Appreciating the ‘person’ in long-term care

Director and Head of Person-Centred Practice Research Centre, Institute of Nursing Research, School of Nursing, University of Ulster, Newtownabbey, Northern Ireland, Professor II, Buskerud University College, Drammen, Norway, Adjunct Professor of Nursing, Monash University, Melbourne, Vic., Australia, Adjunct Professor of Nursing, University of Technology, Sydney, NSW, Australia and Honorary Professor of Nursing, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK John A. Hartford BAGNC Scholar, School of Nursing, University of Wisconsin, Madison, WI, USA Professor of Nursing, Care for Older People and Executive Director, My Home Life Programme, School of Health Sciences, City University London, London, UK, Adjunct Professor of Nursing, Care for Older People, Research Centre for Clinical and Community Practice Innovation, School of Nursing and Midwifery, Griffith University, Brisbane, Qld, Australia and Visiting Professor of Nursing, Care for Older People, Institute on Aging, School of Nursing, University of Wisconsin, Madison, WI, USA Canadian Institutes of Health Research/Saskatchewan Health Research Foundation Applied Chair in Health Services and Policy Research, Professor, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada Research Fellow, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
International Journal of Older People Nursing 12/2012; 7(4):284-294. DOI: 10.1111/j.1748-3743.2012.00342.x
Source: PubMed


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.

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Available from: Veronique M Boscart, May 22, 2015
    • "Because the PCQ-P has not been previously evaluated in long-term care facilities, an assessment of the tool was included in the study. Internationally , approaches to long-term care for older people are changing and the present focus is on person-centredness , with regard to culture, care and strategies (Edvardsson et al. 2008b, McCormack et al. 2012). Also, contemporary nursing literature describes high-quality care for older persons as being person-centred (Slater 2006, Edvardsson et al. 2008b). "
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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 · 1.26 Impact Factor
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    • "A comparison of long-term care through home- and community-based services with nursing homes that affect outcome trajectories of older adults is difficult [13]. However, deinstitutionalized care settings maximize opportunities for older people to participate in decision-making models of care, which are community orientated [14]. Therefore, there are some community-based care programs for older adults. "
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    ABSTRACT: The aim of this study was to identify the effects of community-based home healthcare projects that influence service performances with regard to Korean national long-term care insurance services in older adults. The project's applicants were 18 operational agencies in national long-term care institutions in Korea, and participants were care recipients (n = 2263) registered in long-term care institutions. We applied our healthcare system to the recruited participants for a 3-month period from October 2012 to December 2012. We measured the community-based home healthcare services such as long-term care, health and medical service, and welfare and leisure service prior to and after applying the community-based home healthcare system. After the implementation of community-based home healthcare project, all community-based home healthcare services showed an increase than prior to the project implementation. The nutrition management service was the most increased and its increase rate was 628.6%. A comparison between the long-term care insurance beneficiaries and nonbeneficiaries showed that health and medical services' increase rate of nonbeneficiaries was significantly higher than beneficiaries (p < 0.001). Our community-based home healthcare project might improve the service implementation for older adults and there was a difference in the increase rate of health and medical services between Korean national long-term care insurance beneficiaries and nonbeneficiaries.
    10/2013; 4(5):233-239. DOI:10.1016/j.phrp.2013.09.002
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    • "Caring, empathic relationships are as crucial to a resident's quality of life as providing quality of care and quality of management. Without these relationships among residents, relatives and staff within the home, personcentred care is unlikely to be achieved (McCormack et al., 2012). To properly serve the residents living in LTC, all involved must have the commitment to a person-centred approach for both patients and staff and the commitment to put this into practice. "
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    ABSTRACT: Internationally, the role of the registered nurse (RN) in long-term care (LTC) settings has evolved in response to the demands of governmental and organisational priorities. In stark contrast to the regulatory mandates, a person-centred care approach in LTC settings would require different outcomes, processes and competencies of the RN. This article explores the implications of defining the RN's role in delivering person-centred care in LTC homes. Based on a review of the literature, we present a framework that can be used to gather evidence on the outcomes, processes of care and competencies required of RNs to lead their teams to person-centred LTC homes. The development of the framework highlighted several issues: (i) current measures of quality in LTC settings focus on health outcomes and avoiding adverse events rather than on resident quality of life and well-being, which influences the RN's practice; (ii) person-centred care has emerged as a focus of care, yet measures currently developed are limited, and thus, new outcomes are proposed; (iii) to practice in a person-centred way, RNs must work through others on their team to ensure that staff truly relate to their residents, tailor approaches based on the remaining abilities of the residents and manipulate environments to match the competence of the individual, while focusing on residents' personhood and (iv) competencies of RNs to deliver person-centred care include leadership, facilitation, clinical excellence and critical thinking skills. RNs need to be supported, allowed and encouraged in redesigning their role, to work to their full capacity if they are truly to support person-centred care in LTC settings.
    International Journal of Older People Nursing 12/2012; 7(4):303-9. DOI:10.1111/opn.12010
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