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Stewart V, McMillan SS, Hu J, Collins JC, El‐Den S, O'Reilly C, Wheeler AJ. Experiences of goal planning in Australian community pharmacy settings for people experiencing mental illness: A qualitative study. Health Expect 2023; 26:2205-2215. [PMID: 37424358 PMCID: PMC10632654 DOI: 10.1111/hex.13818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/19/2023] [Accepted: 06/30/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Person-centred goal planning is increasingly being incorporated into healthcare interventions. People experiencing severe and persistent mental illnesses (SPMIs) have high levels of co-occurring health conditions, reducing their life expectancy when compared with the general population. As medications are commonly used in the treatment of SPMIs, community pharmacists are well-placed to support the health and wellbeing of this population. OBJECTIVES To examine pharmacists' and service users' experiences of goal planning as a component of a community pharmacy-based health intervention for people experiencing SPMIs (PharMIbridge intervention). METHODS This study utilised a qualitative exploratory approach with an interpretive description method. Semistructured interviews were undertaken with community pharmacists (n = 16) and service user participants (n = 26) who had participated in pharmacist support services for people experiencing SPMIs (PharMIbridge intervention). RESULTS Four themes relating to goal planning were identified. First, goal planning provided purpose and motivation for participation in the intervention. Planning realistic goals was important but often challenging. Both pharmacists and service users highlighted the relational aspects of goal planning and how strong relationships supported positive behaviour change and outcomes. Finally, individualised and flexible approaches were important aspects of the intervention, ensuring goals were meaningful to service users. CONCLUSIONS The findings from this study identified positive outcomes from the inclusion of goal-planning processes in a community pharmacy-based health intervention. Further research regarding tools, strategies or training that could support future goal-planning interventions in primary healthcare is needed. PATIENT OR PUBLIC CONTRIBUTION The PharMIbridge randomised controlled trial research team included lived experience members and was overseen by an expert panel that included members with a lived experience of mental illness and representatives from key organisations. The training provided to pharmacists was co-designed and co-delivered by the researchers and lived experience representatives, and pharmacists were supported by lived experience mentors. Service user participants were invited to participate in the interviews through a number of pathways (e.g., at the completion of the intervention, flyers). Those interested were provided with the full study participant information and provided with a $30 gift voucher at the conclusion of the interview.
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Affiliation(s)
- Victoria Stewart
- Centre for Mental HealthGriffith UniversityNathanAustralia
- Menzies Health Institute QueenslandGriffith UniversityNathanAustralia
- School of Pharmacy and Medical SciencesGriffith UniversityNathanAustralia
| | - Sara S. McMillan
- Centre for Mental HealthGriffith UniversityNathanAustralia
- Menzies Health Institute QueenslandGriffith UniversityNathanAustralia
- School of Pharmacy and Medical SciencesGriffith UniversityNathanAustralia
| | - Jie Hu
- School of Pharmacy and Medical SciencesGriffith UniversityNathanAustralia
| | - Jack C. Collins
- Faculty of Medicine and HealthThe University of Sydney School of Pharmacy, The University of SydneyCamperdownNew South WalesAustralia
| | - Sarira El‐Den
- Faculty of Medicine and HealthThe University of Sydney School of Pharmacy, The University of SydneyCamperdownNew South WalesAustralia
| | - Claire O'Reilly
- Faculty of Medicine and HealthThe University of Sydney School of Pharmacy, The University of SydneyCamperdownNew South WalesAustralia
| | - Amanda J. Wheeler
- Menzies Health Institute QueenslandGriffith UniversityNathanAustralia
- School of Pharmacy and Medical SciencesGriffith UniversityNathanAustralia
- School of Pharmacy, Faculty of Health and Behavioural SciencesUniversity of AucklandAucklandNew Zealand
