Background and Objectives Improved measures capable of capturing the influence of person-centered... more Background and Objectives Improved measures capable of capturing the influence of person-centered caregiving by staff in formal care settings on people living with dementia beyond deficit-oriented outcomes such as absence or reduction of symptoms are important for measuring progress toward improvements in well-being. This exploratory ethnographic study aimed to identify verbal and nonverbal expressions evidenced by people living with dementia surrounding person-centered caregiving approaches and to consider their use in informing temporally specific observational measures. Research Design and Methods This study adopted a microethnographic approach through secondary analysis of 5.3 h of audiovisual observations of people living with dementia (N = 9) in nursing home settings at mealtimes. We observed expressions surrounding person-centered caregiving approaches. A systematic review of audiovisual observations generated codes (observable indicators) of expressions that were characteriz...
Person-centered care (PCC), or delivery of care consistent with preferences, has been associated ... more Person-centered care (PCC), or delivery of care consistent with preferences, has been associated with improved care and quality of life for residents in long-term care (LTC). However, research has shown PCC has not been universally adopted. While general implementation barriers have been identified, little research has focused on barriers to meeting specific types of resident daily care and activity preferences. The purpose of this study was to describe LTC staff barriers to fulfilling specific types of resident preferences. A descriptive, qualitative study with 19 assisted living staff from nursing, dietary, and activities was conducted. Semi-structured interviews focused on identifying work system barriers to meeting specific types of resident preferences were analyzed using thematic analysis. Findings suggest shift assignments, staffing challenges, and facility schedules influence staff ability to meet certain types of preferences. The results suggest innovative design of shift s...
In order to design patient-centered art making interventions for health and well-being, investiga... more In order to design patient-centered art making interventions for health and well-being, investigators need to understand the population of interest regarding their relationship to engagement in art making activities. This study, therefore, aimed to examine older adults' characteristics that were associated with engagement in art making activities, and to provide practical examples of how to use the identified characteristics. We conducted correlation analyses to evaluate such associations, using cross-sectional survey data from the 2014 Health and Retirement Study (n=731). Female sex, higher education, personality traits, positive attitude toward the arts, and a larger social network size were positively associated with engagement in art making activities (p<.05). Males and those with lower education could be targeted, while the type of art making activity could be tailored based on personality traits for patient-centered art making interventions. Future studies can use this information to empirically study art making interventions for older adults.
There is increasing awareness that lack of activity engagement is associated with poor sleep qual... more There is increasing awareness that lack of activity engagement is associated with poor sleep quality. However, the majority of studies have focused on the effect of a single type of activity engagement on sleep quality. Little is known about the combined effect of multiple types of activity engagement on sleep quality. The aim of this study is to identify relationships among different types of activity engagement and sleep quality among older adults. This study is a secondary data analysis using the Health and Retirement Study data. The participants included 3,357 persons who were age 65 or older and who responded to survey modules on activity engagement and sleep quality in 2016. Before we conducted primary analysis, factor analyses and calculating coefficient omega were conducted to identify factor structure, construct validity and reliability of the activity engagement questionnaire. Then, regression was conducted to examine the relationships among multiple types of activity enga...
