Person-centred Way Research Articles

Risk and dementia.

People with dementia and their family carers may be subject to a number of different risks; these risks may overlap with, and impact on one another. Due to changes in capacity that come with dementia, people with the diagnosis may be overly cautious about decisions made relating to risk made on their behalf, and this may have a negative impact on their wellbeing and quality of life. This article aims to educate community nurses on the risks they need to be aware of when working with families affected by dementia, and presents a risk enablement framework as a way of assessing and managing risk in a person-centred way.

Missed nursing care in surgical care– a hazard to patient safety: a quantitative study within the inCHARGE programme

BackgroundMissed nursing care occurs globally, and the consequences are severe for the patients when fundamental care needs are not fulfilled, nor delivered in a person-centred way. This study aimed to investigate the occurrence and cause of missed nursing care, and the relationship between registered nurses’ and nursing assistants’ perceptions of missed nursing care, in a surgical care context.MethodsA quantitative study was performed using the MISSCARE survey, measuring missed nursing care and associated reasons, in three surgical wards with registered nurses and nursing assistants as the participants (n = 118), during May-November in 2022. The MISSCARE survey also covers background data such as job satisfaction and intention to leave. The survey was distributed paper-based and the response rate was 88%.ResultsAspects of nursing care rated to be missed the most were ‘attending interdisciplinary care conferences’, ‘turning patient every 2 h’, ‘ambulation 3 times per day or as ordered’, and ‘mouth care’. Differences between registered nurse and nursing assistant ratings were detected for eight out of 24 items, where registered nurses rated more missed nursing care. The uppermost reasons for missed nursing care were ‘inadequate number of staff’ and ‘unexpected rise in patient volume and/or acuity on the unit’. Registered nurses and nursing assistants rated differently regarding six of 17 items. Almost every fourth staff member (24.6%, n = 29) had the intention to leave within a year in the present department.ConclusionsThe occurrence of missed nursing care is frequent in the surgical context, and in combination with a high number of staff members intending to leave their employment, poses a hazard to patient safety. Registered nurses, holding higher educational levels, reported more missed care compared with the nursing assistants. The main reason for missed nursing care was an inadequate number of staff. These findings support a warranted investment in nursing within the organisation. The results can be used to form strategies and interventions, to reduce nurse attrition and optimise competence utilisation, and to achieve safe person-centered fundamental care.

Community-based intervention for promoting healthy habits through MAHA mobile application in Basque elderly population.

Background: Population over 65 years of age in EU is increasing, rising costs in health and social care systems and making changes in biological, physiological, and psychosocial field. Promoting healthy ageing has become a key to improve the lifelong health and wellbeing of ageing population. Health technologies and eHealth tools can be an effective instrument to address the challenge of ageing. They provide an opportunity to improve the health and well-being of older people, and to prevent, treat and ensure the sustainability of health systems.
 Digital technologies aimed at promoting active ageing enable access to greater knowledge, better communication and a better relationship with people's environment, if they are designed in a person-centred way. They open up a range of new possibilities and resources that represent a way to reduce the generation gap and bring older people closer to the rest of the community.
 Methods: The Basque Country region has implemented a community-based intervention to promote active and healthy ageing through the use of a self-managed mobile MAHA App within Gatekeeper European project (H2020, nº857223). MAHA app developed in a co-creation process involving end-users and professionals from community settings is available in Google Play and App Store for iOS. The tool offers activities and materials to reinforce socialization and, promote healthy, meaningful, creative and fulfilling lives among elderly people.
 This quasi-experimental and longitudinal study is targeted at 10,000 older people and/or their caregivers from the Basque Country (Spain). The community-based intervention in the Basque Country has been designed to involve Primary Health Care services and key agents from different sectors at the community level that can influence the well-being and health of the elderly population. The Support Network created for the intervention has the participation of 39 community organisations and entities belonging to the Basque Health Ecosystem.
 Results: A mixed methods approach to evaluation will be carried out, using quantitative techniques, through validated questionnaires and usage metrics to assess effectiveness; and qualitative techniques, to collect user experience. An analysis of the implementation process has been executed, to identify the determinants, factors, and aspects that impact the intervention, and the commitment, adherence and dropout rate towards user engagement. The intermediate data shows that the actions implemented are effective, as the intervention has been widely disseminated and many people have been contacted. Although more than half have accepted to participate in the intervention, only 3% finally registered in the application. This intervention also shows low adherence to the intervention and a high level of dropout, as it is understood that once the user accepted to participate, they do not follow the study protocol. 
 Discussion and Conclusions: The community-based intervention implemented will contribute to generating awareness and new data on research into the intention-to-treat, adherence and attrition rate of the use of self-managed eHealth applications by the elderly. Likewise, a tool with these characteristics can be considered an effective health asset for improving elderly people's health, making healthy options more accessible and incorporating new habits in this population.
 

