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Policy makers and health professionals are grappling with the high costs of and demand for health care, questions of sustainability and value, and changing population demographics—in particular, ageing populations. Digital solutions, including the adoption of patient‐reported measures, are considered critical in achieving person‐centred and value‐based health care. However, the utility of patient‐reported measures and the data they produce may be subject to ageist beliefs, prejudices and attitudes, rendering these data ineffective at promoting improved patient experiences and outcomes for older adults. This article explores the ethical considerations raised in relation to patient‐reported measures and the digital agency of older patients. [ABSTRACT FROM AUTHOR]

Aim: This article presents the findings of a qualitative study focusing on the experiences of people aged over 70 years in the interpersonal nurse–patient care relationship in hospital settings during and after the COVID‐19 pandemic. The aim was to analyse different aspects of this relationship, including nurses' behaviour and caring attitudes, the person‐centred model of care, patients' involvement in their own care and communication in the hospital context. Design: An exploratory qualitative study was conducted on the basis of an interpretative framework. Methods: Six focus groups were conducted. A total of 34 participants were purposively recruited from three nursing homes in Spain, Italy and Portugal. Specific inclusion criteria were used to select participants. Results: Five main categories were identified. Analysis revealed the importance of empathy and sensitivity in caring relationships, as well as the need for personalized and patient‐centred care. The importance of effective communication and recognition of ageist behaviour by professionals was highlighted. In addition, independent of the pandemic, situational factors in the hospital environment were identified that influence the interpersonal care relationship. Conclusions: The study highlights the need to promote a person‐centred model of care that takes into account the specific preferences and needs of older people. This is achieved by identifying elements of the interpersonal nurse–patient relationship. In addition to highlighting the disparity of opinion regarding an active or passive role in self‐care and decision making, the importance of addressing ageism and improving communication is emphasized. What problem did the study address?: The importance of the patient–nurse relationship in hospital care has been highlighted in previous studies.Critical elements of the patient care experience have been identified as empathy and effective communication.Ageism in healthcare has been recognized as a potential barrier to patient‐centred care. What were the key findings?: The main findings highlight the importance of empathy and personalized care, emphasize the importance of effective communication and address ageist behaviours in the nurse–patient relationship. Where and who will the research impact?: By highlighting the need for person‐centred care and improved communication strategies, particularly in the context of caring for older patients during and after the COVID‐19 pandemic, this research will have an impact on healthcare professionals, policy makers and carers. Reporting Method: The COREQ guideline was used. Patient or public contribution: This study adopted a collaborative approach to ensure that patient perspectives were integrated into the research process. We organized regular focus groups. Patients were actively involved in shaping the research questions, refining the study design and interpreting the emerging findings. Their valuable input helped us to understand the nuances of their experience and to prioritize the aspects that were critical to their well‐being. In addition, their insights guided the development of practical recommendations aimed at improving the interpersonal care relationship between nurses and patients in hospital settings, ensuring that their voices were heard and reflected in the proposed interventions. This patient‐centred approach fostered a sense of empowerment among the participants. It reinforced the notion that their experiences and opinions are integral to shaping healthcare practice. [ABSTRACT FROM AUTHOR]

Aim: To describe how clinicians provide culturally responsive care to culturally diverse people with kidney failure in haemodialysis centres. Background: Culturally diverse individuals receiving in‐centre maintenance haemodialysis have unique cultural needs. Unmet cultural needs can impair and profoundly affect their experiences. Given culturally responsive care has the potential to enhance the experiences of culturally diverse people, it is vital to understand how clinicians provide culturally responsive care. Method: A scoping review was undertaken using Arksey and OMalleys framework. Five databases: Medline and CINAHL Complete (EBSCO), PsycINFO, Embase (OVID) and ProQuest Theses and Dissertation databases were searched for research literature published in English between 1990 and 2023. Narrative synthesis was used to synthesise the data. Results: From the 17,271 records screened, 17 papers reporting 14 studies met the inclusion criteria. Narrative synthesis revealed two themes: (i) communication enablers and barriers including linguistic differences, professional and lay interpreter use; and (ii) the importance of culture, which encompassed acknowledging cultural priorities, accommodating cultural food preferences and access to cultural training. Conclusion: While competing priorities associated with haemodialysis may be a challenge for clinicians, recognising the significance of cultural care needs and accommodating them in care is important. Demonstrating respect towards cultural diversity and providing person‐centred care by facilitating the unique cultural needs of people with kidney failure in haemodialysis is imperative. Relevance to Clinical Practice: Culturally responsive care is complex and multidimensional. Individuals' cultural care needs should be acknowledged, respected, and accommodated in care. Patient or Public contribution: No patient or public contribution. The study protocol was registered in the Open Science Framework. https://osf.io/uv8g3. [ABSTRACT FROM AUTHOR]

Purpose: Value-based health care (VBHC) argues that health-care needs to re-focus to maximise value creation, defining value as the quota when dividing the outcomes important for the patient, by the cost for health care to deliver such outcomes. This study aims to explore the perception of value among different stakeholders involved in the process of implementing VBHC at a Swedish hospital to support leaders to be more efficient and effective when developing health care. Design/methodology/approach: Participants comprised 19 clinicians and non-clinicians involved in the implementation of VBHC. Semi-structured interviews were conducted and content analysis was performed. Findings: The clinicians described value as a dynamic concept, dependent on the patient and the clinical setting, stating that improving outcomes was more important than containing costs. The value for non-clinicians appeared more driven by the interplay between the outcome and the cost. Non-clinicians related VBHC to a strategic framework for governance or for monitoring different continuous improvement processes, while clinicians appreciated VBHC, as they perceived its introduction as an opportunity to focus more on outcomes for patients and less on cost containment. Originality/value: There is variation in how clinicians and non-clinicians perceive the key concept of value when implementing VBHC. Clinicians focus on increasing treatment efficacy and improving medical outcomes but have a limited focus on cost and what patients consider most valuable. If the concept of value is defined primarily by clinicians' own assumptions, there is a clear risk that the foundational premise of VBHC, to understand what outcomes patients value in their specific situation in relation to the cost to produce such outcome, will fail. Health-care leaders need to ensure that patients and the non-clinicians' perception of value, is integrated with the clinical perception, if VBHC is to deliver on its promise. [ABSTRACT FROM AUTHOR]

Background: Where available, Parkinson's Nurse Specialists (PNS) provide a range of care, support, guidance, and advocacy for people with Parkinson's (PwP), and, where appropriate, their care partners (CP). Parkinson's is a complex and progressive condition. Consequently, evaluating health outcomes is not a reliable method to understand the value and impact of PNS. Previous research has identified PNS can improve the subjective well-being of PwP in the community, also that barriers to care include heavy caseloads and a lack of time. Yet little is known about the value of the role of the PNS, particularly about the impact of pharmacological management and review. This research aims to close this research gap by providing explanatory theories of the impact and value of PNS to PwP, their CP, and other professionals. Methods: A social constructivist grounded theory approach was used. Semi-structured interviews were conducted with three groups, PNS, PwP, and CP. Interviews were analysed using NVivo for coding and categorising and Word for memo-writing. Data was analysed inductively and iteratively to identify contexts, social processes, actions, and behaviours, before final emergent theories were identified. Results: 46 semi-structured interviews (PNS 18, PwP 19, CP 9) led to four data categories and 13 sub-categories that delineated PNS value. (1) Expert Counsel; provision of emotional support, education, and lifestyle guidance; CP inclusion; provision from diagnosis; and across all stages of Parkinson's. (2) Conduit of Care; signposting, referral, and connection to PwP, CP, others; PNS barriers and facilitators; (3) Team/Partnership; continuity and partnership, 'working together'; (4) Pharmacological Support, PNS prescribing; concordance; speed of treatment. Where PNS were accessible they could offer personalised support and partnership, so providing person-centred care that improves health and well-being. Conclusion: Where a PNS is accessible due to service availability and manageable caseloads, to provide person-centred care, they deliver several benefits to PwP and CP which improve health and perceived well-being. Where PNS are not available, PwP and CP often struggle to manage their Parkinson's with negative impacts on health and well-being. [ABSTRACT FROM AUTHOR]

