity index values and expert panel judgement, a test version of TEXP-Q was developed, the content and face validity of which were considered good. This version consisted of 17 items answered on a five-point Likert scale, and three open-ended questions answered in free text. During EFA, four items were removed, and a three-factor solution was recognised as most adequate, accounting for 60% cumulative variance and one single cross-loading. After EFA, the instrument comprised 13 questions, divided into three latent factors. Cronbach’s alpha for the complete instrument was 0.866, which indicates good internal consistency. Crohnbach’s alpha approximated to 0.8 for all factors respectively.ConclusionTEXP-Q is a newly developed, person-centred instrument which has proven to be both valid and reliable when applied to youths with T1D. The questionnaire fills a need for instruments focusing on emerging adults’ experiences of preparation for transition and transfer.

Scoliosis school screening of 139,922 multi-ethnic children in Dali, southwestern China: A large epidemiological study

Idiopathic scoliosis (IS) primarily impacts adolescents and requires early intervention to prevent deformity. Early diagnosis and prediction of spine curvature in children could be aided by school scoliosis screening (SSS). In the Dali Bai Autonomous Prefecture, SSS, including 139,922 children from 18 ethnic groups in 8 counties ranging in age from 6 to 18, was carried out. A medical team conducted the screening with inspection, Adam's test, and angles of trunk rotation (ATR). The overall prevalence of suspected scoliosis was 2.37%, with girls (2.5%) more affected than boys (2.0%). Using penalized regression analysis of LASSO, the variable-selection process was conducted to determine the final regression model. The results showed that age, gender, height, BMI, altitude, latitude, ethnicity, and county were all influencing variables for suspected scoliosis, according to the adjusted final model of multi-factor regression analysis. These results provide substantial information and suggestions for preventative and person-centered healthcare interventions for IS.

We are not even allowed to call them patients anymore: Conceptions about person-centred care.

Although the implementation of person-centred care (PCC) has gained momentum in healthcare systems, it is not always obvious why it is an important objective in clinical settings and educational institutions that train future healthcare professionals. Various conceptions about PCC have flourished, such as that it only works in certain healthcare contexts, it is the same as the patient making all their own healthcare decisions, it is too demanding for most patients, the word 'patient' may no longer be used, the care provided is already person-centred, and that there is simply not enough time and resources to achieve it. This viewpoint paper aims to problematize these conceptions and may be used for didactical and reflective exercises that support the transition towards more person-centred healthcare. PATIENT OR PUBLIC CONTRIBUTION: The Person Council for patients and carers at the University of Gothenburg provided focus group input on and validated the occurrence of the conceptions discussed in the present paper. The person council consists of a group of persons with many years of personal experiences of health care, either as patients and/or relatives/carers. One member of the person council who is also a designer and artist created the illustration for the article.

A multisite cross-sectional study of intercultural competencies in doctor of physical therapy students

BackgroundPhysical therapists (PTs) work in diverse communities with individuals whose identities and beliefs may differ significantly from their own. Academic institutions must include intentional curriculum aimed at graduating PTs who can skillfully navigate intercultural encounters. Being prepared to engage with difference and demonstrate skills related to intercultural competencies (ICC) will prepare entry-level PTs to provide individualized, high-quality care. Intercultural competencies are essential skills that can reduce healthcare disparities, and promote equitable and inclusive healthcare delivery. This study examined the impact of PT curricula, student demographics, and participation in intercultural learning experiences (ILEs) on students’ development of ICC.MethodsA cross-sectional study of 8 Doctor of Physical Therapy (DPT) programs in the United States (US) compared ICC in first-year (F) and third-year students (T), and T who participated in an ILE (T + ILE) to those who did not (T-only). Subjects included 1,038 students. Outcome measures included The Inventory for Assessing the Process of Cultural Competence-among healthcare professionals-Student Version© (IAPCC-SV), and a demographic survey.ResultsIndependent t-tests showed that group T (mean = 64.34 ± 5.95, 95% CI: 63.78-64.90) had significantly higher IAPCC-SV total scores than group F (mean = 60.8 ± 5.54, 95% CI = 60.33-61.27, p < 0.05). Group T + ILE (mean = 65.81 ± 5.71, 95% CI = 64.91-66.71) demonstrated significantly higher IAPCC-SV total scores than group T-only (mean = 63.35 ± 5.8, 95% CI = 62.6-64.1, p = 0.039). A one-way ANOVA and post hoc comparisons showed that the 25 to 34-year age group (mean = 63.80 ± 6.04, 95% CI = 63.25-64.35, p < 0.001) and the ≥ 35-year age group (mean = 64.21 ± 5.88, 95% CI = 62.20-66.22, p < .024) had significantly higher IAPCC-SV total scores, than the 18 to 24-year age group (mean = 60.60 ± 5.41, 95% CI = 60.09-61.11). Students who identified in US census minority ethnic or racial categories (US-Mn) (mean = 63.55 ± 5.78, 95% CI = 62.75-64.35) had significantly higher IAPCC-SV total scores than students who identified in US majority ethnic or racial categories (US-Mj) (mean = 61.98 ± 5.97, 95% CI = 61.55-62.413, p = .0001).ConclusionsResults of the study support the hypothesis that DPT programs can promote the development of intercultural skills in students. The ultimate objective of this academic preparation is to improve the student’s ability to deliver equitable, person-centered healthcare upon entry into practice. Specific ICC for entry-level DPT students are not clearly defined by US physical therapy professional organizations, academic institutions, or accrediting body. Students who participated in an ILE exhibited higher levels of ICC when compared to those who did not. Findings from this study can guide curriculum development, utilization of resources, and outcomes assessment. More research is needed to examine characteristics of an ILE that could inform best practice.

