The factors that influence care home residents’ and families’ engagement with decision-making about their care and support: an integrative review of the literature

BACKGROUND: As care homes play an important role in the lives of an increasing number of older people, it is pivotal to understand how residents’ and their families engage in decision-making about their care and support. Internationally, there is an increasing emphasis in long-term care settings on the right of residents to be actively involved in all aspects of decision-making about their care and support. However, the steps necessary to achieving a culture of shared decision-making in long-term care settings remain unclear. The aim of this literature review is to summarise what is known in the literature about the factors that influence care home residents’ and families’ engagement with decision-making about their care and support. METHODS: An integrative literature reviews was carried out, guided by the methodological framework proposed by Whittemore and Knafl (2005). CINAHL, Medline Ovid and ProQuest Health and Medical databases were searched for relevant articles from 2011 to 2021. A three-step method was used, including the use of reference and citation management software to manage search results and identify duplicate citations. Abstracts and full texts were reviewed by two reviewers. Details of the selected articles were then extracted using the Data Extraction Form. RESULTS: In total, 913 articles were located and 22 studies were included in the final analysis. The thematic analysis identified three main themes that illustrate the complexities of shared decision-making in care homes: (a) a positive culture of collaborative and reciprocal relationships; (b) a willingness to engage and a willingness to become engaged; and (c) communicating with intent to share and support rather than inform and direct. CONCLUSION: The implementation of shared decision-making in care homes is highly dependent on the support and nurturing of collaborative and reciprocal relationships between residents, families, and staff. Part of this process includes ascertaining the willingness of residents and families to become engaged in shared decision-making. Communication skills training for staff and guided approaches that view decision-making as a supportive process rather than a once off event are essential prerequisites for implementation. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-022-03503-8

The development of the Person-Centred Situational Leadership Framework: Revealing the being of person-centredness in nursing homes

Aims and objectives\ud \ud To implement and evaluate the effect of using the Person-Centred Situational Leadership Framework to develop person-centred care within nursing homes.\ud \ud \ud Background\ud \ud Many models of nursing leadership have been developed internationally in recent years but do not fit with the emergent complex philosophy of nursing home care. This study develops the Person-Centred Situational Leadership Framework that supports this philosophy. It forms the theoretical basis of the action research study described in this article.\ud \ud \ud Methods\ud \ud This was a complex action research study using the following multiple methods: nonparticipatory observation using the Workplace Culture Critical Analysis Tool (n = 30); critical and reflective dialogues with participants (n = 39) at time 1 (beginning of study), time 2 (end of study) and time 3 (6 months after study had ended); narratives from residents at time 1 and time 2 (n = 8); focus groups with staff at time 2 (n = 12) and reflective field notes. Different approaches to analyse the data were adopted for the different data sources, and the overall results of the thematic analysis were brought together using cognitive mapping.\ud \ud \ud Results\ud \ud The Person-Centred Situational Leadership Framework captures seven core attributes of the leader that facilitate person-centredness in others: relating to the essence of being; harmonising actions with the vision; balancing concern for compliance with concern for person-centredness; connecting with the other person in the instant; intentionally enthusing the other person to act; listening to the other person with the heart; and unifying through collaboration, appreciation and trust.\ud \ud \ud Conclusions\ud \ud This study led to a theoretical contribution in relation to the Person-Centred Practice Framework. It makes an important key contribution internationally to the gap in knowledge about leadership in residential care facilities for older people.\ud \ud \ud Relevance to clinical practice\ud \ud The findings can be seen to have significant applicability internationally, across other care settings and contexts

Partnering for performance in situational leadership: a person-centred leadership approach

