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Edvardsson, D., Baxter, R., Corneliusson, L., Anderson, R. A., Beeber, A., Boas, P. V., . . . Zuniga, F. (2019). Advancing Long-Term Care Science Through Using Common Data Elements: Candidate Measures for Care Outcomes of Personhood, Well-Being, and Quality of Life. Gerontology and geriatric medicine, 5
Open this publication in new window or tab >>Advancing Long-Term Care Science Through Using Common Data Elements: Candidate Measures for Care Outcomes of Personhood, Well-Being, and Quality of Life
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2019 (English)In: Gerontology and geriatric medicine, E-ISSN 2333-7214, Vol. 5Article in journal (Refereed) Published
Abstract [en]

To support the development of internationally comparable common data elements (CDEs) that can be used to measure essential aspects of long-term care (LTC) across low-, middle-, and high-income countries, a group of researchers in medicine, nursing, behavioral, and social sciences from 21 different countries have joined forces and launched the Worldwide Elements to Harmonize Research in LTC Living Environments (WE-THRIVE) initiative. This initiative aims to develop a common data infrastructure for international use across the domains of organizational context, workforce and staffing, person-centered care, and care outcomes, as these are critical to LTC quality, experiences, and outcomes. This article reports measurement recommendations for the care outcomes domain, focusing on previously prioritized care outcomes concepts of well-being, quality of life (QoL), and personhood for residents in LTC. Through literature review and expert ranking, we recommend nine measures of well-being, QoL, and personhood, as a basis for developing CDEs for long-term care outcomes across countries. Data in LTC have often included deficit-oriented measures; while important, reductions do not necessarily mean that residents are concurrently experiencing well-being. Enhancing measurement efforts with the inclusion of these positive LTC outcomes across countries would facilitate international LTC research and align with global shifts toward healthy aging and person-centered LTC models.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
long-term care, care homes, measurement, personhood, quality of life, well-being
National Category
Gerontology, specialising in Medical and Health Sciences Nursing
Identifiers
urn:nbn:se:umu:diva-161865 (URN)10.1177/2333721419842672 (DOI)000475377200001 ()31106240 (PubMedID)
Available from: 2019-08-06 Created: 2019-08-06 Last updated: 2019-08-29Bibliographically approved
Grealish, L., Simpson, T., Soltau, D. & Edvardsson, D. (2019). Assessing and providing person-centred care of older people with cognitive impairment in acute settings: threats, variability, and challenges. Collegian, 26(1), 75-79
Open this publication in new window or tab >>Assessing and providing person-centred care of older people with cognitive impairment in acute settings: threats, variability, and challenges
2019 (English)In: Collegian, ISSN 1322-7696, E-ISSN 1876-7575, Vol. 26, no 1, p. 75-79Article in journal (Refereed) Published
Abstract [en]

Background: Person-centred care is widely accepted in health policy as a central focus for health services. However, research studies indicate that, for nurses, the person-centred care of older people with cognitive impairment is challenging. Aim: This study aimed to compare levels of person-centred care between wards and professional groups (ENs and RNs) providing tertiary hospital care of older people with cognitive impairment. Methods: A descriptive cross-sectional survey design, using the 15-item Person-centredness of Older People with cognitive impairment in Acute Care (POPAC) survey instrument, was undertaken. Results: Nurses working in hospital wards of a tertiary-level health service (n = 240; RR = 54.3%) responded. Person-centred care was rated lower in wards with higher patient turnover compared to wards with lower patient turnover. Person-centred care was rated higher by enrolled nurses compared to registered nurses. Discussion: Hospital context, specifically high turnover wards, present a threat to person-centred care, possibly related to the limited time available to undertake the personal care and associated conversations that can enhance nurses' knowledge of the person. ENs carry more responsibility for these tasks, possibly explaining the variability in person-centred scores between RNs and ENs. In comparison to other studies, nurses in this study had higher average scores for person-centred care, raising measurement as an important challenge in monitoring the implementation of person-centred care policy. Conclusion: The focus on health service efficiency appears to pose a threat to nurses' delivery of person-centred care. Further research into the variability between person-centred care of RNs and ENs, and investigation into the practices of other health disciplines would be valuable. Given the importance of person-centred care to the safety and quality of health services, the POPAC addresses the challenge of monitoring person-centred policy initiatives. However, self-report instruments should be balanced with other sources of information about practice. (C) 2018 Australian College of Nursing Ltd. Published by Elsevier Ltd.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE BV, 2019
Keywords
person-centred, older person, cognitive impairment, dementia, acute care
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-157532 (URN)10.1016/j.colegn.2018.03.009 (DOI)000460754300012 ()
Available from: 2019-04-01 Created: 2019-04-01 Last updated: 2019-04-01Bibliographically approved
Vassbø, T. K., Kirkevold, M., Edvardsson, D., Sjögren, K., Lood, Q., Sandman, P.-O. & Bergland, Å. (2019). Associations between job satisfaction, person-centredness, and ethically difficult situations in nursing homes: A cross-sectional study. Journal of Advanced Nursing, 75(5), 979-988
Open this publication in new window or tab >>Associations between job satisfaction, person-centredness, and ethically difficult situations in nursing homes: A cross-sectional study
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2019 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 75, no 5, p. 979-988Article in journal (Refereed) Published
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.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2019
Keywords
cross-sectional study, ethical difficult situations, nursing home staff, person-centred care, person-centred climate
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-158317 (URN)10.1111/jan.13890 (DOI)000465107000007 ()30375019 (PubMedID)
Available from: 2019-04-23 Created: 2019-04-23 Last updated: 2019-09-05Bibliographically approved
Lood, Q., Kirkevold, M., Sjögren, K., Bergland, Å., Sandman, P.-O. & Edvardsson, D. (2019). Associations between person-centred climate and perceived quality of care in nursing homes: a cross-sectional study of relatives' experiences. Journal of Advanced Nursing
Open this publication in new window or tab >>Associations between person-centred climate and perceived quality of care in nursing homes: a cross-sectional study of relatives' experiences
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2019 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648Article in journal (Refereed) Epub ahead of print
Abstract [en]