Development of the PREMIUM computerized adaptive testing for measuring the access and care coordination for patients with severe mental illness

Severe mental illness (SMI) patients often have complex health needs, which makes it difficult to access and coordinate their care. This study aimed to develop a computerized adaptive testing (CAT) tool, PREMIUM CAT-ACC, to measure SMI patients' experience with access and care coordination. This multicenter and cross-sectional study included 496 adult in- and out-patients with SMI (i.e., schizophrenia, bipolar disorder, or major depressive disorder). Psychometric analysis of the 13-item bank showed adequate properties, with preliminary evidence of external validity and no substantial differential item functioning for sex, age, care setting, and diagnosis, making it suitable for CAT administration. A post-hoc CAT simulation demonstrated that the tool was efficient and accurate, with an average of seven items, compared to the full item bank administration. Its use by clinicians can contribute to optimizing patient care pathways and transitioning towards more person-centered healthcare.

Association between Johns Hopkins Adjusted Clinical Groups risk scores and self-reported outcome measures: an observational study among individuals with complex or long-term conditions in Norway

ObjectiveInvestigate the association between Johns Hopkins Adjusted Clinical Groups (ACG) risk scores and low scores in self-reported outcome measures (SROMs) among individuals with complex or long-term conditions.DesignLongitudinal study using five...

Prevalence of workplace violence against registered nurses and their perceptions of relevant management systems in acute care hospitals

Purpose: This study investigated the prevalence and perceptions of workplace violence against registered nurses (RNs) in hospitals.Methods: One thousand RNs replied to a nationwide survey from November 14 to December 22, 2022. They reported their general characteristics, prevalence of and their responses to different types of workplace violence from patients, family caregivers, physicians, and nurse peers, as well as their perceptions of workplace violence management systems.Results: A total of 71.1% of the RNs reported that they had experienced workplace violence in the last six months. The violence and sexual harassment experienced from patients and family caregivers were 57.3% and 19.1%, respectively. Furthermore, violence, sexual harassment, and workplace harassment from physicians were experienced by 24.6%, 4.0%, and 7.4%, respectively, of the RNs, and those from nurse peers by 21.4%, 3.1%, and 11.3%, respectively. The RNs stated that they often responded to workplace violence with passive and inactive behaviors, which were more serious toward physicians’ workplace violence or sexual harassment from different perpetrators. Only 69.5% were aware of their hospital’s workplace violence management systems, while only 14.7%~27.4%, according to the type of hospital (&lt;i&gt;p&lt;/i&gt;=.471), perceived the systems as effective. Multiple important strategies were identified to prevent workplace violence.Conclusion: Critical suggestions are discussed for the prevention of workplace violence, including protecting the human rights of healthcare professionals, inter-organizational collaboration, and a culture of person-centered healthcare, and training nurse managers’ competency in managing workplace violence.

