The impact of person-centered care on residents' perceptions of care quality in nursing homes: an intervention study

Main Article Content

Vigdis Abrahamsen Grøndahl
Liv Berit Fagerli
Heidi Karlsen
Ellen Rosseland Hansen
Helena Johansson
Anne Gerd Mathisen
Ann Karin Helgesen


Background: The quality of care offered to older people is still poor. Nursing home administrators often claim that they provide person-centered care, but research indicates that institutional goals take precedence. Aim: The aim was to explore the impact of person-centered care on residents’ perceptions of care quality.  Methods: An intervention study was conducted in one nursing home (41 residents). Person-centered care was operationalized into the interventions: greeting the resident on each shift, one-to-one contact (resident – carer) for 30 minutes twice a week, informing the residents continuously about changes in medication, and informing the residents about their legal rights at admission and three months after admission. The interventions were systematically conducted for 12 months. Face-to-face interviews using the Quality from Patient’s Perspective (QPP) questionnaire were conducted both prior to interventions and immediately after the 12-month period. Descriptive and comparative statistics were used to test for differences between care quality perceptions before and after intervention (p ≤ .05). Results: The residents rated all four quality dimensions (caregivers’ medical-technical competence and identity-oriented approach, care organization’s socio-cultural atmosphere, and physical-technical conditions) more highly after the 12-month period, and the socio-cultural atmosphere was rated significantly more highly. At item level, 44 items received higher scores, and, among them, significantly higher scores were given to 6 items. One item received a significantly lower score. Conclusions: Residents’ perceptions of care quality increase when person-centered care is operationalized and takes precedence over the ward’s routines or is part of the ward’s routines. The results indicate that it is possible to design a care system where the residents are at the centre of the health care offered.

Article Details

Regular Articles
Author Biographies

Vigdis Abrahamsen Grøndahl, Østfold University College, Halden, Norway


Liv Berit Fagerli, Østfold University College


Heidi Karlsen, Halden Municipality


Ellen Rosseland Hansen, Halden Municipality


Helena Johansson, Halden Municipality


Ann Karin Helgesen, Østfold university college



McCormack, B., Dewing, J., McCance, T. (2011). Developing person-centered care: addressing contextual challenges through practice development. The Online Journal of Issues in Nursing 16. DOI: 10.3912/OJIN.Vol16No02Man03.

Mezzich, J., Snaedal, J., Weel, C.van, Heath, I. (2010). Toward person-centered medicine: from disease to patient to person. Mount Sinai Journal of Medicine 77:304-306. DOI: 10.1002/msj.20187.

Rodgers, V., Welford, C., Murphy, K., Frauenlob, T. (2012). Enhancing autonomy for older people in residential care: what factors affect it? International Journal of Older People Nursing 7:70-74. DOI: 10.1111/j.1748-3743.2012.00310.x.

Syse, A. Pham, D.Q. (2014). Befolkningsframskrivinger 2014-2100: Dødelighet og levealder, Økonomiske analyser Statistisk Sentralbyrå 4, 44-50 (in Norwegian).

Askari M., Wierenga, P.C., Eslami, S., Medlock, S., Rooij, S.E., Abu-Hanna, A. (2011). Assessing quality of care of elderly pasients using the ACOVE quality indicator set: a systematic review. PLoS ONE 6. e28631. DOI: 10.1371/journal.pone.0028631.

Hughes, K., Moore, S. (2012). Quality of life versus quality of care: elderly people and their experience of care in South Australian residential facilities. Practice: Social Work in Action 24:275-285. Available at:

Hunter, S, Levett-Jones, T. (2010). The practice of nurses working with older people in long term care: an Australian perspective. Journal of Clinical Nursing 19:527-36. DOI: 10.1111/j.1365-2702.2009.02967.x.

McCance, T., McCormack, B., Dewing, J. (2011). An exploration of person-centredness in practice. Online Journal of Issues in Nursing 16. DOI: 10.3912/OJIN.Vol16No02Man01.

McCormack, B., McCance, T. (2006). Development of a framework for person-centred nursing. Journal of Advanced Nursing 56:472–479. DOI: 10.1111/j.1365-2648.2006.04042.x.

Sloan, P.D., Hoeffer, B., Mitchell, C.M., et al. (2004). Effect of person-centered showering and the towel bath on bathing-associated aggression, agitation, and discomfort in

nursing home residents with dementia: a randomized, controlled trial. Journal of the American Geriatrics Society 52:1795-1804. DOI: 10.1111/j.1532-5415.2004.52501.x.

Fossey J., Ballard, C., Juszczak, E., James, I., Alder, N., Jacoby, R., Howard, R. (2006). Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: cluster randomised trial. British Medical Journal 332:756–761. DOI: 10.1136/bmj.38782.575868.7C

Edvardsson, D., Fetherstonhaugh, D., Nay, R. (2010). Promoting a continuation of self and normality: person-centred care as described by people with dementia, their family members and aged care staff. Journal of Clinical Nursing 19:2611–2618. DOI: 10.1111/j.1365-2702.2009.03143.x.