AIMS: To explore the extent to which a more person-centred climate could explain the variation in quality of care, as rated by relatives to nursing home residents in three countries.

DESIGN: A cross-sectional, correlational, anonymous questionnaire study.

METHODS: Questionnaires were administered to 346 relatives to residents in six nursing homes in Australia, Norway and Sweden between April-June 2016. Relatives (N = 178) agreed to participate. Data were analysed using descriptive statistics and hierarchical multiple regression.

RESULTS: The results showed that the relatives' experiences of a more person-centred climate were associated with higher ratings of the quality of care. A person-centred climate of safety had the strongest unique association with the quality of care, explaining 14% of the variance in quality of care. In addition, the results indicated that the relatives in general were satisfied with the quality of care and that children to the residents rated the quality of care higher than partners or other relatives.

CONCLUSION: This study advances the understanding of the relationship between person-centredness in nursing homes and quality of care, showing that person-centred climate aspects of safety and hospitality have a significant role in the quality of care as perceived by relatives.

IMPACT: Person-centredness in nursing homes is often mentioned as a quality of care indicator, but the empirical evidence for this suggestion is limited. This study expanded the evidence-base for person-centredness as a significant aspect of relatives' experiences of the quality of care in nursing homes.

Keywords
care home, caring environment, family members, nursing, older people, person-centered care, person-centred care, residential aged care
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-158653 (URN)10.1111/jan.14011 (DOI)30937934 (PubMedID)
Available from: 2019-05-06 Created: 2019-05-06 Last updated: 2019-05-07
Baxter, R., Björk, S. & Edvardsson, D. (2019). Commentary on: Sullivan and Willis (2018). Towards Changing the Long-Term Care (LTC) Paradigm: Explicating the Concept of Thriving in Older Adults Living in LTC [Letter to the editor]. Issues in Mental Health Nursing, 40(7), 639-640
Open this publication in new window or tab >>Commentary on: Sullivan and Willis (2018). Towards Changing the Long-Term Care (LTC) Paradigm: Explicating the Concept of Thriving in Older Adults Living in LTC
2019 (English)In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 40, no 7, p. 639-640Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
TAYLOR & FRANCIS INC, 2019
National Category
Psychiatry Nursing
Identifiers
urn:nbn:se:umu:diva-162335 (URN)10.1080/01612840.2019.1590486 (DOI)000477964200014 ()31135240 (PubMedID)
Available from: 2019-08-20 Created: 2019-08-20 Last updated: 2019-08-29Bibliographically approved
Nilsson, A., Edvardsson, D. & Rushton, C. (2019). Nurses’ descriptions of person‐centred care for older people in an acute medical ward—On the individual, team and organisational levels’. Journal of Clinical Nursing, 28(7–8), 1251-1259
Open this publication in new window or tab >>Nurses’ descriptions of person‐centred care for older people in an acute medical ward—On the individual, team and organisational levels’
2019 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, no 7–8, p. 1251-1259Article in journal (Refereed) Published
Abstract [en]

AIM AND OBJECTIVES: To describe nurses' experiences of providing person-centred care for older people on an acute medical ward.

