In order to determine the relationship of a patient-centered care (PCC) model, as a framework for best practice, measurement can be achieved by using recurring themes as outcome correlates. As mentioned by Ortiz (2018) in his article regarding PCC, patients, who experienced respect, accommodation, recognition, and support, was a chosen group of substantiating markers for desired outcomes. Additionally, these outcomes were reported frequently (Ortiz, 2018). What does this mean?
Family Nurse Practitioners (FNP’s) are accountable for the design, and implementation of health care plans. The PCC is a tool for FNP’s to consider patient needs. For example, if an individual seeking treatments states that he – or she – does not take Lasix, because it makes them urinate too often, the FNP should acknowledge this statement and determine what measures can be taken to fix the situation. This improves the situation in a few ways.
Psychologically and socially, this action displays caring, respect, and mindfulness. Potentially, the patient may become: more willing to comply; more likely to adhere to care plans; more willing to share communication; and have a better feeling about the plan. This can be demonstrated in an individual’s need for interpersonal relationships, and emotional support, which was shown to be a noteworthy 85% recurring rate of mention in one qualitative sample study (Malgorzota & Jan, 2018).
The opposite of PCC would be to ignore the patient’s concern, and say something like: “You have to take Lasix or … (insert bad consequence here).” This creates a loss of control and an air of indifference. It is difficult to trust a FNP with something as important as health, while feeling neglected – latent or not. Further, it most likely will not change the patient’s willingness to take Lasix over the long-term.
In light of a chronic condition, a more desired response might be: “Perhaps I can get you access to a bedside commode, and/ or a home healthcare evaluation. Does that sound like something you might try?” This offering of choice would give the individual control of the situation, and improve the likeliness of synergistic efforts. There is research that corroborates these examples.
PCC can be implemented on a micro scale in the example mentioned above, and on a larger scale if incorporated into company culture. On a larger scale, PCC would demand encouragement and training for employees. According to Liberati, Gorli, Moja, Galuppo, Pipamonti, and Scaratti (2015), caregivers should “negotiate” to determine a plan. This sustains the idea that PCC models are inclusive of specific patient needs. Additionally, PCC outcomes include: internal knowledge generation, and actionable knowledge on a macro level (Liberati, Gorli, Moja, Galuppo, Pipamonti, and Scaratti, 2015).
Further, on a macro-level, patient satisfaction is measured through close-ended patient surveys such as Hospital Consumer Assessment of Healthcare Providers and Systems Surveys (HCAHPS). These measures show a positive correlation with patient satisfaction based on PCC care (Uribe & Schub, 2018). This is desirable. However, there are some considerations, which need to be reviewed.
HCAHPS are mandated at a macro-level to govern micro-level interactions, which have specific variables, which cannot be accounted for within surveys. For instance, because of the importance of the Health Insurance Portability and Accountability Act (HIPAA), health care providers may not share other patients’ information, and in fact take measure to protect privacy. It is clear that adherence of HIPAA is paramount to maintain ethical operations, but because of this, transparency is not possible. A patient asking a nurse: “What took so long?” may get an answer like: “I was with another patient.” This is because the provider is in essence adhering to HIPAA. Is this a marginal occurrence?
Other possible barriers to PCC – as it is measured by HCAHPS – include: acuity of patients, nurse to patient ratio, support from management, staffing, and etc. There may also be pressure from management to implement selected PCC attributes systematically. This is counterproductive and counterintuitive, because customization is not a systematic action. This barrier calls for revision of framework implementation for true synergy from the genesis of nursing and patient perspectives. In other words, a survey completed by a nurse should be included for each survey completed by a patient to gauge the relationship between perceptions.
Ultimately, PCC is recommended by multiple research studies. It is recommended on both macro and micro-levels, and shows a positive correlation to patient-satisfaction. With this in mind, we must address how effective implementation can be improved by truly analyzing barriers toward true PCC practice, and avoiding engineering survey targeted perceptions. What is truly the root cause and solution for improved healthcare? Is it a script or patient-centered care? Is it possible for nurses to carry out PCC with the available resources?
References
Liberati, E. G., Gorli, M., Moja, L., Galuppo, L., Ripamonti, S., & Scaratti, G. (2015). Exploring the practice of patient centered care: The role of ethnography and reflexivity. Social Science & Medicine, 13345-52. doi:10.1016/j.socscimed.2015.03.050
Małgorzata, N., & Jan, C. (2018). The Structure of Character Strengths: Variable- and Person-Centered Approaches. Frontiers In Psychology, Vol 9 (2018), doi:10.3389/fpsyg.2018.00153/full
Uribe, L. M., & Schub, T. B. (2018). Patient Satisfaction and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey. CINAHL Nursing Guide.