Life In The Slower Lane

Here is the structured PICO analysis for the forty-fifth article you uploaded:

---

✅ 

Full Title (verbatim and exact):

“Person‐directed care planning in nursing homes: A scoping review”

Lepore M, Scales K, Anderson RA, et al.

International Journal of Older People Nursing (2018); 13:e12212

DOI: https://doi.org/10.1111/opn.12212

---

📄 

Type of Article:

Scoping review

---

🔍 

PICO Analysis:

Population:

• Residents of nursing homes (primarily older adults, often with dementia)
• Includes insights relevant to family members, care staff, interdisciplinary teams, and policymakers
• Review includes literature from various care settings, but the focus is on residential long-term care facilities in the United States and internationally 

---

Intervention:

Person-directed care planning (PDCP) – defined as a process where individuals and/or their families are actively involved in:

• Setting goals of care
• Designing, reviewing, and updating care plans
• Ensuring plans reflect their values, preferences, and life historyThis goes beyond “person-centred” to mean that the individual is the decision-maker about their care planning, not just an informant 

---

Comparator:

• No direct comparator group; this is a conceptual and implementation-focused scoping review
• However, the paper contrasts traditional provider-led care planning with person-directed approaches, identifying barriers, facilitators, and outcomes

---

Outcome:

1. Person-centred outcomes:

• Improved physical and psychological well-being
• Greater independence in activities of daily living (ADLs)
• Enhanced sense of autonomy, self-worth, and validation
• Increased satisfaction with care among residents and families
• Reductions in communication-related adverse events

2. Process outcomes:

• Key processes enabling PDCP include:
  • Knowing the person (history, values, relationships)
  • Integrating personal goals into care planning
  • Revising plans as needs/preferences evolve
  • Including residents/families in care conferences
  • Staff education and leadership commitment to PDCP
  • Use of adaptive leadership to distinguish between technical and adaptive barriers (e.g., time vs culture) 
• Barriers:
  • Lack of time and reimbursement for care planning
  • Staff untrained in participatory communication
  • Cognitive impairment among residents
  • Institutional culture favouring medical compliance over choice
• Facilitators:
  • Regulatory mandates (e.g., CMS regulations requiring resident involvement)
  • Cultural change movements
  • HIT tools, such as electronic assessments or decision aids
  • Family involvement and staff empowerment 

3. Health system outcomes:

• Not directly measured, but theorised benefits include:
  • Potential reduction in costs through reduced overtreatment
  • Potential reduction in hospitalisations via more goal-concordant care
  • Improved staff morale and retention when care planning is collaborative 

---

Summary Conclusion:

This scoping review synthesises the concept, mechanisms, barriers, and benefits of person-directed care planning (PDCP) in nursing homes. PDCP requires rebalancing power toward residents and families in shaping care plans, aligning with recent policy and cultural shifts in aged care. While evidence indicates potential improvements in well-being, satisfaction, and autonomy, implementation remains challenging due to both technical barriers (time, training) and adaptive challenges (culture, beliefs about capacity). The authors recommend aligning reimbursement, documentation practices, and staff training with PDCP principles to achieve meaningful uptake.

---