BACKGROUND: There is evidence that person-centred care for older people contributes to a higher quality care and increased satisfaction with care. However, there is a shortness of studies providing concrete examples of what facilitates nurses providing person-centred care for older people in acute care.

DESIGN: An interview study with qualitative content analysis. COREQ guidelines have been applied.

METHOD: Fourteen registered nurses and enrolled nurses from an acute care ward participated in semi structured research interviews. The interviews were conducted during 2016 and interpreted using qualitative content analyses.

RESULTS: Person-centred care was described at different levels in care; at the individual nurse level, person-centred care was described as involving person-centred assessing, relating and spacing which involved personalising assessments, relationships as well as the physical environment. At the team level, person-centred care was described in terms of person-centred goal setting, team responsibilities and team support, and involved having shared and personalised goals, different team responsibilities and a climate of support and collaboration. At the organisational level, person-centred care was described in terms of having person-centred routines, workloads and staff roles that all contributed to put the person at the core of the organisation and build routines to support this.

CONCLUSIONS: The current study emphasises that, rather than confining person-centred care to specific moments or relationships, a systematic, multilevel organisational approach seems needed to enable nurses as individuals and teams to provide person-centred care consistently and continuously to older people in acute care settings.

RELEVANCE TO CLINICAL PRACTICE: The results of this study should inspire nurses and managers to expedite implementation of person-centred care for older care recipients hospitalised in acute care wards. Examples of person-centred care are presented herein at clearly identified sites, namely, the "individual," "team" and "organisational levels."

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
aged, care, emergency nursing, organisation, patient-centred care, person, team, ward
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-155365 (URN)10.1111/jocn.14738 (DOI)000460767400021 ()30552784 (PubMedID)2-s2.0-85059650873 (Scopus ID)
Available from: 2019-01-14 Created: 2019-01-14 Last updated: 2019-04-04Bibliographically approved
Bölenius, K., Lämås, K., Sandman, P.-O., Lindkvist, M. & Edvardsson, D. (2019). Perceptions of self-determination and quality of life among Swedish home care recipients - across-sectional study. BMC Geriatrics, 19, Article ID 142.
Open this publication in new window or tab >>Perceptions of self-determination and quality of life among Swedish home care recipients - across-sectional study
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2019 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 19, article id 142Article in journal (Refereed) Published
Abstract [en]

Background: It is acknowledged that preservation of self-determination is very important in order for older adults to experience good quality of life, but to what degree and in what areas people receiving help from home care service experience self-determination is unknown. Few studies have examined the perception of self-determination in relation to quality of life among older adults living at home with help from home care services. Thus, the aim of this study was to explore perceptions of self-determination among older adults living at home with the support of home care services, and to test whether older adults who perceive a higher degree of self-determination also feel they have a better quality of life.

Methods: This cross-sectional study was conducted in one municipality in northern Sweden. A total of 134 older adults (≥ 65 years) were included. Data were collected by means of a survey including questionnaires about background characteristics, self-determination, and health-related quality of life. Descriptive statistics regarding background characteristics for groups with high and low self-determination respectively were presented and the differences between the groups were analyzed using the Chi-square test and the Mann-Whitney U test.

Results: Our main finding shows that the majority of older adults with support from home care services experience self-determination in the dimensions use of time, and self-care. However, a wide variation was found in self-reported self-determination in all dimensions. Results also show that the group with higher self-reported self-determination also reported a greater degree of experienced quality of life in comparison with the group with lower self-reported self-determination.

Conclusions: In line with earlier research, our results found a positive relation between self-determination and quality of life. The results are relevant for the care of older adults and indicate a need of further research. The results presented in this paper could serve as a guide when planning for improved self-determination among older adults in home care service.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Aged care, Health, Home care services, Nursing care, Older adults, Older people, Self-determination, Quality of life
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-160298 (URN)10.1186/s12877-019-1145-8 (DOI)000468889900006 ()31126243 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2019-06-17 Created: 2019-06-17 Last updated: 2019-06-17Bibliographically approved
Corneliusson, L., Sköldunger, A., Sjögren, K., Lövheim, H., Wimo, A., Winblad, B., . . . Edvardsson, D. (2019). Residing in sheltered housing versus ageing in place: population characteristics, health status and social participation. Health & Social Care in the Community, 27(4), E313-E322
Open this publication in new window or tab >>Residing in sheltered housing versus ageing in place: population characteristics, health status and social participation
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2019 (English)In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 27, no 4, p. E313-E322Article in journal (Refereed) Published
Abstract [en]