A Political History of the Subject: Brij V. Lal on Leadership

ABSTRACT Brij V. Lal was the most prolific writer on post-colonial politics in Fiji. Many of these writings concerned political leaders and the nature of political leadership. Biographies of A.D. Patel and Jai Ram Reddy stand out, but Lal's other writings on politics nevertheless foregrounded people, and the way their personalities shaped, and were shaped by, the times in which they lived. In this article I consider how this biographer’s sensibility implicitly invokes a theory of political leadership and re-read Lal’s contribution to the study of politics in Fiji from this standpoint. I argue that his ‘political history of the subject’ offers both a justification for, and approach to, studying leadership in a person-centred way.

Reflecting on challenges and opportunities for the practice of person-centred rehabilitation

Objectives To (1) reflect on challenges to the practice of person-centred rehabilitation; and (2) propose opportunities for the development of person-centred rehabilitation. Challenges Person-centred practice has received widespread endorsement across healthcare settings and is understood to be an important, positive approach in rehabilitation. However, the rhetoric of this approach does not always translate meaningfully into practice. Emphasis on patient choice, patient involvement in decision making, and increasing patient capacity for self-management have become a proxy for person-centred rehabilitation in lieu of a more fundamental shift in practice and healthcare structures. System (e.g. biomedical orientation), organisational (e.g. key performance indicators) and professional (e.g. identity as expert) factors compete with person-centred rehabilitation. Opportunities Four key recommendations for the development of person-centred rehabilitation are proposed including to: (1) develop a principles-based approach to person-centred rehabilitation; (2) move away from the dichotomy of person-centred (or not) rehabilitation; (3) build person-centred cultures of care in rehabilitation; and (4) learn from diverse perspectives of person-centred rehabilitation. Conclusion Fixed assumptions about what constitutes person-centred rehabilitation may limit our ability to respond to the needs of persons and families. Embedding person-centred ways of working is challenging due to the competing drivers and interests of healthcare systems and organisations. A principles-based approach, enabled by person-centred cultures of care, may achieve the aspirations of person-centred rehabilitation.

A role for educational psychologists: using Planning Alternative Tomorrows with Hope (PATH) and participatory action research (PAR) to develop a Relationships and Sex Education (RSE) support group with staff in a special school

ABSTRACT Relationships and Sex Education (RSE) for those with special educational needs and/or disabilities (SEND) is a complex and historically overlooked area, affected by socio-cultural factors, attitudes and beliefs. Research calls for professionals to work collaboratively, in a participatory, person-centred way, with scarce guidance to inform ways of working. This study explored and evaluated how an RSE support group can be developed, supported by an educational psychologist (EP) using Planning Alternative Tomorrows with Hope (PATH) to include the views of parents, school staff and pupils. An exploratory ethnographic case study design was used through participatory action research (PAR). The EP’s knowledge, skills and relationship with the school was pivotal in planning, facilitating and supporting the group and providing a safe space for staff to implement RSE and contemplate key issues. Findings suggest that PATH provided a structured, participatory person-centred framework to plan for and support the group process.

