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The implementation and effects of person-centred care in residential care facilities have been explored in previous studies of staff or older people, as has the importance of leadership for person-centred care implementation. There is, however, sparse knowledge of the leaders' understanding of person-centred care. This study therefore aimed to explore how discourses of person-centred care are constructed in the narratives of leaders of residential care for older people. The material consisted of individual and focus group interviews with 36 leaders (i.e., first-line managers and registered nurses) of residential care facilities in seven Swedish municipalities, conducted October 2021–December 2022. The transcribed interviews were analysed using discourse analysis to explore discursive tensions and contradictions appearing in the leaders' narratives. The results indicated that the leaders constructed the meaning of person-centred care as taking older persons' autonomy, individual needs, and care environment into account; the results also exposed inherent paradoxes in their discourses on the meaning of respect for autonomy, the significance of past and present, and the shared environment. The study highlights that leaders’ ways of constructing the meaning of person-centred care vary, despite existing frameworks and policies promoting person-centred care. This, in turn, has implications for how person-centred care is applied in the everyday care of older persons, as residential care facility leaders play a crucial role in providing practical support to staff, helping them navigate the associated challenges. Rather than additional guidelines or policies, there seems to be an urgent need for critical dialogue on the understanding and practical application of person-centred care in residential care facilities and other complex healthcare organizations.

Aim: To cross-culturally adapt a framework for person-centred leadership in residential care for older people in Sweden.

Design: This study has an exploratory and descriptive design.

Methods: The translation procedure followed a cyclic process of translation into Swedish and back-translation into English by two independent bilingual linguists. An evaluation of conceptual and semantic equivalence and comprehensiveness between the original English version and the translated Swedish version was performed by an expert committee. The translated version of the framework was validated by leaders (n = 34) in residential care, who assessed its relevance through a web form. The adaptation of the framework followed recommended guidelines for cross-cultural adaptation.

Results: The translation procedure resulted in two minor changes related to the wording in two descriptors. The results of the validation procedure showed that the framework is relevant for leaders in Swedish residential care for older people. Conclusion: The cross-culturally adapted framework is useful and suitable for leaders in Swedish residential care for older people. The framework clarifies the leader's role and identifies leadership attributes and requirements for person-centred leadership in residential care, thereby providing support to leaders by framing person-centred leadership.

Implications for the Profession and/or Patient Care: The framework can be used as a guide for leadership training and/or development initiatives in residential care. It can be further extended to nursing curriculums, leadership development programs, and organisational performance and development processes. It may also provide a foundation for policy and guidelines by establishing the activities required for leaders to promote person-centredness in the care of older people.

Reporting Method: This study followed the STROBE checklist for cross-sectional studies.

Patient and Public Contribution: There was no patient or public contribution.

Background: The COVID-19 pandemic placed considerable pressure on nursing homes, where care workers faced high workloads, uncertainty, and emotional strain while also being expected to implement extensive infection prevention and control (IPC) measures. Understanding how such everyday experiences affect adherence to IPC measures is essential for strengthening future guideline implementation and training. This study aimed to explore care workers’ experiences during the COVID-19 pandemic, with a focus on IPC measures and the realities of everyday work.

Methods: A qualitative descriptive design was used. Semi-structured interviews were conducted with 22 nurse assistants and care aides from 19 nursing homes in northern and southern Sweden (May–November 2023). The interviews were recorded, transcribed and then analyzed using inductive qualitative content analysis. The study was guided by the Consolidated Criteria for Reporting Qualitative Research.

Results: Three main categories captured nurse assistants’ and care aides’ experiences of how demanding everyday realities during the pandemic shaped adherence to IPC measures. (1) Organizational determinants highlighted the importance of leadership presence, clear information, and resource availability. (2) Individual aspects described how knowledge, beliefs, and physical discomfort influenced motivation to adhere. (3) Ethical issues related to IPC measures reflected tensions between IPC practices and meeting residents’ social and emotional needs.

Conclusions: This study highlights how leadership, resources, and knowledge supported IPC adherence, while personal beliefs and ethical implications complicated practice. Future preparedness requires policies that integrate organizational support with the human dimensions of care, ensuring that infection control and dignified care are mutually reinforced.

Objectives: The aim of the present study was to describe the association between behavioral and psychological symptoms and psychotropic drug use among older Swedish nursing home residents with cognitive impairment.

