Nursing Research Paper on Patient Centered Care: Concept Analysis paper

Patient Centered Care: Concept Analysis paper

Abstract

Patient-centered care (PCC) is a in the frontline of health care as improvements are being recommended. This paper describes a concept analysis using the Walker and Avant’s methodology as an organizing framework. A definition of PCC, defining attributes, and antecedents and consequences are discussed.

Keywords: Care, patient-centered care, individualized care, patient autonomy, and therapeutic communication

Patient Centered Care: Concept Analysis

Aim of the Analysis

The purpose of this analysis is to scrutinize the distinctiveness of the concept of Patient Centered Caring in inter specialized literature and delineate it more visibly and propose a nursing characterization that adds to the caring theory. The analysis also reviews the various dimensions of patient centered care with an aim of recommending an integrative model. Research on PCC has been limited on the nursing profession and exploring its definitions on the literature of supplementary health career is important in appreciating the concept’s use amongst the health professionals. An unambiguous meaning of the concept is required for theoretical clearness of the concept in nursing which can facilitate further research through dimension of its important variables.

Uses of the Concept

Definitions

To start a concept analysis, there is need to recognize the use of the concept in the literature and in practice. A literature search was performed on PCC, which give up a large number of articles. Some had limitations such as being short of substantiation and to overcome this, the writing focused on research based articles because they offer equipped definitions and identify appropriate variables. Identification of articles was done using a various ways. Articles that included relevant information especially on measurement or definition of PCC were used. Some of the obtained articles were excluded due to repetition or did not contribute to the topic at all.

Definition of PCC is from various perspectives. The IOM (2010) expresses PCC as a way of giving care that integrates valuing patient diversities, involving patients in making decisions, listening to patients, campaigning, and organizing care, as well as advancing health, wellbeing, and preventing diseases. The Agency for Health Research and Quality, AHRQ, give emphasis to PCC as a way of improving the quality of relations between patients and health care givers empowering patients in the process. A definition by Hobbs (2009), describes the term from the nursing outlook.  Hobbs defines PCC as an intricate event that involves a number of relations from the patient, nurses, and the environment with a definitive objective of alleviating vulnerabilities.

Literature Review

Nursing instigators have decided that sharing pronouncements, individualized care based on patient’s inclinations, values, and requirements are significant defining factors of PCC (Lee & Lin, 2010). Stringed all through inter professional literature are images including communication behaviors and paying attention. Caring is also an important part of PCC as described a number of authors. The environment that the care is given is essential in the deliverance of PCC. The type of the care given may affect the definition of PCC as the patient’s requirement varies. Nevertheless, from the analysis of the literature, variables that are available in PCC seem to share universal antecedents in spite of the variation on the environment.

The aim of every healthcare is to enhance health and well being of its patients and healthcare authors agrees that doing well to the patients should be encouraged. According to previous studies both patients and nurse’s perspectives have shown that there is a universal inconsistency between a nurse and a patient’s outlook, exposure, and prospects concerning caring. Nurses appear to underrate different aspects that patients find necessary like professional competency and in most cases are not conscious of their patient’s outlook. When there is a misunderstanding between the health care providers and patients on their expectations, it can lead to discontent with healthcare (Garrouste-Orgeas et al, 2014). This misunderstanding can cause serious issues, not only in communication but also on building nurse- patient relationship.

Growth of a therapeutic relationship with patients is an important aspect in assessing and understanding their requirements thus ensuring deliverance of an efficient and effective patient centered care. A therapeutic relationship can be said as the one where patients are at ease in being open and honest with the healthcare provider and it is associated with the growth of a helpful relationship and positive patient results. The relationship is established by employing listening and asking questions techniques alongside giving information, support and making sure that care is inclined to the patient unlike in task oriented  (Doherty & Thompson, 2014). Hence, to support the growth of a therapeutic relationship, the healthcare provider must be an adept conversationalist.

Defining Attributes

Based on the definitions and review of the literature, the attributes were identified. Caring appears as a reoccurring aspect in the literature. In healthcare perspective, caring is defined as the moral responsibility. Stringed all through the literature are elements that are important in analyzing caring linked with PCC. Therapeutic relationship growth with respect for patient is stressed and caring actions are described as important to PCC. Another attribute is the healthcare provider and patient’s communication. Various ways on how to exchange information in a PCC are included when defining PCC. A wide range of both verbal and non-verbal communication such as asking questions, summarizing crucial information in a diary and keeping eye contact can be utilized in PCC communication.

