Empathic nurses with sufficient job resources are work-engaged professionals who deliver more individualized care

AIMS

This study examined whether nurse work engagement mediated the associations of job resources (collegial support and autonomy) and a personal resource (empathy) with individualized care delivery, in both hospital and long-term care settings. We also explored potential setting-specific differences in how strongly the resources were associated with work engagement and individualized care delivery among nurses.

DESIGN

We conducted a cross-sectional study in three hospitals and two long-term care facilities.

METHODS

In total, 454 nurses completed a web-based survey including validated measures on resources (collegial support, autonomy, empathy), work engagement and individualized care delivery. Data were analysed using mediation and moderated mediation analyses.

RESULTS

In both settings, all resources were indirectly associated with individualized care delivery via work engagement. Empathy was also directly associated with individualized care delivery, and a stronger association was found in the long-term care setting than in the hospital setting.

CONCLUSION

The present study showed work engagement to mediate the associations of job resources and empathy with individualized care delivery in both hospital and long-term care settings. Individualized care delivery was furthermore directly facilitated by high levels of empathy, especially among nurses working in long-term care settings.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Patients may benefit from better individualized care delivery by empathic nurses who are more work-engaged in the face of sufficient job resources in their practice environment.

IMPACT

Nurses are better able to deliver individualized care when provided with sufficient job resources (collegial support and autonomy) that support their being work-engaged professionals. Furthermore, empathic nurses also reported being able to better support patient individuality. These findings can be translated to policies of hospitals and long-term care facilities, to optimize job resources and enhance empathy and thus facilitate the support of patient individuality by nurses.

REPORTING METHOD

This study adhered to the STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

Nurses were involved in the design and data collection of the study.

Individualized care for older adults with diabetes and its relationship with communication, psychosocial self-efficacy, resources and support for self-management and socio-demographics

AIM

To examine the relationship between patient-provider communication, psychosocial patient self-efficacy, resources and support for self-management and socio-demographics within individualized care of older adults with diabetes.

DESIGN

A quantitative study with a cross-sectional survey design.

METHODS

Data were collected from September 2019 to January 2021 using: Individualized Care Scale, The Communication Assessment Tool, The Diabetes Empowerment Scale and The Resources and Support for Self-Management Scale. Patients with either Type 1 or Type 2 diabetes mellitus that were 65 years old and over (N = 145) participated in the study.

RESULTS

The most positive aspects of patient-provider communication were respect and creating a comfortable environment for the patient. A significant relationship was observed between patients' perceptions and support of individualized care and diabetes-related measures. Effective communication was the main factor associated with support for individualizing care, and together with education level, empowerment and access to resources, explained 23% of the variance.

[Partnership relaxation]

Therapeutic relaxations, as psycho-corporal practices, weave the body-mind links. The relaxation partnership, a structured and flexible approach, is inspired by the same principle, by specifically remodeling the relational positions and postures of professionals and users. It responds to precise indications and contraindications and is proposed to the patient in an individual or group approach.

Patient and Clinician Perspectives on Shared Decision Making in Vascular Access Selection: A Qualitative Study

RATIONALE & OBJECTIVE

Collaborative approaches to vascular access selection are being increasingly encouraged to elicit patients' preferences and priorities where no unequivocally superior choice exists. We explored how patients, their caregivers, and clinicians integrate principles of shared decision making when engaging in vascular access discussions.

STUDY DESIGN

Qualitative description.

SETTING & PARTICIPANTS

Semistructured interviews with a purposive sample of patients, their caregivers, and clinicians from outpatient hemodialysis programs in Alberta, Canada.

ANALYTICAL APPROACH

We used a thematic analysis approach to inductively code transcripts and generate themes to capture key concepts related to vascular access shared decision making across participant roles.

RESULTS

42 individuals (19 patients, 2 caregivers, 21 clinicians) participated in this study. Participants identified how access-related decisions follow a series of major decisions about kidney replacement therapy and care goals that influence vascular access preferences and choice. Vascular access shared decision making was strengthened through integration of vascular access selection with dialysis-related decisions and timely, tailored, and balanced exchange of information between patients and their care team. Participants described how opportunities to revisit the vascular access decision before and after dialysis initiation helped prepare patients for their access and encouraged ongoing alignment between patients' care priorities and treatment plans. Where shared decision making was undermined, hemodialysis via a catheter ensued as the most readily available vascular access option.

