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Veerhuis N, Merizzi A, Papoulias S, Bradbury C, Sheret K, Traynor V. 'It is empowering and gives people dignity in a very difficult process': A multistage, multimethod qualitative study to understand the views of end users in the cultural adaptation of a dementia and driving decision aid. Health Expect 2024; 27:e14006. [PMID: 38497286 PMCID: PMC10945392 DOI: 10.1111/hex.14006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 02/06/2024] [Accepted: 02/11/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Decisions about driving for individuals living with dementia (ILWD) can be challenging. There are limited evidence-based person-centred interventions in the United Kingdom that support decisions about transitioning to not driving or guidelines for developing decision aids for ILWD. This study aimed to understand the important features of a decision aid through the cultural adaptation of Australian dementia and driving decision aid (DDDA) for ILWD residing in the United Kingdom. METHODS This qualitative study was theoretically underpinned by a person-centred framework and conducted over three stages: (1) Development of a draft UK-specific DDDA; (2) semistructured interviews with ILWD and an online survey with stakeholders to obtain their views on a draft UK DDDA and (3) content analysis and synthesis of qualitative data to inform the final version of the decision aid. RESULTS Eleven ILWD and six of their spouses participated in interviews, and 102 stakeholders responded to an online survey. The four broad features identified as important to include in a decision aid for drivers living with dementia were: a structured and interactive format; positive and supportive messaging and presentation; relevant and concise content and choice-centred. The perceived benefits of the decision aid were identified as supporting conversations, enhancing collaborative decision making and enabling agency with decisions about driving and future mobility options. CONCLUSIONS Decision aids that are underpinned by interactive choice-driven questions enhance a person-centred approach to decisions about driving. Positively framing decision aids through the presentation and content can facilitate engagement with the decision-making process about driving. The findings have implications for the development of decision aids designed for ILWD on other important health and social topics. PATIENT AND PUBLIC INVOLVEMENT Advocating for the development of a UK DDDA were ILWD. Healthcare professionals contributed to the development of a draft UK DDDA. Former and current drivers living with dementia, family members, healthcare professionals and other support networks of ILWD participated in interviews or an online survey which informed the final version of the UK DDDA.
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Affiliation(s)
- Nadine Veerhuis
- Aged, Dementia, Health Education and Research Centre, Faculty of Science Medicine and Health, School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Alessandra Merizzi
- Memory Assessment and Treatment Service, Pennine Care National Health Service Foundation Trust, Oldham, UK
| | - Stephanie Papoulias
- Memory Assessment and Treatment Service, Pennine Care National Health Service Foundation Trust, Oldham, UK
| | - Claire Bradbury
- Memory Assessment Service, Dorset Healthcare University Foundation Trust, Alderney Hospital, Poole, UK
| | - Kathy Sheret
- Memory Assessment Service, Dorset Healthcare University Foundation Trust, Alderney Hospital, Poole, UK
| | - Victoria Traynor
- Aged, Dementia, Health Education and Research Centre, Faculty of Science Medicine and Health, School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
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Blackwell J, Allen-Collinson J, Evans A, Henderson H. How Person-Centred Is Cardiac Rehabilitation in England? Using Bourdieu to Explore Socio-Cultural Influences and Personalisation. Qual Health Res 2024; 34:239-251. [PMID: 37933668 PMCID: PMC10768332 DOI: 10.1177/10497323231210260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
The National Health Service (NHS) cardiac rehabilitation patient care pathway has remained largely unchanged for many years despite, on average, half of all eligible patients declining to engage. To investigate reasons for non-engagement, we explored the experiences of ten cardiac patients who participated in cardiac rehabilitation, dropped out, or declined, as well as experiences of seven people deemed significant others by participants. Our ethnographic study involved participant observations, repeat in-depth semi-structured interviews, and reflexive journaling. Reflexive thematic analysis was conducted, focusing on participants' lived experiences. Utilising Bourdieusian concepts of habitus, capital, and field, this article highlights how personal biography, material conditions, and dispositional inclinations combine to make cardiac health care decision-making individual and complex. Despite this, health professionals were not always attuned to specific circumstances arising from differences in patients' experiences and lifeworlds. By considering service improvement recommendations that acknowledge socio-cultural influences, cardiac rehabilitation can work towards providing patients and their significant others with more appropriate, personalised, and person-centred support.
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Affiliation(s)
- Joanna Blackwell
- School of Sport and Exercise Science, University of Lincoln, Lincoln, UK
| | | | - Adam Evans
- Department of Nutrition, Exercise, and Sport, University of Copenhagen, Copenhagen, Denmark
| | - Hannah Henderson
- School of Sport and Exercise Science, University of Lincoln, Lincoln, UK
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Lim E, Wynaden D, Heslop K. Mental health nurses' attitudes towards mental illness and recovery-oriented practice in acute inpatient psychiatric units: a non-participant observation study International Journal of Mental Health Nursing, doi: 10.1111/inm.13152. Int J Ment Health Nurs 2024; 33:189-191. [PMID: 37684713 DOI: 10.1111/inm.13224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/23/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023]
Affiliation(s)
- Eric Lim
- School of Nursing, Curtin University, Perth, Western Australia, Australia
| | - Dianne Wynaden
- School of Nursing, Curtin University, Perth, Western Australia, Australia
| | - Karen Heslop
- School of Nursing, Curtin University, Perth, Western Australia, Australia
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Hodge G, Lang I, Byng R, Pearce S. Older peoples' lived experiences of personalised care in care homes: A meta-ethnography. Int J Older People Nurs 2024; 19:e12585. [PMID: 37899684 DOI: 10.1111/opn.12585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 09/06/2023] [Accepted: 10/19/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Guidance and policy on personalised (or person-centred) care of older people living in care homes advocates that all residents must have their preferences considered, and that all care provided must be reasonably adjusted to meet the person's specific needs. Despite this, research that considers what matters to residents in terms of the care they receive is limited. OBJECTIVES Our review aims to explore care home residents' lived experiences of personalised care and understand what really matters to them. METHODS Six electronic databases (CINHAL, Medline (Ovid), Embase, PubMed, Web of Science & PsychInfo) and Google Scholar (grey literature) were searched to identify qualitative studies relating to personalised care in care home settings, which also included resident (voices) quotes. The literature review and synthesis are reported using eMERGe guidance. RESULTS Fifteen studies met the inclusion criteria for our meta-ethnography. Four conceptual categories (the challenge of fitting into institutional care, the passing of time, holding onto a sense of self and a desire to feel at home) and two key concepts (creating a culture of purposeful living and caring and forming and maintaining meaningful & empowering relationships) were identified. Finally, a conceptual framework of understanding represents what personally matters to residents in terms of their care. CONCLUSION Our meta-ethnography, guided by residents' lived experiences of personalised care, offers a new perspective of what personally matters to residents in terms of the care they receive. The conceptual framework of understanding highlights the importance of moving from an institutional position of doing for residents to a person-centred position of doing with residents. IMPLICATIONS FOR PRACTICE Our findings highlight the importance of understanding the differences between personalised and person-centred care for policy and practice. Further considerations are required on how this might be applied through nurse and care home professionals' education and work practices.
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Affiliation(s)
- Gary Hodge
- School of Nursing & Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Iain Lang
- Medical School, University of Exeter, Exeter, UK
| | - Richard Byng
- Peninsula Schools of Medicine and Dentistry, Primary Care, University of Plymouth, Plymouth, UK
| | - Susie Pearce
- School of Nursing & Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
- Torbay and South Devon NHS Foundation Trust, Torquay, UK
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Beck I, Törnquist K, Gruvebäck A, Rasmussen BH, Olsson Möller U. Nurses' experiences of using the Integrated Palliative care Outcome Scale with patients in specialized palliative care-A qualitative focus group study. Nurs Open 2023; 10:7639-7649. [PMID: 37771265 PMCID: PMC10643850 DOI: 10.1002/nop2.2004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 08/15/2023] [Accepted: 09/17/2023] [Indexed: 09/30/2023] Open
Abstract
AIM To explore nurses' experiences of using the Integrated Palliative care Outcome Scale (IPOS) as a communication tool in specialized palliative care. DESIGN This study employed a qualitative inductive approach. The Standards for Reporting Qualitative Research were followed for reporting. METHODS Five focus groups were conducted with nurses from four specialized palliative care units, and the discussions were analysed with quality content analysis. RESULTS Using IPOS for communication with the patient gave an opportunity to understand the patient's care needs and to let these care needs guide care interventions. Prerequisites in terms of relation, atmosphere, skills and flexibility were needed to establish an interactive communication. It was challenging to communicate about issues that evoked emotional reactions in the patient. There was a balancing act between the use of a structured scale and overcoming communication challenges. Nonetheless, when the two complemented each other, IPOS was a useful tool for nurses to promote person-centred care.
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Affiliation(s)
- Ingela Beck
- Department of Nursing and Integrated Health Sciences, Faculty of Health SciencesKristianstad UniversityKristianstadSweden
- Institute for Palliative CareLund University and Region SkåneLundSweden
- Department of Clinical Sciences Lund, Oncology, Faculty of MedicineLund UniversityLundSweden
| | - Kicki Törnquist
- Institute for Palliative CareLund University and Region SkåneLundSweden
- Palliative Care UnitRegion SkåneLundSweden
| | - Anders Gruvebäck
- Institute for Palliative CareLund University and Region SkåneLundSweden
- Palliative Care UnitRegion SkåneLundSweden
| | - Birgit. H. Rasmussen
- Institute for Palliative CareLund University and Region SkåneLundSweden
- Department of Health Sciences, Faculty of MedicineLund UniversityLundSweden
| | - Ulrika Olsson Möller
- Department of Nursing and Integrated Health Sciences, Faculty of Health SciencesKristianstad UniversityKristianstadSweden
- Department of Health Sciences, Faculty of MedicineLund UniversityLundSweden
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Skelton M, Carr E, Buckman JEJ, Davies MR, Goldsmith KA, Hirsch CR, Peel AJ, Rayner C, Rimes KA, Saunders R, Wingrove J, Breen G, Eley TC. Trajectories of depression and anxiety symptom severity during psychological therapy for common mental health problems. Psychol Med 2023; 53:6183-6193. [PMID: 36510471 PMCID: PMC10520600 DOI: 10.1017/s0033291722003403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/22/2022] [Accepted: 10/10/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is substantial variation in patient symptoms following psychological therapy for depression and anxiety. However, reliance on endpoint outcomes ignores additional interindividual variation during therapy. Knowing a patient's likely symptom trajectories could guide clinical decisions. We aimed to identify latent classes of patients with similar symptom trajectories over the course of psychological therapy and explore associations between baseline variables and trajectory class. METHODS Patients received high-intensity psychological treatment for common mental health problems at National Health Service Improving Access to Psychological Therapies services in South London (N = 16 258). To identify trajectories, we performed growth mixture modelling of depression and anxiety symptoms over 11 sessions. We then ran multinomial regressions to identify baseline variables associated with trajectory class membership. RESULTS Trajectories of depression and anxiety symptoms were highly similar and best modelled by four classes. Three classes started with moderate-severe symptoms and showed (1) no change, (2) gradual improvement, and (3) fast improvement. A final class (4) showed initially mild symptoms and minimal improvement. Within the moderate-severe baseline symptom classes, patients in the two showing improvement as opposed to no change tended not to be prescribed psychotropic medication or report a disability and were in employment. Patients showing fast improvement additionally reported lower baseline functional impairment on average. CONCLUSIONS Multiple trajectory classes of depression and anxiety symptoms were associated with baseline characteristics. Identifying the most likely trajectory for a patient at the start of treatment could inform decisions about the suitability and continuation of therapy, ultimately improving patient outcomes.