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Kime N, Wright A, Heaven A, Hawkins R, Smith J, Cundill B, Foy R, Lawton R, Farrin A, Hulme C, Clegg A. Implementing personalised care planning for older people with frailty: a process evaluation of the PROSPER feasibility trial. BMC Geriatr 2022; 22:760. [PMID: 36114521 PMCID: PMC9479257 DOI: 10.1186/s12877-022-03426-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022] Open
Abstract
Background Personalised Care Planning (PCP) is a collaborative approach used in the management of chronic conditions. Core components of PCP are shared decision making to achieve joint goal setting and action planning by the clinician and patient. We undertook a process evaluation within the PROSPER feasibility trial to understand how best to implement PCP for older people with frailty in the community. Methods The trial was set in two localities in England. We observed training sessions and intervention delivery at three time points during the 12-week intervention period. We interviewed delivery teams before, during and after the intervention period, as well as primary care staff. We interviewed older people who had received, declined or withdrawn from PCP. We explored training of staff delivering PCP, structures, mechanisms and resources needed for delivery, and influences on uptake. We undertook a framework approach to data analysis. Findings We observed thirteen training sessions and interviewed seven delivery staff, five primary care staff, and twenty older people, including seven who had declined or withdrawn from the intervention. Delivery teams successfully acquired skills and knowledge, but felt underprepared for working with people with lower levels of frailty. Timing of training was critical and ‘top-ups’ were needed. Engagement with primary care staff was tenuous. Older people with lower frailty were unclear of the intervention purpose and benefits, goal setting and action planning. Conclusions PCP has the potential to address the individualised needs of older people with frailty. However, training requires careful tailoring and is ideally on-going. Considerable efforts are required to integrate statutory and voluntary stakeholders, understanding the expectations and contributions of each agency from the outset. In addition, older people with frailty need time and support to adjust to new ways of thinking about their own health now and in the future so they can participate in shared decision making. These key factors will be essential when developing models of care for delivering PCP to support older people with frailty to sustain their independence and quality of life. Trial registration ISRCTN 12,363,970 – 08/11/2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03426-4.
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Kolanowski A, Zhu S, Van Haitsma K, Resnick B, Boltz M, Galik E, Behrens L, Eshraghi K, Ellis J. 12-month trajectory and predictors of affect balance in nursing home residents living with dementia. Aging Ment Health 2022; 26:1686-1692. [PMID: 34253099 PMCID: PMC8752645 DOI: 10.1080/13607863.2021.1947964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/15/2021] [Indexed: 10/20/2022]
Abstract
Objectives:Emotional expressions in late-stage dementia have traditionally been studied within a deficit paradigm. Moving the narrative of the dementia trajectory from a solely negative pathological experience to one that acknowledges the potential for positive experiences aligns with international recommendations for living well with dementia. The purpose of this study was to extend prior research by examining the pattern of well-being using affect balance, the ratio of positive to negative affect, in nursing home residents living with dementia over 12 months and its association to factors that could potentially influence resident well-being.Method:This study was a secondary analysis of baseline, 4 and 12-month data from a pragmatic clinical trial. A total of 536 residents with moderate to severe cognitive impairments from 55 nursing homes were included in the multivariable linear mixed model regression analyses.Results:Resident function, the number of registered nurse hours devoted to care in the facility, and the quality of staff interaction predicted higher affect balance over time after controlling for other variables.Conclusion:The findings provide support for the utility of affect balance as a meaningful outcome measure of well-being for persons living with dementia. In addition, results point to specific interventions (i.e. maintaining/improving resident function, providing adequate nurse staffing levels, and improving staff communications skills) that can serve as the focus for both research and practice to help residents live well with dementia. Clinicaltrials.gov (NCT03014570).