LIMITATIONS

Our study was limited to patients and clinicians from hemodialysis care settings and included few caregiver participants.

CONCLUSIONS

Findings suggest that earlier, or upstream, decisions about kidney replacement therapies influence how and when vascular access decisions are made. Repeated vascular access discussions that are integrated with other higher-level decisions are needed to promote vascular access shared decision making and preparedness.

Nurse competence provides more individuality in the care of older hospitalized people

AIM

The aim of the study was to assess Registered Nurses' perceptions of general nurse competence, patient-centred care competence, and individuality in the care of older patients and to explore their associations.

DESIGN

A descriptive correlative survey.

METHODS

Data were collected using questionnaires at one Finnish university hospital during winter 2016-2017 amongst Registered Nurses (n = 223) and analyzedd statistically using descriptive and inferential statistics (ANOVA, Pearson's correlations coefficients) and path analysis.

RESULTS

Registered Nurses assessed their general competence, patient-centred care competenc,e and individuality in the care of older patients at a good level. The Path model confirmed general nurse competence was a predictor of patient-centred care competence, which in turn was a predictor of individuality in the nursing care of older patients. The novelty lies in empirical confirmation of the association between nurse competence and individuality in the care. Increasing competence may enhance individuality in the care of older people and enable interventions to support care outcomes.

Relationship between nurses' perceptions of conscience and perceptions of individualized nursing care: A cross-sectional study

PURPOSE

To identify the relationship between the perception of conscience and individualized nursing care.

DESIGN AND METHODS

A cross-sectional study. The sample of the study consisted of 326 nurses working in internal medicine and surgical clinics. The data were collected using the Nurses' Perceptions of Conscience Questionnaire and Individualized Care Scale-Nurse (ICSA) Version.

FINDINGS

Their mean score for the ICSA-Nurse was 3.96 ± 0.72. There was a statistically significant positive correlation between their scores for the ICSA-Nurse and Voice of Conscience and basic qualities of conscience.

CONCLUSION

The participants considered their conscience as a reference when performing their care actions and defined conscience as an expression of social and spiritual values.

PRACTICE IMPLICATIONS

Nurses' awareness of perceptions of conscience and the effect of conscience on the patient-nurse relationship can help them to provide more sensitive care to their patients.

The relationship between the individualized care perceptions and spiritual care perceptions of nurses

PURPOSE

To determine the relationship between the individualized care perceptions and spiritual care perceptions of nurses.

DESIGN AND METHODS

This descriptive and correlational study was conducted with 263 nurses. Data were collected using a Structured Questionnaire Form, the Individualized Care Scale-A-Nurse Version and the Spirituality and Spiritual Care Rating Scale.

FINDINGS

There was a positive and significant relationship between the individualized care perceptions and spiritual care perceptions of the nurses.

PRACTICE IMPLICATIONS

The results of this study revealed the reflections of the philosophy of nursing on the field of practice, with findings on the individualized care perceptions and spiritual care perceptions of nurses and the relationship between these variables.

Occupational fatigue, individualized nursing care, and quality of nursing care among hospital nurses

PURPOSE

This study aimed to evaluate the relationships among nurse fatigue, individualized nursing care, and nurse-reported quality of care.

DESIGN

The study used a cross-sectional design. Data from 858 registered nurses providing bedside care in hospitals were collected between March and April 2021 in the United States.

METHODS

Participants completed a self-administered online survey, including the Occupational Fatigue Exhaustion Recovery scale, the Individualized Care Scale-Nurse version, and a single item assessing nursing care quality. Relationships among the study variables were examined using multiple linear and logistic regression models.

FINDINGS

Nurses' higher levels of acute fatigue were significantly associated with decreased perceptions of individualized nursing activities provided to patients on their last shifts, specifically related to personal life condition and decision-making control. Nurses' higher levels of chronic fatigue were significantly associated with decreased perception of individualized nursing activities provided to patients on their last shifts related to clinical condition, personal life condition, and decision-making control. Nurses with higher levels of acute or chronic fatigue, and who perceived their nursing care activities as less individualized were less likely to assess their quality of care as excellent.

