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Continuing education interventions about person-centered care targeted for nurses in older people long-term care: a systematic review



Person-Centered Care is often seen as an indicator of quality of care. However, it is not known whether and to what extent person-centered care can be enhanced by continuing education interventions in older people’s long-term care settings. This systematic review aimed to analyze and synthesize the existing research literature about person-centered care-based continuing educational interventions for nurses working in long-term care settings for older people.


Five databases were searched 6/2019 and updated 7/2020; PubMed (Medline), CINAHL, PsycINFO, Cochrane and Eric using the keywords person-centered car* OR person-centred car * OR patient-centered car* OR client-centered car* OR tailored car* OR resident-centered car* OR individualized car* AND older* OR elder* OR old person* AND Long-Term Care OR Nursing home OR 24-h treatment OR long-term treatment. Twenty-seven full texts from 2587 initially retrieved citations were included.


The continuing educational interventions found were divided into five themes: person-centered interventions focusing on medication; interaction and caring culture; nurses’ job satisfaction; nursing activities; and older people’s quality of life. The perspective of older people and their next of kin about the influence of continuing education interventions were largely absent. The background theories about interventions, the measurements taken, and the clarity around the building blocks of the continuing-care interventions need further empirical verification. The pedagogical methods used were mainly quite behavioristic mostly lectures and seminars.


Most of person-centered care continuing education interventions are effective. Still more empirical research-based continuing education interventions are needed that include learner-centered pedagogical methods, with measurable outcomes that consider the opinions of older people and their next of kin. Continuing educational interventions for nurses need to be further developed to strengthen nurse’s competence in person-centered care, job satisfaction and for better quality of care.

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The requirements for quality in the nursing care of older people has been written in most countries into: legislation [1], national guidelines [2, 3] and policy papers [4]. The requirements are also written into international ethical guidelines [5, 6] and e.g. in Finland’s legislation [7, 8]. (Ministry of Social Affairs and Health, 2018; Finlex, 980/2012). Person-centered care is often used as a quality indicator and is of ethical value [2,3,4,5,6,7,8].

The conceptual roots of person-centered care are in theories based on the philosophy of humanism, which includes personhood and well-being theory [9], personality theory [10] and nursing theories [11, 12]. In the nursing literature, the concept of person-centered care is often used as a synonym for other terms, such as individualized care, patient-centered care, client-centered care, and personalized care [13]. However, these concepts have differences. The concept of individualized care considers an individual as a biopsychosocial integral whole, focuses on individual differences, preferences, and the values of individuals. Individualized care includes the patient’s clinical situation, personal life situation and decisional control [11]. Person- and patient-centered care concepts have different goals. Patient-centered care considers the patient as the center and prioritizes functional life, whilst the person-centered care takes a wider stance prioritizing the whole life, including the interactions with others and the achievement of a meaningful life [14]. The way in which people are cared for often defines which concept is used in practice, for example, if person is given the status of a client or patient [13]. The core of each of the care concepts is human autonomy and respect for dignity [11, 13,14,15]. Person-centered care asserts its strong place in the care of older people because it is associated with the quality of life [16] and experiences of the quality of care [17] with a whole life orientation including, but not limited to a health problem orientation [14].

Continuing Education been defined in terms of continuing professional development, in-service training, or further training [18]. Usually the purpose of continuing education, which takes place after formal nurse registration education, is to develop nurses’ competence [19]. In different hospital settings, individual nurse’s competence consists of personal skills, abilities, and knowledge [20]. The collective competence of a group or team of nurses has a broader base and is greater than that of the sum of the individuals’ competence, facilitating the growth and development of individuals with varying competence within the team [21]. Organizational culture has been found to affect the quality of care delivery by nursing teams, both positively and negatively [22]. Therefore, the promotion of competence through in long-term care is important, not only for individual nurses but also the collective competence of the team.

Young people’s perceptions of the nursing profession are quite negative [23]. Nurses (Registered Nurses, Practical Nurses and Nursing Assistants) have reported a high level of job strain in nursing homes where the many residents suffer from dementia [24]. Nurses have and suggested there is poor support from the organization managers for the quality of their work in long-term care [25]. The use of person-centered care may mitigate these issues by reducing stress, burnout, and improving job satisfaction among dementia care nurses, though the research in this area is currently weak making firm conclusions difficult [26]. Person-centered care interventions that have a positive influence in older people’s long-term care discussed in the literature include: environmental changes; interaction relationships; relationships with managers; the empowerment of nurses; staff-resident relationships and the care culture so that care is more about the individual [27]. Psychosocial interventions in person-centered care of older people in long-term care include elements such as: communication training; emotional response support; dementia care mapping; retaining abilities; sensory strategies; integrity-promoting care; organizational level changes; and others not categorized by researchers [28]. The outcomes of these interventions seem to support the use of person-centered care approach although generalizability of the results is limited due to the complexity of the interventions [27, 28]. However, there seems to be little useful evidence about the effects of person-centered continuing education interventions on nurses working with older people in long-term care and even less from the perspective older people and their next of kin. Given the importance of the topic, more needs to be known about the efficacy of person-centered care continuing education interventions, especially as the older people population increases [29] and older people are expected to live longer, many with long-term health conditions [30].

The aim of this review was to analyze and synthesize the existing research literature about person-centered care-based continuing educational interventions for nurses working in long-term care settings for older people. The goal was to increase the understanding of the current pedagogical methods and results of continuing education interventions from the perspective of nurses, older people and their next of kin.