Person-centred online lifestyle coaching in childhood, adolescent, and young adult cancer survivors: protocol of the multicentre PanCareFollowUp lifestyle intervention feasibility study

BackgroundPhysical inactivity and unhealthy dietary habits are known to be disadvantageous for the development of late adverse effects in survivors of childhood, adolescent, and young adult cancer. To make interventions, aimed at improving lifestyle, fit into the daily life of survivors, interventions should be designed and delivered in a person-centred way with a limited time burden. As part of the European PanCareFollowUp project, an eHealth intervention was developed to support sustainable changes to physical activity levels and/or diet of childhood, adolescent, and young adult cancer survivors. This feasibility study aims to gain insight into the feasibility and potential effect sizes of the PanCareFollowUp lifestyle intervention.MethodsThe PanCareFollowUp lifestyle intervention consists of person-centred 3–6 screen-to-screen sessions with a certified lifestyle coach. The intervention will be evaluated with a single-arm pre-post feasibility study conducted at two survivorship care clinics in the Netherlands. A total of 60 participants who are (i) diagnosed with cancer <25 years, (ii) ≥ 5 years post-treatment, (iii) aged 16–55 years, and (iv) have a low physical activity level and/or unhealthy dietary intake manifested by overweight will be recruited. Using reports, hospital records, and questionnaires for survivors, coaches, and late effect doctors, feasibility will be based on (i) adherence to intervention, (ii) acceptability, (iii) practicality, (iv) integration/implementation, (v) demand, and (vi) attrition. The potential effect sizes of the intervention will be explored by determining the percentage of survivors that reach the personalized lifestyle goals that were set with the coach. Physical activity level, dietary intake, BMI, general self-efficacy, self-management, and motivation level will be assessed at three time points with questionnaires, reports, and/or an accelerometer.DiscussionData of this study will be gathered to assess the feasibility and potential effect sizes. This will allow for further intervention refinement as needed as well as to inform a future large-scale intervention study and a manual for implementation at other centres.Trial registrationInternational Clinical Trial Registry Platform (ICTRP) number: NL8932 (ICTRP Search Portal (who.int)). Registered on September 29, 2020.

Shared decision-making with adults transitioning to long-term care: A scoping review.

Transitions to long-term care are challenging for individuals and often associated with a loss of autonomy. Positive experiences are noted, especially when decisions involve the individual in a person-centred way which are respectful of the person's human rights. One approach which facilitates self-determination during a transitional period is shared decision-making, but there is a lack of clarity on the nature and extent of research evidence in this area. The purpose of this scoping review is to identify and document research related to shared decision-making and transitioning to long-term care. A comprehensive search in CINAHL, Medline and Psych-info identified papers which included evidence of shared decision-making during transitions to a long-term care setting. The review following the JBI and PAGER framework for scoping reviews. Data were extracted, charted and analysed according to patterns, advances, gaps, research recommendations and evidence for practice. Eighteen papers met the inclusion criteria. A body of knowledge was identified encompassing the pattern advancements in shared decision-making during transitions to long-term care, representing developments in both the evidence base and methodological approaches. Further patterns offer evidence of the facilitators and barriers experienced by the person, their families and the professional's involved. The evidence identified the complexity of such decision-making with efforts to engage in shared decision-making often constrained by the availability of resources, the skills of professionals and time. The findings recognise the need for partnership and person-centred approaches to optimise transitions. The review demonstrates evidence of approaches that can inform future practice and research to support all adult populations who may be faced with a transitional decision to actively participate in decision-making.

Informal caregivers and assistive technology in Norwegian nursing homes.

To explore informal caregivers' experiences and perspectives concerning assistive technology (AT) in two nursing homes, through the conceptual lens of person-centredness. The integration and use of AT and a person-centred approach to care are political intentions within healthcare services, both internationally and in Norway. In nursing homes, informal caregivers are often collaborators with the staff, and can be important partners concerning the implementation of AT in a person-centred way. However, there is little knowledge about the informal caregivers' perspectives on the use of AT in nursing homes, or of whether or how they are included in the integration and use of AT. The study had a qualitative design and comprised eleven informal caregivers of residents in two nursing homes in Norway. In-depth interviews were used for data collection. The data were analysed using content analysis. COREQ reporting guidelines were applied to ensure comprehensive reporting. Emerging themes highlighted the slow-going transition from old to new technology, and how the informal caregivers experienced that AT both promoted and degraded the dignity of their family members. Informal caregivers were positive to the use of technology, but have sparse knowledge and information about ATs in the nursing homes. They express a desire for AT to increase activity and safety, which promotes dignity, quality of life, and quality of the care for their family member. The informal caregivers want their family member to be seen, heard, and to get assistance on their own terms, even with regard to technology. Before AT can be implemented, informal caregivers need to be informed and listened to and included in the processes. Through their stories, one can form an idea of how important a person-centred approach is to contributing to individually tailored and introduced AT in collaboration with the informal caregivers.