CONCLUSION

These findings suggest that addressing hospital nurses' acute and chronic fatigue may contribute to promoting the delivery of individualized nursing care and in improving patients' quality of care.

CLINICAL RELEVANCE

Healthcare institutions are encouraged to regularly monitor and manage nurse fatigue to improve the delivery of individualized and quality nursing care to their patients.

Kairos care in a Chronos world: Midwifery care as model of resistance and accountability in public health settings

BACKGROUND

In the United States (US), pregnancy-related mortality is 2-4 times higher for Black and Indigenous women irrespective of income and education. The integration of midwifery as a fundamental component of standard maternity services has been shown to improve health outcomes and service user satisfaction, including among underserved and minoritized groups. Nonetheless, there remains limited uptake of this model in the United States. In this study, we examine a series of interdependent factors that shape how midwifery care operates in historically disenfranchised communities within the Unites States.

METHODS

Using data collected from in-depth, semi-structured interviews, the purpose of this study was to examine the ways midwives recount, describe, and understand the relationships that drive their work in a publicly funded urban health care setting serving minoritized communities. Using a qualitative exploratory research design, guided by critical feminist theory, twenty full-scope midwives working in a large public health care network participated. Data were thematically analyzed using Braun & Clarke's inductive thematic analysis to interpret data and inductively identify patterns in participants' experiences.

FINDINGS

The overarching theme "Kairos care in a Chronos World" captures the process of providing health-promoting, individualized care in a system that centers measurement, efficiency, and pathology. Five subthemes support the central theme: (1) the politics of progress, (2) normalizing pathologies, (3) cherished connections, (4) protecting the experience, and (5) caring for the social body. Midwives used relationships to sustain their unique care model, despite the conflicting demands of dominant (and dominating) medical models.

CONCLUSION

This study offers important insight into how midwives use a Kairos approach to maternity care to enhance quality and safety. In order to realize equitable access to optimal outcomes, health systems seeking to provide robust services to historically disenfranchised communities should consider integration of relationship-based strategies, including midwifery care.

Relationship between individualized care perception and innovativeness among final-year nursing students

PURPOSE

The aim of this study was to evaluate the relationship between individualized care (IC) perceptions and innovativeness among final-year nursing students.

DESIGN AND METHODS

The population of this analytical study consisted of 230 students. Data were collected using a student information form (individualized care scale [ICS]-nurse version, individual innovativeness). Data analysis was carried out using descriptive, comparative, correlational, and stepwise regression analysis statistics.

FINDINGS

Nursing students had a high perception of IC and an early majority level of innovativeness. As their innovativeness levels increased, their perceptions of IC also increased. There was a positive correlation between the total ICS-A-nurse score and the individual innovativeness scale/openness to experience subscale. In regression analysis, the individual innovativeness total increased IC.

PRACTICE IMPLICATIONS

Courses and practical work should be organized for students to raise their awareness of IC and to increase their innovativeness.

Effectiveness of nursing interventions for preoperative anxiety in adults: A systematic review with meta-analysis

AIMS

The aim of this review and meta-analysis is to analyse the effectiveness of nursing interventions for the management of preoperative anxiety in adults.

BACKGROUND

The perioperative process is a stressful situation for many people who are going to be operated and it can generate feelings of anxiety. Also, preoperative anxiety can appear in the perioperative period. Nursing management of preoperative anxiety through individualized interventions can be effective for reducing anxiety.

DESIGN

A systematic review with meta-analysis was performed.

DATA SOURCES

CINAHL, CUIDEN, Pubmed, ProQuest and Scopus databases were consulted without restriction per year of publication. The search was conducted in February 2020.

REVIEW METHODS

Experimental studies on nursing management in preoperative anxiety with adults sample (>18 years) published in English and/or Spanish were included. All types of surgery were included in the review. A random effects meta-analysis was performed to estimate the effect size for preoperative anxiety measured with STAI.