This study is a systematic review of the empirical research literature after Harris [31] focused on person-centered care-based continuing education interventions for nurses working in long-term care settings for older people. The review was conducted following internationally recommended scientific practice in every phase [32] and reported according to Preferring Reporting Items for Systematic Reviews and Meta-Analyses PRISMA [33].

Search strategy

A systematic search from five relevant databases was conducted on 06/2019 and updated on 7/2020, published articles written in English without any time limit: PubMed (Medline), CINAHL, PsycINFO, Cochrane and ERIC using keywords and Boolean operators. The search phrase PubMed (Medline) was: (“Patient-Centered Care”[Mesh] OR person-centered car* OR person-centred car* OR “person centered care” OR “person centred care” OR “patient centered care” OR “patient centred care” OR patient-centered car* OR “patient-centred care” OR “client centered care” OR “client centred care” OR tailored car* OR “resident centered care” OR “resident centred care” OR “resident-centred care” OR “resident-centered care” OR individualized car* OR individualized car*) AND (“Frail Elderly”[Mesh] OR “Aged”[Mesh] OR “Aged, 80 and over”[Mesh] OR “Senior Centers”[Mesh] OR older* OR elder* OR aged OR senior* OR resident* OR old people* OR old person*) AND (“Insurance, Long-Term Care”[Mesh] OR “Long-Term Care”[Mesh] OR “Nursing Homes”[Mesh] OR “After-Hours Care”[Mesh] OR “Conservative Treatment”[Mesh] OR long-term car* OR LTC OR nursing home* OR 24-h treatment* OR 24-h car* OR enhanced treatment* OR enhanced car* OR long-term treatment*).

Study selection

Studies were included in the review if they were: (1) experimental study designs; RCTs; controlled clinical trials (CCTs); quasi-experimental and pre-posttest studies with or without control groups. (2) intervention studies with person-centered care elements; (3) studies focused on continuing education interventions for nurses working in long-term settings for older people; and (4) peer-reviewed research studies published in the English language. Studies were excluded if they were (1) implementation studies or feasibility studies not assessing any outcomes and (2) interventions other than person-centered care-based continuing educational interventions for nurses working in long-term care settings for older people.

Retrieval of the studies was conducted in four steps [33] (Fig. 1). The initial search of the databases retrieved 2587 citations. After removing duplicate studies (n = 277), in the second step, three researchers (MP, MS and RS) screened the titles and abstracts to identify eligible records for full text analysis removing 2310 scripts. In the third step the remaining 47 papers were analyzed against the inclusion and exclusion criteria. During this analysis researchers eliminated 20 papers by consensus leaving 27 papers for further analysis. A manual search of the reference lists of the 27 included studies identified no further relevant studies.

Fig. 1
figure 1

Retrieval of the studies

Quality appraisal

The quality of the 27 included papers was assessed by Joanna Briggs Institute [34] checklist for quasi-experimental studies. The aim of the appraisals was to assess methodological quality of studies considering bias in designs, research conduct and the analyses with nine appraisal questions and a maximum score of 9. The quality appraisal was recorded but not used as part of the inclusion criteria.

Data analysis

Data were collected in tabular format: the author(s); year of publication; country of origin; design; aim of study; sample; participants; data collection instruments; and methods. The contents, pedagogical methods and outcomes from the perspective of Nurses (N), Next of kin (NK) and Older People (OP) were also collected within the same tabular format. The outcomes of the interventions, positive or no effect, were analyzed using a two-step categorization (+ = a positive effect of the intervention, 0 = no effect of the intervention). As the outcome variables differed from each other it was not possible to calculate meta-analysis. Data were analyzed using conventional content analysis [35]. The original expressions used by authors in their articles were used to reduce interpretation. The analysis was performed by one researcher and the results were confirmed in the research team before tabulation.


Characteristics of the studies

The studies (Table 1) were carried out mainly in Europe: Portugal (n = 5);Sweden (n = 1); UK (n = 2) Belgium (n = 3) Germany (n = 1) The Netherlands (n = 2) and also, in USA (n = 7); Australia (n = 4); Canada (n = 1) and Japan (n = 1). The studies were published between 2004 and 2019, mostly in 2015 or after (n = 19).

Table 1 Studies included in the review (n = 27)

The design of the studies were RCTs (n = 9), experimental designs (n = 6), quasi-experimental design (n = 2), pretest-posttest designs (n = 10). All studies conducted pretests and posttests after the intervention. Four studies were carried out without control group and there were two experimental groups in one RCT design. The quality appraisal, mean and median scores using the JBI checklist, were 7.70 and 9, out of nine respectively.

The study informants were mainly older people (n = 11), nurses (n = 7) or both together (n = 6). In one study nurses responded as a team. In another study nurses and older people formed a dyad. The next of kin of the older people participated in one study together with older people and nurses. In the experimental groups, the mean and mode of the participants were 82 (range 6–677) and 24 respectively. In the control groups the mean and mode were 100 (range 6–660) and 29 respectively.

Implementation of the continuing education interventions

The pedagogical methods used in the continuing education interventions (Table 2) were contact teaching via seminars, workshops, or team sessions (n = 27), usually with the on-site support (n = 17). In some studies, a few “key nurses”, attended continuing education (n = 5). Within the continuing education sessions digital material such as videos were used (n = 8) and in one study simulation and role-playing games.