Introduction Methods Consumer and Community Involvement Results Conclusion PLAIN LANGUAGE SUMMARY Climate change threatens the environments in which person‐centred occupational therapy occurs. Environmental sustainability is directly linked with the health and wellbeing of current and future generations, presenting occupational therapists with a unique advocacy and activist role. As practitioners of the future, there is an urgent need to understand students' attitudes, perceptions of, and self‐perceived preparedness for, dealing with environmental determinants of health and intergenerational occupational and climate justice.A cross‐sectional exploratory descriptive survey collected United Kingdom (UK) based allied health professional students' attitudes, perceptions, and self‐perceived preparedness for advocating for environmental sustainability in the context of person‐centred care. The survey was distributed to 48 gatekeepers in UK institutions with approved allied health professional training programmes (44 offered occupational therapy); 62 occupational therapy students responded. Descriptive and non‐parametric inferential statistics were used to analyse quantitative data. Text and short answers were analysed qualitatively via inductive content analysis.The study was co‐designed and implemented with MSc (pre‐registration) occupational therapy students.Participants (94%) expressed concerns for climate change, with 84% feeling responsible for addressing environmental sustainability in health care. While 64.5% identified climate justice as a top priority, a perceived challenge emerged between person‐centred care and sustainability, with only 18% of participants feeling prepared for environmental sustainability in occupational therapy practice. Participants requested education on personal and professional sustainability practices, as well as collective action. Sharing personal climate change experiences, advocating with family and friends, and facilitating connections for collective action were highlighted as potentially transformative educational tools in this area.Occupational therapy curricula should address environmental sustainability through pragmatic, critical, and ethical lenses to enhance students' preparedness for this advocacy and activist role. Reflection and continuous professional development for environmentally sustainable practices is recommended.Occupational therapists believe that it is important to support people to participate in occupations that matter to them. However, the activities that some people choose to participate in may have negative effects on the environment and the planet. It is important to ensure that when occupational therapists support people in their choices of activities, this does not lead to unequal access to healthy and meaningful occupations of others, now or in the future. That is because occupational therapists also have a responsibility to prevent occupational injustice. Occupational therapy students are the professionals of the future, so it is important to include them in research about this topic. They need to develop skills that allow them to simultaneously make sure that they are delivering person‐centred care, which is not environmentally detrimental and that does not lead to occupational injustice. Making sure that occupational therapists provide person‐centred care while also managing risks of occupational injustice may be seen as a profession‐specific dilemma. In this study, occupational therapy students in the UK completed a survey about their feelings, views, and readiness for managing this dilemma. Results showed that most respondents are concerned about climate change, but do not feel that their occupational therapy education sufficiently prepared them to practise in an environmentally sustainable way. They were asked to propose ideas for addressing this issue, and the article discusses how occupational therapy curricula might be changed in accordance. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Background Design Method Results Conclusions To explore the experiences and perceptions of communication about managing medication across transitions of care for residents living in aged care homes and their family caregivers.Effective medication communication across transitions of care involves exchanging information, resident, and family caregiver's participation in decision‐making, and shared responsibility.A qualitative meta‐synthesis.This review was conducted in accordance with the PRISMA 2020 guidelines and the accompanying 27‐item checklist. A systematic search of seven electronic databases (Embase, PsycINFO, Medline Ovid, Scopus, CINAHL, EmCare and Web of Science) was performed from inception to December 2023. Studies eligible for inclusion in this review were required to be published in peer‐reviewed English journals and focus on medication communication among healthcare providers, residents and family caregivers during transitions of care for aged care residents. The JBI Critical Appraisal Checklist for Qualitative Research was employed for the critical appraisal of the studies, and the COREQ checklist was used to evaluate their quality.Of the 2610 studies identified, 12 met the inclusion criteria. No study was excluded based on quality. Two main themes were generated: (1) Medication information exchange involving residents and families, and (2) resident and family factors influencing medication communication engagement. The findings revealed a lack of supportive structure for effective communication and collaboration among residents, family caregivers and healthcare providers during transitions of care, marked by one‐way interactions and limited evidence of shared decision‐making or family caregiver engagement in medication management communication, despite varying individual needs and preferences.Communication about medication management during transitions of care focused on sharing details rather than active engagement. Residents and their family caregivers have individual needs and perspectives regarding communication about medication management, which are not well addressed by healthcare providers during transitions of care. Healthcare providers' communication remains limited, and family caregivers are underutilised. [ABSTRACT FROM AUTHOR]

Background: Care transitions from hospital to home are a critical period for patients and their families, especially after a stroke. The aim of this study was to assess the feasibility, fidelity and acceptability of a co‐designed care transition support for stroke survivors. Methods: A non‐randomised controlled feasibility study recruiting patients who had had stroke and who were to be discharged home and referred to a neurorehabilitation team in primary healthcare was conducted. Data on the feasibility of recruitment and fidelity of the intervention were collected continuously during the study with screening lists and checklists. Data on the perceived quality of care transition were collected at 1‐week post‐discharge with the Care Transition Measure. Data on participant characteristics, disease‐related data and outcomes were collected at baseline (hospitalisation), 1 week and 3 months post‐discharge. Data on the acceptability of the intervention from the perspective of healthcare professionals were collected at 3 months using the Normalisation Measure Development Questionnaire. Results: Altogether, 49 stroke survivors were included in the study: 28 in the intervention group and 21 in the control group. The recruitment and data collection of patient characteristics, disease‐related data, functioning and outcomes were feasible. The fidelity of the intervention differed in relation to the different components of the co‐designed care transition support. The intervention was acceptable from the perspective of healthcare professionals. Concerns were raised about the fidelity of the intervention. A positive direction of effects of the intervention on the perceived quality of the care transition was found. Conclusion: The study design, data collection, procedures and intervention were deemed feasible and acceptable. Modifications are needed to improve intervention fidelity by supporting healthcare professionals to apply the intervention. The feasibility study showed a positive direction of effect on perceived quality with the care transition, but a large‐scale trial is needed to determine its effectiveness. Patient or Public Contribution: Stroke survivors, significant others and healthcare professionals were involved in a co‐design process, including the joint development of the intervention's components, contextual factors to consider, participant needs and important outcomes to target. Trial Registration: ClinicalTrials.gov ID: NCT0292587. [ABSTRACT FROM AUTHOR]

ABSTRACT The prominence of person‐centred care has been widely recognised in recent decades. In England, care governance frameworks prioritise the views and wishes of individual people receiving support. Despite workforce development initiatives linked to this agenda, there remains no consensus on the meaning of person‐centred care in the English care sector. An actor‐centred study explored understandings of person‐centred care from the perspective of care workers and managers working with older people in residential and community care. Analysis of interviews with 20 participants led to development of a typology based on the beliefs, values and practices of the interviewees. The three typological groups interpreted person‐centred care within their own distinctive philosophies: Nurturing Mental Health, Nurturing Agency and Nurturing Intimacy. The findings offer fresh insight into the ways an abstract concept is understood within the context of day‐to‐day practice with older people. Existing workforce development guidance encourages professionals to understand person‐centred care by enacting a series of wide‐ranging, desirable outcomes, which is potentially confusing for those working on the front line. This study shows, instead of trying to be all things to all people, staff emphasise a few specific outcomes and values in enacting person‐centred care, reflecting nuances in their overall understanding of older people's well‐being. [ABSTRACT FROM AUTHOR]

Background: Little is known about patients' or carers' reported experiences of dental care provided using dental behaviour support (DBS) techniques. Qualitative literature can provide unique insight into these experiences. Aim: To explore and synthesize qualitative literature related to patient experience of dental behaviour support. Methods: A PROSPERO‐registered systematic review of qualitative articles was undertaken. Studies were identified through MEDLINE, Embase and PsycINFO. Abstracts were screened by two reviewers and data were extracted to summarize the qualitative findings included within them. A thematic summary approach was used to synthesize the qualitative data identified. Results: Twenty‐three studies were included. Studies primarily explored experiences of dental care of children by speaking to their parents (n = 16), particularly regarding paediatric dental general anaesthesia (DGA) (n = 8). Studies of adults' experiences of DBS (n = 7) covered a range of techniques. Nine studies explored broader dental care experiences and did not study specific DBS approaches. A thematic synthesis identified five themes applicable across the studies identified: Trust and the therapeutic alliance supporting effective care delivery; considered information sharing often alleviated anticipatory anxiety; control and autonomy‐reduced anxieties; variations in the perceived treatment successes and failures of DBS techniques; and DBS techniques produced longer positive and negative impacts on patients beyond direct care provision. Conclusion: Qualitative research has been under‐utilized in research on DBS techniques. Care experiences of most DBS techniques outside of paediatric DGA are poorly understood. Building trust with patients and enabling autonomy appear to support positive patient‐reported experiences of care. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known about the subject: Treatment groups in Mental Health Service is cost‐effective, increases patients´ self‐understanding and stimulate changeResearch shows that people with mental illness have different barriers to attend group sessions which often originates from a lack of trust in other people, but it is known that the possibility to build gradual trust among the participants encourages attendance. What the paper adds to existing knowledge: This study is based on the experience from outpatients and illuminates how discovery groups from the Tidal Model can be used as introductory sessions to build gradual trust among people with mental illness before engaging in a person‐centred group intervention.The study fills a research gap in methods to create a safe and trusting environment in treatment groups for people with mental illness working with recovery‐oriented person‐centred interventions. What are the implications for practice: This study emphasizes the importance of meeting concerns about social interactions in persons with mental illness when joining treatment groups. It presents a recovery‐oriented method which meets this requirement and is easy to implement in practice. Introduction: Recovery‐oriented interventions delivered individually or in groups are more and more common within mental health nursing. However, persons with mental illness may be cautious about engaging in groups. Therefore, it is important to provide a trusting basis in the group to allow for the best opportunities to promote engagement, attendance and impact of treatment. Aim: The aim was to explore how discovery group sessions were experienced as introductory sessions from the perspectives of participants and facilitators before engaging in a person‐centred group intervention. Method: A qualitative interview study was conducted, involving four group facilitators and 16 participants with mental illness from five completed groups. Data were analysed with Ricoeur's theory of interpretation. Results: The findings showed that the two discovery group sessions were experienced as useful and meaningful to all and created a safe atmosphere and a trusted relationship among group participants and facilitators. Discussion: Feeling safe and sharing experiences and emotions contribute to the relational climate in a group. Implication for practice: Addressing concerns about social interactions in persons with mental illness is important in group treatment. This study proved that engaging patients in designing or adapting interventions for mental health services is important to improve quality. [ABSTRACT FROM AUTHOR]

