Person-centred care is a holistic care approach that aims to build up and support the personhood of residents with dementia, and thereby enhance quality of life. Through a review of the literature on mealtimes in long term care homes, four main aspects of person-centred mealtime care were identified: providing food choices and preferences, supporting residents’ independence, promoting the social side of eating, and showing respect. Using a critical realist lens, this descriptive qualitative study examined current implementation of person-centred mealtime care, the influences on its implementation, and steps to more fully adopt a person-centred approach. Semi-structured interviews were conducted with 52 staff from four diverse long term care homes in southern Ontario. Participants included frontline workers, registered health care professionals, and managers. Interviews were transcribed and analysed for themes. A conceptual framework was developed through analysis of the interview data, identifying five key ways to support staff to provide person-centred care: forming a strong team, working together to provide care, enabling staff to know the residents better, equipping staff with a toolbox of strategies, and creating flexibility to optimize care. Specific strengths and areas for improvement in implementation of person-centred mealtime care were identified and explained using this conceptual framework. Elements of the framework were also applied to explain important considerations for hiring staff, educating and training staff, developing a culture of good teamwork, and involving family members and volunteers in mealtime care. / Canadian Foundation for Dietetic Research; Alzheimer Society of Canada

Older adults living with dementia are marginalized in society through the socially constructed binaries of old/young, able/disabled and ultimately us/them. These are manifested in a culture dominated by approaches towards illnesses that favor clinically inclined models of care which entail the search for cures rather than attention to the care required by and for individuals. To heighten their vulnerability, from an individual perspective, the cognitive nature of dementia often prevents people living with it from having a voice in their representation. Person-centered care is a philosophy that recognizes the importance of who the individual is and where they are situated in an effort to create a more holistic care experience. The Lodge at Broadmead is a residential care facility that has operationalized an explicitly person-centered philosophy of care. The main objectives of this project were to gain an understanding of the lived experience and implementation of person-centered dementia care from the many different perspectives contained within this facility as well as the methodological barriers associated with including people living with dementia in this type of research. To this end, one-on-one interviews and focus groups were conducted with a total of 16 staff members and leadership at The Lodge at Broadmead as well as one resident. These were informed by a 4 month period of observation in the form of volunteer work. Three main themes emerged around the implementation of person-centred care at The Lodge at Broadmead: identity maintenance, facilitating relationships, and aligning values. These themes represent the most important theoretical links between the physical and social aspects of the environment, and person-centred care’s ultimate goal of maintenance and enhancement of personhood for the residents. Drawing from my own research experience, there were several methodological challenges in undertaking the research as well which were: the institutional necessity of consent by proxy, a rigid interview approach, and not enough time spent with the residents. / Graduate / 0336 / 0351 / kyle.plumb@gmail.com

Older adults living with dementia are marginalized in society through the socially constructed binaries of old/young, able/disabled and ultimately us/them. These are manifested in a culture dominated by approaches towards illnesses that favor clinically inclined models of care which entail the search for cures rather than attention to the care required by and for individuals. To heighten their vulnerability, from an individual perspective, the cognitive nature of dementia often prevents people living with it from having a voice in their representation. Person-centered care is a philosophy that recognizes the importance of who the individual is and where they are situated in an effort to create a more holistic care experience. The Lodge at Broadmead is a residential care facility that has operationalized an explicitly person-centered philosophy of care. The main objectives of this project were to gain an understanding of the lived experience and implementation of person-centered dementia care from the many different perspectives contained within this facility as well as the methodological barriers associated with including people living with dementia in this type of research. To this end, one-on-one interviews and focus groups were conducted with a total of 16 staff members and leadership at The Lodge at Broadmead as well as one resident. These were informed by a 4 month period of observation in the form of volunteer work. Three main themes emerged around the implementation of person-centred care at The Lodge at Broadmead: identity maintenance, facilitating relationships, and aligning values. These themes represent the most important theoretical links between the physical and social aspects of the environment, and person-centred care’s ultimate goal of maintenance and enhancement of personhood for the residents. Drawing from my own research experience, there were several methodological challenges in undertaking the research as well which were: the institutional necessity of consent by proxy, a rigid interview approach, and not enough time spent with the residents. / Graduate / 0336 / 0351 / kyle.plumb@gmail.com

This thesis describes an interpretative, qualitative study of one person centred planning, circle of support. The eight people in the circle support a person with a learning disability, to help plan the life the person would like, utilising person centred planning techniques and tools. This study uses an ontological foundation of phenomenology, existentialism, and social psychology to examine the authenticity of the process of person centred planning for the circle of support members, and the person they have all chosen to support (focused person). A variety of data collection methods are employed, particularly those utilising ethnographic characteristics, and participatory approaches. These include video of a circle of support meeting, informal interviews using a video elicitation technique with circle members, and the use of photographs of the person’s plan. The data analysis is interpretative, and uses a two stage thematic analysis. Findings focus on the key concepts of individual agency, social inclusion, rights, choice and social emancipation. In addition the study attempts to examine the individual’s “truth” of current service experiences, and of person centred planning as a method of life planning, for people with learning disabilities. This study adds to understandings of learning disability, and disability generally, by providing new insights into how people should be supported in the future. It emphasises recognising the importance of individual experience both as participants in circles of support, but also as people involved in, or using learning disability services in the United Kingdom. This includes appreciating that human experience is shaped not only by what can be observed and measured, but that individual agency, imagination, feelings and thought are just as important in how individuals view and experience their world.