Table 2 Continuing education interventions, pedagogical methods, assessments, and their outcomes

The continuing education interventions were categorized into five themes: (1) medication (n = 5); (2) interaction and caring culture (n = 11); (3) nurses’ job satisfaction (n = 3); (4) nursing activities (n = 5); and (5) older people’s quality of life (n = 3). In the medication themed interventions, the typical goal was to reduce the number of medications older people took and to learn to use person-centered care to reduce behavioral issues that disturbed other residents. The aim of the interaction and care culture themed interventions was to increase positive communication between nurses and the older people and to influence the caring culture, making it more person-centered. Some continuing education interventions focused on increasing nurses’ job satisfaction. Nursing activities themed interventions were aimed at influencing residents’ daily routines and activities.

Outcomes of the continuing education interventions

Most of the continuing education interventions about person-centered care had positive effects (Table 2) but four studies indicated that the interventions did not have the any effect [50, 53, 61, 68].

Medication themed intervention outcomes described a significant decrease in use of psychotropic drugs [36, 73]. The proportion of residents using neuroleptic drugs in research centers was significantly lower than in control homes [62] which reduced costs [38]. Continuing education intervention influence on the staff and older people’s behavior varied. The interventions had no effect on residents’ behavioral symptoms such as agitation and disruption in one study, but these symptoms also did not increase with fewer medications [62]. In another study, continuing education intervention did reduce residents’ agitation, their general neuropsychiatric symptoms and increased their positive interactions between nurses and residents [38].

Interaction and caring culture themed continuing education interventions had a positive influence on: nurses’ person-centeredness [42]; verbal communication [44, 48, 71]; non-verbal communication [44]; increased direct gaze duration between residents and nurses; reduced sadness and increased smiling [72]. In one study, both nurses and residents reported increased satisfaction in their relationship after the continuing education intervention and residents reported a closer relationship with nurses [57]. Nurses reported increased knowledge about meeting the needs of people with dementia and organizational culture change experiences and next of kin were also satisfied with these changes and quality of care [69]. Also, positive effects on care providers’ mood, burden [67] and residents’ behaviour were reported [63].

Nurses’ job satisfaction themed continuing education interventions seemed to positively influence nurse’s emotional exhaustion, emotional management, self-care awareness and enhanced cohesion within the group, which can reduce nurses burnout [47]. One study had no significant effect on job satisfaction based on quantitative data analysis but included details of a qualitative analysis which showed a positive impact of the intervention on daily work performance [49]. It was suggested that without managerial support, the influence of the continuing education intervention would not be as strong and would be less likely to be established in the workplace [65].

Nursing activities themed continuing education interventions demonstrated the abstract nature of person-centered care [14]. In one study, the continuing education intervention, delivered using a digital device, reported improved sleep for residents with dementia. The experimental group of residents had significantly more nighttime sleep (p = 0.03) and less daytime sleep (p = 0.01) in the post test [66]. Nursing activities such as bathing [64]; reduced agitation, aggression, and discomfort in persons with dementia [71] and oral hygiene [70] had a positive influence.

The quality of life of older people themed continuing education interventions outcomes varied. In some studies, there was no effect on the quality of residents life [53] but in another study the intervention has got effectiveness to the residents’ quality of life [75]. On these quality-of-life continuing education interventions is usually compared different education methods as person-centered care and Dementia Care Mapping [56].

Instruments used in continuing education interventions

Although all reviewed studies included person-centered care within the educational intervention, only one study [50] used a validated person-centered care instrument to measure person-centered care outcomes. The Person-Centered Environment and Care Assessment Tool was also used, but its validity is difficult to evaluate as it is within an unpublished PhD thesis [54]. The most commonly used quantitative instruments were, the Cohen-Mansfield Agitation Inventory [40] (n = 7), and the Maslach Burnout Inventory [59] (n = 4) (Table 1).


This study aimed to analyze and synthesize the existing research literature about person-centered care-based continuing educational interventions for nurses working in long-term care settings for older people. The analysis revealed the focus of this continuing education is on: older people’s medication; the interaction and caring culture; nurses’ job satisfaction; nursing activities and older people’s quality of life. Much of the delivery of this continuing educational training used behaviorist, using pedagogical methods such as lectures and seminars. The method of delivery of education can have an influence on the effectiveness of the intervention [38, 42], but it may be useful to use more learner-centered approaches to improve outcomes in future research [76]. The outcomes of the continuing education interventions of person-centered care were largely collected e.g. from nurses [42, 48, 50] observation of older people or e.g. from older people’s documents [36, 38, 68]. It may be useful, if data on outcomes were also routinely collected from older people and their next of kin [77].

The content of the continuing education activities included person-centered care elements that were designed to influence the interactions between the residents and nurses, and through this, the care environment. However, the influence of continuing education on person-centered care was measured in only one study [50]. Differences in the type of design, outcomes, number of participants, and duration of continuing education intervention hindered study comparisons and generalizations. Moreover, a range of methodological weakness made it difficult to provide any conclusive indication about the effectiveness of these approaches. This heterogeneity of the background theories and measurements of the continuing education interventions used in the studies reviewed, gives the impression of conceptual imprecision. Other researchers support this view [26] thought there is evidence that theory-based educational interventions are effective [78]. Although person-centered care is an abstract concept and so difficult to measure, the creation of a stronger argument for its use requires more rigorous research including the wider use of valid, person-centered care measurement instruments.

Pedagogical methods were at the core of the effectiveness of the continuing education interventions. Some of the studies educated “key nurses,” leaving these nurses to help other nurses learn to implement change in their workplace [50, 53, 56, 61]. There are some risks associated with using “key nurses” in this way, as the process of implementing person centered care requires an understanding of the origin and content of the concepts alongside the practical uses in care situations. The work environment, level of job satisfaction, managerial approaches and the personalities of nurses can help or hinder the work of these “key nurses”, who will require stronger managerial support, encouraging flexible working practices and the involvement of nurses in care decisions [53]. Earlier studies have reported that the collective competence of a team is greater than one persons’ competence [21]. Studies in this review using “key nurses” to introduce person-centered care were not effective in developing the collective competence of the nursing teams directly, limiting the possible benefits of the education e.g. [50].