Nurses play a key role in the assessment and planning of patient care. Using a case study approach, this article discusses the importance of a person-centred approach in identifying a care need, determining a goal of care and providing evidence-based nursing interventions. [ABSTRACT FROM AUTHOR]

This article provides an overview of what healthcare assistants need to understand about person-centred care, the fifth standard of the care certificate. [ABSTRACT FROM AUTHOR]

Objective: Person-centred care (PCC) is an important approach as it positively affects disease management. Guiding studies are needed on the use and development of PCC in hard-to-heal (chronic) wound management. This study aimed to determine attitudes and approaches of nurses and physicians working in hard-to-heal wound management towards PCC, and obtain their views and suggestions for its scope and improvement. Method: Participants of this descriptive survey study consisted of nurses and physicians responsible for hard-to-heal wound care and treatment in healthcare institutions at all levels in Turkey. Data were collected through a structured online survey shared with members of professional associations via social media platforms between March–November 2020. Descriptive statistics and qualitative inductive content analysis were used to analyse data. Results: Participants (n=418) included physicians (84.2%) and nurses (15.8%). Mean participant-graded their person-centred behaviour level was 8.18±1.80 (out of 10 points). The majority of participants reported that they informed patients about care, treatment processes and options (87.3%) as well as including them in the decision-making process (74.6%). Responses of the participants regarding the scope of PCC were classified into five main categories, the most prominent being: 'individual', 'care', 'professional development' and healthcare system'. Suggestions for the improvement of PCC were classified into seven main categories, with 'personalised care', 'disease-specific care', 'continued training of healthcare professionals should be ensured' and 'home care system should be developed for the continuity of care' among the prominent subcategories. Conclusion: The findings of this study suggests that education on PCC is an important approach. Institutional protocols and guidelines can support person-centred hard-to-heal wound management. In this study, the level of person-centred behaviour of the participants was determined to be good. Although the results of the study cannot be generalised to all health professionals—the majority of the participants were physicians—it is recommended to develop and disseminate the PCC model in hard-to-heal wound management using the findings. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodResultConclusionThe research objectives were to explore the communication needs pertaining to (a) people with primary progressive aphasia (PwPPA); (b) family members of PwPPA; and (c) the different variants of primary progressive aphasia (PPA), from the perspectives of speech-language pathologists (SLPs).This investigation used a qualitatively driven concurrent mixed methods research design. Data collection involved semi-structured interviews and mixed methods questionnaires with 14 SLPs. Qualitative content analysis of interview and questionnaire data was used to identify codes and categories related to the research objectives. Quantitative analysis of questionnaire data involved single item summaries and cross item tabulations.Analysis revealed eight categories of communication need pertaining to PwPPA and six pertaining to their family members. Results regarding communication needs according to variant of PPA revealed limited findings.SLPs perceived several important areas of communication need for PwPPA and their family members, highlighting key clinical implications for proactive communication care across the continuum of care. Future research can build on the current findings and integrate the perspectives of PwPPA and their family members on this topic, to develop interventions and explore models of service delivery to meet their progressive and complex communication needs. [ABSTRACT FROM AUTHOR]

Background: The shift towards person-centred care has become integral in achieving high-quality healthcare, focusing on individual patient needs, preferences, and values. However, existing instruments for measuring person-centred practice often lack theoretical underpinnings and comprehensive assessment. The Person-centred Practice Inventory – Staff (PCPI-S) and the Person-centred Practice Inventory – Care (PCPI-C) were developed in English to measure clinicians' and patients' experience of person-centred practice. The aim of this study was to investigate the psychometric properties of the French version of the PCPI-S and PCPI-C. Methods: A multi-centred cross-sectional study was conducted in six hospitals in French-speaking Switzerland. Construct validity of the PCPI-S and the PCPI-C was evaluated by using confirmatory factor analysis and McDonald's Omega coefficient was used to determine the internal consistency. Results: A sample of 558 healthcare professionals and 510 patients participated in the surveys. Psychometric analyses revealed positive item scores and acceptable factor loadings, demonstrating the meaningful contribution of each item to the measurement model. The Omega coefficient indicated acceptable to excellent internal consistency for the constructs. Model fit statistics demonstrated good model fit for the PCPI-S and PCPI-C. Conclusions: The findings support the construct validity and internal consistency of the PCPI-S and PCPI-C in assessing person-centred practice among healthcare professionals and patients in French-speaking Switzerland. This validation offers valuable tools for evaluating person-centred care in hospital settings. [ABSTRACT FROM AUTHOR]

Background and aim: Communication is a key factor in intraprofessional collaboration between hospital nurses and homecare nurses in hospital‐to‐home transitions of older patients with complex care needs. Gaining knowledge of the nature of cross‐sectoral communication is crucial for understanding how nurses collaborate to ensure a seamless patient trajectory. This study explores how cross‐sectoral electronic health records communication influences collaboration between hospital nurses and homecare nurses when discharging older patients with complex care needs. Method: The study is based on qualitative group interviews with six hospital nurses and 14 homecare nurses working at different hospitals and municipalities across Denmark. Data were analysed using reflexive thematic analysis, as described by Braun and Clark. Findings: The themes Collecting pieces for the 'puzzle': Losing the holistic picture of the patient; Working blindfolded: limited provision of and access to critical information; and Bypassing the 'invisible wall': dialogue supports cohesion illustrate the impact of organisational structures within electronic health records have on hospital nurses' and homecare nurses' intraprofessional collaboration across sectors. Challenges with predefined and word‐limited elements in digital communication, and inadequate and limited access to significant medical information were identified. To compensate for the inadequacy of the electronic health records, direct contact and dialogue were emphasised as ways of fostering successful collaboration and overcoming the barriers created by electronic health records. Conclusion: Despite hospital nurses' and homecare nurses' desire to conduct holistic patient assessments, their ability to collaborate was hindered by failures in electronic health record communication resulting from restrictive organisational structures across sectors. Thus, it became necessary for hospital nurses and homecare nurses to bypass the electronic health record system and engage in dialogue to provide holistic care when discharging older patients with complex care needs. However, by hospital nurses and homecare nurses compensating for counter‐productive organisational structures, problems brought about by the electronic health record system paradoxically remain invisible. [ABSTRACT FROM AUTHOR]

Background: Patient participation is fundamental in nursing care and has yielded benefits for patient outcomes. However, despite their compassionate care approach, nurses do not always incorporate patients' needs and wish into evidence‐based practice, quality improvement or learning activities. Therefore, a shift to continuous quality improvement based on evidence‐based practice is necessary to enhance the quality of care. The patient's opinion is an essential part of this process. To establish a more sustainable learning culture for evidence‐based quality improvement, it is crucial that nurses learn alongside their patients. However, to promote this, nurses require a deeper understanding of patients' care preferences. Objective: To explore patients' needs and wishes towards being involved in care processes that nurses can use in developing an evidence‐based quality improvement learning culture. Methods: A qualitative study was conducted in two hospital departments and one community care team. In total, 18 patients were purposefully selected for individual semi‐structured interviews with an average of 15 min. A framework analysis based on the fundamental of care framework was utilised to analyse the data deductively. In addition, inductive codes were added to patients' experiences beyond the framework. For reporting this study, the SRQR guideline was used. Results: Participants needed a compassionate nurse who established and sustained a trusting relationship. They wanted nurses to be present and actively involved during the care delivery. Shared decision‐making improved when nurses offered fair, clear and tailored information. Mistrust or a disrupted nurse–patient relationship was found to be time‐consuming and challenging to restore. Conclusions: Results confirmed the importance of a durable nurse–patient relationship and showed the consequences of nurses' communication on shared decision‐making. Insights into patients' care preferences are essential to stimulate the development of an evidence‐based quality improvement learning culture within nursing teams and for successful implementation processes. [ABSTRACT FROM AUTHOR]

