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

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.

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S558-S559
Author(s):  
Kimberly Van Haitsma ◽  
Caroline Madrigal ◽  
Ann M Kolanowski ◽  
Barb Resnick ◽  
Beth Galik ◽  
...  

Abstract How behavioral and psychological symptoms of dementia (BPSD) are understood and managed is important to person-centered care. No knowledge tests associated with dementia specifically address staff knowledge of person-centered behavioral approaches to BPSD. The Knowledge of Person-Centered Behavioral Approaches for BPSD Test was developed by our team to fill that gap. We tested the reliability and validity of this measure using a Rasch analysis and additional psychometric testing. 1,071 nurses from 35 nursing homes participated in the study. Reliability was evident based on an item separation of 11.00 and item reliability of 0.99. Construct validity was evident in that all of the items fit the model with INFIT and OUTFIT statistics (0.6-1.4). Associations between test scores and observed positive and negative care interactions (r=.38, p=.03; r=-.26, p=.12), person-centered care approaches (r=-.25, p=.15), and resistance to care (r=-.31, p=.07) will be examined and implications for person-centered care discussed.


2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S359-S359
Author(s):  
Nancy Kusmaul ◽  
Gretchen Tucker

Abstract Implementation of culture change in nursing homes shifts the care model from a traditional, more medically focused approach to person-directed care. Person-directed care promotes resident autonomy and decision making and the empowerment of direct care staff. In this paper, we examine how different stakeholders in nursing homes (residents, family members, direct care staff, administrative staff) conceptualize and experience a selection of person-centered care concepts (consistent assignment, meal choice, waking/bedtime practices, and bathing). We describe the commonalities and differences in the ways different groups of stakeholders operationalize these core person centered care practices and describe areas of potential conflict of views. Lastly, we consider how the well-being and quality of life for residents is affected by the use of these practices.


2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S505-S505
Author(s):  
Lauren Stratton ◽  
Hannah Dannewitz ◽  
Jennifer Margrett ◽  
Mack Shelley ◽  
Linda Brown ◽  
...  

Abstract Long-term care staff outcomes, such as job satisfaction and providing personalized care, are positively influenced by person-centered interventions. Implemented in eight facilities across Iowa, the Targeted Training Intervention 360 (TTI) program aimed to increase person-centered care among direct care professionals (DCP). Throughout the course of TTI, three waves of data were collected from DCPs regarding person-centered care (Person-Centered Care Assessment Tool; P-CAT) and feelings of burnout (Maslach Burnout Inventory; MBI). Analysis of variance tests were employed to identify significant differences in subscale scores across the three waves. Between waves one and two, results revealed significant increases in the P-CAT Extent of Personalizing Care (p=0.03) and Amount of Organizational Support subscales (p=0.001). Additionally, significant decreases from waves one and two were found in the MBI Emotional Exhaustion subscale (p=0.04). Between waves two and three, there were no significant changes in the P-CAT subscales; however, there was a significant increase in the MBI Emotional Exhaustion subscale (p=0.04). To supplement these findings, in wave three DCPs indicated barriers to implementing person-centered care, which included lack of time (49.0%), lack of experience (29.4%), and lack of administrative support (21.6%). Though there were no significant changes in P-CAT scores between the last two waves as well as barriers that must be addressed, DCPs described positive organizational and personal changes regarding person-centered care in the facility, including consistent staffing, using person-centered techniques in care, and individualized activities. Discussion focuses on ways to address barriers to person-centered care and sustain efforts in implementing change.


2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 837-837
Author(s):  
Liza Behrens ◽  
Kimberly Van Haitsma ◽  
Ann Kolanowski ◽  
Marie Boltz ◽  
Mark Sciegaj ◽  
...  

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.


2020 ◽  
Vol 46 (11) ◽  
pp. 17-27
Author(s):  
Justine S. Sefcik ◽  
Caroline Madrigal ◽  
Allison R. Heid ◽  
Sheila L. Molony ◽  
Kimberly Van Haitsma ◽  
...  

2020 ◽  
Author(s):  
Kyung Hee Lee ◽  
Ji Yeon Lee ◽  
Bora Kim

Abstract Background and Objectives The concept of person-centered care has been utilized/adapted to various interventions to enhance health-related outcomes and ensure the quality of care delivered to persons living with dementia. A few systematic reviews have been conducted on the use of person-centered interventions in the context of dementia care, but to date, none have analyzed intervention effect by intervention type and target outcome. This study aimed to review person-centered interventions used in the context of dementia care and examine their effectiveness. Research Design and Methods A systematic review and meta-analysis were conducted. We searched through five databases for randomized controlled trials that utilized person-centered interventions in persons living with dementia from 1998 to 2019. Study quality was assessed using the National Institute for Health and Clinical Excellence. The outcomes of interest for the meta-analysis were behavioral and psychological symptoms in dementia (BPSD) and cognitive function assessed immediately after the baseline measurement. Results In total, 36 studies were systematically reviewed. Intervention types were: reminiscence, music, and cognitive therapies, and multisensory stimulation. Thirty studies were included in the meta-analysis. Results showed a moderate effect size for overall intervention, a small one for music therapy, and a moderate one for reminiscence therapy on BPSD and cognitive function. Discussion and Implications Generally speaking, person-centered interventions showed immediate intervention effects on reducing BPSD and improving cognitive function, although the effect size and significance of each outcome differed by intervention type. Thus, healthcare providers should consider person-centered interventions as a vital element in dementia care.


2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 836-836
Author(s):  
Katherine Abbott ◽  
Kristine Williams

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.


2018 ◽  
Vol 31 (06) ◽  
pp. 799-813 ◽  
Author(s):  
Jacki Stansfeld ◽  
Nadia Crellin ◽  
Martin Orrell ◽  
Jennifer Wenborn ◽  
Georgina Charlesworth ◽  
...  

ABSTRACTObjectives:Sense of competence defines a caregiver’s feeling of being capable to manage the caregiving task and is an important clinical concept in the caregiving literature. The aim of this review was to identify the factors, both positive and negative, associated with a caregiver’s perception of their sense of competence.Design:A systematic review of the literature was conducted, retrieving both quantitative and qualitative papers from databases PsycINFO, CINAHL, EMBASE, and Medline. A quality assessment was conducted using the STROBE and CASP checklists, and the quality rating informed the inclusion of papers ensuring the evidence was robust. Narrative synthesis was employed to synthesize the findings and to generate an updated conceptual model of sense of competence.Results:Seventeen papers were included in the review, all of which were moderate to high quality. These included 13 quantitative, three mixed-methods and one qualitative study. Factors associated with sense of competence included: behavioral and psychological symptoms of dementia (BPSD), caregiver depression, gratitude, and the ability to find meaning in caregiving.Conclusions:The results of this review demonstrate that both positive and negative aspects of caring are associated with caregiver sense of competence. Positive and negative aspects of caregiving act in tandem to influence caregiver perception of their competence. The proposed model of sense of competence aims to guide future research and clinical interventions aimed at improving this domain but requires further testing, as due to the observational nature of the include papers, the direction of causality could not be inferred.


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