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Affiliation(s)
- Megan Skelton
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ewan Carr
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joshua E. J. Buckman
- Research Department of Clinical, Centre for Outcomes Research and Effectiveness (CORE), Educational and Health Psychology, University College London, London, UK
- iCope – Camden and Islington Psychological Therapies Services, Camden and Islington NHS Foundation Trust, London, UK
| | - Molly R. Davies
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Colette R. Hirsch
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Alicia J. Peel
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christopher Rayner
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Katharine A. Rimes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rob Saunders
- Research Department of Clinical, Centre for Outcomes Research and Effectiveness (CORE), Educational and Health Psychology, University College London, London, UK
| | - Janet Wingrove
- Talking Therapies Southwark, South London and Maudsley NHS Foundation Trust, London, UK
| | - Gerome Breen
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Thalia C. Eley
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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Rucsineanu O, Agbassi P, Herrera R, Low M, McKenna L, Stillo J, Winarni P, Acharya A, Sari AH. Shorter TB treatment regimens should be safer as well. Public Health Action 2023; 13:104-106. [PMID: 37736577 PMCID: PMC10446660 DOI: 10.5588/pha.23.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/26/2023] [Indexed: 09/23/2023] Open
Abstract
Most ongoing and planned TB therapeutic trials are focused on shortening the duration of treatment while giving less consideration to other aspects of TB care that are important to people with TB. Here we argue that other variables besides duration of TB treatment should also be considered when developing new TB treatment regimens, including drug toxicity, time spent in monitoring and overall quality of life while on therapy. We examine the specific use of linezolid in treatment-shortening trials for drug-susceptible TB and propose additional endpoints that should be prioritised in TB treatment studies.
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Affiliation(s)
- O Rucsineanu
- Moldova National Association of Tuberculosis Patients "SMIT" (Society of Moldova against Tuberculosis), Balti, Moldova
- Global TB Community Advisory Board, New York, NY, USA
| | - P Agbassi
- Global TB Community Advisory Board, New York, NY, USA
| | - R Herrera
- Global TB Community Advisory Board, New York, NY, USA
| | - M Low
- Department of Computer Science, University of Cape Town, Cape Town, South Africa
| | - L McKenna
- Global TB Community Advisory Board, New York, NY, USA
- Treatment Action Group, New York, NY, USA
| | - J Stillo
- Global TB Community Advisory Board, New York, NY, USA
- Department of Anthropology, Wayne State University, Detroit, MI, USA
| | - P Winarni
- Global TB Community Advisory Board, New York, NY, USA
| | - A Acharya
- Independent Consultant, Mumbai, India
| | - A H Sari
- Global TB Community Advisory Board, New York, NY, USA
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Russell C. "We Can Do This!": The Role of Physical Activity in What Comes Next for Dementia. Int J Environ Res Public Health 2023; 20:6503. [PMID: 37569043 PMCID: PMC10418976 DOI: 10.3390/ijerph20156503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/06/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023]
Abstract
There is increasing interest in physical activity as a response to the harm caused by dementia. The focus has been upon interventions to prevent or delay symptoms or to support people living with the condition to reminisce. Whilst this is welcome, there are other features inherent to physical activity that remain unrecognised or underutilised and, consequently, its full potential for good is unrealised. Most prominent is the ability physical activity has to enable participants to claim and sustain a place in the world through what they do, crucial to a context where the impact of dementia tends to annihilate this for those living with the condition. The article addresses this gap. In doing so, it presents key findings. These include (1) highlighting the fundamental importance of features such as person-centred care, human rights and social citizenship to enabling people with dementia to live lives of quality and (2) identifying synergies with these features and what physical activity can offer; for example, emphasising the value of bringing these together to illustrate how physical activity can contribute to enabling people with dementia to live lives characterised by quality, and the maintenance of their place in the world. The article concludes by suggesting what must come next to ensure physical activity can play the fullest role possible.
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Affiliation(s)
- Christopher Russell
- Association for Dementia Studies, University of Worcester, Henwick Grove, Worcester WR2 6AJ, UK
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Rose ML. Elizabeth Usher memorial lecture: Beyond our practice borders-using a biopsychosocial framework to improve long-term outcomes for people living with aphasia. Int J Speech Lang Pathol 2023:1-9. [PMID: 37323004 DOI: 10.1080/17549507.2023.2220995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Purpose: Over 140 000 Australians live with aphasia after stroke, with this number of people living with aphasia increasing significantly when aphasia arising from traumatic brain injury, neoplasm, and infectious and progressive neurological diseases is also included. The resulting communication disability frequently compromises every aspect of daily life, significantly impacting everyday activity, employment, social participation, mental health, identity, and family functioning. Rehabilitation services rarely meet the needs of this group who have, for example, poorer healthcare outcomes than stroke peers without aphasia, nor address long-term recovery and support needs.Method: In this discussion paper, I argue that given the broad impacts of aphasia, a biopsychosocial approach to aphasia rehabilitation is required. Rehabilitation must include: interventions to improve the communication environment; programs that directly target identity, wellbeing, and mental health; and therapies focusing on functional activity, communication participation, and long-term self-management.Result: The evidence for these approaches is mounting and includes strongly stated consumer needs. I discuss the need for multidisciplinary involvement and argue that for speech-language pathologists to achieve such comprehensive service provision, an expanded scope of practice is required.Conclusion: There is a need to rethink standard therapy approaches, timeframes, and funding mechanisms. It is time to reflect on our practice borders to ask what must change and define how change can be achieved.
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Affiliation(s)
- Miranda L Rose
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
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Abstract
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.
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Affiliation(s)
- Aileen Bergström
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Mandana Fallahpour
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Sofia Vikström
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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Kinsella N, Pentland D, McCormack B. How context influences person-centred practice: A critical-creative case study examining the use of research evidence in occupational therapy with people living with dementia. Scand J Occup Ther 2023; 30:398-414. [PMID: 36073249 DOI: 10.1080/11038128.2022.2119162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Occupational therapists are encouraged to use research evidence to guide therapeutic interventions that holistically address the consequences of dementia. Recent efforts to use research evidence in practice have emphasized the challenges of doing so in ways aligned to person-centred and professional principles. Using research evidence is a complex process influenced by multiple contextual factors and layers. The influence of context in occupational therapy for dementia is currently unclear. AIMS To explore the contextual complexities of using research evidence in practice with people with dementia, and to develop knowledge to improve the approach to using evidence in person-centred, occupation-focused practice. MATERIAL & METHODS A case study methodology was used, in which the contextual conditions of practice were clarified through the facilitation of critical and creative reflection using the following methods - Think Aloud, practice observation, creative expression and reflective dialogue. RESULTS Cultural beliefs that affected evidence use included technically-orientated understandings of evidence-based practice. These were underpinned by apprehensions about losing professional identity and taking risks when processes derived from research evidence were adjusted to incorporate a persons' occupations. These cultural factors were perpetuated at the organizational layers of context, where systemic priorities and other team members' needs disproportionately influenced occupational therapists' decisions. CONCLUSIONS & SIGNIFICANCE Occupational therapists' potential to make reflexive and responsive decisions by adjusting evidence-based processes can be affected by their perceived freedom to address organizational tensions. Raising consciousness of the influence of the organizational context on decision-making about evidence use could adjust occupational therapists' perceptions of their freedom and ability to be person-centred. Intentionality in reflective processes in practice are required to foster reflexivity.
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Affiliation(s)
- Niamh Kinsella
- Division of Occupational Therapy and Arts Therapies, Queen Margaret University, Musselburgh, Edinburgh, UK
| | - Duncan Pentland
- Division of Occupational Therapy and Arts Therapies, Queen Margaret University, Musselburgh, Edinburgh, UK
| | - Brendan McCormack
- Queen Margaret University, Edinburgh and The Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
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Barber TJ, Crabtree B, Cortes CP, Guaraldi G, Hoy JF, Rajasuriar R, Castilho J, Agosto-Rosario M, Murzin K, Falutz J. Practical management of complexity in older people with HIV: approaching an international consensus. AIDS Care 2023:1-5. [PMID: 36994591 DOI: 10.1080/09540121.2023.2190956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
ABSTRACTGlobally the community of people with HIV is ageing, and some of these have increasingly complex care needs, with a known excess of non-HIV related comorbidities and related issues including consequent polypharmacy. At the 2022 International AIDS Conference in Montréal, Canada, the "Silver Zone" was created in the Global Village as a safe space for older people with HIV. As part of the Silver Zone activities, a session discussing global models of care for in this group was held. HIV treatment providers and advocates from diverse resource settings and with a diversity of expertise were invited to share their experience, reflections, and ideas, and this consensus statement was formed based on these discussions. Different approaches to care emerged, based on local needs and resources, and it became clear that issues of complexity and frailty need not be age limited. Despite clear regional differences, some common themes became apparent, and a consensus was established on basic principles that may be considered in diverse settings. These are discussed here, with agreement on necessary proximal steps to develop bespoke person-centred care models.
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Affiliation(s)
- Tristan J Barber
- Ian Charleson Day Centre, Royal Free London NHS Foundation Trust, London, UK
- Institute for Global Health, University College London, London, UK
| | - Brenda Crabtree
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
| | | | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Jennifer F Hoy
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia
| | - Renna Rajasuriar
- Faculty of Medicine, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jessica Castilho
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Julian Falutz
- Division of Geriatrics and Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
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Gustafsson T, Maurin Söderholm H, Sundler AJ, Karlsson P, Lindberg E. 'Sometimes you need an eye-opener': A qualitative study on nursing assistants' experiences of developing communication skills through an educational intervention on person-centred communication. Nurs Open 2023. [PMID: 36882996 DOI: 10.1002/nop2.1702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 12/12/2022] [Accepted: 02/20/2023] [Indexed: 03/09/2023] Open
Abstract
AIM To explore nursing assistants' (NAs') experiences of developing communication skills while participating in an educational intervention on person-centred communication. DESIGN A descriptive qualitative study was conducted. METHODS Data were collected from interviews and written assignments before, during and after an educational intervention on person-centred communication targeting NAs in home care services. The data were analysed using a phenomenological approach. A total of 25 NAs participated in the study. RESULTS The findings describe NAs' experiences concerning the communication skills needed for building relationships with older persons and handling emotionally challenging situations. The educational intervention increased their knowledge and awareness of the importance of communication skills and how such skills are developed and refined.
