Person-centred Care Approach Research Articles

Barriers and enablers to the implementation of person-centred care in an Indonesian hospital: a qualitative study

Introduction: Person-centred care (PCC) is increasingly considered as one of the criteria standards for delivering healthcare in hospitals. Registered nurses are increasingly expected to provide PCC in daily practice. However, although the hospital commits to enhancing and improving PCC, implementing this approach into practice has faced barriers and enablers. As the implementation of PCC is still at an early stage of development, it is well-recognised that the need to identify barriers and enablers is essential. This study aims to explore these barriers and enablers to implementing PCC in Indonesian hospitals. Methods: This study employed a qualitative exploratory study conducted from July 2023 to September 2023 at a public hospital in Pekanbaru, Riau Province. It applied semi-structured interviews to collect data on barriers and enablers to implement PCC from 2 managers and 12 nurses from the medical ward. All participants were selected using a purposive sampling technique. Data collected from interviews were transcribed and then thematically analysed. Results: Three barriers-related themes emerged, namely time constraints and workload, lack of resources, and communication challenges. Furthermore, three enablers themes also emerged, including leadership, commitment, and sufficient monitoring and supervision. Conclusions: The study results lead hospital managers and policymakers to overcome existing barriers using adaptive planning and strategies and to improve enablers with well-trained professionals and strong leadership to deliver a PCC approach into practice. The implications to practice are that healthcare organisations must continue their support to decrease the barriers and optimise professional care in healthcare facilities to improve healthcare services.

'You're Just Thinking About Going Home': Exploring Person-Centred Medication Communication With Older Patients at Hospital Discharge.

The hospital discharge process poses significant safety risks for older patients due to complexities in communication and coordination among stakeholders, leading to potential drug-related problems post-discharge. Adopting a person-centred care (PCC) approach in medication communication by healthcare professionals (HCPs) is crucial to ensure positive health outcomes. This study aimed to explore the practice of PCC in medication communication between older patients and HCPs during the hospital discharge process. We conducted a qualitative study using non-participatory direct observations of patient-HCP consultations during hospital discharge, followed by semi-structured interviews with observed patients and, when applicable, their informal caregivers. Data collection occurred from October 2020 to May 2021 at two Swedish hospitals. We gathered data using an observational form and audio-recorded all consultations and interviews. The data were analysed thematically using the systematic text condensation method. Twenty patients were included (median age: 81 years [range: 65-94]; 9 female) in observations and 13 of them participated in interviews. Two patients were accompanied by an informal caregiver during the interviews. Three main themes were identified: (1) The impact of traditional authoritarian structures, depicts power dynamics between patients and their HCPs, showing how traditional structures influence the practice of PCC in medication communication during hospital discharge; (2) Consultation timing and mode not on patients' terms, describes suboptimal times and settings for consultations, along with the use of complex language that hinders effective communication; and (3) Discrepancy in expectations of self-care ability, illustrates a mismatch between the self-care guidance provided by HCPs during hospital discharge and the actual needs and preferences of patients and informal caregivers. Medication communication between older patients and HCPs during hospital discharge is frequently inconsistent with the practice of PCC. Not only must HCPs improve their communication strategies, but patients and their informal caregivers should also be better prepared for discharge communication and encouraged to participate in their care. This involvement would give them relevant knowledge and tailor communication to their individual needs, preventing problems in managing their medications after discharge. An advisory group of six patients and/or informal caregiver contributors provided input on the study design, edited the consent forms, and helped develop the interview guide.