When introducing person-centered care, pedagogical methods such as face-to-face teaching, though important, were not seen to be sufficient generally [36] and most of the interventions in this review used additional on-site support and consultation e.g. [42, 48, 68, 70] video material e.g. [57, 61, 74] brainstorming [72] and role-playing [68, 72] to achieve their preferred outcomes. Additionally, more student-centered approaches such as simulation-based nursing education interventions have been shown to improve critical and creative thinking [79] though simulation was only used in one reviewed study [72].

Digitalization as part a pedagogical method can support learning activities [80, 81]. Appropriate applications including learner-centered approaches, improve communication between students and educators and enable a collaborative learning environment [82]. However, use of these digital platforms have strengths and weaknesses. It has been reported that Moodle promotes professionalism, ethical behavior and develops critical thinking, but the use of other participatory web-based platforms, including social media platforms may suffer from credibility of information and are open to student misinterpretation [83]. The choice of appropriate platform requires some competence [80].

In this review, after the continuing education, nurses: increased the number of positive interactions with residents [38], improved person-centered care delivery [42], communication [44], and satisfaction in relationship with older people [46, 57], and increased their knowledge about meeting the needs of people with dementia [69]. Other improvements delivered by the outcomes of the reviewed studies were: a reduction in the use of medicines [36, 73]; improved behavioral symptoms [38, 56, 62, 69, 71] and relationships with nurses [57, 64, 72, 74] improved the quality of life for the older people [48, 67, 75]; and increased the number of support for daily activities [66, 70]. These results demonstrate the usefulness of research of continuing education interventions, especially when these changes have been brought about in work practice: reduce nurses burnout [46, 47, 65] have positive effects on nurses mood and burden [67]; and influence organizational culture, changing nurses experiences for the better [48, 69]. This general increase in the quality of care and care environment after suitable continuing education is also supported by other evidence [17].

The data that informed the research came from: residents’ medication charts; nurse-completed questionnaires; video recordings and from observation. In only one study did researchers collect data from the next of kin, about person-centered care interventions [69]. This is disappointing as the opinions of the older people and their next of kin on the results of the continuing education intervention might facilitate a better understanding of the interventions that meet their needs. The lack of old people’s and their next of kin views and perceptions need to be addressed in future research.

Most of the interventions used, produced the positive outcomes described above. However, in some studies the sample sizes were quite small and not power analyzed e.g. [42, 57, 75]. In other studies the content or delivery of the intervention may not have been appropriate [50, 61, 68]. Many other weaknesses were described in the studies reviewed. Additionally, the drop-out rate from the research may have been a major difficulty [48, 50]. This drop-out occurs, for example through the mortality of the residents, and nursing staff turnover [84, 85]. Four studies did not report any positive outcomes from the continuing education interventions [50, 55, 61, 68]. There were quite several studies that did not follow the reporting guidelines, in which case the primary and secondary measures and outcomes were not clearly mentioned [42, 44, 46,47,48,49,50, 57, 61, 63, 64, 67, 69, 74, 75].

This review has identified and analyzed the available continuing education interventions about person-centered nursing in studies from many different countries. Overall, the studies are difficult to evaluate thoroughly often lacking rigorous conceptual and theory bases. This situation could be improved by careful design, choice of research settings, and strict protocols designed to provide robust evidence about the effectiveness of continuing education interventions.

Strengths and limitations

This review has some strengths. Firstly, this review focused on all research-based continuing education interventions about person-centered care, targeting nurses in older people’s long-term care. The review sought literature from five relevant databases without time limits to provide the best opportunity to find as much of the relevant literature as possible. Using the inclusion criteria, the review considered all available experimental designs, randomized controlled trials alongside those with no control group. This approach facilitated the capture of the widest variety of continuing education intervention studies in this field [86, 87].

The computerized search from databases was conducted by one researcher with the support of an information specialist and then determined by research group.

Secondly, we used the whole research team to assist with study selection, reducing selection bias through discussion towards consensus. For example, in step one (Fig. 1) the citations were evaluated by two researchers first independently and then together. Where consensus was not found a third opinion was sought from another member of the research group.

The limitations of the review relate to the quality of the available studies, limited language only in English and unpublished studies. The research quality appraisal was challenging, because of the limitations of the study designs or number of participants, even though the quality score averaged 7.70 out of 9 [34]. Statistically, the meta-analysis was not applicable because the interventions were different in content and the outcome variables were not comparable [86].


This review enhances the understanding about person-centered care-based continuing education interventions for nurses working in long-term care settings for older people. Firstly, we identified five themes describing the contents of this type of continuing education. However, concept person-centered care is used in quite different ways and the use of stronger theory-based interventions which can be measured with validated person-centered care instruments is still required. Secondly, we identified the pedagogical methods which were used in these continuing education interventions about person-centered care. Pedagogical methods are quite traditional and could be enhanced using more learner-centered approaches such as appropriate simulation, digital platforms and social media which were not used sufficiently in the reviewed studies. Thirdly, we found that the evaluation of the results of continuing education interventions were mainly conducted from a nurse’s perspective, through for example, medication charts or by qualitative methods such as observation. The perspective of the older person and their next of kin was not evident and should be taken into consideration in future research.

