Introduction

 Personal care was known to have many benefits to person health including improved outcomes, decreased agitation, increased quality of life, and better mental health. This style of care focused on providing care according to the persons’ wishes. Despite recommended care guidelines, implementation barriers existed in the form of poor communication, staff resistance, and other structural barriers. Thematic summary and analysis of the dependent and independent variables proved relatively telling in exposing their interconnectedness. Organization of evidence in the form of the Donabedian process focused on the thematic relationship of structure, process, and outcomes between variables in personal care. This article sought to define and identify these barriers to practice through a qualitative review of the literature. The effect of communication on these barriers to the implementation of personal care was identified as primary in prevention and first-line in defense. Therefore, a clinical practice change was proposed using communication as a guide for addressing these changes in practice.

Defining Personal care Outcomes

Personal care processes vary widely in their approach and implementation. As an established care guideline, personal care represents a hallmark of evidence-based practice. However, many healthcare staff neither recognize nor practice personal care. While the idea of including the persons’ preferences in care is a fascinating one, implementing these remains challenging in clinical practice. The review of the literature sought to establish a consensus on the issue. This examination includes a pertinent literary review, contributing factors, person population, significance of phenomenon, and theoretical framework. The clinical purpose of the issue can best be described by objectives, clinical questions, and search strategy. From there, the literary synthesis summarizes the independent and dependent variables and their impact on the issue at hand. Finally, an implementation model affecting both the personal care and its’ implementation barriers are chosen. Stakeholders are identified along with targeted strategies sufficient to achieve the aims of the research question. Following this, strategies are sought to bring about improvements in the current provision of care. This project proposal aims to define personal care and propose strategies to overcome key implementation barriers in current practice. To this end, an administrative practice change using communication to affect the delivery of care is sought. In this way, personal care changes to care will be realized.

Background

Description

Numerous studies put forth the barriers and facilitators of implementing personal care as described by a review of research that is currently floating around in certain academic circles of learning. Personal care is as always considered from the person’s viewpoint of wishes for their wellbeing. More than that, nursing staff are considered team implementors under this viewpoint. They ensure that person wishes for care are respected and achieved. This viewpoint leads to the natural inclusion of persons as partners with an active voice in their own healthcare. Personal care means very directly to respect and respond to what the person individually values as care. This perspective may even influence certain clinical decisions. Other shared values include care, concern, treatment, and engagement. Nevertheless, several barriers to personal care currently exist in centers of treatment and care. These barriers are considered inherent process factors due to the institutional, personal, environmental, and communicative agents of change. This project proposal focuses on the need to improve the implementation of personal care at all levels through the use of communication. Task-centered, process-centered, and personal care communication types are all perceived as crucial to achieving the desired person outcomes.

Contributing Factors

Personal care, as the name suggests, is largely oriented around the person and their wishes for care. Personal care originated after many hours spent observing tense staff and person interactions plaguing a number of institutions. This tension arose in many forms and included medication refusals, verbal aggression, hostility with staff and other residents, and even physical violence. Traditional forms for the treatment of tension include the use of frequent discussions, managerial interventions, psychotropic medications, and restraints. Tensions in older adults receiving care are particularly common due to disease and life process states. Several common disorders that result in increased person-staff tension while necessitating additional care include predictors of poor physical and mental health.

Description of Population

Many older adults present for nursing care in the long-term and skilled sectors. With a rapidly aging population, roughly fifty-two million older adults are considered seniors. Increasingly larger numbers of these need institutionalized nursing care of some sort. Mental health more commonly is known as a debilitating illness affecting a large sector of the older adult population. It is presents as life-limiting with deficits noted in memory, awareness, and self-care. More than six to thirty-three percent more older adults are expected to receive new diagnoses of mental health or physical health processes. As a result, much of the older adult institutionalized population are considered dependent on providers and a good number present with behaviors of physical, verbal, and situational tension towards self, staff, and others.

Significance of Phenomenon

Personal care is shown to reduce tensions of all varieties in the institutionalized setting. Additionally, older adult recipients of personal care report higher quality of life measures in both content and satisfaction on national and organizational

surveys. Personal care is characterized by person involved in planning of care. This involvement is shown to improve mental and physical functioning in all areas. Person-staff tensions are known to lead to expressions of aggression, falls, medical comorbidities, weakness, debility, loss of self-control, and worsened mental health. Persistence of these issues can lead to negative health outcomes if these concerns are not resolved in a satisfactory manner. This article aims to examine the impact that personal care makes on facility outcomes from a total wellness perspective.

