Providers and women's perspectives on person-centered maternity care: a mixed methods study in Kenya.

BackgroundGlobally, there has been increasing attention to women's experiences of care and calls for a person-centered care approach. At the heart of this approach is the patient-provider relationship. It is necessary to examine the extent to which providers and women agree on the care that is provided and received. Studies have found that incongruence between women's and providers' perceptions may negatively impact women's compliance, satisfaction, and future use of health facilities. However, there are no studies that examine patient and provider perspectives on person-centered care.MethodsTo fill this gap in the literature, we use cross-sectional data of 531 women and 33 providers in seven government health facilities in Kenya to assess concordance and discordance in person-centered care measures. Additionally, we analyze 41 in-depth interviews with providers from three of these facilities to examine why differences in reporting may occur. Descriptive statistical methods were used to measure the magnitude of differences between reports of women and reports of providers. Thematic analyses were conducted for provider surveys.ResultsOur findings suggest high discordance between women and providers' perspectives in regard to person-centered care experiences. On average, women reported lower levels of person-centered care compared to providers, including low respectful and dignified care, communication and autonomy, and supportive care. Providers were more likely to report higher rates of poor health facility environment such as having sufficient staff. We summarize the overarching reasons for the divergence in women and provider reports as: 1) different understanding or interpretation of person-centered care behaviors, and 2) different expectations, norms or values of provider behaviors. Providers rationalized abuse towards women, did not allow a companion of choice, and blamed women for poor patient-provider communication. Women lacked assurance in privacy and confidentiality, and faced challenges related to the health facility environment. Providers attributed poor person-centered care to both individual and facility/systemic factors.ConclusionsImplications of this study suggests that providers should be trained on person-centered care approaches and women should be counseled on understanding patient rights and how to communicate with health professionals

From dementia mindsets to emotions and behaviors:Predicting person-centered care in care professionals

Background and Objective: High-quality care standards for dementia care are increasingly based on person-centered care principles. To better understand facilitating factors of person-centered care this research focuses on individual characteristics of care professionals. Applying mindset theory to dementia care, we examined dementia mindsets (viewing dementia symptoms as either malleable or fixed) in care professionals. We tested whether there is a positive relationship between a malleable dementia mindset and person-centered care as well as a negative relationship between a fixed dementia mindset and person-centered care. Moreover, we examined whether care professionals’ emotional responses in care situations help explain associations between dementia mindsets and person-centered care. Research Design and Method: In two cross-sectional studies, care professionals of long-term care facilities (total N = 370) completed a measure of dementia mindsets and reported their emotional and behavioral responses to five care scenarios. Regression and mediation analyses were performed. Findings: The tested hypotheses were partially supported. A fixed dementia mindset predicted reported person-centered care negatively, while a malleable dementia mindset did not. Mediation analyses suggest that reduced negative emotions may underlie the association between a malleable mindset and reported person-centered care, while reduced positive emotions in care situations may underlie the association of a fixed mindset and reported person-centered care. Study 2 partially replicated these findings. A fixed mindset and positive emotional responses were the most robust predictors of reported person-centered care. Discussion and Implications: This study extends knowledge on facilitators (positive emotional responses to care situations) and barriers (fixed dementia mindset) to person-centered care in care professionals working with persons with dementia. We discuss how dementia mindsets and emotional responses to care situations may be a fruitful target for trainings for care professionals

Perceptions of Dignity, Person-Centered Care, and Person-Centered Leadership in Elder Care

This review explores dignity as it relates to the elder-care field, specifically in the areas of person-centered care and person-centered leadership. This review analyzes literature from these three subjects: person-centered care, person-centered leadership, and dignity, attempting to find connections between them. This integrative review examined multiple articles, and found fifteen pieces of literature on those three subjects that were the most relevant. Out of the fifteen resources, four articles and two books were chosen for this review. Two studies on person-centered care, two integrated reviews on person-centered leadership and two books written by renowned dignity expert Donna Hicks, PhD. Findings are as follows: Person-centered care, still considered a best care practice in aged care. Person-centered leadership is needed in order to create and implement person-centered care. Though aspects of dignity are found in literature on person-centered care and person-centered leadership, a more direct connection between dignity and person-centered approaches is hard to find. This study raised several questions related to the literature that would benefit from future study. The researcher offers recommendations for further study to explore dignity education in person-centered care and person-centered leadership

How staff characteristics influence residential care facility staff’s attitude toward person-centered care and informal care

Abstract Background Staff members, and their attitudes, are crucial for providing person-centered care in residential care facilities for people with dementia. However, the literature on the attitudes of nursing staff regarding person-centered care is limited. The objective of this study is to explore the association between staff characteristics (age, education level, years of work experience and function, i.e., care or welfare) and staff attitudes toward perceived person-centered care provision and including informal caregivers in the caregiving process in residential care facilities. Methods A convenience sample of 68 care staff – nurses and nurse assistants - welfare staff members – activity counselors, hostesses, and living room caretakers - of two residential care facilities filled out a questionnaire. Staff attitudes regarding perceived person-centered care were measured with the Person-centered Care Assessment Tool (P-CAT). Staff attitudes regarding informal care provision were measured with the Attitudes Toward Families Checklist (AFC). Multiple linear regression analysis explored the association between variables age, work experience, education, and function (care or welfare). Results A higher age of staff was associated with a more negative attitude toward perceived person-centered care and informal care provision. Welfare staff had a more negative attitude toward the inclusion of informal caregivers than care staff. The perceived person-centered care provision of the care and welfare staff was both positive. Work experience and education were not associated with perceived person-centered care provision or informal care provision. Conclusion This study is one of the first to provide insight into the association between staff characteristics and their attitude toward their perceived person-centered care provision and informal care provision. A higher age of both the care and welfare staff was associated with a more negative attitude toward their perceived person-centered care and informal care provision. Welfare staff had a less positive attitude toward informal care provision. Additionally, future studies, also observational studies and interview studies, are necessary to collect evidence on the reasons for negative attitudes of older staff members towards PCC and informal care giving, to be able to adequately target these reasons by implementing interventions that eliminate or reduce these negative attitudes

