scholarly journals Risky Preferences: Nursing Staff Perceptions of Risks May Impede Delivery of Person-Centered Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 837-837
Author(s):  
Liza Behrens ◽  
Kimberly Van Haitsma ◽  
Ann Kolanowski ◽  
Marie Boltz ◽  
Mark Sciegaj ◽  
...  
Keyword(s):  
Nursing Staff ◽  
Care Delivery ◽  
Health And Safety ◽  
Direct Care ◽  
Measurement Development ◽  
Future Research ◽  
Staff Perceptions ◽  
Major Barrier ◽  
Person Centered Care ◽  
Centered Care

Abstract Nursing home (NH) staff perceptions of risks to residents’ health and safety is a major barrier to honoring resident preferences, the cornerstone of person-centered care delivery. This study examined direct-care nursing staff perceptions of risk (possibilities for harm or loss) associated with honoring residents’ preferences for everyday living and care activities. Participants (N=27) were mostly female (85%), had more than 3 years of experience (74%), and worked in NHs experiencing 6-12 health citations. Content analysis of 12 focus groups indicated nursing staff perceptions of risks may impede delivery of PCC. This is supported by the overarching theme: pervasive risk avoidance; and sub-themes of: staff values, supports for risk-taking, and challenges to honoring preferences. Findings will be discussed considering a newly modified risk engagement framework meant to understand and inform the clinical management of older adult preferences perceived to carry risks. Opportunities for future research will be discussed (e.g. measurement development). Part of a symposium sponsored by the Research in Quality of Care Interest Group.

scholarly journals Pervasive Risk Avoidance: Nursing Staff Perceptions of Risk in Person-Centered Care Delivery

2020 ◽  
Vol 60 (8) ◽  
pp. 1424-1435
Author(s):  
Liza L Behrens ◽  
Marie Boltz ◽  
Ann Kolanowski ◽  
Mark Sciegaj ◽  
Caroline Madrigal ◽  
...  
Keyword(s):  
Nursing Staff ◽  
Care Delivery ◽  
Health And Safety ◽  
Direct Care ◽  
Risk Avoidance ◽  
Staff Perceptions ◽  
Major Barrier ◽  
Perceptions Of Risk ◽  
Person Centered Care ◽  
Centered Care

Abstract Background and Objectives Nursing home (NH) staff perceptions of risks to residents’ health and safety are a major barrier to honoring resident preferences, the cornerstone of person-centered care (PCC) delivery. This study explored direct-care nursing staff perceptions of risk (possibilities for harm or loss) associated with honoring residents’ preferences for everyday living and care activities. Research Design and Methods Qualitative, descriptive design using sequential focus group (FG) methodology. Results Participants (N = 27) were mostly female (85%), had more than 3 years of experience (74%), and worked in NHs recently experiencing 6–12 health citations. Content analysis of 12 sequential FGs indicated nursing staff perceptions of risks may impede delivery of person-centered care. This is supported by the overarching theme: pervasive risk avoidance; and subthemes of: staff values, supports for risk-taking, and challenges to honoring preferences. Discussion and Implications Development of a multidimensional framework with specific risk engagement measures that account for the unique risk perspectives of nursing staff will contribute significantly to the clinical management of older adult preferences and research on the effectiveness of preference-based PCC delivery in the NH setting.

scholarly journals Nursing Staff Perceptions of Risk Outcomes in Delivering Preference-Based Person-Centered Care

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 270-270
Author(s):  
Marie Boltz ◽  
Ann Kolanowski ◽  
Mark Sciegaj ◽  
Katherine Abbott ◽  
Caroline Madrigal ◽  
...  
Keyword(s):  
Nursing Staff ◽  
Work Experience ◽  
Health And Safety ◽  
Direct Care ◽  
Life Outcomes ◽  
Staff Perceptions ◽  
Perceptions Of Risk ◽  
Collective Work ◽  
Person Centered Care ◽  
Centered Care

Abstract Effective management of the perceived risks associated with delivering preference-based person-centered care (PBPCC) is historically challenging for nursing home staff. Existing research lacks the granularity needed to guide clinicians who fear negative health and safety outcomes for residents. This study examined direct-care nursing staff perceptions of outcomes associated with delivering PBPCC. Participants (N=27) worked in NHs experiencing 6-12 health citations, were mostly female (85%), and represented diverse ages, race, education, and collective work experience in NHs. Content analysis of verbatim transcripts from 12 focus groups identified an overarching theme of: “person-centered outcomes related to risk engagement”; and sub-themes of: harms to staff (e.g. fear, frustration, guilt); harms to residents (e.g. negative moods and behaviors, physical discomfort); and positive shared outcomes (e.g. building nurse-resident relationships, positive care environment). Implications for risk management that improves quality of care and life outcomes in a post-COVID era will be discussed.

scholarly journals INTEREST GROUP SESSION—NURSING CARE OF OLDER ADULTS: MAKING IT HAPPEN: PERSON-CENTERED DEMENTIA CARE FOR BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S557-S558
Author(s):  
Ann M Kolanowski ◽  
Barbara Bowers
Keyword(s):  
Psychological Symptoms ◽  
Pragmatic Trial ◽  
Direct Care ◽  
High Rate ◽  
Care Staff ◽  
Future Research ◽  
Prescribing Practices ◽  
Person Centered Care ◽  
Centered Care ◽  
Behavioral And Psychological Symptoms

Abstract Person-centered care is the standard of practice in communal living sites, yet many facilities struggle to make this a reality. Both direct care staff and administrators find residents’ behavioral and psychological symptoms of dementia (BPSD) particularly challenging. Our research team is conducting a pragmatic trial, the goal of which is to help staff use person-centered, non-pharmacological approaches for these symptoms. During the past three years we have gained insights into what may affect the ability of staff to deliver high quality person-centered care. We share these insights in this symposium. In the first paper, the investigators present data indicating that a high rate of psychotropic drug use among residents with dementia persists despite little association to BPSD, and bring into question the need for education around de-prescribing practices. In the second paper, the investigators discuss the conceptual basis and empirical evidence for using affect balance, in addition to symptom reduction, as an important and meaningful outcome for residents. The third paper examines gender differences in the expression of BPSD and how these differences may work to limit staff ability to identify treatment approaches for women who, nonetheless, have significant symptoms. In the final paper the psychometric properties and results of a new Knowledge of Person-centered Approaches for BPSD Test, that was developed by the team and given to staff, are examined and the implications of the findings for the delivery of person-centered care are considered. The discussant will reflect on these findings and provide direction for future research and practice.