RESULTS

After the selection process n = 9 quantitative studies with nursing interventions for preoperative anxiety were included. A preoperative educational and informative interview was used in six studies, one study used empathic interview, one used motivational interview and one used hand massage. The meta-analysis, including four studies using nursing interviews, had a sample of n = 419 in the intervention group and n = 445 in the control group. The mean difference in preoperative state anxiety measured with the STAI was in favour of the nursing intervention.

CONCLUSION

Nursing interventions for patients who are going to be operated seems to have a positive impact in their preoperative anxiety. However, due to the low number of studies and the heterogeneity of the sample, more research is needed about the topic.

Care dependency and management of urinary incontinence in nursing homes: A descriptive study

AIM

To explore the differences in managing urinary incontinence in residents in nursing homes aged 65 years or older in relation to their care dependency.

DESIGN

The 2015 data of the Dutch annual independent (Inter)national Prevalence Measurement of Quality of Care of Maastricht University were used. The design involved a cross-sectional, multi-centre point prevalence measurement in hospitals, care homes, and home care.

METHODS

Secondary data analysis on the data provided by care home organizations.

RESULTS

In the care independent group, the solely use of absorbing material was the mostly applied intervention. In the group of care dependent persons, the combination of absorbing material with toilet on set times and on individual basis was the most common approach.

CONCLUSION

The outcome of this study indicated that the management of urinary incontinence in residents in nursing homes differs depending on their care dependency.

IMPACT

Caregivers in nursing homes should be aware of preferences of residents regarding the management of their urinary incontinence. Researchers should investigate criteria used by caregivers and care receivers into the decision of the application of interventions for urinary incontinence.

Individualized Care Is Superior to Standardized Care for the Majority of Critically Ill Patients

Tools for standardizing patient care can take many forms, including but not limited to, bundles, quality improvement and performance measures, guidelines, and protocols. Each is intended to improve compliance with interventions believed to be supported by the best available evidence, ensuring consistency of management across all patients with the ultimate goal of improving outcomes. However, in the ICU, patients typically present with complex acute illnesses and accompanying comorbidities, requiring careful tailoring of interventions and treatments for each individual patient. The rapidly changing nature of the underlying conditions also demands continuous reassessment and modification of each patient’s management on a frequent and sometimes moment-by-moment basis. Disrupting this individualized treatment approach by imposing prescriptive, overly restrictive, “one-size-fits-all” standardized treatments in the critical care setting may prevent the clinician from meeting individual patients’ needs and decrease care quality (1 ). This problem is compounded if the standardization tools adopted are not only inflexible but also have a poorly supported or entirely absent scientific basis. Importantly, identifiable patient subcategories often exist that fit poorly into the populations for which many interventions were developed and tested. Of equal concern, critical care trainees may become dependent on a standardized/cookbook approach to care and fail to recognize and learn how treatments must be tailored for the unique needs of each critically ill patient. Rather than rigidly standardizing critical care, approaches that recognize this complexity and are both scientifically sound and responsive to patient differences should be readily available to critical care clinicians without replacing sensible clinical judgment. Such strategies that acknowledge the limitations of available evidence hold more hope of improving, rather than inadvertently worsening, the outcome.

Assessing person-centred care: An item response theory approach

BACKGROUND AND OBJECTIVES

Given recent advances in psychometric assessment, there is a need for assessment studies using modern test theory in the field of person-centred care, mainly due to the dominant use of analytical strategies based on classical test theory. The main objective of the present study was thus to examine whether selected items from commonly used instruments of person-centred care were able to differentiate between respondents with a reasonably even level of measurement precision across different regions of the construct range using item response theory (IRT).

RESEARCH DESIGN AND METHODS

A Swedish sample of care staff in elderly care (N = 1342) completed a survey including a selection of items from three previously validated measures of person-centred care.

RESULTS

All questionnaire items were submitted to IRT analyses to examine the extent to which the items produced information on the underlying construct. The items exhibited different levels of information. However, in general, for those items exhibiting some information, the pattern of information across the trait range was similar for most of them, that is, the items discriminated better in the lower levels of person-centredness.

