Abstract

As part of a initiative of the federal state Lower Austria the development of a framework for all 48 Nursing Homes was commissioned. Two perspectives - that of science and practice - should ensure that both the current scientific debate as well as regional practical knowledge and innovative ideas of the nurses were considered. The aim was the development, the implementation and the evaluation of a framework that meets regional conditions, cultural diversity and different forms of care and guarantees innovation, feasibility and long-term sustainability.

For development the process has been designed action-oriented (in alternating phases of developing, feedback, reflection) and participatory to actively incorporate the expertise and experience of the nurses. In addition to the continuous literature research, focus groups (4 /n = 47), 9 site visits in selected nursing homes, 2 expert rounds and 2 panel sessions were conducted. First results of the literature research structured the focus groups. They were analysed thematically and merged with the theoretical findings. Site visits and expert discussions were conducted to gain a closer look at specific practices. To develop a first concept, the structure of W.K. Kellog Stiftung (2004) was used. At the end of the process, 2 panel sessions took place, to validate the first construct. Since the core concept was person centredness, the concept was merged with the Person Centred Practice Framework (McCormac&McCance 2017).

The result of the development process is the "Integrative Model of Person Centred Care (IMP-NÖ)" (image1) that describes person centredness at different levels and provides a basis for all care and support processes as well as for organizational, strategic and structural measures at the state level. It also provides the theoretical framework for evaluation. In an implementation process based on the principle of action-oriented learning, it was introduced in all state nursing homes. Additionally a 4-year research project for theory based evaluation has begun. This includes the development of a framework for evaluation at all levels (organisational, care-givers, nursing clients) as well.

For a first conclusion, we can say that Person centredness is a framework, that fits for long term care settings very well, because it provides a base for changes in the perspective and culture care. The new developed 6 basic principles are the necessary concepts, to operationalize person-centredness on the residents perspective. Because it is a cultural change, the implementation processes must be participative and in a step-by step and iterative way. To evaluate the outcomes, all level have to considered. There are some adequate instruments for the measurement of person centredness and person centred culture, but they have to be adapted. Especially the fact of the different cognitive status of the residents makes it necessary to develop different evaluation instruments and methods to combine a personal and a proxy perspective.