Implementation of communication routines facilitating person-centred care in long-term residential care: A pilot study

Investigating Person-Centred Care Planning in Care Homes Across England: An Exploratory Study of Practices and Contextual Factors

AIMS

To report how person-centred care principles are applied to care planning and to explore the contextual factors affecting their implementation in older adult care homes in England.

DESIGN

A combined framework analysis and quantitative content analysis study.

METHODS

Using a semi-structured questionnaire, we interviewed 22 care home managers in England, exploring topics around care planning processes. Audio recordings were transcribed verbatim. Transcripts were analysed through a combined framework approach and content analysis.

RESULTS

Most care home managers discussed person-centred care planning in terms of understanding residents' values and preferences and their engagement in decision-making. Factors facilitating person-centred planning implementation included accessible planning tools, supportive care home leadership, effective communication and collaborative partnerships. Inhibiting factors included regulatory and care practice misalignment, time constraints and adverse staffing conditions.

CONCLUSION

Differences between care home practitioners' understanding and practice of person-centred care planning require further examination to improve understanding of the sector's complexity and to develop suitable care planning instruments.

IMPLICATIONS FOR THE PROFESSION

Findings demonstrate a need for improved staff access to specialised person-centred care training and an opportunity for care home nursing practitioners to lead the co-development of digital person-centred care planning tools that reflect the reality of long-term care settings.

IMPACT

Identifying factors influencing the implementation of holistic approaches to care planning makes clear the need for modernising long-term care policy and practice to adapt to the contemporary challenges of the care home sector.

REPORTING METHOD

Study reporting was guided by the Standards for Reporting Qualitative Research.

PATIENT OR PUBLIC CONTRIBUTION

Two public involvement advisors with lived experience of caring for a relative living in a care home contributed to the development of the interview guide, advised on care home engagement, guided the interpretation of the findings and commented on the drafted manuscript.

Communication partner training for aged-care workers: A scoping review

BACKGROUND

In aged-care settings, direct care staff play a crucial role in supporting older people with communication needs. Many direct care staff, however, have unmet skill needs in interpersonal, intercultural, and intergenerational communication. Communication Partner Training (CPT) provides a potential solution. However, it is not known if existing programs address the diverse communication needs encountered in aged-care settings. We sought to identify the key features of existing CPT programs to determine their suitability for the Australian aged-care context.

AIMS

To identify existing CPT programs relevant to aged-care settings and to describe their content and format.

METHODS

A scoping review was conducted in alignment with the Joanna Briggs Manual for Evidence Synthesis and Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews reporting guidelines. Using a systematic search, we identified peer-reviewed articles from five electronic databases: PubMed, PsycINFO, Embase, Cochrane and CINAHL. All retrieved articles were screened by title and abstract; 20% were independently screened by a second reviewer. All full-text articles were independently assessed by two reviewers. Data describing the content and format of identified CPT programs was extracted using the Intervention Taxonomy and an author-developed tool.

MAIN CONTRIBUTION

This review highlights critical gaps in existing CPT programs for aged-care settings. Identified programs were predominantly disorder-specific (79%), with the vast majority focusing on conditions like dementia or aphasia and failing to address broader communication needs arising from personal, social and environmental factors. Notably, no programs addressed intercultural communication, despite known cultural and linguistic diversity among aged-care workers and recipients in countries such as Australia. Furthermore, few (9%) included intergenerational communication considerations. Most programs relied on in-person delivery methods (67%), often led by health professionals (71%), which may be impractical for resource-constrained and geographically dispersed aged-care services. Furthermore, reported outcome measures varied (187 across 90 articles), and few evaluated both trainee and client (the 'dyad') outcomes. These findings underscore the need for comprehensive, scalable and contextually relevant CPT programs to address the complex communication challenges seen in aged-care settings.