DISCUSSION AND IMPLICATIONS

Item response theory analyses are instrumental in creating shorter measurement instruments that may perform nearly as well as the original longer instruments. Given time and other resource constraints in questionnaire administration, there is a gain in only including the most informative items which efficiently and evenly tap the underlying construct along its entire range and in the context of person-centred care assessment this study was an initial step towards this goal. Thus, a set of ten items with satisfactory levels of psychometric quality, that is relatively high information levels across a relatively broad range of the underlying construct, is proposed.

The relationship between nurses' empathic tendencies, empathic skills, and individualized care perceptions

PURPOSE

The study aims to determine the relationship between nurses' empathic tendencies, empathic skills, and individualized care perceptions.

DESIGN AND METHODS

This study employed a descriptive and correlational design. Data were collected from nurses in eight training and research hospitals in Turkey. The study sample consisted of 472 nurses who were both volunteered to participate and randomly selected.

FINDINGS

A definite high-level relation was determined between nurses' empathic tendencies and individualized care perceptions, but no relation was determined between nurses' empathic skills and individualized care perceptions.

PRACTICE IMPLICATIONS

This study can underline practices accounting for empathy and individualized care in nursing research and training programs.

Removing the Mask of Average Treatment Effects in Chronic Lyme Disease Research Using Big Data and Subgroup Analysis

Lyme disease is caused by the bacteria borrelia burgdorferi and is spread primarily through the bite of a tick. There is considerable uncertainty in the medical community regarding the best approach to treating patients with Lyme disease who do not respond fully to short-term antibiotic therapy. These patients have persistent Lyme disease symptoms resulting from lack of treatment, under-treatment, or lack of response to their antibiotic treatment protocol. In the past, treatment trials have used small restrictive samples and relied on average treatment effects as their measure of success and produced conflicting results. To provide individualized care, clinicians need information that reflects their patient population. Today, we have the ability to analyze large data bases, including patient registries, that reflect the broader range of patients more typically seen in clinical practice. This allows us to examine treatment variation within the sample and identify groups of patients that are most responsive to treatment. Using patient-reported outcome data from the MyLymeData online patient registry, we show that sub-group analysis techniques can unmask valuable information that is hidden if averages alone are used. In our analysis, this approach revealed treatment effectiveness for up to a third of patients with Lyme disease. This study is important because it can help open the door to more individualized patient care using patient-centered outcomes and real-world evidence.

What Influences Mental Illness? Discrepancies Between Medical Education and Conception

OBJECTIVE

This preliminary study examined the differences between what was taught during a formal medical education and medical students' and psychiatry residents' conceptions of notions regarding the causes and determinants of mental illness.

METHODS

The authors surveyed 74 medical students and 11 residents via convenience sampling. The survey contained 18 statements which were rated twice based on truthfulness in terms of a participant's formal education and conception, respectively. Descriptive statistics and a Wilcoxon signed rank test determined differences between education and conception.

RESULTS

Results showed that students were less likely to perceive a neurotransmitter imbalance to cause mental illness, as opposed to what was emphasized during a formal medical education. Students and residents also understood the importance of factors such as systemic racism and socioeconomic status in the development of mental illness, which were factors that did not receive heavy emphasis during medical education. Furthermore, students and residents believed that not only did mental illnesses have nonuniform pathologies, but that the Diagnostic and Statistical Manual of Mental Disorders also had the propensity to sometimes arbitrarily categorize individuals with potentially negative consequences.

CONCLUSIONS

If these notions are therefore part of students' and residents' conceptions, as well as documented in the literature, then it seems appropriate for medical education to be further developed to emphasize these ideas.

Person-centred care: an overview of reviews

BACKGROUND

Existing evidence suggests that a person-centred approach can improve coordination and access to health care and services.

OBJECTIVES

This overview sought to: (1) identify and define components of person-centred care; (2) explore nursing and health-care provider behaviours that are person-centred; and (3) identify systems level supports required to enable person-centred care.

METHODS

An overview of reviews was conducted to locate synthesized literature published between June 2005 and April 2014. Two independent reviewers screened, extracted data and quality appraised the sources. Results were synthesized narratively.

RESULTS

A total of 46 articles were deemed relevant to this overview. This paper synthesizes the results of 43 of the 46 articles. A universal definition of person-centred care was not found, however; common components, associated health-care provider behaviours and the organizational supports required for person-centred care are discussed.

