Introduction
The notion of patient-centered care is among the most widely used concepts in clinical practice. There is ambiguity concerning the definition of this term, which results in the different views of nurses on the services they should provide patients. Advanced practice nurses should pay precise attention to the meaning of patient-centered care to fulfill their professional duties. Patient-centered care supposes attention to the physical state of the ill person and to their psychological and spiritual well-being to make the hospital stay less traumatic to the individual. In other words, advanced practice nurses should learn how to provide their patients with high-quality care that pays equal attention to all various needs of the individual while staying in the medical facility, which is a complicated task.
This concept analysis paper includes a literature review on patient-centered care, the definition of the concept and its attributes, and the description of the model case and alternative cases to understand the notion in more detail. The analysis of the antecedents and consequences of patient-centered care allows conclusions about applying the concept of patient-centered care in clinical practice. Therefore, a clear vision of patient-centered care is essential for nursing in general and me as a professional nurse because it allows for finding definite ways of interacting with the patient. The current analysis aims to define the concept of patient-centered care to make the vision of advanced practice nurses more practically applicable. It is possible to state that lack of understanding and clarity about the goals of patient-centered care leads to ambiguity in the behavior of nurses.
Literature Review
Definition of the Concept
- Bokhour et al. (2018, p. 2): “Patient-centered care represents a shift from traditional, paternalistic, provider-driven, disease-focused approaches towards healthcare systems that ensure patients—including their preferences, needs, desires and experiences—are fully integrated into every phase of medical consultation, treatment and follow-up. Patient-centered care includes empowering patients, focusing on the patient-provider relationship, and enabling providers to partner with patients to better meet patient goals.”
- Chapman (2021, p. 439): “The withdrawal of care or the implementation of ceilings of care for patients is a common area of discussion among clinicians. The importance of a patient-centered approach is unquestionable when we make treatment decisions. In resource-limited scenarios, such as those experienced in some areas during coronavirus disease 2019 outbreaks, the discussions regarding levels of treatment are unequivocally more challenging. However, these decisions must still be taken with a holistic viewpoint, with quality of life and dependency examined together with clinical features.”
- Dong (2021, p. 1): Patient-centered care supposes using daily seduction before medical manipulations, explaining the process to the patient, and considering the demographic characteristics of the particular patient. These issues are especially critical while working with children in the pediatric department.
- Håkansson et al. (2019, p. 3): “Person-centered care broadens and extends the perspective of patient-centered care by considering the whole life of the patient.”
- Hwang et al. (2019, p. 1): “Patient participation in nursing practice involves relationships between health care professionals and patients characterized by power and control sharing by health care professionals, shared health-related information, and engagement in physical activities and clinical communication.” Patient-centered care includes such activities as minimizing adverse events during a patient’s hospital stay, a safe environment, and safe medication management.
- Makou (2021, p. 677): “The Patient-Centered Innovation (PCI) feature of Patient Education and Counseling aims to highlight work at the intersection of patient-centeredness and innovation, ideally efforts that prioritize patient perspectives in the design, implementation, and evaluation of interventions intended to improve health and transform health care delivery.”
- Ortiz (2018, p. 291): “Patient-centered care is care that is organized around the patient, where providers partner with patients and families to identify and satisfy the full range of patient needs and preferences.” The main principles of patient-centered care include respect for the needs and values of the patient, family integration, integration of the patient into the healing process, informing and educating the patient, physical comfort, and emotional support.
- Poitras et al. (2018, p. 2): Long-term and chronic health conditions require a patient-centered approach to care. It includes alleviating the economic burden associated with the illness, working with the psychological stability of the individual who suffers from anxiety and depression, and self-managing and treatment managing, especially during complex drug prescriptions.
Definition of Attributes
The notion of patient-centered care features specific critical attributes that reflect the essence of this concept. It is possible to assume that the details constantly repeated in the definitions of patient-centered care are objectivity, multidimensional character, and dynamism. The dynamic characteristic means that the way the nurse provides the patient with assistance might change over time depending on the context, clinical requirements, and the patient’s needs at the particular moment. For instance, the aggravation of the health state might lead to the growing demand for managing treatment more carefully and educating the patient about the new things in their situation. These situations affect the way the advanced practice nurse provides patient-centered care.
The objectivity of patient-centered care supposes that all actions of the advanced practice nurse should correspond to the criteria of public health care. In other words, the perception of the services the nurse provides to patients might differ depending on the particular individual’s views. Though, in all cases, these actions should correlate with the medical ethics and principles of safety. This characteristic shows that objectivity in evaluating patient-centered care is more universal than subjective evaluation, which can be misleading in certain situations.
The third vital attribute of the concept is the multidimensional character of the patient-centered practice. It means that patient-centered care should emphasize different aspects of a patient’s life. Among them are the patient’s physical, emotional, and spiritual states, who can experience various issues with managing therapy, coping with anxiety or depression, or learning how to live with the diagnosis. Among the patient’s physical needs are their daily regime, ability to sleep, adequate rest, and exercise, which are essential for preserving the required therapeutic effect. Emotional assistance supposes the nurse’s attention to the patient’s psychological stability and ability to cope with stress. Assistance in spiritual questions includes interactions of the advanced practice nurse with the patient’s religious values and appealing to faith in communication with them.