Qualitatively exploring the attributes of adaptability and resilience amongst recently graduated nurses

AimTo explore newly graduated nurse’s understandings and practices of adaptability and resilience in clinical environments. BackgroundThe everyday practice of nursing work involves managing emotional and practical everyday demands related to the role. Adaptability and resilience are two critical attributes that equip nurses for this by enabling them to manage challenges and be flexible with their practices and expectations in the face of rapidly changing and unpredictable circumstances. DesignInformed by the theoretical underpinnings of the Person-centred Practice Framework, semi-structured interviews using topic guides were conducted with nine newly graduated registered nurse participants recruited through purposive sampling. Interviews occurred between March-October 2020 with participants working across seven different healthcare settings in three Local Health Districts in NSW, Australia. ResultsAnalysis of the data generated the core themes of: 1) ‘Making sense’ explored how nurses defined resilience and adaptability; 2) ‘Surviving as the nurse’ focused on how nurses experienced adaptability and resilience as a newly qualified nurse; 3) ‘Trusting oneself’ reflected the interconnection of nurses’ developed adaptability and resilience to their clinical self-assurance; and 4) ‘Doing it again’ described how adaptability and resilience can be further supported by the university sector. Findings demonstrated that adaptability and resilience in combination are essential attributes and required for effective nursing practice post-graduation. However, both collegial and organizational support were found to be lacking in positively reinforcing these attributes in this study. ConclusionNewly graduated nurses can develop adaptability in clinical practice, so they are a more resilient future workforce. However, greater organizational leadership is required to model and strengthen these attributes for nurses. When perceptions, knowledge and experiences of adaptability and resilience are developed using person-centred approaches, they will be used in person-centred ways. Tweetable abstractNewly graduated nurses can develop adaptability in clinical practice, so they are a more resilient future workforce. However, greater organizational leadership is required to model and strengthen these attributes for nurses. When perceptions, knowledge and experiences of adaptability and resilience are developed using person-centred approaches, they will be used in person-centred ways.

A pilot pathway for people living with persistent widespread pain and fibromyalgia: Individualised assessment, care planning and stratified rehabilitation options

Keyword: Fibromyalgia Purpose: NHS Forth Valley does not have a pathway for patients with persistent widespread pain and fibromyalgia (FM). People with FM are often diagnosed and discharged by Rheumatology, as it is not an inflammatory condition. However, FM is characterised by emotional distress and/or functional disability and people often struggle to self manage due to lack of support, understanding and validation (Toye et al., 2021). The NICE (2021) and SIGN (2013) guidelines for chronic pain highlight the importance of a biopsychosocial assessment and individualised care plans that promote self-management. Pain Management Physiotherapy currently provides this; however, there is limited capacity (1.4WTE). People perceived to be coping by Consultants were often discharged with advice. The aim of this project was to address gaps and inefficiencies identified by people with FM and clinicians, through a comprehensive biopsychosocial assessment and care plan, with stratified options, including a physiotherapy-led group. Methods: A tool was developed by Pain Management and Rheumatology for GPs to help them with identification and diagnosis of FM in the community. Prior to this, people were referred to secondary care services for diagnosis. We reviewed 7 patient journeys within the Pain Management and Rheumatology caseloads. Patient feedback was collated to identify what improvements would be valued. We pragmatically developed a four session physio-led group using existing Pain Management Programme materials. Each patient was referred by a cnsulatant and assessed by a physiotherapist prior to commencing the group. Content of the group included understanding FM and the impact on people's lives. The project is currently staffed within current job plans. It is delivered via MS Teams, due to COVID 19 restrictions. A qualitative survey was completed by participants in the group. Results: Following a review of pathways for patients with FM in NHS Forth Valley, we identified inequities in patients’ healthcare experiences. As there are limited biomedical treatment options for people with FM, discussions with clinicians in Rheumatology, GPs and patients, identified that support to develop self management skills is needed. The feedback suggested that group sessions normalise symptoms, reduce isolation and stigma, validate experience and increases the access to an intervention that promotes recovery and behaviour change. Participants valued the discussion and reflection in the group format. They reported making meaningful changes to their lives. “I got more than I expected from the group” [P3] The facilitators “are very knowledgable and understanding” [P5] Conclusion(s): This pilot demonstrates that even when perceived to be functioning well, the validation, deeper understanding of their condition and guidance on how to move forward was valued by people living with FM. The physiotherapy-led group is an efficient and person-centred way to support this population. Efficacy data will continue to be collected. Impact: This project is part of a larger redesign project to equitably meet the needs of people living with FM. The physiotherapy-led group offers more options for people diagnosed with FM to learn how to self manage their persistent pain condition. The next phase of the project will involve collaboration with the Rheumatology Service to develop the pathway further. Funding acknowledgements: This project was not funded.