An evaluation of activities and intervention approaches in an acute dementia setting

Background:Recommended interventions for dementia prioritises person-centred care and non-pharmacological approaches. The evidence-base for various therapies such as Cognitive Stimulation Therapy (CST), music therapy and sensory based interventions has been growing in recent years; however, there is limited guidance surrounding best practice for working with advanced dementia in acute settings, and research regarding the evaluation of ward interventions is scarce.Method:An audit checklist was compiled from the current recommendations and evidence base. Observations of structured activity sessions were conducted across two acute dementia wards to identify how well these aligned with evidence-based recommendations.Results:Our results suggest that activity sessions on the wards align to the evidence base. Specifically, the wards offer high quality interventions integrating CST approaches. It was revealed that the capturing of these interventions was limited within the clinical notes systems, and an action plan to facilitate efficient capturing was identified and initiated.Conclusion:The study found that it is possible to offer evidence-based activity sessions in an acute setting, for patients with typically advanced dementia presentations. Staff feedback led to the production of a poster to help staff identify the interventions they implicitly use as part of their role, aiming to encourage staff to be proud of their work on the ward and be more aware of evidence-practice links.

Person Centred Dementia Care Made Simple

Abstract Background This poster will outline the development and rollout of our person-centred dementia care microlearning course for all patient-facing staff based in St. James's Hospital, Dublin. Person centred care (PCC) appears to make a difference to how well people with dementia manage on hospital wards (Scerri et al., 2020). The term PCC is used widely in healthcare services and the approach is embedded in St James's nursing professional practice model, standards and policies. Yet there are health professionals who find PCC difficult to define and demonstrate in their practice (Byrne et al., 2020). Through our interactions with staff on wards and in nursing homes, Dementia Services Information Development Centre (DSiDC) are aware that healthcare staff can face difficulties in establishing a rapport with a patient with dementia. Therefore, we identified the need to design a course to facilitate the continued development of meaningful interactions between hospital staff and people with dementia. The course was divided into four stand-alone modules using clear, uncomplicated language and demonstrates how staff can use key elements of Kitwood’s PCC approach in their daily practice. Methods It is becoming harder for hospital staff to be released for onsite training courses due to increasing demands on their time. With this in mind, the DSiDC team sought innovative time-efficient ways to provide dementia education to hospital staff and so a microlearning educational tool was adopted. Microlearning delivers short pieces of content in easily understandable ways utilising a variety of methods such as: video, short written text and quizzes. Accessed by a QR code, staff can complete the course on their mobile phone at a time and place that suits the individual. A pilot study of the course was conducted among staff in a nursing home and on a key ward in St. James’s Hospital. Results 73% of participants found the content ‘extremely helpful’. At start of course, 21% of participants rated their knowledge about person centred dementia care as ‘excellent’. On completion of course, this increased to 50%. One outcome of the pilot study identified an improvement of course design to three modules as opposed to four. Conclusion As a result of the positive outcomes from pilot study, it was decided as part of the wider dissemination of the course across St. James’s Hospital, to conduct a focus group to further measure the impact of the training.

Enhancing Care For Nursing Home Residents Through A Specialised Geriatrician-led Acute Care Team

Abstract Background Nursing home residents (NHRs) represent one of the most vulnerable groups of older adults, requiring complex and comprehensive care due to their multiple comorbidities and intricate healthcare needs. The establishment of a specialised Geriatrician-led Acute Care Team specifically for NHRs can provide better clinical outcomes over traditional care models. These services are designed to address the unique needs of this population, providing appropriate treatment in settings conducive to their well-being and aiming to mitigate adverse consequences associated with unnecessary hospitalizations. Methods In 2023, 343 NHRs were admitted to acute care via Emergency Department in a University Teaching Hospital. Of these, 227 (66%) were admitted under the care of this specialized geriatrician-led team, with an average length of stay of 7 days, totalling 376 bed days, and a readmission rate of 15%. In contrast, 112 NHRs admitted under other non-medical services (surgical specialities) had an average length of stay of 9 days, totalling 849 bed days, and a readmission rate of 11%. Results The primary advantage of this specialist team lies in the personalized attention and expertise provided by gerontologically attuned practitioners. These professionals have a profound understanding of age-related changes, complex health conditions, and psychosocial aspects affecting older adults. By tailoring care plans to individual needs and preferences, they optimize treatment outcomes and enhance quality of life for NHRs. Conclusion In conclusion, the establishment of a specialised acute care team specifically for NHRs represents a significant advancement in addressing the complex needs of this cohort. By leveraging the expertise of gerontologically attuned practitioners and emphasizing person-centred care approaches, these services offer a holistic and tailored solution to improve outcomes and enhance the quality of life for this vulnerable population. Continued investment in developing and expanding such services is crucial for advancing care standards for older adults and promoting a more age-friendly healthcare system.