Methods: Data was collected from a questionnaire survey which was sent out between 4 and 12 February 2019 within the Swedish National Inventory of Care and Health in Residential Aged Care (SWENIS) II. Sixty municipalities in Sweden were randomly selected and invited. Of these, 49 municipalities accepted the invitation. Six withdrew resulting in 43 participating municipalities and 187 nursing homes. The final study population comprised 1,541 participants, 65 years or older, with cognitive impairment. The Swedish Prescribed drug register was utilized to identify psychotropic drug use. Backward eliminating binary logistic regression analyses were conducted.

Results: At least one psychotropic drug was used of 80.8% of the study population, 20.5% used at least one antipsychotic drug, 32.0% used anxiolytic drugs, 21.3% used hypnotic and sedatives, 58.4% used antidepressants and 32.1% of the residents used antidementia drugs. Among residents with mild cognitive impairment, anxiolytics were significantly associated with anxiety. Also, anxiolytics and hypnotics and sedatives were significantly associated with sleep and nighttime behavior disorders. Antidepressants were significantly associated with depression/dysphoria. The same pattern was found among residents with moderate cognitive impairment. However, anxiolytics were also significantly associated with worsening depression/dysphoria. Hypnotics and sedatives were also associated with anxiety and hallucinations. Moreover, antipsychotic drug use was significantly associated with agitation/aggression and anxiety. Among residents with severe cognitive impairment, antipsychotics, anxiolytics and hypnotics and sedatives were significantly associated with aberrant motor behavior. Anxiolytics were also significantly associated with anxiety and apathy/indifference, and hypnotics and sedatives were significantly associated with agitation/aggression and depression/dysphoria.

Conclusions: Psychotropic drug use is remarkably high among Swedish nursing home residents but the prevalence of antidementia drugs is somewhat low. Associations found, call for further studies examining the treatment of behavioral and psychological symptoms (BPS) in this vulnerable group of people.

Background: Although the benefits of person-centered care (PCC) are widely recognized, there is a lack of empirical research on how PCC is best developed and implemented by the leaders responsible for driving such initiatives. To achieve meaningful change and ensure the sustainability of PCC practices, it is crucial to understand how leaders can foster care environments rooted in person-centered values while managing operational challenges. This knowledge gap highlights the need for an in-depth exploration of the conceptual foundations, experiences, mechanisms, strategies, and outcomes of person-centered leadership (PCL) to design an intervention for strengthening such leadership.

Objective: The Person-Centered Care and Leadership in Residential Care Facilities (PERLE) study aims to (1) explore and develop tools to measure PCL; (2) develop, test, implement, and investigate the effects of an intervention to strengthen PCL in residential care facilities (RCFs) for older people; and (3) generate knowledge about the process of development and implementation of the intervention.

Methods: The PERLE study builds on the Medical Research Council framework for the development of complex interventions. It includes several studies with exploratory, descriptive, correlational, and quasi-experimental designs and is based on the research group’s previous research on PCL. The project is composed of 5 work packages (WPs). Each WP includes research questions with different samples; data collection; and methodological approaches, such as qualitative, mixed methods, and quantitative studies. As this project involves sensitive issues, a high level of ethical awareness was maintained throughout. The primary challenge is the possible interference with participants’ work time, which could otherwise be devoted to supporting older people and staff. Nevertheless, the involvement of leaders and staff can lead to valuable knowledge that can improve the quality of PCC. Participants will be provided with both oral and written information about the study and assured of their right to withdraw at any time without providing a reason.

Results: As of July 2025, 6 studies in WP I have been conducted, and one is in progress. The conducted studies address leaders’ understanding of PCC, the meaning of PCL in RCFs from the perspective of leaders, the ethical challenges in providing PCC during the COVID-19 pandemic, and the cultural adaptation of the aged care clinical leadership qualities framework.

Conclusions: This project aims to provide new insights into the support that first-line managers need to advance PCC in RCFs, highlight their specific challenges, and create tailored support measures for the implementation of PCL. The intervention could potentially reduce staff turnover and related costs while supporting leadership training and education to benefit future leaders in aged care, which may be important from an international perspective.

Introduction: Early in 2020, the World Health Organisation (WHO) declared COVID-19 to be a pandemic. Older people were especially vulnerable to illness and death from the virus. For care staff, including assistant nurses (ANs) working in residential care facilities (RCFs), many circumstances related to the pandemic caused ethical challenges.

