Exploring Interrelations Between Person-Centered Care and Quality of Life Following a Transition Into Long-Term Residential Care: A Meta-Ethnography

Abstract

Background and Objectives Globally, a culture change in long-term residential care (LTRC) moving towards person-centred care (PCC) has occurred in an attempt to improve resident quality of life (QoL). However, a clear understanding of how different aspects contributing to a PCC approach are interrelated with resident QoL is still lacking. This review explores interrelating aspects between PCC and QoL in LTRC using qualitative synthesis. Research Design and Methods Ten relevant primary studies were identified from a search of interdisciplinary research databases providing qualitative information. Studies were critically reviewed for key themes and concepts by the research team. We used a meta-ethnography approach to inductively interpret findings across multiple studies and reinterpreted the information using a constructivist approach. Results We identified 5 second order constructs sharing commonalities suggesting interrelations between PCC and QoL: (1) Maintaining dignity, autonomy and independence. (2) Knowing the whole person. (3) Creating a ‘homelike’ environment. (4) Establishing a caring culture. (5) Integrating families and nurturing internal and external relationships. Synthesis translation led to the following third order constructs: (1) Personalising care within routines (2) Optimising resident environments (3) Giving residents a voice. Discussion and Implications There are many interrelating aspects of PCC and QoL following a permanent transition into LTRC, but successful implementation of PCC, which enhances QoL presents challenges due to organisational routines and constraints. However, by prioritising resident voices to include their needs and preferences in care, QoL can be supported following a transition into LTRC.

Exploring resident experiences of person-centred care at mealtimes in long-term residential care: a rapid ethnography

“…Regardless resident ability, they can experience smells and engage in food preparation, which is believed important for PCC and feeling at home [36]. Enabling a greater level of resident engagement in choice has been suggested in previous research as important for providing continuity following a move into LTRC as well as maintaining a sense of identity for residents within a communal setting [14,37]. Furthermore, encouraging residents to be actively involved in their care and environment provides meaningful engagement for residents [35].…”

“…This can also lead to a more institutional feel in the mealtime setting, which research suggests can reduce resident autonomy [17]. Providing care should not overshadow independent resident choice, even though this must also be balanced with providing both care and choice in a communal environment [37].…”

Body work and body meanings in patient-centered care

“…This study also illustrates that time, space, and medical instruments can help the practice of empathetic gazing and touching and of playing and joking, all of which can support HPs and patients. Supporting these body practices allows HPs and patients to engage in a stronger reciprocal acknowledgment and, in such a way, in more personalized care (Davies et al, 2023; Martinez et al, 2023).…”

“…In particular, the contribution to PCC’s implementation of the physical perceptions and related feelings and emotions, exchanged in the relationship between HPs and patients, warrants further research. The physical, emotional, body-related aspects of the interactions between HPs and patients are important, because they can constitute the medium for more direct and intuitive communication and for a greater integration of the patients in the provision of their care (Davies et al, 2023; Martinez et al, 2023). The sensorial and physical components of the HP–patient relationship are critical to PCC, because they contribute to accounting for how HPs reflect on themselves and engage in the relationship with their patients through the consideration of their own and their patients’ bodies.…”

Provincial Policies Affecting Resident Quality of Life in Canadian Residential Long-term Care

“…[42][43][44][45][46][47][48] These initiatives rest on a premise that that LTC residents value a sense of control and empowerment over their life choices. [10,11,44,45,47,[49][50][51] Despite this cultural shift in LTC policies and practices, residential facilities are fraught with "circumstances that direct attention towards physical care and organisational needs at the expense of residents' overall wellbeing." [50 p.4] A recent study of residential care homes determined that space and time pressures negatively impacted the care staff provided to long-term care residents, with implications for hygiene and infection control standards, plus more interpersonal "virtues" such as dignity and respect, [52 p.1] where "the 'invisible', emotional, and immeasurable aspects of care, largely became the rst to be relinquished."…”