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  • 101.
    Rasmussen, Birgit H
    et al.
    Umeå University, Faculty of Medicine, Omvårdnad.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Omvårdnad.
    The influence of environment in palliative care: supporting or hindering experiences of 'at-homeness'.2007In: Contemporary Nurse, ISSN 1037-6178, Vol. 27, no 1, p. 119-31Article in journal (Refereed)
  • 102. Rokstad, Anne Marie Mork
    et al.
    Engedal, Knut
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    Selbaek, Geir
    Psychometric evaluation of the Norwegian version of the Person-centred Care Assessment Tool2012In: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 18, no 1, p. 99-105Article in journal (Refereed)
    Abstract [en]

    The Person-centred Care Assessment Tool (P-CAT) was developed as a self-reporting assessment scale for staff ratings of the person-centredness of their nursing practice.

    This study investigates the psychometric properties of P-CAT in a sample of staff working in residential units for older people.

    Descriptive characteristics were calculated for each item and an independent-sample t-test was used to compare ratings from different groups. Internal consistency and reliability were examined using the Cronbach's alpha coefficient. Exploratory factor analysis was used to evaluate construct validity. Test-retest reliability was examined by means of intra-class correlation and the Pearson correlation coefficient.

    The mean score of P-CAT was 45.3 (standard deviation 7.8). Cronbach's alpha was 0.83. The factor analysis resulted in a two-component solution organizing the items into two subscales. There were significant differences between ordinary care units and special-care units and between various occupational groups, indicating a discriminating ability of the tool.

  • 103. Ruggiano, Nicole
    et al.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    Person-Centeredness in Home-and Community-Based Long-Term Care: Current Challenges and New Directions2013In: Social work in health care, ISSN 0098-1389, E-ISSN 1541-034X, Vol. 52, no 9, p. 846-861Article in journal (Refereed)
    Abstract [en]

    Person-centered care (PCC) has demonstrated to be a viable and preferred model of providing health and institutionalized long-term care services. However, the concept of PCC has not been fully extended to home- and community-based long-term care services (HCBS) for older adults with chronic conditions. This review highlights the need for PCC in HCBS and suggests that social workers may play a role in overcoming cultural and structural barriers to extending PCC to HCBS that include: the fragmentation of the industry, financial structures, regulation of services, and paternalism in policy and practice. Recommendations for practice, policy, and research are provided.

  • 104. Ruggiano, Nicole
    et al.
    Shtompel, Natalia
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. Austin Health Clinical School of Nursing, La Trobe University, Melbourne, Australia.
    Engaging in Coordination of Health and Disability Services as Described by Older Adults: Processes and Influential Factors2015In: The Gerontologist, ISSN 0016-9013, E-ISSN 1758-5341, Vol. 55, no 6, p. 1015-1025Article in journal (Refereed)
    Abstract [en]

    Purpose of the Study: There is little consensus on the definition and design of effective care coordination for older adults with chronic conditions, and the majority of care coordination models minimize the role and voice of older patients. Our objectives are to examine how older adults perceive and engage in the process of care coordination of health and disability support services and the factors that influence their engagement.

    Design and Methods: Thirty- seven older adults with chronic conditions and 9 geriatric case managers participated in semistructured interviews that focused on older adults' experiences with self-managing and coordinating their health and support services. Interview data were systematically analyzed for themes.

    Results: The interview data revealed that involving older adults in care coordination is a complex, multistage process, conceptualized as making self-health assessments, making informed decisions about care, and executing and coordinating care. The findings indicate that a number of factors facilitate older adults' decision and capacity to become involved in the coordination of their care, including their perceptions about how their condition impacted their everyday lives, and availability of intrinsic resources, tangible resources, and social network. Low perceptions of control over health and lack of such resources constrain their involvement.

    Implications: Practitioners may facilitate older adults' involvement in care coordination by using language with older patients that emphasizes psychosocial experiences in addition to medical symptomatology. They may also provide targeted support for patients with limited facilitating factors to promote involvement at multiple stages of the care coordination process.

  • 105. Rushton, Carole
    et al.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    Reconciling concepts of space and person-centred care of the older person with cognitive impairment in the acute care setting2017In: Nursing Philosophy, ISSN 1466-7681, E-ISSN 1466-769X, Vol. 18, no 3, article id e12142Article in journal (Refereed)
    Abstract [en]

    Although a large body of literature exists propounding the importance of space in aged care and care of the older person with dementia, there is, however, only limited exploration of the acute care space' as a particular type of space with archetypal constraints that maybe unfavourable to older people with cognitive impairment and nurses wanting to provide care that is person-centred. In this article, we explore concepts of space and examine the implications of these for the delivery of care to older people who are cognitively impaired. Our exploration is grounded in theorisations of space offered by key geographers and phenomenologists, but also draws on how space has been constructed within the nursing literature that refers specifically to acute care. We argue that space, once created, can be created and that nursing has a significant role to play in the process of its recreation in the pursuit of care that is person-centred. We conclude by introducing an alternative logic of space aimed at promoting the creation of more salutogenic spaces that invokes a sense of sanctuary, safeness, and inclusion, all of which are essential if the care provided to the older person with cognitive impairment is apposite to their needs. The concept of person-centred space' helps to crystallize the relationship between space and person-centred care and implies more intentional manipulation of space that is more conducive to caring and healing. Significantly, it marks a return to Nightingale's wisdom, that is, to put the person in the best possible conditions for nature to act upon them.

