The influences of person-centered dementia care; on the satisfaction, involvement and strain of formal and informal caregivers
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More and more people are affected by dementia, in the Netherlands about 260.000 people suffer from the disease. Not only do the people with dementia suffer, also their direct social environment encounters difficulties. Professional nurses struggle with the demands and stress in caring for persons with dementia, with difficulties such as understaffing, high turnover, minimal training and limited professional nurse leadership in nursing homes. More than half of the family members who take care of a relative with dementia are heavily burdened. Even if the person with dementia lives in a nursing home, a lot of family members feel strained by the care for their relative. In former times, dementia care was primarily focused on the quality of physical care, but nowadays care is increasingly adapted to personal preferences and tastes. This method is also referred to as ‘person-centered care’, and the principles of person-centered care rest on the notion of valuing people with dementia and their caregivers. It is therefore important to treat people as individuals, with their unique history, identity, personality and resources. The aim of this thesis is to provide insights into the effects of person-centered care on caregivers’ and family’s satisfaction, involvement and emotional exhaustion / strain. Firstly, to create a better picture of the current level of person-centered dementia care in the Netherlands. Secondly, to render more conclusive answers about the effects of person-centered care on satisfaction, involvement and strain of nurses and family. And lastly to see if working person-centered provides solutions for current problems in dementia care by developing practical implications. Cross-sectional survey data from the Living Arrangements for people with Dementia (LAD) study were used, from which 456 nurses - and 373 family questionnaires of 54 different nursing homes were analyzed. To find out whether family members and professional caregivers differed in their view of person-centeredness, their perceptions of the provision of person-centered care were compared to each other. For nurses a multilevel linear regression analysis was used to study the mediating effects of person-centered care on job demands and resources to explain why working more person-centered would lead to more satisfied, involved and less emotionally exhausted personnel. For the analysis of family members data linear regression was used to analyze the relationship between person-centered care and satisfaction, involvement and experienced strain. The results of the study show that both staff and family members experience the Dutch dementia care to be quite person-centered. They do not differ in their views about the amount of person-centeredness in the nursing homes. The results also show that the perceived amount of person-centered care associates with more satisfaction, involvement and with less emotional exhaustion/strain, for caregivers as well as for family members. For caregivers part of these found relationships between person-centeredness and the outcome measures are explained by the influence of working person-centered on job demands and resources. In the lights of these results, this study advices to stimulate the practice of person-centered care in nursing homes. Since there are many frameworks and manuals for how person-centered care should be implemented in practice, this research adds to current knowledge by placing the results of this study in a broader context. By relating the results of the previously described study with current trends and developments in the Dutch dementia care, opportunities and challenges for nursing homes are uncovered. The trends discussed in this thesis are: the increasingly self-organizing nature of nursing homes and the emergence of family participation. The practical implications with which this thesis ends, advices nursing homes to carefully regard the effects of self-organization on the job demands and resources of nurses and presents nursing homes with opportunities to shape family participation.