How to practice person‐centred care: A conceptual framework Santana, Maria J.; Manalili, Kimberly; Jolley, Rachel J. ...
Health expectations : an international journal of public participation in health care and health policy,
April 2018, Letnik:
21, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Background
Globally, health‐care systems and organizations are looking to improve health system performance through the implementation of a person‐centred care (PCC) model. While numerous conceptual ...frameworks for PCC exist, a gap remains in practical guidance on PCC implementation.
Methods
Based on a narrative review of the PCC literature, a generic conceptual framework was developed in collaboration with a patient partner, which synthesizes evidence, recommendations and best practice from existing frameworks and implementation case studies. The Donabedian model for health‐care improvement was used to classify PCC domains into the categories of “Structure,” “Process” and “Outcome” for health‐care quality improvement.
Discussion
The framework emphasizes the structural domain, which relates to the health‐care system or context in which care is delivered, providing the foundation for PCC, and influencing the processes and outcomes of care. Structural domains identified include: the creation of a PCC culture across the continuum of care; co‐designing educational programs, as well as health promotion and prevention programs with patients; providing a supportive and accommodating environment; and developing and integrating structures to support health information technology and to measure and monitor PCC performance. Process domains describe the importance of cultivating communication and respectful and compassionate care; engaging patients in managing their care; and integration of care. Outcome domains identified include: access to care and Patient‐Reported Outcomes.
Conclusion
This conceptual framework provides a step‐wise roadmap to guide health‐care systems and organizations in the provision PCC across various health‐care sectors.
Elaboration of the Gothenburg model of person‐centred care Britten, Nicky; Moore, Lucy; Lydahl, Doris ...
Health expectations : an international journal of public participation in health care and health policy,
June 2017, Letnik:
20, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Background
Person‐centred care (PCC) is increasingly advocated as a new way of delivering health care, but there is little evidence that it is widely practised. The University of Gothenburg Centre ...for Person‐Centred Care (GPCC) was set up in 2010 to develop and implement person‐centred care in clinical practice on the basis of three routines. These routines are based on eliciting the patient's narrative to initiate a partnership; working the partnership to achieve commonly agreed goals; and using documentation to safeguard the partnership and record the person's narrative and shared goals.
Objective
In this paper, we aimed to explore professionals' understanding of PCC routines as they implement the GPCC model in a range of different settings.
Methods
We conducted a qualitative study and interviewed 18 clinician‐researchers from five health‐care professions who were working in seven diverse GPCC projects.
Results
Interviewees’ accounts of PCC emphasized the ways in which persons are seen as different from patients; the variable emphasis placed on the person's goals; and the role of the person's own resources in building partnerships.
Conclusion
This study illustrates what is needed for health‐care professionals to implement PCC in everyday practice: the recognition of the person is as important as the specific practical routines. Interviewees described the need to change the clinical mindset and to develop the ways of integrating people's narratives with clinical practice.
Aim
To validate the Hebrew version of the Person‐Centered Care of Older People with Cognitive Impairment in the Acute Care scale.
Background
The Person‐Centered Care of Older People with Cognitive ...Impairment in Acute Care scale is a reliable and valid measure to assess the extent to which person‐centred care among people with dementia is adopted in the acute care setting.
Methods
A cross‐sectional study using a self‐reporting structured questionnaire was conducted with 678 professionals (69% nurses, 26% physicians, 5% other health care professionals) in five hospitals across Israel.
Results
Similar to other languages, best results were obtained using 14 of the 15 items included in the original scale. Confirmatory factor analysis indicated the appropriateness of a three‐factor structure for the Hebrew version of the scale. Cronbach's alpha scores for these factors were moderate to good.
Conclusions
The Hebrew version of the scale is a reliable and valid tool for assessing hospital professionals' perceptions of person‐centred care.
Implications for Nursing Management
A new language validated version of the scale will allow nurse managers to learn from multiple countries' experience while conducting international comparisons. Such developments will improve and expand the implementation of the person‐centred care among people with dementia in hospital settings.
Background
To empower patients and improve the quality of care, policy‐makers increasingly adopt systems to enhance person‐centred care. Although models of person‐centredness and patient‐centredness ...vary, respecting the needs and preferences of individuals receiving care is paramount. In Sweden, as in other countries, healthcare providers seek to improve person‐centred principles and address gaps in practice. Consequently, researchers at the University of Gothenburg Centre for Person‐Centred Care are currently delivering person‐centred interventions employing a framework that incorporates three routines. These include eliciting the patient's narrative, agreeing a partnership with shared goals between patient and professional, and safeguarding this through documentation.
