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Backman, A. C., Ahnlund, P., Sjögren, K., Lövheim, H., McGilton, K. S. & Edvardsson, D. (2020). Embodying person-centred being and doing: Leading towards person-centred care in nursing homes as narrated by managers. Journal of Clinical Nursing, 29(1-2), 172-183
Open this publication in new window or tab >>Embodying person-centred being and doing: Leading towards person-centred care in nursing homes as narrated by managers
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2020 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 29, no 1-2, p. 172-183Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES: To explore how managers describe leading towards person-centred care in Swedish nursing homes.

BACKGROUND: Although a growing body of research knowledge exists highlighting the importance of leadership to promote person-centred care, studies focused on nursing home managers' own descriptions of leading their staff towards providing person-centred care is lacking.

DESIGN: Descriptive interview study. COREQ guidelines have been applied.

METHODS: The study consisted of semi-structured interviews with 12 nursing home managers within 11 highly person-centred nursing homes purposively selected from a nationwide survey of nursing homes in Sweden. Data collection was performed in April 2017, and the data were analysed using content analysis.

RESULTS: Leading towards person-centred care involved a main category; embodying person-centred being and doing, with four related categories: operationalising person-centred objectives; promoting a person-centred atmosphere; maximising person-centred team potential; and optimising person-centred support structures.

CONCLUSIONS: The findings revealed that leading towards person-centred care was described as having a personal understanding of the PCC concept and how to translate it into practice, and maximising the potential of and providing support to care staff, within a trustful and innovative work place. The findings also describe how managers co-ordinate several aspects of care simultaneously, such as facilitating, evaluating and refining the translation of person-centred philosophy into synchronised care actions.

RELEVANCE TO CLINICAL PRACTICE: The findings can be used to inspire nursing home leaders' practices and may serve as a framework for implementing person-centred care within facilities. A reasonable implication of these findings is that if organisations are committed to person-centred care provision, care may need to be organised in a way that enables managers to be present on the units, to enact these strategies and lead person-centred care.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020
Keywords
aged care, elder care, leadership, long-term care, management, nursing research, person-centred, qualitative descriptive
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-165634 (URN)10.1111/jocn.15075 (DOI)31612556 (PubMedID)2-s2.0-85074759005 (Scopus ID)
Available from: 2019-12-02 Created: 2019-12-02 Last updated: 2020-03-23Bibliographically approved
Lämås, K., Bölenius, K., Sandman, P.-O., Bergland, Å., Lindkvist, M. & Edvardsson, D. (2020). Thriving among older people living at home with home care services-A cross-sectional study. Journal of Advanced Nursing, 76(4), 999-1008
Open this publication in new window or tab >>Thriving among older people living at home with home care services-A cross-sectional study
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2020 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 76, no 4, p. 999-1008Article in journal (Refereed) Published
Abstract [en]

AIM: To explore the level of thriving and associated factors among older adults living at home with support from home care services.

DESIGN: An exploratory, cross-sectional survey design.

METHOD: A sample of 136 participants (mean 82 years) responded to a survey about thriving, health, psychosocial and care-related factors in 2016. Descriptive analysis and multiple logistic regression analysis with a stepwise backwards elimination procedure were performed.

RESULT: The results showed that the level of thriving was relatively high among adults living at home with support from home care services, with dimensions concerning engaging in activities and peer relations and keeping in touch with people and places being rated the lowest. Regression analysis showed that participating in social relations and experiencing self-determination in activities in and around the house were associated with thriving.

CONCLUSION: Facilitating social relations and creating opportunities for self-determination seem necessary to support thriving among older adults living at home with support from home care services.

IMPACT: The findings in this study add important knowledge about place-related well-being when living at home with home care services.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020
Keywords
aged, health, home care service, nursing, older adults, thriving, well-being
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-168382 (URN)10.1111/jan.14307 (DOI)000512802700001 ()31994235 (PubMedID)
Available from: 2020-02-21 Created: 2020-02-21 Last updated: 2020-03-26Bibliographically approved
Corneliusson, L., Sköldunger, A., Sjögren, K., Lövheim, H., Lindkvist, M., Wimo, A., . . . Edvardsson, D. (2020). Well‐being and Thriving in Sheltered Housing versus Ageing in Place: Results from the U‐Age Sheltered Housing Study. Journal of Advanced Nursing, 73(3), 856-866
Open this publication in new window or tab >>Well‐being and Thriving in Sheltered Housing versus Ageing in Place: Results from the U‐Age Sheltered Housing Study
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2020 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, no 3, p. 856-866Article in journal (Refereed) Published
Abstract [en]

Aims: To explore to what extent type of residence (sheltered housing or ageing in place) contributes to thriving and well-being in older adults, when controlling for age, sex, living alone, being a widow and adjusting for functional status, self-rated health, and depressive mood.

Design: A matched cohort study.Methods A self-report survey was sent out to a total population of residents in all sheltered housings in Sweden and a matched control group ageing in place (N = 3,805). The data collection took place between October 2016-January 2017.

Results: The interaction analyses related to thriving showed that with increasing level of depressive mood and decreasing levels of self-rated health and functional status, those residing in sheltered housing generally reported higher levels of thriving, as compared with those ageing in place. Well-being was not found to be significantly associated with type of accommodation.

