To make and execute decisions throughout life: A person-centred model that facilitates self-determination in residential care, developed through participatory research

Relationship-Centered Care for Older Adults in Long-Term Care Homes: A Scoping Review

This scoping review, following Levac et al.'s methodology, examines the implementation and impact of relationship-centered care (RCC) in long-term care (LTC) settings for older adults. Peer-reviewed articles from AgeLine, CINAHL Complete, MEDLINE, PsycINFO, and Web of Science were included if published after 2000, involved older adults in LTC homes, focused on RCC, and conducted in Australia, Europe, New Zealand, or North America. Key findings were organized using inductive content analysis, and 41 empirical studies with qualitative, quantitative, and mixed-methods designs were included. Three categories emerged: (1) Core Practices of RCC-relationship building and reciprocal exchange; (2) Transformative Impacts of RCC-improved care quality and collaboration; and (3) Pathways and Roadblocks to RCC-individual and organizational factors. By understanding the key elements, facilitators, and barriers of RCC, policymakers and practitioners can develop targeted strategies to improve care experiences and outcomes for residents, families, staff, and all others involved in LTC.

Narrative competence disparities between Children's hospital and General hospital in China: A comparative survey

BACKGROUND

Narrative medicine was introduced in China in 2011 and has been applied as a tool for humane medical practice. The prominent problem in the narrative medicine is the lack of adequate attention and devotion. This study aimed to investigate Chinese medical staffs' narrative competence and the influencing factors, confirming whether the level of narrative competence is different in different hospital settings.

METHODS

A cross-sectional survey was conducted among 1003 medical staffs, including 201 from Children's hospital and 802 from the General hospital. The participants were scored based on the Chinese narrative competence scale, a brief Chinese version of the resilience scale, and a Chinese version of the self-efficacy scale. Data were analyzed using IBM SPSS version 25.0.

RESULTS

A total of 1003 medical staff from Children's hospital and General hospital participated in the survey, with a response rate of 94.36%. Our results showed that the score of narrative competence of General hospital and Children's hospital was 149.45±26.22 and 147.10±18.87, respectively, both of which were in intermediate level. Resilience, familiarity with narrative medicine were influencing factors of narrative competence in 2 kinds of hospitals, and whether having written parallel charts before were the influencing factors of narrative competence in General hospital. Besides, our study found that the level of narrative competence (χ2 = 13.672, p≤0.001), resilience score (personal ability dimension, t = 3.439, p≤0.001) and self-efficacy (t = 1.976, p<0.005) are different between General and Children's hospital.

CONCLUSIONS

Narrative competence is different between General hospital and Children's hospital. Medical staff in General hospital are more familiar with narrative medicine. The competence of medical staff in China needs to be improved.

Factors impacting the demonstration of relational autonomy in medical decision-making: A meta-synthesis

BACKGROUND

Relational autonomy is an alternative concept of autonomy in which an individual is recognized as embedded into society and influenced by relational factors. Social context, including social location, political structure, and social forces, significantly influence an agent to develop and exercise autonomy skills. The relational approach has been applied in clinical practice to identify relational factors impacting patient autonomy and decision-making, yet there is a knowledge gap in how these factors influence the demonstration of relational autonomy in the context of medical decisions of adults.

OBJECTIVE

The present study targeted the existing knowledge of what and how relational factors impact individuals making medical decisions using the theoretical framework of relational autonomy.

METHODS

A meta-synthesis study was utilized. Four electronic databases, including Embase, OVID Medline, CINAHL, and PubMed, were searched, along with gray literature and reference lists, to identify relevant studies.

RESULTS

23 studies reporting 21 qualitative and two mixed-method studies were reviewed. Four themes emerged from the qualitative findings: (1) supportive relationships facilitate an individual's relational autonomy; (2) obtaining comprehensive information from broader sources helps individuals exercise relational autonomy; (3) undue family pressure impedes the exercising of patient relational autonomy; and (4) healthcare providers' dominant voice hampers the demonstration of relational autonomy.

CONCLUSIONS

Applying relational autonomy to assist adults in making well-considered decisions is essential. The meta-synthesis suggests establishing a supportive relationship between individuals, healthcare providers, and family. A supportive relationship will allow healthcare providers to make judgments in line with an individual's values and wishes with the aim of promoting relational autonomy. Advance care planning was proposed as the effective solution to obtain a consensus between individuals and their families while respecting an individual's values and preferences. Furthermore, it is considered crucial for healthcare providers to appreciate an individual's values and incorporate their preferences into recommendations.

Development and psychometric properties of the Person-centered Palliative Care Nursing Instrument (PPCNI) in the Philippines

Background

Over the years, a few tools and instruments have been developed to assist in the assessment within a palliative care setting. However, many of these tools and instruments do not reflect a person-centered palliative care model.