What are the long and short term effects of working with suicidal clients on the person-centred counsellor? As suicide remains a major public health issue with the latest figures for the UK of 5706, an increase from 5377 in 2007 (ONS, 2010), suicide prevention strategies remain high on the public health sector agenda. With this statement in mind, and financial resources and funding at a low, an increased demand on psychological therapies can be assumed. As a result, the impact on individual practitioners will most likely intensify, personally and professionally. This research aims to explore the extent the impact may have, personally and professionally on the person-centred counsellor. The study was structured using semi-structured interviews with a purposeful sample of ten person-centred counsellors. A constant comparative method was applied to analyse transcribed data, from which four main categories emerged: ‘Experiencing the Therapeutic Encounter’, ‘Experiencing the Self within the Therapeutic Encounter’, ‘Seeking Solace – finding understanding’ and ‘Counsellor’s Grounding through Knowledge’, each subsumed by several lower order categories, from which a core category ‘The Counsellor’s Resilience’ emerged. The findings propose that, although the participants in this study were at times deeply affected, both personally and professionally, by their clients’ stories, they were able to reclaim their strength through seeking and finding support from supervisors, peers, holistic self-care and tacit knowledge, gained through personal experience and understanding. Formal training was identified as lacking in counselling training courses. The implications of the findings and recommendations are discussed.

No / Communication involves the exchange of information between at least two people, a giver and a receiver. If left unaddressed, communication difficulties may have a profound effect on quality of life and quality of care. Poor communication may result in high levels of anxiety and depression for the person living with dementia. Communication breakdown contributes to high rates of depression in spouses of people living with dementia and is a major problem for family and carers. Positive and supportive communication is essential to ensure good quality dementia care. A person-centred approach focuses on supporting a person to use and retain their skills and abilities. Person-centred communication involves a commitment to including the perspective of the person living with dementia, and an understanding of who the person is, their life history and preferences.

Yes / Person-centered care (PCC) has been the subject of several intervention studies, reporting positive effects on people with dementia. However, its impact on staff’s outcomes remains unclear. The purpose of this systematic review was to assess the impact of PCC approaches on stress, burnout and job satisfaction of staff caring for people with dementia in care homes. The databases PubMed, Web of Knowledge, Scopus and EBSCO and reference lists from relevant publications, were searched between December 2012 and March 2013. The review was limited to experimental and quasi-experimental studies, published in English and involving direct care workers (DCWs). Seven studies were included, addressing different PCC approaches: dementia care mapping (n=1); stimulation-oriented approaches (n=2); emotion-oriented approaches (n=2) and behavioral-oriented approaches (n=2). Five studies reported benefits on DCWs, suggesting a tendency towards the effectiveness of PCC on staff. However, methodological weaknesses and heterogeneity among studies make it difficult to draw firm conclusions. / Portuguese Foundation for Science and Technology

Yes / An experimental study using a pre-posttest control group design was conducted to assess the effects of a person-centred care based psycho-educational intervention on direct care workers’ stress, burnout and job satisfaction. The intervention aimed to develop person-centred care competences and tools for stress management. Four aged care facilities were randomly assigned to a psycho-educational or an education-only intervention (control). Data were collected from fifty-six direct care workers (female, mean age 44.72±9.02) through measurements of burnout (Maslach Burnout Inventory), job satisfaction (Minnesota Satisfaction Questionnaire-short form) and stress (Perceived Stress Scale) and focus-group interviews. Results showed significant positive effects in emotional exhaustion (p=0.029) and positive but no significant effects in stress and job satisfaction. According to qualitative data, the experimental group perceived enhanced group cohesion, emotional management and self-care awareness. Psycho-educational interventions may contribute to reduce direct care workers’ burnout. Further work is needed to determine the extent of its benefits. / Portuguese Foundation for Science and Technology

Yes / Many intervention studies lack an investigation and description of the factors that are relevant to its success or failure, despite its relevance to inform future interventions. This study aimed to explore the facilitators and barriers to the implementation of a psycho‐educational intervention for care assistants caring for people with dementia in aged‐care facilities. A process evaluation was carried out alongside a pretest/post‐test controlled study conducted in aged‐care facilities. Seven focus‐group interviews involving 21 care assistants (female; mean age 43.37 ± 10.0) and individual semi‐structured interviews with two managers (female; mean age 45.5 ± 10.26) were conducted 2 weeks and 6 months after the intervention, in two aged‐care facilities. Interviews were recorded, transcribed and submitted to content analysis by two independent researchers. Results were organised into implementer, participant and organisation level hindered and facilitator factors. Findings enable the interpretation of the experimental results and underscore the importance of collecting the perception of different grades of staff to obtain information relevant to plan effective interventions. / Foundation for Science and Technology (FCT). Grant Number: SFRH/BD/72460/2010 and RIPD/CIF/109464/2009

Yes / The quality of care for persons living with dementia in institutional care settings is of global concern. The provision of person-centred care (PCC) for people with dementia is internationally recognised as best practice, which promotes possibilities for people with dementia to experience well-being. However, there remains a lack of evidence of approaches that can help to support delivery of PCC for older people with dementia in long-term care, in South Africa. Dementia Care Mapping (DCM) is a successful practice development tool, originating in the UK, used for supporting the implementation of PCC. However, to date it has not been considered for use by South African occupational therapists working in residential care facilities. This article defines the components of the DCM tool, its process of use and potential outcomes for care practice. In an attempt to scrutinise the value of findings from an occupational therapy perspective, the Kawa Model is drawn upon to explain how the data from DCM can be interpreted. The Kawa Model provides a strong focus on how a sense of being is promoted by a person's context, and is an established vehicle to aid understanding of the potential for application of PCC in South African care facilities.