Patient-Centered Care in Nursing

Introduction

Healthcare practitioners increasingly acknowledge the need to make patient-centered care (PCC) a part of their everyday clinical practice. A growing recognition to embrace PCC as a core of new models of care delivery is also evident among governments, international healthcare organizations, and lobby groups (Kitson, Marshall, Bassett, & Zeitz, 2013). PCC is a critical element of nursing practice that becomes instrumental in shaping many policy initiatives by introducing additional layers of responsibility (Kitson et al., 2013). The push for the patient-centered approach is a part of large-scale changes in the delivery of healthcare in Canada, which endorses the idea of realizing substantial improvements in patient outcomes through the change in “principles by which people carry out their work” (Best et al., 2012, p. 423). Unfortunately, the understanding of the concept of PCC is problematic. In nursing literature, it has been referred to as “a philosophy, a process, a model, a concept, and a partnership” (Flagg, 2015, p. 76). The philosophy of holistic nursing is closely aligned with PCC; however, in order to introduce meaningful changes in nursing practice, it is necessary to eliminate confusion surrounding the concept.

The aim of this paper is to outline a plan for a critical analysis of the concept of PCC in nursing. The paper will also provide a summary of the extant literature on the topic and describe key features associated with it.

Rationale

Safe and efficient practice is a goal of every nurse; therefore, traditional clinical environments increasingly introduce PCC models in order to strengthen patient-caregiver communication patterns, thereby achieving better health outcomes. Training techniques that are based on traditional role modeling emphasize empathy and communication as avenues for delivering PCC without clearly defining the concept (Morgan & Yoder, 2012). When clarification of the concept and its key dimensions is lacking, it is not possible to ensure that clinical reasoning in patient-caregiver interactions is not skewed by misconceptions about it. I work in an acute medical ward where PCC is critical for ensuring that patients are both physically and emotionally comfortable, safe, and supported. Therefore, in order to increase my ability to productively participate in patient-centered care initiatives in the acute setting, it is necessary to reduce the confusion surrounding the concept under discussion.

Key Features

The process of critical concept analysis starts with the identification of a concept of interest, its key dimensions, and labels surrounding it. Currently, the definition of the concept of PCC is mired in confusion and controversy (Lusk & Fater, 2013; Pope, 2012). Therefore, a solid theoretical delineation of the concept requires a careful review of a large body of literature with a high degree of validity.

The key labels used in the extant nursing literature to mark the concept are person-centered care, client-centered care, PCC, personalized care, relationship-centered care, and resident-centered care (Morgan & Yoder, 2012; Munthe, Sandman, & Cutas, 2012). Terminology associated with the concept is diverse in its application (Munthe et al., 2012). In order to eliminate potential connections to multiple ideas, the researcher will use PCC as a label of choice for the analysis. A narrative review of key seminal texts on the topic of the patient-centered approach to care in nursing suggests that the concept includes three key features: patient participation and involvement, relationships between nurses and patients, and the context of care delivery (Kitson et al., 2013). These features can help to elucidate how the concept shapes nursing care, the organization of professional practice, and the identification of nursing priorities. The first feature is patient participation and involvement that presupposes the creation of a care plan, which revolves around the physical and emotional needs of a patient. It means that PCC requires nursing teams to exhibit certain behaviors and attitudes in order to address patients’ individual needs.

The second feature is relationships between nurses and patients that involve unrestrained communication of knowledge and expertise, the presence of pertinent skills and knowledge, and “having a cohesive and cooperative team of professionals” (Kitson et al., 2013, p. 11). Nursing literature emphasizes that communication can occur within the following domains: patient-as-person, biopsychosocial, sharing power and responsibility, therapeutic alliance, and clinician-as-person (Slatore et al., 2012). Professional development literature also reverberates that therapeutic alliance is a means of improving nurses’ attitudes to patients (Pope, 2012). The context of care delivery is the third feature that focuses on barriers to the delivery of PCC. These barriers include but are not limited to, the lack of time, equipment, and nursing staff (Kitson et al., 2013).

The concept in Nursing Literature

The use of PCC-based terminology in nursing literature is extremely abundant; however, due to the fact that the concept is context-dependent, its description is vague. According to the definition provided by the Institute of Medicine, PCC is “care that is respectful of and responsive to individual patient preferences, needs, and values” (Greene, Tuzzio, & Cherkin, 2012, p. 50). Mead and Bower have made an attempt to define the concept in terms of its distinct dimensions that include recognition of a patient as a unique individual, sharing of power, and therapeutic alliance (as cited in Flagg, 2015). Lusk and Fater (2013) maintain that “relationship development with respect for the patient” has emerged as a dominant theme in PCC-related writings (p. 98).

