Person-centered care practices in nursing homes: Staff perceptions and the organizational environment

Factors Promoting a Sense of Home Among Older Adults in Residential Care Facilities in Italy

Understanding the housing needs of older adults is crucial for policy makers, service providers, and professional carers. Evidence about the factors that contribute to older adults' "sense of home" and their practical and policies implications are lacking. Semi-structured interviews were conducted with 78 community-dwelling older adults to investigate which structural and organizational requirements and relational-affective environments could contribute to their experiencing a sense of home. Through inductive content analysis 119 subcategories were derived and grouped into eight main categories: being considered as a person; a safe, quiet, welcoming, and personalizable environment; meaningful relationships; optional and stimulating activities; active involvement in the organization within the facility; competent care personnel; preserving life memories; facility open and integrated with the community. Findings suggest that multiple factors might influence "feeling at home," and many strategies can be adopted to facilitate older adults' successful adaptation. It is important that healthcare organizations consider these factors from a person-centered care perspective, and that care staff are trained in this type of care to enhance staff decision-making and older adults' wellbeing.

Nurses' Shared Subjectivity on Person-Centered Care for Behavioral and Psychological Symptoms of Dementia in Nursing Homes

BACKGROUND

Person-centered care (PCC), an approach to healthcare that focuses on the individual needs, preferences, and values of patients, is particularly important in the context of caring for residents of nursing homes (NHs) with the behavioral and psychological symptoms of dementia (BPSD). However, implementing PCC in NHs varies widely due to individual staff, NH environment, and country factors, leading to heterogeneity in person-centered approaches.

PURPOSE

This study was designed to explore and gain insight into the shared subjective perspectives of nurses on providing PCC to manage BPSD in NHs in order to elicit a deeper understanding of how nurses interpret and approach the provision of PCC.

METHODS

Q methodology was applied to explore the subjective perspectives of nurses. Twenty-nine NH nurses with more than 3 years of experience in managing BPSD completed a Q-sorting task, categorizing 43 Q-samples into a normal distribution shape. Postsorting interviews were conducted after the participants had completed this task. The collected data were analyzed using centroid factor analysis and varimax rotation run within the PQMethod 2.35 program. Interpretation of the resulting factors was based on factor arrays, field notes, and interview data.

RESULTS

Four factors from the shared subjective perspectives of nurses related to PCC were identified, including (a) sharing information focused on details to update care strategies, (b) monitoring until the true needs of residents are identified, (c) awareness of interactive cues in relationships, and (d) connecting an individual's life pattern to their current care.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The findings highlight that a one-size-fits-all approach may not be suitable for all nurses and interventions, indicating that nurses should consider the applicable subjective frames to ensure the effectiveness of planned interventions. A need for PCC education that specifically addresses BPSD management is suggested, with the findings implying that a strong organizational climate with respect to PCC in managing BPSD should promote higher job satisfaction and commitment and reduce turnover rates among nurses in NHs. Facilitating the development of PCC interventions appropriate for BPSD management that encompass the various categories and ranges of NH settings and nursing phenomena is thus recommended.

Caregiver interactions, perceived control, and meaning in life of elderly: the moderating effect of the elderly-to-social worker ratio

BACKGROUND

Meaning in life is a widely accepted aim in promoting psychosocial health in institutional care. However, how caregiver interaction and perceived control impact meaning in life among the elderly remains unclear. This study explores the effect of institutional caregiver interaction, family caregiver interaction, and perceived control on meaning in life among elderly residents in China, and the potential moderating effect of elderly-to-social worker ratio in these associations.

METHODS

Multistage random sampling was used to recruit a sample of 452 elderly residents from 4 elderly care homes in urban China. A structural equation model was used to test the study hypothesis.

RESULTS

Institutional caregiver interaction is positively related to meaning in life, and perceived control among elderly residents has a positive impact on meaning in life. Moreover, the elderly-to-social worker ratio moderated the relationship between institutional caregiver interaction and meaning in life, as well as between family caregiver interaction and meaning in life.