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Affiliation(s)
- Ann Kolanowski
- Professor Emerita, College of Nursing, Penn State, University Park, Pa. 16802
| | - Shijun Zhu
- Associate Professor & Statistician, University of Maryland School of Nursing, 655 West Lombard Street, Suite 402K, Baltimore, MD 21201
| | | | - Barbara Resnick
- Sonya Ziporkin Gershowitz Chair in Gerontology, School of Nursing, University of Maryland, Baltimore MD 21218
| | - Marie Boltz
- Professor and Elouise Ross Eberly and Robert Eberly Endowed Chair, College of Nursing, Penn State, University Park, Pa. 16802
| | - Elizabeth Galik
- Professor, School of Nursing, University of Maryland, Baltimore MD 21218
| | - Liza Behrens
- Project Director, College of Nursing, Penn State, University Park, Pa. 16802
| | - Karen Eshraghi
- Project Director, College of Nursing, Penn State, University Park, Pa. 16802
| | - Jeanette Ellis
- Project Director, School of Nursing, University of Maryland, Baltimore MD 21218
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Allerby K, Goulding A, Ali L, Waern M. Increasing person-centeredness in psychosis inpatient care: staff experiences from the Person-Centered Psychosis Care (PCPC) project. BMC Health Serv Res 2022; 22:596. [PMID: 35505358 PMCID: PMC9066767 DOI: 10.1186/s12913-022-08008-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/28/2022] [Indexed: 01/14/2023] Open
Abstract
Background Interventions to increase person-centeredness in hospital care for persons with psychotic illness are needed. Changing care delivery is however a complex venture, requiring staff to reconsider their mindsets and ways of working. A multidisciplinary educational intervention for hospital staff at four wards was launched to increase person-centeredness in the care of patients with schizophrenia and similar psychoses. This study aims to explore staff experiences of working to increase person-centeredness. Methods A heterogenic sample of staff (n = 23) from all participating wards were recruited for six focus group interviews. Semi-structured questions covered staff perceptions of person-centered care and the process of increasing person-centeredness. Transcribed data was analyzed using thematic analysis according to Braun and Clarke. Results Staff viewed person-centered care as an approach rather than a method. They described central aspects of person-centered care, such as recognizing the patient as a capable person who can participate in her/his care. Statements further showed how these core features were put into practice. Changes related to the intervention were presented in terms of evolving patient and staff roles, improved contact with patients, more flexible care routines, and a more positive ward climate. Neither psychotic symptoms nor involuntary status were considered barriers for person-centered care, but organizational factors beyond staff control seemed to impact on implementation. Conclusions After implementation, participants displayed good understanding of the core concepts of person-centered care in both thinking and action. They attributed several improvements in the care milieu to an increased level of person-centeredness. Psychotic behavior and involuntary treatment did not present major barriers to person-centered care. Findings suggest person-centered care is feasible in the psychosis inpatient setting and could improve quality of care. Trial registration The study is part of a larger study evaluating the intervention Person-Centered Psychosis Care (PCPC). It was registered retrospectively at clinicaltrials.gov, identifier NCT03182283.
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Affiliation(s)
- K Allerby
- Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 15, 41345, Gothenburg, Sweden. .,Region Västra Götaland, Psychosis Department, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden. .,Institute of Health Care Sciences, Centre for Person-Centered Care, Sahlgrenska Academy, University of Gothenburg, Box 100, 40530, Gothenburg, Sweden.
| | - A Goulding
- Region Västra Götaland, Psychosis Department, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden
| | - L Ali
- Institute of Health Care Sciences, Centre for Person-Centered Care, Sahlgrenska Academy, University of Gothenburg, Box 100, 40530, Gothenburg, Sweden.,Region Västra Götaland, Psychiatry Department, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden
| | - M Waern
- Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 15, 41345, Gothenburg, Sweden.,Region Västra Götaland, Psychosis Department, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden.,Institute of Health Care Sciences, Centre for Person-Centered Care, Sahlgrenska Academy, University of Gothenburg, Box 100, 40530, Gothenburg, Sweden
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"I see your punitive measure and I raise you a person-centered bar": Supervisory Strategies to Promote Adoption of Person-Centered Care. Community Ment Health J 2021; 57:1595-1603. [PMID: 33566270 PMCID: PMC8353014 DOI: 10.1007/s10597-021-00783-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
Person-centered care remains a high priority within community mental health services. Clinical supervision is an embedded resource for professional development and promotion of high quality care. This study examined supervisory strategies during the implementation of person-centered care planning (PCCP) across two northeastern US States. A criterion sample of supervisor-provider teams participated in qualitative interviews (N = 34) and direct observation from 2016 to 2017. Modified grounded theory analyses were conducted and three supervisory strategies were identified. Supervisory attunement to providers (knowing their audience), active collaborative engagement with providers (practicing together), and infusing reminders and opportunities for feedback (chipping away) were critical strategies to engage providers in adopting PCCP. These strategies changed providers' practice patterns by improving supervisors' calibration to dynamic contextual and individual needs during implementation and communicating supervisors' expectations of PCCP enactment. Workplace-based clinical supervision holds promise as a key intervention point to embed high quality care.