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Affiliation(s)
- Tanja Gustafsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Hanna Maurin Söderholm
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.,PreHospen Centre for Prehospital Research, University of Borås, Borås, Sweden
| | - Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Pernilla Karlsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.,Närhälsan Fristad Primary Health Care Center, Borås, Sweden
| | - Elisabeth Lindberg
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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14
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Yu R, Leung G, Lai D, Tong C, Tam LY, Cheng C, Kong S, Woo J. Assessing the Readiness for Implementing the World Health Organization's ICOPE Approach in Hong Kong: Perspectives from Social Care and Policy Stakeholders. J Frailty Aging 2023; 12:126-133. [PMID: 36946709 DOI: 10.14283/jfa.2023.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Although integrated care has been considered a key strategy in reforming health systems around the world, it seems hard to realise in practice, particularly in the part of medical social integration. Worse still, little is known about the capacity of social care professionals who implement it, or their perceived roles and responsibilities, as well as the barriers and facilitators that stakeholders from the health and social sectors identify as factors affecting the ICOPE implementation process. Therefore, the present study was performed to probe into these issues. Data were collected from an online survey based on the WHO ICOPE scorecard (N = 34), and focus groups with policy makers, managers, health and social care professionals (N = 47). Inductive analyses were performed in accordance with the service and system levels within the WHO ICOPE implementation framework. While the findings from the scorecard survey highlight the gap in actualizing the ICOPE approach within the existing social services and care structures, we found support for a model of integrated care underpinned by the WHO ICOPE approach. Factors that may hinder and facilitate ICOPE implementation include workforce capacity-building, coordinated networks and partnerships, and financial mechanisms. This finding can help inform subsequent actions that further support health and social care advancement and collaboration, and the implementation of the ICOPE approach.
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Affiliation(s)
- R Yu
- Ruby Yu, The Chinese University of Hong Kong, Hong Kong,
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15
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Anantapong K, Davies N, Sampson EL. Communication between the multidisciplinary team and families regarding nutrition and hydration for people with severe dementia in acute hospitals: a qualitative study. Age Ageing 2022; 51:6834151. [PMID: 36434801 PMCID: PMC9701106 DOI: 10.1093/ageing/afac230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND When a person with severe dementia is in hospital and has eating and drinking difficulties, communication between the multidisciplinary team and families can be challenging and lead to suboptimal care. OBJECTIVE To gain in-depth understanding about the experiences, views and needs of family carers and hospital staff, regarding communication and conversations about nutrition and hydration, for hospital patients with severe dementia. DESIGN Qualitative semi-structured interview study. SETTING Acute hospital in England. METHODS From January to May 2021, semi-structured interviews were conducted with 29 family carers and hospital staff. Interviews were transcribed verbatim and analysed using reflexive thematic methods. RESULTS Four overarching themes were developed: (i) prerequisites to initiating communication about eating and drinking; (ii) communication aiming to develop agreed care plans; (iii) difficulty discussing palliative and end-of-life care; and (iv) needs of information and plans about future eating and drinking difficulties. Families tended to wait for hospital staff to initiate discussions but usually experienced frustration with delays and repeated conversations with different staff. Some staff felt unprepared to manage these conversations and found it challenging to work across the multidisciplinary team. During discharge processes, key information and care plans about eating and drinking were not regularly passed on to people involved to avoid unnecessary readmissions. CONCLUSIONS In acute hospitals, family carers and hospital staff can have disjointed communications and conversations about nutrition and hydration for persons with severe dementia. Timely reassurance, ongoing discussions and clear information sharing will support communication between those involved.
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Affiliation(s)
| | - Nathan Davies
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK,Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK,Department of Psychological Medicine, Royal London Hospital, East London NHS Foundation Trust, London, UK
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16
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Larsson A, Barenfeld E, Fors A, Gjertsson I, Bergenheim A, Mannerkorpi K. Person-centred health plans for physical activity in persons with chronic widespread pain (CWP) - a retrospective descriptive review. Disabil Rehabil 2022; 45:1857-1864. [PMID: 35658763 DOI: 10.1080/09638288.2022.2077992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Physical activity is recommended as first-choice treatment in chronic pain conditions. The aim was to describe the content and perceptions of person-centred health plans, and to evaluate patients' implementation of the health plan in their everyday life. MATERIALS AND METHODS A descriptive retrospective review was conducted of person-centred health plans to support physical activity in 133 participants. Quantitative content analysis was used to analyse the content of the health plans. Questionnaires on physical activity and on implementation and perception of the health plans, and a test of physical capacity were administered. RESULTS Participants' goals were found to be related to physical function (n = 118), general health (n = 90), activity and participation (n = 80) and symptoms (n = 35). Participants identified personal (n = 174), social (n = 69) and material resources (n = 36). They identified fears and obstacles related to health issues (n = 95), difficulties getting it done (n = 41), competing priorities (n = 19) and contextual factors (n = 12). Participants identified need for external support (n = 110). Participants' level of physical activity and physical capacity increased significantly during the first 6 months of the study. CONCLUSION The person-centred approach seems helpful in enhancing motivation to achieve set goals and strengthen self-efficacy in physical activity also supported by increased physical activity and physical capacity. Implications for rehabilitationA person-centred approach can be helpful to enhance motivation to achieve set goals and self-efficacy to manage symptoms when engaging in physical activity.Shared documentation of a personal health plan helps to visualize resources to promote regular physical activity as well as alternative ways to reach set goals.The co-created health-plan captures the participant's goals, resources, fears and need of support, helps the participant to overcome challenges, and supports the participant to be physically active.
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Affiliation(s)
- Anette Larsson
- Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden.,General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emmelie Barenfeld
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Fors
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Inger Gjertsson
- Department of Rheumatology and Inflammation Research, University of Gothenburg, Gothenburg, Sweden
| | - Anna Bergenheim
- Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - Kaisa Mannerkorpi
- Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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17
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Stogiannos N, Carlier S, Harvey-Lloyd JM, Brammer A, Nugent B, Cleaver K, McNulty JP, dos Reis CS, Malamateniou C. A systematic review of person-centred adjustments to facilitate magnetic resonance imaging for autistic patients without the use of sedation or anaesthesia. Autism 2022; 26:782-797. [PMID: 34961364 PMCID: PMC9008560 DOI: 10.1177/13623613211065542] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
LAY ABSTRACT Autistic patients often undergo magnetic resonance imaging examinations. Within this environment, it is usual to feel anxious and overwhelmed by noises, lights or other people. The narrow scanners, the loud noises and the long examination time can easily cause panic attacks. This review aims to identify any adaptations for autistic individuals to have a magnetic resonance imaging scan without sedation or anaesthesia. Out of 4442 articles screened, 53 more relevant were evaluated and 21 were finally included in this study. Customising communication, different techniques to improve the environment, using technology for familiarisation and distraction have been used in previous studies. The results of this study can be used to make suggestions on how to improve magnetic resonance imaging practice and the autistic patient experience. They can also be used to create training for the healthcare professionals using the magnetic resonance imaging scanners.
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Affiliation(s)
| | - Sarah Carlier
- University of Applied Sciences and Arts Western Switzerland (HES-SO), Switzerland
- University of Lausanne, Switzerland
| | | | | | - Barbara Nugent
- City, University of London, UK
- MRI Safety Matters® Organisation, UK
- NHS National Education for Scotland, UK
| | | | | | - Cláudia Sá dos Reis
- University of Applied Sciences and Arts Western Switzerland (HES-SO), Switzerland
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18
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Bejerholm U, Allaskog C, Andersson J, Nordström L, Roe D. Implementation of the Recovery Guide in inpatient mental health services in Sweden-A process evaluation study. Health Expect 2022; 25:1405-1417. [PMID: 35340092 PMCID: PMC9327815 DOI: 10.1111/hex.13480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/27/2022] [Accepted: 03/05/2022] [Indexed: 12/31/2022] Open
Abstract
Background Involving service users in inpatient care and recovery planning has gained interest worldwide. Our purpose was to evaluate the process of implementation of a coproduced Recovery Guide (RG) intervention in 22 inpatient wards in Sweden, in terms of context, implementation process and mechanisms of impact over 12 months. Methods A mixed method design and a process evaluation framework were used to guide data collection and to deductively analyze perspectives and descriptive statistics of delivery from three stakeholder groups. Results Results showed that although initial contextual barriers were present (e.g., lack of resources, and interest, uncertainty in the organization, a dominant illness perspective), it was possible to implement the RG in 14 wards, where 53% of admitted service users received the intervention. Legitimacy of the intervention, engaged managers and staff, capacity of staff and ward organization, coproduction and continuous support from user organization were critical mediators. Mechanisms of impact concerned (1) a new perspective on mental health, well‐being and recovery, (2) capacity building of a recovery approach in inpatient settings and (3) a meaningful outlet for users' thoughts and feelings on recovery, sharing narratives and influencing care and goals. Conclusions The RG intervention has the potential to promote a recovery approach in inpatient mental health services (MHSs). Coproduction among stakeholders created trust and a sustainable implementation that made it possible for wards to resume implementation when contextual barriers had been resolved. Patient and Public Contribution The current study involved stakeholders including a service user organization, the public, first‐line managers and staff (including peer support workers) in inpatient and community MHS and researchers, who greatly contributed to the implementation programme, including codesign of the RG intervention as well as coproduction of the implementation in inpatient MHS. All authors have their own lived experiences of mental health problems as a service user or as a relative.
