Patient-Centered Care in Nursing: Explained

Patient-centered care in nursing is a philosophy that means putting the holistic needs of the patient at the forefront of your practice. As the name suggests, it prominently involves focusing on the patient’s individual needs, values, preferences, and personal health goals rather than the provider’s conveniences. The core of this concept revolves around seeing your patients as partners in their care rather than passive recipients of treatment.

Core Principles of Patient-Centered Care in Nursing

Providing patient-centered care in nursing requires being intentional about your approach. By implementing fundamental principles, you can provide high-quality, patient-centered care that results in better patient, nursing, and professional outcomes.

1.Respect and Dignity

A significant factor in providing effective patient-centered care is respect. I cannot stress enough how important it is to begin building respect from your first encounter with your patients. In your first encounter, you will perform an initial assessment. It is during this time that you should be open to listening to your patients and encourage them to share their thoughts, feelings, values, needs, and preferences for care. Learning what is important to your patients and respecting those things by working to see their wants and needs are met are two of the most important principles of patient-centered care in nursing.

2.Coordination and Integration of Care

Another key principle in patient-centered nursing care involves multidisciplinary collaboration. While talking with each member of the interdisciplinary team may not be possible, there are ways to make care coordination and integration with all team members possible. One thing I suggest is to work with one member of each discipline to include patient-centered care in the care plan. If members of each discipline provide care work together, you can create a care plan that is individualized to the patient and includes services of each discipline, making the approach more patient-centered.

3.Information Sharing & Awareness

The third principle of patient-centered care in nursing involves creating a sense of awareness for the patient. We inform patients by providing them with essential information and encouraging open communication. Through effective communication, we educate patients.

One strategy I have found effective when implementing this principle is to ask open-ended questions. Asking open-ended questions helps engage patients, encourages them to express their thoughts and feelings, and supports their involvement in shared decision-making.

4.Physical Comfort & Emotional Support

Another key principle in patient-centered care is to provide an environment that promotes feelings of physical comfort. When patients feel comfortable, they are more likely to engage in communicating with you and become involved in decision-making regarding their care. Remove distractions by turning the television off or muting it, close the door or pull the privacy curtain, and ask what you can do to help them feel comfortable.

We must approach patient-centered care with the same courtesy that we expect from providers when we are patients. Simple steps such as providing for privacy or asking direct questions about what makes your patient comfortable can make a big difference in their response to care.

Patients who are sick, hurt, or afraid face the same challenges. As nurses, it is our responsibility to promote emotional support for our patients and alleviate fear and anxiety. You can do this by taking your time and allowing your patients to voice their thoughts and feelings and showing empathy and compassion for what they are experiencing.

5. Involvement of Family and Friends

In most cases, there is no bond stronger or influence greater than the ones we experience with family and friends. Because family and friends are so important, nurses should involve the people in a patient’s circle in their care if the patient gives permission. Involving the people who are most important to patients not only helps the patient but also gives their family and friends a sense of feeling they can make a difference for their loved ones. Additionally, when loved ones become actively involved in patient care, patients are more at ease, which helps improve patient health outcomes.

6. Individualised Care Planning

Individualised care plans, or support plans, are legal documents that outline the agreed treatment for each client. They cover both routine and emergency situations, and as such, you might have one or several care plans for each client.

These documents ensure that every team member knows how to care for the client, including when the unexpected happens. In this way, they can improve the quality and consistency of care while ensuring that the client’s needs and wishes are respected.

7. Continuity of Care

I understand what it is like to have several patients to care for during one shift and the feeling of rushing to get a patient discharged or transferred to another unit or facility. One thing I learned through the years is that during the transition phase of patient care, we can make or break a nurse-patient relationship and impact patient outcomes.

Many patients, especially the elderly or those who are chronically ill, express concern about whether they can provide good self-care after discharge from the hospital or other healthcare facilities. One way to implement patient-centered care in nursing is to follow the principle focused on transition and continuity of care. You can do this by providing detailed information and education to patients regarding dietary needs, medications, and other health maintenance interventions, coordinating ongoing care after the patient is discharged from your care, and providing information about resources the patient can access to find social, financial, clinical, mental, and physical support following discharge.