Patient involvement in caring process is another attribute. An outstanding aspect frequently depicted in the literature is actively involving patient in every bit in care. Engaging patient in making decisions and persuading patients to participate in consultations are important elements associated with PCC. The significance of helping patients to make an informed decision is decorated in the literature. This incorporates valuing patient’s preferences and encouragement of feedbacks. The other attribute is empowering the patients by recognizing their capacity to manage essential aspects of their illness and encouraging them to take responsibility to provide solution on how to improve health condition. This also involves the support given to patients’ autonomy by providing training programs and healthcare interventions.

A Model Case

Mercy completes undergoing chemotherapy for a stage 3 ovarian cancer. Her diagnosis is unfortunate but the healthcare giver informs Mercy and her family that there are other options available. The healthcare giver clarify the other options, radiation therapy, surgery, and hospice care with a complete attention   and asks Mercy whether she needs further clarification. The healthcare giver also asses Mercy’s and her family’s understanding of hospice care and based on the evaluations, the giver provides the required training to them.  Then the care giver, Marcy, and the family holds a discussion on the goal of care.

In this case, the healthcare giver offers training to the patient and family giving knowledge that enhances active participation in making decision for her treatment. The caregiver works together with the patient in making a decision for goals of care in line with patient’s preferences. The caregiver treats the patient with as an individual, communicates, and respects the patient’s preferences. These elements support the defining features of PCC.

Borderline Case

Mercy completes undergoing chemotherapy for a stage 3 ovarian cancer. Her diagnosis is unfortunate but the healthcare giver informs Mercy and her family that there are other options available. The healthcare give notes the other options without clarifying them in a way that Mercy and her family did not understand them well. Then the caregiver asks them for the option convenient to them without giving much attention.

In this case, the caregiver does not give much details of the other three option in way that would help Mercy and her family to make an informed decision on which is the best option for her.

Contrary Case

A patient undergoes a chemotherapy treatment for a stage 4 Uterus cancer. Her prognosis is bad. The caregiver informs her and the family that there are still three other options remaining and gives an explanation to them but recommends surgery without considering their opinions.

In this case, the caregiver explains the other options but does not involve the patient or her family in making decision contrary to the defining attributes of PCC.

Antecedents and Consequences

            Two antecedents are recognized in this case, healthcare involvement and the capability of a patient to play a part in his/her care. If one of the two antecedents is not present, then there would be no chance for provision of PCC.  This shows the significance of the relationship of the antecedents to defining attributes. For instance, incapability to play a part in care would make autonomy unattainable. PCC free of the defining attribute of patient autonomy would conceptualize it wrongly.

            Consequences of PCC are complex to enumerate because PCC has differing definitions in the literature. Most reviewed literature used qualitative approach in defining the concept of PCC. There is substantiation of enhanced health results and contentment though the goal measure of health did not get better when the illustrated components of PCC were employed in one study.

Empirical Referents

For further clarification of the concept, it is important to extrapolate the empirical referents. These real phenomenons let one to measure the concept and can be similar with the defining attributes. Taking into account the PCC attributes, encouraging patient autonomy, caring attitude of the caregiver, and individualizing care, empirical referents are complex to define since there is a subjective nature to the exposure of this concept. The solution to empirical referents of the PCC concept is in the capacity to measure the patient’s autonomy, a caring outlook, perception of individualized care and connecting them to enhanced results.

There are two tools in the literature that can be of importance in ensuring measurement of these phenomena, a questionnaire and the Schmidt Perception of the Nursing care survey (Wolf et al., 2008).  These tools have objects necessary to capture the defining attributes of PCC. The next phase would be to evaluate the patient’s results in a group that got PCC and compare the results with a group that did not receive PCC.

Conclusion

            PCC is an important practice in the modern time because of patient movements, values of accrediting bodies and the demand for an improved healthcare. A definition of PCC from the reviewed literature can be illustrated as the provision of care that includes the aspects that promote patient autonomy, a caring attitude of the caregiver, and individualized patient care. 

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