Theoretical Framework

Application of the Donabedian framework seeks to refine the current understanding of personal care into a three-fold conceptual structure. This understanding is further broken down by structures, processes, and outcomes. Outcomes are the result of a treatment, action, or the provision of care. These are largely person-dependent. Processes describe how nursing care is given. It can be any action that leads to the desired outcome being obtained. Persons and healthcare staff frequently have opposing views regarding these. Finally, structures describe the organization in which person care is provided.

A recent article applies the Donabedian framework to personal care. In personal care, structures are considered the design and development piece. This includes staff education regarding care’s meaning, application, and performance. The latter three objectives describe the way in which this care is achieved. Finally, personal care outcomes are defined as the persons’ accessibility to care. These also refer to the person experiences and definitions of care received.

In many facilities there are still noticeable gaps between clinical guidelines and current practice. As a result, the vast majority of geriatric nurses surveyed lack appropriate knowledge of personal care. Still others report barriers to personal care’s implementation at a facility level. Facility wide barriers to implementation of personal care include lack of organizational structure and internal support. Through application of the Donabedian framework, a better understanding of the issues presented can be achieved. Viewing personal care through the Donabedian process, current gaps in best practice are identified and workable solutions established. The Donebedian process helps to conceptually identify these gaps in care as well as visualizing a viable project proposal.

Purpose

Objectives

The purpose of this administrative proposal is to explore and define personal care in its truest form. In doing so, common conceptions of personal care are sought for understanding and clarity. Furthermore, the proposal seeks to identify any gaps present in current care domains. One article presents a rather compelling report that highlights these efforts to comply with current clinical guidelines. It summarizes a recent quality improvement report sponsored by certain financial services that offer themes of resiliency and documentation of person wishes by means of the electronic medical record. Additional themes of innovation and person feedback are also identified in an effort to gain insight into current practices of care.

Another article examines the barriers and facilitators of implementing personal care. The article poses the question as to whether the use of person guidance in benefit-harm assessments would improve current practice guidelines. Limitations to the article include stakeholder involvement, person preferences, and resistance from medical professionals. The person preferences were then calculated on a case-by-case basis and used to determine their sensitivity and applicability to care. In conclusion, the article found that self-identified person preferences resulted in improved clinical outcomes when compared with best-practice guidelines. Thus, the research could be generalized to include person preferences across the wider spectrum of elder-care.

Outstanding Question

The project proposal questions how older adults benefit from the implementation of personal care compared to the present standard of care in six months. In this case, the person refers to the larger representative sample of older adults receiving personal care. The comparison concerns the conditions of care affecting the larger person population. The outcome looks at the outcomes resulting from the provision or withholding of personal care. The intervention determines the way in which personal care is implemented in current clinical practice. Finally, time examines the difference in care received in six months.

Variables

Due to the article design being that of a nursing practice intervention following the analysis of an independent and dependent variable, a mixture of studies presenting with applicable data have been sought. Additionally, certain measures of care have been consulted such as person outcomes and application to current practice. Research necessary to inform the practice proposal has two main points of comparison. These hinge on rigor, results, and applicability of research to inform current care practices. The description and exploration of common themes is often used. In this case, communication has been identified as an integral component of personal care. Thus, targeted communication can in theory be used to improve the practice of personal care as it is currently known. As a result, the independent variable would be considered the delivery of care along with the communication needed to achieve the desired result. The dependent variable would be the benefits received from the implementation of personal care.

Search Strategy

Selections for this qualitative literary analysis were made using purposive sampling with articles being chosen by the quantitative and qualitative data necessary to answer the clinical question. Person care outcomes and experiences are considered a subset of this method of research. As a result, these can be grouped together by relevance to care. These include healthcare knowledge, person preference, provider communication, and supportive systems. Sampling types for this include the cross-sectional data analysis. Twenty articles have been selected for thematic analysis from databases of care, namely Google Scholar from there. Related themes and keywords chosen for search introduction relate to personal care and its implementation. All research articles chosen are based on content, publication date, and rank in the search results. Limitations of the research include the lack of articles sufficient to answer the clinical question.

Literature Synthesis

Independent Variable: Process

 When articleing the Donabedian concept of process structure, the independent variable is considered the intervention. In this case, the selected intervention includes the use of communication to connect the person wishes with those of the staff. Communication is what allows the procedural structure of personal care delivery to occur. It is also defined as an attempt by staff to find out the persons’ wishes, to document these, and to act upon them. One article found there was disconnect reported between the person wishes and the staff’s understanding of them. Furthermore, at a deeper level, lack of communication results in an unsafe culture of care. In addition to poor person outcomes, these staff also demonstrate much understanding that is needed of how personal care should be implemented and what it is.