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Stanhope V, Baslock D, Tondora J, Jessell L, Ross AM, Marcus SC. Developing a Tool to Measure Person-Centered Care in Service Planning. Front Psychiatry 2021; 12:681597. [PMID: 34408678 PMCID: PMC8365091 DOI: 10.3389/fpsyt.2021.681597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Delivering person-centered care is a key component of health care reform. Despite widespread endorsement, medical and behavioral health settings struggle to specify and measure person-centered care objectively. This study presents the validity and reliability of the Person-Centered Care Planning Assessment Measure (PCCP-AM), an objective measure of the extent to which service planning is person-centered. Methods: Based upon the recovery-oriented practice of person-centered care planning, the 10-item PCCP-AM tool rates service plans on the inclusion of service user strengths, personal life goals, natural supports, self-directed actions and the promotion of community integration. As part of a large randomized controlled trial of person-centered care planning, service plans completed by community mental health clinic providers were rated using the PCCP-AM. Reliability was tested by calculating inter-rater reliability across 168 plans and internal consistency across 798 plans. To test concurrent validity, PCCP-AM scores for 84 plans were compared to expert rater scores on a separate instrument. Results: Interrater reliability for each of the 10 PCCP-AM items as measured by Kendall's W ranged from W = 0.77 to W = 0.89 and percent of scores within ± 1 point of each other ranged from 85.7 to 100%. Overall internal consistency as measured by Cronbach's alpha across 798 plans was α = 0.72. Concurrent validity as measured by Kendall's W ranged from W = 0.55 to W = 0.74 and percent of item scores within ± 1 point of expert rater scores ranged from 73.8 to 86.8%. Conclusions: Findings demonstrated that the 10-item PCCP-AM was a valid and reliable objective measure of person-centered care. Using the service plan as an indicator of multiple domains of person-centered care, the measure provides a valuable tool to inform clinical supervision and quality improvement across programs. More psychometric testing is needed to strengthen the measure for research purposes.
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Affiliation(s)
- Victoria Stanhope
- Silver School of Social Work, New York University, New York, NY, United States
| | - Daniel Baslock
- Silver School of Social Work, New York University, New York, NY, United States
| | - Janis Tondora
- Program of Recovery and Community Health, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Lauren Jessell
- Silver School of Social Work, New York University, New York, NY, United States
| | - Abigail M Ross
- Graduate School of Service, Fordham University, New York, NY, United States
| | - Steven C Marcus
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, United States
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Kuipers SJ, Nieboer AP, Cramm JM. Easier Said Than Done: Healthcare Professionals' Barriers to the Provision of Patient-Centered Primary Care to Patients with Multimorbidity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116057. [PMID: 34199866 PMCID: PMC8200113 DOI: 10.3390/ijerph18116057] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 12/18/2022]
Abstract
Patient-centered care (PCC) has the potential to entail tailored primary care delivery according to the needs of patients with multimorbidity (two or more co-existing chronic conditions). To make primary care for these patients more patient centered, insight on healthcare professionals’ perceived PCC implementation barriers is needed. In this study, healthcare professionals’ perceived barriers to primary PCC delivery to patients with multimorbidity were investigated using a constructivist qualitative design based on semi-structured interviews with nine general and nurse practitioners from seven general practices in the Netherlands. Purposive sampling was used, and the interview content was analyzed to generate themes representing experienced barriers. Barriers were identified in all eight PCC dimensions (patient preferences, information and education, access to care, physical comfort, emotional support, family and friends, continuity and transition, and coordination of care). They include difficulties achieving mutual understanding between patients and healthcare professionals, professionals’ lack of training and education in new skills, data protection laws that impede adequate documentation and information sharing, time pressure, and conflicting financial incentives. These barriers pose true challenges to effective, sustainable PCC implementation at the patient, organizational, and national levels. Further improvement of primary care delivery to patients with multimorbidity is needed to overcome these barriers.