CONCLUSIONS

Key findings from this review outline that health-care providers and organizations need to promote person-centred care by engaging persons in partnerships, shared decision-making, and meaningful participation in health system improvement.

Recognizing and minimizing hypoglycemia: The need for individualized care

Hypoglycemia is a condition known to disrupt many everyday activities and is associated with increased risks of hospitalization, falls, motor vehicle accidents and mortality. Many patients with diabetes have an increased risk of hypoglycemia due to interventions targeting glycemic control. In these patients, hypoglycemia and fear of hypoglycemia may further reduce adherence to glucose-lowering regimens, contributing to the further aggravation of diabetes-related complications. Avoiding hypoglycemia should be one of the principal goals of any treatment strategies employing agents that can induce hypoglycemia in order to prevent the occurrence of associated symptoms and consequences. The education of patients and their families is an important feature of individualized management strategies in order to prevent, mitigate and treat hypoglycemic episodes. Patients with diabetes need to be made aware of how to recognize the signs of hypoglycemia and of the simple, highly effective steps that they can take to self-manage hypoglycemic episodes. Clinicians should be familiar with the risk factors for hypoglycemia, especially the profiles of the different classes of glucose-lowering medications such as the sulfonylureas and insulin. This article aims to review the risk factors for hypoglycemia and its implications for patients and healthcare systems, and provide practical advice for minimizing the risk of hypoglycemia and its consequences.

Person-centred health care: a critical assessment of current and emerging research approaches

RATIONALE, AIMS AND OBJECTIVES

Person-centred health care is prominent in international health care reforms. A shift to understanding and improving personal care at the point of delivery has generated debates about the nature of the person-centred research agenda. This paper purviews research paradigms that influence current person-centred research approaches and traditions that influence knowledge foundations in the field. It presents a synthesis of the emergent approaches and methodologies and highlights gaps between static academic research and the increasing accessibility of evaluation, informatics and big data from health information systems.

FINDINGS

Paradigms in health services research range from theoretical to atheoretical, including positivist, interpretive, postmodern and pragmatic. Interpretivist (subjective) and positivist (objectivist) paradigms have been historically polarized. Yet, integrative and pragmatic approaches have emerged. Nevertheless, there is a tendency to reductionism, and to reduce personal experiences to metrics in the positivist paradigm. Integrating personalized information into clinical systems is increasingly driven by the pervasive health information technology, which raises many issues about the asymmetry and uncertainty in the flow of information to support personal health journeys. The flux and uncertainty of knowledge between and within paradigmatic or pragmatic approaches highlights the uncertainty and the 'unorder and disorder' in what is known and what it means. Transdisciplinary, complex adaptive systems theory with multi-ontology sense making provides an overarching framework for making sense of the complex dynamics in research progress.

CONCLUSION

A major challenge to current research paradigms is focus on the individualizing of care and enhancing experiences of persons in health settings. There is an urgent need for person-centred research to address this complex process. A transdisciplinary and complex systems approach provides a sense-making framework.

"Caring for insiderness": phenomenologically informed insights that can guide practice

Understanding the "insider" perspective has been a pivotal strength of qualitative research. Further than this, within the more applied fields in which the human activity of "caring" takes place, such understanding of "what it is like" for people from within their lifeworlds has also been acknowledged as the foundational starting point in order for "care" to be caring. But we believe that more attention needs to be paid to this foundational generic phenomenon: what it means to understand the "insiderness" of another, but more importantly, how to act on this in caring ways. We call this human phenomenon "caring for insiderness." Drawing on existing phenomenological studies of marginal caring situations at the limits of caring capability, and through a process of phenomenologically oriented reflection, we interrogated some existential themes implicit in these publications that could lead to deeper insights for both theoretical and applied purposes. The paper provides direction for practices of caring by highlighting some dangers as well as some remedies along this path.

Effects of person-centered care on residents and staff in aged-care facilities: a systematic review

BACKGROUND

Several residential aged-care facilities have replaced the institutional model of care to one that accepts person-centered care as the guiding standard of practice. This culture change is impacting the provision of aged-care services around the world. This systematic review evaluates the evidence for an impact of person-centered interventions on aged-care residents and nursing staff.

