What are the factors that influence person centred care in public residential care settings for older people?
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The term Person centred care is used widely in health and social care discourse and is commonly employed in the articulation of policy, both at governmental and professional level. The concept, as it relates to older people in residential care, challenges traditional medical and task-orientated processes and promotes a shift in emphasis to holistic, collaborative, relationship-based care environments. While person centred care has become a watchword for good quality of care and quality of life, problems have been reported in relation to its implementation and sustainability. There is a lack of research on the social relations that influence the experience of person centred care. Institutional ethnography was chosen to explore the everyday living routines of older people in residential care and the organisational practices that influence those routines in three public residential care facilities in the Republic of Ireland. The study was divided into two phases. The first phase of the study explored the everyday life of these residential settings and the implementation of person centred care. This involved interviews with 12 residents, 10 relatives, 13 frontline staff and 11 managers. Observations of the daily routines in non-intimate settings were also undertaken. The second phase connected the everyday life of the resident to the organisational structures of professional practice, human resource management and regulation. Mapping the social relations that influence the everyday lives of residents allowed the disjuncture between the espoused principles of person centred care and the organisational policies and practices to be explored. The findings revealed that while some elements of person centred practice have been implemented, it is yet to be embedded in organisational practices in a way that would change the nature of relationships, shared decision-making or meaningful activity between residents, relatives and staff. These findings warrant the need for organisational and policy changes that give primacy to the implementation of person centred care, and rebalance of power in order to create a level playing field on which to develop interdependent communities within residential care.
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