Worldwide, approximately 50 million people are living with dementia. With the aging population, this number will increase (1). People with dementia are regularly hospitalized due to comorbidity; they occupy approximately 25 percent of the beds in a hospital (2,3). Not all people with dementia are diagnosed as such. Thereby, it is estimated that the actual percentage is higher, specifically, 30 percent up to more than 40 percent of all hospital beds (4,5). During a hospital stay, this population is at risk for falls, inadequate hydration and nutrition, delirium, infection, and functional decline (6–8). These have an impact on the duration of stay, the functioning of the person, and the care that is required following discharge (9). Nursing care for people with dementia should be based on evidence, best-practice care, and processes in combination with Person-centred care to prevent complications (8,10–13). It is known that Person-centred care can improve their quality of life. However, specific knowledge about Person-centred care, also referred to as patient-centered or client-centered care, is limited in hospitals (13). Even though, worldwide, it is the paragon in the care for people with dementia (12,14).
The base of person-centered care in the care for people with dementia is laid by Tom Kitwood (15,16). In a broader context, the framework of McCormack ad McCance is often used (17–19). In the care for people with dementia, the definition and framework of Brooker are often used (3,20). Brooker summarized person-centred care into four elements (23): valuing people with dementia regardless of their cognitive ability, individualizing approaches in care, caring and understanding from the perspective of the person with dementia and, finally, providing a social environment that supports psychological needs. However, a universal definition of person-centered care is not yet available(21).
To improve the quality of care for people with dementia in an acute care setting, knowledge of the level of person-centeredness of the care is important. The literature reports a limited number of instruments that measure person-centred care for people with dementia in an acute hospital setting (10,24). Available instruments are aimed at long term care (25) or more generically on person-centred care in the acute hospital setting as well as the lack of a specific focus on the quality of care for people with dementia (26–29).
The POPAC (24) is aimed at the acute hospital setting and measures the person-centredness of care for older people with dementia. The scale consists of three subscales, which can be connected to the elements of person-centered care of the used definition. The subscale ‘using cognitive assessments and care interventions’ is suitable for valuing people; ‘using evidence and cognitive expertise’ fits to understanding it from the perspective of the person with dementia; and ‘individualizing care’ accords with the individualizing approach and the social environment. In addition to the possibility to measure and improve the quality of care, translating tools into different language versions enables international comparisons of data and comparative analysis of levels, correlations, and outcomes of person-centred care. Besides, there are no Dutch-language instruments available that measure person-centred care in the hospital setting.
The POPAC was designed in 2013 by Edvardsson in Australia to establish quantitative measurement to assess experienced levels of person-centred care for people with dementia in acute hospital settings (24,30). Based on the literature, eight dimensions of best practice were used as the basis for constructing the instrument. Further development with a panel of international experts led to an instrument that consisted of statements on recognizing cognitive impairment, consulting specialist expertise, using evidence-based care protocols or guidelines, making environmental adjustments, providing social enrichments, prioritizing staff continuity and close interactions, avoiding restraints, and individualizing care (24). The degree in which participants agree with item statements is expressed in a 6-point Likert scale with the categories ‘never’ (1), ‘very rarely’ (2), ‘rarely’ (3), ‘frequently’ (4), ‘very frequently’ (5), to ‘always’ (6) (12,24,30). The original instrument was pilot tested with a sample of 212 nurses from different types of wards such as neurology, orthopedics, and cardiology in an acute care hospital in Melbourne, Australia. A retest was conducted with a group of 25 nurses from an orthopedic ward, and the outcomes indicated satisfactory temporal stability (24). To evaluate the overall level of person-centered care, the subscales can be combined into a total score where higher scores indicate higher levels of person-centeredness. An interpretation of the score is not yet available. The totals of the items per subscale suggest possible areas for improvement of care. The instrument allows comparing person-centered care at both national and international levels (24).
Nilsson psychometrically evaluated the instrument in Sweden (2013) and Grealish (2017) in Australia. They report that the POPAC is valid and reliable and can be used to provide insight into the person-centeredness of nursing care in a hospital setting. However, the high correlations between the subscales and the conclusion of the authors that the dimensionality of the instrument requires further research are important tenets for this study. For the use of the POPAC in the Netherlands in a study about person-centered care in a hospital setting, the instrument needed to be translated into Dutch. Measuring psychometric properties is important for assessing validity and reliability (31). Nurses and nursing managers can use the outcomes of the POPAC to improve the quality of care in their ward, and outcomes and data can be used for national and international comparison. Therefore, the purpose of this study was cross-nationally validation and psychometric evaluation of the Dutch version of the POPAC.