scholarly journals Digital tools as promoters for person-centered care practices in chronic care? Healthcare professionals’ experiences from rheumatology care

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Emma Granström ◽  
Carolina Wannheden ◽  
Mats Brommels ◽  
Helena Hvitfeldt ◽  
Monica E. Nyström
Keyword(s):  
Chronic Care ◽  
Healthcare Professionals ◽  
Single Case ◽  
Digital Tools ◽  
Work Practices ◽  
Structured Interviews ◽  
Person Centered Care ◽  
Centered Care ◽  
Care Practices ◽  
Perceived Impact

Abstract Background Person-centered care (PCC) emphasize the importance of supporting individuals’ involvement in care provided and self-care. PCC has become more important in chronic care as the number of people living with chronic conditions is increasing due to the demographic changes. Digital tools have potential to support interaction between patients and healthcare providers, but empirical examples of how to achieve PCC in chronic care and the role of digital tools in this process is limited. The aim of this study was to investigate strategies to achieve PCC used by the healthcare professionals at an outpatient Rheumatology clinic (RC), the strategies’ relation to digital tools, and the perceived impact of the strategies on healthcare professionals and patients. Methods A single case study design was used. The qualitative data consisted of 14 semi-structured interviews and staff meeting minutes, covering the time period 2017–2019. The data were analyzed using conventional content analysis, complemented with document analyses. Results Ten strategies on two levels to operationalize PCC, and three categories of perceived impact were identified. On the individual patient level strategies involved several digital tools focusing on flexible access to care, mutual information sharing and the distribution of initiatives, tasks, and responsibilities from provider to patients. On the unit level, strategies concerned involving patient representatives and individual patients in development of digital services and work practices. The roles of both professionals and patients were affected and the importance of behavioral and cultural change became clear. Conclusions By providing an empirical example from chronic care the study contributes to the knowledge on strategies for achieving PCC, how digital tools and work practices interact, and how they can affect healthcare staff, patients and the unit. A conclusion is that the use of the digital tools, spanning over different dimensions of engagement, facilitated the healthcare professionals’ interaction with patients and the patients’ involvement in their own care. Digital tools complemented, rather than replaced, care practices.

scholarly journals Implementation of Person-Centered Care: A Feasibility Study Using the WE-CARE Roadmap

2021 ◽  
Vol 18 (5) ◽  
pp. 2205
Author(s):  
Roman A. Lewandowski ◽  
Jędrzej B. Lewandowski ◽  
Inger Ekman ◽  
Karl Swedberg ◽  
Jan Törnell ◽  
...  
Keyword(s):  
Pilot Study ◽  
Feasibility Study ◽  
Health Care Professionals ◽  
Quality Care ◽  
Structured Interviews ◽  
Rehabilitation Hospital ◽  
Person Centered Care ◽  
Centered Care ◽  
Multi Disciplinary Team

Background: Person-Centered Care (PCC) is a promising approach towards improved quality of care and cost containment within health systems. It has been evaluated in Sweden and England. This feasibility study examines initial PCC implementation in a rehabilitation hospital for children in Poland. Methods: The WE-CARE Roadmap of enablers was used to guide implementation of PCC for patients with moderate scoliosis. A multi-disciplinary team of professionals were trained in the PCC approach and the hospital Information Technology (IT) system was modified to enhance PCC data capture. Semi-structured interviews were conducted with the nine health care professionals involved in the pilot study and three patients/parents receiving care. Transcribed data were analyzed via content analysis. Results: 51 patients and their families were treated via a PCC approach. High proportions of new PCC data fields were completed by the professionals. The professionals were able to implement the three core PCC routines and perceived benefits using the PCC approach. Patients and their families also perceived improved quality care. The WE-CARE framework enablers facilitated PCC implementation in this setting. Conclusions: This feasibility pilot study indicates that the Gothenburg PCC approach can be successfully transferred to a rehabilitation hospital in Poland with favorable perceptions of implementation by both professionals and patients/their families.

scholarly journals How Assisted Living Staff Conceive of Dementia Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 676-677
Author(s):  
Debra Dobbs ◽  
Sheryl Zimmerman ◽  
Stephanie Miller ◽  
Paula Carder ◽  
Anna Beeber ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Assisted Living ◽  
Medication Management ◽  
Mixed Methods Study ◽  
Organizational Characteristics ◽  
Medical Interventions ◽  
Person Centered Care ◽  
Outcomes Of Care ◽  
Centered Care ◽  
Care Practices