Nakrem, S., Vinsnes, A.G., Seim, A. (2011). Residents’ experiences of interpersonal factors in nursing home care: a qualitative study. International Journal of Nursing Studies 48:1357-1366. DOI: 10.1016/j.ijnurstu.2011.05.012.

Slettebø, Å. (2008). Safe, but lonely: living in a nursing home. Nordic Journal of Nursing Research 28:22-25. DOI:

Helgesen, A.K., Skaug, E.A., Grøndahl, V.A. (2016). Changing men’s everyday lives in nursing homes: a grounded theory study. The International Journal of Person Centered Medicine 6:185-190. DOI:

Grøndahl, V.A., Fagerli, L.B. (2017). Nursing home care quality: a cluster analysis. International Journal of Health Care Quality Assurance 30:25-36.

Wilde-Larsson, B., Larsson, G. (2002). Development of a short form of the Quality from the Patient’s Perspective (QPP) questionnaire. Journal of Clinical Nursing 11:681-687. DOI: 10.1046/j.1365-2702.2002.00640.x

Wilde, B., Larsson, G., Larsson, M., Starrin, B. (1994). Quality of care: development of a patient-centred questionnaire based on a grounded theory model. Scandinavian Journal of Caring Science 8:39-48. DOI: 10.1111/j.1471-6712.1994.tb00223.x

Wilde, B., Starrin, B., Larsson, G., Larsson, M. (1993). Quality of care from a patient perspective: a grounded theory study. Scandinavian Journal of Caring Science 7:113-120. DOI: 10.1111/j.1471-6712.1993.tb00180.x

World Medical Association (2013). World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. JAMA 310:2191-2194. DOI:10.1001/jama.2013.281053.

Field, A. (2013). Discovering Statistics Using SPSS (4th ed.). London: SAGE Publication.

Berkhout, J.M.B., Boumans, N.P.G., Mur, I., Nijhuis, F.J.N. (2009). Conditions for successfully implementing resident-oriented care in nursing homes. Scandinavian Journal of Caring Science 23:298–308. DOI:10.1111/j.1471-6712.2008.00623.x.

Helgesen, A.K., Larsson, M., Athlin, E. (2010). Patient participation’in everyday activities in special care units for persons with dementia in Norwegian nursing homes. International Journal of Older People Nursing 5:169-178. DOI:10.1111/j.1748-3743.2010.00223.x

Lynch, B.M., McCormack, B., McCance, T. (2011). Development of a model of situational leadership in residential care for older people. Journal of Nursing Management 19:1058-1069. DOI: 10.1111/j.1365-2834.2011.01275.x

Zhang, Unruh, Wan (2013). Zhang, N. J., Unruh, L., & Wan, T. T. H. (2013). Gaps in nurse staffing and nursing home resident needs. Nursing Economics 31:289-97. Retrieved from

Shin, J.H., Hyun, T.K. (2015). Nurse Staffing and Quality of Care of Nursing Home Residents in Korea. Journal of Nursing Scholarship 47:555–564. DOI: 10.1111/jnu.12166.

Li, J., Porock, D. (2014). Resident outcomes of person-centered care in long-term care: A narrative review of interventional research. International Journal of Nursing Studies 51:1395-1415.

Helgesen, A.K. (2013). Patient participation in everyday life in special care units for persons with dementia. Karlstads University, Fakulteten för hälsa, natur- och teknikvetenskap (from 2013), Institutionen för hälsovetenskaper (Doctoral dissertation).

Røen, I., Selbæk, G., Kirkevold, Ø., Bergh, S., Engedal, K. (2013). The prevalence of dementia and neuropsychiatric symptoms in patients at admission to Norwegian nursing homes. International Psychogeriatrics 25:53-72. DOI:org/10.1017/S1041610213002147.

Person, A., Finch, L. (2009). Bedside manner: Concept analysis and impact on advanced nursing practice. The Internet Journal of Advanced Nursing Practice 10. Retrieved from

McCormack, B. (2004). Person-centredness in gerontological nursing: an overview of the literature. Journal of Clinical Nursing 13:31-38. DOI: 10.1111/j.1365-2702.2004.00924.x.

Polit, D. F. & Beck, C. T. (2016). Nursing research principles and methods (10th ed.). Baltimore: Lippincott Williams & Wilkins.

Grøndahl V.A., Karlsson, I., Hall-Lord, M.L., Appelgren, J., Wilde-Larsson, B. (2011). Quality of care from patients’ perspective – impact of the combination of person-related and external objective care conditions. Journal of Clinical Nursing 20:2540-2551. DOI: 10.1111/j.1365-2702.2011.03810.x.

Streiner, D.L., Norman, G.R. (2008). Health measurement scales, 4th edition, Oxford University Press, New York.

Rahmqvist, M.,Bara A-C. (2010) Patient characteristics and quality dimensions related to patient satisfaction. International Journal for Quality in Health Care 22:86-92. DOI: org/10.1093/intqhc/mzq008.

Fröjd, C., Swenne, C.L., Rubertsson, C., Gunningberg, L., Wadensten, B. (2011). Patient information and participation still in need of improvement: Evaluation of patients’ perceptions of quality of care, Journal of Nursing Management 19:226–236. DOI:10.1111/j.1365-2834.2010.01197.x