{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:35:11Z","timestamp":1792787711025,"version":"4.5.0"},"reference-count":46,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["KL2TR002015"],"award-info":[{"award-number":["KL2TR002015"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"},{"id":"https:\/\/ror.org\/04pw6fb54","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Center for Advancing Translational Sciences","award":["TR002014"],"award-info":[{"award-number":["TR002014"]}],"id":[{"id":"https:\/\/ror.org\/04pw6fb54","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Dementia"],"abstract":"<jats:p>Honoring individual preferences, like going outside, can enhance the health of nursing home (NH) residents living with Alzheimer\u2019s disease and related dementias (ADRD). Although a hallmark of person-centered care, honoring ADRD residents\u2019 preferences is often restricted when they are perceived to be high-risk for harm by NH staff. Accessible and efficient strategies are needed to help NH staff balance harmful risks to health and safety against the residents\u2019 right to make autonomous choices, especially in under-resourced rural areas. This pilot study (NCT05618678) evaluated the feasibility of Decision-making In aGing and demeNtIa for auTonomY (DIGNITY), a multi-faceted and innovative, theory-based, person-centered risk management intervention aimed at assisting NH staff in respecting the preferences of rural residents living with ADRD, while optimizing safety. Feasibility was assessed using retention rates, staff surveys, and qualitative feedback. Fifty-two NH staff participated (88.7% female, 83.3% White, 94.3% non-Hispanic, and 48% with \u22656\u00a0years NH experience), with a 79% retention rate and 87.8% survey response rate. In the DIGNITY group, average scores (on Likert scale of 1\u20135) indicated high feasibility (3.99), acceptability (4.19), and appropriateness (4.24). Qualitative feedback highlighted the value of in-person training and telemonitoring sessions. The high ratings for feasibility, acceptability, and appropriateness of DIGNITY show its potential for supporting NH staff to more confidently provide person-centered care for ADRD residents.<\/jats:p>","DOI":"10.1177\/14713012261485344","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:45:16Z","timestamp":1790145916000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Feasibility of the DIGNITY Intervention to Support Person-Centered Risk Management  in Rural Nursing Homes"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6143-2654","authenticated-orcid":false,"given":"Liza L.","family":"Behrens","sequence":"first","affiliation":[{"name":"Ross and Carol Nese College of Nursing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Kitt-Lewis","sequence":"additional","affiliation":[{"name":"Ross and Carol Nese College of Nursing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalei H.","family":"Crimi","sequence":"additional","affiliation":[{"name":"Ross and Carol Nese College of Nursing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Madrigal","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System, West Roxbury, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allen R.","family":"Kunselman","sequence":"additional","affiliation":[{"name":"Penn State College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terrence E.","family":"Murphy","sequence":"additional","affiliation":[{"name":"Penn State College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Kraschnewski","sequence":"additional","affiliation":[{"name":"Penn State College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly S.","family":"VanHaitsma","sequence":"additional","affiliation":[{"name":"Ross and Carol Nese College of Nursing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1133-2249","authenticated-orcid":false,"given":"Marie","family":"Boltz","sequence":"additional","affiliation":[{"name":"Ross and Carol Nese College of Nursing"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"issue":"1","key":"e_1_3_6_2_1","first-page":"1","article-title":"2025 Alzheimer\u2019s disease facts and figures","volume":"21","author":"Alzheimer\u2019s Association","year":"2025","unstructured":"Alzheimer\u2019s Association. (2025). 