Conclusion: There may be features in sheltered housing that are associated with resident thriving especially among individuals with impairments of function, health or mood, although further studies are required to identify these specific features.

Impact: This study informs staff and policymakers about thriving and well-being in sheltered housing accommodations. These findings may be used to further the development of sheltered housing accommodations.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020
Keywords
aged, cohort study, housing for the elderly, nursing, older people, quality of life, residence characteristics, social participation, thriving, well-being
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-166130 (URN)10.1111/jan.14285 (DOI)000512486200010 ()31814145 (PubMedID)
Available from: 2019-12-12 Created: 2019-12-12 Last updated: 2020-03-26Bibliographically approved
Wilberforce, M., Sköldunger, A. & Edvardsson, D. (2019). A Rasch analysis of the Person-Centred Climate Questionnaire - staff version. BMC Health Services Research, 19(1), 1-9, Article ID 996.
Open this publication in new window or tab >>A Rasch analysis of the Person-Centred Climate Questionnaire - staff version
2019 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, no 1, p. 1-9, article id 996Article in journal (Refereed) Published
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.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
Person-centred care, Psychometrics, Dementia, Care quality, Rasch analysis
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-167963 (URN)10.1186/s12913-019-4803-9 (DOI)000506204300002 ()31878914 (PubMedID)
Available from: 2020-02-25 Created: 2020-02-25 Last updated: 2020-02-25Bibliographically approved
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: 2019-12-11Bibliographically 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, 75(11), 2526-2534
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 1365-2648, Vol. 75, no 11, p. 2526-2534Article in journal (Refereed) Published
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.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
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)000492705000022 ()30937934 (PubMedID)2-s2.0-85064927450 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-4016Swedish Research Council, 2014-2715
Available from: 2019-05-06 Created: 2019-05-06 Last updated: 2020-01-07Bibliographically approved
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: 2019-12-11Bibliographically approved
Nichols, E., Szoeke, C. E. I., Vollset, S. E., Abbasi, N., Abd-Allah, F., Abdela, J., . . . Murray, C. J. L. (2019). Global, regional, and national burden of Alzheimer's disease and other dementias, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurology, 18(1), 88-106
Open this publication in new window or tab >>Global, regional, and national burden of Alzheimer's disease and other dementias, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016
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2019 (English)In: Lancet Neurology, ISSN 1474-4422, E-ISSN 1474-4465, Vol. 18, no 1, p. 88-106Article in journal (Refereed) Published
Abstract [en]

Background: The number of individuals living with dementia is increasing, negatively affecting families, communities, and health-care systems around the world. A successful response to these challenges requires an accurate understanding of the dementia disease burden. We aimed to present the first detailed analysis of the global prevalence, mortality, and overall burden of dementia as captured by the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016, and highlight the most important messages for clinicians and neurologists.

Methods: GBD 2016 obtained data on dementia from vital registration systems, published scientific literature and surveys, and data from health-service encounters on deaths, excess mortality, prevalence, and incidence from 195 countries and territories from 1990 to 2016, through systematic review and additional data-seeking efforts. To correct for differences in cause of death coding across time and locations, we modelled mortality due to dementia using prevalence data and estimates of excess mortality derived from countries that were most likely to code deaths to dementia relative to prevalence. Data were analysed by standardised methods to estimate deaths, prevalence, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs; computed as the sum of YLLs and YLDs), and the fractions of these metrics that were attributable to four risk factors that met GBD criteria for assessment (high body-mass index [BMI], high fasting plasma glucose, smoking, and a diet high in sugarsweetened beverages).

Findings: In 2016, the global number of individuals who lived with dementia was 43.8 million (95% uncertainty interval [UI] 3 7. 8-51.0), increased from 20.2 million (17. 4-23 5) in 1990. This increase of 117% (95% UI 114-121) contrasted with a minor increase in age-standardised prevalence of 1.7% (1.0-2.4), from 701 cases (95% UI 602-815) per 100 000 population in 1990 to 712 cases (614-828) per 100 000 population in 2016. More women than men had dementia in 2016 (27.0 million, 95% UI 23 .3-31. 4, vs 16.8 million, 14.4-19.6), and dementia was the fifth leading cause of death globally, accounting for 2.4 million (95% UI 2.1-2.8) deaths. Overall, 28.8 million (95% UI 24. 5-34. 0) DALYs were attributed to dementia; 6.4 million (95% UI 3 .4-10. 5) of these could be attributed to the modifiable GBD risk factors of high BMI, high fasting plasma glucose, smoking, and a high intake of sugar-sweetened beverages.

Interpretation: The global number of people living with dementia more than doubled from 1990 to 2016, mainly due to increases in population ageing and growth. Although differences in coding for causes of death and the heterogeneity in case-ascertainment methods constitute major challenges to the estimation of the burden of dementia, future analyses should improve on the methods for the correction of these biases. Until breakthroughs are made in prevention or curative treatment, dementia will constitute an increasing challenge to health-care systems worldwide.

Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-166521 (URN)10.1016/S1474-4422(18)30403-4 (DOI)000453007700024 ()30497964 (PubMedID)
Available from: 2019-12-17 Created: 2019-12-17 Last updated: 2019-12-17Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-8787-2327

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