CONCLUSIONS

Increase elderly's meaning in life is an important service target for the caring professions in institutional care. Social workers affect the effectiveness of interventions on elderly's meaning in life in institutional care. A higher elderly-to-social worker ratio could improve the effectiveness of interventions on meaning in life for elderly residents.

Nurses' experiences of integrating the salutogenic perspective with person-centered care for older people in Swedish nursing home care: an interview-based qualitative study

BACKGROUND

Even though there has been a cultural change within residential aged care to a more person-centered care, there remain improvements to be made for a more consistent way of working. Using a salutogenic approach along with person-centered care is a potential way to promote it. This study aimed to describe nurses' experiences of combining person-centered care with a salutogenic approach at a nursing home for older people.

METHODS

Nine nurses, specially trained in salutogenesis and Sense of coherence, were individually interviewed using a semi-structured interview approach. Data was analysed through qualitative content analysis.

RESULTS

The nurses experienced that the residential aged care was improved by using salutogenesis and Sense of coherence as a complement to person-centered care. Core aspects of person-centered care were thereby promoted, as the resources of the older persons were emphasized, and aged care became more holistic. In addition to improved residential aged care, the results indicate that this manner of working also contributed to enhanced work satisfaction of the care personnel themselves.

CONCLUSIONS

The results suggest that a salutogenic approach facilitates the implementation of person-centered care by focusing on the older persons' resources and maintaining health. The organization needs to prioritize training staff in salutogenesis and person-centered care, as it supports working toward a common goal and benefits both the older persons and the staff.

"They Don't Have Time, But It Would Be Wonderful": Residents' Views of Their Relationships With Staff

Resident-staff relationships is a component of person-centered care (PCC); positive relationships are associated with positive outcomes. The current article explores the finding that residents living in different types of long-term care assigned the lowest ratings of importance to the PCC domain "relationships with staff " (one of eight domains studied). Thematic analysis of spontaneous comments made by residents during interviews identified two themes, Relationship Preferences (for privacy, boundaries, engagement) and Lived Experience With Staff (staff busyness, staff interactions). Low ratings of relationship importance may reflect preferences for privacy and maintaining boundaries with staff. Ratings by some residents may be related to staff busyness, an overarching theme. Staff busyness was associated with lack of personal interaction with staff, including for those who expressed preferences for engagement and those who described positive interactions with staff. Some residents may reappraise their views about the importance of relationships to reduce cognitive dissonance. Improving job quality is necessary to assure quality time with residents. [Journal of Gerontological Nursing, 49(11), 8-14.].

Exploring the Relationship Between Extent of Person-Centered Care Implementation and Staffing Levels in Ohio Nursing Homes

Background: The Preferences for Everyday Living Inventory (PELI) is a person-centered care (PCC) tool that uncovers/honors older adults' important preferences. PCC implementation in nursing homes (NHs) often requires additional resources, such as staff time. We explored if PELI implementation is associated with NH staffing levels. Methods: Using NH-year as the unit of observation (n = 1307), 2015 and 2017 data from Ohio NHs was used to examine the relationship between complete versus partial PELI implementation and staffing levels, measured in hours per resident day, for various positions and total nursing staff. Results: Complete PELI implementation was associated with higher nursing staff levels in both for-profits and not-for-profits; however, total nursing staff levels in not-for-profits were higher than for-profits (0.16 vs. 0.09 hours per resident day). The specific nursing staff associated with PELI implementation varied by ownership. Discussion: For NHs to fully implement PCC, a multifaceted approach to improve staffing is needed.

Chart based data as a resource for tracking and improving a person-centred palliative approach in long-term care

AIMS AND OBJECTIVES

To enhance the practice of a person-centred palliative approach in long-term care.