  • 106. Rushton, Carole
    et al.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. Austin Health, Northern Health Clinical Schools of Nursing, La Trobe University, Heidelberg, VIC, Australia ; College of Science, Health and Engineering, La Trobe University, Heidelberg, VIC, Australia.
    Reconciling conceptualisations of the body and person-centred care of the older person with cognitive impairment in the acute care setting2017In: Nursing Philosophy, ISSN 1466-7681, E-ISSN 1466-769X, Vol. 18, no 4, article id e12160Article in journal (Refereed)
    Abstract [en]

    In this article, we sought reconciliation between the "body-as-representation" and the "body-as-experience," that is, how the body is represented in discourse and how the body of older people with cognitive impairment is experienced. We identified four contemporary "technologies" and gave examples of these to show how they influence how older people with cognitive impairment are often represented in acute care settings. We argued that these technologies may be mediated further by discourses of ageism and ableism which can potentiate either the repressive or productive tendencies of these technologies resulting in either positive or negative care experiences for the older person and/or their carer, including nurses. We then provided examples from research of embodied experiences of older people with dementia and of how nurses and other professionals utilized their inter-bodily experiences to inform acts of caring. The specificity and individuality of these experiences were more conducive to positive care experiences. We conclude the article by proposing that the act of caring is one way nurses seek to reconcile the "body-as-representation" with the "body-as-experience" to mitigate the repressive effects of negative ageism and ableism. The act of caring, we argue, is the essence of caring enacted through the provision of person-centred care which evokes nurses to respond appropriately to the older person's "otherness," their "variation of being" while enabling them to enact a continuation of themselves and their own version of normality.

  • 107. Rushton, Carole
    et al.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. College of Science, Health and Engineering, Austin Clinical School of Nursing, La Trobe University, Heidelberg, Vic., Australia.
    Reconciling conceptualizations of ethical conduct and person-centred care of older people with cognitive impairment in acute care settings2018In: Nursing Philosophy, ISSN 1466-7681, E-ISSN 1466-769X, Vol. 19, no 2, article id e12190Article in journal (Refereed)
    Abstract [en]

    Key commentators on person-centred care have described it as a new ethic of care which they link inextricably to notions of individual autonomy, action, change and improvement. Two key points are addressed in this article. The first is that few discussions about ethics and person-centred are underscored by any particular ethical theory. The second point is that despite the espoused benefits of person-centred care, delivery within the acute care setting remains largely aspirational. Choices nurses make about their practice tend to comply more often with prevailing norms than those championed by person-centred care. We draw on elements of work by moral philosopher LOgstrup and Foucault to provide insight into nurses' ethical conduct and ask why nurses would want to act otherwise, when what they think and do is viewed as normal, or think and act otherwise if doing so is seen within the organization as transgressive? To address these more specific questions, we discuss them in relation to the following constructs: the ethical demand, sovereign expressions of life and parrhesia. We conclude by arguing that a ethical theoretical framework enables nurses to increase their perceptibility and appreciation of the ethical demand particularly those emanating from incommensurability between organizational norms and the norms invoked by person-centred care. We argue that nurses' responses to the ethical demand by way of parrhesia can be an important feature of intra-organizational reflexivity and its transformation towards the delivery care that is more person-centred, particularly for older people with cognitive impairment. We conclude the article by highlighting the implications of this for nursing education and research.

  • 108. Rushton, Carole
    et al.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. Austin Health, Northern Health Clinical Schools of Nursing, College of Science, Health and Engineering, La Trobe University, Heidelberg, Victoria, Australia.
    Reconciling conceptualizations of relationships and person-centred care for older people with cognitive impairment in acute care settings2018In: Nursing Philosophy, ISSN 1466-7681, E-ISSN 1466-769X, Vol. 19, no 2, article id e12169Article in journal (Refereed)
    Abstract [en]

    Relationships are central to enacting person-centred care of the older person with cognitive impairment. A fuller understanding of relationships and the role they play facilitating wellness and preserving personhood is critical if we are to unleash the productive potential of nursing research and person-centred care. In this article, we target the acute care setting because much of the work about relationships and older people with cognitive impairment has tended to focus on relationships in long-term care. The acute care setting is characterized by archetypal constraints which differentiate it from long-term care, in terms of acuity and haste, task-orientated work patterns and influence from “the rule of medicine,” all of which can privilege particular types of relating. In this article, we drew on existing conceptualizations of relationships from theory and practice by tapping in to the intellectual resources provided by nurse researchers, the philosophy of Martin Buber and ANT scholars. This involved recounting two examples of dyadic and networked relationships which were re-interpreted using two complementary theoretical approaches to provide deeper and more comprehensive conceptualizations of these relationships. By re-presenting key tenets from the work of key scholars on the topic relationships, we hope to hasten socialization of these ideas into nursing into the acute care setting. First, by enabling nurses to reflect on how they might work toward cultivating relationships that are more salutogenic and consistent with the preservation of personhood. Second, by stimulating two distinct but related lines of research enquiry which focus on dyadic and networked relationships with the older person with cognitive impairment in the acute care setting. We also hope to reconcile the schism that has emerged in the literature between preferred approaches to care of the older person with cognitive impairment, that is person-centred care versus relationship-centred care by arguing that these are complementary rather than mutually exclusive and can be brought together in one theoretical framework acknowledging personhood as relational in essence.

