Development of the person-centred environment and care assessment tool (PCECAT) and guidelines
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NO FULL TEXT AVAILABLE. This thesis contains 3rd party copyright material. ----- Dementia is currently the most common cause of severe disability in older people admitted to residential aged care services in Australia. Given the significant increase in the ageing population in the next 40 years, the correlated increase in the number of people with dementia will be a major driver of the demand for residential aged care services. The ageing baby boomers, large numbers of whom are likely to develop dementia given current prediction rates, are also expected to demand individualised, tailored residential aged care services that far exceed the expectations of their predecessors. Person-centred care, which focuses on the individual person's strengths, remaining capabilities and distinct characteristics, has been accepted by a growing number of aged care services in Australia as an ideal model to achieve quality care and quality of life for people living with dementia. Worldwide the principles of person-centred are being appreciated as evidenced by recent attempts in the United Kingdom to offer government endorsed national person-centred aged care services. While the Australian Government has also endorsed the person-centred principles as a framework for assessing the quality of aged care services, these have not yet been clearly articulated into the principles of the aged care Accreditation Standards in the Aged Care Act 1997. Access to a user friendly instrument to assess the degree to which the service's organisational structures, environmental features of the care environment and care practices support person-centred principles, would benefit aged care providers, care managers and staff in their pursuit of quality services that align with the requirements of the Accreditation Standards. This study set out to achieve this by developing and testing a self-assessment instrument that measures person-centred care principles in residential aged care services with respect to the Accreditation Standards. The instrument that has been subsequently developed, the Person-Centred Environment and Care Assessment Tool (PCECAT), promotes the principles of person-centred care through a process of self-assessment and continuous improvement, which are core principles of the Accreditation Standards. A mixed-methods approach was used to develop, pilot and test the PCECAT using sequential data collection procedures in five stages over a five year period. Extensive psychometric analysis was undertaken involving principal components analysis, item analysis (missing data, endorsement rates and inter-item correlations), and reliability (internal consistency and inter-rater reliability) in stages four and five. Content and face validity were established for all three PCECAT domains and convergent validity was established for Domain 3 with the Environmental Audit Tool (EAT) (Fleming & Forbes 2011). The study findings are interpreted through the theoretical assumptions of person-centred principles and the philosophy of social ecology, which together provide the development of an integrated conceptual framework against the backdrop of the Accreditation Standards. The PCECA T is recommended for use in the aged care sector as it has the potential to assist in raising service standards in the areas of organisational culture, care practices and environmental quality.
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