Principles Of Person-centred Care Research Articles

Interventions for severe agitation in a 67-year-old combat veteran with severe dementia

Background:Over 5.4 Million people are diagnosed with a type of Dementia in the United States. Every 68 seconds a new diagnosis occurs. There are over 15 million caregivers supporting loved ones with Dementia. Finding an innovative practical approach to care can be overwhelming. Based the foundational principles of Person Centered Care, this session will provide participants a framework and relational strategies that have a positive impact the care for Alzheimer and dementia clients. An emerging behavioral approach will be described with expected measurable results that can be achieved for the person with Alzheimer’s and the care team. This will be a practical hands on approach to care, allowing participants to have an experiential learning session.Methods: In this single case study family members and care givers were taught specific behavioral approaches to care, with individualized tools targeted at the resident’s life history. The approach was based the foundation of Validation and Reminiscence therapy. Intake questionnaire was holistic in which the family contributed life themes about the resident. These life themes then composed the care card which guided the 24 hour wrap around care. Results: For over18 months the resident experienced a decrease in falls, decrease anxiety as observed by the family and an increase in family contentment. The resident experienced an increase in socialization and engagement. Conclusions: Further study is needed to expand these findings. The care team subjectively stated they had less stress when caring for this individual, yet a systematic study is needed to quantify these statements. In addition, multi-site research is necessary to validate through the specific interventions that there will be a decrease in falls as well as a decrease in anxiety for both the resident and the care team.

The challenges of achieving person-centred care in acute hospitals: A qualitative study of people with dementia and their families

BackgroundPerson-centred care has been identified as the ideal approach to caring for people with dementia. Developed in relation to long stay settings, there are challenges to its implementation in acute settings. However, international policy indicates that acute care for people with dementia should be informed by the principles of person-centred care and interventions should be designed to sustain their personhood. ObjectivesUsing Kitwood's five dimensions of personhood as an a priori framework, the aim of this paper was to explore the way in which current approaches to care in acute settings had the potential to enhance personhood in older adults with dementia. DesignData collected to explore the current experiences of people with dementia, family carers and co-patients (patients sharing the ward with people with mental health problems) during hospitalisation for acute illness were analysed using a dementia framework that described core elements of person centred care for people with dementia. SettingsRecruitment was from two major hospitals within the East Midlands region of the UK, focusing on patients who were admitted to general medical, health care for older people, and orthopaedic wards. ParticipantsParticipants were people aged over 70 on the identified acute wards, identified through a screeing process as having possible mental health problems. 34 patients and their relatives were recruited: this analysis focused on the 29 patients with cognitive impairment. MethodThe study involved 72h of ward-based non-participant observations of care complemented by 30 formal interviews after discharge concerning the experiences of the 29 patients with cognitive impairment. Analysis used the five domains of Kitwood's model of personhood as an a priori framework: identity, inclusion, attachment, comfort and occupation. ResultsWhile there were examples of good practice, health care professionals in acute settings were not grasping all opportunities to sustain personhood for people with dementia. ConclusionsThere is a need for the concept of person-centred care to be valued at the level of both the individual and the organisation/team for people with dementia to have appropriate care in acute settings.

Integrating Systems-Based Practice, Community Psychiatry, and Recovery Into Residency Training

Behavioral health services involving multiple systems of care are increasingly being provided in community as well as hospital settings. Residents therefore should be familiar with multiple systems and the role of the psychiatrist in these systems. The authors describe a curriculum incorporating principles of systems-based practice (SBP), community psychiatry, and recovery. This curriculum was designed to include lectures, clinical rotations, specialized written/oral presentations, and supervision focused on SBP and recovery principles. Residents also participate in home and site visits for further immersion into the multiple systems that their patients have to navigate. The essential elements of this curriculum are the 1) consistent review and emphasis on the four researched-based SBP roles of the psychiatrist; 2) recovery principles of person-centered care and shared decision-making; 3) requirement that residents interact with patients in community and home settings; 4) integration of didactic courses and clinical rotations; and 5) focus on the supervisor/supervisee relationship.