METHODS

We searched Medline, Cinahl, Academic Search Premier, Scopus, Proquest, and Expanded Academic ASAP databases for studies published between January 1995 and October 2012, using subject headings and free-text search terms (in UK and US English spelling) including person-centered care, patient-centered care, resident-oriented care, Eden Alternative, Green House model, Wellspring model, long-term care, and nursing homes.

RESULTS

The search identified 323 potentially relevant articles. Once duplicates were removed, 146 were screened for inclusion in this review; 21 were assessed for methodological quality, resulting in nine articles (seven studies) that met our inclusion criteria. There was only one randomized, controlled trial. The majority of studies were quasi-experimental pre-post test designs, with a control group (n = 4). The studies in this review incorporated a range of different outcome measures (ie, dependent variables) to evaluate the impact of person-centered interventions on aged-care residents and staff. One person-centered intervention, ie, the Eden Alternative, was associated with significant improvements in residents' levels of boredom and helplessness. In contrast, facility-specific person-centered interventions were found to impact nurses' sense of job satisfaction and their capacity to meet the individual needs of residents in a positive way. Two studies found that person-centered care was actually associated with an increased risk of falls. The findings from this review need to be interpreted cautiously due to limitations in study designs and the potential for confounding bias.

CONCLUSION

Typically, person-centered interventions are multifactorial, comprising: elements of environmental enhancement; opportunities for social stimulation and interaction; leadership and management changes; staffing models focused on staff empowerment; and assigning residents to the same care staff and an individualized philosophy of care. The complexity of the interventions and range of outcomes examined makes it difficult to form accurate conclusions about the impact of person-centered care interventions adopted and implemented in aged-care facilities. The few negative consequences of the introduction of person-centered care models suggest that the introduction of person-centered care is not always incorporated within a wider "hierarchy of needs" structure, where safety and physiological need are met before moving onto higher level needs. Further research is necessary to establish the effectiveness of these elements of person-centered care, either singly or in combination.

Collaboration as a foundation for advancing research in personalized medicine in cancer care

Transforming healthcare through collaborative relationships is the key to making successful advances in personalized medicine. The strategies for building a framework to bring together expertise and resources in order to realize all the possibilities of personalized medicine are discussed in this article. The key to this endeavor is the ability to identify potential collaboration with academic medical centers, research laboratories, biotechnology companies and community cancer centers. Translation of research from bench to bedside is only paradigm changing if it can then be translated to community care. The value of clinical prospective biospecimen collection with high quality clinical annotation will be explored. Recognizing the opportunities for performing clinical trials, beta-testing of new technology especially in community clinical practice will be emphasized. The goal is to expand the realm of personalized cancer care to allow for integration of molecular marker and individualized therapy to the majority of cancer patients worldwide.

Recreational Activities to Reduce Behavioural Symptoms in Dementia

Few clinicians have an educational grounding in the use of nonpharmacological therapies for people with dementia. In this article, we explore the utility of recreational activities as one nonpharmacological intervention that has demonstrated effectiveness for reducing the behavioural symptoms of dementia. The implementation of effective recreational activities involves three components: understanding the evidence for this approach; acknowledging the need to reduce medications that have the potential to interfere with activity effectiveness; and individualizing activities so that the maximum benefit from the intervention is obtained.

Developing adaptive treatment strategies in substance abuse research

For many individuals, substance abuse possesses characteristics of chronic disorders in that individuals experience repeated cycles of cessation and relapse; hence viewing drug dependence as a chronic, relapsing disorder is increasingly accepted. The development of a treatment for a chronic disorder requires consideration of the ordering of treatments, the timing of changes in treatment, and the use of measures of response, burden and adherence collected during treatment to make further treatment decisions. Adaptive treatment strategies provide a vehicle through which these issues can be addressed and thus provide a means toward improving and informing the clinical management of chronic substance abuse disorders. The sequential multiple assignment randomized trial (SMART) is particularly useful in developing adaptive treatment strategies. Simple analyses that can be used with the SMART design are described. Furthermore, the SMART design is compared with standard experimental designs.