A learning process towards person-centred care: A second-year follow-up of guideline implementation

Experiences of person-centered care for sundown syndrome among nurses and nurse aides in dementia special care units: a qualitative study

BACKGROUND

To explore the response and management experiences of nurses and nurse aides in dementia special care units when caring for residents with sundown syndrome based on the person-centered care model.

METHODS

Focus group interviews were conducted among nurses and nurse aides from four dementia special care units that have been accredited by the Ministry of Health and Welfare in Taiwan. Content analysis was used for data analysis.

RESULTS

The 29 nurses and nurse aides were recruited to participate in the study. Analysis of interview content revealed six themes, identifying the intra-individual, inter-individual, and organizational dimensions. The central topic was commitment. Under the umbrella of commitment, six themes including self-preparation, non-suppression, diversion, pacification, continuity of meeting, and collaboration, which had 18 subthemes, emerged as responsive care practices for person-centered care when supporting residents with sundown syndrome.

CONCLUSIONS

The findings provide responsive care practices based on person-centered care for people living with dementia who develop sundown syndrome. The study can inform practices for quality of care for dementia in long-term care institutions and contribute to the development of materials for nursing training and education.

Women's experience of the health information process involving a digital information tool before commencing radiation therapy for breast cancer: a deductive interview study

BACKGROUND

Individuals undergoing radiation therapy for breast cancer frequently request information before, throughout and after the treatment as a means to reduce distress. Nevertheless, the provision of information to meet individuals needs from their level of health literacy is often overlooked. Thus, individuals information needs are often unmet, leading to reports of discontent. Internet and digital information technology has significantly augmented the available information and changed the way in which persons accesses and comprehends information. As health information is no longer explicitly obtained from healthcare professionals, it is essential to examine the sequences of the health information process in general, and in relation to health literacy. This paper reports on qualitative interviews, targeting women diagnosed with breast cancer who were given access to a health information technology tool, Digi-Do, before commencing radiation therapy, during, and after treatment.

METHODS

A qualitative research design, inspired by the integrated health literacy model, was chosen to enable critical reflection by the participating women. Semi-structured interviews were conducted with 15 women with access to a digital information tool, named Digi-Do, in addition to receiving standard information (oral and written) before commencing radiation therapy, during, and after treatment. A deductive thematic analysis process was conducted.

RESULTS

The results demonstrate how knowledge, competence, and motivation influence women's experience of the health information process. Three main themes were found: Meeting interactive and personal needs by engaging with health information; Critical recognition of sources of information; and Capability to communicate comprehended health information. The findings reflect the women's experience of the four competencies: to access, understand, appraise, and apply, essential elements of the health information process.

CONCLUSIONS

We can conclude that there is a need for tailored digital information tools, such as the Digi-Do, to enable iterative access and use of reliable health information before, during and after the radiation therapy process. The Digi-Do can be seen as a valuable complement to the interpersonal communication with health care professionals, facilitating a better understanding, and enabling iterative access and use of reliable health information before, during and after the radiotherapy treatment. This enhances a sense of preparedness before treatment starts.

Occupational gaps reported by proxies for persons with dementia residing in a nursing home

BACKGROUND

In accordance with Swedish national dementia guidelines, persons with dementia residing in nursing homes should have the possibility to participate in everyday occupations. Securing choices and desires for participating in occupations is challenging due to the nature of dementia and is not evident in empirical studies regarding nursing home residents.

AIM

to describe gaps in participation in everyday occupations among persons with dementia living in a nursing home, as reported by a proxy respondent.

METHOD

To record the congruence or discrepancy between doing and wanting to do, the Occupational Gaps Questionnaire was used. Results were analysed with descriptive statistics.

RESULTS

The respondents scored that over half of the persons with dementia had two or more occupational gaps and one-fourth wanted to participate in minor shopping. However, less than two percent were deemed to do this activity.

CONCLUSIONS

Persons with dementia living in nursing homes risk restrictions in participation. Securing valuable information regarding individuals' choices and desires, adhering to the persons' inherent rights to expression, can be the first step in promoting participation in everyday occupations.

SIGNIFICANCE

Occupational therapists with their unique theoretical knowledge can facilitate participation in occupations, supporting the citizenship of nursing home residents.

Experiences of implementing person-centered care for individuals living with dementia among nursing staff within collaborative practices: A meta-synthesis

BACKGROUND

Person-centered care is considered standard care in long-term care for individuals living with dementia. However, qualitative reviews that synthesize the staff experiences of the implementation of person-centered care are lacking.