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Perception of Recovery Orientation as a Predictor of Clinician Turnover in Community Mental Health Clinics. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:79-87. [PMID: 33956268 DOI: 10.1007/s10488-021-01142-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
Turnover in community mental health clinics threaten the delivery of quality behavioral health services; recovery orientation has been shown to be associated with lower levels of burnout but its relationship with actual turnover has not yet been examined. This study aimed to examine the relationship between provider perceptions of recovery orientation and 12-month turnover status among community mental health providers. Secondary data analyses were conducted with data collected from 224 community mental health providers from ten organizations across 14 clinic sites participating in a larger effectiveness-implementation trial. Chi square analyses were used to examine between-site variation in 1-year turnover rates among the ten organizations. Logistic regression was used to examine effects of perceptions of recovery orientation along with known predictors of turnover among community mental health providers. Results revealed no between-site variation in organizational turnover rates. The logistic regression model was statistically significant, χ2(17) = 47.64, p < .0001 and explaining 30% (Nagelkerke R2) of within-site variance and correctly classifying 79% of cases. Perceptions of recovery orientation emerged as the sole significant predictor of 12-month turnover status, with higher levels of recovery orientation significantly associated with lower odds of turnover at 12 months [B = .90, p = .008, OR 2.47 (95% CI 1.23, 4.82)]. Perceptions of recovery orientation was protective against 12-month turnover status suggesting that a more person-centered and empowering approach to care may improve the provider experience. More research is needed to further understand how recovery orientation can contribute to workforce stability.
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Tiainen M, Suominen T, Koivula M. Nursing professionals' experiences of person-centred practices in hospital settings. Scand J Caring Sci 2020; 35:1104-1113. [PMID: 33155712 DOI: 10.1111/scs.12925] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/31/2020] [Accepted: 10/05/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Person-centred culture has been studied very little in Scandinavian Countries, yet it significantly affects in the care experiences of patients and staff. Current research indicates there are many factors restricting or enabling person-centred care in the hospital setting. AIM The purpose of this study was to describe person-centred practice in hospital settings and the factors associated with it. METHOD Data were collected from nursing professionals (N = 276) in a purposefully selected city hospital in one hospital district in Finland. The professionals worked in inpatient wards that had the average duration of treatment period more than one day. The Person-Centred Practice Inventory-Staff (PCPI-S) instrument was used to obtain data via an electronic questionnaire. Data were analysed statistically. RESULTS A 30% response rate was achieved (n = 82). Person-centred practice was described in positive ways. Nursing professionals' assessments of the implementation of person-centred practice were fairly positive, prerequisites (mean = 3.93, SD = 0.40), the care environment (mean = 3.64, SD = 0.50) and the care process (mean = 3.98, SD = 0.42). There were a few background factors such as the nursing professionals' age, job title, work experience in current unit, employment relationship and the number of nursing professionals in the ward that were associated with how they assessed the prerequisites of person-centred practice. Nursing professionals' demographic variables such as their job title and working experience in nursing associated with how they assessed the implementation of person-centredness in the care environment and the care process. CONCLUSIONS Nursing professionals have the ability to implement person-centred practice. However, newly graduated or less experienced nursing professionals need support to explore person-centredness in their work.