The Narrative-Based Evolution of a Stakeholder-Engaged Research Team

Millions of people worldwide have experienced abrupt and traumatic disruption in the flow of their personal life story as a result of stroke and the onset of aphasia. For each one who survives and embarks on the journey toward recovery, their unique and evolving narrative yields gems of wisdom borne of the experience. This wisdom is shared with others through interpersonal narrative exchange and engagement, which foster biographical coherence and provide sources of hope to others on the path toward a productive and fulfilling life. This case study illustrates how a biography-based approach to stakeholder-engaged research merges personal stories in three ways. First, the case illustrates how the personal and professional stories of the candidate research team members merged to form the team through networking over time. Second, the biography-based approach led the team to identify the written personal accounts of 259 people living with aphasia as the raw data set for their research, with the intended goal of mining gems of practical wisdom from these written biographical works. Third, the case illustrates how the biography-based approach draws on the personal stories of in-hospital experiences of research team members with aphasia to prospectively hone the initial research focus. Specifically, the team will tap the collective voice within the written accounts to evaluate the in-hospital experiences of people with aphasia. The ultimate goal will be to catalyze participatory action, in collaboration with transdisciplinary health care providers, to advance responsive, person-centered health care. The authors address challenges and priorities in stakeholder-engaged research team development, the importance of honing a research focus, and the identification of research dissemination venues. Oral and written accounts of life with aphasia offer a timeless and potentially rich source of wisdom that can be tapped through the process of stakeholder-engaged research.

Parents' perspectives on reasonable adjustments in acute healthcare for people with intellectual disability: A qualitative descriptive study.

To describe parents' perspectives on reasonable adjustments in acute healthcare for people with intellectual disability (ID). People with ID are vulnerable in terms of their health needs and marginalized when accessing and utilizing acute healthcare services. Reasonable adjustments are positive measures that can help alleviate health disparities. However, despite significant research advocating their use, evidence of implementation of reasonable adjustments in acute healthcare practice is limited. A qualitative descriptive study. Qualitative semi-structured interviews were conducted with six parents of children with ID, who had accessed and used acute healthcare services. The interviews were conducted between January and May 2022, audio-recordings were transcribed and thematically analysed. Parents described limited or no experiences of reasonable adjustments when accessing or utilizing acute healthcare services for their children. The findings are captured in three themes; describing the reality, understanding the impact and signposting the future. The findings highlight a lack of implementation of reasonable adjustments in acute healthcare which negatively impacts the experience of all stakeholders. There is a pressing need for reasonable adjustments to be implemented at a strategic level across acute healthcare services, so that people with ID and their families can access person-centred acute healthcare when needed. The research findings will inform researchers interested in reasonable adjustments and implementation research, and those interested in advocating for the rights of people with ID. This study adhered to the Equator research reporting checklist: Consolidated criteria for reporting qualitative research: a 32-item checklist for interviews and focus groups. A parent of a child with an ID was part of the research team informing the design, data collection, data analysis and write-up of this article.

Struggling to Keep up and Have a Good Life: A Qualitative Study of Living with Impaired Balance Control Due to Multiple Sclerosis.

To explore and describe the experiences of people with multiple sclerosis (MS) living with impaired balance control and how balance impairment can be managed in everyday life. A qualitative design was used. Data was collected through semi-structured interviews. Transcripts were analyzed using qualitative inductive content analysis. Sixteen participants (12 women) with MS and variation in level of balance control were interviewed. Age ranged between 35 and 64years, and overall MS-disability ranged between 2.0 (mild) and 5.5 (moderate) according to the Expanded Disability Status Scale. Five main categories emerged: balance is an automatic skill that now requires attention; contributors to balance impairment; burdens of balance impairment; management of balance impairment; and negotiation between capacity and ambition for continuing the good life. Body functions emphasized as central to keeping balance were somatosensory-motor functions, vision, and management of fatigue. Day-to-day variation in capacity and being in stimuli-rich environments were conditions highlighted as impacting balance. The main categories yielded the overarching theme of being restrained by impaired balance control and struggling to keep up. Participants with MS described balance impairment as balance no longer being an automatic skill and having an adverse impact on everyday life. A strong effort was shown to not let shortcomings control and determine quality of life. To manage limitations and restrictions and to move forward in the struggle to keep up a good life, an extensive toolbox of strategies aiming to minimize the impact of balance impairment was used to maintain quality of life. This study highlights the importance of person-centered health care in MS, with increased awareness of the individual perspective of how balance impairment is perceived. The person-centered focus increases both quality and efficiency in therapy since it involves the individual's thoughts of a life where participation in valued activities is less restricted.

