Life In The Slower Lane

Here is the PICO analysis for the sixteenth uploaded article:

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✅ PICO Analysis

Full Article Title:

A model for implementing guidelines for person-centered care in a nursing home setting

Type of Study:

Participatory Action Research (PAR) intervention study

Journal and Year:

International Psychogeriatrics (2015); 27(1):49–59

DOI: 10.1017/S1041610214001598

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P – Population

• Setting:
  • A large dementia-specific nursing home on the outskirts of Stockholm, Sweden
  • 200 residents living across 24 small-scale units
• Participants:
  • Entire daytime care staff (~200 staff, including 170 nurse aides, 25 health professionals, and 5 managers)
  • Staff who worked exclusively night shifts or were temporary were not involved 

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I – Intervention

• Nature of Intervention:
  • Implementation of national guidelines for dementia care using a Participatory Action Research (PAR)model
  • The intervention was delivered via:
    1. Two thematic seminars introducing the national dementia care guidelines
    2. Unit-based reflective seminars and SWOT analyses to identify improvement priorities
    3. Facilitated team meetings (ten 2-hour sessions over 8 months)
    4. Reflective poster exhibitions and cross-unit knowledge exchange
• Guideline Domains Targeted:
  • Person-centred care, small-scale environments, physical environments, care climate, activity/rest balance, continuity, and family support 

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C – Comparison

• Comparator:
  • No traditional control group (PAR design)
  • Comparison is made between units’ baseline care practices and their post-intervention reflections and reported changes
  • Some internal contrast between more and less engaged units is noted, particularly in engagement with evidence-based resources and follow-through 

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O – Outcomes

Process and Implementation Outcomes:

• All 24 units participated in identifying challenges and designing their own quality improvement projects
• Improvements included:
  • Mealtime atmosphere
  • Resident weight gain
  • Family engagement practices
  • Activity scheduling and staff-resident interactions
• 14 of 24 units expressed intention to continue the quality improvement process independently after project conclusion 

Experiential Staff Outcomes:

• Reported benefits:
  • Better planning and person-centred thinking
  • Increased staff engagement and empowerment
  • Improved communication with families
  • Increased motivation and job satisfaction
• Reported barriers:
  • Time pressure, competing priorities
  • Low digital/evidence literacy and limited IT access
  • Conflicts between national guidelines and local policies (e.g. rigid activity scheduling)
  • Dependence on individual staff champions in some units 

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Outcome Classification

• Person-centred outcomes: Indirect evidence of improved resident well-being (e.g. calmer environments, improved communication, personalised care planning)
• Process outcomes: Implementation of unit-led improvements, evidence of shared ownership and empowerment in quality improvement
• System outcomes: Sustainable quality improvement culture emerging in >50% of units; challenges remain in guideline-to-practice translation

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Summary Conclusion

This study implemented Swedish national dementia care guidelines using a participatory action research approach in a 200-resident nursing home. Staff across 24 care units undertook unit-specific quality improvement projects aligned to the guidelines. The intervention fostered greater staff engagement, improved team cohesion, and generated observable care practice changes—especially in meal environments, family inclusion, and daily activities. Barriers included staff time constraints, limited access to evidence resources, and misalignment between flexible person-centred care and local directives. The study highlights the importance of grounded, flexible, staff-led implementation models for translating dementia care guidelines into everyday practice .

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