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AimTo evaluate the psychometric properties of the Arabic language person-centred climate questionnairestaff version. BackgroundThere have been increasing calls for a person-centred rather than a disease-centred approach to health care. A limited number of tools measure the extent to which care is delivered in a person-centred manner, and none of these tools have been validated for us in Arab settings. MethodThe validated form of the person-centred climate questionnairestaff version was translated into Arabic and distributed to 152 health care staff in teaching and non-teaching hospitals in Saudi Arabia. Statistical estimates of validity and reliability were used for psychometric evaluation. ResultsItems on the Arabic form of the person-centred climate questionnairestaff version had high reliability (Cronbach's alpha .98). Cronbach's alpha values for the three sub-scales (safety, everydayness and community), were .96, .97 and .95 respectively. Internal consistency was also high and measures of validity were very good. ConclusionArabic form of the person-centred climate questionnairestaff version provides a valid and reliable way to measure the degree of perceived person-centredness. Implications for nursing managementThe tool can be used for comparing levels of person-centredness between wards, units, and public and private hospitals. The tool can also be used to measure the extent of person-centredness in health care settings in other Arab countries.

Introduction: Most health care systems strive to improve the quality, safety and value of healthcare, with an emphasis on moving towards patient-centered care/person-centered care (PCC) approach. The aim of the current study was to assess health care providers’ perspectives on PCC climate in hospital setting and to identify the role of providers in determining the perception of the PCC climate.

Methods: A survey, using person-centered climate questionnaire-staff version, was employed in health care providers of a tertiary care hospital. Data included variables age, gender, education level, occupation, and years of experience and three PCC dimensions. PCC overall and subscale scores were reported as mean and standard deviation. Factors associated with PCC climate perception were analyzed using a Poisson model.

Results: Out of 1216 respondents; the majority 47% aged between 18 and 34 years; 79% women, 68% were nurses. The overall mean score was 45.96±15.36 (range 0–70). Subscale scores were Safety 20.15±5.0 (range 0–30), Everydayness 12.02±3.52 (range 0–20) and Community 13.79±3.34 (range 0–20). Increasing age was a significant factor associated with PCC scores for the overall, safety, everydayness, and community scales, with a positive association. Lower scores were reported more by women compared with men, for overall (p=0.0005), and everydayness (p=0.006) scales. Higher safety scores were reported by health care providers with a diploma compared to master’s degree (p=0.009), Ph.D. (p=0.007), for technicians compared with nurses (p=0.007), and for day shift compared with day/night shift workers (p=0.025). PCC scores were not significantly different across health care providers’ years of experience.

Conclusion: There is a room for PCC climate improvement based on the low scores compared to the literature. The study findings indicated that the main factors associated with HCPs’ perception of PCC were higher age and female gender, and these factors would benefit from further research.

Background:Although a growing body of research knowledge exists highlighting the importance of leadership for person-centred care, studies focused on nursing home managers’ own descriptions of leading their staff to provide person-centred care is lacking. This study aims to explore the process of nursing home managers’ leading person-centred care in Swedish nursing homes.

Methods:The methods of the study consisted of semi-structured interviews with 12 nursing home managers within 11 highly person-centred nursing homes purposively selected from a national wide survey of nursing homes in Sweden. A qualitative content analysis was performed for data analyses.

Results:The study revealed that the leading person-centred care in nursing homes can be outlined as comprising four processes: Embodying person-centred being and doing; promoting a person-centred atmosphere; maximizing person-centred team potential; and finally, optimizing person-centred support structures.

Conclusion:This study contributes to the literature by providing concrete descriptions of how person-centred care can be operationalised and supported in everyday practice by the leadership of nursing home managers. The study is significant in that it provides evidence on how the provision of person centred care can be facilitated by managers and the important role they play in developing and maintaining this philosophy of care within nursing homes.

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.

Background: Promoting healthy work environment as a manager in nursing homes is important to safeguard staff health and well-being as well as care quality when facing increasing demands. The impact of leadership on staff work environment needs further exploration.

Objectives: To describe longitudinal changes in nursing home leadership, direct care staff characteristics, job strain and social support.

Methods: This study has a repeated cross-sectional design, a five-year follow-up study. Nursing home staff in 181 corresponding units (n = 1253 in 2014 and n = 1176 in 2019) completed surveys about leadership, staff job strain and social support in a five-year follow-up study. Descriptive and regression analyses were conducted.

Results: A higher degree of leadership defined by coaching and providing direct feedback to care staff, handling conflicts in a constructive way and having control of the clinical work, was significantly associated with a lower degree of job strain and a higher degree of social support among staff, with stronger associations at follow-up. The proportion of enrolled nurses increased significantly at follow-up.

Conclusions: Leadership is increasingly important for staff work environment, especially in times of increased workload and decreasing collegiality and deteriorating work atmosphere at work. Implications for Practice: Stakeholder and policy makers in nursing home care may reflect on how managers' leadership is prioritised in these environments because such leadership is associated with staff job strain and social support. Managers striving to improve the work situation of staff may consider their own role and allow flexibility in how and when the work can be performed.

Aims and objectives: The aim was to explore changes in nursing home managers' leadership, person-centred care and psychosocial climate comparing matched units in a five-year follow-up and to explore the significance of managers' educational qualifications and the ownership of nursing homes for perceived leadership, person-centred care and psychosocial climate in the follow-up data.

Background: Leadership has been described as crucial for person-centred care and psychosocial climate even though longitudinal data are lacking. The significance of managerial leadership, its characteristics, managerial qualifications and ownership of nursing homes for perceived leadership, person-centred care and psychosocial climate also needs further exploration.

Design: Repeated cross-sectional study.