Abstract For those who provide care to the more than 40% of persons with dementia in assisted living (AL) communities, behavioral expressions (BEs) can be challenging. The objective of this mixed-methods study was to understand how AL staff conceive of BEs and what strategies they use to address them. Staff from 250 AL communities in seven states were asked to describe one successful and unsuccessful case of care. A conceptual model related to antecedents, behaviors, and consequences was developed and expanded to include staff strategies and outcomes of care; organizational characteristics associated with care practices were examined. Anxiety/restlessness, combativeness and resistance to care were the most prevalent BEs. Medical interventions (e.g., inpatient psychiatric assessment, medication management) were used in two-thirds of cases. Person-centered care was used more often in successful cases. Respondents in dementia-only communities identified antecedents to BEs more often than those in other communities.

scholarly journals Healthcare professionals’ practice and interactions in older peoples’ cross-sectoral clinical care trajectories when acutely hospitalized - a qualitative observation study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maiken Hjuler Persson ◽  
Christian Backer Mogensen ◽  
Jens Søndergaard ◽  
Helene Skjøt-Arkil ◽  
Pernille Tanggaard Andersen
Keyword(s):  
Decision Making ◽  
Older People ◽  
New Public Management ◽  
Healthcare Professionals ◽  
Clinical Care ◽  
Research Integrity ◽  
Care Practice ◽  
Observation Study ◽  
Person Centered Care ◽  
Centered Care

Abstract Background Healthcare services have become more complex, globally and nationally. Denmark is renowned for an advanced and robust healthcare system, aiming at a less fragmented structure. However, challenges within the coordination of care remain. Comprehensive restructures based on marketization and efficiency, e.g. New Public Management (NPM) strategies has gained momentum in Denmark including. Simultaneously, changes to healthcare professionals’ identities have affected the relationship between patients and healthcare professionals, and patient involvement in decision-making was acknowledged as a quality- and safety measure. An understanding of a less linear patient pathway can give rise to conflict in the care practice. Social scientists, including Jürgen Habermas, have highlighted the importance of communication, particularly when shared decision-making models were introduced. Healthcare professionals must simultaneously deliver highly effective services and practice person-centered care. Co-morbidities of older people further complicate healthcare professionals’ practice. Aim This study aimed to explore and analyse how healthcare professionals’ interactions and practice influence older peoples’ clinical care trajectory when admitted to an emergency department (ED) and the challenges that emerged. Methods This qualitative study arises from a hermeneutical stand within the interpretative paradigm. Focusing on the healthcare professionals’ interactions and practice we followed the clinical care trajectories of seven older people (aged > 65, receiving daily homecare) acutely hospitalized to the ED. Participant observations were combined with interviews with healthcare professionals involved in the clinical care trajectory. We followed-up with the older person by phone call until four weeks after discharge. The study followed the code of conduct for research integrity and is reported in accordance with the Standards for Reporting Qualitative Research (SRQR) guidelines. Results The analysis revealed four themes: 1)“The end justifies the means – ‘I know what is best for you’”, 2)“Basic needs of care overruled by system effectiveness”, 3)“Treatment as a bargain”, and 4)“Healthcare professionals as solo detectives”. Conclusion Dissonance between system logics and the goal of person-centered care disturb the healthcare practice and service culture negatively affecting the clinical care trajectory. A practice culture embracing better communication and more person-centered care should be enhanced to improve the quality of care in cross-sectoral trajectories.

scholarly journals What is good communication for people living with dementia? A mixed-methods systematic review

2017 ◽  
Vol 29 (11) ◽  
pp. 1785-1800 ◽  
Author(s):  
Sarah Alsawy ◽  
Warren Mansell ◽  
Phil McEvoy ◽  
Sara Tai
Keyword(s):  
Systematic Review ◽  
Mixed Methods ◽  
Family Caregivers ◽  
Interpersonal Relationships ◽  
Healthcare Professionals ◽  
Eligibility Criteria ◽  
Good Communication ◽  
Person Centered Care ◽  
People With Dementia ◽  
Centered Care

