1) Describe the evolution of person-centered care as a focal point in healthcare delivery.

2) Describe factors impacting the importance of person-centered interactions within the healthcare system.

3) Evaluate the impact of effective person-centered care in fostering patient engagement.

4) Appraise the major responsibilities of nursing in relation to the promotion of person-centered care.

Case study with questions:

Sarah, the director of nursing (RN-DON), has 24-hour accountability for an 80-bed, long-term care facility. In addition to Sarah, who is an experienced manager and clinician, a full-time geriatric nurse practitioner just joined the staff a week ago and is being oriented at the facility's main offices across town. The facility ensures 24-hour coverage by registered nurses. Licensed vocational nurses (LVNs) work 12-hour shifts as charge nurses. Most medications are administered by one of the LVNs. Certified nurse aides, chaplains, housekeepers, and dietary personnel compose the rest of the staff. A medical director provides on-call services and visits the facility at least once a week for several hours. Additionally, the facility contracts for services from physical therapists, occupational therapists, and social workers.

One of the primary concerns that Sarah has is patient safety. In the past 2 months, the medication error rate has increased. The charts are kept at the nursing station in a secured area and are in paper format only. The pharmacist reports that more than 700 different medications have been supplied to the facility during the past month. Review of medication incident reports shows that most of the errors were caused by the interactions of, or adverse reactions to, medications that were prescribed by various physicians who have been seeing a large number of residents for the first time as the result of influenza complications. Pharmacists from a contracted agency visit the facility once a week to review residents' charts for the appropriateness of medications prescribed.

The facility has a quality review committee that meets every month to review events of the past month, including follow-up of any unusual incidents.

 

1. Is a change needed? What is the perceived problem? What standards will support and guide any change that may be needed?

2. If you were Sarah, what kind of assessment would you complete? What framework or strategy would you use initially to collect data comprehensively about the factors in the change situation? What questions would you ask?

3. At what point would you involve other individuals, and why? How would you apply systems thinking to this issue?

4. Would you consider this a low- or a high-complexity change situation? What change management approaches will probably be needed? Justify your selections.

5. Whom do you perceive as potential change agents who will champion patient safety measures associated with the medication administration system in the facility?

6. What is the role of staff followers in this situation?

7. How will you select appropriate strategies that will relate to the behavioral styles and responses of the staff and the major players and allow for optimal constructive participation in this situation?

 

Answer:

• Person-centered care involves providing care to a client, handling a client accessing care with respect and worth, and engaging clients in all decision-making procedures concerning their wellbeing. It is equally referred to as patient-centered care since it is associated with an individual's medical care rights.

Question 1.

Evolution of person-centered care in care delivery

The foundations of some basic guidelines within the concept of patient- and person- centeredness go way back to the old enlightenments that ideologized wellbeing entirely and considered dignity for people as a vital merit. It is just recently that each perception has been brought out as a separate term, but the definitions and evaluation of the emergence of these ideas differ among authors. In the United Kingdom and Canada, the phrase person-centered therapy and person-centeredness are connected to overall practice and family therapy. This is according to Balint in 1960s, who explained patient-centeredness in healthcare in the case of the doctor-patient experience, suggesting that doctors should comprehend the patient holistically, recognizing their uniqueness. The same adjustments were seen in Europe, France, Switzerland and Sweden, about mid-twentieth century. In America, the care mechanism can be linked to the patient rights initiative from nineteen sixties, and the evolution of the idea is evident in various disciplines of healthcare, starting from patient-care, to healthcare legislation, healthcare education and efficacy affirmation in care delivery (Laine & Davidoff, 1996). Nevertheless, nursing practice has adopted and embraced the concept of patient-centered care and connected it profoundly to the perception of caring., tracking its roots to Florence Nightingale and the origination of contemporary nursing. The primary concentration in all these efforts is the patient, contrasting the medical view which focuses more on the illness. Carl Rogers greatly impacted the medical field in 1940s when he emphasized on comprehension of the interaction between the medical experts and the patient in developing a medical relationship as a vital element of person-centered care. Corporations that depended entirely on a command-and-control approach of governance had low chances of offering person-centered care in relation to those organizations that adopted shared leadership. Conclusively, the notion has advanced and grown over time having diverse vocabularies, descriptions and vast spheres debated in the medical field globally.

 

Question 2

Factors impacting the relevance of person-centered interactions in healthcare.