  • 109. Rushton, Carole
    et al.
    Nilsson, Anita
    Umeå University, Faculty of Medicine, Department of Nursing. Latrobe University/Austin Health/Northern Health Clinical Schools of Nursing, Victoria, Australia.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. Latrobe University/Austin Health/Northern Health Clinical Schools of Nursing, Victoria, Australia.
    Reconciling concepts of time and person-centred care of the older person with cognitive impairment in the acute care setting2016In: Nursing Philosophy, ISSN 1466-7681, E-ISSN 1466-769X, Vol. 17, no 4, p. 282-289Article in journal (Refereed)
    Abstract [en]

    The aim of this analysis was to examine the concept of time to rejuvenate and extend existing narratives of time within the nursing literature. In particular, we hope to promote a new trajectory in nursing research and practice which focuses on time and person-centred care, specifically of older people with cognitive impairment hospitalized in the acute care setting. We consider the explanatory power of concepts such as clock time, process time, fast care, slow care and time debt for elucidating the relationship between 'good care' and 'time use'. We conclude by offering two additional concepts of time, plurotemporality and person-centred time (PCT) which we propose will help advance of nursing knowledge and practice. Nurse clinicians and researchers can use these alternative concepts of time to explore and describe different temporal structures that honour the patient's values and preferences using experiential, observation-based nursing research approaches.

  • 110. Sandberg, Linda
    et al.
    Borell, Lena
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Heidelberg, VIC, Australia.
    Rosenberg, Lena
    Boström, Anne-Marie
    Job strain: a cross-sectional survey of dementia care specialists and other staff in Swedish home care services2018In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, Vol. 11, p. 255-266Article in journal (Refereed)
    Abstract [en]

    Introduction: An increasing number of older persons worldwide live at home with various functional limitations such as dementia. So, home care staff meet older persons with extensive, complex needs. The staff's well-being is crucial because it can affect the quality of their work, although literature on job strain among home care staff is limited.

    Aim: To describe perceived job strain among home care staff and to examine correlations between job strain, personal factors, and organizational factors.

    Methods: The study applied a cross-sectional survey design. Participants were dementia care specialists who work in home care (n=34) and other home care staff who are not specialized in dementia care (n=35). The Strain in Dementia Care Scale (SDCS) and Creative Climate Questionnaire instruments and demographic variables were used. Descriptive and inferential statistics (including regression modeling) were applied. The regional ethical review board approved the study.

    Results: Home care staff perceived job strain - particularly because they could not provide what they perceived to be necessary care. Dementia care specialists ranked job strain higher (m=5.71) than other staff members (m=4.71; p=0.04). Job strain (for total score and for all five SDCS factors) correlated with being a dementia care specialist. Correlations also occurred between job strain for SDCS factor 2 (difficulties understanding and interpreting) and not having Swedish as first language and SDCS factor 5 (lack of recognition) and stagnated organizational climate.

    Conclusion: The study indicates that home care staff and particularly dementia care specialists perceived high job strain. Future studies are needed to confirm or reject findings from this study.

  • 111.
    Sandman, Per-Olof
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    Karlsson, Stig
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Association between work characteristics of nursing staff and the prevalence of behavioural symptoms among people with dementia2007In: International Psychogeriatrics, 2007Conference paper (Other academic)
  • 112.
    Sjögren, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sandman, Per-Olof
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutetet.
    Zingmark, Karin
    Research Department, County Council of Norrbotten.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.
    Characteristics of person-centred residential aged care unitsManuscript (preprint) (Other academic)
  • 113.
    Sjögren, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindkvist, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing. Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden ; Division of Caring Sciences, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.
    Zingmark, Karin
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.
    Organisational and environmental characteristics of residential aged care units providing highly person-centred care: a cross sectional study2017In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 16, article id 44Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Few studies have empirically investigated factors that define residential aged care units that are perceived as being highly person-centred. The purpose of this study was to explore factors characterising residential aged care units perceived as being highly person-centred, with a focus on organisational and environmental variables, as well as residents' and staff' characteristics.

    METHODS: A cross-sectional design was used. Residents (n = 1460) and staff (n = 1213) data from 151 residential care units were collected, as well as data relating to characteristics of the organisation and environment, and data measuring degree of person-centred care. Participating staff provided self-reported data and conducted proxy ratings on residents. Descriptive and comparative statistics, independent samples t-test, Chi(2) test, Eta Squared and Phi coefficient were used to analyse data.