Behind training, systems improvement, and the provision of care lies communication. This consideration gives rise for the necessary improvements to affect the current quality of care that has been given. The use of communicative based assessments in some cases has highlighted the need for increased person insight into their care and in others pulled the entire healthcare system together.

A recent caregiving guideline found that education, comfort, and support are equally important to ascertain person needs and wishes for care as well as to communicate information quickly. Without the presence of communication, additional strategies for the reduction of stress and violence aimed primarily at nursing staff caring for the older adult population are needed. Due to this, additional research is sought highlighting best strategies in person de-escalation and incident reduction that could be solved by simply following the persons’ wishes. This review of the current literature highlights the need for improvements in personal care brought about by gaps in implementation.

Barriers to implementing personal care include institutional, communicative, environmental, personal, and other factors. Communication has been identified notably as the best facilitator of personal care. Various types of communication that aid in implementation and care planning include task, process, and personal care processes. Improving personal care through communication is encouraged at all levels and environments. Improved communication is needed to improve person outcomes, foster staff engagement, and renew focus on healthcare results.

Dependent Variable: Structure

The dependent variable is the benefits received from person centered care including certain changes due to improved communicative processes. Another article examines the need for personal care in an ever-changing landscape of eldercare. With much of the population aging rapidly, there is an increased demand for quality of care. A recent article of local nursing facilities found issues in the implementation process for a variety of reasons including those relating to lack of knowledge of care, discomfort with providing personal care, as well as other organizational barriers. A total of 32 nursing facilities total were surveyed using regression analysis surveys tabulating self-reported knowledge of personal care. Correlations between environment, knowledge, and outcomes were also significant at p > 0.05% with a mean average of 0.07% for all categories. Cronbach’s alpha, correlation, and mean of all knowledge scores was calculated with a facility-wide average of 68.4. Additional facility support from administration is needed for personal care. Furthermore, areas of learning needs within the facility relating to personal care are identified. These include personal care goals not being met by staff due to limited understanding. Based on the needs assessment, this issue ought to be a priority for facility leadership.

Shared values of personal care include healthcare knowledge, person preference, healthcare provider communication, and supportive healthcare systems. The issue with quantitative studies addressing personal care is found in the dearth of available research sufficient to answer the question. Therefore, any research done in this regard would be largely thematic and self-exploratory. Personal care outcomes can be considered vital to the discussion of this sort of research. The results of the findings also hold importance to inform nursing care, regulation, as well as legislation.

Healthcare values are determined by importance to the person through a descriptive analysis of common research themes. Sources of knowledge are considered along with places to find opportunities and assistance in pursuit of personal care healthcare literacy. Person care outcomes most often are according to person description of benefit and risks. In addition, these outcomes are bolstered by a strong focus on person comfort and wellbeing as those wishes are followed. Structural limitations of personal care include the possibility of marginalization by academic professionals. Additional research is needed to establish communication’s effect on personal care as a defining biomarker of care. Conclusions include integration of the persons’ preferences into their everyday care. Accessibility and continuity of care are equally important for maintaining a welcoming environment of care. Family also continue to be valuable sources of opinions, wishes, and guidance for care.

Summary

Various outcome measures include producing quality, equity, safety, engagement, resiliency, electronic medical records, innovation, and alignment of care . All these outcome measures identity the quality of care provided. Quality is best shown in the time and attention given to details of the care provided. In essence, it is healthcare that is believed to be of the same quality or greater given to everyone with allowances made for individual details. Furthermore, the delivery of quality of care is also a safe one. Safety can be fostered through a culture of personal care changes. Additionally, persons are encouraged to take an active role in their healthcare goals and outcomes. In order to keep track of ever-changing health-care landscape resiliency is needed. Resiliency includes healthcare roles and responsibilities which are meant to fluctuate in response to personal needs. Keeping track of personal preferences and care outcomes can be done through the implementation of electronic data which offers additional insights needed to guide the quality of care. Finally, innovation and person feedback help to inform and impact care.

Process measure outcomes include outcomes of personal care, person wishes for care, and differing viewpoints between the persons and staff in the care provided. This proposal seeks to describe person preferences as well as define their experiences

shared under personal care. Understanding these leads to improvements in personal care by means of addressing current gaps in practice. One way to look at this is through the use of the Donabedian process. The Donabedian process conceptual framework looks at care from the viewpoint of structure, process, and outcome. All of these possess the ability to inform current standards of care and improve them. Quality of medical care is defined through the various means o