OBJECTIVE

This review aims to synthesize the experiences of nursing staff members after the implementation of person-centered care for individuals living with dementia.

DESIGN

A meta-synthesis was conducted.

DATA SOURCES

Overall, five electronic databases (i.e., PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, PsycINFO, and Cochrane Library) were searched for the following terms: "dementia," "person-centered care," and "qualitative." The search was limited to articles published in English from January 1998 to December 2021, considering the period when person-centered care was applied in dementia care.

REVIEW METHODS

Qualitative content analysis was conducted using a person-centered nursing framework. Meta-data analysis, meta-method, and meta-theory analysis were used to synthesize the results of the included studies. The methodological quality of included studies was assessed using the Critical Appraisal Skills Programme (CASP) tool.

RESULTS

Altogether, 19 studies were included in this review. Through meta-synthesis, 12 themes, including professionally competent, perspective shift, shared decision-making among staff, appropriate supportive system, understanding and respecting individuals living with dementia, interaction with persons living with dementia and their family members, collaboration among staff members, concern about the well-being of an individual living with dementia, meaningful relationship between staff members and individuals living with dementia, quality care, reflections for maintenance, and barriers to overcome, emerged.

CONCLUSIONS

A person-centered nursing framework could be implemented in person-centered care for individuals living with dementia. However, the framework should be modified based on the characteristics of individuals living with dementia. Additionally, reflection strategies for maintenance and barriers are added to facilitate successful person-centered care implementation.

REGISTRATION

The study was registered with PROSPERO (International prospective register of systematic reviews) in May 2022 (registration number: CRD42022316097).

Exploring documentation in Person-centred care: A content analysis of care plans

BACKGROUND

Person-centred care is a growing imperative in healthcare, but the documentation of person-centred care is challenging. According to the Gothenburg Framework of Person-centred Care, care should be documented in continuously revised care plans and based on patients' personally formulated goals and resources to secure a continuous partnership.

OBJECTIVES

This study aimed to examine care plans produced within a randomised controlled trial that tested a person-centred care intervention in older people with acute coronary syndrome. Nurses with training in the theory and practice of person-centred care had written the care plans.

METHODS

We conducted a secondary analysis of care plans developed in a randomised controlled trial for assessing person-centred care in patients with acute coronary syndrome (Myocardial Infarct [MI] or unstable angina pectoris). The study sample included 84 patients, with three care plans for each patient from inpatient (T1), outpatient (T2) and primary care (T3), that is, a total of 252 care plans. We conducted a descriptive quantitative content analysis of the care plans to examine the reported patients' life-world and medical/health resources and goals.

RESULTS

The analysis illustrates the differences and overlaps between life-world and medical/health goals and resources. The documented goals and resources change over time: life-world goals and resources decreased with time as medical/health goals and resources documentation increased.

CONCLUSIONS

This paper illustrates that in the setting of a randomised controlled trial, nurses with training in person-centred care recorded fewer life-world and more medical/health goals over time. Placing life-world goals at the top of the goal hierarchy enables alignment with medical/health goals. Further research should explore whether the goals and resources documented in care plans accurately reflect patients' wishes as they transition along the care chain.

TRIAL REGISTRATION

Swedish registry, Researchweb.org, ID NR 65 791.

Evaluating the use of participatory action research to implement evidence-based guidance on dementia palliative care in long-term care settings: A creative hermeneutic analysis

BACKGROUND

Dementia affects a large proportion of society and places a significant burden on older people and healthcare systems internationally. Managing symptoms at the end of life for people with dementia is complex. Participatory action research can offer an approach that helps to encourage implementation of evidence-based practices in long-term care settings.

METHODS

Three evidence-based guidance documents (pain assessment and management, medication management, nutrition and hydration management) were introduced in three long-term care settings for older people. Data generated from work-based learning groups were analysed using a critical hermeneutic approach to explore the use of participatory action research to support the implementation of guidance documents in these settings.

RESULTS

Engagement and Facilitation emerged as key factors which both enabled and hindered the PAR processes at each study site.

CONCLUSIONS

This study adds to the body of knowledge that emphasises the value of participatory action research in enabling practice change. It further identifies key practice development approaches that are necessary to enable a PAR approach to occur in care settings for older people with dementia. The study highlights the need to ensure that dedicated attention is paid to strategies that facilitate key transformations in clinical practice.