ABSTRACTBackground:Many strategies have been recommended to support caregivers in communicating with people who live with dementia. However, less is known about what makes communication a good and meaningful experience from the perspective of people with dementia. Understanding this may enhance the person with dementia's sense of connectedness, strengthen their relationships, and facilitate person-centered care. The current review aimed to evaluate research that examined experiences of communication in people living with dementia. Studies that examined reports provided by people with dementia, healthcare professionals, and family caregivers were included.Methods:A mixed-methods systematic review was conducted using PsychINFO, MEDLINE, and EMBASE databases.Results:After applying the eligibility criteria, 15 studies were included. Although eight of these recruited people with dementia, only one focused on their perspectives of communication experiences and the remaining studies focused on the perspectives of family caregivers and healthcare professionals. These studies either explored experiences without suggestions of communication methods, “open exploration,” or through examining experiences of strategies, “exploration of strategies.” A significant theme was around communication difficulties that affected interpersonal relationships and activities of daily living. Conversely, personhood strategies and a strong underlying relationship were believed to facilitate communication. The one study that examined the perspectives of people with dementia emphasized the importance of retaining valued relationships and feeling respected during communication.Conclusions:The need to involve people with dementia in research, particularly around their experiences of communication, is evident. Such research would be imperative for facilitating person-centered care, strengthening social relationships, and informing training programs.

scholarly journals 415 - Evaluation of an e-learning aiming to improve person-centered attitude in healthcare professionals working with people with dementia

2020 ◽  
Vol 32 (S1) ◽  
pp. 131-131
Author(s):  
Claudia van der Velden ◽  
Marleen Prins ◽  
Henriëtte van der Roest
Keyword(s):  
Pilot Study ◽  
Healthcare Professionals ◽  
Well Being ◽  
User Friendliness ◽  
Sense Of Competence ◽  
Positive Effects ◽  
Person Centered Care ◽  
People With Dementia ◽  
Centered Care ◽  
E Learning

Introduction Healthcare professionals working with people with dementia (PwD) have increasingly been moving away from task-oriented models of healthcare towards a more person-centered care (PCC) model. Several studies have showed positive results of PCC on the quality of life of PwD. Also, it shows positive effects on self -esteem and work satisfaction of healthcare professionals. An effective way to educate professionals in PCC and improve their knowledge and person-centered attitude is by using online learning tools.We developed an e-learning in co-creation with end users focusing on well-being and (changing) behavior of PwD. The interactive e-learning supports healthcare professionals in developing a person-centered attitude, by using practical videos and exercises.Methods In the current pilot study, the e-learning is evaluated. To date, 33 healthcare professionals working in Dutch care homes from different care organizations participated in the study and completed the e-learning. In addition, they filled in online questionnaires before and after completing the e-learning. The questionnaires include the Approach to Dementia Questionnaire, Dementia Knowledge, Person Centered Care, Sense of Competence in Dementia Care Questionnaire. Post-measurement also included questions about satisfaction with the e-learning and user-friendliness.Results The final participants are currently completing their post-measurement questionnaires and final results are expected in September 2019. Preliminary data-analysis shows promising results. Positive effects on knowledge about dementia, person-centered attitude and sense of competence are expected. Also, user-friendliness, especially the flexibility of the e-learning (being able to follow the e-learning at home or at work and being able to stop and continue at any time) and the practice-oriented videos are positively evaluated.Conclusion Preliminary results of this pilot study suggest that the e-learning might contribute to developing a more person-centered attitude in healthcare professionals and indicate that participants have positive experiences with the e-learning module.

scholarly journals Dignity of informal caregivers of migrant patients in the last phase of life. A qualitative study.

2020 ◽  
Author(s):  
Xanthe de Voogd ◽  
Dick Willems ◽  
Marieke Torensma ◽  
Bregje Onwuteaka-Philipsen ◽  
Jeanine Suurmond
Keyword(s):  
Quality Of Life ◽  
Healthcare Professionals ◽  
Informal Caregiver ◽  
Informal Caregivers ◽  
Good Care ◽  
Structured Interviews ◽  
Value Differences ◽  
Centered Care ◽  
Family Centered

