Implementing national guidelines for person-centered care of people with dementia in residential aged care: effects on perceived person-centeredness, staff strain, and stress of conscience

• Published in: International psychogeriatrics 2014-07, Vol.26 (7), p.1171-1179
• Main Authors: Edvardsson, David, Sandman, P. O., Borell, Lena
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Aged; Alzheimer's disease; Biological and medical sciences; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Dementia; Dementia - therapy; Female; Geriatrics; guidelines; Health Personnel - education; Health Personnel - psychology; Homes for the Aged - manpower; Homes for the Aged - organization & administration; Homes for the Aged - statistics & numerical data; Humans; Intervention; interventions; long-term care; Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Neurology; Nursing homes; Organic mental disorders. Neuropsychology; Organizational Innovation; Practice Guidelines as Topic; Precision Medicine - methods; Precision Medicine - standards; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Quality of care; Quality of Health Care - standards; residential aged care; staff; Stress, Psychological - etiology; Sweden
• ISSN: 1041-6102; 1741-203X; 1741-203X
• DOI: 10.1017/S1041610214000258

Person-centeredness has had substantial uptake in the academic literature on care of older people and people with dementia. However, challenges exist in interpreting and synthesizing the evidence on effects of providing person-centered care, as the person-centered components of some intervention studies are unclear - targeting very different and highly specific aspects of person-centeredness, as well as not providing empirical data to indicate the extent to which care practice was actually perceived to become more person-centered post-intervention. The study employed a quasi-experimental, one-group pre-test-post-test design with a 12-month follow-up to explore intervention effects on person-centeredness of care and the environment (primary endpoints), and on staff strain and stress of conscience (secondary endpoints). The intervention resulted in significantly higher scores on person-centeredness of care at follow-up, and the facility was rated as being significantly more hospitable at follow-up. A significant reduction of staff stress of conscience was also found at follow-up, which suggests that, to a larger extent, staff could provide the care and activities they wanted to provide after the intervention. The results indicated that an interactive and step-wise action-research intervention consisting of knowledge translation, generation, and dissemination, based on national guidelines for care of people with dementia, increased the staff self-reported person-centeredness of care practice, perceived hospitality of the setting, and reduced staff stress of conscience by enabling staff to provide the care and activities they want to provide.