Sustainable implementation of person-centred care in residential care facilities: hindering and supporting factors when improving incontinence care

Purpose: The aim of the present study was to focus on the impact of the implementation of a person-centred approach on staff perception of the likelihood of being able to provide person-centred care and strain in the workplace. Design: The study was a controlled prospective cohort study performed at three residential care facilities in western Sweden involving all nursing staff members active from 2013 through 2015 at baseline and at three follow-ups during and after the implementation period. Two of the residential care facilities were assigned to the intervention group and one was assigned to the control group. Method: The study was designed to test the sustainability of a person-centred approach based on three aspects: partnership, narrative and documentation. A cross-section of 20 coworkers were purposively sampled from a total of 100 persons working at the two Intervention nursing homes to participate in the intervention group. The process outcome was measured as: perceived ward atmosphere, using the staff version of the validated Person-Centred Climate Questionnaire; person-centred care, measured using the validated Person-centred Care Assessment Tool; and experience of strain in work, using the Strain in Nursing Care Assessment Scale. Descriptive statistics were calculated for all variables using the SPSS Statistics software package. Findings: The results show that, at the control site, there were lower staff perceptions of the care atmosphere, higher level of strain experienced in their work and a lower likelihood of providing a person-centred care approach, whereas these factors remained rather stable over time at the intervention residential care facilities. Two contrasting results were observed—namely, that the higher the staff's perception of the likelihood of being able to provide individualised care and of a more person-centred ward atmosphere, the higher their stress levels experienced at work. In addition, older ages and long durations of work experience significantly negatively affected the staff's assessment of their ability to create an atmosphere of everydayness and to adopt a person-centred approach in care. Conclusions: The findings show that sustainability of a person-centred ward atmosphere is possible in the care of older people, despite staffing problems and other organisational challenges, according to the staff's assessment, after implementation of a person-centred programme. The more experienced staff members assessed their likelihood of being able to provide a person-centred care as lower after the implementation phase, indicating that despite the ambition of supporting person-centredness and quality of care, staffing and management difficulties that are present at the outset of the programme's implementation can later lead to stress and frustration relating to roles and routines.

Perceptions of Restrictiveness in Forensic Mental Health: Do Demographic, Clinical, and Legal Characteristics Matter?

Where safe, forensic mental health systems should provide care in the least restrictive environment possible. Doing so can maximize patient autonomy and empowerment while minimizing unnecessary social disconnection and stigmatization. This study investigated whether patients’ perceptions of restrictiveness were associated with demographic, clinical, and legal characteristics. The Forensic Restrictiveness Questionnaire (FRQ) was used to measure perceptions of restrictiveness in 235 patients in low-, medium-, and high-secure settings in England. The results showed that restrictiveness scores were significantly higher for patients who experienced an adverse event in the past week or were diagnosed with a personality disorder compared to those with a mental illness. A regression analysis suggested that only diagnosis was predictive of FRQ scores when controlling for perceptions of ward atmosphere and quality of life. Age, length of stay, ethnicity, level of security, legal section, and offence type were not associated with FRQ scores. Future research should investigate the roles that individual symptoms, insight into illness, mood, personality, and expectations of care have in influencing perceptions of restrictiveness.

Clinical supervision factors as perceived by the nursing staff

Objective: Assess clinical supervision factors as perceived by nurses and first line nurse managers at Assiut University Hospital, and explore the relationships among personal characteristics and clinical supervision factors of studied nurses and first line nurse managers.Methods: A descriptive design was utilized in Medical and Surgical departments at Assiut University Hospital for A convenience sample of first line nurse managers (N = 30) and nurses (N = 151) by using study tools for nurses included two parts: 1) personal characteristics data sheet; 2) clinical supervision factors, and Study tool for first line nurse managers included two parts: 1) personal characteristics data sheet; 2) clinical supervision factors.Results: The highest mean scores were in trust and rapport & Supervisor advice and support of clinical supervision factors among the studied nurses. While among first line nurse managers' the highest mean scores were in improved care and skills & personal issues and reflection of clinical supervision factors.Conclusions: The most important clinical supervision factors which had the positive correlations were between finding time and ward atmosphere with age & years of experience with importance and value of clinical supervision among the studied first line nurse managers, while there was a negative significant correlation between age and trust and rapport & leadership style of the ward manager among the studied nurses. Nurse Managers should direct, monitor and evaluate the staff nurses through scientific standards of supervision as recommendation for the study results.