Trends in incidence of self-harm, neurodevelopmental and mental health conditions among university students compared to the general population: a nationwide electronic data linkage study in Wales.

Objective and ApproachThey are growing concerns that self-harm and mental health conditions are increasing in university students. This may reflect widening access to higher education, existing population trends or stressors associated with this setting. We linked real-world data from the Higher Education Statistics Agency between 2012-2018 with primary and secondary healthcare records. Students were undergraduates aged 18 to 24 years at university entry. Non-students were pseudo-randomly selected based on an equivalent age distribution. We used regression approach to examine characteristics of students and non-students and their risks of self-harm and mental health conditions before and during university. ResultsThis e-cohort study included 96,760 students and 151,795 non-students. Being male, self-harm and mental-health conditions recorded before university entry, and higher deprivation levels resulted in lower odds of entering university and higher odds of dropout. Risks of self-harm, Autistic Spectrum Disorder (ASD), depression, anxiety, drug misuse, and schizophrenia were lower for students. Risks of self-harm, ASD, ADHD, depression, alcohol misuse and schizophrenia were increasing more in students over time. Older students experienced higher risk of self-harm and mental-health conditions. Younger students were more at risk of alcohol misuse than non-students. ConclusionsMental health conditions in students are common, diverse and they influence their academic outcomes. University students have mental health needs and trajectories that differ from those of the general population. ImplicationsThe diversity and complexity of students’ needs require integrated person-centred stepped care approach within universities including triage, access to well-being support, counselling, and referral pathways to mental health services.

Unlocking the benefits of montessori-based reading activities in nursing home: A multiple baseline study on groups of individuals with severe dementia.

Group activities are commonly offered to residents of nursing homes, and increasingly with a person-centred care approach. The aim of this study is to compare the impacts of a Montessori-based reading activity with a more traditional reading activity. A multiple baseline design was used, with 3 groups of 5 older adults with moderate to severe dementia. All sessions were videorecorded and analysed by independent judges, blinded to our hypotheses and conditions. Impacts of the type of activity (storytelling or Montessori-based reading) on verbal interactions, engagement level, affect and behavioural aspects were estimated with both visual analyses and statistical analyses using the between-case standardised mean differences method. Significant differences were found in favour of the Montessori-based activities with regard to the number of verbal interactions, constructive and passive engagement and positive affect expressed, with moderate to large effect size (from 0.46 to 1.66). The Montessori-based reading group activity really seems to be preferable to a more traditional storytelling activity, with multiple benefits for residents. Depending on the preserved abilities and interests of the participants, it can also be aimed at people with severe dementia.

Including patient perspectives in secondary prevention: one step closer to patients needs