Person-centred care in speech-language therapy research and practice for adults: A scoping review.

Person-centred care (PCC) has shown positive effects in various health-care settings and therefore is desirable in clinical work. However, as PCC is still being developed, the literature reflects a heterogeneous use of both terminology and conceptualisation. This lack of consistency hinders the implementation or adaptation of PCC in general and in select fields of practice such as speech-language therapy (SLT). To describe how the concept of PCC manifests in current speech and language therapy research and practice for adult patients. Searches for published literature were conducted in five databases (PubMed, Scopus, CINAHL, Psych INFO, and Linguistics and Language Behaviour Abstracts) using search terms related to PCC and SLT. Records were included if they involved an adult population, were written in English, and focused on PCC and SLT irrespective of year of publication. A total of 134 records published 1996-2020 were included in this review. Many of these records were discussion papers that described how speech-language therapists (SLTs) can or should work in a person-centred way. The search did not find any records that explore the implementation, effects, or patients' views of person-centred SLT. This literature review revealed that person-centred SLT practice mainly relates to the International Classification of Functioning, Disability, and Health framework, and the Life Participation Approach to Aphasia. Studies incorporating exploration of proposed clinical routines of PCC demonstrate specific context-dependant aspects including barriers to eliciting a patient narrative, involving patient and family members, and documenting SLT. This study provides information that can be used to implement person-centred care in SLT education, clinical practice, and research by providing an inventory of the current knowledge and the existing gaps. PCC has shown positive effects and is currently being implemented in various health-care settings worldwide. This study provides an account of the current state in research and practice on how PCC for adults is described, discussed, and evaluated. While related concepts such as family-centred care have mainly been explored within paediatrics, little is known about how PCC manifests in SLT for adults. Our results show that PCC is presently being discussed and valued in SLT although obstacles exist, and few studies explore whether current practice is person centred and the potential effects of such practice. WHAT ARE THE POTENTIAL OR ACTUAL CLINICAL IMPLICATIONS OF THIS WORK?: This study provides clinicians, researchers, and policymakers' guidance on what aspects to consider when working to implement person-centred SLT for adults.

Editorial: The power of collaboration

Since Covid-19 appeared almost two years ago, strategic leaders and academics have offered their wisdom to leaders ‘in the field’ in terms of what worked for them during previous crises. Learning from others’ experiences may be helpful, but the unprecedented nature of the context in which we are living and working has called for innovation, creativity and collaboration, to ‘work things out’. A theme of positivity runs through literature, encouraging leaders to foster hope through being available, listening, responding and showing compassion at a time when there seemed little reason to be positive. Over the difficult period of the pandemic, though, there have been so many stories of close collaborations, person-centred ways of being, helpfulness and kindness, and collaboration is a central theme in this issue of the IPDJ. Over recent months, we have reviewed and refined the aim and scope of the journal, alongside our key stakeholders at the Foundation of Nursing Studies, the International Practice Development Collaborative (IPDC) and the Person-centred Practice International Community of Practice (PCP-ICoP).