    RESULTS: Highly person-centred residential aged care units were characterized by having a shared philosophy of care, a satisfactory leadership, interdisciplinary collaboration and social support from colleagues and leaders, a dementia-friendly physical environment, staff having time to spend with residents, and a smaller unit size. Residential aged care units with higher levels of person-centred care had a higher proportion of staff with continuing education in dementia care, and a higher proportion of staff receiving regular supervision, compared to units with lower levels of person-centred care.

    CONCLUSIONS: It is important to target organisational and environmental factors, such as a shared philosophy of care, staff use of time, the physical environment, interdisciplinary support, and support from leaders and colleagues, to improve person-centred care in residential care units. Managers and leaders seeking to facilitate person-centred care in daily practice need to consider their own role in supporting, encouraging, and supervising staff.

  • 114.
    Sjögren, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sandman, Per-Olof
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutetet.
    Zingmark, Karin
    Research Department, County Council of Norrbotten.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.
    Person-centredness and its association with resident well-being in dementia care units2013In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 10, p. 2196-2205Article in journal (Refereed)
    Abstract [en]

    Aim: To report a study of the relationship between person-centred care and ability to perform activities of daily living, quality of life, levels of pain, depressive symptoms, and agitated behaviours among residents with dementia in residential care facilities.

    Background: Standardized measurements of person-centred care have not previously been used to investigate the relationship between person-centred care and well-being for residents with dementia in residential aged care units.

    Design: This study had a cross-sectional design.

    Method: Staff and resident surveys were used in a sample of 1261 residents with dementia and 1169 staff from 151 residential care units throughout Sweden. Valid and reliable scales were used to measure person-centredness and ability to perform activities of daily living, quality of life, levels of pain, depressive symptoms, and agitated behaviours in residents. All data were collected in May 2010.

    Findings: Person-centred care was correlated with residents' ability to perform activities of daily living. Furthermore, residents in units with higher levels of person-centred care were rated as having higher quality of life and better ability to perform activities of daily living compared with residents in units with lower levels of person-centred care.

    Conclusions: There seems to be a relationship between person-centredness, residents' ability to perform activities of daily living, and residents' quality of life. Further studies are needed to explain the variation of person-centredness between units and the extent and ways this might impact on the quality of life and well-being of frail older residents with cognitive impairments in clinical practice.

  • 115.
    Sjögren, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Sandman, Per-Olof
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutetet.
    Zingmark, Karin
    Research Department, County Council of Norrbotten.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.
    Psychometric evaluation of the Swedish version of the Person-Centered Care Assessment Tool (P-CAT)2012In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 24, no 3, p. 406-415Article in journal (Refereed)
    Abstract [en]

    Background: Person-centered care is a multidimensional concept describing good care, especially within aged care and care for people with dementia. Research studies evaluating person-centered care interventions seldom use direct measurement of levels of person-centeredness. Existing scales that measure person-centeredness need further testing. This study evaluated the psychometric properties of the Swedish version of the Person-Centered Care Assessment Tool (P-CAT).

    Methods: A cross-sectional sample of 1465 staff from 195 residential care units for older people in Sweden participated in the study. Validity, reliability, and discrimination ability of the scale were evaluated.

    Results: Confirmatory factor analysis, parallel analysis and exploratory factor analysis supported the construct validity of a two-factor solution. Reliability and homogeneity were satisfactory for the whole P-CAT as demonstrated by a Cronbach's α of 0.75. Test-retest reliability showed temporal stability of the scale, and the discrimination ability of the scale was satisfactory.

    Conclusion: The Swedish version of the P-CAT was found to be valid, reliable, and applicable for further use. Two subscales are recommended for the Swedish version.

  • 116.
    Sjögren, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sandman, Per-Olof
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutetet.
    Zingmark, Karin
    Research Department, County Council of Norrbotten.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.
    To what extent is the work environment of staff related to person-cented care? A cross-sectional study of residential aged care.Manuscript (preprint) (Other academic)
    Abstract [en]

    Background Person-centred care is often described as the model of choice in residential aged care and in the care of persons with dementia. Few empirical studies have reported on the relationship between person-centred care and how staff experience different aspects of their work.

    Aim To explore the relationship between person-centred care, staff characteristics and perceived work environment in residential aged care units.

    Method A cross sectional quantitative design was used. Staff in 151 residential aged care units in Sweden (n=1169) completed surveys which included questions about staff characteristics, valid and reliable measures of person-centred care, satisfaction with work and care, job strain, stress of conscience and psychosocial unit climate. Statistical analyses of correlations, group differences, and explanatory regression models were conducted.

    Results Higher levels of person-centred care was associated with higher levels of staff satisfaction, lower levels of job strain, lower levels of stress of conscience, higher levels of a supportive psychosocial unit climate, and a higher proportion of staff who had received continuing education in dementia care. A supportive psychosocial climate, i.e., where residents and staff experience safety, everydayness and community, explained most of the variation in person-centred care in the regression model.