Aim: The aim of this study was to explore ANs' experiences of ethical challenges during the pandemic, while working in RCFs for older people in Sweden.

Methods: This study used an explorative qualitative design based on focus group interviews with 19 ANs. The interviews were analysed using thematic analysis.

Results: Ethical challenges faced by ANs in RCFs during the pandemic included (a) being unable to give dignified care, depriving older people of their human rights; (b) being duty-bound to follow restrictions despite the suffering of relatives, witnessing injustice; (c) facing the deprioritisation of older people, being part of providing care on unequal terms; (d) being restricted and devalued, feeling abandoned; (e) being forced to adhere to personal constraints, having integrity and autonomy severely violated; and (f) fulfilling duty with life at stake, sensing the fear.

Conclusion: During the pandemic, ANs in Sweden experienced ethical challenges in the care of older people in RCFs, as well as personal ethical challenges. Such challenges arose in various situations, and their consequences entailed undignified and compromised care.

Aim: The aim of this work was to investigate whether leadership, person-centred care and social interactions are associated with residents' health, including cognitive impairment, neuropsychiatric symptoms, activities of daily living and health-related quality of life, and to assess whether these relationships change over a period of 5 years.

Design: A repeated cross-sectional survey study was carried out in 2014 and 2019. Valid and reliable scales were used to assess leadership, person-centred care, neuropsychiatric symptoms, cognition, activities of daily living and health-related quality of life. The study involved care units participating in both surveys (n = 182). At T1, there were 1587 residents and 1239 staff. At T2, there were 1382 residents and 1169 staff. Regression analyses were used. Interaction analyses explored changes over time, emphasising leadership and PCC as the main explanatory variables.

Results: Stability was observed over time for person-centred care in relation to health-related quality of life, neuropsychiatric symptoms, activities of daily living function and cognitive function. Person-centred care was associated with a higher level of health-related quality of life and cognitive function, and a lower level of neuropsychiatric symptoms. Leadership showed no significant association with the outcomes.

Patient or Public Contribution: Residents did not actively participate in the study, as data was obtained by proxy rating. No public was involved in the design, data collection, or dissemination plans of this study.

Aims and objectives: To explore person-centred leadership in residential care from the perspective of first-line managers.

Background: Studies have shown that person-centred leadership is important for leading person-centred care. Although person-centred care is the current model of care, there is limited knowledge of what person-centred leadership entails in the context of residential care for older people.

Methods: This was an exploratory qualitative study using focus groups and individual interviews with 21 first-line managers in residential care facilities for older persons in five municipalities in Sweden. Data were collected from October 2021 to March 2022. Data were analysed using conventional content analysis.

Findings: Person-centred leadership entailed being person-centred as a leader, focusing on the relationship with personnel, and leading person-centred care by highlighting the older persons’ needs.

Conclusions: Being person-centred as a leader involves acknowledging the personhood of personnel in words and actions, which has the potential to promote person-centred practices. Person-centred leadership entails promoting personnel to meet older person’s changing needs, which must drive operations, while simultaneously trying to meet the needs of personnel.

Registered nurses’ leadership involves promoting and implementing the recommended model of care, person-centred care, in residential care facilities. Research on registered nurses’ leadership of person-centred care is, however, limited. The aim was to explore person-centred leadership in residential care for older people from the perspective of registered nurses.

Methods: Focus-group and individual interviews were conducted with registered nurses (n = 15) working clinically in residential care facilities in seven municipalities in southern and northern Sweden. All interviews were performed digitally. Data were analysed using qualitative content analysis.

Results: Person-centred leadership meant leading through sense-making person-centredness in a complex care environment. This required both skills and abilities in leading person-centred care, while simultaneously managing various challenges in leading person-centred care.

Conclusions: This study explores the skills required for person-centred leadership and the challenges of applying these skills. The results advance our knowledge by conceptualising person-centred leadership among registered nurses in residential care facilities by sense-making person-centredness in a fragmented organisation. The results indicate that registered nurses’ person-centred leadership is defined by their beliefs, abilities, and actions and not always by their position of authority.

Implications: Person-centred leadership has the potential to improve the person-centred care of older people, which is why the challenges encountered in practice need to be addressed. Knowledge of registered nurses’ experiences of person-centred leadership can be used to improve their skills and abilities in leading person-centred care and to appropriately address the organisational challenges encountered in residential care facilities.