ProFoUND PCC= A Program For a Userbased Nursing Development in Person-Centered Care, is a Project That Aims to Develop, Test and Evaluate Effects of a Co-created Intervention to Increase Person-centred Care in Residential Care Settings for Older People.

BACKGROUND It is well known that the older population is increasing rapidly worldwide. Many individuals have a healthy life in higher ages, while some will live longer with multimorbidity and a need of advanced care in home care and residential care facilities (RCFs). In Sweden, high-quality residential care is commonly captured in terms of Person-centred care (PCC), and guidelines and strategy document such as the statue reports of care of older people3 are grounded in PCC.

PCC is a concept fundamentally rooted in the subjective experiences of individuals requiring care and support, and builds upon the persons prevailing preferences, priorities, values, and exigencies. Operationalising a humanistic and relational ethic in care contexts, PCC provides a caring theory that outlines that all forms of care have a relational dimension that needs to be considered, and requires an ethical awareness of listening to, confirming, and responding to the needs, wants, wishes and priorities of the person that needs care. If this ethical dimension of care is prioritised and included in care, the likelihood of providing PCC increases.

Despite a growing body of evidence supporting PCC, important knowledge gaps remain regarding how and why PCC works in practice, and how such approaches can be sustained over time. PCC interventions in the care of older people show positive effects on residents' well-being yet highlights a lack of synthesis of underlying mechanisms and strategies for long-term implementation/sustainability. A review suggest that PCC-interventions need to be co-created with residents, relatives and staff and build on a person-centred foundation. Another review state that high-quality interventions need to be implemented over an extended time to identify how person-centred care can be best implemented to improve resident outcomes. A third, suggest that research need to focus on effective strategies to strengthen organisational support, including leadership development, staff retention, and resource allocation, as well as evaluate how organisational culture influences the adoption and success of person-centred care practices.

There is also a recognised need for research-based continuing education for staff, as well as for the involvement of older people and their relatives in the design and evaluation of PCC interventions. Such efforts are considered important not only for strengthening competence in PCC, but also for supporting staff well-being and maintaining high-quality care.

As a relational and value-based approach, PCC requires flexibility and responsiveness to individual needs, which contrasts with healthcare systems often characterised by task-oriented care, standardisation and time-controlled workflows. This misalignment makes PCC difficult to operationalise in everyday practice. Previous research also highlights several facilitating factors. Training and education are often emphasised as important for successful implementation. However, implementation requires more than education alone; it also depends on organisational support, facilitation, and adaptation to local conditions. Supportive leadership and interprofessional teamwork, including the involvement of patients, are likewise important for PCC. In line with this, PCC interventions need to be context-sensitive and developed in collaboration with those involved in care.

In Swedish contexts, several initiatives have aimed to implement PCC. For one, the KISAM project represents a large-scale collaboration between academia and municipal care, focusing on the implementation of national guidelines underpinned by PCC, where research and practice developed in parallel. Similarly, the U-AGE program focused on implementing PCC through development and evaluation of health-promoting living conditions for older people receiving home care and residential care. Findings from these initiatives indicate that PCC interventions are feasible and can lead to positive outcomes, such as increased thriving among residents and relatives, as well as improvements in the work environment for staff. They also highlighted how concrete strategies at organisational levels (e.g. leadership) can support the implementation of PCC in practice. However, sustaining these interventions over time has proven challenging. This has been linked to limited implementation competence within care organisations, as well as limited capacity for systematic improvement work and lack of structures for continued collaboration between care organisations and academia. As a result, practices introduced during research projects are often difficult to maintain once projects have ended, with organisations tending to revert to previous routines.

Although PCC is known to improve care processes and health outcomes, studies repeatedly show that it remains difficult to implement and sustain in RCFs for older people. This project will contribute to the literature on effects, meanings, costs and sustainability of person-centred care interventions in RCFs. The co-creation component involves close collaboration with residents, relatives, staff, managers, and community stakeholders, with particular attention to sustainable practices likely to be continued beyond the research period.