South Asian person-centered psychiatric healthcare projects: an exploratory overview

Background: Nowadays with better treatment modalities at our disposal, there has been an improvement in the acceptance of the persons with psychiatric disorder in the community, although a lot still remains to be achieved. Most institutions still follow an authoritarian approach to provide care for these patients, without particular concern for the latter’s opinion. There is a need to integrate the patient and people close to him/her in planning the treatment pathway in order to achieve better compliance, regular follow-up and patient satisfaction, in accordance with the principles of person-centered care. Aims: The purpose of this paper was to perform a review of published literature in English on person-centered psychiatric care/projects and related topics from south Asian countries. Methods: A review of the literature on person-centered psychiatric care/projects until December 2010, published in English was conducted with following keywords: person/client-centered planning/care/project/medicine. Due to the scarcity of literature, no exclusion/inclusion criteria were taken into account in this exploratory overview. Result and Conclusion: Four published studies of relevance to the topic of study were identified and three nongovernmental organizations practising principles of person-centeredness partly and/or fully were identified. In countries of south Asia, the idea of person-centered care is at a primitive level, with no/minimal encouragement from Government agencies. Fertile ground for applicability of person-centered projects and barriers to it are both present. There is a need for further research.

Making health care more person-centred in low and middle income countries: a consideration of possible strategies with an emphasis on south-east Asia

With the introduction of scientific methods into medicine, the personal aspects of treatment have become endangered. The challenge for modern medicine is how to regain personalised care, but on a scientific basis. South-east Asia is home to approximately one-fourth of the world’s population. Although no large scale systematic research has yet been carried out, there is evidence that even patients in these low and middle income countries would prefer healthcare delivery to be person-centred. Despite numerous challenges in the application of the principles of person-centred care in this region, the future of person-centred care in these settings appears exciting. Some suggestions for implementation of person-centred healthcare are advanced.

Effects of person-centred care in patients with chronic heart failure: the PCC-HF study

AimsPerson-centred care (PCC) emphasizes a partnership in care between patients and healthcare professionals and is advocated by WHO as a key component of quality health care. We evaluated outcomes of PCC in hospitalized patients with chronic heart failure (CHF) with respect to the length of hospital stay (LOS), activities of daily living (ADL), health-related quality of life (HRQL) and 6-month readmission rate.Methods and resultsDuring 2008–2010, 248 consecutive patients hospitalized for symptoms of worsening CHF were enrolled in a controlled before and after designed study. A Usual care group (n= 123) was recruited according to pre-defined criteria to map usual CHF care and assess outcomes at five designated hospital wards. Based on the mapping, a panel of in-house clinicians and researchers developed measures aimed at aligning usual care with basic PCC principles. These measures were incorporated into a study protocol to guide care procedures at the same five wards. Person-centred care was then implemented at these wards and evaluated in 125 patients. Both length of hospital stay and 6-month readmission were extracted from patient records. Activities of daily living were evaluated at baseline and discharge and HRQL was evaluated at baseline and after 3 months. In the analysis of all patients, the LOS was reduced by 1 day (P= 0.16) while retaining ADL (P= 0.07). When PCC was fully implemented (per protocol analysis), LOS was reduced by 2.5 days (P= 0.01) and the ADL-level better preserved (P= 0.04). Health-related quality of life and time-to-first readmission did not differ.ConclusionIn this proof-of-concept study, our findings suggest that a fully implemented PCC approach shortens hospital stay and maintains functional performance in patients hospitalized for worsening CHF, without increasing risk for readmission or jeopardizing patients' HRQL.

Making Home Work: Theatre-making with Older Adults in Residential Care

The paper reflects on the significance of artistic practice with older adults in residential care settings, asking what ‘home’ means to residents living with dementia. To consider how cultural stereotypes of ageing as narratives of loss and decline might be challenged, this paper draws on a recent production On Ageing that was staged at the Young Vic Theatre in London. This play dramatised gerontologist Tom Kirkwood's view that ageing is not a process of deterioration but accumulation, which determines how the body ages physically. Socially, we also accumulate ‘stuff’ as we grow older and home is often defined by the emotional significance of possessions. So what happens when, in old age, people's physical space shrinks?. The research draws on the principles of person-centred care and non-humanist theories of materiality to debate how home is constructed through the imagination and in the material, spatial and temporal practices of everyday life. In considering how and why creative activity with older adults can help to change a residential care home from an institution to a domestic space, it suggests that the arts have a significant role to play in end of life care.

Incorporating person centred care principles into an ongoing comprehensive cancer management program: An experiential account

Recent research indicates a definite positive impact on treatment outcomes when an integrative approach that focuses on symptom control and quality of life is provided along with the standard therapeutic regimens. However implementation or practice of this approach is not seen widely due to the culture of medical training and practice. This article presents the initial development of a program for incorporating integrative care principles into an ongoing comprehensive cancer care program at a tertiary centre. The key purpose of the program being to develop, facilitate, and establish comprehensive and holistic processes including palliative care principles, that would positively enhance the quantity and quality of life of the person with disease, as well as create an environment that reflects and sustains this approach. The vision, objectives, goals, strategies, activities and results within the 7 months of implementation are documented. The new learnings gained during the process have also been noted in the hope that the model described may be used to conceptualize similar care giving facilities in other centres.

