Person-centered care (PCC) is a philosophy of care emphasizing the individual needs, priorities, and preferences of patients over those of health care team members or institutions. Past efforts to ameliorate known quality of care concerns in nursing homes have been inadequate, and this approach to care has been recommended by the Institute of Medicine as a means to address these quality concerns. This philosophy of care is now being widely promoted in the United States and other Western countries. However, there is a lack of understanding about how PCC is implemented during hands-on care. The proposed study seeks to contribute to developing this understanding through the development of conceptual definitions of person-centered interactions that occur during assistance with morning care between professional caregivers and persons with dementia (Aim 1). It is through the interactions between the professional caregiver and the person with dementia that PCC has the greatest potential impact on the quality of care and quality of life for this vulnerable population. Because caregiving interactions are not isolated occurrences, the proposed study will also explore the contextual factors that serve as facilitators or barriers to person-centered interactions (Aim 2). In this qualitative descriptive study, qualitative content analysis will be used to examine existing video recorded episodes of morning care. Observational methods using video-recorded data are particularly amenable to study of detailed human interaction such as is involved in caregiving. Interactions will be described, coded, and classified as person-centered, non-person centered or neither based on an inductive exploration of what is already known about PCC. Person-centered interactions will serve as a basis for defining critical attributes from which conceptual definitions will be developed. A detailed descriptive summary of environmental factors and care dyad factors that facilitate or impede person-centered interactions will also result from the proposed study. This resulting contextually based, comprehensive understanding of the complex person-centered interactions that occur during morning care will contribute to advancing theory about PCC and support the development of valid measurement tools by guiding a future coding scheme, ensuring that future studies accurately represent and measure person-centered interactions during caregiving. Findings will also contribute to the development of targeted intervention strategies for caregivers that can be used in many settings.
