Diana Alves Vareta

Background: Intrahospital transportation of critically ill patients is a high-risk process, frequently linked to complications and increased vulnerability to adverse events. Ensuring safety requires nursing interventions that uphold the standards of care provided in critical care units. Objective: To identify nursing interventions that promote patient safety during intrahospital transportation. Methods: A scoping review was conducted following Arksey and O’Malley’s framework. The search was performed in 2024 across PubMed and EBSCOhost (CINAHL Complete, MEDLINE Complete, Nursing & Allied Health Collection: Comprehensive, and Cochrane Central Register of Controlled Trials). Results: Seven publications met the criteria. All studies emphasized the need for strategies to prevent complications during transport. Four categories of interventions emerged: identification and management of adverse events, use of checklists, continuous nurse training, and effective communication. Conclusions: Nurses play a pivotal role in maintaining safety and quality of care. By applying evidence-based strategies, they minimize risks and ensure safer intrahospital transportation.

Background: Person-centered practice has increasingly become a key structural component of health systems, driving the progressive reformulation of public health policies internationally. Despite broad consensus regarding its importance, its integration into clinical practice continues to face significant challenges. The Person-Centred Practice Framework identifies the macro context as a critical domain for sustainable implementation, as it encompasses the structural and strategic factors that shape healthcare delivery. Objective: To characterize the person-centered practice framing within the macro context of the Portuguese healthcare system. Methodology: Qualitative, descriptive, and retrospective documentary study. A systematic literature search was conducted on the websites of entities responsible for defining, guiding, and regulating healthcare in Portugal. Using predefined eligibility criteria, 40 documents were selected. Textual analysis was performed using IRAMUTEQ® software and guided by the constructs of the macro context domain of the Person-Centred Practice Framework. Results: The lexicometric analysis identified five classes, grouped into two thematic fields: i) Structural and organizational determinants of person-centered practice , comprising the classes Systemic vision and integrated response , Organizational culture and participation , Digital transformation and information management , and Political vision and governance structures ; and ii) Operationalization of person-centered practice , represented solely by the class Care approach , reflecting its thematic specificity. Factorial analysis revealed distinct and poorly connected discursive patterns associated with different action levels within the healthcare system. Similarity analysis highlighted a discourse centered on the health-care-person nucleus, showing relations with service organization, care integration, and person participation, albeit with word dispersion suggesting misalignment between organizational and practice levels. Conclusion: The macrocontextual framing of person-centered practice in the Portuguese healthcare system demonstrates significant political and strategic advances, as seen in the emphasis on humanized care, investment in health literacy and digitalization, and the introduction of Integrated Care Pathways. However, implementation remains limited due to the absence of clear formative guidelines, biomedical paradigm persistence, and lack of evaluation mechanisms sensitive to care experience.

Background: In person-centered practice implementation and development, it is essential to incorporate standardized measurements that consider the perspectives of those involved in the therapeutic relationship. This work aims to translate, culturally adapt, and validate the Person-Centered Practice Inventory – Care (PCPI-C) for the Portuguese healthcare context. The PCPI-C is derived from the middle-range theory of the Person-Centered Practice Framework and is an 18-item self-reported inventory. Methods: This methodological study followed a two-stage research design entailing the translation and cultural adaptation of the PCPI-C from English to European Portuguese and the Portuguese healthcare context in phase I, followed by a psychometric evaluation (N = 312) conducted using principal component and confirmatory factor analysis in SPSS version 27.0 and SPSS AMOS version 21.0 in phase II. The model was continuously and iteratively refined until it was considered acceptable per gold standard estimators. Results: In phase I, the results revealed linguistic and contextual cultural differences compared to the original version. The cognitive debriefing showed that the respondents considered the items understandable and adequate for the purpose. In phase II, among the two adjusted PCPI-C models fit, i.e., first-order, and single-factor, the best fit to the empirical data was revealed by the single-factor structure, reflecting a good fit (x2/df = 2.408, CFI = .93, RMSEA = .07, SRMR = .05). Conclusions: The PCPI-C is a valid and reliable instrument for assessing the perceptions of Portuguese service users regarding person-centered practice. It is necessary to consider the purpose for which the instrument is used to select the most appropriate measurement model, i.e., process evaluation as an outcome or as an inventory measure for continuous improvement.