Objectives: Effective self-management in individuals with multiple chronic conditions is necessar... more Objectives: Effective self-management in individuals with multiple chronic conditions is necessary to optimize health outcomes. Self-management in multiple chronic conditions involves an iterative process prioritizing multiple changing needs/conditions. However, self-management in multiple chronic conditions has been assessed with instruments designed to assess selfmanagement of a single chronic illness. The instruments may not address the complexity of selfmanagement in multiple chronic conditions. Thus, this review aimed to examine how selfmanagement has been operationalized in the context of multiple chronic conditions. Design: A narrative review method was used. Data Source: The online databases, Pubmed, CINAHL Plus, and PsycInfo, were searched. The search was conducted of the database from January 2006 through November 2017. Review methods: Peer-reviewed research articles which operationalized self-management in adults with at least two or more chronic illnesses were selected for review. Two reviewers read full text of selected articles and extracted data regarding operational definitions of self-2 management and instruments used to assess self-management. Operational definitions were categorized to conceptualize how self-management has been assessed. Results: A total of seven peer-reviewed research articles were selected for inclusion. This review found that self-management has been assessed through prerequisites of self-management and behaviors involved in self-management. Prerequisites of self-management included attitude, selfefficacy, perceived ability, and knowledge. Behaviors included an individual's engagement in selfmanagement such as health-related behaviors, health service use, and medication adherence. Conclusions: This review revealed that current literature does not operationalize self-management in multiple chronic conditions as a process, indicating incomplete assessments of self-management. To obtain a more comprehensive understanding of self-management in multiple chronic conditions, future studies should consider self-management as an iterative process in addition to prerequisites for self-management and behaviors. Such studies will inform the development of patient-centered self-management interventions for individuals with multiple chronic conditions.
Mealtime behavioral symptoms are distressing and frequently interrupt eating for the individual e... more Mealtime behavioral symptoms are distressing and frequently interrupt eating for the individual experiencing them and others in the environment. A computer-assisted coding scheme was developed to measure caregiver person-centeredness and behavioral symptoms for nursing home residents with dementia during mealtime interactions. The purpose of this pilot study was to determine the feasibility, ease of use, and inter-observer reliability of the coding scheme, and to explore the clinical utility of the coding scheme. Trained observers coded 22 observations. Data collection procedures were acceptable to participants. Overall, the coding scheme proved to be feasible, easy to execute and yielded good to very good inter-observer agreement following observer re-training. The coding scheme captured clinically relevant, modifiable antecedents to mealtime behavioral symptoms, but would be enhanced by the inclusion of measures for resident engagement and consolidation of items for measuring care...
Self-determination is a core value of person-centered care. Research has shown residents and fami... more Self-determination is a core value of person-centered care. Research has shown residents and families want to be involved in decisions about care. Care conferences are one existing structure where residents and families can engage in decision-making about care goals. However, there are few tools to support effective engagement. To inform future tool development, this study sought to understand what resident and family stakeholders value about engaging in care conferences. In virtual meetings, 16 stakeholders identified 3 key areas of engagement: being informed about health/well-being, influencing care goals, and advocating for needs. They indicated current approaches do not achieve these engagement goals, which is particularly problematic during COVID when families cannot engage in person. Stakeholders offered ideas for supporting engagement such as provision of data before the conference. The study has implications for individualizing care conferences and encouraging resident and f...
The Veterans Affairs (VA) Storybook Program was developed to enhance nurse-patient relationships ... more The Veterans Affairs (VA) Storybook Program was developed to enhance nurse-patient relationships and satisfaction with care. Personal stories about nurses were distributed to patients on a medical/surgical unit. Quantitative and qualitative evaluation data were collected from patients and nurses to capture patients’ descriptions of nurses and perceptions of program value. Results show patients describe nurses differently after reading the storybook. Patients were highly satisfied with the program, and interviews suggest the stories fostered connection and developed an atmosphere of trust. Story programs may be an effective, structured approach to enhancing nurse-patient relationships.
Social support and social relationships have been repeatedly identified as essential to nursing h... more Social support and social relationships have been repeatedly identified as essential to nursing home resident quality of life. However, little is known about ways residents develop relationships with peers or staff. This study was conducted to explore the ways resident develop relationships with peers and staff in nursing homes. Fifteen cognitively intact nursing home residents from two facilities were interviewed for this grounded theory study. Sampling, interviewing, and analysis occurred in a cyclical process with results at each stage of the study informing decisions about data collection and analysis in the next. Unstructured interviews and field observations were conducted. Data were analyzed with open, axial, and selective coding. Residents developed relationships with peers and staff largely as an unintended consequence of trying to have a life in the nursing home. Having a life was a two-step process. First, life motivations (Being Self and Creating a Positive Atmosphere) i...