• The level of cooperation between care providers and patients
• Establishing a person-centered-care system that promotes productive relationships and efficient collaboration between clients and clinicians. Person-centered care boosts healthcare results when there exist a strong and authentic bond between care providers and their clients, this bond is vital to enhance trust between patients and their care-givers. Trust in healthcare plays an essential role when it comes to clients sharing their confidential health information with the physicians. Information from clients makes it easy for healthcare providers to recommend appropriate therapeutic interventions which boosts health outcomes.
• Knowledge of the patients on therapeutic preferences and dedication to handling their own health.
• Patient-centered-care results to productive health outcomes when the patients are informed and can comprehend their desirable therapeutic interventions and their desire and dedication to manage their health status. In this context, the care providers play the role of interpreters for the client's signs and symptoms, and interacts with the patients as an associate in the effort to better their wellbeing for on long-term basis.
• Dedication by medical practitioners to attain the healthcare requirements of clients within the scope of their sickness encounter.
• Patient-centered-care contributes to successful health outcomes when the medical staff are committed in their service delivery. Dedication, devotion and determination of healthcare providers is a very significant factor in establishing a productive person-centered-care mechanism in a facility. When doctors are committed in putting patient needs first, the patient-centered-care system becomes of high value in healthcare facilities. Lack of dedication among healthcare staff will lead to inefficiencies in person-centered-care hence lowering its significance.
•  Continuous training of the medical staff on person-centered-care delivery.
• Consistency in training the healthcare practitioners will make them upgrade their skills thus impacting the patients directly through the services delivered in patient-centered-care. employees must always be updated on the emerging trends in the care setting to ensure quality service delivery. Clinicians should be educated on the technological advancements, new therapeutic interventions, improved ways of conducting research, appropriate communication approaches etc. this is an essential role for administrators to ensure effectiveness and efficiency bin service delivery. As a result, patient-centered care boosts health outcomes of patients.  Failure to adopt this strategy will lead to low quality services in person-centered-care settings due to use of obsolete mechanisms.

 

• Involving interdisciplinary team mechanism in care delivery.
• The multi-disciplinary team enhances the efficacy of care because all the independent medical experts combine their unique skills while involving the client, to develop the best healthcare interventions that will help in boosting patient-satisfaction in person-centered-care. This is crucial in patient-centered-care because it makes the patient feel involved and appreciated in the intervention. The technique is effective since the decision-making process is not biased as the patient is not coerced to make decisions, they make their decisions autonomously. Without involving the interdisciplinary team, it would be hard to attain productive outcomes in person-centered-care.

Question 3

Impact of person-centered-care on patients' involvement

• It has led to patients being integrated in the decision-making process during therapeutic interventions, as a result, it has promoted the aspect of autonomy on patient's side as they can regulate access to their bodies. This is evident where the patient-centered-care mechanism has incorporated the interdisciplinary team in care delivery. Patients are invited to contribute in the decision-making process, this has positive impact on health outcomes because it provides patient-contentedness.
• The initiative has enabled patients to realize and establish their personal strengths, weaknesses hence encouraging them to adopt and embrace independence in accomplishing healthy lifestyles.
• Patients have learnt to accommodate their psychological, physical and social requirements and those of the care providers as a way of replicating the compassion shown to them by the care providers through the person-centered-care initiative.
• The initiative has enhanced development of authentic relationships between patients and clinicians thus enabling patients trust the care providers with their confidential health information that has helped in improving the quality of care.

 

Question 4.

Evaluation of key responsibilities of nursing in patient-centered care

1. Nurses are obliged to ensure dignity in providing care

• The person-centered-care initiative emphasizes on the relevance of dignity and honor in providing care for clients by nursing practitioners. Honor comes in different perspectives, then nurse must respect the patient's religious beliefs, cultural norms, personal opinions and spiritual preferences. Additionally, nursing ethical standards require nurses to adhere to the simple demands by clients for an enabling environment in the care setting, this has to do with things like offering comfort and being friendly to the patient.
• Creating an enabling environment for patients is necessary to ensure comfort of the patient, it is a therapy on its own, it can be done through music therapy, providing sources of natural light etc.
• Treating clients with respect earns the care providers trust and respect from patients which improves quality of care.

1. Providing mentorship services to next generation colleagues

• Nurses are expected to show care by passing the knowledge to their successors in the profession to ensure they leave behind an endowment of proficiency and patient contentedness in their sphere of professionalism. This will help in ensuring consistency in the quality of care provided under patient-centered-care mechanism because the level of knowledge will keep growing hence improving healthcare outcomes.

1. Improving your skills and knowledge on the basics of person-centered-care in nursing.

• Nurses are expected to advance their education through learning the essential elements of person-centered-care because the initiative is core in healthcare systems and it keeps evolving progressively, as a result, nurses must upgrade their knowledge in the field to ensure the efficacy of care through adjusting with the changing needs of patient-centered-care system. By embracing this criterion, nurses will achieve diversity in service provision.