8. Access to Care

If there is anything I have heard patients consistently say that is of utmost importance to them, it is access to care. No wonder access to care is listed as one of the main principles of patient-centered care in nursing. Access to care means having access to locations where care is provided, such as hospitals, doctors’ offices, and mental health clinics. Access to care also means ensuring easy scheduling, transportation to and from appointments, and help or guidance in ensuring access to services when continuity and transition of care are required.

Benefits:

1. Improved patient satisfaction
2. Enhanced patient outcomes
3. Increased patient safety
4. Better adherence to treatment plans
5. Reduced readmissions and complications
6. Improved quality of life
7. Increased nurse job satisfaction
8. Reduced healthcare costs

Nursing Strategies:

1. Active listening and open communication
2. Assessing patient values and preferences
3. Involving patients in care planning
4. Providing education and support
5. Encouraging self-care and empowerment
6. Using patient-centered language
7. Fostering a supportive environment
8. Collaborating with interdisciplinary teams

Barriers and Challenges:

1. Time constraints and workload
2. Lack of resources and support
3. Communication barriers
4. Cultural and language differences
5. Patient complexity and comorbidities
6. Staff burnout and turnover
7. Organizational culture and policies
8. Technological limitations

Communication Skills Required for Patient-Centered Care

The key communication skills required for a Nurse to effectively deliver patient-centered care are as follows.

1.Active Listening

Active listening forms the foundation of any solid nurse-patient relationship. You should pay full attention to the patient, avoid distractions, and provide appropriate responses to their concerns. In doing so, you are portraying empathy and understanding, which can ease their comfort and willingness to express their feelings and symptoms.

2.Clear and Concise Communication

Equally important is the ability to communicate clearly and concisely. Miscommunications can lead to misunderstandings, errors, and reduced quality of care. While conveying medical information, you should simplify complex medical terminologies into plain language that is easier for your patient to understand.

3.Non-Verbal Communication

Non-verbal cues such as facial expressions, body language, and gestures can heavily influence how your message is received. Reflect a positive attitude, maintain eye contact, and use an open body posture to make your patient feel comfortable and valued. On the flip side, being aware of your patient’s body language can be a valuable tool in assessing their comfort level and understanding.

4.Emotional Intelligence

A high degree of emotional intelligence enables you to understand your patients’ emotional needs and appropriately respond to them. This involves recognizing and managing your own emotions, understanding the emotions of others, and acting in a way that recognizes those emotions. Keeping a patient’s emotions at the forefront of care ensures a more holistic approach to their treatment.

5.Professional Boundaries

A professional boundary must always be maintained when communicating with patients. This means balancing friendliness and approachability with respect, professionalism, and objectivity. Keeping boundaries clear prevents dependent relationships and maintains the focus on safe, effective patient care.

6.Technological Communication Skills

In today’s digital age, you also need to be proficient with technological communication tools. Electronic health records (EHRs), patient portals, and other digital interfaces are used for documenting, sharing, and accessing patient information. Being able to successfully navigate and utilize this technology is crucial to patient care.

Implementing Patient-Centered Care Models:

To ensure you are effectively implementing patient-centered care, you’ll want to adopt various strategies in your daily nursing practice.

Step 1: Assess Readiness

1. Evaluate organizational culture and values
2. Assess staff attitudes and skills
3. Identify existing patient-centered care practices
4. Engage stakeholders (patients, families, staff)

Step 2: Develop a Plan

1. Define patient-centered care goals and objectives
2. Identify target populations and priorities
3. Develop strategies for implementation
4. Establish metrics for evaluation

Step 3: Build Infrastructure

1. Establish patient-centered care teams
2. Develop patient engagement strategies
3. Implement care coordination processes
4. Enhance communication and information sharing

Step 4: Educate and Train Staff

1. Provide patient-centered care education and training
2. Develop skills in communication, empathy, and shared decision-making
3. Foster a culture of continuous learning
4. Support staff well-being and resilience