Continuing educational interventions for nurses working in long-term care settings for older people need to be further developed to strengthen nurse’s competence in person-centered care. The positive outcomes in the five themes identified in this review improve the quality of older people’s long-term care. More empirical research-based continuing education interventions are needed, that include a wider set of learner-centered pedagogical methods with measurable outcomes which consider the opinions of older people and their next of kin. These measurable outcomes should be quantified using validated instruments. These developments are important for the quality of care delivery, the quality of life of older people in care and nurses job satisfaction.

Availability of data and materials

The dataset from this study is available from the corresponding author upon reasonable request.



Cumulative index to nursing and allied health literature


A world-class resource for abstracts and citations of behavioral and social science research


Education resources information center


Preferred reporting items for systematic reviews and meta-analysis


Randomized controlled trial


Controlled clinical trial


The Joanna Briggs Institute checklist for quasi-experimental studies




Next of kin


Older people


A positive effect of the intervention


Non effect of the intervention


Primary outcome


Secondary outcome




Experimental group


Control group


All participants


Person-centered care


Person-centered environment


Dementia care mapping


  1. Guzman, J., Pawliczko, A., Beales, S., & Voelcker, I.. Overview of available policies and legislation , data and research , and institutional arrangements relating to older persons – progress since Madrid. 2012. Retrieved from

    Google Scholar 

  2. Wynne, M.. Office of Nursing and Midwifery Services Director Quality Care-Metrics Project Group. National guideline for nursing and midwifery quality care-metrics data measurement in older person services. 2018. Retrieved from

    Google Scholar 

  3. NICE. National institute for health and care excellence. Older people with social care needs and multiple long - term conditions, October; 2015. p. 1–166. Retrieved from

    Google Scholar 

  4. WHO. Global strategy on people-centred and integrated health services. 2015. Retrieved from

    Google Scholar 

  5. Zahedi F, Sanjari M, Aala M, Peymani M, Aramesh K, Parsapour A, et al. The code of ethics for nurses. Iran J Public Health. 2013;42(1):1–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  6. ICN. The ICN code of ethics for nurses. Int Counc Nurs. 2012;8 Retrieved from Accessed 22 Apr 2021.

  7. Ministry of Social Affairs and Health. Quality recommendation to guarantee a good quality of life and improved services for older persons 2017-2019. Publications of the Ministry of Social Affairs and Health 1/2018. 2018. Retrieved from

    Google Scholar 

  8. Finlex 980/2012. Act on supporting the functional capacity of the older population and on social and health care services for older persons. Retrieved from Accessed 22 Apr 2021.

  9. Kitwood T, Bredin K. Towards a theory of dementia care: personhood and well-being. Ageing Soc. 1992;12:269–87 Retrieved from

    Article  PubMed  Google Scholar 

  10. Rogers, Carl R. by Introduction by Peter, D., Kramer, M. D. On becoming a person. New York: Houghton Mifflin Company; 1995.

    Google Scholar 

  11. Suhonen R, Charalambous A. The concept of individualized care. In: Suhonen R, Stolt M, Papastavrou E, editors. Individualized care theory, measurement, research and practice: Springer International Publishing; 2018. p. 27–38.

    Google Scholar 

  12. Nolan MR, Davies S, Brown J, Keady J, Nolan J. Beyond “person-centred” care: a new vision for gerontological nursing. J Clin Nurs. 2004;13(s1):45–53

    Article  PubMed  Google Scholar 

  13. Morgan S, Yoder LH. A concept analysis of person-centered care. J Holist Nurs. 2012;30(1):6–15

    Article  PubMed  Google Scholar 

  14. Håkansson Eklund J, Holmström IK, Kumlin T, Kaminsky E, Skoglund K, Höglander J, et al. “Same same or different?” a review of reviews of person-centered and patient-centered care. Patient Educ Couns. 2019;102(1):3–11

    Article  PubMed  Google Scholar 

  15. Zhao J, Gao S, Wang J, Liu X, Hao Y. Differentiation between two healthcare concepts: person-centered and patient-centered care. Int J Nurs Sci. 2016;3(4):398–402

    Google Scholar 

  16. Terada S, Oshima E, Yokota O, Ikeda C, Nagao S, Takeda N, et al. Person-centered care and quality of life of patients with dementia in long-term care facilities. Psychiatry Res. 2013;205(1–2):103–8

    Article  PubMed  Google Scholar 

  17. Edvardsson D, Watt E, Pearce F. Patient experiences of caring and person-centredness are associated with perceived nursing care quality. J Adv Nurs. 2017;73(1):217–27

    Article  PubMed  Google Scholar 

  18. Ministry of Education and Culture. Vocabulary of education: Publications of the Ministry of Education and Culture, Finland; 2018. p. 22, 166. Retrieved from

    Google Scholar 

  19. Gallagher L. Continuing education in nursing: a concept analysis. Nurse Educ Today. 2007;27(5):466–73

    Article  PubMed  Google Scholar 

  20. Meretoja R, Leino-Kilpi H, Kaira AM. Comparison of nurse competence in different hospital work environments. J Nurs Manag. 2004;12(5):329–36

    Article  PubMed  Google Scholar 

  21. Bing-Jonsson PC, Hofoss D, Kirkevold M, Bjørk IT, Foss C. Sufficient competence in community elderly care? Results from a competence measurement of nursing staff. BMC Nurs. 2016;15(5):1–11

    Google Scholar 

  22. Suhonen R, Gustafsson M-L, Katajisto J, Välimäki M, Leino-Kilpi H. Nurses’ perceptions of individualized care. J Adv Nurs. 2010;66(5):1035–46

