title: "Wish we would have known that!" Communication Breakdown Impedes Person-Centered Care.
abstract: OBJECTIVE
  To understand how nursing home staff obtain information needed for implementing person-centered care (PCC) to residents with dementia who exhibit behavioral and psychological symptoms of dementia (BPSD), and how they communicate this information to other staff. Barriers to PCC and information exchange were also explored.
  
  
  METHODS
  Participants were 59 staff from two nursing homes. Focus group methodology captured discussions in eight 1-hr sessions. Sessions were audiotaped and transcribed. Data were analyzed using qualitative content analysis to provide a comprehensive summary of real world context of implementing PCC.
  
  
  RESULTS
  To deliver PCC staff identified a need for access to psychosocial/medical history of the resident and knowledge of strategies families used for managing BPSD in the past. However, resident information is not routinely shared with all staff and written documentation systems for communicating resident-specific information do not support the time-pressured work pattern of certified nursing assistants (CNAs). Word-of-mouth was considered more reliable and expedient than educational sessions. CNAs described themselves as visual learners who prefer educational programs addressing individual resident emergent behaviors and programs that are scheduled at dedicated times.
  
  
  CONCLUSIONS
  To improve PCC the flow of information exchange requires: inclusion of all staff, particularly CNAs; systems of communication that consider the time and resource constraints of nursing homes; development of educational programs for BPSD that are responsive to staff learning styles; administrative investment in nursing leadership to effect these changes; and reimbursement approaches to encourage culture change investments.
authors.affiliation: Elouise Ross Eberly Professor, College of Nursing, Penn State, University Park, Pennsylvania. amk20@psu.edu.
authors.forename: Ann
authors.initials: A
authors.lastname: Kolanowski
authors.affiliation: College of Nursing, Penn State, University Park, Pennsylvania.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Van Haitsma
authors.affiliation: College of Nursing, Penn State, University Park, Pennsylvania.
authors.forename: Janice
authors.initials: J
authors.lastname: Penrod
authors.affiliation: Clare M. Fagin Fellow, College of Nursing, Penn State, University Park, Pennsylvania.
authors.forename: Nikki
authors.initials: N
authors.lastname: Hill
authors.affiliation: School of Nursing, Duquesne University, Pittsburgh, Pennsylvania.
authors.forename: Andrea
authors.initials: A
authors.lastname: Yevchak
mesh_terms: D000368:Aged; D003142:Communication; D003704:Dementia / Q000451:nursing*; D017144:Focus Groups; D005851:Geriatric Nursing / Q000379:methods; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D007857:Leadership; D009735:Nursing Homes / Q000458:organization & administration*; D009740:Nursing Staff / Q000523:psychology*; D018802:Patient-Centered Care / Q000379:methods*; D036301:Qualitative Research; D012112:Residential Facilities
keywords: Behavior; Nursing homes; Person-centered care; Qualitative research methods