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Affiliation(s)
- Ulrika Bejerholm
- Department of Health Sciences, Centre of Evidence-Based Psychosocial Interventions, CEPI, Lund University, Lund, Sweden.,Department of Research, Development and Education, Division of Psychiatry and Habilitation, Lund, Sweden
| | - Conny Allaskog
- The Swedish Partnership for Mental Health, NSPH, Skåne, Sweden
| | | | - Linda Nordström
- The Swedish Partnership for Mental Health, NSPH, Skåne, Sweden
| | - David Roe
- Department of Health Sciences, Centre of Evidence-Based Psychosocial Interventions, CEPI, Lund University, Lund, Sweden.,Department of Community Mental Health, University of Haifa, Haifa, Israel.,Department of Clinical Medicine, Psychiatry, Aalborg University, Aalborg, Denmark
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19
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Ruissen MM, Sont JK, van Vugt HA, Kunneman M, Rutten GEHM, de Koning EJP. Key Factors Relevant for Healthcare Decisions of Patients with Type 1 and Type 2 Diabetes in Secondary Care According to Healthcare Professionals. Patient Prefer Adherence 2022; 16:809-819. [PMID: 35370405 PMCID: PMC8974434 DOI: 10.2147/ppa.s354686] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/11/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Understanding which factors are important for healthcare decisions of patients with diabetes in clinical practice is important to personalise diabetes care strategies and tailor care plans to the individual. The main drivers for these healthcare decisions remain unclear. This study assessed which key factors are relevant for healthcare decisions during clinical consultations for patients with type 1 diabetes (T1DM) and type 2 diabetes (T2DM), according to healthcare professionals. MATERIALS AND METHODS Annual diabetes reviews were performed as part of a trial assessing the impact of a consultation model facilitating person-centred diabetes care in six hospital outpatient clinics. After each consultation, we asked healthcare professionals to choose a maximum of three out of 20 factors that were most relevant for healthcare decisions about treatment goals and the professional support needed during the upcoming year. Factors were characterised as either person or disease-related. Percentages reflect the number of annual diabetes reviews in which the key factor was reported. RESULTS Seventeen physicians and eight diabetes specialist nurses reported the key factors relevant for healthcare decisions in 285 annual diabetes reviews (T1DM n = 119, T2DM n = 166). Healthcare professionals most often reported quality of life (31.9%), motivation (27.0%) and diabetes self-management (25.6%), and to a lesser extent glycaemic control (24.2%), to be important for decisions about treatment goals. For decisions about the professional support needed during the upcoming year patient's preferences (33.7%), diabetes self-management (33.3%), quality of life (27.0%) and motivation (25.6%) were most often considered relevant by healthcare professionals. CONCLUSION According to healthcare professionals, person-related factors such as quality of life, diabetes self-management and motivation are predominantly relevant for healthcare decisions about treatment goals and the professional support needed during the upcoming year.
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Affiliation(s)
- Merel M Ruissen
- Department of Medicine, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Biomedical Data Sciences, Section of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Jacob K Sont
- Department of Biomedical Data Sciences, Section of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Heidi A van Vugt
- Julius Centre for Health Sciences and Primary Care, Department of General Practice, University Medical Centre Utrecht, Utrecht, the Netherlands
- Dutch Diabetes Federation, Amersfoort, the Netherlands
| | - Marleen Kunneman
- Department of Biomedical Data Sciences, Section of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Guy E H M Rutten
- Julius Centre for Health Sciences and Primary Care, Department of General Practice, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Eelco J P de Koning
- Department of Medicine, Leiden University Medical Centre, Leiden, the Netherlands
- Correspondence: Eelco JP de Koning, Department of Medicine, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands, Tel +31 71 52 62085, Fax +31 71 52 66881, Email
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20
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Almond H, Long K, Leroux G. Tensions Ahead: How Do We Build Feasible Digital Health Systems That Are Person-Centred and Usable? Stud Health Technol Inform 2021; 284:236-238. [PMID: 34920517 DOI: 10.3233/shti210714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Globally, the term person-centred care has become all-pervasive across healthcare delivery. It has been suggested that it has become synonymous with good quality care. The term is used frequently in the aims and objectives for healthcare service and provision, although what lies behind the rhetoric in terms of practice may be questionable. Further, in an environment which is becoming increasingly dependent on technology, the interaction needs the user experience of both consumer and healthcare provider. There is a challenge as national surveys of health professionals continue to criticize the usability of digital health interfaces. This panel discussion aims to highlight the factors, which should be considered when designing health information interfaces as person-centred for all users. Drawing on our panel's expertise, we suggest interfaces need to consider two main factors: personalization and user acceptance.
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Affiliation(s)
- Helen Almond
- Swinburne University of Technology and HISA NI-CoP
| | - Karrie Long
- Melbourne Health and Swinburne University of Technology and HISA UX-CoP
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21
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Kim KM, Meyer N, Hall-Lande J, Freeman R. Supervisory and administrative staff's perspectives of self-directed supports for people with intellectual and developmental disabilities. J Appl Res Intellect Disabil 2021; 35:480-487. [PMID: 34697876 DOI: 10.1111/jar.12955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 09/23/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Self-directed supports (SDS) are a model of disability service delivery that focuses on supporting increased decision-making authority and budget autonomy for people with disabilities and their families. This study identifies supervisory and administrative staff's perspectives within a self-directed, individualised budgeting programme for people with intellectual and developmental disabilities. METHOD Data were collected through 28 face-to-face interviews with supervisory and fiscal administrative staff in Minnesota, USA. RESULTS A qualitative analysis of these interviews resulted in four major themes: (1) the benefits of SDS, (2) the relationship between SDS and person-centred strategies, (3) the perception that a natural tension arises when balancing person-centred approaches with the need for consistent and fair state policy-including rules and regulations within state systems and (4) the unique challenges related to SDS benefits and challenges occurring across Minnesota. CONCLUSIONS The results indicate the importance of providing effective communication and training to all stakeholders.
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Affiliation(s)
- Kyung Mee Kim
- Department of Social Welfare, Soongsil University, Seoul, Republic of Korea
| | | | - Jennifer Hall-Lande
- Institute on Community Integration, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rachel Freeman
- Institute on Community Integration, University of Minnesota, Minneapolis, Minnesota, USA
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22
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Gibson B, Umeh K, Davies I, Newson L. The best possible self-intervention as a viable public health tool for the prevention of type 2 diabetes: A reflexive thematic analysis of public experience and engagement. Health Expect 2021; 24:1713-1724. [PMID: 34258837 PMCID: PMC8483206 DOI: 10.1111/hex.13311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/10/2021] [Accepted: 06/06/2021] [Indexed: 11/30/2022] Open
Abstract
Background Public health initiatives seek to modify lifestyle behaviours associated with risk (e.g., diet, exercise, and smoking), but underpinning psychological and affective processes must also be considered to maximize success. Objective This study aimed to qualitatively assess how participants engaged with and utilized the best possible self (BPS)‐intervention specifically as a type 2 diabetes (T2D) prevention tool. Design and Methods Fourteen participants engaged with a tailored BPS intervention. Reflexive thematic analysis analysed accounts of participant's experiences and feasibility of use. Results All participants submitted evidence of engagement with the intervention. The analysis considered two main themes: Holistic Health and Control. The analysis highlighted several nuanced ways in which individuals conceptualized their health, set goals, and received affective benefits, offering insights into how people personalized a simple intervention to meet their health needs. Conclusions To our knowledge, this is the first study to tailor the BPS intervention as a public health application for the prevention of T2D. The intervention enabled users to identify their best possible selves in a way that encouraged T2D preventive behaviours. We propose that our tailored BPS intervention could be a flexible and brief tool to assist public health efforts in encouraging change to aid T2D prevention. Public Contribution The format, language and application of the BPS intervention were adapted in response to a public consultation group that developed a version specifically for application in this study.
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Affiliation(s)
- Benjamin Gibson
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, Merseyside, UK
| | - Kanayo Umeh
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, Merseyside, UK
| | - Ian Davies
- School of Sports and Exercise Sciences, Faculty of Science, Liverpool John Moores University, Liverpool, Merseyside, UK
| | - Lisa Newson
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, Merseyside, UK
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23
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Ramsay J. Sentience and transcendence: personal reflections on physical and mental adaptation from a near-death event and life-limiting surgery. BJPsych Bull 2021; 45:163-167. [PMID: 33357255 PMCID: PMC9059314 DOI: 10.1192/bjb.2020.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In this article I reflect on my experience of adapting physically, mentally and spiritually to a medical trauma that had life-changing consequences. I consider how, over 7 years to the time of writing, mental difficulties were inseparable from the physical; and how, for me, both are aspects of a form of understanding knowable only as mystery. Writing from a position of religious faith, I try to convey my experiences in a way that will be of interest to others regardless of their views. At the end, I reflect on aspects of my care that might be particularly relevant for a holistic, person-centred therapeutic approach.
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24
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Petersén C, Carlsson E. Life with a stoma-coping with daily life: Experiences from focus group interviews. J Clin Nurs 2021; 30:2309-2319. [PMID: 33829581 DOI: 10.1111/jocn.15769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/23/2021] [Accepted: 03/04/2021] [Indexed: 12/25/2022]
Abstract
AIMS AND OBJECTIVES To describe patients' experiences of coping with daily life practically and emotionally during the first years after stoma surgery. BACKGROUND For people with a stoma, a new life awaits with altered bowel function and body image. This means a profound change in a person's life. DESIGN A qualitative descriptive design using focus group interviews to gain an understanding of patients' experiences of coping with daily life. This study followed the COREQ checklist for reporting qualitative research. METHOD Six focus groups including 21 patients with a stoma experience of 1-3 years. Mean age was 65 (23-79) and comprised 9 men and 12 women. Thirteen participants had a colostomy, 8 had an ileostomy. The interviews were analysed with a qualitative content analysis. RESULTS Patients lived with uncertainty due to lost control over bowel function and did not feel comfortable with the new body. They had adjusted to the new life with a positive impact, by changing their attitude, enabling a social- and working life and tried to take control over the situation. Patients with a temporary stoma put life on hold. CONCLUSION Patients with a stoma lived with uncertainty, not trusting their body like before. They strived to regain control of their lives according to their own resources and conditions and with support from healthcare professionals. Interacting with others in similar situations and exchanging experiences, in demanding areas such as body image, sexuality and social activities could support patients in coping with their new life with a stoma. RELEVANCE TO CLINICAL PRACTICE The findings can help stoma care nurses and healthcare professionals plan themed lectures and group discussions for patients regarding coping with areas that are especially demanding. A themed evening would give patients the chance to share and exchange experiences and receive affirmation from others in the same situation.
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Affiliation(s)
- Charlotta Petersén
- Surgical Department, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.,Institute of Health and Care sciences, the Sahlgrenska Academy Gothenburg University, Gothenburg, Sweden
| | - Eva Carlsson
- Surgical Department, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.,Institute of Health and Care sciences, the Sahlgrenska Academy Gothenburg University, Gothenburg, Sweden.,Gothenburg Centre for personcentred care, the Sahlgrenska Academy Gothenburg University, Gothenburg, Sweden
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25
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Juhlin S, Bergenheim A, Gjertsson I, Larsson A, Mannerkorpi K. Physical activity with person-centred guidance supported by a digital platform for persons with chronic widespread pain: A randomized controlled trial. J Rehabil Med 2021; 53:jrm00175. [PMID: 33576434 PMCID: PMC8814874 DOI: 10.2340/16501977-2796] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To determine the effectiveness of a person-centred intervention, including advice on physical activity, for improving pain intensity, physical activity, and other health-related outcomes in persons with chronic widespread pain, when delivered with digital eHealth support compared with standard telephone follow-up. Design Randomized controlled trial. Subjects Individuals with chronic widespread pain (n = 139), aged 20–65 years, who had previously participated in a pain educational programme at primary healthcare units, were contacted during the period 2018–19 and randomized to an intervention group (n = 69) or an active control group (n = 70). Methods Together with a physiotherapist, participants in both groups developed person-centred health plans for physical activity. The intervention group was supported via a digital platform for 6 months. The active control group received support via one follow-up phone call. Primary outcome was pain intensity. Secondary outcomes were physical activity and other health-related outcomes. Results No significant differences were found between the groups after 6 months, except for a significant decrease in global fatigue in the active control group compared with the intervention group. Conclusion Future development of interventions supporting persons with chronic pain to maintain regular exercise is warranted.
