Adaptation and Validation of the Person-Centred Assessment Tool for the Acute Care Setting.

INTRODUCTION: Person-centred care (PCC) is synonymous with best practice in the care of persons with dementia. Despite this, PCC is not routinely assessed, and there is no validated tool for in the acute care setting. We aimed to validate the Person-Centred Assessment Tool (P-CAT) in an acute setting. METHODS: P-CAT was administered independently to a total of 161 nurses (n = 16, from a specialized dementia unit with PCC training; n = 116, geriatric wards; n = 30, medical/surgical wards). The word "residents" was replaced with "patients" in P-CAT. We employed confirmatory factor analysis with principal component extraction to verify the previously reported three- and two-factor solutions. A one-way between-groups ANOVA was then used to investigate group differences in the P-CAT score (total scale and subscale). RESULTS: Factor analysis revealed a two-factor solution (explained variance 42.28%): (i) extent of personalizing care and (ii) amount of organizational and environmental support. Out of the 13 items, only 2 items did not load as expected. The internal consistency reliability of the scale was satisfactory (Cronbach's α = 0.77). Nurses' P-CAT scores were significantly different across ward settings [Welch's F(2,37.20) = 13.01, p < 0.001, ω2 = 0.09], with the highest among those PCC trained. Post hoc analyses revealed a significant difference in mean subscale scores between PCC-trained nurses and nurses from the other two ward settings. P-CAT scores were not significantly correlated with age, r(159) = 0.01, p = 0.861, or with nursing experience, r(159) = 0.04, p = 0.615. DISCUSSION/CONCLUSION: P-CAT possesses adequate validity and reliability as a quantitative assessment tool of PCC in the acute care setting.

Person-Centred Dementia Care in an Acute Hospital: Experiences from Nurses Working in a Specialized Dementia Unit.

BACKGROUND: Person-centred care (PCC) is synonymous with best practice in the care of persons with dementia. However, the research focus has been in long-term care settings with less attention in acute hospitals. We aimed to study the perspectives and experiences of nurses implementing PCC in an acute hospital dementia unit (Care for Acute Mentally Infirm Elders [CAMIE]). METHOD: This was an exploratory qualitative study involving individual, face-to-face, semi-structured in-depth interviews. A purposive sample of 10 nurses participated in the interview. We employed an inductive thematic analysis approach to analyse the qualitative data. RESULTS: The findings highlighted the positive experiences, for example, meaningful connection with patients and the challenges, for example, managing challenging behaviour in providing PCC. The initial challenges were due to a lack of prior knowledge and experience. Through formal and informal learning, the nurses built confidence and competence, and also provided support to one other. They emphasized the importance of teamwork and camaraderie in the CAMIE team but raised concerns about the negative perceptions of non-CAMIE nurses on the value of their work. CONCLUSION: Despite the challenges, adequate knowledge and robust organizational level support are the key support for nurses to embrace PCC as their care ethos in the acute care setting.

Person-centered care for older people with dementia in the acute hospital.

INTRODUCTION: Patients with dementia (PWDs) are often subjected to enforced dependency and experience functional decline and emotional distress during hospital stay. Person-centered care (PCC) with specialized psychosocial interventions, minimally obtrusive medical care, and physical restraints-free practice holds potential to improve patient outcomes. We evaluate the effectiveness of an acute hospital dementia unit (Care for Acute Mentally Infirm Elders [CAMIE]) that adopts a PCC protocol. METHODS: Prospective naturalistic cohort study whereby PWDs in the CAMIE unit (n = 170) were compared with a control group in usual care wards (n = 60) over 6 months. Assessments included patient demographics, dementia type and stage, comorbidities (Charlson's Comorbidity Index), acute illness severity, Well-Being, Ill-Being, functional status (Modified Barthel Index), agitation levels (Pittsburgh Agitation Scale), and quality of life (EuroQoL), assessed on admission and discharge. Multivariate analysis of covariance examined the effect of CAMIE versus usual care on pre-post outcomes. RESULTS: CAMIE patients showed statistically significant greater gains in Modified Barthel Index function and Well-Being, decreased Ill-Being and agitation, and greater improvement in EuroQoL index score (effect size: Δ = 0.18) after adjusting for baseline differences that translated to a quality-adjusted life years gain of 0.045, assuming stability over 3 months. Estimating added cost of CAMIE stay over usual care at SGD 1500 (USD 1040) for average length of stay of 15 days per patient, the incremental cost-effectiveness ratio fell within the threshold for cost-effectiveness at USD 23,111. DISCUSSION: PCC for PWDs in acute hospitals not only improves clinical outcomes for patients but is also cost-effective. The results support the adoption of PCC on a wider scale for better care of PWDs.