Appreciating the 'person' in long-term care.
ABSTRACT Background. Internationally, approaches to the long-term care of older people are changing. New models are being developed that aim to de-institutionalise care settings, maximise opportunities for older people to participate in decision-making and move from a predominant medical model of care to one that is community orientated. Aims. The aim of this study is to highlight similarities and differences between the different models that exist and explore the implications of these for the role of the registered nurse in long-term care. Methods. We chose three models for review as these represent a range of views of person centredness, each having distinct roots and focus. The models chosen were as follows: (i) culture change, (ii) person-centred practice and (iii) relationship-centred care. Results. The review highlights two key issues - (i) the distinctiveness of different models and frameworks and (ii) different interpretations of 'person'. Firstly, we identify a disconnection between espoused differences between models and frameworks and the reality of these differences. The evidence also identifies how some models and frameworks adopt a more inclusive conceptualisation of person and personhood and do not define personhood in relation to role (resident, nurse and family member). Conclusions. There is merit in the development of models and frameworks that try to make explicit the different dimensions of person centredness in long-term care. However, the focus on the development of these, without sufficient attention being paid to evidence of best practices grounded in the concept of personhood, person-centred care is in danger of losing its original humanistic emphasis. Further, models and frameworks need to take account of the personhood of all persons. Implications for practice. Registered nurses need to have an understanding of the concept of personhood to make sense of the various person-centred practice frameworks that exist. Without this understanding, there is a danger that the essence of personhood may be lost in the zeal to implement particular models and frameworks.
Journal of the American Medical Directors Association 03/2014; 15(3):154-7. DOI:10.1016/j.jamda.2013.11.023 · 4.78 Impact Factor
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ABSTRACT: AimTo examine the relationship between levels of adaptation to independent living in continuing care communities and the personality trait, routinization.Methods Using a correlative design, structured face-to-face interviews were carried out with 120 older adults residing in independent housing units across six continuing care facilities in Israel, using the Index of Relocation Adjustment and the Variety Assessment Scale questionnaires.ResultsIn a mixed model, one of the two routinization subscales (disliking disruption) was moderately associated with adaptation, controlling for decision to enter the facility, satisfaction with the facility, family relationship, functional status, education, family status and type of setting. Residents who expressed high levels of disliking disruption, higher functional status and less involvement in the decision to enter the facility reported poorer adaptation to their living conditions.Conclusion Our findings point out the complexity and intricacy of personal attributes as factors associated with adaptation to transitions in older age, and highlight the potential contribution of the trait of routinization to adaptation. Further research is required to identify ways to best support older adult transitions to institutional environments, considering different personality traits and environments. Geriatr Gerontol Int 2014; ●●: ●●–●●.Geriatrics & Gerontology International 05/2014; 15(4). DOI:10.1111/ggi.12289 · 1.58 Impact Factor
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ABSTRACT: Aims and objectivesTo assess the content validity and reliability of the Person-centred Climate Questionnaire-Patient version in long-term care facilities, to describe residents' perceptions of the extent to which their ward climate was person-centred and to explore whether person-centredness was associated with facility and resident characteristics, such as facility and ward size, having a sensory garden and having a primary caregiver.Background The importance of the physical environment to persons with dementia has been investigated. However, research is lacking regarding the extent to which mentally lucid residents experience their physical and psycho-social ward climate as person-centred and the factors influencing their experience.DesignCross-sectional survey design.Methods The Person-centred Climate Questionnaire–Patient version was translated into Norwegian with forward and backward translation. The content validity index for scales was assessed. The Person-centred Climate Questionnaire –Patient version was completed by 145 mentally lucid residents in 17 Norwegian long-term care facilities. Reliability was assessed by Cronbach's α and item–total correlations. Test–retest reliability was assessed by paired samples t-test and Spearman's correlation. To explore differences based on facility and resident characteristics, independent-samples t-test and one-way anova were used.ResultsThe content validity index for scales was satisfactory. The Person-centred Climate Questionnaire–Patient version was internally consistent and had satisfactory test–retest reliability. The climate was experienced as highly person-centred. No significant differences were found, except that residents in larger facilities experienced the climate as more person-centred in relation to everyday activities (subscale 2) than residents in smaller facilities.Conclusion The Norwegian version of the Person-centred Climate Questionnaire–Patient version can be regarded as reliable in a long-term care facility context. Perceived degree of person-centredness was not associated with facility or resident characteristics, such as the number of residents, having a sensory garden or knowing that one has a primary caregiver.Relevance to clinical practiceA person-centred climate can be attained in different kinds of long-term care facilities.Journal of Clinical Nursing 04/2014; 24(3-4). DOI:10.1111/jocn.12614 · 1.23 Impact Factor