Coping Strategies Used by Older Adults to Deal with Contact Isolation in the Hospital during the COVID-19 Pandemic.

Due to the COVID-19 pandemic, many older adults have experienced contact isolation in a hospital setting which leads to separation from relatives, loss of freedom, and uncertainty regarding disease status. The objective of this study was to explore how older adults (55+) cope with contact isolation in a hospital setting during the COVID-19 pandemic in order to improve their physical and psychological wellbeing. The realist evaluation approach was used to formulate initial program theories on coping strategies used by (older) adults in an isolation setting. Twenty-one semi-structured interviews with older patients (n = 21) were analysed. This study revealed that both emotion-focused coping strategies as well as problem-focused coping strategies were used by older adults during contact isolation. The study also uncovered some new specific coping strategies. The results have useful implications for hospital staff seeking to improve the wellbeing of older adults in contact isolation in hospitals. Problem-focused coping strategies could be stimulated through staff performing care in a person-centred way. Trust in staff, as part of emotion-focused coping strategies, could be stimulated by improving the relationship between patients and staff.

Nurses' experiences of caring for persons with dementia experiencing responsive behaviours in an acute hospital: A qualitative descriptive study.

To explore nurses' experiences of caring for persons with dementia experiencing responsive behaviours in an acute hospital. Caring for persons with dementia who have an acute medical illness and are experiencing responsive behaviours in acute hospitals can be challenging for nurses. While existing research has explored the experiences of nurses in providing dementia care in this setting, there is limited knowledge about the specific care experiences of nurses when working to meet the needs of persons with dementia who experience responsive behaviours alongside an admitting diagnosis. A qualitative descriptive design was implemented. Semi-structured interviews were carried out with nine nurses working in medical and surgical wards. A thematic analysis approach was used to analyse the data. Ethical approval to conduct the study was received from the writers' university. Three themes were found: (a) challenges encountered, (b) a person-centred response and (c) dementia preparedness. Key findings about challenges encountered by nurses included: the acute hospital environment; increased need for enhanced knowledge; and emotional challenges. Person-centred responses such as working in partnership with others and reminiscence were identified as strategies to address the challenges. Finally, nurses identified particular interventions that were supportive to them in enhancing their preparedness to meet the needs of persons with dementia who experience responsive behaviours. Persons with dementia who are acutely unwell and are experiencing responsive behaviours, within acute hospitals, have specific and individualised care needs. Nurses working in these settings must therefore be supported in developing competence in managing these frequently complex clinical cases, while also providing person-centred care. Nurses' narratives demonstrate that they continue to experience challenges in the presence of responsive behaviours. There is a consequent need for dementia-specific education on person-centred ways to address responsive behaviours within acute hospital settings.

The role of social prescribers in wales: a consensus methods study.

Aims:Social prescribing continues to grow and change across healthcare services in Wales; however, research of the day-to-day performance of social prescribers is limited. This study aimed to explore which roles are perceived to be the most important and frequently used by social prescribers in Wales and compare these results to reports in studies of services in other countries in order to support future role development and potential standardisation.Methods:This study used the Group Concept Mapping via the Concept Systems Global Max™ software to collect and analyse all data from both participants and literature.Results:There was a total of 101 statements generated (119 participants, 84 literature) ranging from generic interpersonal skills to specialised training (cognitive behavioural therapy). These statements were then sorted by conceptual similarity into seven clusters (Providing a Specialist Service, Working in a person-centred way, Skills, Connecting Clients with Community, Collaborative Working, Evaluating and postprogramme duties, and Networking/Community). Statements were rated based on their perceived importance and frequency, with the ‘Skills’ cluster having the highest overall average and ‘Providing a Specialist Service’ having the lowest.Conclusions:Reports indicate that in general there is variation in the roles performed by individual participants in Wales; however, greater variation was observed between participants and literature suggesting geographical divergence in practice. In the top 12 highest rated statements for both frequency and importance, individualistic traits such as empathy and ‘being a listener’ are favoured over specialised methods such as cognitive behavioural therapy and behaviour change taxonomy. Results suggest that local need plays a part in the choices and performance of social prescribers and as such should be considered in future standardisation.