2025 Alzheimer\u2019s disease facts and figures. Alzheimer's and Dementia, 21(Suppl. 1), 1\u2013100. https:\/\/www.alz.org\/getmedia\/ef8f48f9-ad36-48ea-87f9-b74034635c1e\/alzheimers-facts-and-figures.pdf","journal-title":"Alzheimer's and Dementia"},{"key":"e_1_3_6_3_1","unstructured":"Alzheimer\u2019s Disease International. (2025). World alzheimer report 2025: Reimagining life with dementia \u2013 The power of rehabilitation. https:\/\/www.alzint.org\/u\/World-Alzheimer-Report-2025.pdf"},{"key":"e_1_3_6_4_1","unstructured":"American Nurses Association. (2025). Code of ethics for nurses with interpretive statements. https:\/\/codeofethics.ana.org\/home"},{"issue":"10","key":"e_1_3_6_5_1","first-page":"1400","article-title":"Project ECHO: A telementoring model to expand healthcare capacity","volume":"92","author":"Arora S.","year":"2017","unstructured":"Arora S., Kalishman S., Thornton K., Komaromy M., Katzman J., Struminger B., Rayburn W. (2017). Project ECHO: A telementoring model to expand healthcare capacity. Academic Medicine, 92(10), 1400\u20131406. https:\/\/doi.org\/10.1097\/ACM.0000000000001684","journal-title":"Academic Medicine"},{"key":"e_1_3_6_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/tbm\/ibaf058"},{"key":"e_1_3_6_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/WAD.0000000000000616"},{"key":"e_1_3_6_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gnaa099"},{"key":"e_1_3_6_9_1","doi-asserted-by":"publisher","DOI":"10.3928\/19404921-20220930-01"},{"key":"e_1_3_6_10_1","unstructured":"Behrens L. L. Crimi K. (2025). Shared beliefs and values around risk engagement in preference-based person-centered care: Triad perspectives in nursing homes [conference presentation]. 37th annual scientific sessions of the eastern nursing research society (ENRS) loews Philadelphia hotel. https:\/\/www.enrs-go.org\/2025-annual-conference"},{"key":"e_1_3_6_11_1","doi-asserted-by":"publisher","DOI":"10.3928\/00989134-20230106-02"},{"key":"e_1_3_6_12_1","doi-asserted-by":"publisher","DOI":"10.1017\/cts.2025.10235"},{"key":"e_1_3_6_13_1","doi-asserted-by":"publisher","DOI":"10.31389\/jltc.31"},{"key":"e_1_3_6_14_1","unstructured":"Center for Rural Pennsylvania. (n.d.). Rural Pennsylvania quick facts. https:\/\/www.rural.pa.gov\/data\/rural-quick-facts"},{"key":"e_1_3_6_15_1","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/7148515"},{"key":"e_1_3_6_16_1","doi-asserted-by":"publisher","DOI":"10.3928\/00989134-20150515-88"},{"key":"e_1_3_6_17_1","volume-title":"Designing and conducting mixed methods research","author":"Creswell J. W.","year":"2017","unstructured":"Creswell J. W., Plano Clark V. L. (2017). Designing and conducting mixed methods research (3rd ed.). Sage Publications.","edition":"3"},{"key":"e_1_3_6_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i5239"},{"key":"e_1_3_6_19_1","volume-title":"Requirements for states and long term care facilities, 42 C.F.R. part 483","author":"Electronic Code of Federal Regulations","year":"2025","unstructured":"Electronic Code of Federal Regulations. (2025). Requirements for states and long term care facilities, 42 C.F.R. part 483. U.S. Government Publishing Office. https:\/\/www.ecfr.gov\/current\/title-42\/chapter-IV\/subchapter-G\/part-483"},{"key":"e_1_3_6_20_1","unstructured":"Emergency Care Research Institute (ECRI). (n.d.). Infection prevention handbook for personal care homes. Long Term Care Rise 2.0: Infection Prevention and Control STARR Ladder Program. https:\/\/www.ecri.org"},{"key":"e_1_3_6_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gnx122"},{"key":"e_1_3_6_22_1","unstructured":"Galler N. Balio C. P. Huang Q. Beatty K. (2024). The rural nursing home landscape. National Rural Health Association. https:\/\/www.ruralhealth.us\/nationalruralhealth\/media\/documents\/advocacy\/whitepaper\/rural-nursing-home-landscape-white-paper-final.pdf"},{"key":"e_1_3_6_23_1","volume-title":"Behavioral intervention research: Designing, evaluating, and implementing","author":"Gitlin L. N.","year":"2016","unstructured":"Gitlin L. N., Czaja S. J. (2016). Behavioral intervention research: Designing, evaluating, and implementing. Springer Publishing Company."