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Affiliation(s)
- Minna Tiainen
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
| | - Tarja Suominen
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
| | - Meeri Koivula
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
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Sefcik JS, Madrigal C, Heid AR, Molony SL, Van Haitsma K, Best I, Resnick B, Galik E, Boltz M, Kolanowski A. Person-Centered Care Plans for Nursing Home Residents With Behavioral and Psychological Symptoms of Dementia. J Gerontol Nurs 2020; 46:17-27. [PMID: 33095889 PMCID: PMC8274316 DOI: 10.3928/00989134-20201012-03] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/23/2020] [Indexed: 11/20/2022]
Abstract
Little literature exists examining the development and implementation of person-centered care (PCC) plans focused on behavioral and psychological symptoms of dementia (BPSD). The current study aimed to describe BPSD documented in nursing home (NH) residents' care plans, the types of approaches staff document in addressing those symptoms, and whether resident and/or facility characteristics are associated with documentation of PCC approaches. The sample included 553 residents from 55 NHs in two East Coast states. Resistiveness to care (44.9%), agitation (42.2%), and aggression (42%) were most frequently documented in care plans. PCC approaches were documented in care plans in 21.3% to 62.7% of cases depending on BPSD type. Resident (e.g., younger age, lower functional ability, lower cognitive ability, longer length of stay, male gender) and facility (e.g., less certified nursing assistant staffing hours, greater percentage of residents taking antipsychotic medications, non-profit status) characteristics were associated with increased odds of PCC approaches being documented. Optimal PCC planning is discussed, and a sample PCC plan is provided. [Journal of Gerontological Nursing, 46(11), 17-27.].
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Resnick B, Kolanowski A, Van Haitsma K, Galik E, Boltz M, Ellis J, Behrens L, Eshraghi K, Viviano N, Madrigal C. Reliability and Validity of the Knowledge of Person-Centered Behavioral Approaches for BPSD Test. J Nurs Meas 2020; 28:472-488. [PMID: 33067367 DOI: 10.1891/jnm-d-19-00016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to test the reliability and validity of the Knowledge of Person-Centered Behavioral Approaches for BPSD based on a Rasch analysis. METHODS This study used baseline data from the Implementation of the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) clinical trial. RESULTS A total 1,071 nurses completed the test. There was evidence of reliability (alpha coefficient of .99), construct validity with INFIT and OUTFIT statistics in the .6 to 1.4 range, and hypothesis testing with a significant correlation between the Knowledge of Person-Centered Behavioral Approaches for BPSD and positive care interactions. CONCLUSIONS Future use of the measure should include more challenging items to differentiate those very high in knowledge of person-centered behavioral approaches for BPSD.
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Affiliation(s)
| | - Ann Kolanowski
- Pennsylvania State University College of Nursing, University Park, PA
| | | | | | - Marie Boltz
- Pennsylvania State University College of Nursing, University Park, PA
| | | | - Liza Behrens
- Pennsylvania State University College of Nursing, University Park, PA
| | - Karen Eshraghi
- Pennsylvania State University College of Nursing, University Park, PA
| | | | - Caroline Madrigal
- Pennsylvania State University College of Nursing, University Park, PA
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Kolanowski A, Behrens L, Lehman E, Oravecz Z, Resnick B, Boltz M, Van Haitsma K, Galik E, Ellis J, Eshraghi K. Living Well With Dementia: Factors Associated With Nursing Home Residents' Affect Balance. Res Gerontol Nurs 2020; 13:21-30. [PMID: 31454406 PMCID: PMC6980972 DOI: 10.3928/19404921-20190823-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/29/2019] [Indexed: 11/20/2022]
Abstract
Well-being is an important outcome for people with dementia. The current study is a secondary analysis of baseline data from an ongoing pragmatic trial. Affect balance, the ratio of positive to negative affect, was used as a measure of well-being, and factors related to it were examined in a sample of 325 nursing home residents. Measures of staff interaction during caregiving, staff knowledge of person-centered approaches for dementia care, staff hours of care, the physical environment, person-centered policies, resident function, and quality of life were obtained using direct observation, staff interview, and medical chart review. The results of the quantile multivariable regression analysis indicated that positive staff interaction and higher resident function were significantly associated with higher affect balance after controlling for other variables. The findings have heuristic value for the development of conceptual frameworks that focus on meaningful outcomes for residents with dementia and future research. [Research in Gerontological Nursing, 13(1), 21-30.].