Abstract Introduction Including patients in the decisions regarding their health is challenging. Patients’ understanding of their health conditions and lifestyle behaviors are strongly influenced by the interactions between patients and health care providers (1). Putting their needs up-front when you are designing projects for a global approach on Secondary Prevention is even more defiant. Following up to the person-centered care approach, the best way to tailor anything is to focus on the patients’ needs, by including the patient in the choices of the services they can have/need available. Having initiated the partnership, it is also necessary to implement it and safeguard it (2). Purpose To identify the patients’ needs, regarding the Prevention Program, in order to better shape the health care services provision. Methods A qualitative design approach was carried out. A focus group was conducted with patients enrolled in the Cardiovascular Risk Prevention Program (N=8), that have participated in more than two components of the program. The aim of this focus group was to obtain feedback from patients in order to improve and develop the services included in the Secondary Prevention Program. Content analysis was performed, results were assessed with dedicated software. Results There were tree specific topics that were evidenced: communication/access; education; time. Regarding the communication/access, patients mostly outlined the need for a close-up partnership, in order for them to have faster and easier communication channel with the health care professionals team. In the education topic, patients identified the need for increasing the number of educational sessions and repeating some contents, in order to have more discussion moments. The need for increase of the interactive component of certain sessions was also outlined. Patients also identified time as an issue, considering that the sessions are during lunch time, the multidisciplinary consultations take longer than the pre-established timings, and they’re only one day per week. Conclusion(s) The obtained results were used for Program improvement, by creating new communication and educational opportunities. They also served as fuelers for safeguarding this partnerships, as patients were involved in the update and further development of the Program, that they were and are still benefiting from. Patient involvement in the development of healthcare services is a great step towards improvement of health systems performance globally.

Person-centered care assessment tool with a focus on quality healthcare: a systematic review of psychometric properties

BackgroundThe person-centered care (PCC) approach plays a fundamental role in ensuring quality healthcare. The Person-Centered Care Assessment Tool (P-CAT) is one of the shortest and simplest tools currently available for measuring PCC. The objective of this study was to conduct a systematic review of the evidence in validation studies of the P-CAT, taking the “Standards” as a frame of reference.MethodsFirst, a systematic literature review was conducted following the PRISMA method. Second, a systematic descriptive literature review of validity tests was conducted following the “Standards” framework. The search strategy and information sources were obtained from the Cochrane, Web of Science (WoS), Scopus and PubMed databases. With regard to the eligibility criteria and selection process, a protocol was registered in PROSPERO (CRD42022335866), and articles had to meet criteria for inclusion in the systematic review.ResultsA total of seven articles were included. Empirical evidence indicates that these validations offer a high number of sources related to test content, internal structure for dimensionality and internal consistency. A moderate number of sources pertain to internal structure in terms of test-retest reliability and the relationship with other variables. There is little evidence of response processes, internal structure in measurement invariance terms, and test consequences.DiscussionThe various validations of the P-CAT are not framed in a structured, valid, theory-based procedural framework like the “Standards” are. This can affect clinical practice because people’s health may depend on it. The findings of this study show that validation studies continue to focus on the types of validity traditionally studied and overlook interpretation of the scores in terms of their intended use.

Development of a person-centred care approach for persons with chronic multimorbidity in general practice by means of participatory action research.

The management of persons with multimorbidity challenges healthcare systems tailored to individual diseases. A person-centred care approach is advocated, in particular for persons with multimorbidity. The aim of this study was to describe the co-creation and piloting of a proactive, person-centred chronic care approach for persons with multimorbidity in general practice, including facilitators and challenges for successful implementation. A participatory action research (PAR) approach was applied in 13 general practices employing four subsequent co-creation cycles between 2019 and 2021. The target population included adults with ≥3 chronic conditions. Participating actors were general practitioners (GPs), practice nurses (PNs), patients (target group), the affiliated care cooperation, representatives of a health insurer and researchers. Each cycle consisted of a try-out period in practice and a reflective evaluation through focus groups with healthcare providers, interviews with patients and analyses of routine care data. In each cycle, facilitators, challenges and follow-up actions for the next cycle were identified. Work satisfaction among GPs and PNs was measured pre and at the end of the final co-creation cycle. Identified essential steps in the person-centred chronic care approach include (1) appropriate patient selection for (2) an extended person-centred consultation, and (3) personalised goalsetting and follow-up. Key facilitators included improved therapeutic relationships, enhanced work satisfaction for care providers, and patient appreciation of extended time with their GP. Deliberate task division and collaboration between GPs and PNs based on patient, local setting, and care personnel is required. Challenges and facilitators for implementation encompassed a prioritisation tool to support GPs appropriately who to invite first for extended consultations, appropriate remuneration and time to conduct extended consultations, training in delivering person-centred chronic care available for all general practice care providers and an electronic medical record system accommodating comprehensive information registration. A person-centred chronic care approach targeting patients with multimorbidity in general practice was developed and piloted in co-creation with stakeholders. More consultation time facilitated better understanding of persons' situations, their functioning, priorities and dilemma's, and positively impacted work satisfaction of care providers. Challenges need to be tackled before widespread implementation. Future evaluation on the quadruple aims is recommended.