Methods: This study used valid and reliable measures of leadership, person-centred care, psychosocial climate and demographic variables collected from managers and staff n = 3605 in 2014 and n = 2985 in 2019. Descriptive and regression analyses were used. The STROBE checklist was used in reporting this study.

Results: Leadership was still positively significantly associated to person-centred care in a five-year follow-up, but no changes in strength were seen. Leadership was still positively significantly associated with psychosocial climate, with stronger associations at follow-up. Six leadership characteristics increased over time. It was also shown that a targeted education for nursing home managers was positively associated with person-centred care.

Conclusions: Leadership is still pivotal for person-centred care and psychosocial climate. Knowledge of nursing home managers' leadership, characteristics and educational qualifications of significance for person-centred delivery provides important insights when striving to improve such services.

Relevance to clinical practice: The findings can be used for management and clinical practice development initiatives because it was shown that nursing home managers' leadership is vital to person-centred care practices and improves the climate for both staff and residents in these environments.

Background: Leadership and stress are common concepts in nursing, and this study explores empirically the connection between leadership and stress of conscience in the context of aged care practice. Previous literature has shown that when staff are unable to carry out their ethical liabilities towards the residents, feelings of guilt may occur among staff, which may be an expression of stress of conscience. Although leadership has been described as crucial for staff’s work perceptions of stress as well as for person-centred practices, the influence of nursing home managers’ leadership on stress of conscience among staff and person-centred practices is still not fully explored. This study attempts to address that knowledge gap by exploring the relationship between leadership, person-centred care, and stress of conscience.

Methods: This study was based on a cross-sectional national survey of 2985 staff and their managers in 190 nursing homes throughout Sweden. Descriptive statistics and regression modelling were used to explore associations.

Results: Leadership was associated with a higher degree of person-centred care and less stress of conscience. A higher degree of person-centred care was also associated with less stress of conscience. The results also showed that leadership as well as person-centred care were individually associated with lower levels of stress of conscience when adjusting for potential confounders.

Conclusion: Nursing home managers’ leadership was significantly associated with less staff stress of conscience and more person-centred care. This indicates that a leadership most prominently characterised by coaching and giving feedback, relying on staff and handling conflicts constructively, experimenting with new ideas, and controlling work individually can contribute to less staff stress as well as higher degree of person-centred care provision.

Aim: To identify characteristics of highly rated leadership in nursing homes. Background: An ageing population entails fundamental social, economic and organizational challenges for future aged care. Knowledge is limited of both specific leadership behaviours and organizational and managerial characteristics which have an impact on the leadership of contemporary nursing home care. Design: Cross-sectional. Method: From 290 municipalities, 60 were randomly selected and 35 agreed to participate, providing a sample of 3605 direct-care staff employed in 169 Swedish nursing homes. The staff assessed their managers' (n = 191) leadership behaviours using the Leadership Behaviour Questionnaire. Data were collected from November 2013 - September 2014, and the study was completed in November 2016. A two-parameter item response theory approach and regression analyses were used to identify specific characteristics of highly rated leadership. Results: Five specific behaviours of highly rated nursing home leadership were identified; that the manager: experiments with new ideas; controls work closely; relies on subordinates; coaches and gives direct feedback; and handles conflicts constructively. The regression analyses revealed that managers with social work backgrounds and privately run homes were significantly associated with higher leadership ratings. Conclusion: This study highlights the five most important leadership behaviours that characterize those nursing home managers rated highest in terms of leadership. Managers in privately run nursing homes and managers with social work backgrounds were associated with higher leadership ratings. Further work is needed to explore these behaviours and factors predictive of higher leadership ratings.

Aim: To explore the association between leadership behaviours among managers in aged care, and person‐centredness of care and the psychosocial climate.

Background: Theory suggests that leadership is important for improving person‐centredness in aged care, however, empirical evidence is lacking.

Methods: A cross‐sectional design was used to collect data from Swedish aged care staff (n = 3661). Valid and reliable questionnaires assessing leadership behaviours, person‐centeredness of care and the psychosocial climate were used. Data were analysed using multiple linear regression including interaction terms.

Results: Leadership behaviours were significantly related to the person‐centredness of care and the psychosocial climate. The level of person‐centredness of care moderated the impact of leadership on the psychosocial climate.

Conclusions and implications for nursing management: The leadership behaviour of managers significantly impacts person‐centred care practice and contributes to the psychosocial climate for both staff and residents in aged care. This study is the first empirically to confirm that middle managers have a central leadership role in developing and supporting person‐centred care practice, thereby creating a positive psychosocial climate and high quality care.

Aims and objectives: To explore the association between nursing home managers' leadership, job strain and social support as perceived by direct care staff in nursing homes.

Background: It is well known that aged care staff experience high levels of job strain, and that aged care staff experiencing job strain are exposed to increased risk for adverse health effects. Leadership styles have been associated with job strain in the literature; however, the impact of perceived leadership on staff job strain and social support has not been clarified within nursing home contexts.

Design: This study had a cross‐sectional design.

Methods: Participating staff (n = 3,605) completed surveys which included questions about staff characteristics, valid and reliable measures of nursing home managers' leadership, perceived job strain and social support. Statistical analyses of correlations and multiple regression analysis with interaction terms were conducted.

Results: Nursing home managers' leadership were significantly associated with lower level of job strain and higher level of social support among direct care staff. A multiple regression analysis including an interaction term indicated individual and joint effects of nursing home managers' leadership and social support on job strain.

Conclusions: Nursing home managers' leadership and social support were both individually and in combination associated with staff perception of lesser job strain. Thus, nursing home managers' leadership are beneficial for the working situation and strain of staff.

Relevance to clinical practice: Promoting a supporting work environment through leadership is an important implication for nursing home managers as it can influence staff perception of job strain and social support within the unit. By providing leadership, offering support and strategies towards a healthy work environment, nursing home managers can buffer adverse health effects among staff.

