Concept Analysis: Patient Centered Care

The concept ‘Patient Centered Care’ has always held a significant meaning in healthcare, although it is not clearly defined, and does seem to be more talk than action, it does play a major role in the patient and family experience and should be reflected in the day to day operation and strategic planning of healthcare institutions. If patient centered care is to be maintained as the essence of our profession, then there should be clarity to the concept, it should lack ambiguity and its strength and limitations thoroughly researched.

Personally, to me it means treating other individuals the way I want to be treated as a human being. Patient centered care is care that is provided by all the members of the healthcare team, it is individualized and involves the patient and family members in his/her care. This is essential in the improvement of the outcome of care and does provide for a better experience during this vulnerable time of their life.

This is also the provision of care which incorporates respect to the patient and family beliefs, culture, race and personal preferences being interwoven into their care to arrive at the best outcome. The aim of implementing patient centered care is to involve patients and families in the decision-making process and provides for open access in the provision of health information that enables a better understanding of their care. (https://creativityinhealthcare. com. )

With the increase of challenges being faced in the work place such as increase in the patient to nurse ratio, short staff, mandatory hours and overtime, it has become increasingly challenging for nurses to provide adequate patient centered care. Patient centered care speaks to meeting the comprehensive needs of the patient, which does include the co-ordination of care in and out of the hospital settings with the involvement of all team members, inclusive of social worker and health care navigators which will account for continuity and stability of care.

There should be the giving of care that is equal and unbiased, delivered in a timely manner to patients regardless of their background, culture, race or color of their skin. Communication to the patient and family members should be open, honest and reliable. There is also the potential for ineffective communication between team members which will ultimately lead to failure to provide effective individualized patient centered care. (Dhurjati, Roopa, 2011)

Sources and Evidence of the Concept

The term ‘Patient Centered Care’, is a word that is use frequently in a variety of settings in our daily practice. However, this concept is not well defined as there is no consistent agreement as to what this entails. A patient can be described as the individual receiving care, and ‘care’ as defined by the American heritage dictionary is the “expression of feeling, concern and empathy to each other. ” (American heritage dictionary, 4th edition. ), problem does arise when attempting to describe or define patient centered care.

Patient centered care has been defined as a “dimension in the quality of care which is individualized and customized to patients and families, and in which they, not the clinicians, have control over healthcare decisions. ” (Berwick, D. M 2009 p. 555-565. ) Faye Glenn Addellah, nurse theorist defines it as care which is tailored to meet the individual or unique need of every patient. (Nursing-theory. org). It has also been defined as “patient and family care that is considered an integral component of the decision making and delivery processes. ”

(Hughes, R. , May 31, 2011.) or a “quality of personal, professional and organizational relationships that helps patients to be more active in changes in their healthcare, which allows them and their families to be at the center of this care. ” (Epstein RM, Fiscella K, Lesser CS, Stange KC, 2009). The most widely use theory about patient centered care is Jean Watsons theory of ‘human caring’ in which she referred to ‘transpersonal caring relationship’ which is respecting or showing love, that is honoring the patients’ needs, wishes or rituals and connecting human to human in the provision of care.

She spoke to a caring occasion or caring moment, which occurs when the patient and the nurse, each with their own “phenomenal field” background or experience, come together in a human-to-human contact that is meaningful and real, honoring the person, and sharing human experiences that expands each other worldview, leading to the discovery of self and others and new life possibilities. (http://www. watsoncaringscience. org) A study was conducted by researchers from Harvard medical school, on behalf of Picker Institute and the Commonwealth Fund.

The population studied involved focused groups of recently discharged patients, family members, physician and non-physician staff. The model found that there are eight elements unique to a positive patient experience in the implementation of patient centered care, this formed the Picker’s Eight Principles of Patient-Centered Care which is depicted in Figure 1. (Committee on Quality Healthcare in America, Institute of Medicine, 2001. ) Figure 1 – Picker’s Eight Principles of Patient-Centered Care.

In the implantation of patient centered care the model speaks to respect for patients’ preferences, which includes respect for the value system, culture and beliefs, and integrating this in the provision of care and the inclusion of all members of the team in the coordinating and integration of care. Communication, which is very vital in keeping patients and their family members educated and informed regarding procedures, diagnoses and plan of care.

Another element is physical comfort, which is very important as this includes the four P’s, pain management, potty, position and personal effects and the provision of emotional support to patient and their family members. Recognition and the involvement of friends and family members in the decision-making process sometimes ensure better compliance by the patient. Discharge planning and access to care is a fundamental aspect of patient centered care, and does serve to reduce anxiety regarding life after the illness. (Committee on Quality Healthcare in America, Institute of Medicine, 2001.)

Figure 2. Nursing Practice Model The nursing practice model was developed by a clinic in Cleveland, who utilized this visual depiction of the world’s best care being delivered with the patient at the center. This model gives a unified approach to nursing and helped the nurses feel they are part of a unified team that is delivering patient centered care. (Small, D. , Small, R. , May 31, 2011) However, there was a major problem with the model as it lacked a ‘hook’, that is something that would encourage world-class performance by the nurses.

