How does your staff feel about person-centered care?
For just about every study, conference talk or article touting the benefits of person-centered care in nursing homes, it seems an argument can be raised to dispute the findings.
Allowing residents to incorporate their personal preferences into the choices they make each day? It's simply not achievable if the residents' choices are expensive or unachievable. Giving residents the ability to make choices regarding what they eat, and when? They'll start ordering filet mignon for every meal!
While these statements seem reactionary, there are real concerns behind them. Giving residents more choices in their everyday lives is great, but how can providers truly implement person-centered care ideas when trying to juggle residents' health and safety needs, or the ability of their staff?
That was the idea behind a study published earlier this month in Geriatric Nursing, by researchers with the Edith Nourse Rogers Memorial Veterans Hospital in Bedford, MA, and the Boston University School of Public Health. The research included interviews with staff at two Veterans Health Administration nursing homes that transitioned to a Green House model, in order to pinpoint what staff members there viewed as facilitators or barriers to their ability to support residents' choices.
After interviewing facility leadership, clinicians and frontline caregivers, the researchers identified resident choice-related tensions on three levels: issues by an individual, such as a staff member; issues between residents and staff; and issues within the organization, such as choices clashing with facility policies.
The study includes multiple anecdotes from staff on these tensions, such as staff concerns that a resident's choices could harm his or her health. (“We've got an 89-year-old lady who has diabetes and wants to eat a [MoonPie] once a week.”) Or caregivers being unsure of where to “draw the line.” (“Do we continue to just give them everything they want?”).
“Throughout our interviews, staff conveyed uncertainty and divided feelings around this tension,” wrote lead researcher Jennifer A. Palmer, PhD. “We found, however, that staff were not necessarily unilaterally opposed to achieving resident choice in the face of medical and safety concerns; they were rather conflicted.”
There's no magic bullet that will make these questions, concerns or doubts vanish. The Geriatric Nursing study offers some possible resolutions, such as staff education, reinforcement, stakeholder collaboration and supportive leadership. As the researchers note, further study will be needed to see which types of resolutions work best for certain situations.
Until then, take note from this investigation in shaping your own person-centered care programs. It's not enough to scoff at the possibility that a resident's choice may not be what's best for them, or even attainable by the facility. Ask staff members their thoughts, and think critically to see if there's a creative workaround or solution to the issue.
As Palmer writes in the study, nursing home staff can work to clear up these resident choice-related tensions with innovative solutions that can honor residents' choices while keeping them safe and health — “the two aims do not have to conflict but can co-exist.”
Sounds like a winning combination to me.
Follow Staff Writer Emily Mongan @emmongan.