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Affiliation(s)
- Sofia Juhlin
- Physiotherapy, Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. E-mail:
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26
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Nicholson C, Finlay WML, Stagg S. Forms of resistance in people with severe and profound intellectual disabilities. Sociol Health Illn 2021; 43:642-659. [PMID: 33635551 DOI: 10.1111/1467-9566.13246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/26/2020] [Accepted: 01/06/2021] [Indexed: 06/12/2023]
Abstract
Government policy in the UK emphasises that people with intellectual disabilities should have the opportunity to make choices and exert control over their own lives as much as possible. The ability of a person to resist activities and offers is therefore important, particularly for people with severe and profound intellectual disabilities, who are likely to have language impairments and need to communicate their choices non-verbally. Video and ethnographic data were collected from two services for people with severe and profound intellectual disabilities. Examples of resistance by people with severe and profound intellectual disabilities and responses to that resistance by support workers were collected and examined using conversation analysis and ethnographic description. A range of non-verbal resistance behaviours are described, and the difficulty for support workers in identifying resistance when behaviour is ambiguous is discussed. The importance of understanding these behaviours as examples of decision-making is stressed.
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Affiliation(s)
- Clare Nicholson
- Faculty of Sports, Health and Applied Science, St Mary's University, Twickenham, London, UK
| | - W Mick L Finlay
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK
| | - Steven Stagg
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK
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27
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Abstract
Hospital discharge planning is valuable in improving care and avoiding discharge delays. This is highly relevant to older people. Although usual discharge planning is now well understood and applicable to most patients, a range of different discharge scenarios exist that involve different considerations. These less common scenarios appear less well understood and can be challenging for clinical staff. To improve understanding and care, this Commentary suggests a basic classification of six discharge planning scenarios. These are: usual discharge planning, premature discharge, rehabilitation selection, safety concerns, reluctant discharge and delayed discharge. Clinical and system responses to each scenario are briefly discussed. This classification could potentially be useful in clinical education and quality improvement.
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Affiliation(s)
- Brent Hyslop
- Department of Medicine, Dunedin School of Medicine, University of Otago, Otago, New Zealand
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McNaughton H, Weatherall M, McPherson K, Fu V, Taylor WJ, McRae A, Thomson T, Gommans J, Green G, Harwood M, Ranta A, Hanger C, Riley J. The effect of the Take Charge intervention on mood, motivation, activation and risk factor management: Analysis of secondary data from the Taking Charge after Stroke (TaCAS) trial. Clin Rehabil 2021; 35:1021-1031. [PMID: 33586474 DOI: 10.1177/0269215521993648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To use secondary data from the Taking Charge after Stroke study to explore mechanisms for the positive effect of the Take Charge intervention on physical health, advanced activities of daily living and independence for people after acute stroke. DESIGN An open, parallel-group, randomised trial with two active and one control intervention and blinded outcome assessment. SETTING Community. PARTICIPANTS Adults (n = 400) discharged to community, non-institutional living following acute stroke. INTERVENTIONS One, two, or zero sessions of the Take Charge intervention, a self-directed rehabilitation intervention which helps a person with stroke take charge of their own recovery. MEASURES Twelve months after stroke: Mood (Patient Health Questionnaire-2, Mental Component Summary of the Short Form 36); 'ability to Take Charge' using a novel measure, the Autonomy-Mastery-Purpose-Connectedness (AMP-C) score; activation (Patient Activation Measure); body mass index (BMI), blood pressure (BP) and medication adherence (Medication Adherence Questionnaire). RESULTS Follow-up was near-complete (388/390 (99.5%)) of survivors at 12 months. Mean age (SD) was 72.0 (12.5) years. There were no significant differences in mood, activation, 'ability to Take Charge', medication adherence, BMI or BP by randomised group at 12 months. There was a significant positive association between baseline AMP-C scores and 12-month outcome for control participants (1.73 (95%CI 0.90 to 2.56)) but not for the Take Charge groups combined (0.34 (95%CI -0.17 to 0.85)). CONCLUSION The mechanism by which Take Charge is effective remains uncertain. However, our findings support a hypothesis that baseline variability in motivation, mastery and connectedness may be modified by the Take Charge intervention.
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Affiliation(s)
- Harry McNaughton
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Mark Weatherall
- Department of Medicine, University of Otago, Wellington, New Zealand
| | | | - Vivian Fu
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - William J Taylor
- Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand
| | - Anna McRae
- Auckland District Health Board, Auckland, New Zealand
| | - Tom Thomson
- Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - John Gommans
- Hawkes Bay District Health Board, Hastings, New Zealand
| | - Geoff Green
- Counties-Manukau District Health Board, Auckland, New Zealand
| | - Matire Harwood
- Te Kupenga Hauora Māori, University of Auckland, Auckland, New Zealand
| | - Annemarei Ranta
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Carl Hanger
- Canterbury District Health Board, Christchurch, New Zealand
| | - Judith Riley
- Medical Research Institute of New Zealand, Wellington, New Zealand
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Roller-Wirnsberger R, Liotta G, Lindner S, Iaccarino G, De Luca V, Geurden B, Maggio M, Longobucco Y, Vollenbroek-Hutten M, Cano A, Carriazo AM, Goossens E, Cacciatore F, Triassi M, D'Amico M, Illario M. Public health and clinical approach to proactive management of frailty in multidimensional arena. Ann Ig 2021; 33:543-554. [PMID: 33565567 DOI: 10.7416/ai.2021.2426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background Demographic changes have forced communities and people themselves to reshape ageing concepts and approaches and try to develop actions towards active and healthy ageing. In this context, the European Commission launched different private-public partnerships to develop new solutions and answers on questions related to this topic. The European Innovation Partnership on Active and Healthy Ageing, including topic related action groups as well reference sites committed towards a common action to facilitate active and healthy ageing, has contributed key elements for interventions, scaled up best practices and evaluated impact of their action to drive innovation across many regions in Europe over the past years. Methods This paper describes action taken by A3 action group in the European Innovation Partnership on Active and Healthy Ageing. This paper gives an overview of how the partnership combined the view on frailty coming from public health as well as the clinical management. Results Within different European regions, to tackle frailty, EIPonAHA partners have conceptualized functional decline and frailty, making use of good practice models working well on community programs. The A3 Group of EIPonAHA has worked alongside a process of innovation, targeting all ageing citizens with the clear goal of involving communities in the preventive approach. Conclusion Engagement needs of older people with a focus on functionally rather than disease management as primary objective is considered as an overarching concept, also embracing adherence, compliance, empowerment, health literacy, shared decision-making, and activation. Furthermore, training of staff working with ageing people across all sectors needs to be implemented and evaluated in future studies.
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Affiliation(s)
| | - G Liotta
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - S Lindner
- Department of Internal Medicine, Medical University of Graz, Austria
| | - G Iaccarino
- Department of Advanced Biomedical Sciences, Federico II University, Napoli, Italy
| | - V De Luca
- Unit for Health Innovation, Campania Region Health Directorate, and Federico II University, Department of Public Health, Naples, Italy
| | - B Geurden
- Center for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Belgium.,Center for Gastrology, Leuven, Belgium
| | - M Maggio
- Department of Medicine and Surgery, University of Parma, Italy
| | - Y Longobucco
- Department of Medicine and Surgery, University of Parma, Italy
| | - M Vollenbroek-Hutten
- Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, The Netherlands
| | - A Cano
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, and INCLIVA, Valencia, Spain
| | - A M Carriazo
- Regional Ministry of Health and Families of Andalusia, Seville, Spain
| | | | - F Cacciatore
- Unit for Health Innovation, Campania Region Health Directorate, and Federico II University, Department of Public Health, Naples, Italy
| | - M Triassi
- Unit for Health Innovation, Campania Region Health Directorate, and Federico II University, Department of Public Health, Naples, Italy
| | - M D'Amico
- Specialization School of Hygiene and Preventive Medicine, Tor Vergata University, Rome, Italy
| | - M Illario
- Unit for Health Innovation, Campania Region Health Directorate, and Federico II University, Department of Public Health, Naples, Italy
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Wang M, Dewing J. Exploring mediating effects between nursing leadership and patient safety from a person-centred perspective: A literature review. J Nurs Manag 2020; 29:878-889. [PMID: 33283350 DOI: 10.1111/jonm.13226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 11/17/2020] [Accepted: 12/01/2020] [Indexed: 11/27/2022]
Abstract
AIMS To evaluate the mechanism through which nursing leadership impacts patient safety. BACKGROUND Patient safety has received considerable attention among policymakers, governments and public sectors with the emphasis in health care settings on minimizing the risk to patients. Claims are made leadership plays a crucial role in patient safety. However, the incidents of adverse events are consistently high in hospitals. EVALUATION Published English-only research articles that examine the mechanism by which nursing leadership impacts patient safety were selected from seven electronic databases and manual searches. Data extraction, quality assessments and analysis were completed for ten research studies. KEY ISSUES There is evidence of significant mediating effects between nursing leadership and decreased adverse patient outcomes specifically with regard to workplace empowerment, leader-nurse relationship and the quality of the care environment. CONCLUSION The findings suggest that nursing leadership has a significant indirect impact on patient safety outcomes. From a person-centred perspective, the care environment requires workplace empowerment and effective relationships between leaders and nurses. IMPLICATIONS FOR NURSING MANAGEMENT To improve patient safety outcomes, managers must strive to emphasize workplace empowerment, leader-nurse relationship and the quality of the care environment. Managers must consider these domains as part of an effective workplace culture.
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Affiliation(s)
- Meini Wang
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Jan Dewing
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
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Abstract
Background: Client-centred practice aims to involve the person in making decisions during the therapeutic intervention process, giving him or her a central and active role.Objectives: To analyze the effects of client-centred practice in occupational therapy on issues related to occupational performance and participation among people with stroke and traumatic brain injury.Material and methods: A systematic review of randomized clinical trials examining the effects of a client-centred practice carried out by occupational therapists in patients with stroke or traumatic brain injury aged over 18 years was conducted. PubMed, Web of Science, Scopus, OT Seeker, PsycINFO and EBSCO were used to retrieve potentially eligible publications.Results: Eight studies, from 294 identified, were included. The extracted data showed that the application of client-centred practice in occupational therapy improved satisfaction with occupational performance compared to conventional interventions. However, client-centred practice and conventional intervention had similar effects on functionality (Activities of Daily Living), life satisfaction and burden on caregivers.Conclusions and significance: Client-centred practice has the effect of achieving greater satisfaction with occupational performance. This suggests that client-centred practice in occupational therapy helps patients to accept the new limitations on their occupational performance. Further studies are needed to determine the effects of client-centred practice on other aspects.