BACKGROUND

Implementing a person-centred palliative approach in long-term care entails placing residents at the centre of care planning that attends to the 'whole' person, rather than prioritising biomedical needs.

DESIGN

We conducted a four-stage directed content analysis of long-term care progress notes to meet our study aims and applied the EQUATOR guidelines for qualitative research publication (COREQ).

METHODS

We qualitatively analysed 78 resident charts across three long-term care homes in southern Ontario to capture the extent to which person-centred care was absent, initiated or implemented in different types of documented care interactions.

RESULTS

Most residents had interactions related to daily care activities (65/78, 83%), social concerns (65/78, 83%) and treatment decisions (53/78, 68%). By contrast, interactions around pain and discomfort (34/78, 44%) and spirituality (27/78, 35%) were documented for less than half of the residents. Almost all (92%) residents had at least one progress note where staff initiated person-centred care by documenting their preference for a certain type of care, but only a third had at least one progress note that suggested their preference was implemented (35%).

CONCLUSIONS

While person-centred care is often initiated by nurses and other allied health professionals, changes to care plans to address resident preferences are implemented less often. Nurses and other allied health professionals should be encouraged to elicit care preferences crucial for holistic care planning and equipped with the skills and support to enact collaborative care planning.

RELEVANCE TO CLINICAL PRACTICE

Collaborative care planning appears relatively absent in charted progress notes, constraining the full implementation of a person-centred palliative approach to care.

PATIENT OR PUBLIC CONTRIBUTION

An advisory group consisting of long-term care resident and staff representatives informed the overall study design and dissemination of the results.

Portuguese Older Persons' Views about Living in a Nursing Home: Challenges to the Rehabilitation of the Image of LTC in Post-Pandemic Times

This paper addresses the broad topic of what older people think about nursing homes in Portugal. In the aftermath of the COVID-19 pandemic and considering the tragic events taking place in nursing homes, the challenge of reimagining the sector involves not only improving procedures and models of care, making sure they meet what citizens consider adequate, but also rehabilitating the image people have about nursing homes and rebuilding trust. Current and future decisions about how one meets LTC needs is influenced by the extent to which individuals see the alternatives as adequate. The paper presents evidence collected from a qualitative study run just before the COVID-19 pandemic began, with a sample of 45 community-dwelling individuals aged 60 plus, in Portugal. Opinions and views about nursing homes were collected and the results point to enduring negative aspects that are considered at odds with what constitutes adequate care. The paper discusses in length what those aspects are and concludes that future reforms of the nursing homes sector in Portugal need to consider what current and future users think and feel about that specific type of service. Debates in Portugal tend to be more focused on discussions about expanding the sector and less on aspects of quality of care. Views and opinions of interviewed participants, however, suggest that people may be more worried about quality of care.

Communication Disparities between Nursing Home Team Members

Optimal care in nursing home (NH) settings requires effective team communication. Certified nursing assistants (CNAs) interact with nursing home residents frequently, but the extent to which CNAs feel their input is valued by other team members is not known. We conducted a cross-sectional study in which we administered a communication survey within 20 Utah nursing home facilities to 650 team members, including 124 nurses and 264 CNAs. Respondents used a 4-point scale to indicate the extent to which their input is valued by other team members when reporting their concerns about nursing home residents. We used a one-way ANOVA with a Bonferroni correction. When compared to nurses, CNAs felt less valued (CNA mean = 2.14, nurse mean = 3.24; p < 0.001) when reporting to physicians, and less valued (CNA mean = 1.66, nurse mean = 2.71; p < 0.001) when reporting to pharmacists. CNAs did not feel less valued than nurses (CNA mean = 3.43, nurse mean = 3.37; p = 0.25) when reporting to other nurses. Our findings demonstrate that CNAs feel their input is not valued outside of nursing, which could impact resident care. Additional research is needed to understand the reasons for this perception and to design educational interventions to improve the culture of communication in nursing home settings.