Introduction: Many older people who cannot live independently live in aged residential care facilities to obtain support with social and healthcare needs. Despite old age being a precious time for people to live well, many facility residents have limited access to activities that promote their well‐being and connectedness. In New Zealand, one provider of aged residential care developed a village inspired by de Hogeweyk in the Netherlands, where resident engagement in valued activities supports continuing lifelong identities. Methods: The study aimed to explain the transition from a traditional Aged Residential Care facility to a clustered domestic model of care. A critical realist theoretical perspective underpinned case study research. Data comprised transcripts of interviews with key informants, facility staff, residents and their families, records of observation of residents' daily lives, organisational documents, photographs and the first author's study journal. Results: The intersection of philosophical workplace change to support delivery of person‐centred care and a change in the physical environment enabled realisation of the organisational vision of residents living normal lives. Conclusion: Policy makers and practitioners must be aware that while a domestic‐scale environment provides cues to normal living, staff who know residents and what is important to them enable participation in community and valued activities. Implications for Practice: Innovative living arrangements are a synthesis of philosophical aspirations, architectural and design vision, dedicated leadership and committed teamwork. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise the importance of effective pretreatment consultations (PTCs) for patients with cancer and their relatives • To learn about the potential benefits and disadvantages of group PTCs for patients, relatives and nurses • To be aware of the need to explore the feasibility and acceptability of delivering group PTCs in practice. Background: Patients with cancer receiving systemic anticancer therapy (SACT) historically attended a one-to-one hospital pretreatment consultation (PTC) with a SACT nurse who provided educational and psychological support. However, these PTCs had limitations for patients, relatives and the SACT nurses delivering them. Aim: To develop a psychosocial and educational group intervention to support the SACT informational needs of patients with cancer and their relatives. Method: A multi-method qualitative study design was adopted. A group PTC was developed through: observations of one-to-one nurse-led PTCs and doctors obtaining patients’ consent for SACT; two focus groups with healthcare professionals (n=12); semi-structured interviews with healthcare professionals (n=6); two focus groups with patients who received SACT (n=10) and their relatives (n=2); and semi-structured interviews with patients who received SACT (n=4). The intervention was presented in a workshop and SACT nurses (n=10) were trained in its delivery. Findings: Overall, the intervention proposal appeared to be received positively by patients, relatives and healthcare professionals. However, questions remained over the feasibility and acceptability of delivering group PTCs. Conclusion: The group PTC seems to be promising, although it requires piloting. Group PTCs are expected to encourage patients and relatives to manage and report symptoms, by promoting family-centred care. It is also anticipated that the group approach will make better use of SACT nurses’ time so they are more available to provide individualised care during treatment administration, while also reducing their emotional labour. [ABSTRACT FROM AUTHOR]

Abstract Background The shift towards person-centred care has become integral in achieving high-quality healthcare, focusing on individual patient needs, preferences, and values. However, existing instruments for measuring person-centred practice often lack theoretical underpinnings and comprehensive assessment. The Person-centred Practice Inventory – Staff (PCPI-S) and the Person-centred Practice Inventory – Care (PCPI-C) were developed in English to measure clinicians’ and patients’ experience of person-centred practice. The aim of this study was to investigate the psychometric properties of the French version of the PCPI-S and PCPI-C. Methods A multi-centred cross-sectional study was conducted in six hospitals in French-speaking Switzerland. Construct validity of the PCPI-S and the PCPI-C was evaluated by using confirmatory factor analysis and McDonald’s Omega coefficient was used to determine the internal consistency. Results A sample of 558 healthcare professionals and 510 patients participated in the surveys. Psychometric analyses revealed positive item scores and acceptable factor loadings, demonstrating the meaningful contribution of each item to the measurement model. The Omega coefficient indicated acceptable to excellent internal consistency for the constructs. Model fit statistics demonstrated good model fit for the PCPI-S and PCPI-C. Conclusions The findings support the construct validity and internal consistency of the PCPI-S and PCPI-C in assessing person-centred practice among healthcare professionals and patients in French-speaking Switzerland. This validation offers valuable tools for evaluating person-centred care in hospital settings.

Introduction: Person-centred care (PCC) may hold promise for improved healthcare experiences and outcomes among patients living with obesity. A validated instrument to assess the delivery of PCC to patients living with obesity is, however, currently lacking. This study aimed to validate such an instrument. In this article, we describe the development and psychometric testing of the 40-item and 24-item short version of the Person-Centred Obesity Care (PCOC) instrument. Methods: A total of 590 individuals living with obesity (BMI 33.4 ± 3.9) from a representative Dutch sample completed the 49-item PCOC instrument measuring the eight dimensions of PCC (patient preferences, physical comfort, coordination of care, emotional support, access to care, continuity and transition, information and education, and family and friends), and two measures of satisfaction with care. We performed confirmatory factor analyses to verify the factor structure of the instrument and examined its reliability and validity. Results: Fit indicators of the first model with all 49 items showed that the model left room for improvement (comparative fit index [CFI]

Abstract Background Task shifting is an approach where specific tasks are transferred, when convenient, from health workers with high qualifications to health workers with less training and lower qualifications. This approach is mainly used to utilize the available human resources for health. Tasks that are traditionally linked to the physician role have increasingly been transferred to registered nurses during the last decade. Knowledge regarding the experiences and reflections of physicians and their leaders related to giving up tasks or how such policies can best be implemented is limited. This study aimed to explore physicians’ and their leaders’ perspectives on task shifting, especially to registered nurses, in different Norwegian emergency departments. Methods The study was carried out from June to October 2022. It had an explorative and descriptive qualitative design and an inductive approach, semi-structured interviews was used. The study involved ten physicians and leaders from three different regional hospitals in south-eastern Norway. Manifest and latent content analysis were used to analyse the data. The COREQ guidelines were applied in the study. Results From the three categories 1) The rationale for task shifting, 2) Teambuilding and 3) Implementation of task shifting, with nine subcategories. One overall main theme emerged: It is not the task, it is the shifting – moving towards a person-centred culture. Conclusions The study indicates that developing a person-centred culture and fostering a team approach in emergency departments is more important than simply shifting tasks, as task shifting may lead to fragmented care and resistance from physicians. Hospital leaders must invest time and effort into organising teams and providing clear leadership to support the redesign of professional roles, recognising the cultural and traditional challenges involved. Policymakers should promote guideline development, team training programs, and cooperation methods to support a person-centred culture and effective task shifting in emergency departments.

Abstract Background and aim The evidence about the acceptability and effectiveness of innovative paediatric models of care for Type 1 diabetes is limited. To address this gap, we synthesised literature on implemented models of care, model components, outcomes, and determinants of implementation and sustainability. Methods A systematic review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Database searches of Medline, CINAHL, EMBASE and Scopus were conducted. Empirical studies focused on Type 1 diabetes paediatric models of care, published from 2010 to 2022 in English were included. Results Nineteen extant studies reported on models and their associations with health and psychosocial outcomes, patient engagement with healthcare, and healthcare costs. Thirteen studies described multidisciplinary teamwork, education and capacity building that supported self-care. Four studies involved shared decision making between providers and patients, and two discussed outreach support where technology was an enabler. Fourteen studies reported improvements in health outcomes (e.g. glycaemic control), mostly for models that included multidisciplinary teams, education, and capacity building (11 studies), outreach support or shared care (3 studies). Four studies reported improvements in quality of life, three reported increased satisfaction for patients and carers and, and one reported improved communication. Four of five studies describing shared care and decision-making reported improvements in quality of life, support and motivation. Outreach models reported no negative outcomes, however, accessing some models was limited by technological and cost barriers. Eight studies reported on model sustainability, but only half reported implementation determinants; none reported applying a theoretical framework to guide their research. Conclusion Some health and psychosocial benefits were associated with newer models. To address knowledge gaps about implementation determinants and model sustainability, longitudinal studies are needed to inform future adoption of innovative models of care for children with Type 1 diabetes.

Abstract Background Today, person-centred care is seen as a cornerstone of health policy and practice, but accommodating individual patient preferences can be challenging, for example involving caesarean section on maternal request (CSMR). The aim of this study was to explore Swedish health professionals’ perspectives on CSMR and analyse them with regard to potential conflicts that may arise from person-centred care, specifically in relation to shared decision-making. Methods A qualitative study using both inductive and deductive content analysis was conducted based on semi-structured interviews. It was based on a purposeful sampling of 12 health professionals: seven obstetricians, three midwives and two neonatologists working at different hospitals in southern and central Sweden. The interviews were recorded either in a telephone call or in a video conference call, and audio files were deleted after transcription. Results In the interviews, twelve types of expressions (sub-categories) of five types of conflicts (categories) between shared decision-making and CSMR emerged. Most health professionals agreed in principle that women have the right to decide over their own body, but did not believe this included the right to choose surgery without medical indications (patient autonomy). The health professionals also expressed that they had to consider not only the woman’s current preferences and health but also her future health, which could be negatively impacted by a CSMR (treatment quality and patient safety). Furthermore, the health professionals did not consider costs in the individual decision, but thought CSMR might lead to crowding-out effects (avoiding treatments that harm others). Although the health professionals emphasised that every CSMR request was addressed individually, they referred to different strategies for avoiding arbitrariness (equality and non-discrimination). Lastly, they described that CSMR entailed a multifaceted decision being individual yet collective, and the use of birth contracts in order to increase a woman’s sense of security (an uncomplicated decision-making process). Conclusions The complex landscape for handling CSMR in Sweden, arising from a restrictive approach centred on collective and standardised solutions alongside a simultaneous shift towards person-centred care and individual decision-making, was evident in the health professionals’ reasoning. Although most health professionals emphasised that the mode of delivery is ultimately a professional decision, they still strived towards shared decision-making through information and support. Given the different views on CSMR, it is of utmost importance for healthcare professionals and women to reach a consensus on how to address this issue and to discuss what patient autonomy and shared decision-making mean in this specific context.