Aim
To explore the barriers and facilitators to the delivery of person‐centred care interventions, in different contexts.
Method
Qualitative interviews were conducted with a purposeful sample of 18 researchers from seven research studies across contrasting healthcare settings. Interviews were transcribed, translated and thematically analysed, adopting some basic features of grounded theory.
Ethical issues
The ethical code of conduct was followed and conformed to the ethical guidelines adopted by the Swedish Research Council.
Results
Barriers to the implementation of person‐centred care covered three themes: traditional practices and structures; sceptical, stereotypical attitudes from professionals; and factors related to the development of person‐centred interventions. Facilitators included organisational factors, leadership and training and an enabling attitude and approach by professionals. Trained project managers, patients taking an active role in research and adaptive strategies by researchers all helped person‐centred care delivery.
Conclusion
At the University of Gothenburg, a model of person‐centred care is being initiated and integrated into practice through research. Knowledgeable, well‐trained professionals facilitate the routines of narrative elicitation and partnership. Strong leadership and adaptive strategies are important for overcoming existing practices, routines and methods of documentation. This study provides guidance for practitioners when delivering and adapting person‐centred care in different contexts.
Objective
To explore how nurses in hospitals enact person‐centred fundamental care delivery.
Background
Effective person‐centred care is at the heart of fundamental nursing care, but it is deemed to ...be challenging in acute health care as there is a strong biomedical focus and most nurses are not trained in person‐centred fundamental care delivery. We therefore need to know if and how nurses currently incorporate a person‐centred approach during fundamental care.
Design
Focused ethnography approach.
Methods
Observations of 30 nurses on three different wards in two Dutch hospitals during their morning shift. Data were collected through passive observations and analysed using framework analysis based on the fundamentals of care framework. The COREQ guideline was used for reporting.
Results
Some nurses successfully integrate physical, psychosocial and relational elements of care in patient interactions. However, most nurses were observed to be mainly focused on physical care and did not take the time at their patients’ bedside to care for their psychosocial and relational needs. Many had a task‐focused way of working and communicating, seldom incorporating patients’ needs and experiences or discussing care planning, and often disturbing each other.
Conclusions
This study demonstrates that although some nurses manage to do so, person‐centred fundamental care delivery remains a challenge in hospitals, as most nurses have a task‐focused approach and therefore do not manage to integrate the physical, relational and physical elements of care. For further improvement, attention needs to be paid to integrated fundamental care and clinical reasoning skills.
Relevance to clinical practice
Although most nurses have a compassionate approach, this study shows that nurses do not incorporate psychosocial care or encourage patient participation when helping patients with their physical fundamental care needs, even though there seems to be sufficient opportunity for them to do so.
Aims
We evaluated the outcome of person‐centred and integrated Palliative advanced home caRE and heart FailurE caRe (PREFER) with regard to patient symptoms, health‐related quality of life (HQRL), ...and hospitalizations compared with usual care.
Methods and results
From January 2011 to October 2012, 36 (26 males, 10 females, mean age 81.9 years) patients with chronic heart failure (NYHA class III–IV) were randomized to PREFER and 36 (25 males, 11 females, mean age 76.6 years) to the control group at a single centre. Prospective assessments were made at 1, 3, and 6 months using the Edmonton Symptom Assessment Scale, Euro Qol, Kansas City Cardiomyopathy Questionnaire, and rehospitalizations. Between‐group analysis revealed that patients receiving PREFER had improved HRQL compared with controls (57.6 ± 19.2 vs. 48.5 ± 24.4, age‐adjusted P‐value = 0.05). Within‐group analysis revealed a 26% improvement in the PREFER group for HRQL (P = 0.046) compared with 3% (P = 0.82) in the control group. Nausea was improved in the PREFER group (2.4 ± 2.7 vs. 1.7 ± 1.7, P = 0.02), and total symptom burden, self‐efficacy, and quality of life improved by 18% (P = 0.035), 17% (P = 0.041), and 24% (P = 0.047), respectively. NYHA class improved in 11 of the 28 (39%) PREFER patients compared with 3 of the 29 (10%) control patients (P = 0.015). Fifteen rehospitalizations (103 days) occurred in the PREFER group, compared with 53 (305 days) in the control group.
Conclusion
Person‐centred care combined with active heart failure and palliative care at home has the potential to improve quality of life and morbidity substantially in patients with severe chronic heart failure.
