It is acknowledged by healthcare practitioners around the world that patient-centered care (PCC) is central to the philosophy of holistic care. The phrase ‘patient-centered care’ is in common use in the modern nursing discourse. However, despite a growing recognition and acceptance of the concept and its role in the enhancement of the quality of care, it is still not clearly defined (Lawrence & Kinn, 2012). Taking into consideration substantial challenges facing the global healthcare community, it is of utter importance to properly conceptualize PCC, which is often referred to as a core competence for the facilitation of interprofessional care (Sidani & Fox, 2014).
Prior to launching into the concept analysis, it has been understood by the student that an ever-increasing fragmentation of the healthcare system drives nurses towards focusing their attention on tasks instead of dedicating themselves to individual patients and their need to be cared for, which inevitably diminishes the quality of their care. Heavy patient loads further exacerbate the problem, thereby leaving nurses less time to exercise their professional qualities at the level of individualized patient care. It follows that without the elimination of inconsistencies surrounding the concept, it is difficult to improve the quality of nursing care that is bi-directionally linked to PCC (Pope, 2012; Slatore et al., 2012). Unfortunately, the task is complicated by a lack of intra-professional consensus regarding the definition of PCC.
The aim of this paper is to conduct a critical analysis of the concept of PCC by examining psychological, medical, and social science perspectives. Research articles from several disciplines will be used to delineate key dimensions of the concept and arrive at its working definition. By analyzing different professional perspectives on the concept, differences in its meaning will be explored. The paper will also discuss practical, theoretical, and ethical implications of the definition.
PCC in Nursing
In the field of nursing, PCC has been described as “a philosophy, a process, a model, a concept, and a partnership” (Flagg, 2015, p. 76). The extant nursing literature attaches multiple labels to the concept such as client-centered care, personalized care, person-centered care, and resident-centered care (Morgan & Yoder, 2012; Munthe, Sandman, & Cutas, 2012). The diverse use of terminology is accompanied by diverging perspectives on the nature of the concept. Whereas, Lusk and Fater (2013) argue that the dominant theme in PCC-related nursing literature is sharing of power and relationship development, Lawrence and Kinn (2012) maintain that PCC is an inherently paternalistic approach to the delivery of nursing care.
The analysis of the use of the concept in nursing academic articles allows distilling the following PCC-related key qualities and elements: a nurse, a patient, and an environment (Greene et al., 2012). It is often suggested that the need for an intervention functions as an antecedent of the concept. Nursing authors maintain that the ability of a nurse to recognize a patient’s role in their own care is central to delivering PCC (Lusk & Fater, 2013). It is also argued that PCC presupposes patient preferences, involvement, and individualization (Lusk & Fater, 2013). It means that nurses practicing PCC approaches help their patients to develop greater autonomy, thereby improving their wellbeing.
After culling and analyzing a large body of current nursing literature on the subject of PCC, it is clear the concept is associated with a wide-range of narratives and contexts complicating its operationalization with respect to the nursing practice. However, the central theme in the majority of the reviewed writings is that the concept presupposes the accommodation of patients’ individual needs and relationship development. With that in mind, it is necessary to proceed to explore perspectives on PCC other than those held by nursing authors.
The Aim of Analysis
This analysis aims to critically analyze the use of the concept of PCC in medicine, sociology, and psychology and develop a nursing definition of the concept, thereby contributing to professional practice. Taking into consideration the fact that the current use of the concept in nursing writings is mired in confusion and controversy, its clarification is much needed to facilitate both future research and holistic practice.
To develop a working definition of PCC, it was necessary to gather and analyze conceptual knowledge from multiple disciplines. To this end, a validated methodological framework for concept analysis was used. The systematic approach helped to “strategically progress toward a deeper examination of divergent views to advance a better explication of probable truth” (Hupcey & Penrod, 2005, p. 206). For the purposes of this analysis, a methodological framework developed by Walker and Avant (2005) was used. The model presupposes several sequential steps the goal of which is to develop a working definition (Coughlan & Cronin, 2016).
Data pertinent to the concept of PCC was identified by using the following electronic databases: EBSCO, PsycINFO, Google Scholar, and PubMed. The search strategy is justified by the need to ensure that the concept is applicable across several disciplines such as medicine, sociology, and psychology. The following search terms were used to find relevant studies: patient-centered care, personalized care, resident-centered care, individualized patient care, and PCC (Greene et al., 2012). A broad search yielded 17, 081 articles, the vast majority of which were not suitable for the study due to a lack of definition. To identify pertinent articles during the second step of the search process, their titles were read, which allowed excluding the majority of studies. During the next stage of the process, articles that contained information on the concept and were published in the English language within the years of 2012 to 2017 were selected. Only those studies that contributed to the topic in terms of clarity and relevancy were included in the study. Upon careful evaluation of the search results, 16 articles were included in the final analysis.
From the psychological point of view, PCC is defined as the delivery of healthcare in a manner consistent with patients’ choices, needs, and values (Livingston, Nijdam-Jones, & Brink, 2012). The research in this area delineates the concept along five dimensions: the recognition of a holistic nature of care, viewing a patient as a person whose needs extend beyond their illness, sharing power with patients, establishing a therapeutic alliance, and the recognition of the influence of personal qualities of a provider (Livingston et al., 2012). The need of the development of a therapeutic alliance is underscored by Kazak, Nash, Hiroto, and Kaslow (2017) who also add that patient-centeredness presupposes “a focus on respect for patients’ personal, family, and cultural backgrounds” (p. 2). The current psychology studies emphasize shared-decision making as a central component of PCC by proposing that patients should be regarded as self-determining agents (Livingston et al., 2012). This view has to be balanced with perspectives from other disciplines.