'Caregivers' Experiences of a Singing Training Program to Support Person-Centered Dementia Care.

Music-based interventions are acknowledged to be accessible and beneficial to people living with dementia. As part of an over-arching research project exploring the contributions of person-centered caregiver singing (PCCS) intervention to caregiver's provision of care, this study aimed to explore caregiver's experiences of a PCCS training program. 8 caregivers across 2 care homes in South Africa participated in 4 iterative participatory cycles aimed at refining the training protocol. We completed a thematic analysis of semi-structured interviews of caregivers' experiences of the training. 3 themes emerged: workshop components contributed to positive learning experiences; caregivers' increased knowledge and insight into dementia, music, and personhood; and caregivers' enhanced self-efficacy which encompassed their emotional wellbeing, self-awareness, and confidence. Our study highlights caregivers' self-efficacy, self-hood, and personhood as valuable benefits in person-centered care training. Caregivers experienced training as both professionally and personally beneficial. While PCCS supported a shift toward a person-centered care approach, further research would help establish approaches to support sustainability of PCCS training and use in wider contexts.

Person-centered care as a tool to reduce behavioral and psychological symptoms in older adults with dementia living in residential care facilities

Among older adults living in dementia residential care facilities (RCF) behavioral and psychological symptoms (BPSD) are common, affecting the quality of life (QOL) for the residents as well as being challenging for the staff. The person-centered care (PCC) approach addresses BPSD by giving trained staff mandate to focus on the relation and to adapt the encounter and the environment to increase QoL for the person with dementia. The aims with this study were to improve PCC, decrease BPSD and improve QOL among older persons with dementia living in RCFs, and to explore leaders' and healthcare staff's experiences of a PCC intervention. An educational program was implemented at two RCFs. Data was collected through questionnaires, from national quality registries and through focus group interviews. A significant increase in PCC and QOL at three months was seen. However, no significant difference in BPSD was seen. The interviews showed the importance of a trust-based relationship, and support from an active management to improve PCC, as well as changing old patterns and recognising competence among staff. Factors that affect implementation of PCC in RCF are discussed in the article.

Investigating barriers & facilitators for the successful implementation of the BP@home initiative in London: Primary care perspectives.

The COVID-19 pandemic led to the implementation of a national policy of shielding to safeguard clinically vulnerable patients. To ensure consistent care for high-risk patients with hypertension, NHS England introduced the BP@home initiative to enable patients to self-monitor their blood pressure by providing them with blood pressure monitors. This study aimed to identify barriers and facilitators to the implementation of the initiative based on the experience and perspectives of programme managers and healthcare professionals (HCPs) involved in its implementation in London. We conducted five semi-structured focus groups and one individual interview with a total of 20 healthcare professionals involved at different levels and stages in the BP@home initiative across four of the five London Integrated Care Systems (ICSs). All focus groups and interviews were audio-recorded, transcribed and analysed thematically following the Framework Method. Respondents reported being challenged by the lack of adequate IT, human and financial resources to support the substantial additional workload associated with the programme. These issues resulted in and reinforced the differential engagement capacities of PCNs, practices and patients, thus raising equity concerns among respondents. However respondents also identified several facilitators, including the integration of the eligibility criteria into the electronic health record (EHR), especially when combined with the adoption of practice-specific, pragmatic and opportunistic approaches to the onboarding of patients. Respondents also recommended the provision of blood pressure monitors (BPMs) on prescription, additional funding and training based on needs assessment, the incorporation of BP@home into daily practice and simplification of IT tools, and finally the adoption of a person-centred care approach. Contextualised using the second iteration of the Consolidated Framework for Implementation Research (CFIR), these findings support key evidence-based recommendations to help streamline the implementation of the BP@home initiative in London's primary care setting. Programs such as BP@Home are likely to become more common in primary care. To successfully support HCPs' aim to care for their hypertensive patients, their implementation must be accompanied by additional financial, human and training resources, as well as supported task-shifting for capacity building. Future studies should explore the perspectives of HCPs based in other parts of the UK as well as patients' experiences with remote monitoring of blood pressure.