Background: The relevance of person-centred care as an optimising approach to the quality of care provided to older adults has sparked the development of important instruments that measure this approach at residential care facilities and requires validation for the Portuguese population.

Objectives: This study aims to adapt and validate the Person-centered Care Assessment Tool (P-CAT) to the Portuguese population.

Methods: The P-CAT assesses the level of person-centred care provided by residential care facilities, according to staff. The process of adapting the P-CAT to the Portuguese population includes its translation, backtranslation and a pilot study. To recruit participants for the validation study, we contacted the Portuguese residential care facilities with emails provided in the official registries, and the study was also divulged on social media.

Results: The study had the participation of 573 staff members. The mean score of P-CAT was 50.76 (SD = 7.65). The exploratory factor analysis showed three dimensions: the extent of care personalisation, the amount of organisational support and the degree of environmental accessibility. The results show good internal consistency for the total scale (α = 0.809) and good temporal stability in the test–retest assessed by intraclass correlation coefficient (0.893).

Conclusions: This version of the P-CAT for the Portuguese population has shown adequate psychometric properties and contributes to the study of care provided at residential care facilities in Portugal through self-reporting from staff.

Implications for practice: The availability of this instrument is useful for professional practice and research purposes and supports technical and scientific advancements that are necessary for the evolution of care frameworks.

Aim: To explore contributors for thriving in nursing homes by evaluating, analysing and synthesizing peer‐reviewed qualitative literature on the topic.

Background: Thriving is a positive life‐world concept that has been explored by several qualitative studies; however, descriptions of thriving and contributors to thriving have not been compared or contrasted among different studies and contexts, nor have they been reviewed and synthesized.

Design: Qualitative meta‐ethnography.

Data sources: Four electronic databases were searched in October 2019, with sources published between 2000 and 2019 included.

Review methods: Sources of peer‐reviewed literature that employed qualitative methods to explore thriving in nursing homes were evaluated. In total, 1,017 sources were screened at title‐level, 95 advanced to abstract‐level review and 11 were assessed at full‐text level. Each source was evaluated by two researchers independently in relation to methodological quality and relevance to the study aim. Themes pertaining to thriving in nursing homes were extracted, interpreted and synthesized.

Results: In total, seven sources of peer‐reviewed literature were included. Two main themes illustrating the contributors to thriving were identified: ingredients for thriving (subthemes: personal contributors and social contributors) and environment for thriving (subthemes: spacial contributors and societal contributors).

Conclusion:Contributors to thriving in nursing homes include personal attributes, relationships with others, the lived environment and societal structures. Thriving for older people could thereby be defined as a holistic concept denoting lived experiences of situated contentment. Future studies should explore different temporal facets of thriving in the nursing home setting.

Impact: This meta‐synthesis proposes a ‘recipe’ for thriving as comprising the right ingredients and the right environment, determined by the preferred ‘taste’ of the individual person. The proposed definition and contributors illuminate thriving as a positive life‐world concept that is based on one's lived experiences and context.

Background: Postgraduate education is said to support the development of nurses' professional competence and confidence, essential to the delivery of safe and effective care. However, there is a shortness of empirical evidence to demonstrate an increase to nurses' self-reported confidence and competence on completion of critical care postgraduate certificate-level education.

Objectives: To explore the impact of a critical care postgraduate certificate course on nurses' self-reported competence and confidence. To explore the psychometric properties and performance of the Critical Care Competence and Confidence Questionnaire.

Design: A quasi-experimental pre/post-test design.

Participants: A total population sample of nurses completing a critical care postgraduate certificate course at an Australian University.

Methods: The Critical Care Competence and Confidence Questionnaire was developed for this study to measure nurses' self-reported competence and confidence at baseline and follow up. Descriptive and inferential statistics were used to explore sample characteristics and changes between baseline and follow-up. Reliability of the questionnaire was explored using Cronbach's Alpha and item-total correlations.

Results: There was a statistically significant increase in competence and confidence between baseline and follow-up across all questionnaire domains. Satisfactory reliability estimates were found for the questionnaire.

Conclusions: Completion of a critical care postgraduate certificate course significantly increased nurses' perceived competence and confidence. The Critical Care Competence and Confidence Questionnaire was found to be psychometrically sound for measuring nurses' self-reported competence and confidence.

ObjectiveThis study aimed to explore changes to resident thriving in Swedish nursing homes over a 5-year period and describe changes in associated factors.

MethodsCross-sectional data were collected from a randomised sample of Swedish nursing homes in 2013/2014 (baseline) and 2018/2019 (follow-up). Descriptive statistics, independent samples t-tests, and chi squared tests were used to statistically evaluate differences between the samples. Simple and multiple linear regression analyses were used to explore associations between thriving and the study variables.

ResultsResident characteristics were relatively consistent between the full baseline (N = 4831) and follow-up (N = 3894) samples. Within a sub-sample of nursing homes that participated in both data collections mean thriving scores were found to have increased from 152.9 to 155.2 (p ≤ 0.003; d =0.09) and overall neuropsychiatric index scores had decreased from 16.0 to 14.3 (p ≤ 0.004; d =0.09), as had the prevalence of several neuropsychiatric symptoms. Thriving was found to have a positive association with the neuropsychiatric symptom of elation/euphoria, and negative associations with the symptoms of aggression/agitation, depression/dysphoria, apathy, and irritability.

ConclusionsThe results show an increase in overall thriving scores and a decrease in overall neuropsychiatric scores between baseline and follow-up. This study confirmed associations between thriving and certain neuropsychiatric symptoms and established comparative knowledge regarding changes in resident thriving, characteristics, and symptom prevalence. These findings could inform future care and organisational policies to support thriving in nursing homes, particularly among residents at risk of lower thriving due to cognitive impairment or neuropsychiatric symptoms.