Improving Person-Centred Leadership: A Qualitative Study of Ward Managers' Experiences During the COVID-19 Crisis.

PurposeIn order to provide guidance and prepare ward managers for future crisis situations similar to the COVID-19 pandemic, the aim of this study was to reflect and learn how person-centred nursing leadership may be strengthened in such situations.BackgroundThe pandemic has forced nurse leaders to face new challenges. Knowledge about their experiences may contribute to advancing leadership practices in times of future crises.MethodsA qualitative directed content analysis was chosen. The theoretical perspective was person-centred leadership. Thirteen ward managers from a Danish university hospital were included and interviewed using telephone interviews three months after the first national COVID-19 case was confirmed.FindingsThe main findings of the study revealed that the ward managers often experienced a lack of timely, relevant information, involvement in decision-making and acknowledgement from the head nurse of department and the executive management. This was caused by the existing organizational cultures and the traditional hierarchy of communication. This meant that the ward managers' sense of own competences and leadership values and beliefs came under high pressure when they had to balance different stakeholders' needs.ConclusionWhen the experience of ward managers results in them being unable to lead authentically and competently in a crisis like the COVID-19 pandemic, lack of engagement can occur, with serious consequences for patients, staff and the ward managers themselves. Traditional organizational cultures that are hierarchical and controlling needs to be challenged and reoriented towards collaborative, inclusive and participative practices of engagement and involvement. Leadership development must be an established and integrated component of organizations, so that ward managers are able to sustain person-centred ways of being and doing in times of crisis.

The image of the tree: Indigenous thinking about psychotic functioning

Three decades of listening to people suffering from psychosis is crystallised in the image of the tree. This narrative about mental health, in general, and psychotic symptomology, in particular, was created for daily therapeutic work in residential psychiatry. It is a person-centred and strength-oriented way of looking at the existential impact of psychologically alienating experiences. Although indigenously unique, the author believes the image is universal and can serve many.

From clinical reasoning to ehealth interventions; a study on how nurses asses care and ehealth in home care

The assessment of care in homecare today is complex. Nurses have to decide on care for clients with multiple health problems. Technological innovations promise solutions for support of self-management of older people. We do not know, however, how and when nurses assess eHealth. A qualitative study design was used, in which 43 homecare nurses participated in focus groups and think aloud interviews. The study shows that nurses believe a trusting relationship necessary in order to suggest eHealth interventions. Nurses say they need home visits for the assessment of eHealth. Nurses also have some strong opinions on eHealth, like the notion that eHealth isn't a fitting option for frail older people. It becomes clear that nurses need to see eHealth interventions fit for clients in a person-centred way and in close connection to health problems they've prioritised in order to assess it. Implications for practice and further research are to focus on how nurses can be convinced to assess and use eHealth in a person-centred way and how to discuss this with their clients. Next to that training and a tool that provides up to date information linked to frequently seen health problems are recommended.

Perspectives on activities in nursing homes

Abstract Introduction: Access to meaningful activities is an indicator of quality of nursing homes, and contributes to wellbeing and dignity. Lack of activities can lead to boredom, apathy, disruptive behaviour or lack of confidence or meaning. Recent inspections undertaken by the authorities in nursing homes in Norway show lack of activity provision, which is in line with research. This indicates that the government’s policy and new regulations to increase the level of activities in nursing homes has not succeeded, probably related to challenges in developing care practices. However, nursing homes should strive to incorporate meaningful activities for residents to occupy their time and provide a sense of purpose. Few studies have discussed the meaning of activities as well as the challenges in developing a practice focused on activities. Therefore, we want to point out some important perspectives which policy makers, researchers and practitioners can reflect on. Aims: A scoping study was undertaken to discuss what constitutes meaningful activities as well as the opportunities to develop a person-centred practice focused on activities. Conclusions and implications for practice development: The understanding of activities in a residential nursing home setting needs to be reconsidered, broadened and further developed. For example, what most people might recognize to be passive activity, may be interpreted by nursing home residents as an activity. Activities must be person-centred recognising and accepting individuals wishes. The goal is to transform practice cultures to enable person-centred ways of working.