    Article  PubMed  Google Scholar 

  23. Glerean N, Hupli M, Talman K, Haavisto E. Young peoples’ perceptions of the nursing profession: an integrative review. Nurse Educ Today. 2017;57:95–102

    Article  PubMed  Google Scholar 

  24. Sandberg L, Borell L, Edvardsson D, Rosenberg L, Boström AM. Job strain: a cross-sectional survey of dementia care specialists and other staff in Swedish home care services. J Multidiscip Healthc. 2018;11:255–66

    Article  PubMed  PubMed Central  Google Scholar 

  25. Suhonen R, Alikleemola P, Katajisto J, Leino-Kilpi H. Nurses’ assessments of individualised care in long-term care institutions. J Clin Nurs. 2012;21(7–8):1178–88

    Article  PubMed  Google Scholar 

  26. Barbosa A, Sousa L, Nolan M, Figueiredo D. Effects of person-centered care approaches to dementia care on staff. Am J Alzheimers Dis Other Dement. 2015;30(8):713–22

    Article  Google Scholar 

  27. Brownie S, Nancarrow S. Effects of person-centered care on residents and staff in aged-care facilities: a systematic review. Clin Interv Aging. 2013;8:1–10

    Article  PubMed  PubMed Central  Google Scholar 

  28. Blake D, Berry K, Brown LJE. A systematic review of the impact of person-centred care interventions on the behaviour of staff working in dementia care. J Adv Nurs. 2020;76(2):426–44

    Article  PubMed  Google Scholar 

  29. UN. United Nations, Department of Economic and Social Affairs. World Population Prospects 2019: Highlights. New York: UN; 2019. p. 2–3. Retrieved from

    Google Scholar 

  30. WHO. Global health and aging: National Institute on Aging, National Institutes of Health, U.S. Department of Health and Human Services; 2012. Retrieved from

    Google Scholar 

  31. Harris JD, Quatman CE, Manring MM, Siston RA, Flanigan DC. How to write a systematic review. Am J Sports Med. 2014;42(11):2761–8

    Article  PubMed  Google Scholar 

  32. Allea. ALLEA. The European code of conduct for research integrity. 2017. Retrieved from

    Google Scholar 

  33. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):1006–12

    Article  PubMed  Google Scholar 

  34. Joanna Briggs Institute. Checklist for quasi-experimental studies. 2017.

    Google Scholar 

  35. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88

    Article  PubMed  Google Scholar 

  36. Azermai M, Wauters M, De Meester D, Renson L, Pauwels D, Peeters L, et al. A quality improvement initiative on the use of psychotropic drugs in nursing homes in Flanders. Acta Clin Belg. 2017;72(3):163–71

    Article  PubMed  Google Scholar 

  37. Wauters M, Azermai M, Perehudoff K, Versluys K, Steeman E, Petrovic M. Development and validation of the psychotropic education and knowledge (PEAK) test on psychotropic drugs for nurses in an acute geriatric care setting. Eur Geriatr Med. 2016;7(2):135–41

    Article  Google Scholar 

  38. Ballard C, Corbett A, Orrell M, Williams G, Moniz-Cook E, Romeo R, et al. Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: a cluster-randomised controlled trial. PLoS Med. 2018;15(2):1–18

    Article  Google Scholar 

  39. Mulhern B, Rowen D, Brazier J, Smith S, Romeo R, Tait R, et al. Development of DEMQOL-U and DEMQOL-PROXY-U: generation of preference-based indices from DEMQOL and DEMQOL-PROXY for use in economic evaluation. Health Technol Assess. 2013;17(5):1–160

    Article  Google Scholar 

  40. Cohen-Mansfield J. Measurement of inappropriate behavior associated with dementia. J Gerontol Nurs. 1999;25(2):42–51

    Article  CAS  PubMed  Google Scholar 

  41. Wood S, Cummings JL, Hsu MA, Barclay T, Wheatley MV, Yarema KT, et al. The use of the neuropsychiatric inventory in nursing home residents: characterization and measurement. Am J Geriatr Psychiatr. 2000;8(1):75–83

    Article  CAS  Google Scholar 

  42. Barbosa A, Nolan M, Sousa L, Figueiredo D. Person-centredness in direct care workers caring for residents with dementia: effects of a psycho-educational intervention. Dementia. 2017;16(2):192–203

    Article  PubMed  Google Scholar 

  43. Grosch K, Medvene L, Wolcott H. Person-centered caregiving instruction for geriatric nursing assistant students: development and evaluation. J Gerontol Nurs. 2008;34(8):23–31

    Article  PubMed  Google Scholar 

  44. Barbosa A, Marques A, Sousa L, Nolan M, Figueiredo D. Effects of a psycho-educational intervention on direct care workers’ communicative behaviors with residents with dementia. Health Commun. 2016;31(4):453–9

    Article  PubMed  Google Scholar 

  45. Kitwood T. Toward a theory of dementia care: ethics and interaction. J Clin Ethics. 1998;9(1):23–34 Retrieved from

    Article  CAS  PubMed  Google Scholar 

  46. Barbosa A, Nolan M, Sousa L, Marques A, Figueiredo D. Effects of a psychoeducational intervention for direct care workers caring for people with dementia. Am J Alzheimers Dis Other Dement. 2016;31(2):144–55

    Article  Google Scholar 

  47. Barbosa A, Nolan M, Sousa L, Figueiredo D. Supporting direct care workers in dementia care: effects of a psychoeducational intervention. Am J Alzheimers Dis Other Dement. 2015;30(2):130–8