The review of the current literature shows the presence of a marked divergence between nursing scholars who emphasize autonomy when discussing the concept and those who believe that the delivery of PCC should be paternalistic. For example, Lawrence and Kinn (2012) state that the concept presupposes a paternalistic approach to care delivery. Lusk and Fater (2013), on the other hand, recognize that autonomy is a mainstay of comprehensive PCC. McCormack proposes that instead of treating the concept as a relationship, it should be regarded as “the formation of a therapeutic narrative between professional and patient” (as cited in Morgan & Yoder, 2012, p. 4).

Key Qualities and Elements

Nursing authors maintain that PCC is a complex concept key elements of which are a patient, a nurse, and an environment (Greene et al., 2012). In terms of antecedents of the concept, Walker and Avant established that PCC emerges in a nursing environment as a response to the need for intervention (as cited in Lusk & Fater, 2013). The scholars also argue that PCC is mitigated by “the ability of the patient or significant other to participate in his/her own care” (as cited in Lusk & Fater, 2013, p. 95). The concept’s consequences are an individualization of care, improvement of self-care ability and autonomy, improved collaboration and patient outcomes, and increased pain management among others (Lusk & Fater, 2013). When reviewing the current literature on the topic, patient preferences, patient involvement, and patient individualization emerged as critical elements of PCC (Flagg, 2015; Rathert, Wyrwich, & Boren, 2013). In the absence of one or more of these key elements, an approach to care cannot be patient-centered.

Plan

Approach

The critical analysis of the concept of PCC will use principle-based examination as a framework for extracting conceptual meanings from the extant literature on the topic. The method has recently entered the field of scientific research and requires critical and multifaceted thinking on the part of a researcher (Hupcey & Penrod, 2005). It is important to stress that in order to analyze a scientific meaning attached to a concept, a researcher has to cull a large body of evidence and draw meaningful summative conclusions. Hupcey and Penrod (2005) argue that by doing so, it is possible to “strategically progress toward a deeper examination of divergent views to advance a better explication of probable truth” (p. 206). To achieve a meaningful degree of conceptual clarity, the data for the project will be gathered strategically and purposefully.

Data Sources

The concept of PCC in nursing will be analyzed with the help of data from Cochrane, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Medical Literature Analysis and Retrieval System (MEDLINE) databases. English articles from peer-reviewed nursing journals published within the years 2007 to 2017 will be included in the analysis. The following search terms will be used for the project: patient-centered care, PCC, personalized care, relationship-centered care, and resident-centered care, and individualized patient care (Morgan & Yoder, 2012). The quality of articles for inclusion in the analysis will be assessed based on pragmatic utility principles that hinge on three elements: clarity, validity, and relevancy.

Conclusion

The paper has presented a plan for a critical analysis of PCC in the field of nursing. It has been argued that confusion surrounding the concept prevents nurses from implementing patient-centered approaches in their practice with a meaningful degree of efficiency.

References

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Flagg, A. J. (2015). The role of patient-centered care in nursing. Nursing Clinics of North America, 50(1), 75-86.

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Hupcey, J., & Penrod, J. (2005). Concept analysis: Examining the state of the science. Research and Theory for Nursing Practice: An International Journal, 19(2), 197-208.

Kitson, A., Marshall, A., Bassett, K., & Zeitz, K. (2013). What are the core elements of patient-centered care? A narrative review and synthesis of the literature from health policy, medicine and nursing. Journal of Advanced Nursing, 69(1), 4-15.

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Pope, T. (2012). How person-centered care can improve nurses’ attitudes to hospitalized older patients. Nursing Older People, 24(1), 32-36.

Rathert, C., Wyrwich, M. D., & Boren, S. A. (2013). Patient-centered care and outcomes: A systematic review of the literature. Medical Care Research and Review, 70(4), 351-379.

Slatore, C. G., Hansen, L., Ganzini, L., Press, N., Osborne, M. L., Chesnutt, M. S., & Mularski, R. A. (2012). Communication by nurses in the intensive care unit: Qualitative analysis of domains of patient-centered care. American Journal of Critical Care, 21(6), 410-418.