    Conclusions This study shows that the work environment and psychosocial climate as perceived by staff, are associated with the extent to which staff perceive the care as being person-centred in residential aged care. These empirical findings support the theoretical postulation that the environment is an important aspect of person-centred care. Thus, promoting a positive and supportive psychosocial environment to enable person-centred care practice seems to be an important implication for managers and leaders in residential aged care.

    Keywords: Conscience, Cross sectional study, Environment, Job satisfaction, Nursing staff, Patient-centred care, Psychological stress, Residential facilities

  • 117.
    Sjögren, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindkvist, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sandman, Per-Olof
    Division of Nursing, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.
    Zingmark, Karin
    Research Department, County Council of Norrbotten, Luleå, Sweden.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Melbourne, Vic., Australia.
    To what extent is the work environment of staff related to person-centred care?: A cross-sectional study of residential aged care2015In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 9-10, p. 1310-1319Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To explore the relationship between staff characteristics, perceived work environment and person-centred care in residential aged care units.

    BACKGROUND: Person-centred care is often described as the model of choice in residential aged care and in the care of persons with dementia. Few empirical studies have reported on the relationship between how staff experience different aspects of their work and person-centred care.

    DESIGN: The study had a cross-sectional quantitative design.

    METHODS: Staff in 151 residential aged care units in Sweden (n = 1169) completed surveys which included questions about staff characteristics, valid and reliable measures of person-centred care, satisfaction with work and care, job strain, stress of conscience and psychosocial unit climate. Statistical analyses of correlations, group differences and multiple linear regression analysis estimated with generalised estimating equation were conducted.

    RESULTS: Higher levels of staff satisfaction, lower levels of job strain, lower levels of stress of conscience, higher levels of a supportive psychosocial unit climate and a higher proportion of staff with continuing education in dementia care were associated with higher levels of person-centred care. Job strain and a supportive psychosocial climate, explained most of the variation in person-centred care.

    CONCLUSIONS: This study shows that the work environment as perceived by staff is associated with the extent to which staff perceive the care as being person-centred in residential aged care. These empirical findings support the theoretical postulation that the work environment is an important aspect of person-centred care.

    RELEVANCE TO CLINICAL PRACTICE: Promoting a positive and supportive psychosocial climate and a work environment where staff experience balance between demands and control in their work, to enable person-centred care practice, seems to be important implications for managers and leaders in residential aged care.

  • 118.
    Sjögren, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Petersson, L
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandman, Per-Olof
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    Everyday activities are associated with higher resident quality of life2012In: The Gerontologist, ISSN 0016-9013, E-ISSN 1758-5341, Vol. 52, no S1, p. 451-451Article in journal (Other academic)
  • 119.
    Sköldunger, Anders B.
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.  Karolinska Institutet, Division of Neurogeriatrics, Stockholm, Sweden.
    Wimo, A.
    Sandman, Per-Olov
    Umeå University, Faculty of Medicine, Department of Nursing.
    Backman, Annica
    Umeå University, Faculty of Medicine, Department of Nursing.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. La Trobe University, School of Nursing and Midwifery, Melbourne, Australia.
    Cognitive impairment and resource use in Swedish nursing homes: results from the Svenis study2016In: The Gerontologist, ISSN 0016-9013, E-ISSN 1758-5341, Vol. 56, p. 389-389Article in journal (Other academic)
  • 120.
    Sköldunger, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Division of Neurogeriatrics, Karolinska Institutet, Huddinge, Sweden.
    Wimo, Anders
    Sjögren, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Björk, Sabine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Backman, Annica C.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing. Division of Neurogeriatrics, Karolinska Institutet, Huddinge, Sweden.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. College of Science, Health and Engineering, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.
    Resource use and its association to cognitive impairment, ADL functions, and behavior in residents of Swedish nursing homes: Results from the U-Age program (SWENIS study)2019In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 34, no 1, p. 130-136Article in journal (Refereed)
    Abstract [en]

    Objectives: We aimed to investigate resource use and its association to cognitive impairment, activities of daily living, and neuropsychiatric symptoms in residents of Swedish nursing homes.

    Methods: Data were collected in 2014 from a Swedish national sample of nursing home residents (n = 4831) and were collected by staff in the facility. The sample consists of all nursing homes in 35 of 60 randomly selected Swedish municipalities. Demographic data and data on resource use, cognitive and physical function as well as neuropsychiatric symptoms were collected through proxies. Descriptive statistics and regression modeling were used to investigate this association.

    Results: We found that cognitive impairment, activities of daily living, and neuropsychiatric symptoms were associated with 23 hours per week increase in total resource use versus cognitively intact persons. This was also the case for being dependent in activities of daily living. Being totally dependent increased the amount of resource use by 25 hours per week. The sex of a resident did not influence the resource use. Annual costs of resource use with no functional dependency were 359 685 SEK, and in severely cognitive impaired resident, the cost was 825 081 SEK.