Background and Objectives Improved measures capable of capturing the influence of person-centered... more Background and Objectives Improved measures capable of capturing the influence of person-centered caregiving by staff in formal care settings on people living with dementia beyond deficit-oriented outcomes such as absence or reduction of symptoms are important for measuring progress toward improvements in well-being. This exploratory ethnographic study aimed to identify verbal and nonverbal expressions evidenced by people living with dementia surrounding person-centered caregiving approaches and to consider their use in informing temporally specific observational measures. Research Design and Methods This study adopted a microethnographic approach through secondary analysis of 5.3 h of audiovisual observations of people living with dementia (N = 9) in nursing home settings at mealtimes. We observed expressions surrounding person-centered caregiving approaches. A systematic review of audiovisual observations generated codes (observable indicators) of expressions that were characteriz...
Person-centered care (PCC), or delivery of care consistent with preferences, has been associated ... more Person-centered care (PCC), or delivery of care consistent with preferences, has been associated with improved care and quality of life for residents in long-term care (LTC). However, research has shown PCC has not been universally adopted. While general implementation barriers have been identified, little research has focused on barriers to meeting specific types of resident daily care and activity preferences. The purpose of this study was to describe LTC staff barriers to fulfilling specific types of resident preferences. A descriptive, qualitative study with 19 assisted living staff from nursing, dietary, and activities was conducted. Semi-structured interviews focused on identifying work system barriers to meeting specific types of resident preferences were analyzed using thematic analysis. Findings suggest shift assignments, staffing challenges, and facility schedules influence staff ability to meet certain types of preferences. The results suggest innovative design of shift s...
In order to design patient-centered art making interventions for health and well-being, investiga... more In order to design patient-centered art making interventions for health and well-being, investigators need to understand the population of interest regarding their relationship to engagement in art making activities. This study, therefore, aimed to examine older adults' characteristics that were associated with engagement in art making activities, and to provide practical examples of how to use the identified characteristics. We conducted correlation analyses to evaluate such associations, using cross-sectional survey data from the 2014 Health and Retirement Study (n=731). Female sex, higher education, personality traits, positive attitude toward the arts, and a larger social network size were positively associated with engagement in art making activities (p<.05). Males and those with lower education could be targeted, while the type of art making activity could be tailored based on personality traits for patient-centered art making interventions. Future studies can use this information to empirically study art making interventions for older adults.
There is increasing awareness that lack of activity engagement is associated with poor sleep qual... more There is increasing awareness that lack of activity engagement is associated with poor sleep quality. However, the majority of studies have focused on the effect of a single type of activity engagement on sleep quality. Little is known about the combined effect of multiple types of activity engagement on sleep quality. The aim of this study is to identify relationships among different types of activity engagement and sleep quality among older adults. This study is a secondary data analysis using the Health and Retirement Study data. The participants included 3,357 persons who were age 65 or older and who responded to survey modules on activity engagement and sleep quality in 2016. Before we conducted primary analysis, factor analyses and calculating coefficient omega were conducted to identify factor structure, construct validity and reliability of the activity engagement questionnaire. Then, regression was conducted to examine the relationships among multiple types of activity enga...