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.

BACKGROUND: Thriving has emerged as a contemporary and health-promoting concept for older people living in nursing homes; however, there has been limited research to explore how nursing home staff identify thriving in their everyday practice. The aim of this study was to explore how staff recognize expressions of thriving among persons living in nursing homes.

METHODS: Semi-structured interviews were conducted with 14 nurses working at a nursing home in Victoria, Australia. The interviews were audio-recorded, transcribed and analyzed using qualitative content analysis.

RESULTS: The analysis resulted in six sub-categories and three main categories. Expressions of thriving were recognized in relation to how staff understood thriving, observed thriving and sensed thriving. Staff described comparing and contrasting clinical assessment indicators with their own personal and professional understandings of thriving, as well as their overall sense of the individual person within the wider situational and environmental context.

CONCLUSIONS: Our results illuminate how staff recognize everyday expressions of thriving for people living in nursing homes and emphasizes the importance of utilizing person-centred care principles in clinical assessments. These findings have practical implications with regards to how thriving is identified and assessed in long-term care, and could be used to inform and guide staff education, person-centred care strategies, and organizational policies to better support and promote thriving in nursing homes.

Aims and objectives. To assess the content validity and reliability of the Person-centred Climate Questionnaire-Patient version in long-term care facilities, to describe residents' perceptions of the extent to which their ward climate was person-centred and to explore whether person-centredness was associated with facility and resident characteristics, such as facility and ward size, having a sensory garden and having a primary caregiver.

Background. The importance of the physical environment to persons with dementia has been investigated. However, research is lacking regarding the extent to which mentally lucid residents experience their physical and psycho-social ward climate as person-centred and the factors influencing their experience.

Design. Cross-sectional survey design.

Methods. The Person-centred Climate Questionnaire-Patient version was translated into Norwegian with forward and backward translation. The content validity index for scales was assessed. The Person-centred Climate Questionnaire-Patient version was completed by 145 mentally lucid residents in 17 Norwegian long-term care facilities. Reliability was assessed by Cronbach's alpha and item-total correlations. Test-retest reliability was assessed by paired samples t-test and Spearman's correlation. To explore differences based on facility and resident characteristics, independent-samples t-test and one-way ANOVA were used.

Results. The content validity index for scales was satisfactory. The Person-centred Climate Questionnaire-Patient version was internally consistent and had satisfactory test-retest reliability. The climate was experienced as highly person-centred. No significant differences were found, except that residents in larger facilities experienced the climate as more person-centred in relation to everyday activities (subscale 2) than residents in smaller facilities.

Conclusion. The Norwegian version of the Person-centred Climate Questionnaire-Patient version can be regarded as reliable in a long-term care facility context. Perceived degree of person-centredness was not associated with facility or resident characteristics, such as the number of residents, having a sensory garden or knowing that one has a primary caregiver.

Relevance to clinical practice. A person-centred climate can be attained in different kinds of long-term care facilities.

Background: The physical and psychosocial environments in nursing homes influence the residents everyday life as well as their well-being and thriving. The staffs perceptions of and relationships with the residents are crucially important to quality care. Quality care is described often as person-centred. Few measurement tools exist that focus on person-centred care in nursing homes.

Objective: The aim of this study was to evaluate the psychometric properties of the Norwegian version of the Person-centred Climate QuestionnaireStaff version (PCQ-S).

Design: This study had a cross-sectional survey design.

Participants and Settings: Two hundred and nine healthcare and support staff in five nursing homes in the eastern part of Norway.

Methods: The Swedish PCQ-S was translated into Norwegian with forward and backward translation. The relevance of the items included in the questionnaire was assessed by an expert panel of 10 nursing home care staff, because the questionnaire has not been used in this context previously. A psychometric evaluation using statistical estimates of validity and reliability was performed. The discriminatory capacity of the questionnaire was also tested.

Results: The content validity index was satisfactory (0.78). The PCQ-S showed high internal consistency reliability in that Cronbachs a was satisfactory for the total scale (0.92) and the three subscales (0.81, 0.89 and 0.87). The testretest reliability was also satisfactory as evident from a Spearmans correlation coefficient of 0.76 (p < 0.01) between the total PCQ scores at test and retest. The Norwegian version retained the original factor structure of the Swedish version.

Conclusion: As the psychometric evaluation showed satisfactory validity and reliability scores, this study supports the Norwegian version of the PCQ-S when applied to a sample of nursing home staff.

Aims. To develop an instrument for measuring thriving among residents in long-term care facilities, to assess the correspondence between proxy ratings and self-report and the internal consistency of the Norwegian version. Background. The instrument was developed from the life-world concept of thriving and thereby has a different theoretical basis than existing 'dementia related' quality-of-life instruments. Thriving relates the experience of older persons to the place where they live. Proxy instruments need to be developed for residents in long-term care facilities who are not able to report their subjective experiences. Design. Instrument development using cross-sectional survey design. Methods. The instrument was developed in three versions (resident, family and staff) from a theory on thriving. Forty-eight triads consisting of a resident, family member and primary nurse from 12 Norwegian nursing homes participated. Data collection took place between March-December 2011. Inter-rater agreement between the groups was assessed by Cohen's kappa coefficient (weighted). Internal consistency was evaluated by Cronbach's alpha. Homogeneity was explored through item-total correlations. Results. Agreement between residents, family members and staff was poor or fair (<0.41) in six of 38 items. These items were excluded. The 32-items instrument had satisfactory Cronbach's alpha values in each of the three samples and satisfactory homogeneity as item-total correlations was substantial without being excessive and thus indicated that items were measuring the same construct. Conclusion. The instrument appears to have internal consistency and enable reliable proxy measures of the thriving construct. Further psychometric assessment including checking for possible item redundancy is needed.

