Concept Analysis of Patient Centered Care

A concept analysis seeks to outline, distinguish, and enhance the clarity of the nursing profession as well as stimulate future research endeavors. Within the development of a concept analysis, notions and thoughts are outlined and examined through the fundamental features of that particular concept. According to Walker & Avant (2011), the seven steps to accomplishing a concept analysis includes the selection of a concept, determining the purpose of analysis, identifying all uses of the concept, defining attributes, identifying a model case of the concept, identifying antecedents and consequences, and identifying empirical references.

Patient centered care is an imperative task performed by not only nurses, but the absolute interdisciplinary staff involved. It is essential to the establishment of quality care with the ultimate goal of positive patient outcomes. Several responsibilities of the nurse for patient centered care may include pain relief, listening, advocating for the patient, disease prevention, health promotion, respect for patient values and preferences, and maintaining patient dignity and identity (Lusk & Fater, 2013). Jean Watson’s theory of caring closes correlates with the concept of patient centered care in respect to the practice of nursing. This concept analysis of patient centered care includes examination of the aim of the selected analysis, literature review, concept usage, defining attributes, model cases, contrary cases, antecedents and consequences, and empirical referents. Aim of the Analysis

The objective for this analysis of patient centered care is to propose a formal conceptual definition with promotion of Jean Watson’s theory of caring. There is a deficiency in research and reports on a standard definition and relevant interventions on patient centered care in regards to the nursing practice. A well- defined meaning of the concept is imperative to the understanding of the nursing practice and may assist in future research endeavors in respect to its proposed principal essentials. Comprehension of a predetermined set of interventions or tasks for implementation are needed for the production of substantial positive outcomes. Literature Review

Within the context of the healthcare team, the patient is viewed as an integral entity. Patient centered care incorporates the individual’s values and beliefs, healthcare preferences, and application of healthcare related activities (Fredricks, Lapum, & Hui, 2015). To execute these demands it necessitates the nurse to exude a respectful demeanor as well as caring approach. According to Fredricks, Lapum & Hui (2015), four elements have been corroborated within the nurse-patient theoretical framework to include characteristics and competencies of the nurse, the healthcare setting in relation to the care that is being provided, the individual patients’ developments, and the outcomes of the patient centered care. Selected interventions should be designed specifically for the individual patient. Patient participation in the selected interventions offers active involvement in their care.

Historically, phases of healthcare practice has ranged from task orientation to evidence based practice with emphasis on holistic nursing. Lusk & Frater (2013) stated, the demand for patient centered care and the transformation of the healthcare delivery system stems from the ever-changing expectations of the nurse for superior quality care for the patient. Communication is an essential part to the provision of patient centered care. Communication forms the basis for high quality care and all measures should be instituted in order to achieve effective transmission. Examples of patient centered care approaches comprises of efficient communication styles from the nurse which may include open ended interview questions to effectively distinguish the trepidations of the patient and to collaboratively work with them in an effort to overcome the disputes (Cheraghi, Manookian, & Nasrabadi, 2014).

Respect is a prominent principal in the healthcare environment. Respect not only incorporates the interaction between the nurse and patient but it also integrates the concept of privacy and dignity. Without respect or effective communication, high quality health care is neglected. Tasks such as protecting the patients’ health information and addressing the patient by name are concepts of respect that can be classified as patient centered care. Concept Usage

Providing patient centered care opportunes the individual patient to become more actively involved in care resulting in improved positive patient outcomes. According to Lee & Lin (2010), patient centered care is accentuated as an aim for the quality of care improvement and the enhanced communication amongst patient and the healthcare disciplines.. The goal of patient centered care is alleviation of patient weaknesses through the integration of patient and healthcare collaboration (Hobbs, 2010). Patient weaknesses can have a detrimental effect on the overall outcome of health. Some weaknesses may include, compliance, lack of interest, and prolonged or continuation of the disease process. As stated above, incorporating patient centered care can lead to a cessation in those barriers. Defining Attributes

Patient autonomy is a beneficial factor in the execution of patient centered care. The ability of the patient to make informed decisions of their care and become an active participant, increases with the concept of autonomy. “As power is shared and the patient’s ability to control the care increases, patient autonomy is enhanced” (Lusk & Frater, 2015, p.94). This concept also supports Jean Watson’s concept of caring in relation to the solution outcomes and problem solving phenomena. Another defining attribute consist of specializing each individuals care to tailor the needs of the patient. According to Lusk and Frater (2015), it takes collaboration with the patient to meets the specific needs and determine the goals and treatment outcomes. Incorporating the patient and promoting self-sufficiency and autonomy are recognized as adjuncts to the concept patient centered care. Model Cases

A physician has recently diagnosed Mr. Hag with stage IV prostate cancer. The physician has explained all treatment options with the patient and family to include chemotherapy/radiation, surgery, or hospice. Within this explanation, the physician informs the patient and family that despite the treatment options the prognosis is very poor. After the physician has completed his consultation, the nurse enters the room and levels at the eye with patient. She asks if clarification is needed and offers to answer any questions they may have while assessing their understanding of the listed treatment options. Together the nurse, patient, and family devises a plan with considerations of religious, social, and personal preferences. The nurse then displays attentive listening skills and listens to any concerns while encouraging the patient to take time to conclude a decision. The nurse has incorporated patient collaboration and embraced active participation. This succeeds the attribute of individualized care.