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Doherty M, Bond L, Jessell L, Tennille J, Stanhope V. Transitioning to Person-Centered Care: a Qualitative Study of Provider Perspectives. J Behav Health Serv Res 2019; 47:399-408. [PMID: 31820326 PMCID: PMC9017674 DOI: 10.1007/s11414-019-09684-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Meredith Doherty
- LCSW CUNY Graduate Center/Silberman School of Social Work, Hunter College, 2180 Third Avenue, New York, NY, 10035, USA.
| | - Lynden Bond
- Silver School of Social Work, New York University, New York, USA
| | - Lauren Jessell
- Silver School of Social Work, New York University, New York, USA
| | - Julie Tennille
- Graduate Social Work Department, West Chester University of Pennsylvania, West Chester, USA
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Rahman R, Matthews EB, Ahmad A, Rizvi SM, Salama U, Samad L, Khan M. Perceptions of patient-centred care among providers and patients in the orthopaedic department of a tertiary care hospital in Karachi, Pakistan. J Eval Clin Pract 2019; 25:1160-1168. [PMID: 31334911 DOI: 10.1111/jep.13242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/08/2019] [Accepted: 07/12/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined the perspectives of 18 health care providers (nurses, consultant doctors, residents, radiologists, and physiotherapists) and 18 patients regarding best practices for patient-centred care (PCC) in a free private hospital in Pakistan, studying the congruence between provider and patient perspectives. METHODS Six focus group interviews (FGIs) were conducted from January to March 2017: three with providers and three with patients. Focus group interviews were audio-recorded and transcribed verbatim. A deductive approach was used to analyse the data using the key dimensions of Scholl's framework, which was then complemented with constant comparison analysis to explore variability and similarity among participants across the six focus groups. RESULTS Findings indicated that providers and patients acknowledged maintaining a collaborative relationship with patients by using empathy. Patients and providers agreed that providers allocated time to counsel the patient and alleviated their fears. Family involvement was seen as a key indicator in decision making for patients. Some discrepancies were found between patient and provider perceptions of inhibitors to PCC, notably a lack of teamwork exhibited by providers and continuity of care offered postdischarge. CONCLUSIONS We recommend practices of PCC that are congruent with non-Western settings where religion and family play a primary role in matters dealing with patients' illnesses. Our findings suggest the need for recurrent training to improve teamwork among providers; questioning the implicit agreement of patients who may be vulnerable to decision making of authoritarian figures in their family; and the inclusion of peer-support workers or community health workers to offer aftercare support to patients in their home.