Trial registration: NCT01304381
•A comprehensive systematic review on person-centered care.•A consensus about the crucial components of person-centered care for older people.•A guide to support policymakers and health care ...professionals in implementing person-centered care.•A guide to improve the quality of care for older people, particularly for those with complex health care needs.•The crucial components of person-centered care based on Ricœur's philosophy and ethics.
of this study was to explore the content and essential components of implemented person-centered care in the out-of-hospital context for older people (65+).
A systematic review was conducted, searching for published research in electronic databases: PubMed, CINAHL, Scopus, PsycInfo, Web of Science and Embase between 2017 and 2019. Original studies with both qualitative and quantitative methods were included and assessed according to the quality assessment tools EPHPP and CASP. The review was limited to studies published in English, Swedish, Danish, Norwegian and Spanish.
In total, 63 original articles were included from 1772 hits. The results of the final synthesis revealed the following four interrelated themes, which are crucial for implementing person-centered care: (1) Knowing and confirming the patient as a whole person; (2) Co-creating a tailored personal health plan; (3) Inter-professional teamwork and collaboration with and for the older person and his/her relatives; and (4) Building a person-centered foundation.
Approaching an interpersonal and inter-professional teamwork and consultation with focus on preventive and health promoting actions is a crucial prerequisite to co-create optimal health care practice with and for older people and their relatives in their unique context.
Aims and objectives
To identify person‐centred care as an intervention in controlled trials, where patients had been involved as a partner, and to describe the outcomes of these studies.
Background
...The notion of person‐centred care asserts that patients are persons and partners in care and should not be reduced to their disease alone.
Design
A systematic literature review.
Method
Searches were undertaken in the databases PUBMED and CINAHL. The inclusion criteria were that person‐centred care as an intervention was described as a partnership between the caregiver and the patient, and that the studies were randomised controlled trials or quasi‐experimental designs. The studies were analysed based on methodology, context and type of intervention, outcomes and effects of the interventions. Eleven trials fulfilled the inclusion criteria.
Results
The studies were carried out in a variety of contexts with diverse outcomes. Person‐centred care as an intervention was shown to be successful in eight of the studies. The internal and external validity in the studies were generally good. However, as regards the precision of the studies there was a wide variation.
Conclusions
The value and efficacy of person‐centred care as an intervention have only been studied to a limited extent. Methodological problems in trial design and execution could account for the general lack of research on person‐centred care. Evidence that person‐centred care is effective is insufficient, more stringent studies are needed.
Relevance to clinical practice
The results suggest that person‐centred care may lead to significant improvements, but the implementation and relevant effects needs to be assessed in more studies.
Aims and Objectives
To determine nurses’ perceived barriers to the delivery of person‐centred care to complex patients with multiple chronic conditions in acute care settings.
Background
Complex ...patients have multiple physical and mental health problems, and their life is also greatly affected by sociocultural and economic determinants of health. These patients require person‐centred care, but nurses often find it challenging to provide effective care to these patients due to their complex health needs.
Design
A descriptive qualitative design was used. The COREQ guidelines were followed for reporting.
Methods
Semi‐structured interviews were conducted with a purposive sample of 19 nurses in two hospitals. Data were analysed using deductive thematic analysis guided by the Theoretical Domains Framework, which entails 14 domains about factors affecting behaviours.
Results
The key barriers were identified under environmental context and resources, social influences, emotions, knowledge and skills domains. Deep‐rooted social issues delay patients’ health‐seeking and nurses’ abilities to understand patients’ needs and discern appropriate care. Interpersonal hostility influenced nurse–patient–families interactions, and doctor–nurses conflicts affected collaborative efforts towards optimal care.
Conclusions
Nurses’ perceived barriers to care were intertwined with the deep‐rooted social and cultural beliefs about nurses’ image, patients’ expectations and families’ preference for home remedies over specialised nursing care. These barriers to person‐centred care demonstrate an intricate interplay of personal, social and organisational issues and power struggles. Multifaceted implementation strategies targeting environmental context and resources, social influences, emotions, knowledge and skills domains may be beneficial to enable nurses to provide better person‐centred care to complex patients.
Relevance to clinical practice
Designing implementation facilitation teams, organising person‐centred care grand rounds, and allocation of stress management resources to address hostility, social‐cultural influences, and organisational barriers is essential. Nurses could focus on their self‐awareness and collaborative skills to address emotional and interprofessional conflicts.
People who use drugs often continue to use drugs while in hospital. However, health‐care systems often expect abstinence from drugs as a condition of engagement in various services. This commentary ...piece proposes that this approach is inconsistent with the principles of person‐centred care. A harm reduction‐based approach in conjunction with collaboration of people who use drugs is proposed as a model for providing person‐centred care to people who use drugs during hospital‐based treatment.
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