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Affiliation(s)
| | | | - Jose Antonio Merchán-Baeza
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Spain
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Guidetti S, Eriksson G, von Koch L, Johansson U, Tham K. Activities in Daily Living: The development of a new client-centred ADL intervention for persons with stroke. Scand J Occup Ther 2020; 29:104-115. [PMID: 33295237 DOI: 10.1080/11038128.2020.1849392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND An intervention that contains several interacting components can be defined as a complex intervention. This intervention was developed in accordance with the Medical Research Council (MRC) guidance for complex interventions. AIM To describe the development, theoretical framework, and content of a client-centred activities in daily living intervention (CADL) for people with stroke. MATERIAL AND METHODS Different steps were used; identifying the evidence base, identifying/developing theory and the modelling process and outcomes in the development of the CADL. The remodelling of the process and content of the intervention that emerged are defined. RESULTS Findings from a series of qualitative studies of people with stroke demonstrated the need to develop an ADL intervention based on the clients' lived experiences. The theoretical framework is based on empirical research, theories about human occupation and client-centredness. The CADL is applying an occupational and phenomenological perspective in order to enable agency in daily activities and participation in everyday life among persons with stroke. CONCLUSIONS AND SIGNIFICANCE The article can be used as an example of how to present the development and theoretical framework of a new complex intervention in occupational therapy.
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Affiliation(s)
- Susanne Guidetti
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Gunilla Eriksson
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden
| | - Lena von Koch
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Ulla Johansson
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research, Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - Kerstin Tham
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
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Hutchinson C, Lay K, Alexander J, Ratcliffe J. People with intellectual disabilities as business owners: A systematic review of peer-reviewed literature. J Appl Res Intellect Disabil 2020; 34:459-470. [PMID: 33280214 DOI: 10.1111/jar.12836] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 08/24/2020] [Accepted: 10/28/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Microenterprises are very small businesses requiring little capital and can be an employment pathway for people with intellectual disabilities. This systematic review aims to identify the facilitators, barriers and outcomes from microenterprise. METHOD Web of Science, Scopus, EconLit, PsycINFO and ProQuest were searched to identify peer-reviewed studies on microenterprises owned by people with intellectual disability published up to and including 1 October 2019. RESULTS A total of 1080 papers were independently screened by two reviewers. Six papers met the inclusion criteria. Barriers included lack of access to business expertise and resources, and the tension between growing microenterprises and maintaining eligibility for welfare payments. Formal and informal supports were key facilitators. Outcomes experienced included additional income, skills development, increased confidence and engagement in meaningful activities. CONCLUSION Additional research is required to develop an evidence base which may support investment in this employment pathway, making microenterprise more accessible to people with intellectual disabilities.
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Affiliation(s)
- Claire Hutchinson
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Kiri Lay
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - June Alexander
- Disability and Community Inclusion Unit, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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McNamara B, Same A, Rosenwax L. Creating person-centred support for people with intellectual disabilities at the end of life: An Australian qualitative study of unmet needs and strategies. J Intellect Disabil 2020; 24:543-558. [PMID: 30727802 DOI: 10.1177/1744629518823887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND People with intellectual disabilities at the end of life are at risk of receiving inadequate and inequitable end-of-life care. This study explores their unmet needs, opportunities for person-centred care and experiences of health service use. METHODS Qualitative interviews with 26 experienced health professionals and carers were used to explore their patients' and residents' unmet needs and end-of-life care options and to outline strategies to support them. RESULTS A range of challenges and unmet needs experienced by people with intellectual disabilities are presented in themes: (1) accommodation setting at the end of life: dying 'at home'; (2) personal factors and networks: a circle of support; (3) end-of-life medical care and decision-making. Strategies to facilitate good end-of-life care and a model of care are presented. CONCLUSIONS Well-prepared and collaborative disability and health service workforces are needed, together with flexible and adequate end-of-life funding to ensure compassionate and person-centred care.
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Moreira PAS, Inman RA, Cloninger K, Cloninger CR. Student engagement with school and personality: a biopsychosocial and person-centred approach. Br J Educ Psychol 2020; 91:691-713. [PMID: 33247604 DOI: 10.1111/bjep.12388] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/21/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Engagement with school is a key predictor of students' academic outcomes, yet little is known about its association with personality. No research has considered this association using Cloninger's biopsychosocial model of personality. This model may be particularly informative because it posits the structure of human personality corresponds to three systems of human learning and memory that regulate associative conditioning, intentionality, and self-awareness, all of which are relevant for understanding engagement. AIMS To test for defined personality phenotypes and describe how they relate to student engagement. SAMPLE 469 adolescents (54.2% female) attending the eighth (Mage = 13.2, SD = .57) or 11th (Mage = 16.5, SD = .84) grades. METHODS Students completed self-report measures of personality and engagement. We used mixture models to identify latent classes defined by common (1) temperament profiles, (2) character profiles, and (3) joint temperament-character networks, and then tested how these classes differed in engagement. RESULTS Latent class analysis revealed three distinct joint temperament-character networks: Emotional-Unreliable (emotionally reactive, low self-control, and low creativity), Organized-Reliable (self-control but not creative), and Creative-Reliable (highly creative and prosocial). These networks differed significantly in engagement, with the emotional-unreliable network linked to lower engagement. However, the magnitudes of these differences across engagement dimensions did not appear to be uniform. CONCLUSIONS Different integrated configurations of the biopsychosocial systems for associative conditioning, intentionality, and self-awareness (differences in personality) underlie student engagement. Our results offer a fine-grained understanding of engagement dimensions in terms of their underlying personality networks, with implications for educational policies and practices.
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Affiliation(s)
- Paulo A S Moreira
- Instituto de Psicologia e de Ciências da Educação [Institute of Psychology and Education], Universidade Lusíada-Norte, Porto, Portugal.,Centro de Investigação em Psicologia para o Desenvolvimento (CIPD) [The Psychology for Positive Development Research Center], Porto, Portugal
| | - Richard A Inman
- Centro de Investigação em Psicologia para o Desenvolvimento (CIPD) [The Psychology for Positive Development Research Center], Porto, Portugal
| | - Kevin Cloninger
- Anthropedia Foundation, Washington, District of Columbia, USA
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Yu R, Tong C, Woo J. Effect of an integrated care model for pre-frail and frail older people living in community. Age Ageing 2020; 49:1048-1055. [PMID: 32479591 DOI: 10.1093/ageing/afaa087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/05/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES to evaluate the effect of an integrated care model for pre-frail and frail community-dwelling older people. DESIGN a quasi-experimental design. SETTING AND PARTICIPANTS we enrolled people aged ≥60 years from a community care project. An inclusion criterion was pre-frailty/frailty, as measured by a simple frailty questionnaire (FRAIL) with a score of ≥1. METHODS we assigned participants to an intervention group (n = 183) in which they received an integrated intervention (in-depth assessment, personalised care plans and coordinated care) or a control group (n = 270) in which they received a group education session on frailty prevention. The outcomes were changes in frailty, individual domains of frailty ('fatigue', 'resistance', 'ambulation', 'illnesses' and 'loss of weight') and health services utilisation over 12 months. Assessments were conducted at baseline and at the 12-month follow-up. RESULTS the mean age of the participants (n = 453) at baseline was 76.1 ± 7.5 years, and 363 (80.1%) were women. At follow-up, the intervention group showed significantly greater reductions in FRAIL scores than the control group (P < 0.033). In addition, 22.4% of the intervention and 13.7% of the control participants had reverted from pre-frail/frail to robust status, with the difference reaching significance when the intervention was compared with the control group (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.0-2.4) after adjustments for age, sex, living arrangement/marital status and hypercholesterolemia. For individual domains of frailty, the adjusted OR for improved 'resistance' was 1.7 (95% CI 1.0-2.8). However, no effects were found on reducing use of health services. CONCLUSION the integrated health and social care model reduced FRAIL scores in a combined population of pre-frail/frail community-dwelling older people attending older people's centres.
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Affiliation(s)
- Ruby Yu
- Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Cecilia Tong
- Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Jean Woo
- Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
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Shoesmith E, Charura D, Surr C. Acceptability and feasibility study of a six-week person-centred, therapeutic visual art intervention for people with dementia. Arts Health 2020; 13:296-314. [PMID: 32744920 DOI: 10.1080/17533015.2020.1802607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND There has been increasing interest in dementia, the arts and creativity across different disciplines in recent years, with previous literature illustrating the benefits of visual arts for people with dementia. METHOD A mixed-methods, quasi-experimental, pre/post design to assess the feasibility, acceptability and preliminary efficacy of a newly developed therapeutic, person-centred visual art intervention for people with dementia attending a day care centre or residing in an assisted living facility. RESULTS Five themes were identified from the interviews. Two themes reflected the feasibility/acceptability and the perceived impacts of the intervention, and three themes represented perceived successful elements: participant choice, socialisation and mentally stimulating activities. The quantitative data tentatively indicated enhanced social functioning and quality of life scores post-intervention. CONCLUSION These findings indicate that engagement with visual art is effective for people with dementia, and taking into account the factors that impact on feasibility and acceptability will promote future robust evaluation.
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Affiliation(s)
- Emily Shoesmith
- Centre for Dementia Research, Leeds Beckett University, Leeds, UK
| | - Divine Charura
- Psychological Therapies and Mental Health, Leeds Beckett University, Leeds, UK
| | - Claire Surr
- Centre for Dementia Research, Leeds Beckett University, Leeds, UK
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Ward MC, Milligan C, Rose E, Elliott M, Wainwright BR. The benefits of community-based participatory arts activities for people living with dementia: a thematic scoping review. Arts Health 2020; 13:213-239. [PMID: 32552336 DOI: 10.1080/17533015.2020.1781217] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The drive towards living well with dementia has resulted in a growing recognition of the value of community-based participatory arts activities. This review aimed to explore their overall impact and holistic benefits for people with early to moderate stages of dementia. METHODS Using a scoping review methodology and thematic analysis, this review explored relevant literature published between 2008 and 2019. RESULTS 26 published papers were identified, comprising visual arts, literary arts, comedy, music and dance. The key themes included person-centred, in-the-moment approaches; participation and communication; attention and cognition; social cohesion and relationships; and the role of space, place and objects. CONCLUSIONS There is strong evidence in support of using participatory arts for dementia, regardless of art form. In-the-moment and person-centred approaches were deemed impactful. Further research is needed to explore the importance of setting, material culture and the methodological or theoretical perspectives in participatory arts and dementia research.