},{"key":"e_1_3_6_24_1","volume-title":"Lessons learned during the pandemic can help improve care in nursing homes (OEI-02-20-00492)","author":"Grimm C. A.","year":"2024","unstructured":"Grimm C. A. (2024). Lessons learned during the pandemic can help improve care in nursing homes (OEI-02-20-00492). U.S. Department of Health and Human Services, Office of Inspector General. https:\/\/oig.hhs.gov\/reports\/all\/2024\/lessons-learned-during-the-pandemic-can-help-improve-care-in-nursing-homes\/"},{"key":"e_1_3_6_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_3_6_26_1","doi-asserted-by":"publisher","DOI":"10.2196\/50863"},{"key":"e_1_3_6_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-022-03503-8"},{"key":"e_1_3_6_28_1","volume-title":"The gerontologist","author":"Marnfeldt K.","year":"2025","unstructured":"Marnfeldt K., Wilber K. (2025). Balancing safety and autonomy in long-term care: Ethical tensions in risk engagement. In: The gerontologist. Advance online publication. https:\/\/doi.org\/10.1093\/geront\/gnaf111"},{"key":"e_1_3_6_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gnaf134"},{"key":"e_1_3_6_30_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.38911"},{"key":"e_1_3_6_31_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-019-4548-5"},{"key":"e_1_3_6_32_1","volume-title":"The national imperative to improve nursing home quality: Honoring our commitment to residents, families, and staff","author":"National Academies of Sciences, Engineering, and Medicine","year":"2022","unstructured":"National Academies of Sciences, Engineering, and Medicine. (2022). The national imperative to improve nursing home quality: Honoring our commitment to residents, families, and staff. The National Academies Press. https:\/\/doi.org\/10.17226\/26526"},{"key":"e_1_3_6_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-021-00585-4"},{"key":"e_1_3_6_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/scs.13230"},{"key":"e_1_3_6_35_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40814-020-00634-w"},{"key":"e_1_3_6_36_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-023-01286-z"},{"key":"e_1_3_6_37_1","doi-asserted-by":"publisher","DOI":"10.3928\/00989134-20211109-09"},{"key":"e_1_3_6_38_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.22111"},{"key":"e_1_3_6_39_1","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/47.1.69"},{"key":"e_1_3_6_40_1","volume-title":"Rural health information hub","author":"Rural Health Information Hub","unstructured":"Rural Health Information Hub. (n.d.). Rural health information hub. Retrieved August 31, 2026. https:\/\/www.ruralhealthinfo.org\/"},{"key":"e_1_3_6_41_1","doi-asserted-by":"publisher","DOI":"10.1186\/1745-6215-15-264"},{"key":"e_1_3_6_42_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-10-1"},{"key":"e_1_3_6_43_1","unstructured":"U.S. Department of Labor Wage and Hour Division. (n.d.). Employment relationship under the fair labor standards act (FLSA) [fact sheet]. https:\/\/www.dol.gov\/agencies\/whd\/fact-sheets\/13-flsa-employment-relationship"},{"key":"e_1_3_6_44_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-025-12349-w"},{"key":"e_1_3_6_45_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-017-0635-3"},{"key":"e_1_3_6_46_1","unstructured":"World Health Organization. (2025). State of the world's nursing report 2025. https:\/\/www.who.int\/publications\/i\/item\/9789240110236"},{"key":"e_1_3_6_47_1","doi-asserted-by":"publisher","DOI":"10.1111\/jan.14264"}],"container-title":["Dementia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/14713012261485344","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/14713012261485344","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/14713012261485344","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T13:16:59Z","timestamp":1790428619000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/14713012261485344"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,22]]},"references-count":46,"alternative-id":["10.1177\/14713012261485344"],"URL":"https:\/\/doi.org\/10.1177\/14713012261485344","relation":{},"ISSN":["1471-3012","1741-2684"],"issn-type":[{"value":"1471-3012","type":"print"},{"value":"1741-2684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,22]]},"article-number":"14713012261485344"}}