Exploring facilitators and barriers to using a person centered care intervention in a nursing home setting

Kloos, Noortje; Drossaert, Constance H.C.; Trompetter, H.R.; Bohlmeijer, Ernst Thomas; Westerhof, Gerben Johan

doi:10.1016/j.gerinurse.2020.04.018

Cited by 14 publications

(12 citation statements)

References 37 publications

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“…Qualitative findings of this review provided complementary data to the descriptive findings and meta-analysis. Time constraints were identified as a salient pattern to providing person-centered care; getting to know the resident and working within a collaborative staff environment were identified as enablers to providing person-centered care, all in line with existing literature ( Kloos et al, 2020 ; Vassbo et al, 2019 ). These findings provide important insight, but people living with dementia should also be included in qualitative research ( Webb et al, 2020 ).…”

Section: Discussionsupporting

confidence: 56%

The Delivery of Person-Centered Care for People Living With Dementia in Residential Aged Care: A Systematic Review and Meta-Analysis

et al. 2023

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Background and Objectives Person-centred care is the gold standard of care for people living with dementia, yet few systematic reviews have detailed how it is delivered in practice. This mixed-methods review aimed to examine the delivery of person-centred care, and its effectiveness, for people living with dementia in residential aged care. Research Design and Methods A systematic review and meta-analysis. Eligible studies were identified across four databases. Quantitative and qualitative studies containing data on person-centred care delivered to people with dementia living in residential aged care were included. Meta-analysis using a random effects model was conducted where more than three studies measured the same outcome. A narrative meta-synthesis approach was undertaken to categorise verbatim participant quotes into representative themes. Risk of bias was undertaken using quality appraisal tools from the Joanna Briggs Institute. Results Forty-one studies were identified for inclusion. There were 34 person-centred care initiatives delivered, targeting 14 person-centred care outcomes. Three outcomes could be pooled. Meta-analyses demonstrated no reduction in agitation (standardised mean difference -0.27, 95% CI -0.58, 0.03), improvement in quality of life (standardised mean difference -0.63, 95% CI -1.95, 0.70), or reduced neuropsychiatric symptoms (mean difference -1.06, 95% CI -2.16, 0.05). Narrative meta-synthesis revealed barriers (for example, time constraints) and enablers (for example, staff collaboration) to providing person-centred care from a staff perspective. Discussion and Implications The effectiveness of person-centred care initiatives delivered to people with dementia in residential aged care is conflicting. Further high-quality research over an extended time is required to identify how person-centred care can be best implemented to improve resident outcomes.

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Section: Discussionsupporting

confidence: 56%

The Delivery of Person-Centered Care for People Living With Dementia in Residential Aged Care: A Systematic Review and Meta-Analysis

et al. 2023

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“…A lack of knowledge and training in PCC was also described as a hindering aspect, together with structural barriers such as strict schedules and timetables that create aggravating circumstances, hindering staff from acting according to PCC philosophy and thus interfering with staff's care delivery (Colomer & De Vries, 2016). These findings have been supported by recent studies based on staff-reported data, concluding that insufficient time and resources (Kloos et al, 2020;Kong et al, 2022;Oppert et al, 2018); staff lacking education; and a negative mindset and poor relationships among staff, residents and families were barriers to PCC (Kong et al, 2022).…”

Section: Backg Rou N Dsupporting

confidence: 55%

Nursing home managers' descriptions of multi‐level barriers to leading person‐centred care: A content analysis

Backman,

Ahnlund,

Lövheim

et al. 2023

Int J Older People Nursing

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BackgroundResearch suggests that person‐centred care can be beneficially implemented and sustained, even though barriers remain that prevent uptake in clinical practice. Understanding barriers to person‐centred care seems important, as this has an impact on care practices and resident outcomes. Moreover, there is limited knowledge about nursing home managers' descriptions of barriers when leading person‐centred care.ObjectivesTo explore barriers to leading person‐centred care as narrated by nursing home managers.MethodsA descriptive qualitative design was used to collect data using individual interviews with 12 nursing home managers in highly person‐centred nursing homes. Data were analysed using content analysis.ResultsMulti‐level barriers to leading person‐centred care were identified on the (1) person level, (2) team level and (3) organisational level. Placing professional and family considerations ahead of resident considerations was described as a barrier on the personal level (1). Also, staff's divergent care values, processes, and priorities together with turnover and low foundational knowledge were identified as barriers on the team level (2). On an organisational level (3), constrained finances, functional building design and group level rostering were identified as barriers.ConclusionMulti‐level barriers influence nursing home managers' ability to lead and promote person‐centred care. Promoting the development of person‐centred practices requires efforts to eliminate barriers on person, team and organisational level.Implications for PracticeIdentifying and overcoming barriers at various levels in nursing home care has the potential to promote person‐centred practices. This study can inform stakeholders and policymakers of challenges and complexities in person‐centred practices. Multi‐level strategies are needed to target challenges at person‐, team‐ and organisational level when striving to develop person‐centred care.

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“…Besides, the difference between care-givers was less than one point on average, which may have only limited clinical significance. A recent study showed that when implementing such a method in practice, it is essential to ensure a stable nursing home context and a clear implementation plan (Kloos et al , 2020).…”

Section: Discussionmentioning

confidence: 99%

How well do nursing staff assess the wellbeing of nursing home residents? An explorative study of using single-question scales

et al. 2020

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Person-centred care requires improved documentation of nursing home resident wellbeing, e.g. by nursing staff proxy assessments. Previous studies mainly focused on proxy self-report agreement of quality of life of people with dementia, using lengthy questionnaires. This is the first study to investigate how well nursing staff assess residents’ wellbeing after training, using a single-question assessment method of happiness and engagement. We conducted a cross-sectional mixed-method study, including proxy assessments from 49 nursing staff, and self-reports from 49 nursing home residents without dementia (mean age 85). We explored agreement between colleagues, and between proxy assessments and self-reports, and potential nursing staff characteristics associated to this (age, experience, hours worked per week). Brief written motivations were evaluated on nursing staffs’ understanding of the happiness and engagement concepts. The results showed low agreement between colleagues, and low agreement between proxy assessments and self-reports. Nursing staff assessed happiness and engagement substantially higher than residents’ self-reports. Hours worked per week was related to happiness proxy assessments, but none of the included nursing staff characteristics were related to proxy self-report agreement. Nursing staff interpreted the concepts in diverse ways. Overestimating resident wellbeing when using this single-assessment method may undermine subsequent efforts to improve wellbeing. We could not identify which nursing staff could best provide wellbeing assessments. For now, proxy wellbeing assessments should always be combined with regular self-reports whenever possible.

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Exploring facilitators and barriers to using a person centered care intervention in a nursing home setting

Cited by 14 publications

References 37 publications

The Delivery of Person-Centered Care for People Living With Dementia in Residential Aged Care: A Systematic Review and Meta-Analysis

The Delivery of Person-Centered Care for People Living With Dementia in Residential Aged Care: A Systematic Review and Meta-Analysis

Nursing home managers' descriptions of multi‐level barriers to leading person‐centred care: A content analysis

How well do nursing staff assess the wellbeing of nursing home residents? An explorative study of using single-question scales

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