AimTo explore construct validity and reliability of the Thriving of Older People Assessment Scale. BackgroundThe concept of thriving emphasizes person-environment interaction in relation to well-being. The Thriving of Older People Assessment Scale has been developed and evaluated as a self-report and proxy scale based on the theory of thriving. DesignCross-sectional survey design. MethodThe Thriving of Older People Assessment Scale was completed by a sample of 259 residents, 146 family members and 52 staff from 13 long-term care facilities in Norway and Sweden. Data were collected between April 2010-December 2011. Exploratory factor analysis was applied to explore construct validity in terms of factor structure and dimensionality of the 32-item scale in relation to the thriving theory. Reliability was explored through internal consistency estimation using Cronbach's alpha and through homogeneity evaluation using corrected item-total correlations. ResultsExploratory factor analysis resulted in five factors (subscales) that corresponded meaningfully with the thriving theory and were labelled 1: Resident' attitudes towards being in long-term care; 2: Quality of care and caregivers; 3: Resident engagement and peer relationships; 4: Keeping in touch with people and places; and 5: Quality of the physical environment. The scale had satisfactory internal consistency and homogeneity estimates. ConclusionThe 32-item Thriving of Older People Assessment Scale can be regarded as construct valid and reliable. Its factor structure corresponded logically to the thriving theory and its factors showed satisfactory internal consistency and homogeneity. Nevertheless, the TOPAS would benefit from further testing in other populations and contexts.

Background: Earlier studies in nursing homes show a high prevalence of cognitive impairment, dependency in activities of daily living (ADL), pain, and neuropsychiatric symptoms among residents. The aim of this study was to explore the prevalence of the above among residents in a nationally representative sample of Swedish nursing homes, and to investigate whether pain and neuropsychiatric symptoms differ in relation to gender, cognitive function, ADL-capacity, type of nursing-home unit and length of stay. Methods: Cross-sectional data from 188 randomly selected nursing homes were collected. A total of 4831 residents were assessed for cognitive and ADL function, pain and neuropsychiatric symptoms. Data were analysed using descriptive statistics and the chi-square test. Results: The results show the following: the prevalence of cognitive impairment was 67 %, 56 % of residents were ADL-dependent, 48 % exhibited pain and 92 % exhibited neuropsychiatric symptoms. The prevalence of pain did not differ significantly between male and female residents, but pain was more prevalent among cognitively impaired and ADL-dependent residents. Pain prevalence was not significantly different between residents in special care units for people with dementia (SCU) and general units, or between shorter-and longer-stay residents. Furthermore, the prevalence of neuropsychiatric symptoms did not differ significantly between male and female residents, between ADL capacities or in relation to length of stay. However, residents with cognitive impairment and residents in SCUs had a significantly higher prevalence of neuropsychiatric symptoms than residents without cognitive impairment and residents in general units. Conclusions: The prevalence rates ascertained in this study could contribute to a greater understanding of the needs of nursing-home residents, and may provide nursing home staff and managers with trustworthy assessment scales and benchmark values for further quality assessment purposes, clinical development work and initiating future nursing assessments.

Aim: To explore the extent to which environmental factors are associated with resident thriving. Background: Thriving is a concept that denotes experiences of well-being in relation to the living environment. Although there is a substantial body of research into quality of life in nursing homes, less is known about what contributes to thriving among residents. Recent research on resident thriving has focused mainly on resident characteristics and activities associated with thriving. Less attention has been given to explore associations with the physical and psychosocial environment of the nursing home. This study explores facility- and unit-level factors associated with resident thriving. Design: A cross-sectional national survey. Methods: Data on 4,205 residents, 3,509 staff, and environment of 147 nursing home facilities collected in 2013–2014 were analysed using descriptive statistics, multilevel simple, and multiple linear regression to explore resident thriving in relation to environmental factors. Results: Multilevel analysis revealed that residents’ thriving varied significantly across nursing home units. Several environmental factors were associated with thriving in univariate analyses. However, a positive psychosocial climate of units, having access to newspapers, living in a special care unit, and living in an unlocked facility showed significant positive associations with resident thriving when controlling for resident characteristics. The psychosocial climate showed the strongest association of the environment variables with resident thriving. Conclusions: Nursing home environments may have an impact on residents’ thriving. A positive psychosocial climate of units seems to have an important role in facilitating thriving in nursing home residents.

Aim: To describe the prevalence of everyday activity engagement for older people in nursing homes and the extent to which engagement in everyday activities is associated with thriving.

Background: Research into residents’ engagement in everyday activities in nursing homes has focused primarily on associations with quality of life and prevention and management of neuropsychiatric symptoms. However, the mere absence of symptoms does not necessarily guarantee experiences of well-being. The concept of thriving encapsulates and explores experiences of well-being in relation to the place where a person lives.

Design: A cross-sectional survey.

Method: A national survey of 172 Swedish nursing homes (2013–2014). Resident (n = 4831) symptoms, activities and thriving were assessed by staff using a study survey based on established questionnaires. Descriptive statistics, simple and multiple linear regression, and linear stepwise multiple regression were performed.

Results: The most commonly occurring everyday activities were receiving hugs and physical touch, talking to relatives/friends and receiving visitors, having conversation with staff not related to care and grooming. The least commonly occurring everyday activities were going to the cinema, participating in an educational program, visiting a restaurant and doing everyday chores. Positive associations were found between activity engagement and thriving, where engagement in an activity program, dressing nicely and spending time with someone the resident likes had the strongest positive association with resident thriving.