Abstract Background The countries of the world are becoming increasingly multicultural and diverse, both as a result of growing migration, of people fleeing countries at war but also due to increased mobility related to labour immigration. Culture is a broad concept where the definitions focus on learned and shared values, traditions, and beliefs of a group of individuals. People’s culture affects health and perceptions of illness as well as treatment, symptoms, and care. Moreover, people who are at the end of life, live and exist within all levels and contexts of care. Specialized palliative care requires that the nurse has sufficient knowledge and skills to be responsible for meeting the patient’s nursing needs also on a cultural level, regardless of cultural affiliation. The aim of the study was to highlight nurses’ experiences of the meaning of culture when caring for patients at the end of life in specialized palliative care. Methods The study was conducted with a qualitative design and inductive approach. Semi-structured interviews were conducted with twelve nurses in western Sweden. Data were analysed using qualitative content analysis. Results The nurses had an awareness of culture as a phenomenon and how it affected palliative care at the end of life. The results showed two categories, Awareness of the impact of culture on nursing and Culture’s impact and influence on the nurse’s mindset and approach, consisting of seven subcategories that highlight the nurse’s experience. It emerged that there are differences between cultures regarding notions of dying and death, who should be informed, and treatments. There were also challenges and emotions that arose when cultural preferences differed among everyone involved. A person-centred approach allowed for recognition of the dying person’s culture, to meet diverse cultural needs and wishes. Conclusion Providing culturally competent care is a major challenge. There are often no routines or methods prescribed for how nurses should relate to and handle the diversity of cultural notions that may differ from the values and cornerstones of palliative care. Having a person-centred approach as strategy can help to better manage the situation and provide equitable care on terms that respect cultural diversity.

Abstract Background Childhood, adolescent, and young adult (CAYA) cancer survivors, at risk for late effects, including cancer-related fatigue, cardiovascular issues, and psychosocial challenges, may benefit from interventions stimulating behaviour adjustments. Three nurse-led eHealth interventions (REVIVER) delivered via video calls and elaborating on person-centred care, cognitive behaviour therapy and/or motivational interviewing were developed. These interventions target: 1) fatigue management, 2) healthier lifestyle behaviours, and 3) self-efficacy and self-management. This study aimed to assess the feasibility and potential effectiveness of the REVIVER interventions for CAYA cancer survivors and healthcare professionals. Methods In a single-group mixed methods design, CAYA cancer survivors aged 16–54, more than five years post-treatment, were enrolled. Feasibility, assessed via Bowen's outcomes for feasibility studies, included acceptability, practicality, integration and implementation, demand and adherence. Qualitative data from semi-structured interviews and a focus group interview with survivors and healthcare professionals supplemented the evaluation. Paired sample t-tests assessed changes in self-reported quality of life, fatigue, lifestyle, self-management, and self-efficacy at baseline (T0), post-intervention (T1), and 6-month follow-up (T2). Results The interventions and video consults were generally acceptable, practical, and successfully integrated and implemented. Success factors included the nurse consultant (i.e., communication, approach, and attitude) and the personalised approach. Barriers included sustainability concerns, technical issues, and short intervention duration. Regarding demand, 71.4%, 65.4%, and 100% of eligible CAYA cancer survivors engaged in the fatigue (N = 15), lifestyle (N = 17) and empowerment (N = 3) intervention, respectively, with 5, 5 and 2 participants interviewed, correspondingly. Low interest (demand) in the empowerment intervention (N = 3) and dropout rates of one-third for both fatigue and empowerment interventions were noted (adherence). Improvements in quality of life, fatigue (fatigue intervention), lifestyle (lifestyle intervention), self-efficacy, and self-management were evident among survivors who completed the fatigue and lifestyle interventions, with medium and large effect sizes observed immediately after the intervention and six months post-intervention. Conclusions Our study demonstrates the feasibility of nurse-led video coaching (REVIVER interventions) despite lower demand for the empowerment intervention and lower adherence to the fatigue and empowerment interventions. The medium and high effect sizes found for those who completed the interventions hold potential clinical significance for future studies investigating the effectiveness of the REVIVER interventions.

AbstractPurposeMethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONIn the BigMove intervention, people with physical and mental health conditions assess their functioning, set goals, and define action plans to achieve their goals recorded in an e-health application using all categories of the International Classification of Functioning, Disability, and Health (ICF). This study investigates whether data from this application can provide insight into participants’ self-perceived functioning, goals and action plans and observe changes over time.Data from 446 participants were analysed with descriptive statistics to describe self-perceived functioning and the ICF categories related to the 15 most frequently chosen goals. Action plans were analysed using inductive analysis. Changes over time were investigated by comparing assessments before and after at least 4 months in the intervention.The data provided insight into the self-perceived functioning, goals and action plans. Also, changes over time were observed. Self-perceived functioning changed from being mainly negative before, to mainly positive after the intervention. While goals were mostly related to the same ICF categories, the action plans changed from more specific short-term to more general long-term plans.Our study demonstrates that all categories of the ICF can be used to record self-perceived functioning, goals and action plans and monitor changes over time.The complete International Classification of Functioning, Disability, and Health (ICF) can provide a useful tool to record self-perceived functioning, goals, and action plans.Setting goals by using all ICF categories shows what is relevant to people themselves and can stimulate activities that foster functioning according to what people value.Assessments of self-perceived functioning, related goals, and action plans offer a novel approach to assessing health and comparing healthcare outcomes.The complete International Classification of Functioning, Disability, and Health (ICF) can provide a useful tool to record self-perceived functioning, goals, and action plans.Setting goals by using all ICF categories shows what is relevant to people themselves and can stimulate activities that foster functioning according to what people value.Assessments of self-perceived functioning, related goals, and action plans offer a novel approach to assessing health and comparing healthcare outcomes. [ABSTRACT FROM AUTHOR]

Background: Task shifting is an approach where specific tasks are transferred, when convenient, from health workers with high qualifications to health workers with less training and lower qualifications. This approach is mainly used to utilize the available human resources for health. Tasks that are traditionally linked to the physician role have increasingly been transferred to registered nurses during the last decade. Knowledge regarding the experiences and reflections of physicians and their leaders related to giving up tasks or how such policies can best be implemented is limited. This study aimed to explore physicians' and their leaders' perspectives on task shifting, especially to registered nurses, in different Norwegian emergency departments. Methods: The study was carried out from June to October 2022. It had an explorative and descriptive qualitative design and an inductive approach, semi-structured interviews was used. The study involved ten physicians and leaders from three different regional hospitals in south-eastern Norway. Manifest and latent content analysis were used to analyse the data. The COREQ guidelines were applied in the study. Results: From the three categories 1) The rationale for task shifting, 2) Teambuilding and 3) Implementation of task shifting, with nine subcategories. One overall main theme emerged: It is not the task, it is the shifting – moving towards a person-centred culture. Conclusions: The study indicates that developing a person-centred culture and fostering a team approach in emergency departments is more important than simply shifting tasks, as task shifting may lead to fragmented care and resistance from physicians. Hospital leaders must invest time and effort into organising teams and providing clear leadership to support the redesign of professional roles, recognising the cultural and traditional challenges involved. Policymakers should promote guideline development, team training programs, and cooperation methods to support a person-centred culture and effective task shifting in emergency departments. [ABSTRACT FROM AUTHOR]

Chronic pain rehabilitation helps to reduce pain and restore valued life roles. Patients may have more positive outcomes when they perceive rehabilitation to be personally meaningful. This study examined associations between self-reported, personally meaningful rehabilitation and well-being. A pilot study was conducted using an online survey of people with chronic pain and experiences of rehabilitation. The PROMIS Pain Interference Short Form 8a and The Flourishing Scale were used to explore well-being. A modified self-report measure, the Meaningfulness in Rehabilitation Scale, was pilot-tested for construct validity and used in the survey. Of the 48 participants (81% female; 19% male), most attended a generalist therapy practice (62%) once per week (33%) or once per fortnight (29%). No statistically significant relationship was found between self-reported meaningfulness in rehabilitation and pain interference or other patient and therapy characteristics (duration of chronic pain category, type of therapy practice, resolution of rehabilitation category, and frequency of appointments). The nonparametric analysis identified a statistically significant moderate positive correlation between self-reported meaningfulness in rehabilitation and the flourishing aspect of well-being. This raises important questions and suggests that patients' perception of rehabilitation as meaningful warrants further research. This pilot study provides valuable guidance to inform a larger investigation. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To increase your understanding of ‘elderspeak’ and the use of terms of endearment with older adults • To recognise that acceptance or rejection of the use of terms of endearment may be a matter of opinion • To enhance your practice by considering and acknowledging each individual’s communication preferences. Background: ‘Elderspeak’ has been defined as a form of communication overaccommodation used with older adults that typically involves inappropriate simplified speech. One aspect of elderspeak is the use of terms of endearment such as ‘honey’, sweetie’ and ‘dear’. There is disagreement regarding the use of terms of endearment with older adults, with differing views on whether it is beneficial or harmful. Aim: To explore the perceptions of older adults residing in an assisted living facility on the use of terms of endearment by healthcare staff. Method: This qualitative study used a descriptive phenomenological design. Semi-structured interviews were undertaken with 15 older adults regarding their perceptions of the use of terms of endearment. The data were analysed to identify themes. Findings: Two themes emerged from the interview data: ‘it’s a matter of opinion’ and ‘context matters’. Not all older adults viewed terms of endearment negatively; some liked them, others were neutral and some viewed them as childish or disrespectful. Conclusion: Perceptions regarding the use of terms of endearment appear to differ among older adults. Therefore, the use of such terms should be individualised based on the preferences of the older adult. [ABSTRACT FROM AUTHOR]

