Celia Berdes, PhD, Sociologist and Gerontologist
In our work with elders, we sometimes come up against a question about care or services for which there is no clear answer. In many areas of clinical care, there are best practices, which is a shorthand term for ways of caring that have been proven effective through experience and research. Increasingly, there are data that prove that certain methods and means of providing care succeeds where other methods fail. The increasing focus on these data has yielded the idea that decisions about care should be based on data — that is, it should be evidence-based. In most areas of medicine and nursing, evidence is now available that we use routinely in guiding the care we provide. Best practices and evidence-based care have both driven the development of continuous quality improvement (CQI) techniques, the idea that quality of care can be improved by repeated studies. Another important stream of research over the last decades has been the effort to prove the positive effects of person-centered care as a whole.
So in broad strokes, we know that specific forms of geriatric care and person-centered care or services are effective, that they benefit the people who have access to them. Everyday aspects of person-centered care are less clear. We may ask ourselves: What specific practices do we need to engage in to provide person-centered care? How can the principles of person-centered care be translated in the care and services we provide? Is a particular practice making a difference? What could we change to make our environment more person-centered? How do we balance competing priorities, all aimed at person-centered care? How do we create movement in our organization toward person-centered care? In short, we still need to understand the necessary and sufficient conditions for person-centered care to exist. And all these questions can be asked about the smallest unit of care –the interaction between one resident and one staff member — all the way up to the largest unit of care: the setting in which care is delivered and the regulatory and financing environment in which it exists.
In providing everyday care, you may come up against a question to which you do not know the answer. This can be a clinical question: for example, will this or that form of incontinence care work better for this particular resident? It can be an exploratory question: for example, what is the impact of hearing loss in our residents? It can be a staffing question: for example, what are the characteristics of people who succeed in nursing aide work here? You may think you know the answers to these questions, but until you have done the research, those are more opinions than facts. One key to delivering person-centered care, therefore, is to capture questions to which you lack clear answers and re-frame your work as a research project aimed at answering those questions.
Carrying out research in long-term care communities is fraught with difficulties, not least that it is difficult if not impossible to get permission for research participation — i.e., informed consent — from people who are cognitively challenged. Too, most long-term care communities don’t have access to a university-based “institutional review board” that investigates the ethics of clinical research projects. So we have to build informal or applied research into what we do every day. It can become the foundation of our personal effort to improve the care we deliver.
Applying research to help identify best practices and validate the positive outcomes that we believe occur when providing person-centered care is critical to advancing culture change and making the difference we as Pioneers aspire to see for those we serve.
Want to learn more? Then join Celia Berdes, PhD, a sociologist and gerontologist who has conducted research in many long-term care communities, for her session at the 2017 Pioneer Network Conference, “How to Use Research in Caring Work: A Research Update and Primer” where she will teach participants how to access existing research results in areas of geriatrics and person-centered care that interest them and focus on three questions: how can you become aware of recent research on aspects of person-centered care; how can you access the results of research on aspects of person-centered care; and how can you incorporate current research as you ask and answer questions in your own work?
We look forward to seeing you there!