Developing a curriculum of person-centered care in athletic training

A person-centered model of healthcare is considered the gold standard of care; however, athletic training continues to operate within a biomedical model of care. More research is needed to understand how to best incorporate person-centered care into the culture of care within athletic training. This study evaluated the effectiveness of a four-part learning module on athletic training students’ understanding, use and perceived use of person-centered care in athletic training. The learning module was incorporated into an existing course on psychosocial aspects of healthcare. Ten students (9 female, 1 male) participated in the study. Study measures included a clinical evaluation observation measuring participants’ use of person-centered care in a clinical setting and a pre-post survey measuring participants’ perceived use of person-centered care in a clinical setting. Results of the paired t-tests on the clinical evaluation observation and pre-post survey items demonstrated a significant improvement in participants’ perceived use of PCC in their clinical practice. Findings indicate that actively incorporating person-centered care into the curriculum of athletic training education can have a significant positive impact on students’ use and perceived use of person-centered care in their clinical practice. More research is needed to explore other educational methods for incorporating person-centered care across the athletic training educational curriculum as well as the impact of a person-centered culture of care on patients and clinical outcomes in athletic training settings

Person centered care: advanced philosophical perspectives

The ideas and terminology of person-centred care have been part of health discourse for a very long time. Arguments that in healthcare one treats the whole person, not her/his component parts, date back at least to antiquity and the need to treat the patient as a person is articulated persuasively by clinical authors in the early twentieth century. Yet it is only in recent years that we have seen a growing consensus in health policy and practice literature that PCC, and associated ideas including patient expertise, co-production and shared decision-making, are not simply “fine ideals” or “ethical add-ons” to sound scientific clinical practice, but rather they represent indispensable components of any genuinely integrated, realistic and conceptually sound account of healthcare practice. The underlying conviction of this volume - one belief that, despite their differences, unites all of its contributors - is that PCC should not become the latest “revolutionary” concept to be “operationalised” before being “conceptualised”. It is imperative that we develop an open and inclusive dialogue about what we do and do not mean by “person-centred” to inform our attempts to implement PCC

Are we ready for a person-centered care model for patient- physician consultation? A survey from family physicians and their patients of East Mediterranean Region

Background: Person-centered care has long been identified as a key component of health systems and one of the six domains of quality. This study aimed to identify the perceptions of patients and physicians regarding person-centered care in the Eastern Mediterranean Region (EMR). Methods: A multicountry, cross-sectional study was conducted in 6 countries of EMR during July 2012 to September 2012. From each country, an expert Family Physician (FP) was identified and invited for the study. During the first phase, 190 FPs practising for at least 6 months were recruited. In the second phase, the recruited FPs approached 300 patients aged > 18 years with 1 or more recurring problems. Data analysis was conducted using SPSS version 19. Results: Of a total of 360 patients, 53% were between 25-40 years of age and the majority 55.7% were females. Among physicians, 66.8% were females and 72.1% had undergone specialization in Family Medicine from EMR. About 36% of the patients, while 62.6% of the physicians, preferred a person-centered care model of care. Among physicians, field of specialization (AOR= 0.7; 95% C.I: 0.3-0.9) and regularity in continuing medical education sessions (AOR= 0.3; 95% C.I: 0.1-0.5) were significant factors for preferring a person-centered care model. Educational status (AOR= 3.0; 95% C.I: 1.1- 7.9) was associated with a preference for person-centered care among patients. Conclusion: The results of the study highlight that a majority of physicians prefer person-centered care, while patients prefer a mix of both patient- and physician-centered care. Strategies should be developed that will help physicians and patients to embrace person-centered care practices

An Analysis of Reinforcers Maintaining Caregiving Behaviors of Long-Term Care Facility Staff

Traditionally, the medical model has been the standard level of care in long-term care facilities. However, many facilities are transitioning from the medical model to a person-centered approach. The core of person-centered care is the relationship between frontline staff and residents. Empirical research has found person-centered care to reduce depressive and behavioral symptoms, levels of loneliness, and increase quality of care in residents; person-centered care has increased job satisfaction in nursing staff. Unfortunately, little is known about what motivates caregiving behavior in nursing staff and whether these motivators are consistent with principles of person-centered care. The current study attempted to assess what the motivators are and how often these motivators occur. A questionnaire was developed and included 43 experiences that nursing staff may or may not experience in their day-to-work. Participants were asked to rank how important each item was using a 4-point Likert scale (not at all important to very important) and to rank how often each item occurs using a 4-point Likert scale (never to always). Results indicated that items related to person-centered care were the highest ranked items for importance and frequency, while support from administrators was ranked as important, but was occurring infrequently. These results have implications in terms of staff selection and staff training related to person-centered care

Person-Centered Care Training, May 16, 2014

A FREE training event that will offer valuable and timely information about: *LifeLong Links Network Statewide Expansion *Preadmission Screening and Resident Review (PASRR) in Iowa *Magellan Health Services—SeniorConnect and Integrated Health Homes (IHH) *The role of the Long Term Care Ombudsma