Person-centred care (PCC) is an essential component of high-quality healthcare across professions and care settings. While research is emerging in subacute nutrition services more broadly, there is limited literature exploring the person-centredness of nutrition care in rehabilitation. This study aimed to explore person-centred nutrition care (PCNC) in rehabilitation units, as described and actioned by patients, support persons and staff. Key factors influencing PCNC were also explored. An ethnographic study was undertaken across three rehabilitation units. Fifty-eight hours of field work were completed with 165 unique participants to explore PCNC. Field work consisted of observations and interviews with patients, support persons and staff. Data were analysed through the approach of reflexive thematic analysis, informed by PCC theory. Themes generated were: (1) tensions between patient and staff goals; (2) disconnected moments of PCNC; (3) the necessity of interprofessional communication for PCNC; and (4) the opportunity for PCNC to enable the achievement of rehabilitation goals. PCNC was deemed important to different stakeholders but was at times hindered by a focus on profession-specific objectives. Opportunities exist to enhance interprofessional practice to support PCNC in rehabilitation. Future research should consider the system-level factors influencing PCNC in rehabilitation settings. Understanding what matters to patients in rehabilitation was reported as essential in person-centred nutrition care (PCNC), however varying degrees of this were observed in practice, with tensions exposed between the priorities of patients and staff. Collaborative goal setting is needed to enact PCNC, placing the patient at the centre of the process, rather than focusing on pre-determined, profession-specific agendas. However, reorientating this process must coincide with consideration of influencing systems, service priorities and cultures. Nutrition and mealtime-related goals of patients should be communicated not only within clinical teams, but also with dietetic support staff to better inform interprofessional practice and PCNC. Opportunities exist to better connect nutrition and dietetic services with the broader goals and objectives of rehabilitation. [ABSTRACT FROM AUTHOR]

Dementia is a progressive neurodegenerative condition and poses significant challenges to an individual's quality of life (QoL). As the global prevalence of dementia continues to rise, understanding and enhancing QoL for people living with dementia becomes even more important. This article explores the concept of QoL in the context of dementia, its application in community nursing practice, and the pivotal role nurses can play in improving QoL. An overview of the challenges, considerations, and evidence-based strategies to improve QoL are explored. Through person-centred care, education and advocacy, community nurses can make a significant difference in supporting the wellbeing and dignity of people living with dementia. [ABSTRACT FROM AUTHOR]

Background and aim: The evidence about the acceptability and effectiveness of innovative paediatric models of care for Type 1 diabetes is limited. To address this gap, we synthesised literature on implemented models of care, model components, outcomes, and determinants of implementation and sustainability. Methods: A systematic review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Database searches of Medline, CINAHL, EMBASE and Scopus were conducted. Empirical studies focused on Type 1 diabetes paediatric models of care, published from 2010 to 2022 in English were included. Results: Nineteen extant studies reported on models and their associations with health and psychosocial outcomes, patient engagement with healthcare, and healthcare costs. Thirteen studies described multidisciplinary teamwork, education and capacity building that supported self-care. Four studies involved shared decision making between providers and patients, and two discussed outreach support where technology was an enabler. Fourteen studies reported improvements in health outcomes (e.g. glycaemic control), mostly for models that included multidisciplinary teams, education, and capacity building (11 studies), outreach support or shared care (3 studies). Four studies reported improvements in quality of life, three reported increased satisfaction for patients and carers and, and one reported improved communication. Four of five studies describing shared care and decision-making reported improvements in quality of life, support and motivation. Outreach models reported no negative outcomes, however, accessing some models was limited by technological and cost barriers. Eight studies reported on model sustainability, but only half reported implementation determinants; none reported applying a theoretical framework to guide their research. Conclusion: Some health and psychosocial benefits were associated with newer models. To address knowledge gaps about implementation determinants and model sustainability, longitudinal studies are needed to inform future adoption of innovative models of care for children with Type 1 diabetes. [ABSTRACT FROM AUTHOR]

Aim Design Data Sources Review Methods Results Conclusion Implications for the Profession and/or Patient Care Impact Reporting Method Patient or Public Contribution To explore patients' and community nurses' perceptions and experiences of shared decision‐making in the home.Integrative review.CINAHL, British Nursing Index, Psycinfo, Medline and Social Services Abstracts were searched for qualitative, quantitative and mixed methods papers published between 1 December 2001 and 31 October 2023.A systematic search of electronic databases was undertaken using defined inclusion criteria. The included papers were appraised for quality using the Joanna Briggs Institute critical appraisal checklist for qualitative research. Relevant data were extracted and thematically analysed.Fourteen papers comprising 13 research studies were included. Patients attached great importance to their right to be involved in decision‐making and noted feeling valued as a unique individual. Communication and trust between the patient and nurse were perceived as fundamental. However, shared decision‐making does not always occur in practice. Nurses described tension in managing patients' involvement in decision‐making.The findings demonstrate that although patients and community nurses appreciate participating in shared decision‐making within the home, there are obstacles to achieving a collaborative process. This is especially relevant when there are fundamentally different perspectives on the decision being made. More research is needed to gain further understanding of how shared decision‐making plays out in practice and to understand the tensions that patients and nurses may experience.This paper argues that shared decision‐making is more than the development of a relationship where the patient can express their views (though of course, this is important). Shared decision‐making requires acknowledgement that the patient has the right to full information and should be empowered to choose between options. Nurses should not assume that shared decision‐making in community nursing is easy to facilitate and should recognize the tensions that might exist when true patient choice is enabled.This paper demonstrates how the idea of shared decision‐making needs to be explored in the light of everyday practice so that challenges and barriers can be overcome. In particular, the tensions that arise when patients and nurses do not share the same perspective. This paper speaks to the potential of a gap surrounding shared decision‐making in theory and how it plays out in practice.The reporting of this review was guided by the 2020 guidelines for the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (Page et al., 2021).This review was carried out as part of a wider study for which service users have been consulted. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONThis study aims to explore the meaningful contributions of rehabilitation for participants living with persistent pain.A phenomenological methodology was used. Thirteen purposefully selected participants, who self-identified as substantially improved from persistent pain due to rehabilitation, were interviewed in-depth. Data were analyzed using reflexive thematic analyses.Participants included three men and ten women, age ranging from 22–69 years, pain duration was 2–30 years. Seven interconnected themes were developed: 1) indication of negative pain and health care experiences, 2) supporting working alliance with healthcare professionals, 3) Pain Dialogue, 4) improved self-awareness and self-regulation, 5) different view on pain, 6) autonomy and personal growth and 7) hope and new perspective. Integration of these themes provided a framework for understanding meaningful contributions of rehabilitation from the participants’ perspective.The study identified seven interconnected themes enhancing meaningful contributions of rehabilitation for participants who have substantially improved from persistent pain. These findings provide a novel conceptual understanding of how rehabilitation can foster recovery. The themes strongly support person-centred care, an understanding of Pain Dialogue and personal growth through the lens of the lived experience. The quality of the therapeutic relationship is considered a central vehicle for improved health outcomes.A rehabilitation participant perspective can contribute to better outcomes in pain rehabilitation.A shift from a pain-centred to a person-centred approach should be considered to enhance meaningful contributions of rehabilitation.Pain Education should be reconceptualized into Pain Dialogue.The quality of the therapeutic relationship can be regarded as a key driver for the effectiveness of person-centred care and Pain Dialogue.A rehabilitation participant perspective can contribute to better outcomes in pain rehabilitation.A shift from a pain-centred to a person-centred approach should be considered to enhance meaningful contributions of rehabilitation.Pain Education should be reconceptualized into Pain Dialogue.The quality of the therapeutic relationship can be regarded as a key driver for the effectiveness of person-centred care and Pain Dialogue. [ABSTRACT FROM AUTHOR]