Background: Although the endorsement of a leadership approach that will change the culture of care for older people in nursing homes is a key national issue in several countries including the UK, the Republic of Ireland and the US, few robust studies exist that explore the correlation between transformational leadership and effective nursing care in long-term facilities for older people. Working from the premise that transformational leadership is situational leadership enacted within a person-centred framework, a composite model of situational leadership in residential care was developed. This model subsequently forms the theoretical basis for the author’s action research doctoral programme evaluating the role of situational leadership in facilitating culture change in the practice setting of long-term care for older people. Aims and objectives: The situational leader’s person-centred approach of partnering the follower to improve their performance brings into play the key components of diagnosis, flexibility and various coaching and supportive leadership behaviours. This paper describes these components and discusses how the model of situational leadership in residential care can be operationalised in practice through the process of ‘partnering for performance’. Conclusions: The situational leader diagnoses the performance, competence and commitment of the follower, is flexible in leadership style and partners the follower for performance, taking them through the developmental levels in order to manage the care environment and deliver person-centred care. Implications for practice development: The ‘partnering for performance’ process emphasises the importance of the situational leader’s role as facilitator in developing the follower and has the capacity to support the process of continuous learning within the care environment The facilitated approach to self-reflection adopted by the situational leader enables the follower to deepen their understanding and self-awareness through reflexivity Engagement in a critical reflective process is fundamental to the development of a person-centred philosoph

The experience of being a member of the Student International Community of Practice: a collaborative reflection

Background: In 2010 a community of practice was set up for and by doctoral students engaged in person-centred and practitioner research. After three years, this community became part of a larger international community of practice. Aims and objectives: Captured under the stanzas of a poem and supported by the literature, this paper uses member narratives and creative expressions in a critical reflection on the experience of being a member of the Student International Community of Practice. Conclusions: Membership in the community of practice was experienced as beneficial, providing both support and challenge to enrich the doctoral students’ development as person-centred researchers. Retaining connectivity across an international landscape and finding effective ways to integrate new members into the community presented the greatest challenges. Implications for practice development: The theoretical foundation and experiential knowledge could assist others considering support structures for the development of person-centred practices Shared learning and co-creation of knowledge add value to the experience of being a doctoral researcher Membership fluctuations present challenges to continuity of learning and the maintenance of a safe space with communities of practice. Such fluctuations, however, create chances for community members to experience diverse roles within the group and encourage explicit attention to person-centrednes

Development of a model of situational leadership in residential care for older people

Aim The aim of the present study was to present the process used to develop a composite model of situational leadership enacted within a person-centred nursing framework in residential care. Background Transforming the culture of the residential unit from a restrictive institution to a vibrant community of older adults requires transformational leadership. Situational leadership is one form of transformational leadership, which claims that there is not one leadership style that works in all situations.Method A model of situational leadership in residential care was developed through a series of systematic steps that identified direct linkages between situational leadership and the main constructs of the Person-Centred Nursing Framework. The process included reviewing the evidence, undertaking a comparative analysis, identifying key concepts, connecting the concepts and developing a model.Conclusion A conceptual model is presented which integrates person-centredness with leadership thinking in order to effectively impact on the follower's performance in managing the care environment and delivering person-centred care.Implications for Nursing Management Currently the model is being utilized in an action research study to evaluate the role of leaders in the practice setting of long-term care. While some of the connecting concepts have been identified in the present study, more work needs to be done to unravel these connections in further study of leaders in practice.sch_nur19pub3458pub

Implementing and Measuring Person-centredness using an APP for Knowledge Transfer: the iMPAKT App

OBJECTIVE: The aim of the study was to evaluate a technological solution in the form of an App to implement and measure person-centredness in nursing. The focus was to enhance the knowledge transfer of a set of person-centred key performance indicators and the corresponding measurement framework used to inform improvements in the experience of care. DESIGN: The study used an evaluation approach derived from the work of the Medical Research Council to assess the feasibility of the App and establish the degree to which the App was meeting the aims set out in the development phase. Evaluation data were collected using focus groups (n = 7) and semi-structured interviews (n = 7) to capture the impact of processes experienced by participating sites. SETTING: The study was conducted in the UK and Australia in two organizations, across 11 participating sites. PARTICIPANTS: 22 nurses from 11 sites in two large health care organizations were recruited on a voluntary basis. INTERVENTION: Implementing the KPIs and measurement framework via the APP through two cycles of data collection. MAIN OUTCOME MEASURES: The main outcome was to establish feasibility in the use of the App. RESULTS: The majority of nurse/midwife participants found the App easy to use. There was broad consensus that the App was an effective method to measure the patient experience and generated clear, concise reports in real time. CONCLUSIONS: The implementation of the person-centred key performance indicators using the App enhanced the generation of meaningful data to evidence patient experience across a range of different clinical settings