This hook is important as it requires the active participation of the nurses who sometimes suffer from “compassion burnout,” this is a phase where they merely go through the motion of delivering care and their hearts and minds are not involved. (Douglas 201, p 415-419) Model Case A model case represents all the attributes of patient centered care. A 39year old female presented to the Emergency Room with complaint of feeling weak, fatigued and dizzy.

She was diagnosed as Anemic and lab work confirmed a hemoglobin of 2.7, and hematocrit of 20. The nurse was aware of the patient’s religious preference as in the history it was recorded that she was a Jehovah witness, and it was against her religious belief to receive blood or blood products. Alternative care was provided to alleviate the uncomfortable symptoms she was experiencing and she was educated regarding other bloodless medications that she could consider. The nurse incorporated the patient in all aspect of her care, allowed her to make an informed decision and at no time imposed her beliefs on her.

A major responsibility of the nurse is not to impose her personal or religious belief on the patient regardless of the consequences. (Griffith, R. 2015). Contrary Case Contrary cases are not patient centered care. A patient that was admitted stated that he normally takes his evening medications at six pm. The nurse however, informed the patient that he is not the only patient she has, and evening medications are served at eight pm not at six. The nurse demonstrated a non-caring attitude, did not individualize the patient care and failed to incorporate his wishes into his plan of care.

Strickland et. al 2011 states that the inclusion of the patient’s personal preference into their care will lead to a promotion of growth and health recovery. (Strickland et. al 2011) Conclusion The press ganey Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a survey that is sent to patients after being seen and treated at any health care institution. This survey takes into consideration details specific to the patient centered care received and their overall experience. The results are shared publicly, which does impact the hospitals rating and accounts for 25% of Medicare payments. (www. pressganey. com/solutions/services-a-to-z)

However, due to the subjective nature of the concept of patient centered care, it will be difficult if not impossible to generate a measurable tool that can be used universally for the implementation of this care. Therefore, it can be recommended that more institution base researches be done regarding the concept of patient centered care as it does account for improve health related outcome, increase satisfaction, reduce hospitalization and improvement in the quality of life, and the findings be made applicable to the practice.

The implantation of system wide standards would enhance care that is centered on the patient eventually leading to improvement in patient satisfaction and ultimately the sustenance of long term health behavior changes. (Dhurjati, Roopa, 2011)

References

Berwick, D. M. (2009). What patient centered should mean: Confession of an extremist. Health affairs, 28, W555-565. Creativity in Healthcare, Planetree: A model for patient centered care; Retrieved 10/15/2017 from https://creativityinhealthcare. com/2010/11/19/planetree-a-model-for-patient-centered-care/Committee on Quality Healthcare in America, Institute of Medicine, 2001.

Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D. C. : National Academy Press 2001, Retrieved 10/15/2017 from http://search. library. wisc. edu Dhurjati, Roopa, and Patricia Bachmeier. “Patient-centered-care. ” The American Journal of Nursing, vol. 111, no. 3, 2011, pp. 12–12. JSTOR, Retrieved 10/15/2017 from www. jstor. org/stable/23046275 Douglas, K. (2011, February).

When caring stops, staffing doesn’t really matter. Nursing Economics 28 (6), 415-419 Epstein RM, Fiscella K, Lesser CS, Stange KC, (2009), Why the nation needs a policy push on patient-centered health care. HealthAff (Millwood). 2010; 29(8): 1489-1495. Doi :10. 1377/hlthaff. 2009. 0888 Griffith, R. 2015. Patients who demand or refuse treatment. British Journal of Cardiac Nursing, 10(3), 150-152Hughes, R. , (May 31, 2011), “Overview and Summary: Patient-Centered Care: Challenges and Rewards” OJIN: The Online Journal of Issues in Nursing Vol.16, No. 2. DOI 10. 3912/OJIN. Vol16No02ManOS Nursing Theory.

Retrieved 10/15/2017 from http://www. nursing-theory. org/theories-and-models/Abdellah-twenty-one-nursing-problems. phpPress Ganey, HCAHPS regulatory survey. Retrieved 10/17/2017 from www. pressganey. com/solutions/services-a-to-zSmall, D. , Small, R. , (May 31, 2011) “Patients First! Engaging the Hearts and Minds of Nurses with a Patient-Centered Practice Model” OJIN:

The Online Journal of Issues in Nursing Vol. 16, No. 2, Manuscript 2. DOI: 10.3912/OJIN. Vol16No02Man02 Strickland, B. , Arnn, J. , & Mitchell, J. N. (2011). Individualized patient care. The Journal of Nursing Education, 24(6), 252-255 The American Heritage Dictionary of the English Language, fourth edition, Houghton Mifflin Company, 2006. Retrieved 10/15/2017 from http://dictionary. reference. com Watson, J. (2008). Nursing: The Philosophy and Science of Caring (rev. ed. ), Boulder: University Press of Colorado. Retrieved 10/15/2017 from http://www. watsoncaringscience. org