AbstractObjectiveDesignStudy sampleResultsConclusionsTo explore the clinical use of ‘My Hearing Explained for Children’ (MHEfC) with children aged 8-11 years, from the perspectives of the child, parents and audiologist.A mixed methods randomised control trial. Participants completed evaluation questionnaires after their appointment. Statistical and thematic analyses were used to examine the rating scale and open response elements of the questionnaires respectively.45 families participated, 24 randomised to MHEfC and 21 to standard care.Use of MHEfC increased the appointment duration by 8.2 minutes (95% CI 4.1 to 14.2 minutes), which was acceptable to parents (96%) and audiologists (67%). It promoted conversation around ‘behavioural and communication tactics’, ‘specific listening situations’ and ‘listening effort’ at the expense of ‘anatomy/physiology/aetiology’. MHEfC positively impacted the discussion of test results (54%); ease of finding joint solutions to problems (71%); and the nature of issues and management options discussed (54%). Parental satisfaction with discussion was high on both pathways, so some parents and audiologists questioned MHEfC necessity and recommended targeted use in future.MHEfC was acceptable to children (70%) and parents (86%). It successfully promoted child-centred topics of discussion and can positively impact discussion outcomes. [ABSTRACT FROM AUTHOR]

Background: The countries of the world are becoming increasingly multicultural and diverse, both as a result of growing migration, of people fleeing countries at war but also due to increased mobility related to labour immigration. Culture is a broad concept where the definitions focus on learned and shared values, traditions, and beliefs of a group of individuals. People's culture affects health and perceptions of illness as well as treatment, symptoms, and care. Moreover, people who are at the end of life, live and exist within all levels and contexts of care. Specialized palliative care requires that the nurse has sufficient knowledge and skills to be responsible for meeting the patient's nursing needs also on a cultural level, regardless of cultural affiliation. The aim of the study was to highlight nurses' experiences of the meaning of culture when caring for patients at the end of life in specialized palliative care. Methods: The study was conducted with a qualitative design and inductive approach. Semi-structured interviews were conducted with twelve nurses in western Sweden. Data were analysed using qualitative content analysis. Results: The nurses had an awareness of culture as a phenomenon and how it affected palliative care at the end of life. The results showed two categories, Awareness of the impact of culture on nursing and Culture's impact and influence on the nurse's mindset and approach, consisting of seven subcategories that highlight the nurse's experience. It emerged that there are differences between cultures regarding notions of dying and death, who should be informed, and treatments. There were also challenges and emotions that arose when cultural preferences differed among everyone involved. A person-centred approach allowed for recognition of the dying person's culture, to meet diverse cultural needs and wishes. Conclusion: Providing culturally competent care is a major challenge. There are often no routines or methods prescribed for how nurses should relate to and handle the diversity of cultural notions that may differ from the values and cornerstones of palliative care. Having a person-centred approach as strategy can help to better manage the situation and provide equitable care on terms that respect cultural diversity. [ABSTRACT FROM AUTHOR]

Background: Today, person-centred care is seen as a cornerstone of health policy and practice, but accommodating individual patient preferences can be challenging, for example involving caesarean section on maternal request (CSMR). The aim of this study was to explore Swedish health professionals' perspectives on CSMR and analyse them with regard to potential conflicts that may arise from person-centred care, specifically in relation to shared decision-making. Methods: A qualitative study using both inductive and deductive content analysis was conducted based on semi-structured interviews. It was based on a purposeful sampling of 12 health professionals: seven obstetricians, three midwives and two neonatologists working at different hospitals in southern and central Sweden. The interviews were recorded either in a telephone call or in a video conference call, and audio files were deleted after transcription. Results: In the interviews, twelve types of expressions (sub-categories) of five types of conflicts (categories) between shared decision-making and CSMR emerged. Most health professionals agreed in principle that women have the right to decide over their own body, but did not believe this included the right to choose surgery without medical indications (patient autonomy). The health professionals also expressed that they had to consider not only the woman's current preferences and health but also her future health, which could be negatively impacted by a CSMR (treatment quality and patient safety). Furthermore, the health professionals did not consider costs in the individual decision, but thought CSMR might lead to crowding-out effects (avoiding treatments that harm others). Although the health professionals emphasised that every CSMR request was addressed individually, they referred to different strategies for avoiding arbitrariness (equality and non-discrimination). Lastly, they described that CSMR entailed a multifaceted decision being individual yet collective, and the use of birth contracts in order to increase a woman's sense of security (an uncomplicated decision-making process). Conclusions: The complex landscape for handling CSMR in Sweden, arising from a restrictive approach centred on collective and standardised solutions alongside a simultaneous shift towards person-centred care and individual decision-making, was evident in the health professionals' reasoning. Although most health professionals emphasised that the mode of delivery is ultimately a professional decision, they still strived towards shared decision-making through information and support. Given the different views on CSMR, it is of utmost importance for healthcare professionals and women to reach a consensus on how to address this issue and to discuss what patient autonomy and shared decision-making mean in this specific context. Plain English summary: Person-centered care is today a widespread approach, but accommodating individual patient preferences can be challenging, for example involving caesarean section on maternal request (CSMR). This study examines Swedish health professionals' views on CSMR. Interviews with 12 health professionals reveal conflicts between CSMR and key aspects of person-centered care, in particular shared decision-making. While professionals acknowledge women's autonomy, they question CSMR without medical need. Concerns include for example treatment quality and patient safety, and avoiding treatments that harm others. The Swedish context, balancing collective solutions with individualized care, complicates decision-making. Unlike countries with more private healthcare, where CSMR support might be higher, Swedish health professionals emphasize shared decision-making despite viewing the mode of delivery as primarily a professional decision. This study sheds light on the challenges in integrating CSMR into person-centered care frameworks. [ABSTRACT FROM AUTHOR]

Integrated person-centred care (IPCC) for vulnerable groups is complex and multifaceted and cannot be reduced to simple cause-and-effect relationships. The effectiveness varies across settings due to differing contexts and mechanisms. By applying realist research, this dissertation examines the relationships between the context in which IPCC for vulnerable groups in the Netherlands is applied, the mechanisms by which IPCC (does not) work(s), and the outcomes resulting from this interaction. The findings provide deeper insights into interrelatedness of items that influence effectiveness of IPCC, emphasizing the significance of understanding their interplay and recognizing that they form a larger interconnected system rather than acting independently. [ABSTRACT FROM AUTHOR]

In this article, we investigate how the concept of Care Biography and related concepts are understood and operationalised and describe how it can be applied to advancing our understanding and practice of holistic and person‐centred care. Walker and Avant's eight‐step concept analysis method was conducted involving multiple database searches, with potential or actual applications of Care Biography identified based on multiple discussions among all authors. Our findings demonstrate Care Biography to be a novel overarching concept derived from the conjunction of multiple other concepts and applicable across multiple care settings. Concepts related to Care Biography exist but were more narrowly defined and mainly applied in intensive care, aged care, and palliative care settings. They are associated with the themes of Meaningfulness and Existential Coping, Empathy and Understanding, Promoting Positive Relationships, Social and Cultural Contexts, and Self‐Care, which we used to inform and refine our concept analysis of Care Biography. In Conclusion, the concept of Care Biography, can provide a deeper understanding of a person and their care needs, facilitate integrated and personalised care, empower people to be in control of their care throughout their life, and help promote ethical standards of care. [ABSTRACT FROM AUTHOR]

Background: Deaths due to drug overdose are an international issue, causing an estimated 128,000 global deaths in 2019. Scotland has the highest rate of drug-related deaths in Europe, with those in the most deprived areas at greater risk than those in affluent areas. There is a paucity of research on digital solutions, particularly from the perspective of those who use drugs who additionally access harm reduction and homelessness support services. The Digital Lifelines Scotland programme (DLS) provides vulnerable people who use/d drugs with digital devices to connect with services. Methods: This paper reports on the evaluation of the DLS from the perspective of service users who accessed services for those at risk of drug-related harms. A mixed methods approach was used including an online-survey (n = 19) and semi-structured interviews (n = 21). Survey data were analysed descriptively and interview data through inductive coding, informed by the Technology, People, Organisations and Macroenvironmental factors (TPOM) framework, to investigate the use, access, and availability of devices, and people's experiences and perceptions of them. Results: Most participants lived in social/council housing (63.2%, n = 12), many lived alone (68.4%, n = 13). They were mainly over 40 years old and lived in a city. Participants described a desire for data privacy, knowledge, and education, and placed a nascent social and personal value on digital devices. Participants pointed to the person-centred individuality of the service provision as one of the reasons to routinely engage with services. Service users experienced an increased sense of value and there was a palpable sense of community, connection and belonging developed through the programme, including interaction with services and devices. Conclusions: This paper presents a unique perspective which documents the experiences of service users on the DLS. Participants illustrated a desire for life improvement and a collective and individual feeling of responsibility towards themselves and digital devices. Digital inclusion has the potential to provide avenues by which service users can safely and constructively access services and society to improve outcomes. This paper provides a foundation to further cultivate the insight of service users on digital solutions in this emerging area. [ABSTRACT FROM AUTHOR]