Model Case
The model case is an example that occurs in real life and reflects how the concept of patient-centered care is applied in practice. For instance, the following situation illustrates how the notion of patient-centered care can manifest in real life. John is a 45 years old man who suffers from chronic arthritis and had surgery on his knee a week ago. As a result, he has to cope with the pain after the surgery, sustain an adequate level of physical activity, and follow his physician’s treatment recommendations. The therapy is complex, and John has to change his daily routine significantly after the surgery on the knee.
This example illustrates the main attributes critical in providing John with patient-centered care. First, the nurse’s attitude to John’s situation should be objective, meaning they should follow the professional requirements in assisting the patient. The nurse needs to appeal to John’s physical, psychological, and spiritual concerns in this situation. It supposes that the nurse should inform him about the new regime to ensure John uses therapy right and that his emotional state is optimistic and stable. It represents the multidimensional characteristic of patient-centered care. In addition, the nurse should remember the dynamic character of the given situation because John is after surgery, and his state is aggravated due to this circumstance.
Additional/Alternative Cases
Borderline Case
The borderline case aims at illustrating only some of the characteristics of the discussed concepts, which means that the phenomenon can have only specific attributes in reality. The borderline example of patient-centered care is the following. Charles receives treatment for diabetes according to the approved scheme, and his physical state is stable. Though he suffers from depression due to his diagnosis, no one pays attention to his emotional state. This case shows that not all attributes of patient-centered care are represented in this situation. The multidimensional aspect supposes equal attention to the physical and psychological condition of the patient, but Charles does not receive emotional assistance. This scenario shows that patient-centered care can be partial and exclude some characteristics.
Related Case
The example of the related case supposes that the situation is connected with the discussed concept, but it lacks its significant attributes. For example, Mary sees the images from the hospital where all nurses are smiling when they stand near their patients. Visually, this image represents the patient-centered approach to care, which creates the illusion that the hospital corresponds to these standards. In reality, the hospital might disregard the principles of providing patients with objective, multidimensional, and dynamic assistance. Nurses might not adapt to the instant needs of their patients, they might ignore their psychological state, and they might use their views on adequate medical supervision and assistance that are subjective by their essence.
Contrary Case
The example of the contrary case describes the situation that reminds of patient-centered care only formally, but the critical attributes cannot be applied to this situation. Leo refuses to start treatment for tuberculosis because, as a believer, he thinks that God will save him. He regards his illness as the punishment for his sins and refuses hospitalization. Taking desires of Leo into consideration is not an example of patient-centered care because tuberculosis is infectious. If nurses agree to Leo’s will, they put other people at risk of contamination.
Illegitimate case
The example of the illegitimate case supposes the inappropriate use of the concept that cannot be applied in a particular situation. For instance, Michael experiences severe pain during cancer treatment and wants to end his suffering. He constantly asks the nurse to end the pain and to give him something that will kill him because he cannot endure it anymore. In this case, patient-centered care does not follow Michael’s will because they are illegitimate and violate the principles of a nurse’s work.
Invented Case
Inverted cases feature ideas that do not correspond to the individual’s personal experience and seem unrealistic. For example, a nurse falls in love with the patient and makes everything possible to alleviate his pain. Harry was injured in a car accident, and the nurse felt that she could not resist when Harry asked her to give him more painkillers. The nurse is ready to make everything Harry asks her because of her feelings. This situation is against professional nurses’ ethical norms of behavior, making it unrealistic and unacceptable. At the same time, this example illustrates how the notion of patient-centered care can be misunderstood.
Antecedents and Consequences
The notion of the antecedent supposes the description of the events that are the direct or indirect reasons for the discussed phenomenon. For example, the most apparent antecedent of patient-centered care in nursing is that nurses provide medical assistance to patients, and how they do it can vary. From the abstract point of view, nurses always offer medical help to patients, and the existence of their professional activity is the most important antecedent to patient-centered care (Chapman, 2021). At the same time, not all types of nursing assistants are patient-centered, and there are many examples of situations when the nurse follows medical recommendations without paying attention to the needs of the particular patient.
The consequences of patient-centered care are connected with more precise attention to the needs and desires of the particular patient. It makes the work of the advanced practice nurse more individualized and focused on the circumstances surrounding the patient. In most cases, the consequences of applying the patient-centered approach to care favor patients, because their needs are satisfied, and their treatment is more effective. It also improves the patient’s emotional and physical state because nurses control how patients follow the medical recommendations (Håkansson et al., 2019). Patient-centered approach to care makes patients feel that their desires are heard and heeded, which allows them to relax in the stressful situations connected with medical treatment (Hwang et al., 2019). In all cases, advanced nurse practitioners need to remember that patients are in a vulnerable position both physically and psychologically, which affects their state (Poitras et al., 2018). The nurse’s responsibility is to help patients in these difficult situations and to reduce the number of inconveniences they face during their hospital stay or treatment of the chronic condition.