1. Embracing team collaboration in service provision

• To achieve quality in care delivery, there is need for nurses to exercise teamwork and collaboration in patient-centered-care, by putting the patient needs first. It is ethical to put public interests first as a nurse practitioner to avoid biasedness in service delivery. Nurses must be team-driven to attain the efficacy of care and satisfaction of patients.  If nurses understand the relevance of their responsibilities in the general provision of care, then the overall performance will be higher.

1. Informing patients about their conditions

•  In patient-centered-care, nurses are expected to provide patients with the accurate information concerning their health status. Nurses are recommended to involve family members of the client in the process when the patient is experiencing severe pain or when they are afraid of their condition. It is important to prioritize patient-security in in matters of therapeutic interventions.  The nurses' clinical information and expertise is crucial in ensuring precision and comprehension of the right actions to take.

SECTION II

CASE STUDY

Question 1

• Yes, the facility needs to change their prescription physicians and the technique of presenting their medication chart to staff.
• The perceived challenge is increased rate in the medication errors.

Standards to provide guidance for change.

• The professional competency of the physicians who prescribed the medication for the patients.
• Ethical guidelines of the organization
• The intention of the care provider
• The quality of healthcare outcomes after the medical intervention.
• Evidence indicating responsibilities undertaken by each department.

Question 2

• The Chart/medical record audits assessment - this will be used to assess how the medication processes, the clinical execution and the connected patient health outcomes.

• Direct observation and interviews

Questions I would ask

• Have you undergone the full medical training on drug prescription?
• Did you read the guidelines before administering the medication?
• Were there metric or other dosing unit errors?
• What initiative did you take after realizing your mistake?
• How long have you participated in the medical prescription exercise?

Question 3

• When implementing policy and practice principles to promote and assist in the use of Health Information Technology systems in tackling medication errors and negative use of medicine.
• I would invite other entities because the process of policy making is complex and strenuous. Executing it alone will expose it to errors, but as a group, it will be easy to break it down and obtain quality.

How I would apply mechanisms in line with this issue

• I will integrate the efforts of the interdisciplinary team with the National Quality Strategy Framework to provide guidance for the implementation of policies and nursing practice principles to promote and assist in the use of Health Information Technology systems in tackling medication errors and negative use of medicine within the facility.

Question 4

• High-complexity change scenario.

Justification

The redesigning process is involving other stakeholders to enable role-sharing and breaking down the complex sections of the initiative to be executed. The restructuring process will involve the interdisciplinary team, the National Quality Strategy Framework and the Health Information Technology systems in formulating a long-term solution for tackling medication errors and negative use of medicine within the facility.

• The Structural mechanism

Justification

The adjustments to be made will concentrate on tasks, the flow of jobs and restructuring of the organization in different spheres, with the objective of promoting quality in performance and morale among staff.  Conclusively, I will apply evidence-based approach in care delivery to ensure accountability to improve performance.

Question 5

• Sarah is the key person as a manager in the facility. Leaders are always the pacesetters in any organization conducts a 24-hour surveillance in the facility, she is thus better placed to make changes.
• The review committee. They do quality work by meeting once per month and conduct a monitoring exercise of unusual occurrences in the facility. Using the information from the tracked records, the committee can improve the quality of service in the facility.
• The pharmacists from the contracted agency. They do weekly visits to assess the resident's charts to ensure effectiveness in medical prescriptions. This makes the physicians in the facility to offer quality prescription services because of the pressure from the agency officers.
• The medical director who visits the facility at least once in a week.
• Registered nurses who provide twenty-four-hour surveillance. They should be responsible for everything happening in their units within the facility.
• The full-time geriatric nurse.

Question 6

The review committee

• Monitoring events within the facility that are out of the ordinary.

Sarah the Director

• Ensuring employees in the facility are responsible and accountable of the tasks executed.
• Guiding the staff members and overseeing their task execution as a leader.
• Ensuring patient safety within the facility.

The pharmacist from the contracted agency

• Reviewing resident's medical charts to ensure the medical prescriptions to the residents are effective and accurate.

 

Question 7

• By applying ethical standards and guidelines to identify the appropriate and recommended strategies in the healthcare fraternity.
• By engaging the staff members at all levels to win their support and compel them to the adjustment effort and aid in tailoring the practices in quality medical interventions.
• Researching on similar previous occurrences in a healthcare facility and borrowing the appropriate mechanisms that were used to solve the challenge effectively.
• Involving experts from different spheres that can provide appropriate assistance in the scenario to come up with the best strategies that will gain support from the entire team and address the challenges appropriately.
• Assessing techniques that will mitigate practical obstacles to applying the new practices, for instance, limited accessibility to medical resources.
• Conducting research on the effective and efficient techniques that can be applied to ensure maximum compliance and support.

Reference

Ortiz, M. R. (2018). Patient-centered care: Nursing knowledge and policy. Nursing science quarterly, 31(3), 291-295.