Mapping young people's journeys through mental health services: A prospective longitudinal qualitative study protocol.

Mental ill health is a major health risk for young people. There is unmet need for mental health assessment and treatment across Australia despite significant investment in government-funded plans to cover mental health and youth-oriented services. Understandings of mental health care for young people are impeded by a lack of longitudinal research. Without this research, it is difficult to understand how services do or do not support the recovery of young people over time. This project will analyse the healthcare journeys of young people aged 16-25 years experiencing their first episode of mental ill health for which they have sought GP support, over 12 months in the Australian Capital Territory. The study team will recruit up to 25 diverse young people and their general practitioners (GPs), and conduct four qualitative semi-structured interviews over 12 months with each participant. GP interviews will explore their role in the mental health care and care coordination for the young person. Interviews with young people will explore experiences and perceptions of navigating the health system, and the supports and resources they engaged with during the 12-month period. In between interviews, young people will be asked to keep a record of their mental health care experiences, through their choice of media. Participant-produced materials will also form the basis for interviews, providing stimuli to discuss the lived experience of care. Through analysing the narratives of both young people and their GPs, the study will establish how young people understand value in mental health care delivery. The study will use longitudinal qualitative mapping of healthcare journeys to identify key barriers and enablers to establishing effective, person-centred health care for young people with mental ill health.

Narrative-based learning for person-centred healthcare: the Caring Stories learning framework

This paper describes the learning framework for an innovative narrative-based training platform for healthcare professionals based on older patients’ narratives. The aim of Caring Stories is to place patients’ desires...

Development of Cancer Palliative Care in Turkey.

Palliative care is an important component of integrated, person-centered health care. It can be provided alone or in combination with the patient's medical treatment, not only by the palliative care team but also by the healthcare team caring for the patient. The concept of palliative care was developed in 2010 along with the establishment of the National Cancer Control Program in Turkey, and today there are many palliative care units, especially in metropolitan hospitals, that provide comprehensive palliative care. One-third of patients who come to the palliative care unit for treatment of pain, malnutrition, and respiratory problems are cancer patients. The care needs of all patients presenting to the palliative care unit are assessed, and a multidisciplinary team plans comprehensive palliative care for patients. Theoretical and practical patient care training is provided by palliative care nurses for family members or caregivers. Considering the burden of cancer as well as the increasing life expectancy at birth, it can be stated that the actual need for palliative care in Turkey will be much greater in the near future.

Contribution of Pharmaceutical Care to Person-centered Health Care and the Safety of Pharmacotherapy for Hospitalized Older Individuals in Brazil: An Investigative Single-arm Intervention Trial.

Adverse drug events (ADE) and medication errors (ME) provide large numbers of victims. Older people are more susceptible to these events, due to the continuing search for several chronic degenerative disease treatments. The Third Global Patient Safety Challenge announced the objective of reducing unnecessary polypharmacy, encouraging deprescription, and aiming to ensure the prescription of medications in an appropriate manner, based on the best evidence and taking into account the individual factors of people. To evaluate whether Pharmaceutical Care (PC), when inserted in a geriatric ward and the context of person-centered health care, cooperates with the safety of pharmacotherapy in older individuals in Brazil. This is an investigative, single-arm, preliminary study. individuals aged ≥60 years and admitted to the geriatric ward between August 2019 to January 2020. The PC (with the practice of pharmacotherapeutic follow-up, medication reconciliation, and pharmacotherapy review) was made available to identify ADE and ME, as well as the associated factors and clinical outcomes, were analyzed. 60 participants were included. It was found that, on hospital admission, 93.3% of them were polymedicated and 86.7% had a history of using potentially inappropriate medications (PIM). ADE and ME were detected in 43 individuals (71.7%) and, in total, 115 incidents were identified, with drugs that act on the nervous system associated with them (31.9%). Acceptance of the PC's recommendations reached the rate of 85.2%. Polypharmacy (p=0.03) and the presence of multiple diseases (p=0.03) had an effect on the presentation of ADE and ME. The number of medications in use decreased in the comparison between admission and hospital discharge (p<0.0001). This investigative study indicated that ADE and ME are linked to the polypharmacy in use at the beginning of hospitalization. On the other hand, we showed that the PC (inserted in the multidisciplinary team) contributed to the deprescribing of medications at hospital discharge. Therefore, the PC can provide improvements in this scenario.