Cultural Competence Interventions for Health Professionals Working with Racialized Foreign-born Older Adults: Protocol for a Systematic Review (Preprint)

2021 ◽  
Author(s):  
Diya Chowdhury ◽  
Leonardo Baiocco-Romano ◽  
Veronica Sacco ◽  
Karen El Hajj ◽  
Paul Stolee
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Cultural Competence ◽  
Health Professionals ◽  
Care Delivery ◽  
Future Research ◽  
Culturally Competent ◽  
Foreign Born ◽  
Person Centered Care ◽  
Centered Care

BACKGROUND Integrating culturally competent approaches in the provision of healthcare services is recognized as a promising strategy for improving health outcomes for racially and ethnically diverse populations. Person-centered care, which ensures patient values guide care delivery, necessitates cultural competence of healthcare providers in order to reduce racial/ethnic health disparities. Previous work has focused on interventions to improve cultural competence among healthcare workers generally; however, little investigation has been undertaken regarding current practices focused on racialized foreign-born older adults. OBJECTIVE We seek to synthesize evidence from existing literature in the field to gain a comprehensive understanding of culturally competent interventions for health professionals who work with racialized foreign-born older adults. The aim of this paper is to describe the protocol for this review. METHODS Our protocol will follow the PRISMA guidelines (PRISMA-P) for systematic review protocols. We will conduct a systematic search for relevant studies from three electronic databases that focus on health and social sciences (PubMed, CINAHL, and Scopus). After selecting relevant papers using the inclusion and exclusion criteria, data will be extracted, analyzed, and synthesized to yield recommendations for practice and for future research. RESULTS The systematic review is currently at the search phase where authors are refining the search strings for the selected databases. We expect that the systematic review will be completed within 18 months from the publication of the protocol paper. CONCLUSIONS This study will inform future development and implementation of interventions to support culturally competent, person-centered care of racialized immigrant older adults.

scholarly journals From Micro to Macro: Exploring Preference-Based Person Centered Care from Multiple Perspectives

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 836-836
Author(s):  
Katherine Abbott ◽  
Kristine Williams
Keyword(s):  
Nursing Home ◽  
Assisted Living ◽  
Fixed Effects ◽  
Nursing Home Residents ◽  
Direct Care ◽  
Multiple Perspectives ◽  
Person Centered Care ◽  
Fixed Effects Panel Regression ◽  
Centered Care ◽  
The Impact

Abstract Advancing our knowledge related to honoring nursing home resident preferences is a cornerstone of person-centered care (PCC). While there are multiple approaches to providing PCC, we focus on resident preferences as assessed via the Preferences for Everyday Living Inventory (PELI). The PELI is an evidenced-based, validated instrument that can be used to enhance the delivery of PCC. In this symposium, we explore the perspectives of a variety of stakeholders including nursing home residents, staff, and the impact of preference-based care on provider level regulatory outcomes. First, we present a comparative study of preference importance among n=317 African America and White nursing home residents that found more similarities than differences between the two groups. Second, a content analysis of the responses from n=196 interviews with nursing home residents details the barriers and facilitators connected to their levels of satisfaction with their preferences being fulfilled. Third, perspectives from n=27 direct care workers explore the concept of pervasive risk avoidance to the delivery of PCC. Fourth, systems-level practices, such as shift assignments and provider schedules are identified as barriers to successfully fulfilling resident preferences from the perspectives of n=19 staff within assisted living. Our final presentation utilizes a fixed-effects panel regression analysis with n=551 Ohio nursing home providers to explore the impact of PELI use on regulatory outcomes such as substantiated complaints and deficiency scores reported in the CMS Nursing Home Compare data. Discussant Dr. Kristi Williams will integrate findings, highlighting implications for policy, practice, and future directions. Research in Quality of Care Interest Group Sponsored Symposium.

Person-centered peritoneal dialysis prescription and the role of shared decision-making

2020 ◽  
Vol 40 (3) ◽  
pp. 302-309 ◽  
Author(s):  
Peter G Blake ◽  
Edwina A Brown
Keyword(s):  
Decision Making ◽  
Peritoneal Dialysis ◽  
Shared Decision Making ◽  
Care Delivery ◽  
Shared Decision ◽  
Person Centered Care ◽  
Modern Health Care ◽  
Patient Reported ◽  
Centered Care ◽  
End Stage

Person-centered care has become a dominant paradigm in modern health care. It needs to be applied to people with end-stage kidney disease considering the initiation of dialysis and to peritoneal dialysis (PD) prescription and care delivery. It is relevant to their decisions about goals of care, transplantation, palliative care, and discontinuation of dialysis. It is also relevant to decisions about how PD is delivered, including options such as incremental PD. Shared decision-making is the essence of this process and needs to become a standard principle of care. It requires engagement, education, and empowerment of patients. Patient-reported outcomes and patient-reported experience are also central to person-centered care in PD.

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