    Conclusion: Being cognitively impaired as well as functionally dependent increases the resource use significantly in nursing homes. This has implications for differentiation of costs in institutional settings in health economic evaluations.

  • 121. Stanaway, Jeffrey D.
    et al.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia.
    Murray, Christopher J. L.
    Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 20172018In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 392, no 10159, p. 1923-1994Article in journal (Refereed)
    Abstract [en]

    Background: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk–outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk–outcome pairs, and new data on risk exposure levels and risk–outcome associations.

    Methods: We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk–outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017.

    Findings: In 2017, 34·1 million (95% uncertainty interval [UI] 33·3–35·0) deaths and 1·21 billion (1·14–1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6–62·4) of deaths and 48·3% (46·3–50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39–11·5) deaths and 218 million (198–237) DALYs, followed by smoking (7·10 million [6·83–7·37] deaths and 182 million [173–193] DALYs), high fasting plasma glucose (6·53 million [5·23–8·23] deaths and 171 million [144–201] DALYs), high body-mass index (BMI; 4·72 million [2·99–6·70] deaths and 148 million [98·6–202] DALYs), and short gestation for birthweight (1·43 million [1·36–1·51] deaths and 139 million [131–147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3–6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low.

    Interpretation: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning.

  • 122.
    van den Berg, Johannes
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Bäck, Frida
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hed, Zara
    Umeå University, Faculty of Medicine, Department of Nursing.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.
    Transition to a new neonatal intensive care unit: positive effects on staff working environment and how the physical environment facilitates family-centered care2017In: Journal of Perinatal & Neonatal Nursing, ISSN 0893-2190, E-ISSN 1550-5073, Vol. 31, no 1, p. 75-85Article in journal (Refereed)
    Abstract [en]

    To optimize family-centered care and the staff working environment, the physical care environment should be designed to meet the needs of the infants, their families, and staff. It is important to evaluate the effects of a purpose-built neonatal ward on staff perceptions of job strain, the psychosocial climate, and the appropriateness of the physical environment. This study collected information from staff at a neonatal intensive care unit (NICU), before and after the ward was relocated to a new NICU. Effects were measured using the following variables: job strain, person-centered climate and appropriateness-of-the-physical-environment questionnaires. Data were analyzed using repeated-measures generalized estimating equations and factor analysis. After staff began to work in the new NICU, their job strain significantly increased. At the 2-year follow-up, staff stress levels had returned to preintervention levels. Participating staff perceived the purpose-built neonatal ward as being a significantly more appropriate physical environment for family-centered care of the infants and their families. The staff also perceived the psychosocial climate of the new NICU as significantly more person-centered in terms of having a more homey, comfortable, and everyday ambience and thus experienced as being more supportive. An NICU built according to recommended standards optimized the physical care environment for family-centered care and increased the staff working climate.

  • 123. Vassbo, Tove K.
    et al.
    Kirkevold, Marit
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.
    Sjögren, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lood, Qarin
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Melbourne, Australia; Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
    Bergland, Adel
    The meaning of working in a person-centred way in nursing homes: a phenomenological-hermeneutical study2019In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 18, no 1, article id 45Article in journal (Refereed)
    Abstract [en]

    Background: The present study aims to illuminate the meaning of working in a person-centred way as experienced by staff in nursing homes. Insights into what working in a person-centred way mean for nursing home staff may contribute to a more comprehensive understanding of what gives staff satisfaction in their work and support further development of person-centred care approach in nursing homes.

    Methods: Interviews with 29 health care personnel who had participated in a one-year intervention focusing on person-centred care and thriving in three nursing homes in Australia, Norway and Sweden were performed, and a phenomenological-hermeneutical method was used to explore staffs’ lived experiences of working in a person-centred way in nursing homes.

    Results: For nursing home staff, working in a person-centred way meant that they were able to meet individual resident’s needs and expressed preferences in close family-like relationships, understanding the residents’ rhythms and preferences as the basis of the daily work plans and being able to do ‘the little extra’ for residents. Also, working in a person-centred way meant meeting shared goals by working towards a collective practice in collaborative teams. As a whole, the staffs’ lived experiences of working in a person-centred way in nursing homes was interpreted to mean thriving at work as a psychological state in which individuals experience both a sense of vitality and learning.

    Conclusions: Working in a person-centred way means staff thriving at work in nursing homes. The results further indicate that delivering care by only focusing on routines and practical tasks and not on residents’ preferences and well-being would inhibit thriving among nursing staff, leading to the potential for dissatisfaction with work.

  • 124. Vassbø, Tove K.
    et al.
    Kirkevold, Marit
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. La Trobe University, Melbourne, Vic., Australia.
    Sjögren, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lood, Qarin
    Umeå University, Faculty of Medicine, Department of Nursing. La Trobe University, Melbourne, Vic., Australia; University of Gothenburg, Gothenburg, Sweden.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Sweden.
    Bergland, Ådel
    Associations between job satisfaction, person-centredness, and ethically difficult situations in nursing homes: A cross-sectional study2019In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 75, no 5, p. 979-988Article in journal (Refereed)
    Abstract [en]

    AIM: To explore the associations between job satisfaction and perceived person-centredness and ethically difficult situations among staff in nursing homes (NHs).