In medicine, PCC is defined as a form of practice that keeps the interest of a patient foremost (Bardes, 2012). A thematic analysis of the concept conducted by Hudson et al. (2012) links the concept with the following themes: patient advocacy, acknowledgement of illness experience, and recognition of patient expertise, development of an ongoing partnership, and understanding of the patient as the whole person.
The current sociological literature regards PCC as an approach to care delivery that is “concordant with the patient’s cultural values, needs, and preferences” (Dubbin, Chang, & Shim, 2013, p. 2). It is often argued that ethics serve as a driver for PCC; therefore, all patients should be treated ‘as persons’ (Entwistle & Watt, 2013). It follows that PCC stands in radical opposition to both system-and staff-centered approaches to care.
Medical authors share the psychological perspective in that they emphasize greatly on the shared decision-making component of PCC. For example, Barry (2012) states that “the active engagement of patients when fateful health care decisions must be made” is pivotal to the provision of PCC (p. 780). In this regard, there seems to be no inconsistencies or ambiguities in the two perspectives. However, when it comes to the recognition of the holistic nature of care, medical literature is much more sparse. Social scholars agree with the view of PCC expressed by medical and psychological authors in that this approach to care requires practitioners to exhibit certain behaviors. Specifically, Dubbin et al. (2013) posit that both patients and their decisions should be respected by care providers.
Another point of comparison is the recognition of needs, values, and preferences of a patient. This theme runs across all three perspectives without exception. Marsh, Chibber, and Saad (2017) acknowledge that the provision of respectful PCC is not possible without the focus on patients’ needs, values, and preferences as expressed by them. Authors from the fields of psychology and sociology agree with this point; therefore, there are no conceptual gaps or inconsistencies in this regard. The establishment of a therapeutic alliance or relationship building is also a theme that can be traced through medical, psychological, and sociological studies on the subject (Dubbin et al., 2013; Gabriel & Normand, 2012; Nash, Khatri, Cubic, & Baird, 2013).
Based on the review of the literature, it is possible to assemble defining attributes of PCC. Patient autonomy is identified by several authors as a pivotal characteristic of the concept (Chibber & Saad, 2017; Kitson, Marshall, Bassett, & Zeitz, 2013). Autonomy takes a prominent place in PCC because it is bi-directionally connected with the respect for their goals, values, and decisions. Thus, the manifestation of PCC-based caring attitudes should be aligned with patient preferences, which increases their autonomy.
Another attribute associated with the concept is shared decision making. The attribute is closely connected to the respect for patients’ autonomy; these two characteristics of PCC can be considered mutually reinforcing. It has to be mentioned that decision making has to be realistic since the vulnerability of a patient can prevent them from making reasonable comfort-oriented and life-prolonging choices (Gillik, 2013). Patient empowerment has also been indicated as a function of PCC (McAllister, Dunn, Payne, Davies, & Todd, 2012).
The following model case can help to understand key characteristics of PCC. A patient completes chemotherapy for advanced metastatic lung cancer. The patient has received two regiments of chemotherapy. The chances to control her condition are extremely limited. The patient’s physician explains treatment options to him and his family. A nurse evaluates the patient’s cultural, social, and religious backgrounds to understand how to properly approach them. The practitioner provides the patient with support and additional information about his treatment options. The nurse helps the patient and his family to make a treatment decision while taking into consideration his needs, values, and goals.
A patient completes chemotherapy for a stage IV lung cancer. Following a doctor’s explanation of treatment options, a nurse approaches the patient and her family. The practitioner discusses pros and cons of each option with the two parties and insists on surgery as a preferred intervention (Lusk & Fater, 2013). The case illustrates that the nurse does not place PCC at the center of her professional practice. Specifically, the practitioner does not encourage patient autonomy and does not try to establish a meaningful relationship with them. Most importantly, the nurse does not show regard for the patient’s need, goals, and values, which is inconsistent with the principle of patient empowerment (McAllister et al., 2012).
Antecedents and Consequences
The need for an intervention functions as an antecedent of the concept. Another antecedent is the ability of a patient to take responsibility for their care (Lusk & Fater, 2013). Increased quality of care and patient satisfaction as well as the reduction of readmission rates are often indicated as consequences of PCC (Lawrence & Kinn, 2012; Sidani & Fox, 2014).
To measure the empirical influence of the concept, two referents can be used: Health Care Climate Questionnaire and readmission rates (Lawrence & Kinn, 2012). Nursing Care Survey is also a tool related to the concept (Lusk & Fater, 2013).
Based on the analysis of extant literature from the fields of nursing, medicine, psychology, and sociology, it is possible to create a working definition of the concept that can be used in nursing practice. PCC is an approach to care delivery that necessitates relationship development, shared decision-making, and respect for patient needs, goals, and values as means for increasing their autonomy.
By holding a position on PCC presented in this study, a nurse recognizes ethically significant attributes of care delivery. This ethical standing manifests in a professional’s drive towards acknowledging a patient as an individual whose agency and autonomy are inalienable aspects of their personhood. When it comes to the theoretical consequences of the perspective, there is no denying that it is central to effective and just nursing practice since its philosophical foundation is rooted in respect for patients.
In a practical sense, the definition can help the nurse to measure their performance in the practice setting with the help of empirical referents, thereby ensuring that their practice revolves around key PCC attributes. By making PCC attributes quantifiable, a burden of aligning a theoretical stance with empirical outcomes can be relieved.
The paper has presented a definition of the concept of PCC based on its critical analysis. The concept has been defined after synthesizing the following perspectives in a systematic manner: nursing, psychological, medical, and social. The following definition of the concept has been provided: PCC is an approach to care delivery that necessitates relationship development, shared decision-making, and respect for patient needs, goals, and values as means for increasing their autonomy. The definition can improve nursing practice and facilitate future research.
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