This thesis aimed to critique the research on person centred care (PCC) in neurorehabilitation, and consider how PCC in this setting can be further developed. Paper One reviews the extant literature on PCC in neurorehabilitation. The literature search returned 27 papers, which were critiqued for quality, how they conceptualised PCC, how they practiced PCC and the feasibility of PCC. Conceptualisations of PCC used varied from narrow conceptualisations of PCC as participation in goal setting, to broader ones which also incorporated issues such as shared decision making, outcomes, respect and emotional support. Similarly, methods of practicing PCC primarily used goal setting, with a minority of papers addressing outcomes and communication aspects of PCC. The review found that PCC is feasible for neurorehabilitation, with important benefits for clients and professionals. Providing PCC in neurological rehabilitation can be challenging and the literature review discusses ways to overcome barriers to PCC. The literature review highlights the need for methods to assess and develop PCC which are suitable for people with and without cognitive impairments. Paper Two addresses this need, by presenting research investigating the feasibility of using Dementia Care Mapping (DCM) on a neurorehabilitation ward. DCM is an observational method aims to document the quality of care from the perspective of the patient. DCM was found to be feasible for use on a neurorehabilitation ward, as shown by the suitability of the coding system. Q-methodology was used to assess staff perceptions of DCM. This further supported DCM feasibility, with staff reporting that DCM provided useful information for staff that they could use to improve the care they provided. DCM required some minor amendments in order to be used in a hospital rehabilitation environment and further amendments could improve its suitability for use in neurorehabilitation settings. Paper Three is a critical appraisal of both the literature review and research paper. The strengths and weaknesses of the use of both DCM and Q-methodology are critiqued, and consideration given to the limitations of the research.

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No description available.

Research Doctorate - Doctor of Philosophy (PhD) / There is little evidence to show the critical factors that impact on managing aggression in people with dementia and what model of care ensures integrity for both the resident and the personnel responsible for their care. Aggression in this study is defined as an overt act, involving the delivery of noxious stimuli to (but not necessarily aimed at) another organism, object or self which is clearly not accidental. (Patel and hope 1002. p 212). This study used ethnographic techniques, incorporating the use of critical incidents, to explore and explain the culture and context of care situations where nursing personnel experience aggression and violence when dealing with residents with dementia. A Critical Incident Technique was used to identify behaviours of both staff and residents that contributed to and or reduced the amount of aggression that occurred. In particular, this study explored the nature of aggression and the responses of staff and the tensions that exist in the maintenance of rights of both personnel involved in care and the residents for whom they care. Findings revealed the extent to which responses to violence and aggression are related to staff education and understanding of dementia, as well as the illness the resident is suffering at the time. Staff had employed some creative ways to manage aggression in residents. This idicated that a model of care based on person centred care (Kitwood, 1997) would be appropriate for the management of these residents. A framework for an alternate model for the care of people with dementia who are violent and aggressive based on the person centred care approach is proposed and suggestions made for future research.

A systematic review of the literature that explored the processes and perceived effectiveness of qualitative methods used to elicit the views of young people with autism spectrum disorders (ASD) about their educational experiences was conducted. Studies that were identified and screened using a trialled evaluation checklist and synthesised using the PRISMA guidelines identified data collection methods that were perceived to be useful. Limitations such as the over-representation of participants who were able to engage in verbal discussion and the lack of detailed description and evaluation of data collection methods were also identified. A multiple case study research was then conducted to explore two special schools' processes of eliciting the views of secondary school-aged pupils with ASD about their transition to adulthood and its perceived effectiveness. Qualitative data from semi-structured interviews with the school's staff and an observation of a transition meeting were gathered and thematically analysed individually, then compared and contrasted within school level. The findings revealed that both schools' processes of eliciting young people with ASD's views about transition to adulthood is a long process which involves three phases and is underpinned by a person-centred ethos. Perceived strengths and limitations of the process were also identified. Dissemination of the study's findings will include presentations and consultations with key stakeholders such as mainstream and specialist secondary schools and local authority post-16 steering group to explore the utility of the findings in different contexts. Collaboration with other educational psychologists (EPs) will also be conducted to explore this study's implications in the way they support schools in eliciting the views of young people with ASD.