    BACKGROUND: Previous studies have indicated that person-centredness and few ethically difficult situations can contribute positively to NH staff's job satisfaction. However, empirical evidence of these associations is lacking.

    DESIGN: Cross-sectional survey design.

    METHOD: Nursing home staff (N = 341) in six NHs in Australia, Norway, and Sweden completed the questionnaire measuring job satisfaction, person-centredness, and ethically difficult situations. Data were collected between April - June 2016. Univariate analysis was used to describe the sample, one-way analysis of variance examined differences between variables. Bivariate correlation tested the relationships between variables and hierarchical multiple regression explored the extent to which person-centredness and ethically difficult situations could explain job satisfaction among staff.

    RESULTS: After controlling for socio-demographic variables in a regression model, three variables of person-centredness and "ethically difficult situations" were significantly associated with job satisfaction. A "climate of community" contributed the most, followed by the "amount of organizational and environmental support," "a climate of everydayness," and few "ethically difficult situations."

    CONCLUSION: The results support the theoretical foundation and previous findings suggesting that establishing NHs organizations based on person-centredness will increase staff job satisfaction. However, this is a cross-sectional study and the causality may go in both directions and should be further explored.

  • 125. Vikström, Sofia
    et al.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing. Karolinska Inst, Dept Neurobiol Caring Sci & Soc, Div Nursing, S-14183 Huddinge, Sweden.
    Stenwall, Ewa
    Boström, Anne-Marie
    Saarnio, Lotta
    Kindblom, Kristina
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. La Trobe Univ, Sch Nursing & Midwifery, Bundoora, Vic 3086, Australia.
    Borell, Lena
    A model for implementing guidelines for person-centered care in a nursing home setting2015In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 27, no 1, p. 49-59Article in journal (Refereed)
    Abstract [en]

    Background: Systematic evaluations of knowledge translation interventions in nursing homes to improve practice are scarce. There is also a lack of studies focusing on creating sustainable evidence-based practice in the setting of residential dementia care. Methods: The aim of this paper is to describe a model for implementing national evidence-based guidelines for care of persons with dementia in nursing homes. The secondary aim is to outline the nursing home staff experiences during the first year of the implementation process. The intervention had a participatory action research approach. This included educational activities such as: (i) thematic seminars introducing national guidelines for dementia care, (ii) regular unit-based seminars; and (iii) later dissemination of information in reflective seminars and several days of poster-exhibitions. Areas of practice development were selected on each of the 24 units, based on unit-specific needs, and a quality improvement strategy was applied and evaluated. Each unit met ten times during a period of eight months. Data for this study were extracted from the reflective seminars and poster presentations, analyzed using a qualitative content analysis. Results: Findings showed that implementation of guidelines were perceived by staff as beneficial for both staff and the residents. However, barriers to identification of relevant sources of evidence and barriers to sustainable implementation were experienced. Conclusions: One of our assumptions was that dementia nursing homes can benefit from becoming knowledge driven, with care practices founded in evidence-based sources. Our findings show that to be partly true, even though most staff units found their efforts to pursue and utilize knowledge adversely impacted by time-logistics and practical workload challenges.

  • 126. Vrbnjak, Dominika
    et al.
    Pahor, Dusica
    Brzan, Petra Povalej
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Bundoora, Vic., Australia.
    Pajnkihar, Majda
    Psychometric testing of the Slovenian Person-centred Climate Questionnaire - staff version2017In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 25, no 6, p. 421-429Article in journal (Refereed)
    Abstract [en]

    Aim: To test the psychometric properties of the Slovenian version of the Person-centred Climate Questionnaire - staff version. Background: Person-centredness can be a quality care indicator, but there are no valid and reliable instruments in the Slovene language aimed at exploring the person-centred care climate from a nursing staff perspective. Methods: Content validity based on expert agreement was evaluated by calculating content validity indices. A cross-sectional survey design using a convenience sample of 790 nurses and nursing assistants from medical and surgical wards in 11 hospitals was used to test the construct validity and internal consistency reliability. Results: The average content validity index for the scale was 0.97, all items had content validity indices higher than 0.78, showing satisfactory content validity. Three components, climate of safety, community and everydayness explained 71.22% of the variance in the data and thus confirmed scale dimensionality. Cronbach's was acceptable for whole scale (0.90) and for subscales (0.89, 0.89 and 0.86). Conclusion: The Slovene version of the Person-centred Climate Questionnaire - staff version is valid and reliable and can be further used in surgical and medical wards in hospital settings. Implication for nursing management: The instrument enables further exploration of the relationships between perceived person-centredness and organisational outcomes.