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Affiliation(s)
- Rahbel Rahman
- Graduate School of Social Service, Fordham University, 113 West 60th Street, New York, New York
| | - Elizabeth B Matthews
- Graduate School of Social Service, Fordham University, 113 West 60th Street, New York, New York
| | - Alizeh Ahmad
- Indus Health Network, Plot C-76, Sector 31/5, Opposite Darussalam Society, Korangi Crossing, Karachi, 75190, Pakistan
| | - Syeda Mahnoor Rizvi
- Indus Health Network, Plot C-76, Sector 31/5, Opposite Darussalam Society, Korangi Crossing, Karachi, 75190, Pakistan
| | - Umme Salama
- Indus Health Network, Plot C-76, Sector 31/5, Opposite Darussalam Society, Korangi Crossing, Karachi, 75190, Pakistan
| | - Lubna Samad
- Indus Health Network, Plot C-76, Sector 31/5, Opposite Darussalam Society, Korangi Crossing, Karachi, 75190, Pakistan
| | - Mansoor Khan
- Orthopaedics Department, The Indus Hospital, Plot C-76, Sector 31/5, Opposite Darussalam Society, Korangi Crossing, Karachi, 75190, Pakistan
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Stanhope V, Ross A, Choy-Brown M, Jessell L. A Mixed Methods Study of Organizational Readiness for Change and Leadership During a Training Initiative Within Community Mental Health Clinics. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 46:678-687. [PMID: 31218480 PMCID: PMC6689447 DOI: 10.1007/s10488-019-00946-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This longitudinal mixed-methods study explored variation in organizational readiness for change and leadership behavior across seven organizations during a 12-month training initiative in person-centered care planning. Quantitative data was used to examine trajectories of organizational readiness for change and leadership behavior over time and qualitative data explored provider perspectives on the trajectory of these organizational factors during the 12-month training initiative. Findings indicated that levels of organizational readiness for change and leadership behavior varied across clinics, but most experienced a significant positive change at the mid-point of the training. Organizational readiness for change was positively correlated with leaderships behaviors across time. Provider focus group findings gave insight into their initial resistance to adopting the new practice and their increasing receptivity in the second 6 months due to increased understanding of the practice and leadership endorsement. Increasing provider openness to a new practice prior to training and having a consistently engaged leadership have the potential to improve the efficiency of a training initiative.
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Affiliation(s)
- Victoria Stanhope
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA.
| | - Abigail Ross
- Graduate School of Social Service, Fordham University, New York, USA
| | - Mimi Choy-Brown
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
- School of Social Work, University of Minnesota, Minneapolis, USA
| | - Lauren Jessell
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
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Hower KI, Vennedey V, Hillen HA, Kuntz L, Stock S, Pfaff H, Ansmann L. Implementation of patient-centred care: which organisational determinants matter from decision maker's perspective? Results from a qualitative interview study across various health and social care organisations. BMJ Open 2019; 9:e027591. [PMID: 30940764 PMCID: PMC6500213 DOI: 10.1136/bmjopen-2018-027591] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Health and social care systems, organisations and providers are under pressure to organise care around patients' needs with constrained resources. To implement patient-centred care (PCC) successfully, barriers must be addressed. Up to now, there has been a lack of comprehensive investigations on possible determinants of PCC across various health and social care organisations (HSCOs). Our qualitative study examines determinants of PCC implementation from decision makers' perspectives across diverse HSCOs. DESIGN Qualitative study of n=24 participants in n=20 semistructured face-to-face interviews conducted from August 2017 to May 2018. SETTING AND PARTICIPANTS Decision makers were recruited from multiple HSCOs in the region of the city of Cologne, Germany, based on a maximum variation sampling strategy varying by HSCOs types. OUTCOMES The qualitative interviews were analysed using an inductive and deductive approach according to qualitative content analysis. The Consolidated Framework for Implementation Research was used to conceptualise determinants of PCC. RESULTS Decision makers identified similar determinants facilitating or obstructing the implementation of PCC in their organisational contexts. Several determinants at the HSCO's inner setting and the individual level (eg, communication among staff and well-being of employees) were identified as crucial to overcome constrained financial, human and material resources in order to deliver PCC. CONCLUSIONS The results can help to foster the implementation of PCC in various HSCOs contexts. We identified possible starting points for initiating the tailoring of interventions and implementation strategies and the redesign of HSCOs towards more patient-centredness.
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Affiliation(s)
- Kira Isabel Hower
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Vera Vennedey
- Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne (AöR), Cologne, Germany
| | - Hendrik Ansgar Hillen
- Department of Business Administration and Health Care Management, University of Cologne, Cologne, Germany
| | - Ludwig Kuntz
- Department of Business Administration and Health Care Management, University of Cologne, Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne (AöR), Cologne, Germany
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Lena Ansmann
- Department of Health Services Research, Faculty of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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