Yes / (1) Present deprescribing experiences of patients living with frailty, their informal carers and healthcare professionals; (2) interpret whether their experiences are reflective of person-centred/collaborative care; (3) complement our findings with existing evidence to present a model for person-centred deprescribing for patients living with frailty, based on a previous collaborative care model. Qualitative design in English primary care (general practice). Semi-structured interviews were undertaken immediately post-deprescribing and 5/6 weeks later with nine patients aged 65+ living with frailty and three informal carers of patients living with frailty. Fourteen primary care professionals with experience in deprescribing were also interviewed. In total, 38 interviews were conducted. A two-staged approach to data analysis was undertaken. Three themes were developed: attitudes, beliefs and understanding of medicines management and responsibility; attributes of a collaborative, person-centred deprescribing consultation; organisational factors to support person-centred deprescribing. Based on these findings and complementary to existing evidence, we offer a model for person-centred deprescribing for patients living with frailty. Previous models of deprescribing for patients living with frailty while, of value, do not consider the contextual factors that govern the implementation and success of models in practice. In this paper, we propose a novel person-centred model for deprescribing for people living with frailty, based on our own empirical findings, and the wider evidence base. / This research was funded by the National Institute for Health and Care Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC).

No / People with dementia need increasingly specialised support as they approach the end of life, and so too do their families and the professionals working with them. This book describes not only what can be done to ensure maximum quality of life for those in the final stages of the illness, but also how best to support those involved in caring for them. Emphasising the importance of being attuned to the experiences and needs of the person with dementia, the authors explain why and how they should be included in decisions relating to their end of life care. Practical strategies for ensuring physical and emotional wellbeing are provided, drawing on useful examples from practice and providing solutions to potential challenges that carers and family members will face. Dilemmas surrounding end of life care are explored in detail, including the moral dilemma of medical intervention, and the authors suggest ways of supporting family members through the process in terms of providing information, helping them adjust to change and loss, and involving them in their relative's care, and at how care staff can be supported through appropriate education and training, team building and information-giving.

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Bakgrund: Hjärtsvikt är ett vanligt förekommande sjukdomstillstånd och diagnosen återfinns hos en kvarts miljon människor i Sverige. Behandlingen främjas av en personcentrerad omvårdnad med delaktighet och följsamhet hos den drabbade personen. Detta bygger på att sjuksköterskan ökar sin förståelse för personens unika situation. Syfte: Att beskriva personers upplevelser av att leva med hjärtsvikt Metod: En litteraturöversikt där 13 kvalitativa artiklar inkluderades. Resultat: Personer med hjärtsvikt upplever sig fysiskt begränsade av sin sjukdom. En försämring i både fysisk och psykisk hälsa visade sig. Resultatet redovisas i katergorierna; begränsningar i vardagen, förändringar i sinnesstämningen och förändringar i det sociala nätverket. Slutsats: Resultatet visar på en stor variation i upplevelserna hos personer drabbade av hjärtsvikt. Det är därför viktigt att sjuksköterskan har en bred kunskap och en omfattande förståelse för sjukdomen, då det främjar en individanpassad vård baserad på rådande förhållanden. Nyckelord: hjärtsvikt, personcentrerad omvårdad, upplevelser / Background: Heart failure is a common disease and the diagnosis is found in a quarter of a million people in Sweden. The treatment promoted by person-centered care with the participation and adherence of the affected person. This is based on that the nurse increase the understanding of the person's unique situation. Aim: To describe people's experiences of living with heart failure Methods: A literature review where thirteen qualitative articles were included. Results: People with heart failure feel physically limited by their disease. A deterioration in both the physical and mental health appeared. The results were divided into following main categories; limitations in everyday life, changes in mood and changes in the social network. Conclusion: It is important that the nurse has a broad knowledge and a comprehensive understanding of heart failure, when it showed a great variation in how people perceive their situation. This promotes an individualized care based on current conditions. Keywords: experiences, heart failure, person-centred care