Introducing Mechanically Assisted Cough for Patients With Progressive Neurological Disease: Patient-Physical Therapist Interaction and Physical Therapist Perspective.

The goal of this study was to explore the patient-physical therapist interaction and the physical therapist's experience of the introductory session for mechanical insufflation-exsufflation (MI-E) device treatment for patients with progressive neurological disease. Qualitative content analysis of participant's observation of interaction between patients and physical therapists during 9 MI-E introduction sessions in different clinical care settings and 10 follow-up interviews with 6 physical therapists. The introduction of MI-E emerged as a process of instilling a sense of security in the patient. The process can be described in 4 steps: (1) gain understanding by being responsive to the person's whole life situation; (2) share knowledge and expectations in a respectful and permissive way; (3) introduce the device in a gentle and reciprocal interactivity; and (4) adapt to home use in an inclusive dialog with the patient and their significant others. Physical therapists described a need for assurance to instill a sense of security in the patient, implying a need for confidence, competent peers, guiding yet flexible routines, and emotional support. Physical therapists have a need to foster assurance in employing a person-centered approach to make a patient feel secure in the process of introducing MI-E treatment. Multiple modes of professional knowledge were used together with action-based and relational-based ethics to facilitate a person-centered care approach. This seems to be a promising approach for providing good care when introducing MI-E to patients. Further research is needed to explore this from the patient's perspective. This study added to the body of knowledge regarding MI-E treatment in relation to patients. This has direct implication, particularly for inexperienced physical therapists, for informed care for the patient during introduction. Our study also supports that person-centered care should be implemented at all levels of health care to make it possible for physical therapists to practice person-centered care.

Integrated care in epilepsy: A scoping review of the key components of health and social care delivery

Introduction: Epilepsy is the most common neurological condition globally, and is associated with significant behavioural, physical, and psychological burden. People living with epilepsy and their families often face extreme difficulty receiving timely and efficient healthcare due to the fragmented nature of epilepsy care delivery and the predominance of hospital-based services. The need to integrate epilepsy care services across healthcare sectors and shift care into community settings has become increasingly clear, but the range and type of integration that has occurred worldwide is unknown. This scoping review aimed to identify recommended and/or implemented models of integrated care for epilepsy, or common elements of integrated care models, to broaden current understanding of the progress toward integrated care in epilepsy.
 Methods: Three literature searches were conducted (in 2020 and 2022) across four databases (PubMed, Medline, Embase, and Web of Science) for integrated, shared, coordinated, or person-centred care models and approaches with a focus on epilepsy. Recommended, developed, or implemented models of integrated care for epilepsy were identified, and data were synthesised into the common elements of integrated care featured in the literature.
 Results: A total of 295 studies were identified across the three searches, from which 35 studies were deemed eligible and were included in this scoping review. Most studies were conducted in the USA or Ireland, and qualitative study designs were most common. Fourteen models of integrated care were identified; eight had been implemented, and six were advocated for implementation. Twelve common elements of integrated care were synthesised, associated with cross-sector collaboration and training, transition and self-management services, and technological advancements to optimise communication between healthcare providers.
 Discussion: There is a growing evidence base supporting the need for an integrated, holistic, and person- and family-centred approach to epilepsy care delivery. Substantial progression has been made design and develop integrated care services for epilepsy, but significant challenges are associated with implementing these services. Lack of readiness for change can stifle efforts toward shifting epilepsy care from hospital to community settings, and governance structures across sectors can prevent continuity and coordination of care. Clearer guidelines for epilepsy care and educational interventions in community settings are needed, as well as greater resources to balance workload targets with tailored, patient-centred care.