    Article  Google Scholar 

  48. Boersma P, van Weert JCM, Lissenberg-Witte BI, van Meijel B, Dröes R-M. Testing the implementation of the Verder contact method: a theathre-based communication method in dementia care. The Gerontologist. 2019;59(4):780–91

    Article  PubMed  Google Scholar 

  49. Boersma P, Droandes RM, Lissenberg-Witte BI, Van Meijel B, Van Weert JCM. Does working with the veder contact method influence the job satisfaction of caregivers? A non-randomized controlled trial in nursing homes for people with dementia. Int Psychogeriatr. 2017;29(12):2017–32

    Article  CAS  PubMed  Google Scholar 

  50. Bökberg C, Behm L, Wallerstedt B, Ahlström G. Evaluation of person-centeredness in nursing homes after a palliative care intervention: pre- and post-test experimental design. BMC Palliat Care. 2019;18(44):1–10

    Google Scholar 

  51. Edvardsson D, Fetherstonhaugh D, Nay R, Gibson S. Development and initial testing of the person-centered care assessment tool (P-CAT). Int Psychogeriatr. 2010;22(1):101–8

    Article  PubMed  Google Scholar 

  52. Edvardsson D, Sandman PO, Rasmussen B. Construction and psychometric evaluation of the Swedish language person-centred climate questionnaire - staff version. J Nurs Manag. 2009;17(7):790–5

    Article  PubMed  Google Scholar 

  53. Chenoweth L, Forbes I, Fleming R, King MT, Stein-Parbury J, Luscombe G, et al. PerCEN: a cluster randomized controlled trial of person-centered residential care and environment for people with dementia. Int Psychogeriatr. 2014;26(7):1147–60

    Article  PubMed  Google Scholar 

  54. Chenoweth L, King M, Luscombe G, Forbes I, Jeon YH, Parbury JS, et al. Study protocol of a randomised controlled group trial of client and care outcomes in the residential dementia care setting. Worldviews Evid-Based Nurs. 2011;8(3):153–65

    Article  PubMed  Google Scholar 

  55. Smith SC, Lamping DL, Banerjee S, Harwood R, Foley B, Smith P, et al. Measurement of health-related quality of life for people with dementia. Heal Technol. 2005;9(10):1–93 Retrieved from

    CAS  Google Scholar 

  56. Chenoweth L, King MT, Jeon Y-H, Brodaty H, Stein-Parbury J, Norman R, et al. Articles Caring for Aged Dementia Care Resident Study (CADRES) of person-centred care, dementia-care mapping, and usual care in dementia: a cluster-randomised trial. Lancet Neurol. 2009;8(4):317–25.

    Article  PubMed  Google Scholar 

  57. Coleman CK, Medvene LJ. A person-centered care intervention for geriatric certified nursing assistants. Gerontologist. 2013;53(4):687–98

    Article  PubMed  Google Scholar 

  58. Lann-Wolcott H, Medvene LJ, Williams K. Measuring the person-centeredness of caregivers working with nursing home residents with dementia. Behav Ther. 2011;42(1):89–99

    Article  PubMed  Google Scholar 

  59. Maslach C, Schaufeli WB, Leiter MP. Job Burnout. Annu Rev Psychol. 2001;52(1):397–422.

    Article  CAS  PubMed  Google Scholar 

  60. Heliker D, Nguyen HT. Story sharing: enhancing nurse aide-resident relationships in long-term care. Res Gerontol Nurs. 2010;3(4):240–52

    Article  PubMed  Google Scholar 

  61. Cornelison LJ, Hermer L, Syme ML, Doll G. Initiating Aha moments when implementing person-centered care in nursing homes: a multi-arm, pre-post intervention. BMC Geriatr. 2019;19(115):1–11

    Google Scholar 

  62. Fossey J, Ballard C, Juszczak E, James I, Alder N, Jacoby R, et al. Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: cluster randomised trial. Br Med J. 2006;332(7544):756–8.

    Article  Google Scholar 

  63. Gillis K, Lahaye H, Stijn D, Lips D, Arnouts H, Van Bogaert P. A person-centred team approach targeting agitated and aggressive behaviour amongst nursing home residents with dementia using the senses framework. Int J Older People Nursing. 2019;14(4):e12269.

    Article  Google Scholar 

  64. Hoeffer B, Talerico KA, Rasin J, Mitchell CM, Stewart BJ, Mckenzie D, et al. Assisting cognitively impaired nursing home residents with bathing: effects of two bathing interventions on caregiving. The Gerontologist. 2006;46(4):524–32

    Article  PubMed  Google Scholar 

  65. Jeon YH, Luscombe G, Chenoweth L, Stein-Parbury J, Brodaty H, King M, et al. Staff outcomes from the Caring for Aged Dementia Care REsident Study (CADRES): a cluster randomised trial. Int J Nurs Stud. 2012;49(5):508–18

    Article  PubMed  Google Scholar 

  66. Li J, Grandner MA, Chang Y-P, Jungquist C, Porock D. Person-centered dementia care and sleep in assisted living residents with dementia: a pilot study. Behav Sleep Med. 2017;15(2):97–113

    Article  CAS  PubMed  Google Scholar 

  67. McGilton KS, Rochon E, Sidani S, Shaw A, Ben-David BM, Saragosa M, et al. Can we help care providers communicate more effectively with persons having dementia living in long-term care homes? Am J Alzheimers Dis Other Dement. 2017;32(1):41–50

    Article  Google Scholar 

  68. Richter C, Berg A, Langner H, Meyer G, Köpke S, Balzer K, et al. Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): a cluster-randomised controlled trial. Age Ageing. 2019;48(3):419–25