Mealtimes in Nursing Homes: Striving for Person-Centered Care

Malnutrition is a common and serious problem in nursing homes. Dietary strategies need to be augmented by person-centered mealtime care practices to address this complex issue. This review will focus on literature from the past two decades on mealtime experiences and feeding assistance in nursing homes. The purpose is to examine how mealtime care practices can be made more person-centered. It will first look at several issues that appear to underlie quality of care at mealtimes. Then four themes or elements related to person-centered care principles that emerge within the mealtime literature will be considered: providing choices and preferences, supporting independence, showing respect, and promoting social interactions. A few examples of multifaceted mealtime interventions that illustrate person-centered approaches will be described. Finally, ways to support nursing home staff to provide person-centered mealtime care will be discussed. Education and training interventions for direct care workers should be developed and evaluated to improve implementation of person-centered mealtime care practices. Appropriate staffing levels and supervision are also needed to support staff, and this may require creative solutions in the face of current constraints in health care.

Person-centred interactions between nurses and patients during medication activities in an acute hospital setting: Qualitative observation and interview study

Background There is increasing emphasis on person-centred care within the literature and the health care context. It is suggested that a person-centred approach to medication activities has the potential to improve patient experiences and outcomes. Objectives This study set out to examine how nurses and patients interact with each other during medication activities in an acute care environment with an underlying philosophy of person-centred care. Design A qualitative approach was used comprising naturalistic observation and semi-structured interviews. Setting The study setting was an acute care ward with a collaboratively developed philosophy of person-centre care, in an Australian metropolitan hospital. Participants Eleven nurses of varying levels of experience were recruited to participate in observations and interviews. Nurses were eligible to participate if they were employed on the study ward in a role that incorporated direct patient care, including medication activities. A stratified sampling technique ensured that nurses with a range of years of clinical experience were represented. Patients who were being cared for by participating nurses during the observation period were recruited to participate unless they met the following exclusion criteria: those less than 18 years of age, non-English speaking patients, and those who were unable to give informed consent. Twenty-five patients were observed and 16 of those agreed to be interviewed. Results The results of the study generated insights into the nature of interactions between nurses and patients where person-centred care is the underlying philosophy of care. Three major themes emerged from the findings: provision of individualised care, patient participation and contextual barriers to providing person-centred care. While the participating nurses valued a person-centred approach and perceived that they were conducting medication activities in a person-centred way, some nurse–patient interactions during medication activities were centred on routines rather than individualised patient assessment and management. These interactions were based on nurses’ perceptions of what was important for the patient and did not provide opportunities for patient participation. Two main contextual barriers in relation to a person-centred approach to medication activities were identified as multidisciplinary communication and time constraints. Conclusions While some nurse–patient interactions during medication activities were consistent with the principles of person-centred care, the study results highlighted factors that influence the nature of these interactions, and identified opportunities to improve nursing practice. To ensure person-centred care is applied to medication activities, nurses should undertake ongoing assessment of patients’ needs in relation to their medications and encourage opportunities for increased patient participation.

Collaboration Can Redefine Long-Term Care

Collaboration Can Redefine Long-Term Care

Bridging theory and practice

As a corrective to the depersonalizing tendencies of some caregiving practices and treatment contexts, the principles of person-centred care have been widely espoused. However, proponents of person-centred care often fail to acknowledge the fact that the body is a fundamental means of communication and, as such, the body is essential to the expression of personhood. Using a qualitative research design, we explored with health care practitioners how an embodied notion of personhood could enhance person-centred dementia care. Our findings indicate that the communicative capacity of the body enriches the imagination and connects health practitioners to the personhood of their care recipients, thereby fostering sympathetic care. Our findings further indicate that health care practitioners perceive that when care is premised on the communicative capacity of the body, this may improve the time efficiency of clinical practice, and may reduce, in certain instances, the need for drug therapy as chemical restraint. Further research is needed in order to evaluate the outcomes of an embodied selfhood approach to person-centred dementia care.