Case Study

When older patients enter the healthcare system, determining the origin of injuries requires differentiating accidental from nonaccidental, or neglect-related causes. The involvement of a forensic nurse is invaluable, as the foundational education and expertise help in the assessment and documentation of the person's capacities and competence. Distinguishing between effective care planning and considering the risk of further harm occurs throughout the entire process, where the preservation of the older person's integrity, autonomy, and dignity includes delicately listening to statements made, and confirming the sources of injury. Adopting a trauma-informed person-centered care approach to care and recovery is the goal, creating an environment where older persons feel safe, supported, and understood. In a fast-paced healthcare setting, challenges in addressing lesser-known or less frequently discussed diseases reflect limited knowledge, complicating the care provided. Therefore, ongoing education and training expose the forensic nurse to the latest medical advancements, diminishing misdiagnoses or delayed treatments as outcomes. Critical and accurate communication, coupled with seamless collaboration among interprofessional and community members, serves as the cornerstone to establish a comprehensive and cohesive plan of care. Working together, all members of the interprofessional team ensure that the older person's presenting condition is thoroughly assessed, treated, and supported in the services by the community of providers.

“It feels like I’m coming to a friend’s house”: an interpretive descriptive study of an integrated care site offering iOAT (Dr. Peter Centre)

BackgroundInjectable opioid agonist treatment (iOAT) has proven to be a safe and effective treatment option for severe opioid use disorder (OUD). Yet, iOAT is often isolated from other health and social services. To align with a person-centered care approach, iOAT can be embedded in sites that combine systems and services that have been historically fragmented and that address multiple comorbidities (integrated care sites). The present study investigates the addition of iOAT at an integrated care in Vancouver, British Columbia. We aimed to capture what it means for service users and service providers to incorporate iOAT in an integrated care site and describe the processes by which the site keeps people engaged.MethodsWe conducted 22 interviews with 15 service users and 14 interviews with 13 service providers across two rounds of individual semi-structured interviews (Fall 2021, Summer 2022). The second interview round was precipitated by a service interruption in medication dispensation. Interview audio was recorded, transcribed, and then analysed in NVivo 1.6 following an interpretive description approach.ResultsThe emergent themes from the analysis are represented in two categories: (1) a holistic approach (client autonomy, de-medicalized care, supportive staff relationships, multiple opportunities for engagement, barriers to iOAT integration) and (2) a sense of place (physical location, social connection and community belonging, food).ConclusionIncorporating iOAT at an integrated care site revealed how iOAT delivery can be strengthened through its direct connection to a diverse, comprehensive network of health and social services that are provided in a community atmosphere with high quality therapeutic relationships.

P24: DemenTitude® - Applying the Model of “LAN” to Understand the Experience of People with Dementia