Introduction: An aging population and the increasing prevalence of chronic conditions challenge healthcare systems in developed countries. In response, there is a growing emphasis on person-centered care, as advocated by the World Health Organization and integrated into national health strategies in countries such as the UK and Sweden. However, transitioning to person-centered care is a complex, long-term process shaped by organizational culture and care environments. These contextual factors play crucial roles in the development and sustainability of person-centered practice, significantly transforming the experiences of both older adults and staff.Objective: To describe how workplace culture within an inpatient hospital department shapes person-centered care practices for older adults with chronic illnesses.Methods: A qualitative, descriptive, exploratory-observational study was performed. Data were collected through participant observation guided by the Workplace Culture Critical Analysis Tool^®. In a deductive thematic content analysis, data patterns of meaning were identified. The themes were generated underpinned by the Person-Centered Practice Framework dimensions of prerequisites, the practice environment, and person-centered processes and their respective constructs.Results: Themes related to all person-centered practice dimensions were identified. Task demands during shifts create tension between routine-oriented work and the holistic, individualized approach required for person-centeredness. The absence of systematic multiprofessional team meetings further exacerbates this issue, limiting collaborative decision-making and personalized care planning. The contrasts in some subthemes may be related to discrepancies in the care provided by different professionals.Conclusion: This study highlights the tension between routine-driven care and individualized approaches. Addressing identified challenges, such as formalizing multiprofessional meetings and enhancing reflective practices, is crucial for advancing person-centered care in this setting.

Background: The growing aging trend associated with a higher prevalence of chronic illnesses is increasing the demand for the development of person-centered practice in specific care settings. Knowing the person’s perception of the care and the care experience is essential to improving inpatient care toward person-centeredness. This study aims to characterize the perceptions of person-centered practice of hospitalized older adults with chronic illness at a Portuguese inpatient hospital department. Methods: A quantitative, descriptive, cross-sectional approach was followed. Data were collected using a sociodemographic and health history questionnaire and the Person-Centered Practice Inventory - Care (PCPI-C). The effect of the different variables on each PCPI-C construct was determined using analysis of variance (ANOVA). Results: The results show that person-centered practice was positively perceived in the five constructs of the person-centered processes domain (M = 3.92; SD = 0.47). The highest-scored construct was working with the person’s beliefs and values (M = 4.12; SD = 0.51), and the lowest was working holistically (M = 3.68; SD = 0.70). No significant effect of the independent variables was found to influence the perceptions of any of the constructs in the person-centered processes domain. Conclusions: These results might indicate that person-centered processes are perceived uniquely by each person through individualized therapeutic relationships rather than a pattern of care shared by hospitalized older adults.

Patients with lower limb fractures require rehabilitation but often struggle with adherence to interventions. Adding motivational strategies to rehabilitation programs can increase patient adherence and enhance outcomes. This review aims to identify the motivational strategies used by health professionals in the rehabilitation of people with lower limb fractures. We used Arksey and O’Malley’s methodological framework to structure and conduct this scoping review. The literature search was performed using the Scopus, CINAHL, MEDLINE, Nursing & Allied Health, and Cochrane Central Register of Controlled Trials databases. The final search was conducted in February 2023. A total of 1339 articles were identified. After selecting and analyzing the articles, twelve studies were included in this review. Health professionals use several strategies to motivate patients with lower limb fractures to adhere to rehabilitation programs. These strategies include building a therapeutic alliance, increasing patients’ health literacy, setting achievable goals, personalizing the rehabilitation program, managing unpleasant sensations of exercise, using persuasion, providing positive reinforcement, avoiding negative emotional stimulation, and helping to seek support. The motivational strategies identified may help professionals to increase patient adherence to rehabilitation for lower limb fractures. This knowledge will allow these professionals to help patients overcome barriers to rehabilitation, enhance their motivation, and ultimately improve their recovery outcomes.