CONCLUSIONS

There is a need for a comprehensive CPT program that is fit-for-purpose for direct care staff in aged-care settings. This program should address the multifaceted and intersecting communication support needs of aged-care recipients, including intercultural and intergenerational communication differences. The program should also incorporate resource-feasible delivery methods and evaluate dyadic communication outcomes. Closing these gaps is vital to enhancing quality of care and life for older adults in aged-care settings.

WHAT THIS PAPER ADDS

What is already known on the subject Many older Australians have complex, unmet communication support needs. In aged-care settings, direct care staff play a crucial role in supporting older people to communicate. Many aged-care workers, however, have their own unmet skill needs in interpersonal, intercultural and intergenerational communication. Communication partner training (CPT) provides a potential solution. However, it is not known if existing programs address the diverse communication support needs encountered in aged-care settings. What this paper adds to existing knowledge Using a scoping review methodology, we identified and described CPT programs for direct support staff who work with older adults. Most CPT programs were disorder-specific and targeted communication needs in dementia or aphasia. As aged-care recipients have multifaceted, complex and intersecting communication support needs, these programs may fall short of addressing the training needs of aged-care workers. The mode of training delivery was predominately in-person and health professional-led. Such delivery modes may not support implementation given resource constraints across the Australian aged-care sector. CPT that can be feasibly implemented in aged-care settings to address complex and intersecting communication support needs is required. What are the potential or actual clinical implications of this work? Our analysis highlights the need for comprehensive, disorder-agnostic CPT tailored for aged-care staff to address diverse communication support needs. This CPT should consider scalable delivery modes effective across Australia's vast geography and limited trainer availability. It must include outcome measures reflecting the perspectives of communication support partners-older Australians in aged care with communication challenges. To tackle the health, personal and environmental communication barriers in aged care, a fit-for-purpose CPT program, co-designed with key stakeholders, is essential to ensure the training is both feasible and acceptable to meet the unmet needs of intended end-users.

Personalizing Communication of Clinicians with Chronically Ill Elders in Digital Encounters-A Patient-Centered View

BACKGROUND

Chronically ill elderly patients are concerned about losing the personal connection with clinicians in digital encounters and clinicians are concerned about missing nonverbal cues that are important for the diagnosis, thus jeopardizing quality of care.

AIMS

This study validated the expectations and preferences of chronically ill elderly patients regarding specific communication messages for communication with clinicians in telemedicine.

METHODS

The sample comprised 600 elderly chronically ill patients who use telehealth. We used a conjoint-based experimental design to test numerous messages. The outcome variable is elder patient expectations from communication with clinicians in telemedicine. The independent variables were known categories of patient-clinician communication. Respondents rated each of the 24 vignettes of messages.

RESULTS

Mathematical clustering yielded three mindsets, with statistically significant differences among them. Members of mindset 1 were most concerned with non-verbal communication, members of mindset 2 prefer communication that enhances the internal locus of control, and members of mindset 3 have an external locus of control and strongly oppose any dialogue about their expectations from communication.

CONCLUSIONS

The use of the predictive algorithm that we developed enables clinicians to identify the belonging of each chronically ill elderly patient in the clinic to a sample mindset, and to accordingly personalize the communication in the digital encounters while structuring the encounter with greater specificity, therefore enhancing patient-centered care.

Person-centered care for people with aphasia: tools for shared decision-making

Shared decision-making is a fundamental aspect of person-centered care, and can and should be part of many different aspects of the rehabilitation process. Communication disabilities like aphasia, which affects people's ability to use and understand spoken and written language, can make shared decision-making especially challenging to the resources and skills of rehabilitation practitioners. The purpose of this narrative review is to provide a comprehensive description of tools that can support successful shared decision-making with people with aphasia in the rehabilitation environment. These tools and strategies are appropriate for use by physicians, nurses, social workers, physical therapists (also referred to as physiotherapists), occupational therapists, and other service or care providers. The important role of speech-language pathologists as consultants is also described. Case scenarios throughout the paper illustrate the application of recommended tools and strategies along with best practices.