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Affiliation(s)
- Meghánn Catherine Ward
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Christine Milligan
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.,Centre for Ageing Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Emma Rose
- Institute of Contemporary Arts, Faculty of Arts and Social Sciences, Lancaster University, Lancaster, UK
| | - Mary Elliott
- House Management and Creative Engagement Co-ordination, Theatre by the Lake, Keswick, UK
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Abstract
BACKGROUND There is no agreement about or understanding of what rehabilitation is; those who pay for it, those who provide it, and those who receive it all have different interpretations. Furthermore, within each group, there will be a variety of opinions. Definitions based on authority or on theory also vary and do not give a clear description of what someone buying, providing, or receiving rehabilitation can actually expect. METHOD This editorial extracts information from systematic reviews that find rehabilitation to be effective, to discover the key features and to develop an empirical definition. FINDINGS The evidence shows that rehabilitation may benefit any person with a long-lasting disability, arising from any cause, may do so at any stage of the illness, at any age, and may be delivered in any setting. Effective rehabilitation depends on an expert multidisciplinary team, working within the biopsychosocial model of illness and working collaboratively towards agreed goals. The effective general interventions include exercise, practice of tasks, education of and self-management by the patient, and psychosocial support. In addition, a huge range of other interventions may be needed, making rehabilitation an extremely complex process; specific actions must be tailored to the needs, goals, and wishes of the individual patient, but the consequences of any action are unpredictable and may not even be those anticipated. CONCLUSION Effective rehabilitation is a person-centred process, with treatment tailored to the individual patient's needs and, importantly, personalized monitoring of changes associated with intervention, with further changes in goals and actions if needed.
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Affiliation(s)
- Derick T Wade
- Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR) and Movement Science Group, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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Kidd L, Booth J, Lawrence M, Rowat A. Implementing Supported Self-Management in Community-Based Stroke Care: A Secondary Analysis of Nurses' Perspectives. J Clin Med 2020; 9:E985. [PMID: 32244792 PMCID: PMC7230474 DOI: 10.3390/jcm9040985] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/19/2020] [Accepted: 03/30/2020] [Indexed: 11/27/2022] Open
Abstract
The provision of supported self-management (SSM) is recommended in contemporary guidelines to address the longer-term needs and outcomes of stroke survivors and their families, yet its implementation across stroke pathways has been inconsistent. This paper presents a secondary analysis of qualitative data, which aims to identify and offer insight into the challenges of implementing SSM from the perspectives of community stroke nurses (n = 14). The findings revealed that the implementation of SSM in stroke is influenced by factors operating at multiple levels of the healthcare system. Contextual challenges arise because of different understandings and interpretations of what SSM is, what it comprises and professionals' perceptions of their roles in its implementation in practice. A professionally controlled, one-size-fits-all model of SSM continues to be reinforced within organizations, offering few opportunities for nurses to deliver contextually tailored and person-centred SSM. In conclusion, there are many professional concerns and organizational tensions that need to be addressed across multiple layers of the healthcare system to achieve the consistent implementation of contextually tailored and person-centred SSM following a stroke. Attempts to address these challenges will help to narrow the gap between policy and practice of implementing SSM, ensuring that stroke survivors and families benefit from SSM in the longer-term.
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Affiliation(s)
- Lisa Kidd
- Nursing & Healthcare, School of Medicine, Dentistry & Nursing, University of Glasgow; Glasgow G12 8LL, UK
| | - Joanne Booth
- School of Health & Life Sciences, Glasgow Caledonian University; Glasgow G4 0BA, UK; (J.B.); (M.L.)
| | - Maggie Lawrence
- School of Health & Life Sciences, Glasgow Caledonian University; Glasgow G4 0BA, UK; (J.B.); (M.L.)
| | - Anne Rowat
- School of Health & Social Care, Edinburgh Napier University; Edinburgh EH11 4DY, UK;
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Balqis-Ali NZ, Saw PS, Jailani AS, Yeoh TW, Fun WH, Mohd-Salleh N, Tengku Bahanuddin TPZ, Medan CA, Lee SWH, Sararaks S. Protocol for a cross-sectional study measuring person-centredness among healthcare providers in Malaysian primary care clinics: the adaptation and validation of the Person-Centred Practice Inventory-Staff (PCPI-S) Questionnaire. BMJ Open 2020; 10:e034128. [PMID: 32220914 PMCID: PMC7170592 DOI: 10.1136/bmjopen-2019-034128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Person-centred care (PCC) has become a global movement in healthcare. Despite this, the level of PCC is not routinely assessed in clinical practice. This protocol describes the adaptation and validation of the Person-Centred Practice Inventory-Staff (PCPI-S) tool that will be used to assess person-centred practices of primary healthcare providers in Malaysia. METHODS AND ANALYSIS To ensure conceptual and item equivalence, the original version of the PCPI-S will be reviewed and adapted for cultural context by an expert committee. The instrument will subsequently be translated into Malay language using the forward-backward translation method by two independent bilingual speaking individuals. This will be pretested in four primary care clinics and refined accordingly. The instrument will be assessed for its psychometric properties, such as test-retest reliability, construct and internal validity, using exploratory and confirmatory factor analysis. ETHICS AND DISSEMINATION Study findings will be disseminated to healthcare professionals and academicians in the field through publication in peer-reviewed journals and conference presentations, as well as at managerial clinic sites for practice improvement. The study was approved by the Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia (KKM/NIHSEC/ P18-766 (14) and Monash University Human Research Ethics Committee (2018-14363-19627).
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Affiliation(s)
- Nur Zahirah Balqis-Ali
- Institute for Health Systems Research, National Institutes of Health, Shah Alam, Malaysia
| | - Pui San Saw
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Anis Syakira Jailani
- Institute for Health Systems Research, National Institutes of Health, Shah Alam, Malaysia
| | - Tze Wei Yeoh
- Institute for Health Systems Research, National Institutes of Health, Shah Alam, Malaysia
| | - Weng Hong Fun
- Institute for Health Systems Research, National Institutes of Health, Shah Alam, Malaysia
| | - Noridah Mohd-Salleh
- Family Health Development Division, Ministry Of Health Malaysia, Putrajaya, Malaysia
| | | | - Catherine Anak Medan
- Family Health Development Division, Ministry Of Health Malaysia, Putrajaya, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
- School of Pharmacy, Taylor's University Lakeside Campus, Subang Jaya, Malaysia
| | - Sondi Sararaks
- Institute for Health Systems Research, National Institutes of Health, Shah Alam, Malaysia
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Backman A, Ahnlund P, Sjögren K, Lövheim H, McGilton KS, Edvardsson D. Embodying person-centred being and doing: Leading towards person-centred care in nursing homes as narrated by managers. J Clin Nurs 2019; 29:172-183. [PMID: 31612556 DOI: 10.1111/jocn.15075] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/29/2019] [Accepted: 09/29/2019] [Indexed: 01/09/2023]
Abstract
AIMS AND OBJECTIVES To explore how managers describe leading towards person-centred care in Swedish nursing homes. BACKGROUND Although a growing body of research knowledge exists highlighting the importance of leadership to promote person-centred care, studies focused on nursing home managers' own descriptions of leading their staff towards providing person-centred care is lacking. DESIGN Descriptive interview study. COREQ guidelines have been applied. METHODS The study consisted of semi-structured interviews with 12 nursing home managers within 11 highly person-centred nursing homes purposively selected from a nationwide survey of nursing homes in Sweden. Data collection was performed in April 2017, and the data were analysed using content analysis. RESULTS Leading towards person-centred care involved a main category; embodying person-centred being and doing, with four related categories: operationalising person-centred objectives; promoting a person-centred atmosphere; maximising person-centred team potential; and optimising person-centred support structures. CONCLUSIONS The findings revealed that leading towards person-centred care was described as having a personal understanding of the PCC concept and how to translate it into practice, and maximising the potential of and providing support to care staff, within a trustful and innovative work place. The findings also describe how managers co-ordinate several aspects of care simultaneously, such as facilitating, evaluating and refining the translation of person-centred philosophy into synchronised care actions. RELEVANCE TO CLINICAL PRACTICE The findings can be used to inspire nursing home leaders' practices and may serve as a framework for implementing person-centred care within facilities. A reasonable implication of these findings is that if organisations are committed to person-centred care provision, care may need to be organised in a way that enables managers to be present on the units, to enact these strategies and lead person-centred care.
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Affiliation(s)
| | - Petra Ahnlund
- Department of Social Work, Umeå University, Umeå, Sweden
| | - Karin Sjögren
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Katherine S McGilton
- Toronto Rehabilitation Institute University Health Network & University of Toronto, Toronto, ON, Canada
| | - David Edvardsson
- Department of Nursing, Umeå University, Umeå, Sweden.,School of Nursing and Midwifery, La Trobe University, Melbourne, Vic., Australia
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Sundler AJ, Hjertberg F, Keri H, Holmström IK. Attributes of person-centred communication: A qualitative exploration of communication with older persons in home health care. Int J Older People Nurs 2019; 15:e12284. [PMID: 31642182 DOI: 10.1111/opn.12284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 08/18/2019] [Accepted: 09/27/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Previous research points to challenges related to the home healthcare of older persons and to the complexity of communication. Although person-centred care has been advocated widely, there remains a need for in-depth knowledge on how to enable person-centred and supportive communication in the care of older persons. AIM The aim of this study was to explore attributes of person-centred communication between nurses and older persons being cared for in their home. METHODS A descriptive study with a qualitative approach was conducted. A data set from the COMHOME-study consisting of 77 audio-recorded home healthcare visits between registered nurses and older persons was analysed with a method for qualitative thematic analysis. RESULTS The findings indicate that the attributes of person-centred communication comprise recognising, inviting and involving older persons. To facilitate this form of communication, attentiveness and responsiveness on the part of RNs seemed significant. Person-centred communication was facilitated when the RNs used verbal expressions to emphasise and acknowledge the older persons' views and were attentive to their emotions and expressions. CONCLUSION The nurses' attentiveness and responsiveness seems important for person-centred communication with older persons. Communication skills are needed to recognise, invite and involve older persons in their care and to support their health and well-being. Implication for practice The importance of communication which facilitate a person-centred approach by nurses should be acknowledged when caring for older persons and included in education and training.
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Affiliation(s)
- Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | | | - Helena Keri
- Home healthcare, Jönköping municipality, Jönköping, Sweden
| | - Inger K Holmström
- School of Health Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Lange E, Kucharski D, Svedlund S, Svensson K, Bertholds G, Gjertsson I, Mannerkorpi K. Effects of Aerobic and Resistance Exercise in Older Adults With Rheumatoid Arthritis: A Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2019; 71:61-70. [PMID: 29696812 PMCID: PMC6590333 DOI: 10.1002/acr.23589] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/17/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the effect of a moderate-to-high-intensity, aerobic and resistance exercise with person-centered guidance in older adults with rheumatoid arthritis (RA), through a randomized controlled multicenter trial. METHODS Older adults (ages 65-75 years) with RA (n = 74) were randomized to either a 20-week exercise intervention at a gym (n = 36) or to home-based exercise of light intensity (n = 38). Assessments were performed at baseline, at 20 weeks, and at 12 months. The primary outcome was the difference in the Health Assessment Questionnaire disability index (HAQ DI) score, and the secondary outcomes were the differences in physical fitness assessed by a cardiopulmonary exercise test, an endurance test, the timed up and go test, the sit to stand test, and an isometric elbow flexion force measurement. RESULTS No significant differences between the groups were found for the primary outcome, HAQ DI score. Within the intervention group there was a significant improvement in the HAQ DI score when compared to baseline (P = 0.022). Aerobic capacity (P < 0.001) and 3 of 4 additional performance-based tests of endurance and strength significantly improved (P < 0.05) in the intervention group when compared to the control group. In the intervention group, 71% of patients rated their health as much or very much improved compared to 24% of patients in the control group (P < 0.001). At the 12-month follow-up, there were no significant differences in change between the 2 groups on the HAQ DI score. A significant between-group difference was found for change in an endurance test (P = 0.022). CONCLUSION Aerobic and resistance exercise with person-centered guidance improved physical fitness in terms of aerobic capacity, endurance, and strength in older adults with RA.