Conclusions: Engagement in everyday activities can support personhood and thriving and can be conceptualized and implemented as nursing interventions to enable residents to thrive in nursing homes.

Objectives: The purpose of this study was to explore relations among thriving, cognitive function, and neuropsychiatric symptoms (NPS) in nursing home residents.

Methods: A national, cross-sectional, randomized study of Swedish nursing home residents (N = 4831) was conducted between November 2013 and September 2014. Activities of daily life functioning, cognitive functioning, NPS, and thriving were assessed with the Katz activities of daily living, Gottfries' Cognitive Scale, Nursing Home version of the Neuropsychiatric Inventory, and Thriving of Older People Scale, respectively. Individual NPS were explored in relation to cognitive function. Simple linear and multiple regression models were used to explore thriving in relation to resident characteristics.

Results: Aggression and depressive symptoms were identified as negatively associated with thriving regardless of resident cognitive functioning. At higher levels of cognitive functioning, several factors showed associations with thriving; however, at lower levels of cognitive functioning, only the degree of cognitive impairment and the NPS was associated with thriving. Most of the individual NPS formed nonlinear relationships with cognitive functioning with higher symptom scores in the middle stages of cognitive functioning. Exceptions were elation/euphoria and apathy, which increased linearly with severity of cognitive impairment.

Conclusions: The lower the cognitive functioning was, the fewer factors were associated with thriving. Aggression and depressive symptoms may indicate lower levels of thriving; thus, targeting these symptoms should be a priority in nursing homes.

Background: Self-determination has been shown to be an important factor in mental health and wellbeing, but from the homecare recipients' point of view, autonomy and self-determination is not fully integrated into homecare services. The aim of this study was to explore older adults’ experiences of self-determination when needing homecare services.

Methods: In 2018, a qualitative descriptive study was conducted and a convenience sample of 15 older adults from 3 homecare service facilities were invited to participate in individual interviews. Data were analysed using qualitative content analyse.

Results: The theme Transitioning from self-determination as independence towards self-determination as shared decision-making emerged through the older adults' narratives. This ‘transition’ is one in which older adult’s understanding of self-determination and self-esteem was transitioning towards the acceptance of shared decision-making. The person's inner strength and willingness to make decisions was promoting to enact and preserve independence. Accepting one's dependence on others and being in a positive atmosphere were described as promoting self-determination and shared decision-making, and vice versa. The above overarching theme permeated all subthemes, which included: mobilising inner strength to enact independence; accepting increasing dependence on others; and being influenced by the atmosphere.

Conclusions: The study contributes increased understanding of older adults' experiences of self-determination. The results can act as a guide when planning future person-centred care interventions in the context of homecare services and help improve homecare services' ability to meet the needs of older adults. To summarise, older adults' reflections on their own self-determination highlighted relationships with other people as important for shared decision-making, which could help preserve older adults’ autonomy and self-esteem.

Background: The literature indicates that current home care service are largely task oriented with limited focus on the involvement of the older people themselves, and studies show that lack of involvement might reduce older people's quality of life. Person-centred care has been shown to improve the satisfaction with care and quality of life in older people cared for in hospitals and nursing homes, with limited published evidence about the effects and meanings of person-centred interventions in home care services for older people. This study protocol outlines a study aiming to evaluate such effects and meanings of a person-centred and health-promoting intervention in home aged care services. Methods/design: The study will take the form of a non-randomised controlled trial with a before/after approach. It will include 270 older people >65 years receiving home care services, 270 relatives and 65 staff, as well as a matched control group of equal size. All participants will be recruited from a municipality in northern Sweden. The intervention is based on the theoretical concepts of person-centredness and health-promotion, and builds on the four pedagogical phases of: theory apprehension, experimental learning, operationalization, and clinical supervision. Outcome assessments will focus on: a) health and quality of life (primary outcomes), thriving and satisfaction with care for older people; b) caregiver strain, informal caregiving engagement and relatives' satisfaction with care: c) job satisfaction and stress of conscience among care staff (secondary outcomes). Evaluation will be conducted by means of self-reported questionnaires and qualitative research interviews. Discussion: Person-centred home care services have the potential to improve the recurrently reported sub-standard experiences of home care services, and the results can point the way to establishing a more person-centred and health-promoting model for home care services for older people.

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.

To support person-centered, residential long-term care internationally, a consortium of researchers in medicine, nursing, behavioral, and social sciences from 21 geographically and economically diverse countries have launched the WE-THRIVE consortium to develop a common data infrastructure. WE-THRIVE aims to identify measurement domains that are internationally relevant, including in low-, middle-, and high-income countries, prioritize concepts to operationalize domains, and specify a set of data elements to measure concepts that can be used across studies for data sharing and comparisons. This article reports findings from consortium meetings at the 2016 meeting of the Gerontological Society of America and the 2017 meeting of the International Association of Gerontology and Geriatrics, to identify domains and prioritize concepts, following best practices to identify common data elements (CDEs) that were developed through the US National Institutes of Health/National Institute of Nursing Research's CDEs initiative. Four domains were identified, including organizational context, workforce and staffing, person-centered care, and care outcomes. Using a nominal group process, WE-THRIVE prioritized 21 concepts across the 4 domains. Several concepts showed similarity to existing measurement structures, whereas others differed. Conceptual similarity (convergence; eg, concepts in the care outcomes domain of functional level and harm-free care) provides further support of the critical foundational work in LTC measurement endorsed and implemented by regulatory bodies. Different concepts (divergence; eg, concepts in the person-centered care domain of knowing the person and what matters most to the person) highlights current gaps in measurement efforts and is consistent with WE-THRIVE's focus on supporting resilience and thriving for residents, family, and staff. In alignment with the World Health Organization's call for comparative measurement work for health systems change, WE-THRIVE's work to date highlights the benefits of engaging with diverse LTC researchers, including those in low-, middle-, and high-income countries, to develop a measurement infrastructure that integrates the aspirations of person-centered LTC.

