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Background: Research suggests that person-centred care can be beneficially implemented and sustained, even though barriers remain that prevent uptake in clinical practice. Understanding barriers to person-centred care seems important, as this has an impact on care practices and resident outcomes. Moreover, there is limited knowledge about nursing home managers' descriptions of barriers when leading person-centred care.

Objectives: To explore barriers to leading person-centred care as narrated by nursing home managers.

Methods: A descriptive qualitative design was used to collect data using individual interviews with 12 nursing home managers in highly person-centred nursing homes. Data were analysed using content analysis.

Results: Multi-level barriers to leading person-centred care were identified on the (1) person level, (2) team level and (3) organisational level. Placing professional and family considerations ahead of resident considerations was described as a barrier on the personal level (1). Also, staff's divergent care values, processes, and priorities together with turnover and low foundational knowledge were identified as barriers on the team level (2). On an organisational level (3), constrained finances, functional building design and group level rostering were identified as barriers.

Conclusion: Multi-level barriers influence nursing home managers' ability to lead and promote person-centred care. Promoting the development of person-centred practices requires efforts to eliminate barriers on person, team and organisational level.

Implications for Practice: Identifying and overcoming barriers at various levels in nursing home care has the potential to promote person-centred practices. This study can inform stakeholders and policymakers of challenges and complexities in person-centred practices. Multi-level strategies are needed to target challenges at person-, team- and organisational level when striving to develop person-centred care.

Summary: An interview study was conducted with persons receiving home care services and personal assistance in Sweden (13 individuals, 25 interviews) with the aim to analyze their experiences of managing personal and intimate care. The analytical approach was guided by phenomenologically informed research and Erving Goffman's theoretical work on self-presentation and social life as it differs in frontstage and backstage settings.

Findings: A reflected approach to the complex challenges associated with becoming and being a person in need of personal and intimate care was revealed. This involved continuous adaptations and attuning to organizational and relational conditions of formal home care. Being a recipient of personal and intimate care does not mean being passive. It entails relating to and sustaining the care relation, where even choosing to accept suboptimal conditions is an act of agency. The recipients’ private homes were hybridized, transformed both into a waiting room, with the recipient on standby and into a workplace. The homes thus partly lost their character as a backstage realm where one could avoid the gaze of others. This also led to a hybridization of the personal sphere, in the form of marginal scope for true privacy, necessitating strategies for protecting one's own space.

Applications: It is important both to acknowledge the intrusive nature of personal and intimate care, which results in extensive hybridization of the home and personal sphere and to recognize care recipients’ agency in the relationship that care establishes.

Sweden, as a welfare state, has a long tradition of providing formal home care and support to their citizens in their own homes, either through home care services or personal assistance. A large percentage of frail elderly and persons with disability who receive formal home care require personal and intimate care, such as help with eating, showering, getting dressed and personal hygiene. Managing intimacy and safeguarding the care recipient’s integrity pose particular challenges for staff. The aim of this qualitative interview study is to describe and analyse care workers’ (CWs) and personal assistants’ (PAs) strategies for managing situations and challenges related to provision of personal and intimate care in the context of formal home care. Semi-structured interviews with eleven CWs and nine PAs were conducted. Our analysis reveals a complex repertoire of relational and communicative strategies, within an overall approach - which we labelled 'empathetic attuning'—of relating to the current situation and task at hand whilst safeguarding integrity. These strategies were intertwined with dimensions of time. The possibility to accomplish satisfactory personal and intimate care rests on structural and organisational conditions that promote sustainable working conditions, where relations characterised by continuity, integrity and respect can be realised.

Sweden has a long tradition of providing social care and support to its citizens in their own homes through formal home care, delivered either by home care services or personal assistance. A majority of people given support by formal home care need assistance with personal and intimate care. The focus of this interview study was on exploring care recipients’, care workers’, personal assistants’ and care unit managers’ perceptions and experiences of intimate and personal care in the context of formal home care in Sweden. In total, 57 interviews were conducted with 42 persons. Three themes emerged in the analysis: Personal Hygiene, Personal Sphere, and The Contextual Variability of Intimacy. Interviewees described intimate care as being inseparable from a person’s service needs as a whole. Highlighted was how caring for and washing intimate body parts, intrusion into recipients’ personal spheres, and the need to preserve integrity vary depending on situational, temporal and relational aspects. To safeguard the care recipient’s influence, integrity and dignity in the reception/provision of care work, home care services and personal assistance, it is important to raise awareness of the variation in perceptions of intimate and personal care in education and inhouse training.

I Sverige får ett stort antal sköra äldre och personer med funktionsnedsättning omsorg i hemmet, i form av hemtjänst och/eller personlig assistans. För majoriteten av omsorgsmottagare utgör personlig och intim omsorg både ett centralt och vardagligt inslag i verksamheterna. Fokus för denna intervjustudie var att undersöka omsorgsmottagares, omsorgspersonals och enhetschefers uppfattning om och erfarenheter av personlig och intim omsorg i hemtjänst och personlig assistans. Totalt genomfördes 57 intervjuer med 42 personer. Tre övergripande teman framkom i analysen; personlig hygien, personlig sfär och kontextuell variation av intimitet. Intervjupersonerna beskriver personlig och intim omsorg som något som inte går att separera från behovet av omsorg som helhet. Analysen visar hur intim omsorg och överträdelser av omsorgsmottagarens personliga sfär, samt behovet av att trygga omsorgsmottagarens integritet, varierar beroende på situationella, temporala och relationella aspekter. För att säkra omsorgstagares inflytande, integritet och värdighet i samband med omsorgsarbete, är det viktigt att i utbildning och inskolning skapa en ökad medvetenhet om olikheter och variationer i uppfattningar av vad som räknas som personligt och intimt i hemtjänst och personlig assistans.

Det praktiska sociala arbetet bygger alltmer på vetenskaplig och empiriskt baserad kunskap. Samhället blir alltmer komplext vilket leder till att kunskapsutveckling och forskningsmetoder utgör en allt viktigare del inom såväl utbildningen av socionomer som i andra samhällsvetenskapliga utbildningar. 

Att forska i socialt arbete behandlar forskningsmetodik i relation till empiriska studier av det sociala arbetet. Bokens kapitel speglar variationer i forskningsmetodik och olika metodologiska angrepps­­sätt diskuteras ur olika aspekter. Kapitelförfattarna disku­terar och beskriver allt från kunskapsteori och forskningsetik till forsknings­traditioner samt såväl kvalitativa som kvantitativa analysmetoder. 

I denna andra omarbetade upplaga har alla kapitel reviderats och uppdaterats, vidare finns också några helt nyskrivna kapitel. 

Att forska i socialt arbete vänder sig till studerande på socionom­programmen samt till studerande och yrkesverksamma inom välfärdsområdet.

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.