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Nurses use a multitude of concepts in their daily practice. Some of these concepts have profound theoretical underpinnings, while others become popular without any relation to nursing theory. Patient-centered care is probably one of the most commonly used terms in present-day nursing. Its origins can be traced to Jean Watson's theory of caring. Nurses work hard to translate the concept of patient-centered care into tangible strategies and realistic activities aimed at promoting patients' health. It is gaining momentum in nursing. Nevertheless, the concept is yet to become an integral component of all nursing practices. The purpose of the present work is to reevaluate the current state of science and art surrounding the concept of patient-centered care and its implications for nursing care. The paper includes the analysis of concept uses, its defining attributes, two model cases, one contrary and one borderline case, as well as the discussion of the antecedents, consequences and empirical referents of patient-centered care.
Aims of the Analysis
Concept analysis is gradually becoming an accepted practice among nurses. Its popularity is justified by the fact that many nurses lack a thorough understanding of the basic concepts used in their day-to-day routines. The concept of patient-centered care is not an exception to this rule. Without a doubt, the meaning, value, and importance of patient-centered care are frequently taken for granted. Simultaneously, one can hardly imagine nursing practice not being focused on the needs and preferences of individual patients. This focus on promoting patients' wellbeing transcends every aspect of nursing care. Nurses who misunderstand the purpose and intent of patient-centered care will hardly manage to accomplish their professional mission. This is why the key aim of the present analysis is to systematize the knowledge of patient-centered care so that nurses who read this work can have a better idea of how it could apply in practice. Another aim of the present analysis is to see if any gaps in the knowledge of patient-centered care continue to persist and how they change the nature of nursing practices.
Being person-centered has become an unchangeable truth of modern times in all areas of human and business performance. This phenomenon acts as a double-edged sword. On the one hand, businesses and non-business entities seek to show their commitment to person-centered principles in their interactions with clients and stakeholders. This commitment serves as a key source of organizations' strategic advantage. On the other hand, as person-centered approaches become commonplace, most customers come to view them as an inevitable component of quality and professionalism across organizations. They are likely to criticize and even despise those entities, which fail to deliver their person-centered promise. Not surprisingly, the word combination enjoys a diverse and wide usage in many areas of human activity. For instance, businesses in the hospitality industry know perfectly well how crucial it is for them to be client-centered.
Still, it is nursing and health care that has become home to the concept of person-centered or, rather, patient-centered care. Patient-centered care is used to describe numerous related paradigms but has no universally accepted definition. The terms "patient-centered care" and "person-centered care" are used interchangeably, even though the former is more popular among professional nurses. However, it should be noted that patient-centered is not the same as person-centered. Both concepts are based on the realization that medical professionals should recognize the health issues encountered by people and be ready to see them from a different perspective. However, while patient-centered care implies that nurses understand patients' health needs, person-centered care describes the process of accumulating impersonal knowledge about people, which facilitates early recognition of the most complicated health problems. Thus, it is wrong to believe that person-centered care can be replaced by patient-centered care and vice versa. Similar questions emerge in relation to the growing use of "patient engagement" as a synonym to patient-centered care. Pelletier and Stichler (2014) confirm that it is used interchangeably with the term "patient-centered care". In their opinion, patient engagement is an indispensable component of patient-centered care. Unfortunately, even as more nursing scholars turn themselves to the analysis of patient-centered care, the art and science of nursing lack a single definition of the selected concept.
Different researchers use the concept of patient-centered care in entirely different ways. Cliff (2012) writes that nursing care becomes truly patient-centered when nurses consider patients' personal values, individual preferences, lifestyles and family situations, as well as cultural beliefs. Talerico, O'Brien, and Swafford (2003) use the concept of patient-centered care in a geriatric setting. They define it as an evidence-based approach to caregiving that uses care recipients' unique personal preferences and needs to guide providers as they customize health care. Apparently, the selected concept enjoys numerous uses in nursing literature. The varying definitions of the same concept eventually uncover its most important defining attributes.
Determine Defining Attributes
Patient-centered care is a nursing concept that has numerous attributes. According to Pelletier and Stichler (2014), patient-centered care has six defining attributes. First, it is based on the unequivocal respect of patients' beliefs, principles, values, and personal perspectives on health and illness. Second, patient-centered care always welcomes the inclusion of patients' support systems. Third, it always rests on the trusting therapeutic relationship between the patient and the nurse. Fourth, it entails sound coordination of all nursing care activities across the care continuum. Fifth, patient-centered care is closely associated with the provision of education and information resources that empower patients to become full participants of the caring process. Sixth, it activates patients' internal and external resources that assist them in managing their health.
Morgan and Yoder (2012) offer a more concise review of the key patient-centered care attributes. In their view, patient-centered care is always empowering, respectful, holistic, and individualized. Here, the word "holistic" deserves particular attention. It means that patients are treated as whole and integral personalities, whose physical, spiritual and psychological aspects are intricately related. These attributes create a foundation for developing and presenting a model case.