Diagnostic radiography students’ perspectives on cultural competence and safety

IntroductionCultural competency and safety are essential components to consider in the provision of person-centred equitable healthcare. Therefore, student radiographers' learning should include the necessary knowledge, skill sets and competence to recognise the patient's unique characteristics to enable culturally competent and safe medical imaging services. Therefore, this study explored undergraduate and postgraduate diagnostic radiography students' perspectives on cultural competency and safety. MethodsA qualitative phenomenological design with a hermeneutic phenomenological approach was followed to explore student perspectives. Student radiographers (second and third-year undergraduate and first and second-year postgraduate) from the study site were purposively and conveniently recruited to participate in focus group interviews. Fifteen focus group interviews were conducted, recorded and transcribed verbatim before undergoing thematic analysis. ResultsThematic analysis identified two themes. Theme one centred around the cultural competence and safety learnt by student radiographers at university and the second theme cultural competence and safety learnt in workplace learning. ConclusionThis study demonstrated the importance of cultural competence and safe practice in examining patients of different cultures. It highlights the importance of creating awareness among students of their own abilities and capabilities of cultural sensitivity and safe practice as part of their learning. Future health professionals should be empowered to address and respond to patients’ unique needs in a competent, safe and professional manner to reduce health disparities. Implications for practiceCultural competence and safety are integral to person-centred care. Including these concepts in radiography education is therefore vital to ensure optimal patient outcomes.

'Not always so':Embracing process in the development of curricula for contemporary person-centred healthcare professional education.

Contemporary person-centred healthcare and professional education operates within an interconnected and rapidly changing world of challenge and opportunity in the development of curricula that reflect practice. In times characterised by change and uncertainty, with increasing opportunities for networking and collaboration, educational curricula with an emphasis on 'process' rather than a more traditional, mechanistic emphasis on 'product', would seem appropriate in looking towards the future. Learning and emergent professional identity occurs through individuals'social definitions in turn influenced by knowledge and power relationships. The Dialogical Curriculum Framework seeks to promote a more even distribution of knowledge and power through participation and co-production in the pursuit of tolerance and coherence to support learning and identity. The parameters and dynamics of the Dialogical Curriculum Framework are represented through the interconnected relationship between learner attributes, curriculum themes, and curriculum constructs. The processes of space for reflection, open dialogue, participation and symbolic interactionism drive the curriculum, within the context of UK policy and Society. The emphasis on the pursuit of person-centred care makes it important for students to make connections with their own and other professions/disciplines to reflect the complexities of contemporary healthcare-an understanding of the 'whole', rather than fragmented parts. By way of example, a co-produced module of study within a preregistration MSc Physiotherapy programme is highlighted. Students identify, develop, and design small-group projects working with 'Physiopedia'. Thus, projects hold the potential to contribute to a global educational forum as well as student dialogue for learning.

Evaluating Implementation and Outcomes of a Person-Centered Care Model for People with Dementia in the Rehabilitation In-Patient Setting: Project Protocol.

While Australian guidelines promote person-centered healthcare (PCC) for persons with dementia, healthcare systems, routines, rules, and workplace cultures can pose challenges in the provision of PCC. To present a knowledge translation protocol of the PCC model in a sub-acute rehabilitation hospital. The two-year pre/post/follow-up translation project will include (n = 80) persons with dementia, (n = 80) adult family/carers of patient participants, (n = 60) healthcare staff (medical, nursing, allied health), and (n = 8) PCC staff champions. Champions will complete six half-days' training in PCC. Medical, nursing, and allied health staff will be provided with PCC learning manuals, complete six hours of online PCC education and attend six face-to-face PCC education sessions. Champions will provide ongoing support to staff in PCC practice. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework will be used to evaluate: i) outcomes for prospective patients provided with PCC, compared with a matched sample of retrospective patients (primary outcomes agitation incidence and severity); 2) champion and staff PCC knowledge, confidence, engagement, and practice quality; 3) person, family/carer, champion, and staff satisfaction with PCC; 4) PCC costs and benefits; and 5) organizational structures, systems and policies required to implement and maintain PCC in sub-acute healthcare. We will identify if PCC benefits persons with dementia, staff, and healthcare services, and we will generate evidence on the educational and organizational resources required to embed PCC in practice. Project findings will inform tailored PCC education applications for dissemination in healthcare and produce evidence-based PCC practice guidelines to improve healthcare for persons with dementia.