Elderly care in Sweden faces several significant challenges. The number of older people is increasing at the same time as there are fewer of working age. Elderly care staff, such as nurses, care assistants and nurses, have on average more sick days than many other professional groups and often experience high work-related stress. In some municipalities, there are also problems with high staff turnover and a lack of formal competence. At the same time, research shows that many employees experience work in elderly care as meaningful and valuable. Taking advantage of and strengthening these positive aspects is central to creating good conditions for the health and well-being of staff and for the quality of care and care for older people. An important area of development in elderly care is person-centred care, which means that care is based on the individual person's needs, wishes, life history and resources. Person-centred practice emphasises the relationship between the older person, the staff and, if the person so wishes, relatives. Although person-centered care is often seen as an obvious part of good care, research shows that it is not fully implemented in practice and that the introduction of person-centered working methods can be complex and demanding. This study is being carried out in collaboration between municipalities and the University of Gävle and is linked to the establishment of nursing homes for the elderly that will function as academic nursing homes. In these nursing homes, person-centered care will be a pronounced focus area. Through recurring measurements, the activities will be monitored and developed in close collaboration between practice and research. The overall aim of the study is to investigate older people's experience of academic nursing homes with a focus on person-centered care and nursing, outdoor environment, health and well-being, and to investigate the staff's experience of person-centered working methods, learning, structural conditions and work-related well-being. The study also aims to analyze the relationship between older people's experiences of person-centered care, outdoor environment, health and well-being, both among older people living in academic nursing homes and among older people living in their own homes. The study has a longitudinal design and data will be collected at several points in time using questionnaires and interviews, which enables both statistical analyses and an in-depth understanding of the participants' experiences over time. By highlighting the perspectives of both older people and staff, the study can contribute new knowledge about how person-centered care can be developed and maintained in practice. In the long term, the results can contribute to a more health-promoting, sustainable and attractive elderly care for both older people and staff.
The study aims to answer the following questions: 1. What changes occur over time in the elderly's ratings of person-centered care, outdoor environment, health and well-being before and after moving to/starting an academic SÄBO and are there any differences in the ratings of person-centered care, outdoor environment, health and well-being over time between an intervention group and a comparison group? 2. What changes occur over time in the staff's ratings of person-centered care, learning, structural conditions and well-being? And are there any differences compared to a comparison group? The study has a quasi-experimental design with measurements before and after moving into a newly opened academic nursing homes (in one municipality) and transitioning to an academic nursing home (in the other municipality). Comparison is made with one or more regular nursing homes. In municipality A, 130-140 people live at the municipality's nursing homes, of which approximately 80 will live at an academic nursing homes. In municipality B, there are 116 older people living in nursing homes, of which approximately 25 will live at an academic nursing home. At each measurement, all elderly people living in nursing homes in the two municipalities will be surveyed. In total, approximately 85-90 at the academic nursing homes (60-65 in municipality A and approximately 25 in municipality B) are expected to participate and at least as many in the comparison group. Data are collected using questionnaires that include sociodemographic variables and validated instruments for health (EQ-5D-5L), well-being (LSQ), depression/anxiety (PHQ-4), loneliness (UCLA-3), frailty (TFI), person-centered care and support (PCPI-C) and outdoor environment (Perceived Restorativeness Scale and study-specific questions) before moving in/starting and approximately 6, 12 and 24 months after. Data collection is carried out by staff from a different nursing home than the one being studied. The study also include staff from the nursing homes. The intervention group consists of 126-130 employees at the academic nursing homes (76-80 in municipality A and approximately 50 in municipality B). The comparison group consists of staff from regular nursing homes of at least the same size, which means that the study is estimated to include approximately 300-380 participants in total. Data are collected via a questionnaire before the acamdec nursing homes opens and 12 and 24 months after. The questionnaires include validated instruments for person-centered care (PCPI-S), learning and vitality (Thriving Scale), structural conditions (CWEQ II), stress and intention to leave (BIAJS), psychological empowerment (Spreitzer), work-life conflict (COPSOQ III) and a study-specific question on self-efficacy. Quantitative data are analyzed using descriptive and analytical statistics, such as ANOVA or GEE for repeated measures and clustering. Relationships are analyzed using correlation and regression models. Non-parametric analysis methods are used when necessary. Psychometric analyses include factor analysis for construct validity and Cronbach's alpha for reliability. For translated instruments, face validity and content validity indices are also examined. The power calculation is based on the assumption that effect sizes in nursing research are usually between small and medium (Cohen's d = 0.20-0.50) (Polit \& Beck, 2025). Assuming a medium effect size and a power of 0.80, a minimum of 64 participants per group is required, which is considered to be achieved in this study.