Identifying Model Cases
Mrs. G. is in the terminal stage of pancreatic cancer. She reports having unbearable pain in her abdomen, which is accompanied by dizziness, constipation and fluid retention. The pain has become much stronger in the last few days when she learned that her beloved 19-year-old cat had passed away. Mrs. G. asks the nurse how she can relieve her pain since she is administered the highest permitted dose of opiates. She also asks if she can have some time for prayer, before regular medical procedures. The nurse accepts Mrs. G.'s reports about pain with empathy since the essence of patient-centered care is to take pain as the patient says it is. She tries to clarify Mrs. G.'s beliefs and values, as well as her perspective on her illness and the inevitability of death. The nurse empowers Mrs. G. to share her ideas about pain management and discuss her feelings of loss. The nurse and the female patient make a collective decision to organize a prayer according to Mrs. G.'s spiritual and religious beliefs. Simultaneously, she supplies Mrs. G. with new information about her pain symptoms and recommends possible ways to alleviate her suffering.
Another model case is reported by Morgan and Yoder (2012): Mr. Trent is admitted to a medical facility following an automobile accident. He reports difficulties with spiritual recovery since the accident had killed his best friend. The nurse is aware of the patient's situation and asks him to share his beliefs and values. He says that he is Buddhist and would like to create a healing place in his hospital room. The nurse brings everything required to meet the patient's religious and spiritual demands. She shows respect and understanding of the patient's concerns.
Not all nurses are patient-centered in their attitudes towards care. In the case of Mrs. G., a different nurse could display entirely different reactions to pain and loss in the last stage of a terminal illness. An invented contrary case would look as follows. Mrs. G. is in the terminal stage of pancreatic cancer. She reports having unbearable pain in her abdomen, coupled with dizziness, constipation, and fluid retention. The female patient asks the nurse to help her cope with pain and suffering, but she wants to stay conscious. She says that her physical pain became much stronger, once she learned that her beloved 19-year-old pet had passed away. The nurse responds that Mrs. G. already receives enough opiates and she should realize that it is cancer and that it is always painful. She tells the patient that her symptoms are likely to worsen, as she is approaching the last days of her life. The nurse strongly recommends using palliative sedation, despite the fact that the patient wants to stay conscious as long as it is possible in her health state. She finds it difficult to change the patient's beliefs about her illness and brings the physician to continue the conversation with Mrs. G.
A borderline case would involve the nurse and the patient, who is undergoing chemotherapy for the first time. He is afraid of the side effects of the therapy and asks the nurse if other treatment alternatives are available to him. The nurse shows respect and sensitivity, considering the patient's request. She realizes that the patient disagrees with the proposed course of treatment. However, she does not welcome any treatment ideas from the patient, nor does she ask the patient to share any other information that could inform the development of a better treatment strategy. According to Olenick, Allen, and Smego (2010), the presented case is borderline, since it does not engage the patient in decision making. This is also the reason why the care provided by the nurse does not meet the criteria of patient-centeredness.
Antecedents and Consequences
Due to the fact that the concept of patient-centered care is rather opaque, its antecedents and consequences are difficult to define. Still, two antecedents should be in place to ensure the smooth provision of patient-centered care. First, the organizational culture and setting should be conducive to delivering patient-centered care. Luxford, Safran, and Delbanco (2011) list several organizational attributes that facilitate the process of meeting patient-centered priorities. These include strong senior leadership, a comprehensive organizational vision, and mission, patient engagement in care processes, regular feedback, as well as clear lines of staff accountability across the care continuum. Second, looking at the additional case above, nurses should have a strong commitment to considering and meeting patients' needs. Simply stated, they should be willing to see each problem from a patient's perspective. Not all nurses can readily shift from being provider-focused to the patient- or person-centered in their day-to-day professional activities. This is why not all of them can ensure that patients enjoy the consequences of patient-centered care to the fullest. Such consequences may include increased patient satisfaction, enhanced quality of patient care, higher levels of trust in therapeutic relationships between nurses and patients, and certainly better patient health outcomes.
As mentioned earlier, patient-centered care is a multifaceted concept. Heidenreich (2013) refers to the six IOM quality components which, in his view, should facilitate the process of measuring patient-centered care. These are effectiveness, safety, patient satisfaction, efficiency or cost, health outcomes, and equity. Today, many nurses understand patient-centered care as a subjective concept. That is, the empirical referents of the selected concept will rest on patients' responses and perceptions of the nursing care provided by nurses. Hudon, Fortin, Haggerty, Lambert, and Poitras (2011) report the use of numerous instruments, including the Patient Perception of Patient-Centeredness and Patient Reactions Assessment scales.
Nurses should remember that not all patients readily understand what it takes to be truly patient-centered. A patient can be happy with a nurse administering an additional dose of opiates to relieve her pain, even though it worsens her prognosis and health outcomes. Such care can hardly be described as patient-centered. In the presence of numerous scales that measure patient-centered care, much is yet to be done to develop a comprehensive list of its empirical referents. Morgan and Yoder (2012) are right: the science of patient-centered care is still in the state of infancy, and nurses will have to refine their knowledge to develop a more thorough understanding of the concept and its practice implications.
To conclude, patient-centered care is a sophisticated and challenging concept. Despite its popularity among nurses, the art and science of nursing still lack a single definition of the concept. Overall, patient-centered care is described as the provision of evidence-based care, while considering patients' unique health needs, beliefs, and values. The concept has numerous attributes, antecedents, and consequences. Yet, it is still in the state of scientific infancy. Nurses of the future will need to refine their knowledge of the concept and its utility in nursing practice.
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