A reported objective of Swedish sheltered housing is to postpone care needs and relocation. The aim of this study was to describe migration patterns and explore predictors of relocation to nursing homes and mortality, in a sample of residents in sheltered housing and aging in place. To explore longitudinal differences between groups, study data were combined with registry data. The results showed that a higher percentage of residents in sheltered housing had relocated to a nursing home and deceased over a three-year time period, compared to aging in place, implying further interventions may be required to promote health in sheltered housing.

In Sweden, sheltered housing is a housing model that provides accessible apartments with elevated social possibilities for older people. The environment within sheltered housing is expected to support resident health and reduce the need for care services. A previous study has shown that with increasing levels of depressive mood and decreasing levels of self-rated health and functional status, those residing in sheltered housing report higher levels of thriving compared to those ageing in place. Therefore, the aim of this study was to illuminate aspects of sheltered housing that are facilitators and/or barriers to thriving. Seven semi-structured group interviews in five different sheltered housing accommodations in Sweden were conducted between April 2019 and January 2020 (N = 38). The results, analysed using qualitative content analysis and presented in a model developed by Grol and Wensing, illuminate the four main categories of facilitators and barriers to thriving: individual factors, social context, environmental factors and organisational context. The results of this study show that the factors that influence experiences of thriving in sheltered housing are multifaceted and interconnected. Although the supportive environment provided in sheltered housing seems to contribute to thriving, the limited consideration towards the shifting health of residents is a barrier to thriving. The results of this study may assist in implementing tailored interventions to help support thriving on various levels.

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.

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.

Background: Clinical placements are integral components of undergraduate nurse education. Assessment of student performance routinely involves formative and summative appraisals. Understanding how appraisals are used to promote student learning in undergraduate nurse education and into professional nursing registration is important.

Aim: To describe the experience of clinical appraisal on student learning during clinical placements through the lens of the undergraduate nursing student, the clinical assessor, and university academic staff.

Methods: Descriptive-exploratory-qualitative study using semi-structured interviews with eight undergraduate nursing students, three health service clinical nurses and six university staff were performed. Data were analysed using NVivo. Qualitative content analysis was performed.

Results: Two categories emerged: continuum of learning; and assessment versus learning. Participants reported the formative and summative appraisals promoted student learning and development within the clinical placement and on their journey becoming nurses. The experience of the appraisal process was influenced by the tension between assessment and learning. Factors influencing the experience of the appraisal process for student learning included: the assessment tool, the clinical support model, and expectations of student and assessor role.

Conclusion: Clinical placements are integral to a student's continuum of learning into professional registration. To facilitate positive learning experiences, orientation programs prior to the commencement of clinical placements for assessors and undergraduate students, could be included. Formal training in assessment and feedback may also be beneficial for clinical assessors. Clear expectations for models of clinical support and the process for appraisal assessment, may facilitate a more positive learning experience to promote better student outcomes.

BACKGROUND: The nursing literature is replete with articles on the function of clothing in preventing and controlling infections. However, although contemporary literature demonstrates intimate connections between clothing and identity, there is a lack of studies which illuminate the meanings associated with wearing patient clothing. OBJECTIVES: This study aimed to illuminate the meanings of wearing patient clothing as narrated by patients and nurses in Swedish care settings. DESIGN: The data collection was based on grounded theory. Interviews with patients (n=9) and staff (n=5) were drawn from a larger study and analysed with a phenomenological hermeneutical method. SETTINGS: Data was collected between 2001 and 2003 at a hospice, an in-patient geriatric unit, an acute medical unit, and an in-patient oncology unit in Sweden. RESULTS: The phenomenon of 'wearing patient clothing' was found to consist of four themes: (1) being comfortable and cared for; (2) being depersonalised; (3) being stigmatised; and (4) being devitalised. Interpreted in the light of philosophical literature on identity and symbols, the comprehensive understanding of wearing patient clothing is that it is a balancing between being a person and being a patient. Patient clothes were experienced as being comfortable and practical, but also as being stigmatising symbols of illness, confinement, and depersonalisation. CONCLUSIONS: The tension between patient clothing as being practical and comfortable and at the same time enabling feelings of being depersonalised and stigmatised suggests that nursing staff need to balance the practical benefits of these garments with the social and existential meanings they might have.

Artikeln presenterar forskningsbaserade perspektiv på vad som kan konstituera värdighetsbefrämjande analyser och tolkningar av, samt interventioner mot beteendemässiga och psykologiska symptom vid demenssjukdom (BPSD). I artikeln argumenteras för att beteendeförändringar hos personer med demenssjukdom ofta manifesteras i interaktion med vårdare och/eller medboende, all tid uppstår inom ramen för en omgivande miljö, samt kan influeras av personens livshistoria. Dessa bör inkluderas i en systematisk analys av det förändrade beteendet till grund för interventioner.

This article presents the findings of a study that aimed to describe what constitutes therapeutic environments and interpret what it means to be in such environments for older adults. Interview and observational data collected in Swedish health care contexts were subjected to qualitative content analysis. The findings describe therapeutic environments as being constituted by three interacting and interwoven categories: the physical environment, people's doing and being in the environment, and an organizational philosophy of care. The findings are interpreted in light of the existential philosophy of home as a concept, a place, and an existential experience, highlighting that therapeutic environments can support existential at-homeness among patients. The findings of this study can contribute to nursing practice by providing a conceptual basis for reflecting on and evaluating how the physical environment, staff's doing and being, and the organizational philosophy of care cooperate to support well-being among older adults living in long-term care facilities.