Understanding the self-perception of people with dementia and their interaction with the surrounding others is highly vital to exploring the unmet needs of people with dementia. In preserving the personhood through the person-centred care approach, the synchronization with the experience of the person with dementia and listening to his/her voice of interpreting the surrounding things should be promoted. What is the meaning of the dialogues and the behavior of people with dementia? How can the “LAN” be applied to guide the care providers and the care partners in maintaining a good quality of care? In-depth interviews and participatory observations were conducted during interviews in the community care and residential care homes of Hong Kong. Following the theoretical framework blending interpretivism and the sociocultural perspective on dementia, the finding was not only being used for getting more familiar with the experience of people with dementia but also designing the content of educational programme to the care providers and the care partners in Hong Kong.“LAN” model stands for “L-listening to the experience and voice of people with dementia; A-assess the condition of people with dementia through person-centred care approach; N-Needs of people with dementia to preserve personhood”. As the care providers and the care partners are trying to synchronize the experience of people with dementia, the subjective views and feeling of people with dementia formed by their interpretation will be the key to respond their unmet needs. A particular educational programme was designed for the care providers and care partners. Focusing on the synchronization of the experience of people with dementia with LAN model, the participants got reflection and insights on this idea, which is similar to the “LAN” cable technology. The care providers and care partners found that just like a LAN cable to “plugin” from one device to another device so that the information could be synchronized. In satisfying the needs of people with dementia, the participant should learn from the lens and interpretation of people with dementia. A proper caring attitude with this “LAN” model, called as DemenTitude®, was introduced. The evaluation of the educational training showed a significant improvement in the positive perception of dementia among the participants.

I have not come here because I have nothing better to do: The lived experience of presenting to the emergency department for people with a psychosocial disability and an NDIS plan-A qualitative study.

Almost 60 000 people have a psychosocial disability (PSD) and a National Disability Insurance Scheme (NDIS) plan. As PSD can be a fluctuating condition, people with a PSD and an NDIS plan, at times, may require crisis care and present to the emergency department (ED). This national study explored the experiences of people with a PSD and an NDIS plan when presenting to the ED. To understand the unique lived experience of people with a PSD and an NDIS plan, semi-structured interviews were conducted with 24 people between March and November 2022 and were analysed thematically. A lived experience advisory group was engaged as part of the research team. Participants were asked about their experiences in the ED including barriers to therapeutic care and what worked well. Participants reported emotional distress caused by receiving a biomedical rather than a person-centred mental health response. A previous mental health history overshadowed diagnostic decisions and most participants interviewed stated they would not choose to return to the ED. Half of the participants spoke of one presentation only where needs were met. Four main themes emerged from the data: (a) Diagnostic overshadowing; (b) Judgement and stigma; (c) Waiting without hope; and (d) If things went well. This study provides evidence of the unique lived experience of people with a PSD and an NDIS plan when presenting to the ED. The results highlight the need for clinicians in the ED to understand the complexity and nuances of supporting people with a PSD. Recommendations for a person-centred care approach are provided. Alternative support options for this group of people need to be explored.

The effect of hospital-to-home transitional care using a digital messaging application on the health outcomes of patients undergoing CABG and their family caregivers: a randomized controlled trial study protocol.

Given the increasing trend of care transition from healthcare settings to patients' own home, patients and their family caregivers should take more responsibilities for care at own home. This study is going to investigate the effect of a transitional care program from hospital to own home using a digital messaging application on patients' undergoing coronary artery bypass graft (CABG) surgery and their family caregivers' health outcomes. A parallel randomized controlled trial study will be conducted in a hospital in a metropolis located in southwestern Iran. Sampling will be performed sequentially and the eligible dyad of patients and family caregivers will be randomly assigned to intervention and control groups. The intervention group will receive a transitional care program for 8 weeks using the WhatsApp on the mobile phone based on the person-centered care approach, but the control group will receive routine care for patient's transition. Data collection will be conducted at baseline, immediately after the intervention, and two months after the intervention using demographic questionnaire, Cardiac Self-Efficacy Scale (CSES), MacNew Heart Disease Health-Related Quality of Life questionnaire (MNHD-Q), Cardiac Symptom Scale (CSS), Morisky Medication Adherence Scale, and Caregiver Burden Scale (CBS). Descriptive and inferential statistics will be used for data analysis. The results of this study will allow evaluating the effectiveness of an innovative transitional care program to patients' own home using a digital messaging application. If the transitional program is shown feasible and effective it can be incorporated into existing care programs and stimulate further studies on the use of digital solutions for improving the continuity of care in own home.