Abstract Background An important aim of palliative care is to improve the family’s and patient’s quality of life. To ensure quality of life for migrant patients’ families, the objective of this study was to get insight into the dignity of informal caregivers. This could provide insight on family-centered care for migrant patients. Methods 20 semi-structured interviews with informal caregivers with a Turkish, Moroccan or Surinamese migration background living in the Netherlands were analyzed thematically. Results We found the dignity of the patient and the dignity of the informal caregiver were strongly related. Most important for the dignity of the informal caregiver was to ensure good care for and preserve the dignity of the patient. Ensuring good care encompassed advocating for good and dignified care and wishes of the patient. For many caregivers, it also included delivering care to the patient themselves or with other family members, despite having to give up a part of their own lives. Giving care themselves was part of maintaining a good relationship, it could cater to the patient’s preferences or preserve the patient’s dignity, and it could come with valuable aspects such as times for good conversations. The informal caregiver’s dignity and the patient’s dignity were often compromised simultaneously. When informal caregivers felt healthcare professionals were impairing the dignity of the patient, their own dignity suffered. Also, dignified behavior by the patient such as thankfulness influenced the informal caregiver’s dignity positively, undignified behavior of the informal caregiver themselves, such as showing their emotions to significant others could influence it negatively. According to informal caregivers, healthcare professionals can help them preserve their dignity by taking their advice about the patient seriously, informing them about the disease and the patient’s prognosis, and dealing respectfully with value differences at the end of life. Conclusion The dignity of migrant patients’ informal caregivers in the last phase of the patient’s life is entwined with ensuring good care for and dignity of the patient. Healthcare professionals could strengthen the informal caregiver’s dignity by supporting their role.

scholarly journals 514 - Practice-based intervention to implement Person Centered care in long-term care facilities for people with Dementia

2021 ◽  
Vol 33 (S1) ◽  
pp. 64-65
Author(s):  
Claudia Van Der Velden ◽  
Henriëtte G. Van Der Roest
Keyword(s):  
Healthcare Professionals ◽  
Long Term Care ◽  
Term Care ◽  
Person Centered Care ◽  
People With Dementia ◽  
Care Facilities ◽  
Centered Care ◽  
E Learning

Healthcare professionals working with people with dementia (PwD) have increasingly been moving away from task-oriented models of healthcare towards person-centered care (PCC). Several studies have showed positive results of PCC on quality of life of PwD. Also, it shows positive effects on self-esteem and work satisfaction of healthcare professionals (HCP).We developed an successful practice-oriented intervention to implement PCC in long-term care facilities (LTCFs), based on the theory of Kitwood. The intervention consists of different components and learning methods: 1)Management of the facility is trained. They have an important role in motivating HCPs and safeguarding PCC-policy in the future.2)Dementia Care Mapping (DCM)-observations are carried out to gain understanding of the LTCF. DCM is an evidence-based observational method and aims to give a good understanding of the quality of life of PwD.3)The training of staff starts with a Kick-off-meeting. During a ‘Mirror theater’ with professional actors, an act representing a familiar care situation is performed. Staff participates in the act to become aware of PCC. The kick-off also serves as a warming-up on PCC knowledge.4)After this, staff complete an interactive e-learning on the basic theory of PCC. The e-learning contains practical videos and exercises.5)Finally, staff follow two consecutive, practical-oriented team-trainings. They will learn what PCC means for their daily practice and how to reflect on it. The most effective part is the reflection on examples of their own clients, and get more aware of their own behavior. In between trainings, HCP will carry out a practice exercise and provide feedback in session two.In an early stage of the intervention we discuss the possibilities and adjust the approach to the needs and situation (culture, level of knowledge etc.) of the LTCF. Involvement of all the staff in the intervention is essential, so everyone speaks the same ‘language’ and staff can rely on each other. Based on experience, these factors contributes to a sustainable way to implement PCC in LTCFs.

scholarly journals The work process and care production in a Brazilian indigenous health service

2017 ◽  
Vol 21 (4) ◽  
Author(s):  
Aridiane Alves Ribeiro ◽  
Giovanni Gurgel Aciole ◽  
Cássia Irene Spinelli Arantes ◽  
Jeff Reading ◽  
Donna L.M. Kurtz ◽  
...  
Keyword(s):  
Indigenous Health ◽  
Temporary Employment ◽  
Systematic Observation ◽  
Structured Interviews ◽  
Work Process ◽  
Mato Grosso ◽  
Institutional Rules ◽  
Person Centered Care ◽  
Centered Care ◽  
Health Support

Abstract Objective: To understand the constitutive elements of the work process and care production in an Indigenous Health Support Service. Methods: Case study. Systematic observation and semi-structured interviews were conducted in January and February of 2012. The participants were 10 nursing professionals of an Indigenous Health Support Center, located in Mato Grosso do Sul state, Brazil. The work process was used as a conceptual and analytical category. Results: Through interpretative analysis, the data were organized into three categories. The results showed that care production was focused on procedures and guided by rigid institutional rules and bureaucracy. The prioritization of institutional rules and procedures was detrimental to the provision of person-centered care. Conclusion: The temporary employment contracts and rigid bureaucratic organization generated a tense work environment. These aspects do not maximize the efforts of the nursing staff to provide person-centered care.

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