Denna artikel syftar till att problematisera begreppet “Beteendemässiga och Psykologiska Symptom av Demenssjukdom” (Behavioral and Psychological Symptoms of Dementia -BPSD) genom att belysa hur beteendeförändringar hos personer med demenssjukdom kan uppstå i interaktion med vårdare och vårdmiljö, och då förstås som försök till meningsfull kommunikation. Problematiseringen grundar sig på aktuell empirisk forskning kring förändrat beteende, tillsammans med interaktiva, kommunikativa och miljöfokuserade teorier kring förändrat beteende hos människor med demenssjukdom.

The aim of this article is to describe the Umeå ageing and health research programme that explores person-centred care and health-promoting living conditions for an ageing population in Sweden, and to place this research programme in a national and international context of available research evidence and trends in aged care policy and practice. Contemporary trends in aged care policy includes facilitating ageing in place and providing person-centred care across home and aged care settings, despite limited evidence on how person-centred care can be operationalised in home care services and sheltered housing accommodation for older people. The Umeå ageing and health research programme consists of four research projects employing controlled, cross-sectional and longitudinal designs across ageing in place, sheltered housing, and nursing homes. The research programme is expected to provide translational knowledge on the structure, content and outcomes of person-centred care and health-promoting living conditions in home care, sheltered housing models, and nursing homes for older people and people with dementia.

There has been an impressive development of nursing knowledge around the ethics, principles, frameworks, models and practices of person-centred care over the last 15 years, with colleagues from the Nordic countries making significant contributions to global knowledge across the discipline of nursing and beyond. A disciplinary challenge remains to map the variability in person-centred care with an aim to empirically clarify the invariant in person-centred care. Based on current research and practice, as well as the COVID-19 pandemic, this article argues that the relational aspect of person-centred care is such an invariant, building on the socially constructive notion of ‘personhood’ being a standing or status that is bestowed on one human being by another in the context of relationship and social being. During the current COVID-19 pandemic, several of the key determinants of person-centred care are under threat due to health service responses and/or infection control measures, such as keeping older adults safe, imposing relationship restrictions, social distancing and isolation (or the lack thereof). Clinical examples from an Australian health service are used to show how recognizing the relational invariant of person-centred aged care facilitated supporting lives lived whilst also protecting lives saved. The relational invariant to person-centred care is who we are, constructed or deconstructed by and with others; something that may have become more visible through the relational restrictions imposed due to COVID-19. Protecting relationality in life and care and advocating for both safe and person-centred care for those who need it most is now more important than ever.

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.

This article presents the development and initial testing of a comprehensive pain chart for the assessment, management and documentation of pain in older people in subacute and residential aged care. The pain chart was developed from existing assessment scales and pain indicators, and is targeting needs of older people in residential care and geriatric hospital settings with high prevalence of cognitive impairments. The chart is based on self-report of pain but allows for observation of pain-related behaviours for those unable to report pain. The chart consists of one evaluative and one documentation dimension, and was evaluated by a group of clinicians in geriatric hospital care (n = 15) and residential aged care (n = 6). The chart was found to be content valid, informative and easy to use, facilitating clinical assessments and monitoring, and assisting visual readings of patients' temporal pain trends.

Background: There are challenges in attracting and sustaining a competent and stable workforce in aged care, and key issues of concern such as low staff job satisfaction and feelings of not being able to provide high quality care have been described. This study aimed to explore the association between person-centered care provision and job satisfaction in aged care staff. Methods: Residential aged care staff (n = 297) in Australia completed the measure of job satisfaction and the person-centered care assessment tool. Univariate analyses examined relationships between variables, and multiple linear regression analysis explored the extent to whichperceived person-centredness could predict job satisfaction of staff. Results: Perceived person-centred care provision was significantly associated with job satisfaction, and person-centred care provision could explain nearly half of the variation in job satisfaction. The regression model with the three person-centered care subscales as predictor variables accounted for 40% of the variance in job satisfaction. Personalizing care had the largest independent influence on job satisfaction, followed by amount of organizational support and degree of environmental accessibility. Personalizing care and amount of organizational support had a statistically significant unique influence. Conclusions: As person-centered care positively correlated with staff job satisfaction, supporting staff in providing person-centered care can enhance job satisfaction and might facilitate attracting and retaining staff in residential aged care. The findings reiterate a need to shift focus from merely completing care tasks and following organizational routines to providing high quality person-centered care that promotes the good life of residents in aged care.

AIMS AND OBJECTIVES: This article aims to describe the content of person-centred care as described by people with dementia, family members and staff in residential aged care.

BACKGROUND: Person-centred care is increasingly being regarded as synonymous with best quality aged care; however, studies exploring stakeholders' experiences of person-centred care are few.

DESIGN: A qualitative explorative design was employed using conversational research interviews and content analysis.

METHOD: Research interviews were conducted in 2007 and 2008 with staff working in aged care (n = 37), people with early onset dementia (n = 11), and family members of patients with dementia (n = 19) and were analysed using content analysis.

RESULTS: The findings indicated that the core category of person-centred care was promoting a continuation of self and normality. Five content categories emerged as contributing to promoting a continuation of self and normality: knowing the person; welcoming family; providing meaningful activities; being in a personalised environment; and experiencing flexibility and continuity.

CONCLUSIONS: This study describes person-centred care as it is understood by people with dementia, their family members and staff in residential aged care, and as such it contributes with inside perspectives to current understandings of person-centred care, perspectives that have been largely lacking. Relevance to clinical practice.  The findings of this study are clinically relevant and ready to be operationalised and applied in clinical aged care. The categories can be used as a topic guide for discussions in aged care organisations on the quality of current care and as elements indicating how to increase the person-centredness of care provided.