  • 127. Wilberforce, Mark
    et al.
    Sköldunger, Anders
    Umeå University, Faculty of Medicine, Department of Nursing.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    A Rasch analysis of the Person-Centred Climate Questionnaire - staff version2019In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, no 1, p. 1-9, article id 996Article in journal (Refereed)
    Abstract [en]

    Background: Person-centred care is the bedrock of modern dementia services, yet the evidence-base to support its implementation is not firmly established. Research is hindered by a need for more robust measurement instruments. The 14-item Person-Centred Climate Questionnaire - Staff version (PCQ-S) is one of the most established scales and has promising measurement properties. However, its construction under classical test theory methods leaves question marks over its rigour and the need for evaluation under more modern testing procedures. Methods: The PCQ-S was self-completed by nurses and other care staff working across nursing homes in 35 Swedish municipalities in 2013/14. A Rasch analysis was undertaken in RUMM2030 using a partial credit model suited to the Likert-type items. Three subscales of the PCQ-S were evaluated against common thresholds for overall fit to the Rasch model; ordering of category thresholds; unidimensionality; local dependency; targeting; and Differential Item Functioning. Three subscales were evaluated separately as unidimensional models and then combined as subtests into a single measure. Due to large number of respondents (n = 4381), two random sub-samples were drawn, with a satisfactory model established in the first ('evaluation') and confirmed in the second ('validation'). Final item locations and a table converting raw scores to Rasch-transformed values were created using the full sample. Results: All three subscales had disordered thresholds for some items, which were resolved by collapsing categories. The three subscales fit the assumptions of the Rasch model after the removal of two items, except for subscale 3, where there was evidence of local dependence between two items. By forming subtests, the 3 subscales were combined into a single Rasch model which had satisfactory fit statistics. The Rasch form of the instrument (PCQ-S-R) had an adequate but modest Person Separation Index (< 0.80) and some evidence of mistargeting due to a low number of `difficult-to-endorse' items. Conclusions: The PCQ-S-R has 12 items and can be used as a unidimensional scale with interval level properties, using the nomogram presented within this paper. The scale is reliable but has some inefficiencies due to too few high-end thresholds inhibiting discrimination amongst populations who already perceive that person-centred care is very good in their environment.

  • 128. Winblad, Bengt
    et al.
    Amouyel, Philippe
    Andrieu, Sandrine
    Ballard, Clive
    Brayne, Carol
    Brodaty, Henry
    Cedazo-Minguez, Angel
    Dubois, Bruno
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia.
    Feldman, Howard
    Fratiglioni, Laura
    Frisoni, Giovanni B.
    Gauthier, Serge
    Georges, Jean
    Graff, Caroline
    Iqbal, Khalid
    Jessen, Frank
    Johansson, Gunilla
    Jonsson, Linus
    Kivipelto, Miia
    Knapp, Martin
    Mangialasche, Francesca
    Melis, Rene
    Nordberg, Agneta
    Rikkert, Marcel Olde
    Qiu, Chengxuan
    Sakmar, Thomas P.
    Scheltens, Philip
    Schneider, Lon S.
    Sperling, Reisa
    Tjernberg, Lars O.
    Waldemar, Gunhild
    Wimo, Anders
    Zetterberg, Henrik
    Defeating Alzheimer's disease and other dementias: a priority for European science and society2016In: Lancet Neurology, ISSN 1474-4422, E-ISSN 1474-4465, Vol. 15, no 5, p. 455-532Article in journal (Refereed)
  • 129. Yoon, Ju Young
    et al.
    Roberts, Tonya
    Grau, Bruce
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Australia.
    Person-centered Climate Questionnaire-Patient in English: A psychometric evaluation study in long-term care settings2015In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 61, no 1, p. 81-87Article in journal (Refereed)
    Abstract [en]

    Background: There is increasing evidence that person-centered care improves nursing home residents' quality of life. Despite the clear focus of person-centered care on enhancing care for residents and engaging residents in care, there are few options available for measuring person-centered care from the perspective of the elder residents. Objective: The aim of this study was to assess the psychometric properties of the English version of the Person-centered Climate Questionnaire-Patient (PCQ-P) in U.S. long-term care settings. Methods: A total of 189 older adults from six nursing homes in the Midwestern United States were included. Convergent validity and known-group comparison were examined for construct validity. Exploratory factor analysis and second-order confirmatory factor analysis were utilized to examine the factor structure. Reliability was tested using Cronbach's alpha values for internal consistency. Results: This study demonstrated a substantial convergent validity of the PCQ-P in English as higher scores correlated significantly with higher resident life satisfaction (r = 0.459), and the satisfactory construct validity as evidenced by a significantly higher mean PCQ-P score from residents in higher quality nursing homes. Factor analysis demonstrated that the PCQ-P had three factors (hospitality, safety, and everydayness) in U.S. nursing home residents. The PCQ-P showed satisfactory internal consistency reliability (alpha = 0.89). Conclusion: The English version of the PCQ-P is a valid and reliable tool to directly measure the perceptions of the person-centered climate in the U.S nursing homes. The simple and straightforward PCQ-P items are easy to administer to nursing home residents. Consequently, clinical staff can utilize the PCQ-P to assess the unit climate, and evaluate outcomes of person-centered interventions.

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