Letter

Back to table of contents Previous article Next article LetterFull AccessLetterPatricia E. Deegan Ph.D.Robert E. Drake M.D., Ph.D.Patricia E. Deegan Ph.D.Search for more papers by this authorRobert E. Drake M.D., Ph.D.Search for more papers by this authorPublished Online:1 Jan 2007https://doi.org/10.1176/ps.2007.58.1.140AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In Reply: In response to the thoughtful letters about our Open Forum—the two above and the letter in the December issue from Peyser and Shadoan ( 1 )—we would like to offer this vignette and commentary. In a psychiatric medication clinic located in an urban center in the Midwest, a young woman arrived for her appointment accompanied by her case manager. She was a longtime client of the center and had a diagnosis of a substance use disorder and schizophrenia. Her presentation on this day was disorganized, distressed, and psychotic. At the clinic, she was greeted by a peer specialist, offered food and beverage, and encouraged to use assistive technology to organize the information she wanted to share with her doctor. The young woman sat at a kiosk, put on headphones and, when prompted, entered her responses via a touch screen. The software organized the story that she wanted to tell her doctor, at a time when she could not organize this story herself. When finished, she pressed a print icon, walked to the printer and picked up her one-page report.The report generated by the software program summarized how this client felt she was doing, how she had been using medications, and what her goals for meeting with her doctor were. It also identified her decisional uncertainty about using medications. She brought the report into her appointment. According to the young woman and her doctor, assistive technology enabled her to effectively communicate her concerns and to participate in shared decision making. The technology described in the vignette is part of a decision support center in a psychiatric medication clinic. It represents the types of innovations in decision support that are the future of medicine in the 21st century. As the vignette illustrates, when we move beyond medical paternalism and the related notions of compliance and coercion, innovative strategies to collaboratively engage even the most challenging clients in shared decision making often emerge. Sweeping assumptions that large groups of people require benevolent paternalism and are not fit for shared decision making are empirically unsubstantiated ( 2 ). Most people, including those with a diagnosis of schizophrenia, want some level of involvement in medical decision making ( 3 ). Reliance on unilateral decision making and involuntary interventions can lead to unnecessary curtailment of fundamental civil liberties and little clinical or psychosocial improvement ( 4 ). The 2006 follow-up to the Institute of Medicine's Quality Chasm report concluded that the principles of person-centered care can be applied to those with substance use and mental disorders. Shared decision making is a key to realizing the report's recommendation and "ensuring that patient values guide all clinical decisions" ( 5 ). Shared decision making may not be possible in situations of temporary decisional incapacity. In such situations the use of medical guardianships, advanced crisis planning, and psychiatric advance directives may help clinicians remain faithful to clients' values and preferences. However, this does not mean that shared decision making is a privilege for those with milder mental disorders. Shared decision making is an ethical imperative and is a fundamental tenet of evidence-based medicine. People with psychiatric disabilities want to be involved in treatment decisions. Rather than excluding large groups of people on the basis of clinical or cultural characteristics, we seek ways to create assistive technologies and supports so that all people with psychiatric disabilities can participate in shared decision making.

Shared Decision Making and Medication Management in the Recovery Process

Mental health professionals commonly conceptualize medication management for people with severe mental illness in terms of strategies to increase compliance or adherence. The authors argue that compliance is an inadequate construct because it fails to capture the dynamic complexity of autonomous clients who must navigate decisional conflicts in learning to manage disorders over the course of years or decades. Compliance is rooted in medical paternalism and is at odds with principles of person-centered care and evidence-based medicine. Using medication is an active process that involves complex decision making and a chance to work through decisional conflicts. It requires a partnership between two experts: the client and the practitioner. Shared decision making provides a model for them to assess a treatment's advantages and disadvantages within the context of recovering a life after a diagnosis of a major mental disorder.

Shared Decision Making and Medication Management in the Recovery Process

Mental health professionals commonly conceptualize medication management for people with severe mental illness in terms of strategies to increase compliance or adherence. The authors argue that compliance is an inadequate construct because it fails to capture the dynamic complexity of autonomous clients who must navigate decisional conflicts in learning to manage disorders over the course of years or decades. Compliance is rooted in medical paternalism and is at odds with principles of person-centered care and evidence-based medicine. Using medication is an active process that involves complex decision making and a chance to work through decisional conflicts. It requires a partnership between two experts: the client and the practitioner. Shared decision making provides a model for them to assess a treatment's advantages and disadvantages within the context of recovering a life after a diagnosis of a major mental disorder.

Variation in use of video assisted thoracic surgery in the United Kingdom

<h3>Introduction</h3> Chronic conditions are associated with over one-third of potentially avoidable hospitalisations. Integrated care programmes aim to help people with chronic conditions to self-manage their health, thus avoiding hospital admissions....