The characteristics of health professionals and their understanding of person-centeredness may have important implications for the development of person-centered practice in specific care settings. In this study, we characterized the perceptions of the person-centered practice of a multidisciplinary team of health professionals working in the internal medicine inpatient unit of a Portuguese hospital. Data were collected using a brief sociodemographic and professional questionnaire and the person-centered practice inventory-staff (PCPI-S), and the effect of different sociodemographic and professional variables on each PCPI-S domain was determined using an analysis of variance (ANOVA). The results showed that a person-centered practice was positively perceived in the major constructs of prerequisites (M = 4.12; SD = 0.36), the practice environment (M = 3.50; SD = 0.48), and person-centered process (M = 4.08; SD = 0.62) domains. The highest scored construct was developed interpersonal skills (M = 4.35; SD = 0.47), and the lowest was supportive organization systems (M = 3.08; SD = 0.80). Gender was found to influence the perceptions of knowing self (F(2,75) = 3.67, p = 0.03, partial η² = 0.089) and the physical environment (F(2,75) = 3.63, p = 0.03, partial η² = 0.088), as was profession on shared decision-making systems (F(2,75) = 5.38, p < 0.01, partial η² = 0.125) and commitment to the job (F(2,75) = 5.27, p < 0.01, partial η² = 0.123), and the educational level on being professionally competent (F(1,75) = 4.99, p = 0.03, partial η² = 0.062) and having commitment to the job (F(2,75) = 4.49, p = 0.04, partial η² = 0.056). In addition, the PCPI-S proved to be a reliable instrument for characterizing healthcare professionals’ perceptions of the person-centeredness of care in this context. Identifying personal and professional variables that influence these perceptions could provide a starting point for defining strategies to move practice toward person-centeredness and for monitoring changes in healthcare practice.

The aging trend in the population, the high rate of hospitalization, the affliction by multiple chronic illnesses, and the increased vulnerability of older people when hospitalized undoubtedly require a person-centered approach to healthcare—an approach that values a person’s participation in the healthcare relationship, supports shared decision making and mutual understanding, and respects a person’s values, preferences, and beliefs. However, despite widespread recognition that the adoption of such a clinical practice paradigm is paramount, its implementation and development are still challenging for various health systems and professionals worldwide. The implementation strategy for such a healthcare paradigm must be based on each country’s health system organization and practice contexts, as well as the professionals involved. The present work aims to provide guidelines for the understanding of the state of development of person-centered practice in the daily care of hospitalized older adults with chronic illnesses within the internal medicine department of a secondary hospital in an urban area of Portugal. We focus on the characterization of (i) the perceptions of a multidisciplinary team working at an inpatient hospital department of person-centered practice, (ii) the perceptions of hospitalized older adults with chronic illnesses about person-centered practice, (iii) the work culture of an inpatient hospital department with a high prevalence of older adults with chronic illnesses, (iv) the Person-Centred Practice Framework at the organizational and structural levels of the healthcare system, and (v) the elements that influence the implementation of person-centered practice at the individual, organizational, and structural levels in this specific hospital context. To this end, a mixed-methods analysis with a convergent design was planned to use questionnaire instruments to collect data in parallel and independently from distinct samples of health professionals and older inpatient adults within this department. Furthermore, health policies and strategic plans will be analyzed to identify and evaluate references and guidelines for the practice of person-centered care. Studying the dimensions of clinical practice in this specific healthcare context following the Person-Centred Practice Framework can allow us to understand the extent of its development in terms of prerequisites, care environment, care processes, and the macro-context of the healthcare system. Therefore, it is possible to identify and characterize the dimensions achieved and those that need to be improved and, thus, establish a starting point for the definition of new strategies to advance practice towards person-centeredness and monitor changes in healthcare practice.

There is an increasing emphasis on developing person-centered care in rehabilitation settings. However, this care practice has not been fully implemented due to several factors. This study explores rehabilitation workforce perspectives on the barriers and facilitators to implementing person-centered care (PCC). This was a quantitative descriptive study, which was developed based on interviews with 12 healthcare professionals from a private institution in the region of Lisbon and Tagus Valley in Portugal. The recruitment was made in October 2020. Braun, Clarke, Hayfield, and Terry’s content analysis was applied to the transcripts, and these were transcribed verbatim. The consolidated criteria for reporting qualitative research (COREQ) checklist were applied to this study. Participants described barriers such as an unsupportive organization and leadership, staff constraints, heavy workload, and resistance to change. Unique to this study, a patient’s clinical characteristics were identified as barriers to person-centered care. As facilitators, they described leadership, staff satisfaction, a positive physical environment, training and education, and shared decision-making. It is essential to understand the perceptions of the rehabilitation workforce, as they play an integral role in providing PCC. This study serves as a guide to facilitate person-centered care, as it provides an understanding of key barriers and facilitators for its implementation in rehabilitation settings.