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Berg K, Askim T, Rise MB. What do speech-language pathologists describe as most important when trying to achieve client participation during aphasia rehabilitation? A qualitative focus group interview study. Int J Speech Lang Pathol 2019; 21:493-503. [PMID: 29252012 DOI: 10.1080/17549507.2017.1413134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 10/30/2017] [Accepted: 11/30/2017] [Indexed: 06/07/2023]
Abstract
Purpose: The aim of this study was to investigate what speech-language pathologists describe as most important when trying to achieve client-oriented participation during aphasia rehabilitation. Method: A qualitative study including semi-structured focus group interviews with 11 speech-language pathologists. Interviews were analysed with the use of systematic text condensation. Result: Four main themes emerged from the analysis. (1) It is important to take the vulnerability of the client group into account. (2) It is important to address the client's process of realisation by navigating around unrealistic wishes and goals. (3) It is challenging to involve clients when the evidence-base for clinical practice is limited. (4) It is crucial to make therapy meaningful to the client. Conclusion: This study showed that speech-language pathologists perceived prediction of a clinical course in aphasia rehabilitation as challenging due to the vulnerable client group and the perceived need to guide the clients through the rehabilitation process. They talked about how unrealistic client goals, and the lack of a solid evidence-base to guide their clinical practice, made collaborative goal setting and treatment planning challenging. Due to these barriers, the speech-language pathologists struggled to achieve client participation, and thereby aphasia rehabilitation could not be described as fully client-oriented.
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Affiliation(s)
- Karianne Berg
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology , Trondheim , Norway and
| | - Torunn Askim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology , Trondheim , Norway and
| | - Marit By Rise
- Department of Mental Health, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology , Trondheim , Norway
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Abstract
Purpose: Influential value-driven approaches to aphasia rehabilitation have been proposed previously, but have emphasised how service providers need to deliver their services. The aim of this article is to extract a set of values or habits that define effective aphasia therapists, from a 16-year programme of research that has sought to capture the perspectives of people with aphasia, their family and speech-language pathologists. Method: The findings of 58 studies published by members of our team which have sought the views of people with aphasia (38 studies), speech-language pathologists (11 studies) and family members (5 studies), and those which compared all stakeholder's perspectives (2 studies), were synthesised into seven themes. Presented as habits, these were subsequently described in the same manner as the popular "Seven Habits of Highly Effective People". Result: The seven habits of highly effective aphasia therapists described by people with aphasia and their family were (1) Prioritise relationships; (2) Find a rope team; (3) Begin with the end in mind; (4) Practise SMARTER therapy; (5) Leave no person behind; (6) Look behind the mask and (7) Find a voice. Conclusion: While there are similarities to other value-based approaches to aphasia rehabilitation, these seven habits are detailed using our published research that has privileged the voices of people with aphasia. The seven habits therefore reflect what people with aphasia view as the features of highly effective aphasia therapists. The next steps are to identify how to evaluate evidence-based practices in these areas and ensure their implementation into practice. Effective aphasia therapists are at the heart of effective aphasia rehabilitation.
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Affiliation(s)
- Linda Worrall
- School of Health and Rehabilitation Sciences, University of Queensland , Brisbane , Australia
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Rose V, Stewart I, Jenkins KG, Tabbaa L, Ang CS, Matsangidou M. Bringing the outside in: The feasibility of virtual reality with people with dementia in an inpatient psychiatric care setting. Dementia (London) 2019; 20:106-129. [PMID: 31510801 DOI: 10.1177/1471301219868036] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Emerging research supports virtual reality use with people with dementia in the community, but is limited to this area, warranting further investigation in different care settings. The feasibility of virtual reality within an inpatient psychiatric care setting was therefore explored.Research design and methods: Eight people with dementia and 16 caregivers were recruited in January and February 2018 from a UK hospital specialising in progressive neurological conditions. A mixed methods design measured affect and behaviour using the Observed Emotion Rating Scale, Overt Aggression Scale-Modified for Neurorehabilitation and St Andrew's Sexual Behaviour Assessment. Thematic analysis was conducted following semi-structured interviews. Caregivers who worked at the hospital supported people with dementia throughout the process and were interviewed for their views on Head Mounted Display-Virtual Reality (HMD-VR) use with people with dementia. RESULTS HMD-VR was tried and accepted by people with dementia. Participants viewed HMD-VR positively as a 'change in environment' and would use it again. People with dementia experienced more pleasure during and after HMD-VR compared to before exposure, as well as increased alertness after. Three core themes emerged: 'Virtual Reality Experiences', 'Impact of Virtual Reality' and 'Experiences within the Virtual Environment'. Caregivers discussed preconceptions about virtual reality use and how these changed.Discussion and implications: This is the first study to explore the feasibility of HMD-VR with people with mild to moderately severe dementia in hospital and found that overall HMD-VR is viable. Findings evidence the clinical feasibility of HMD-VR implementation in this environment and inform future research.
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Affiliation(s)
| | | | | | - Luma Tabbaa
- School of Engineering and Digital Arts, University of Kent, Canterbury, UK
| | - Chee Siang Ang
- School of Engineering and Digital Arts, University of Kent, Canterbury, UK
| | - Maria Matsangidou
- School of Engineering and Digital Arts, University of Kent, Canterbury, UK
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Le Bosquet K, Barnett N, Minshull J. Deprescribing: Practical Ways to Support Person-Centred, Evidence-Based Deprescribing. Pharmacy (Basel) 2019; 7:E129. [PMID: 31484305 PMCID: PMC6789835 DOI: 10.3390/pharmacy7030129] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/14/2019] [Accepted: 08/22/2019] [Indexed: 12/20/2022] Open
Abstract
Deprescribing is complex and multifactorial with multiple approaches described in the literature. Internationally, there are guidelines and tools available to aid clinicians and patients to identify and safely withdraw inappropriate medications, post a shared decision-making medicines optimisation review. The increase in available treatments and use of single disease model guidelines have led to a healthcare system geared towards prescribing, with deprescribing often seen as a separate activity. Deprescribing should be seen as part of prescribing, and is a key element in ensuring patients remain on the most appropriate medications at the correct doses for them. Due to the complex nature of polypharmacy, every patient experience and relationship with medications is unique. The individual's history must be incorporated into a patient-centred medication review, in order for medicines to remain optimal through changes in circumstance and health. Knowledge of the law and appropriate recording is important to ensure consent is adequately gained and recorded in line with processes followed when initiating a medication. In recent years, with the increase in interested clinicians globally, a number of prominent networks have grown, creating crucial links for both research and sharing of good practice.
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Affiliation(s)
| | - Nina Barnett
- NHS Specialist Pharmacy Service, London North West University Healthcare NHS Trust, London HA1 3UJ, UK
| | - John Minshull
- NHS Specialist Pharmacy Service, London North West University Healthcare NHS Trust, London HA1 3UJ, UK
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Stallings SC, Boyer AP, Joosten YA, Novak LL, Richmond A, Vaughn YC, Wilkins CH. A taxonomy of impacts on clinical and translational research from community stakeholder engagement. Health Expect 2019; 22:731-742. [PMID: 31321849 PMCID: PMC6737764 DOI: 10.1111/hex.12937] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 05/09/2019] [Accepted: 05/31/2019] [Indexed: 01/10/2023] Open
Abstract
Background Community engagement is increasingly recognized as a valuable tool in clinical and translational research; however, the impact of engagement is not fully understood. No standard nomenclature yet exists to clearly define how research changes when community stakeholders are engaged across the research spectrum. This severely limits our ability to assess the value of community engagement in research. To address this gap, we developed a taxonomy for characterizing and classifying changes in research due to community engagement. Methods Using an iterative process, we (a) identified areas of potential impact associated with community engagement from author experience, (b) categorized these in taxonomic bins based on research stages, (c) conducted semi‐structured interviews with researchers and community stakeholders, (d) validated the codebook in a sample dataset and (e) refined the taxonomy based on the validation. Community stakeholders were involved in every step of the process including as members of the primary study team. Results The final taxonomy catalogues changes into eleven domains corresponding to research phases. Each domain includes 2‐4 dimensions depicting concepts within the domain's scope and, within each dimension, 2‐10 elements labelling activities through which community engagement could change research. Conclusions Community engagement has great potential to enhance clinical and translational research. This taxonomy provides a common vocabulary and framework for understanding the impact of community engagement and suggests metrics for assessing the value of community engagement in research.
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Affiliation(s)
- Sarah C Stallings
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alaina P Boyer
- National Health Care for the Homeless Council, Nashville, Tennessee
| | - Yvonne A Joosten
- Department of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laurie L Novak
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Al Richmond
- Community-Campus Partnerships for Health, Raleigh, North Carolina
| | | | - Consuelo H Wilkins
- Vice President for Health Equity, Vanderbilt University Medical Center, Nashville, Tennessee
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Abstract
BACKGROUND Person-centred care is often described as an ideal way of preserving vulnerable persons' wellbeing and dignity and an essential component of quality-care delivery. However, the staff find that making the care dignified is the most challenging issue, often because of effectivity, everyday stress and overload. In the interests of making the care more person-centred, systematic intervention involving 'one-to-one contact' (resident - carer) was trialled for 30 min twice a week over 12 months in two units in a nursing home in Eastern Norway. OBJECTIVES The aim of the study was to elicit healthcare staff's experiences of implementing 'one-to-one contact' between residents and carers in nursing homes. METHODS The study has a grounded-theory inspired design. Two groups of health care staff were each interviewed three times. Data were collected over an 18-month period. ETHICAL CONSIDERATIONS The study was approved by the Data Protection Official for Research under the auspices of the Norwegian Social Science Data Services. FINDINGS The core category is 'One-to-one contact' at a nursing home is possible, but requires open-mindedness. The core category indicates that open-mindedness is required, since it does not take much for scepticism to take over and cause reversion to habitual practices. The category Expectant but Sceptical describes staff thoughts and experiences before the implementation phase got underway. The category Positive but Undecided describes staff experiences 6 months into the intervention and after 12 months. CONCLUSIONS This study has revealed that systematic 'one-to-one contact' between resident and carer in nursing home is achievable, and that such a simple action might be an important step towards achieving more person-centred care as the resident is seen more as a person. However, in order to make a more person-centred and dignified approach to care constant attentiveness and awareness is required, as there were ongoing factors counteracting it.
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