Lepore Michael, Scales Kezia, Anderson Ruth A, Porter Kristie, Thach Trini, McConnell Eleanor, Corazzini Kirsten
RTI International, Washington, District of Columbia.
Duke University School of Nursing, Durham, North Carolina.
Int J Older People Nurs. 2018 Dec;13(4):e12212. doi: 10.1111/opn.12212. Epub 2018 Oct 25.
Federal regulations require nursing homes in the United States to support residents in directing their own care rather than having their care plans developed for them without their engagement, but knowledge of person-directed approaches to care planning in nursing homes is limited. The purpose of this study was to advance understanding of person-directed care planning (PDCP).
A multidisciplinary research team conducted a scoping review on individual and family involvement in care planning, including literature from a variety of care contexts. Search results were systematically screened to identify literature that addressed individual or family involvement in care planning as a primary concern, and then analysed using thematic content analysis.
Several themes were identified, including definitions of the concept of PDCP, essential elements of PDCP, barriers, facilitators and outcomes. The concept of PDCP is informed by multiple disciplines, including humanist philosophy, disability rights and end-of-life care. Essential elements of PDCP include knowing the person, integrating the person's goals in care planning and updating care plans as individuals' needs or preferences change. Limited time for care planning in nursing homes hinders PDCP. Facilitators include regulatory mandates and humanist social trends. Outcomes of PDCP were found to be positive (e.g., increased independence), but were inconsistently assessed across studies.
This study offers pragmatic information that can support PDCP within nursing homes and insights for policy reform that may more effectively support PDCP.
These findings can be used to guide implementation of PDCP.
美国联邦法规要求养老院支持居民自主安排自己的护理，而不是在他们未参与的情况下为其制定护理计划，但对于养老院中以个人为导向的护理计划制定方法的了解有限。本研究的目的是增进对以个人为导向的护理计划制定（PDCP）的理解。
一个多学科研究团队对个人和家庭参与护理计划制定进行了范围综述，包括来自各种护理背景的文献。对搜索结果进行系统筛选，以确定将个人或家庭参与护理计划制定作为主要关注点的文献，然后使用主题内容分析法进行分析。
确定了几个主题，包括PDCP概念的定义、PDCP的基本要素、障碍、促进因素和结果。PDCP的概念受到多学科的影响，包括人文主义哲学、残疾权利和临终关怀。PDCP的基本要素包括了解个人、将个人目标纳入护理计划制定以及随着个人需求或偏好的变化更新护理计划。养老院护理计划制定时间有限阻碍了PDCP。促进因素包括监管要求和人文主义社会趋势。发现PDCP的结果是积极的（例如，独立性增强），但各研究对结果的评估并不一致。
本研究提供了实用信息，可支持养老院中的PDCP，并为可能更有效地支持PDCP的政策改革提供见解。
这些发现可用于指导PDCP的实施。