Objectives: Effective self-management in individuals with multiple chronic conditions is necessar... more Objectives: Effective self-management in individuals with multiple chronic conditions is necessary to optimize health outcomes. Self-management in multiple chronic conditions involves an iterative process prioritizing multiple changing needs/conditions. However, self-management in multiple chronic conditions has been assessed with instruments designed to assess selfmanagement of a single chronic illness. The instruments may not address the complexity of selfmanagement in multiple chronic conditions. Thus, this review aimed to examine how selfmanagement has been operationalized in the context of multiple chronic conditions. Design: A narrative review method was used. Data Source: The online databases, Pubmed, CINAHL Plus, and PsycInfo, were searched. The search was conducted of the database from January 2006 through November 2017. Review methods: Peer-reviewed research articles which operationalized self-management in adults with at least two or more chronic illnesses were selected for review. Two reviewers read full text of selected articles and extracted data regarding operational definitions of self-2 management and instruments used to assess self-management. Operational definitions were categorized to conceptualize how self-management has been assessed. Results: A total of seven peer-reviewed research articles were selected for inclusion. This review found that self-management has been assessed through prerequisites of self-management and behaviors involved in self-management. Prerequisites of self-management included attitude, selfefficacy, perceived ability, and knowledge. Behaviors included an individual's engagement in selfmanagement such as health-related behaviors, health service use, and medication adherence. Conclusions: This review revealed that current literature does not operationalize self-management in multiple chronic conditions as a process, indicating incomplete assessments of self-management. To obtain a more comprehensive understanding of self-management in multiple chronic conditions, future studies should consider self-management as an iterative process in addition to prerequisites for self-management and behaviors. Such studies will inform the development of patient-centered self-management interventions for individuals with multiple chronic conditions.
Mealtime behavioral symptoms are distressing and frequently interrupt eating for the individual e... more Mealtime behavioral symptoms are distressing and frequently interrupt eating for the individual experiencing them and others in the environment. A computer-assisted coding scheme was developed to measure caregiver person-centeredness and behavioral symptoms for nursing home residents with dementia during mealtime interactions. The purpose of this pilot study was to determine the feasibility, ease of use, and inter-observer reliability of the coding scheme, and to explore the clinical utility of the coding scheme. Trained observers coded 22 observations. Data collection procedures were acceptable to participants. Overall, the coding scheme proved to be feasible, easy to execute and yielded good to very good inter-observer agreement following observer re-training. The coding scheme captured clinically relevant, modifiable antecedents to mealtime behavioral symptoms, but would be enhanced by the inclusion of measures for resident engagement and consolidation of items for measuring care...
Self-determination is a core value of person-centered care. Research has shown residents and fami... more Self-determination is a core value of person-centered care. Research has shown residents and families want to be involved in decisions about care. Care conferences are one existing structure where residents and families can engage in decision-making about care goals. However, there are few tools to support effective engagement. To inform future tool development, this study sought to understand what resident and family stakeholders value about engaging in care conferences. In virtual meetings, 16 stakeholders identified 3 key areas of engagement: being informed about health/well-being, influencing care goals, and advocating for needs. They indicated current approaches do not achieve these engagement goals, which is particularly problematic during COVID when families cannot engage in person. Stakeholders offered ideas for supporting engagement such as provision of data before the conference. The study has implications for individualizing care conferences and encouraging resident and f...
The Veterans Affairs (VA) Storybook Program was developed to enhance nurse-patient relationships ... more The Veterans Affairs (VA) Storybook Program was developed to enhance nurse-patient relationships and satisfaction with care. Personal stories about nurses were distributed to patients on a medical/surgical unit. Quantitative and qualitative evaluation data were collected from patients and nurses to capture patients’ descriptions of nurses and perceptions of program value. Results show patients describe nurses differently after reading the storybook. Patients were highly satisfied with the program, and interviews suggest the stories fostered connection and developed an atmosphere of trust. Story programs may be an effective, structured approach to enhancing nurse-patient relationships.
Social support and social relationships have been repeatedly identified as essential to nursing h... more Social support and social relationships have been repeatedly identified as essential to nursing home resident quality of life. However, little is known about ways residents develop relationships with peers or staff. This study was conducted to explore the ways resident develop relationships with peers and staff in nursing homes. Fifteen cognitively intact nursing home residents from two facilities were interviewed for this grounded theory study. Sampling, interviewing, and analysis occurred in a cyclical process with results at each stage of the study informing decisions about data collection and analysis in the next. Unstructured interviews and field observations were conducted. Data were analyzed with open, axial, and selective coding. Residents developed relationships with peers and staff largely as an unintended consequence of trying to have a life in the nursing home. Having a life was a two-step process. First, life motivations (Being Self and Creating a Positive Atmosphere) i...
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