Elderly Care in Transition - The Elderlys' and the Staffs' Perspective on Person-centered Care, Environment, Health and Well-being
Elderly Care in Transition - The Elderlys' and the Staffs' Perspective on Person-centered Care, Environment, Health and Well-being
Elderly care in Sweden faces several significant challenges. The number of older people is increasing at the same time as there are fewer of working age. Elderly care staff, such as nurses, care assistants and nurses, have on average more sick days than many other professional groups and often experience high work-related stress. In some municipalities, there are also problems with high staff turnover and a lack of formal competence. At the same time, research shows that many employees experience work in elderly care as meaningful and valuable. Taking advantage of and strengthening these positive aspects is central to creating good conditions for the health and well-being of staff and for the quality of care and care for older people. An important area of development in elderly care is person-centred care, which means that care is based on the individual person's needs, wishes, life history and resources. Person-centred practice emphasises the relationship between the older person, the staff and, if the person so wishes, relatives. Although person-centered care is often seen as an obvious part of good care, research shows that it is not fully implemented in practice and that the introduction of person-centered working methods can be complex and demanding.
This study is being carried out in collaboration between municipalities and the University of Gävle and is linked to the establishment of nursing homes for the elderly that will function as academic nursing homes. In these nursing homes, person-centered care will be a pronounced focus area. Through recurring measurements, the activities will be monitored and developed in close collaboration between practice and research. The overall aim of the study is to investigate older people's experience of academic nursing homes with a focus on person-centered care and nursing, outdoor environment, health and well-being, and to investigate the staff's experience of person-centered working methods, learning, structural conditions and work-related well-being. The study also aims to analyze the relationship between older people's experiences of person-centered care, outdoor environment, health and well-being, both among older people living in academic nursing homes and among older people living in their own homes. The study has a longitudinal design and data will be collected at several points in time using questionnaires and interviews, which enables both statistical analyses and an in-depth understanding of the participants' experiences over time. By highlighting the perspectives of both older people and staff, the study can contribute new knowledge about how person-centered care can be developed and maintained in practice. In the long term, the results can contribute to a more health-promoting, sustainable and attractive elderly care for both older people and staff.
The study aims to answer the following questions:
The study has a quasi-experimental design with measurements before and after moving into a newly opened academic nursing homes (in one municipality) and transitioning to an academic nursing home (in the other municipality). Comparison is made with one or more regular nursing homes. In municipality A, 130-140 people live at the municipality's nursing homes, of which approximately 80 will live at an academic nursing homes. In municipality B, there are 116 older people living in nursing homes, of which approximately 25 will live at an academic nursing home. At each measurement, all elderly people living in nursing homes in the two municipalities will be surveyed. In total, approximately 85-90 at the academic nursing homes (60-65 in municipality A and approximately 25 in municipality B) are expected to participate and at least as many in the comparison group. Data are collected using questionnaires that include sociodemographic variables and validated instruments for health (EQ-5D-5L), well-being (LSQ), depression/anxiety (PHQ-4), loneliness (UCLA-3), frailty (TFI), person-centered care and support (PCPI-C) and outdoor environment (Perceived Restorativeness Scale and study-specific questions) before moving in/starting and approximately 6, 12 and 24 months after. Data collection is carried out by staff from a different nursing home than the one being studied.
The study also include staff from the nursing homes. The intervention group consists of 126-130 employees at the academic nursing homes (76-80 in municipality A and approximately 50 in municipality B). The comparison group consists of staff from regular nursing homes of at least the same size, which means that the study is estimated to include approximately 300-380 participants in total. Data are collected via a questionnaire before the acamdec nursing homes opens and 12 and 24 months after. The questionnaires include validated instruments for person-centered care (PCPI-S), learning and vitality (Thriving Scale), structural conditions (CWEQ II), stress and intention to leave (BIAJS), psychological empowerment (Spreitzer), work-life conflict (COPSOQ III) and a study-specific question on self-efficacy.
Quantitative data are analyzed using descriptive and analytical statistics, such as ANOVA or GEE for repeated measures and clustering. Relationships are analyzed using correlation and regression models. Non-parametric analysis methods are used when necessary. Psychometric analyses include factor analysis for construct validity and Cronbach's alpha for reliability. For translated instruments, face validity and content validity indices are also examined. The power calculation is based on the assumption that effect sizes in nursing research are usually between small and medium (Cohen's d = 0.20-0.50) (Polit & Beck, 2025). Assuming a medium effect size and a power of 0.80, a minimum of 64 participants per group is required, which is considered to be achieved in this study.
Inclusion Criteria - Older people:
Inclusion Criteria - Staff:
Exclusion Criteria - Older people:
denice.hogstedt@hig.se+4626645068
maria.engstrom@hig.se