Background: Patients with a life‐limiting illness (LLI) requiring hospitalisation have a high likelihood of deterioration and 12‐month mortality. To avoid non‐aligned care, we need to understand our patients' goals and values. Aim: To describe the association between the implementation of a shared decision‐making (SDM) programme and documentation of goals of care (GoC) for hospitalised patients with LLI. Methods: A prospective longitudinal interventional study of patients admitted to acute general medicine wards in an Australian tertiary hospital over 5 years was conducted. A SDM programme with a new GoC form, communication training and clinical support was implemented. The primary outcome was the proportion of patients with a documented person‐centred GoC discussion (PCD). Clinical outcomes included hospital utilisation and 90‐day mortality. Results: 1343 patients were included. The proportion of patients with PCDs increased from 0% to 35.4% (adjusted odds ratio (aOR), 2.38; 95% confidence interval (CI), 2.01–2.82; P < 0.001). During this time, median hospital length of stay decreased from 8 days (interquartile range (IQR), 4–14) to 6 days (IQR, 3–11) (adjusted estimate effect, −0.38; 95% CI, −0.64 to −0.11; P = 0.005) and rapid response team activation from 28% to 13% (aOR, 0.87; 95% CI, 0.78–0.97; P value = 0.01). Documented treatment preference of high‐dependency unit care decreased from 39.7% to 24.4% (aOR, 0.81; 95% CI, 0.73–0.89; P value < 0.001), and ward‐based care increased from 31.9% to 55.1% (aOR, 1.24; 95% CI, 1.14–1.36; P value < 0.001). Conclusion: The implementation of a SDM programme was associated with increased documentation of person‐centred GoC, changed patient treatment preference to lower intensity care and reduced hospital utilisation. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand the complexity of the needs of people with delirium superimposed on dementia • To enhance your knowledge of second-generation activity theory • To recognise the consequences of the separation of physical health and mental healthcare. Background: Delirium superimposed on dementia (DSD) affects the physical, mental and cognitive well-being of the person. The separation of physical health and mental health means that the care of people with DSD is at odds with the multifaceted aetiology and presentation of the condition. There is a lack of research on DSD from a mental health perspective. Aim: To explore UK mental health nurses’ experiences of providing care for people with DSD. Method: Individual semi-structured interviews were conducted with seven mental health nurses from one NHS trust in England. Participants’ experiences were considered through the lens of second-generation activity theory. Data were analysed using framework analysis. Findings: Six themes were identified: awareness of guidance and tools; guidance or tools as ‘paper exercises’; knowing the patient; the multidisciplinary team; care burden; and mental health versus physical health. Conclusion: When providing care for people with DSD, mental health nurses use their skills in knowing patients as individuals. However, this aspect of ‘knowing’ cannot be readily translated into the use of a numerical scoring tool. An integrated approach is required to support the care of people with DSD. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To increase your awareness of the growing importance of personalised medicine in cancer services • To enhance your understanding of the support needs of patients who undergo genomic testing • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers). Knowledge of genomics and genetic testing is increasingly being used to inform cancer diagnosis, prognosis and effective treatment, known as personalised or precision medicine. The NHS aims to embed genomics into diagnostic pathways, meaning that it is becoming a routine aspect of cancer care. Therefore, it is important that cancer nurses have an understanding of genomics and personalised medicine so that they can provide appropriate information and support to patients and families. This article is designed to equip nurses with the skills to start essential genomic conversations with patients to support them through their cancer pathways. It focuses on Lynch syndrome, an inherited condition that increases the risk of developing certain cancers, and explains the genetics, testing, surveillance and psychological aspects of care for patients and families affected by this syndrome. [ABSTRACT FROM AUTHOR]

There is an outstanding task for all international healthcare organisations to understand how healthcare services learn from the COVID-19 pandemic. We sought to understand whether the treatment and holistic care received by each person who died with presumed nosocomial COVID-19 in our United Kingdom hospital was provided with kindness and compassion. A multi-professional team carried out a service evaluation underpinned by Appreciative Inquiry (AI) methodology. Our current Learning from Death data collection tool was supplemented by the addition of narrative analysis to augment our qualitative findings. We identified a total of 63/143 patients as dying from presumed nosocomial COVID-19 in our hospital. The deaths occurred in hospital between 15 April 2020 and 29 January 2021. We found evidence of individualised decision-making in complex medical situations, alongside the challenge of managing COVID-19, with appropriate management of deterioration and appropriate symptom control. A Learning from Death programme benefits from a multi-professional approach that utilises the skilled workforce mix that exists in our hospitals. The use of AI methodology and addition of narrative analysis is practical and adds valuable qualitative data to the scrutiny of deaths. Sharing the narrative of those who died during the COVID-19 pandemic has reinforced the evidence that healthcare professionals strive to do their best even in the most challenging circumstances and do so with compassion. [ABSTRACT FROM AUTHOR]

Aim: To explore patients' experiences of shared decision‐making, in nursing care during their stay in a healthcare institution. Design: This study employed a qualitative descriptive design. Methods: Twenty participants were interviewed from two rehabilitation centres, a nephrology ward of a hospital, and a rehabilitation ward of a long‐term care facility. A constant comparative method was used for the inductive analysis. Results: The main theme was 'feeling seen and understood', in the context of person‐centred care, which served as the unifying thread across five themes. The five themes included the importance of a positive nurse–patient relationship as a foundation for shared decision‐making. Next, patients experienced collaboration, and this was influenced by verbal and non‐verbal communication. Another theme was that patients often felt overwhelmed during their stay, affecting shared decision‐making. The fourth theme was that many decisions were not made through the shared decision‐making process but were still perceived as satisfactory. The final theme highlighted patients' perspectives on their role in decision‐making and influencing factors. Conclusion: Patients describe how feeling seen and understood is a prerequisite for shared decision‐making as a part of person‐centred care. For nurses, this implies that they should focus on aspects such as building a good relationship and acknowledgement of patients' feelings and circumstances, next to empowering patients to feel knowledgeable and valued. This way patient's motivation to participate in shared decision‐making will be enhanced. Reporting Method: Following the EQUATOR guidelines, reporting was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ). Patient or Public Contribution: Patients were involved in the study through interviews during the research process and member checks during analysis. Implications for the profession and/or patient care: Before initiating shared decision‐making processes, prioritise making the patient feel seen and understood. Be mindful that patients often feel overwhelmed during their stay. Use a person‐centred approach to make patients feel knowledgeable—this empowers them for shared decision‐making. Impact: Research on patients' experiences of shared decision‐making in nursing care is limited, yet crucial for understanding patients' needs in shared decision‐making. This study highlights patients' perceptions that shared decision‐making is best facilitated within the nurse–patient relationship by nurses who primarily focus on ensuring that patients feel acknowledged and understood. [ABSTRACT FROM AUTHOR]

Introduction: Nurse Navigators were introduced in Queensland, Australia, in 2016. Nurse Navigators coordinate person‐centred care, create partnerships, improve care coordination and outcomes and facilitate system improvement, independently of hospital or community models. They navigate across all aspects of hospital and social services, liaising, negotiating and connecting care as needed. People stay with Nurse Navigators for as long as required, though the intent is to transition them from high‐care needs to self‐management. Nurse Navigators are a working model in rural and remote areas of Queensland. Objective: To describe where the rural and remote Nurse Navigator position fits within the Rural Remote Nursing Generalist Framework and to define the depth and breadth of the rural and remote Nurse Navigator's scope of practice. Design: Using template analysis, data from focus groups and interviews were analysed against the domains of the recently released National Rural and Remote Nursing Generalist Framework. Navigators working in rural and remote areas across Queensland Health were invited to an interview (n = 4) or focus group (n = 9), conducted between October 2019 and August 2020. Findings: Rural and remote Nurse Navigators are proficient in all domains of the framework and actively champion for their patients, carers and the communities where they live and work. Discussion: This research demonstrates that rural and remote Nurse Navigators are a working model of advanced nursing practice, acting as 'champions' of The Framework. Conclusion: The Nurse Navigator model of care introduced to Queensland exemplifies proficient registered nurse practice to the full extent of their knowledge and skill. [ABSTRACT FROM AUTHOR]

Introduction: Women and those with younger onset Parkinson's Disease (YOPD) are typically diagnosed later and face unique situations and challenges. This essay aims to raise awareness of the difficulties in diagnosing YOPD and the need for a personalised approach to care for women with YOPD. Methods: Two professional women with YOPD (academic physiotherapist and practicing dentist) and a female neurologist (clinician academic) came together to write a narrative essay on their personal experience and perspectives in relation to women and YOPD. Results: The essay outlines how the experience of diagnosis is likened to a complex puzzle box with many interlocking components that are hidden and difficult to solve. The concerns of the women about their identity, work, family and the future, with most supports targeting those that are older and retired are outlined. Conclusion: It is concluded that YOPD is a complex puzzle to solve, but can be done by understanding all the intricate interlocking components of the puzzle and combined with greater awareness could lead to earlier diagnosis and the delivery of successful person‐centred care. Patient or Public Contribution: People with lived experience were involved in the essay conception and writing. [ABSTRACT FROM AUTHOR]