1 PHI, Bronx, NY, USA.
2 RTI International, Washington, DC, USA.
J Appl Gerontol. 2019 Feb;38(2):183-206. doi: 10.1177/0733464817732519. Epub 2017 Sep 20.
Empowering individuals to direct their own care is central to person-centered care and health care policy. However, there is limited knowledge of how "person-directed care planning" (PDCP) can be achieved in particular settings. This study identifies key structures and processes for operationalizing and implementing PDCP in nursing homes. Using participatory inquiry, we convened "stakeholder engagement sessions" with residents, families, nursing staff, and managers/administrators in two North Carolina nursing homes ( N = 24 sessions; N = 67 unique participants). Stakeholders discussed current care-planning processes and provided feedback on an emergent conceptual framework of PDCP. Three themes emerged through directed-content analysis: strategies included providing formal and informal opportunities to engage in care planning and ensuring effective follow-through; different roles were required among leadership, staff, residents, and families to accomplish PDCP; and limits on achieving PDCP included competing priorities and perceived regulatory and resource constraints. Results are discussed in terms of the specific competencies required for accomplishing PDCP.
赋予个人指导自己护理的权力是以人为本的护理和医疗保健政策的核心。然而,对于如何在特定环境中实现“以患者为导向的护理计划”(PDCP),我们的了解有限。本研究确定了在养老院中实施和实施 PDCP 的关键结构和流程。我们使用参与式调查,在北卡罗来纳州的两家养老院与居民、家属、护理人员和管理人员/行政人员举行了“利益相关者参与会议”(N=24 次会议;N=67 位独特参与者)。利益相关者讨论了当前的护理计划流程,并对 PDCP 的新兴概念框架提供了反馈。通过有针对性的内容分析,出现了三个主题:策略包括提供正式和非正式的机会参与护理计划,并确保有效的后续行动;领导层、员工、居民和家庭需要不同的角色来实现 PDCP;实现 PDCP 的限制包括竞争的优先事项以及感知到的监管和资源限制。结果根据实现 PDCP 所需的特定能力进行了讨论。