Objective

This study aims to develop a Person-centered Palliative Care Nursing Instrument (PPCNI) in the Philippines.

Methods

An exhaustive search of the literature was conducted to develop a pool of items for the instrument. The validity of the instrument was evaluated using the content validity index (CVI), while the factor structure was assessed using exploratory factor analysis (EFA) using maximum likelihood estimation with Promax rotation. Also, the internal reliability was evaluated using Cronbach's alpha.

Results

EFA yielded three factors: 1) Caring as maintaining person's dignity (13 items), 2) caring as empowerment of person's autonomy (14 items), and 3) caring as understanding person's momentary concerns (10 items). Whereas the internal consistency reliability of these subscales appeared excellent (i.e., 0.95, 0.96, and 0.93, respectively), the Cronbach's alpha for the overall scale was 0.98. The item-total correlation coefficients were >0.30 for all items, ranging from 0.310 to 0.726.

Conclusion

Findings support a three-factor, 37-item PPCNI that can be used in clinical practice to ensure that nurses provide palliative care based on patient needs and preferences.

The application, character, and effectiveness of person-centred care with service-users, and the community within the discipline of podiatry: a scoping review

Background

The concept of person-centred care is embedded within healthcare policy, focusing on long-term conditions and multimorbidity. The evidence that person-centred care is being operationalised effectively across all areas of healthcare is limited. The aim of this scoping review was to explore the application, features, and effectiveness of person-centred care with service-users, carers, and the community within podiatry.

Methods

The scoping review was based upon Arksey and Malley’s five stage framework. The following databases were searched between January 2010 and March 2021: AMED, CINAHL, Embase, Cochrane library, SocINDEX, British Education Index, Business Source Complete, MEDLINE (EBSCO), and the EThOS 'Global electronic thesis and dissertation' repository, Prospero, and reference lists of included papers. Primary research articles were included if they reported on a person-centred care focused intervention with podiatry. Research terms were developed, appropriate databases identified, and an initial search resulted in 622 papers which, following removal of duplicates and critical appraisal, resulted in 18 eligible papers. Data extracted involved the types of person-centred care utilised, intervention details, motivations for engaging in person-centred care interventions, and intervention barriers and challenges.

Results

Eighteen articles were included in the review. The main type of person-centred care utilised was patient/carer activities around self-management. None of the studies considered the role of the podiatrist as a person-centred care agent. The data on interventions generated the following themes ‘service facilitated person-centred care’ where a change has been made to service delivery, ‘direct clinician delivery’ where the intervention is delivered by the clinician with the patient present and ‘patient instigated participation’ where patient motivation is required to engage with an activity beyond the consultation. Outcome measures associated with quality of care and effectiveness were absent.

Conclusion

There is a lack of congruency between the concept of person-centred care and how it is operationalised. A whole system approach that considers commissioning, organisational leadership, the role of the practitioners and patients has not been considered. There is immense scope for the podiatrist to play an important part in the personalised-care agenda, but currently research that can evidence the effectiveness of person-centred care in podiatry is absent.

Review registration

Open Science Framework (osf.io/egjsd).

Using Ricoeur's notions on narrative interpretation as a resource in supporting person-centredness in health and social care

This article suggests a shift in focus from stories as verbal accounts to narrative interpretation of the every day as a resource for achieving person-centred health and social care. The aim is to explore Ricoeur's notion of narrative and action, as expressed in his arguments on a threefold mimesis process, using this as a grounding for the use of narration to achieve person-centredness in health and social care practice. This focus emerged from discussions on this matter at the IPONS conference in Gothenburg, 2021. Based on philosophical resources from Ricoeur's notions of narrative and action developed in his arguments on a threefold mimesis process, we propose a wider use of stories in health and social care practices. We suggest expanding from only focusing on verbal accounts to focusing on narrative as a human way to interpret and make sense of everyday life and circumstances and to communicate possible meanings. We discuss how such complementary focus can be a resource in getting patients involved and collaborating in their health and social care and thereby help develop person-centred practices.

Complexities in Studying and Practicing Nursing-A Theoretical Elaboration Based on Reflections by Nurses and Nursing Students

The aim of this study was to explore nursing students' and clinically active nurses' experiential ideas about nursing to provide a foundation for a critical reflection on the complexities involved in studying and practicing nursing. Using a participatory approach, 9 experiential ideas about nursing as a subject, nursing practice, and being a nurse were identified and reflected upon with a total of 238 participants. This was followed by a theoretical analysis in relation to the clinical gaze in nursing and epistemology, which ends in an argument for a rediscovery of the broader Aristotelian view of knowledge in nursing education and practice.