Step 5: Implement and Evaluate

1. Implement patient-centered care practices
2. Monitor and evaluate outcomes
3. Conduct patient and staff surveys
4. Identify areas for improvement

Patient-Centered Care Models:

1. Planetree Model
2. Picker Institute’s Patient-Centred Care Model
3. Chronic Care Model
4. Medical Home Model
5. Shared Decision-Making Model

Challenges and Solutions:

1. Resistance to change: Engage staff and stakeholders
2. Limited resources: Prioritize and allocate resources effectively
3. Communication barriers: Implement effective communication strategies
4. Cultural and language differences: Provide culturally sensitive care
5. Staff burnout: Support staff well-being and resilience

Implementing Patient-Centered Care in Specific Settings:

Paediatrics:

1. Family-centered care rounds
2. Child life programs
3. Parent-to-parent support
4. Pediatric patient-centered medical homes
5. Adolescent-centered care

Gerontology:

1. Geriatric patient-centered medical homes
2. Age-friendly healthcare initiatives
3. Care coordination for older adults
4. Palliative care for older adults
5. Dementia-friendly care environments

Mental Health:

1. Recovery-oriented care
2. Peer support programs
3. Trauma-informed care
4. Mental health patient-centered medical homes
5. Collaborative care models

Oncology:

1. Patient navigation programs
2. Survivorship care planning
3. Palliative care integration
4. Personalized medicine approaches
5. Cancer patient-centered medical homes

Critical Care:

1. Family-centered care in ICU
2. Open visitation policies
3. Patient-centered communication strategies
4. Pain management and comfort care
5. End-of-life care planning

Rural Healthcare:

1. Telehealth services
2. Community health worker programs
3. Rural patient-centered medical homes
4. Care coordination and case management
5. Health literacy initiatives

Implementation Strategies:

1.Cultivate a Patient-Centered Relationship

Begin by building strong therapeutic relationships with your patients. This involves active listening and offering empathy, thus creating an atmosphere of mutual respect and understanding. Gaining a comprehensive understanding of the patient’s personal history, experiences, and perceptions can aid in delivering personalized treatment plans.

2.Involve Patients in Decision Making

Patients should be included in the decision-making process. Inform them about their health status and discuss all the potential treatment alternatives. Their preferences, values, and needs are important factors in deciding on the best course of action.

3.Coordinate Care

Coordinating care involves collaborating with different healthcare professionals to deliver a seamless healthcare experience to the patient. Make sure to maintain clear communication across different healthcare providers to ensure consistent information flow.

4.Promote Health Education

Educating patients on their health condition not only empowers them to take an active role in their health management but also promotes adherence to treatment plans. Use clear and easy-to-understand language to describe conditions, procedures, or instructions to the patient.

5.Continually Improve Quality of Care

Continuous quality improvement involves assessing and adjusting processes, systems, or roles to provide optimal patient care. Broader system-wide changes may be needed to effectively implement patient-centered care.

REFERENCES

1. How Do Nurses Approach Patient-Centered Care? https://nursingeducation.org/insights/patient-centered-care/
2. Robinson JH, Callister LC, Berry JA, Dearing KA. Patient-centered care and adherence: definitions and applications to improve outcomes. J Am Acad Nurse Pract. 2008 Dec;20(12):600-7. doi: 10.1111/j.1745-7599.2008.00360.x. PMID: 19120591.
3. Fix GM, VanDeusen Lukas C, Bolton RE, Hill JN, Mueller N, LaVela SL, Bokhour BG. Patient-centred care is a way of doing things: How healthcare employees conceptualize patient-centred care. Health Expect. 2018 Feb;21(1):300-307. doi: 10.1111/hex.12615. Epub 2017 Aug 25. PMID: 28841264; PMCID: PMC5750758.
4.  Darby Faubion RN, BSN, MBA What is Patient-Centered Care in Nursing? https://www.nursingprocess.org/patient-centered-care-in-nursing.html#

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