Conclusion
Most nurses use patient-centered care in their clinical practice but rarely expand this definition. The critical issue is that the precise meaning of patient-centered care allows nurses to develop simple yet effective methods of working with diverse populations. Therefore, understanding the details connected with the definition of patient-centered care contributes to forming a clear vision of their duties as nurses. This paper investigates the definition of patient-centered care provided by various scholars in academic sources, which makes the research credible. Articulating the definition’s common attributes make understanding the concept’s essence and applying it to clinical practice easier.
It is critical to mention that objective principles of patient-centered care should be applied in clinical practice by advanced practice nurses. They should be the basis for providing patients with medical services and psychological, physical, and spiritual assistance. The multidimensional nature of patient-centered care shows a need to use standard principles in nursing care to make the meaning of the discussion notion universal. The advanced practice nurse needs to use the general professional principles and values in elaborating the patient-centered approach to care. It will ensure their services’ stable high quality, and professional integrity.
Concept Table
- Bokhour et al. (2018, p. 2): “Patient-centered care represents a shift from traditional, paternalistic, provider-driven, disease-focused approaches towards healthcare systems that ensure patients—including their preferences, needs, desires and experiences—are fully integrated into every phase of medical consultation, treatment and follow-up. Patient-centered care includes empowering patients, focusing on the patient-provider relationship, and enabling providers to partner with patients to better meet patient goals.”
- Chapman (2021, p. 439): “The withdrawal of care or the implementation of ceilings of care for patients is a common area of discussion among clinicians. The importance of a patient-centered approach is unquestionable when we make treatment decisions. In resource-limited scenarios, such as those experienced in some areas during coronavirus disease 2019 outbreaks, the discussions regarding levels of treatment are unequivocally more challenging. However, these decisions must still be taken with a holistic viewpoint, with quality of life and dependency examined together with clinical features.”
- Dong (2021, p. 1): Patient-centered care supposes using daily seduction before medical manipulations, explaining the process to the patient, and considering the demographic characteristics of the particular patient. These issues are especially critical while working with children in the pediatric department.
- Håkansson et al. (2019, p. 3): “Person-centered care broadens and extends the perspective of patient-centered care by considering the whole life of the patient.”
- Hwang et al. (2019, p. 1): “Patient participation in nursing practice involves relationships between health care professionals and patients characterized by power and control sharing by health care professionals, shared health-related information, and engagement in physical activities and clinical communication.” Patient-centered care includes such activities as minimizing adverse events during a patient’s hospital stay, a safe environment, and safe medication management.
- Makou (2021, p. 677): “The Patient-Centered Innovation (PCI) feature of Patient Education and Counseling aims to highlight work at the intersection of patient-centeredness and innovation, ideally efforts that prioritize patient perspectives in the design, implementation, and evaluation of interventions intended to improve health and transform health care delivery.”
- Ortiz (2018, p. 291): “Patient-centered care is care that is organized around the patient, where providers partner with patients and families to identify and satisfy the full range of patient needs and preferences.” The main principles of patient-centered care include respect for the needs and values of the patient, family integration, integration of the patient into the healing process, informing and educating the patient, physical comfort, and emotional support.
Poitras et al. (2018, p. 2): Long-term and chronic health conditions require a patient-centered approach to care. It includes alleviating the economic burden associated with the illness, working with the psychological stability of the individual who suffers from anxiety and depression, and self-managing and treatment managing, especially during complex drug prescriptions.
References
Bokhour, B. G., Fix, G. M., Mueller, N. M., Barker, A. M., Lavela, S. L., Hill, J. N., Solomon, J. L., & Lukas, C. V. (2018). How can healthcare organizations implement patient-centered care? Examining a large-scale cultural transformation. BMC health services research, 18(1), 168-179. Web.
Chapman, R. (2021). The importance of patient-centered care. Chest, 159(1), 439–440. Web.
Dong, C. (2021). Patient-centered care from a parent’s perspective. Pediatric radiology, 51(5), 850. Web.
Håkansson, E. J., Holmström, I. K., Kumlin, T., Kaminsky, E., Skoglund, K., Höglander, J., Sundler, A. J., Condén, E., & Summer, M. M. (2019). “Same same or different?” A review of reviews of person-centered and patient-centered care. Patient education and counseling, 102(1), 3–11. Web.
Hwang, J. I., Kim, S. W., & Chin, H. J. (2019). Patient participation in patient safety and its relationships with nurses’ patient-centered care competency, teamwork, and safety climate. Asian nursing research, 13(2), 130–136. Web.
Makou, l. G. (2021). Patient-centered innovation: Lessons learned. Patient education and counseling, 104(4), 677–678. Web.
Ortiz, M. R. (2018). Patient-centered care: Nursing knowledge and policy. Nursing science quarterly, 31(3), 291–295. Web.
Poitras, M. E., Maltais, M. E., Bestard-Denommé, L., Stewart, M., & Fortin, M. (2018). What are the effective elements in patient-centered and multimorbidity care? A scoping review. BMC health services research, 18(1), 1-9. Web.