Study Type
OBSERVATIONAL
Enrollment
600
This study is conducted in collaboration between two municipalities and the University of Gävle and is linked to the establishment of a new nursing home for older adults that will operate as academic nursing homes. In one municipality, a newly built nursing hom will open as an academic nursing home, while in the other municipality an existing nursing home will be transformed into an academic unit. Within these Academic settings, person-centred care and support will constitute a central focus, alongside the development and use of structured supervision and learning models. All decisions regarding changes to care practices, organisational processes, or the implementation of person-centred approaches are made solely by the municipal services themselves. The research group does not participate in operational decision-making and does not influence the practical design or delivery of care within the units.
Older peoples' rating of Person-centered care
Older peoples' experiences of person-centred care measured with the Person-Centred Practice Inventory - Care (PCPI-C), covering domains such as participation, shared decision-making and respect for individual needs. Score range: Min: 1, Max: 5. Interpretation: Higher scores = more person-centred care.
Time frame: Baseline, 6 months, 12 months, 24 months
Person-Centred Care Practice (PCPI-S)
Staff perceptions of person-centred care practices measured using the Person-Centred Practice Inventory - Staff (PCPI-S). The instrument assesses values, care processes, and organisational prerequisites for person-centred care. Score Range: Min: 1-Max: 5. Higher scores indicate stronger alignment with person-centred principles.
Time frame: Baseline, 12 months, 24 months.
Well-being
Self-reported well-being and life satisfaction measured with LSQ, covering domains such as physical and mental well-being, social relations, and activities. Higher scores indicate greater life satisfaction. Score range: Min: 1-Max: 6. Interpretation: Higher scores = better well-being.
Time frame: Baseline, 6 months, 12 months, 24 months.
Symptoms of Depression and Anxiety
Psychological distress measured with the 4-item Patient Health Questionnaire (PHQ-4), capturing core symptoms of anxiety and depression. Score Range: Min: 0 - Max: 12. Interpretation: Higher scores = worse psychological distress.
Time frame: Baseline, 6 months, 12 months, 24 months
Health - EQ-5D-5L Index Score
Overall health status measured using the EQ-5D-5L instrument, including five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression). Outcomes reflect self-reported health. Score Range from 0 (health states worse than death, depending on valuation set) to 1.00. Interpretation: Higher scores = better health.
Time frame: Baseline, 6 months, 12 months, 24 months
Health - EQ-5D-5L Visual Analogue Scale (VAS)
Self-rated health on a visual analogue scale ranging from 0 to 100. Score range from 0 (worst imaginable health) to 100 (best imaginable health). Interpretation: Higher scores = better health.
Time frame: Baseline, 6 months, 12 months, 24 months.
Frailty
Frailty status assessed using the Tilburg Frailty Indicator (TFI), capturing physical, psychological, and social aspects of frailty. Score Range: Min: 0 - Max: 15. Higher scores indicate higher frailty.
Time frame: Baseline, 6 months, 12 months, 24 months.
Outdoor environment
Perceptions of how restorative, supportive, and health-promoting the outdoor environment is, measured using the Perceived Restorativeness Scale together with study-specific questions related to accessibility, usability, and perceived safety. Score Range: Min: 1 - Max: 5. Interpretation: Higher scores = greater perceived restorativeness.
Time frame: Baseline, 3 months, 12 months, 24 months.
Thriving at Work
Employees' sense of vitality and learning at work measured using the Thriving Scale, capturing feelings of growth, energy, and engagement. Higher scores indicate better workplace thriving. Score Range: Min: 1-Max: 7. Interpretation: Higher scores = greater thriving.
Time frame: Baseline, 12 months, 24 months
Structural Empowerment / Work Conditions
Organisational conditions enabling effective work, including access to information, support, resources, and opportunities. Measured with the CWEQ II. Higher scores reflect stronger structural empowerment. Score Range: Min: 6 -Max: 30. Interpretation: Higher scores = greater access to structural empowerment.
Time frame: Baseline, 12 months, 24 months.
Stress Symptoms and Intention to Leave
Affective job satisfaction and emotional responses related to job strain, including intention to leave the workplace. Measured with BIAJS. Score Range: Min: 1 - Max: 5. Interpretation: Higher scores = greater affective job satisfaction (lower intention to leave).Lower satisfaction and higher strain scores may indicate elevated turnover risk.
Time frame: Baseline, 12 months, 24 months.
Psychological Empowerment
Self-perceived meaning, competence, self-determination, and impact at work, measured using Spreitzer's Psychological Empowerment Scale. Score Range: Min: 1 - Max: 7. Higher scores reflect greater psychological empowerment.
Time frame: Baseline, 12 months, 24 months.
Work-Life Conflict
Perceived conflict between work and private life measured using the Work-Life Conflict subscale of COPSOQ III. Score Range: Min: 0 - Max: 100. Higher scores indicate greater conflict and reduced balance.
Time frame: Baseline, 12 months, 24 months.
Self-Efficacy
A single study-specific question assessing staff confidence in their ability to manage work tasks and adapt to changes related to the Academic model. Score Range: Min: 1 - Max: 7. Higher scores indicate greater self-efficacy.
Time frame: Baseline, 12 months, 24 months
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