    Article  PubMed  PubMed Central  Google Scholar 

  69. Roberts G, Morley C, Walters W, Malta S, Doyle C. Caring for people with dementia in residential aged care: successes with a composite person-centered care model featuring Montessori-based activities. Geriatr Nurs. 2015;36(2):106–10

    Article  PubMed  Google Scholar 

  70. Sloane PD, Zimmerman S, Chen X, Barrick AL, Poole P, Reed D, et al. Effect of a person-centered mouth care intervention on care processes and outcomes in three nursing homes. J Am Geriatr Soc. 2013;61(7):1158–63

    Article  PubMed  Google Scholar 

  71. Sloane PD, Hoeffer B, Mitchell CM, McKenzie DA, Barrick AL, Rader J, et al. 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. J Am Geriatr Soc. 2004;52(11):1795–804

    Article  PubMed  Google Scholar 

  72. Sposito G, Barbosa A, Figueiredo D, Yassuda MS, Marques A. Effects of multisensory and motor stimulation on the behavior of people with dementia. Dementia. 2017;16(3):344–59

    Article  PubMed  Google Scholar 

  73. Wauters M, Elseviers M, Peeters L, Meester DD, Christiaens T, Petrovic M. Reducing Psychotripic drug use in nursing homes in Belgium: an implementation study for the roll-out of a practice improvement initiative. Drugs Aging. 2019;36(8):769–80.

    Article  CAS  PubMed  Google Scholar 

  74. Williams KN, Perkhounkova Y, Jao YL, Bossen A, Hein M, Chung S, et al. Person-centered communication for nursing home residents with dementia: four communication analysis methods. West J Nurs Res. 2018;40(7):1012–31

    Article  PubMed  Google Scholar 

  75. Yasuda M, Sakakibara H. Care staff training based on person-centered care and dementia care mapping, and its effects on the quality of life of nursing home residents with dementia. Aging Ment Health. 2017;21(9):991–6

    Article  PubMed  Google Scholar 

  76. Cheng A, Morse KJ, Rudolph J, Arab AA, Runnacles J, Eppich W. Learner-centered debriefing for health care simulation education: lessons for faculty development. Simul Healthc. 2016;11(1):32–40

    Article  PubMed  Google Scholar 

  77. Ekström K, Spelmans S, Ahlström G, Nilsen P, Alftberg Å, Wallerstedt B, et al. Next of kin’s perceptions of the meaning of participation in the care of older persons in nursing homes: a phenomenographic study. Scand J Caring Sci. 2019;33(2):400–8

    Article  PubMed  PubMed Central  Google Scholar 

  78. Zhao FF, Suhonen R, Koskinen S, Leino-Kilpi H. Theory-based self-management educational interventions on patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. J Adv Nurs. 2017;73(4):812–33

    Article  PubMed  Google Scholar 

  79. Santos J, Figueiredo AS, Vieira M. Innovative pedagogical practices in higher education: an integrative literature review. Nurse Educ Today. 2019;72:12–7

    Article  PubMed  Google Scholar 

  80. Lall P, Rees R, Yi Law GC, Dunleavy G, Cotič Ž, Car J. Influences on the implementation of mobile learning for medical and nursing education: qualitative systematic review by the digital health education collaboration. J Med Internet Res. 2019;21(2):e12895

    Article  PubMed  PubMed Central  Google Scholar 

  81. O’Connor S, Jolliffe S, Stanmore E, Renwick L, Booth R. Social media in nursing and midwifery education: a mixed study systematic review. J Adv Nurs. 2018;74(10):2273–89

    Article  PubMed  Google Scholar 

  82. Gorhan R, Carter L, Nowrouzi B, McLean N, Guimond M. Social media and health education: what the literature says. J Dist Educ. 2012;26(2):1–11.

    Google Scholar 

  83. Kitching F, Winbolt M, MacPhail A, Ibrahim JE. Web-based social media for professional medical education: perspectives of senior stakeholders in the nursing home sector. Nurse Educ Today. 2015;35(12):1192–8

    Article  PubMed  Google Scholar 

  84. Ersek M, Polissar N, Du Pen A, Jablonski A, Herr K, Neradilek MB. Addressing methodological challenges in implementing the nursing home pain management algorithm randomized controlled trial. Clin Trials. 2012;9(5):634–44

    Article  PubMed  PubMed Central  Google Scholar 

  85. Maas ML, Kelley LS, Park M, Specht JP. Issues in conducting research in nursing homes. West J Nurs Res. 2002;24(4):373–89

    Article  PubMed  Google Scholar 

  86. Crowther M, Lim W, Crowther MA. Systematic review and meta-analysis methodology. Blood. 2010;116(17):3140–6

    Article  CAS  PubMed  Google Scholar 

  87. Olaussen A, Semple W, Oteir A, Todd P, Williams B. Paramedic literature search filters: optimised for clinicians and academics. BMC Med Inform Decis Mak. 2017;17(1):1–6

    Article  Google Scholar 

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We would like to thank Dr. Norman Rickard RN PhD for his help with the English language.


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All authors have read and approved the final manuscript. The conception and design of the study: MP, MS, RS. Acquisition of data: MP, MS, RS. Analysis and interpretation of data: MP, MS, RS. Drafting the article: MP, MS, AC, RS. Revising it critically for important intellectual content: MP, MS, AC, RS.

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Pakkonen, M., Stolt, M., Charalambous, A. et al. Continuing education interventions about person-centered care targeted for nurses in older people long-term care: a systematic review. BMC Nurs 20, 67 (2021).

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