Sheltered housing is a housing model that provides accessible apartments with elevated social possibilities for older people, which is expected to increase resident health and independence, reducing the need for care. As previous research on sheltered housing is scarce, the aim of this study was to explore the characteristics, health status and social participation of older people living in sheltered housing, compared to ageing in place. The study utilised baseline data from a matched cohort study survey on a nationally representative total population of residents in all sheltered housings in Sweden, and a matched control group (n = 3,805). The data collection took place between October 2016 and January 2017. The survey assessed functional capability using the Katz ADL and Lawton IADL scale, self-rated health using the EQ5D scale, and depressive mood using the GDS-4 scale. Descriptive statistics, frequencies, mean scores, independent t tests, p-values and effect sizes were utilised to compare the two groups. The results of the study show that older people living in sheltered housing, compared to ageing in place, had lower self-reported health (M = 64.68/70.08, p = <0.001), lower self-reported quality of life (M = 0.73/0.81, p = <0.001), lower functional status concerning activities of daily living (M = 5.19/5.40, p = <0.001), lower functional status concerning instrumental activities of daily living (M = 4.98/5.42 p = <0.001,), and higher probability of depressive mood (M = 0.80/0.58, p = <0.001). The results imply that residents in sheltered housing may have more care needs than those ageing in place. Further longitudinal comparative studies are needed to explore the impact residence in sheltered housing has on resident health and well-being.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
geriatric assessment, health status, housing for the elderly, population characteristics, social participation
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-157108 (URN)10.1111/hsc.12734 (DOI)000471832800013 ()30821865 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-4016Swedish Research Council, 521-2014-2715
Available from: 2019-03-11 Created: 2019-03-11 Last updated: 2019-07-12Bibliographically approved
Sköldunger, A., Wimo, A., Sjögren, K., Björk, S., Backman, A. C., Sandman, P.-O. & Edvardsson, D. (2019). 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). International Journal of Geriatric Psychiatry, 34(1), 130-136
Open this publication in new window or tab >>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)
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2019 (English)In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 34, no 1, p. 130-136Article in journal (Refereed) Published
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.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
ADL, care time, cognitive impairment, neuropsychiatric symptoms, nursing home, resource use, RUD
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-155089 (URN)10.1002/gps.5000 (DOI)000453797600017 ()30246433 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, dnr 2014-4016
Available from: 2019-01-10 Created: 2019-01-10 Last updated: 2019-01-10Bibliographically approved
Baxter, R., Lövheim, H., Björk, S., Sköldunger, A., Lindkvist, M., Sjögren, K., . . . Edvardsson, D. (2019). The Thriving of Older People Assessment Scale: Psychometric evaluation and short‐form development. Journal of Advanced Nursing
Open this publication in new window or tab >>The Thriving of Older People Assessment Scale: Psychometric evaluation and short‐form development
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2019 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aim: To evaluate the psychometric properties and performance of the 32‐item Thriving of Older People Assessment Scale (TOPAS) and to explore reduction into a short‐form.

Background: The 32‐item TOPAS has been used in studies of place‐related well‐being as a positive measure in long‐term care to assess nursing home resident thriving; however, item redundancy has not previously been explored.

Design: Cross‐sectional.

Method: Staff members completed the 32‐item TOPAS as proxy‐raters for a random sample of Swedish nursing home residents (N = 4,831) between November 2013 and September 2014. Reliability analysis, exploratory factor analysis and item response theory‐based analysis were undertaken. Items were systematically identified for reduction using statistical and theoretical analysis. Correlation testing, means comparison and model fit evaluation confirmed scale equivalence.

Results: Psychometric properties of the 32‐item TOPAS were satisfactory and several items were identified for scale reduction. The proposed short‐form TOPAS exhibited a high level of internal consistency (α=0.90) and strong correlation (r=0.98) to the original scale, while also retaining diversity among items in terms of factor structure and item difficulties.

Conclusion: The 32‐item and short‐form TOPAS' indicated sound validity and reliability to measure resident thriving in the nursing home context.

Impact: There is a lack of positive life‐world measures for use in nursing homes. The short‐form TOPAS indicated sound validity and reliability to measure resident thriving, providing a feasible measure with enhanced functionality for use in aged care research, assessments and care planning for health promoting purposes in nursing homes.

Keywords
instrument development, scale reduction, psychometrics, thriving, TOPAS, place‐related well‐being, nursing home residents, long‐term care, nursing
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-162729 (URN)10.1111/jan.14180 (DOI)31441533 (PubMedID)
Available from: 2019-08-27 Created: 2019-08-27 Last updated: 2019-08-30
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-8787-2327

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