A Jehovah’s Witness patient arrived to the hospital with a life threatening hemoglobin of 2.6. The nurse was aware of the patient’s religious preference and knew that it was against that particular religion to receive blood products. The nurse respected the patient’s preference and helped to comfort and manage the uncomfortable symptoms the patient was experiencing. While exemplifying a caring and considerate attitude, the nurse reviewed other options that the patient may be able to consider such as bloodless medication. The nurse demonstrated the concept of patient autonomy as outlined in the defining attributes, and allowed for the patient to make his own informed decisions of care. Griffith (2015) stated, it is not the responsibility of the nurse to impose their own beliefs, values, or attitudes on the patient regardless serious consequences that may result. Contrary Cases

The physician that diagnosed Mr. Hag with stage IV prostate cancer has reviewed all of the available treatment options for the patient to include, chemotherapy/radiation, surgery, or hospice. The physician has explained the poor prognosis of the disease process regardless of treatment execution. The nurse offers to answer any questions and provides clarity for understanding but encourages the patient to choose the hospice treatment option. She informs the patient that the prognosis is poor and hospice is a better option for the patient. The nurse has demonstrated a non-caring attitude and failed to incorporate the patient’s wishes. This does not suite the realm of patient centered care. According to Joseph & Letendre (2014), patient autonomy involves the omission of controlling and demanding interference from others and includes the right to act freely.

A patient on the unit expressed a personal preference to have his medications administered at certain time because it was his routine at home and he preferred to keep his routine concurrent. The nurse stated to the patient that she had other patients and declined to agree to the time restraint imposed by the patient. The nurse lacked not only compassion but declined to individualize the patient’s care. The patient was assimilated into the routine of the nurse. This scenario does not supplement the concept of patient centered care. Strickland, Arnn, & Mitchell (2011) stated, aggregating patient’s personal preferences into care along with an enhanced nurse-patient relationship leads to a promotion of growth and healthy recovery. Antecedents and Consequences

The capacity of the patient to participate in his/her own care poses as an antecedent to patient centered care. Lusk and Frater (2015) stated, it would be impossible to implement patient centered care if the patient is not an active participant, therefore making patient autonomy groundless. Patient participation is the foundation for all patient centered care phenomenon. The nurse would not be able individualize care, communication is voided, and positive outcomes are weakened. Negative consequences are inconclusive with the concept of patient centered care. Several positive consequences exist such as improved health outcomes and quality care. According to Hobbs (2010), positive patient outcomes are enhanced with the execution of patient centered care because it promotes a healthy nurse patient relationship and heightened personal growth. Empirical Referents

Although it is difficult to substantiate a measureable tool for patient centered care assessment due to the subjective format of the concept, several surveys and questionaries’ exist. The Health Care Climate

Questionnaire can be used to gauge the patients view on the amount of autonomy that was encouraged and supported from nurses and physicians. The scale used measures the degree in which each discipline supported the patient’s autonomy (Suhonen, Schmidt, & Radwin, 2013). Another scale that can be used is called the Schmidt Perception of the Nursing Care Survey. This survey is used to evaluate the overall satisfaction of nursing care provided. Plan of care individualization and behaviors such as caring attitudes are also measured in this survey. This survey is divided into 4 categories to include seeing the individual patient, responding, watching over, and explaining (Suhonen, Schmidt, & Radwin, 2013). Conclusion

In summation, the inclusion of attributes for patient centered care includes respect for the patient’s religious, social, cultural and personal preferences into the plan of care. Other qualities comprises of adequate pain relief, listening and attentive skills, health promotion, and individualized care. Encouragement of patient autonomy and exuding a caring attitude forms the basis of patient centered care. The ability of patient to participate in care was identified as an antecedent. Positive consequences for patient centered care have only been recognized and includes positive patient outcomes. This concept analysis integrates various nursing standards and principals and is enticed by Jean Watson’s Caring theory. The analysis encompasses integrated understanding from the practice of nursing that proposes appropriateness of its application to practice.

References

Cheraghi, M. A., Manookian, A., & Nasrabadi, A. N. (2014). Human dignity in religion-embedded cross-cultural nursing. Nursing Ethics, 21(8), 916-928. doi: 10.1177/0969733014521095 Fredericks, S., Lapum, J., & Hui, G. (2015). Examining the effect of Patient Centered Care on Outcomes. British Journal of Nursing, 24(7), 394-400. Griffith, R. (2015). Patients who demand or refuse treatment. British Journal of Cardiac Nursing, 10(3), 150-152. Hobbs, J. (2010). A Dimensional Analysis of Patient Centered Care. Nursing Research, 58, 52-62 Joseph, S., & Letendre, C. (2014). Health Care Decision Making. New Bioethics, 20(2), 174-185. doi:10.1179/2050287714Z.00000000051 Lee, Y., & Lin, J. (2010). Do patient autonomy preferences matter? Linking
patient centered care to patient physician relationships and health outcomes. Social Science and Medicine, 71, 1811-1818. doi: 10.1016/j.socscimed.2010.08.008 Lusk, M., & Fater, K. (2013). Patient-centered care. Nursing Forum, 48(2), 89-98. doi:10.1111/nuf.12019 Strickland, B., Arnn, J., & Mitchell, J. N. (2011). Individualizing patient care. The Journal of Nursing Education, 24(6), 252-255. Suhonen, R., Schmidt, A., & Radwin, L. (2013). Measuring individualized nursing care: assessment of reliability and validity of three scales. Journal of Advanced Nursing, 59(1), 77-85. doi:10.1111/j.1365-2648.2007.04282.x Walker, L., & Avant, K. (2011). Strategies for theory construction in nursing (5th ed.) Upper Saddle River, NJ: Prentice Hall.