Differentiation between two healthcare concepts: Person-centered and patient-centered care

In Pursuit of a Person-Centered Approach to Care Delivery: A Qualitative Descriptive Study of the Patient Experience of a Long-Term Conditions Clinic in General Practice

Innovative ways of working are emerging in health care to meet the complex needs of people living with multiple long-term conditions. While these initiatives are often measured for their health and economic outcomes, few studies prioritize the patient experience. This qualitative descriptive study is one of a few studies exploring the patient experience of attending a dedicated long-term conditions annual review clinic in a primary care setting in England. The service model aims to provide a person-centered, holistic approach to the management and support of people living with multiple long-term conditions. The study presents findings from in-depth interviews with 12 participants. Data analyzed through framework analysis revealed four themes relating to the patient experience: the clinic as a place, continuity, staying healthy, and partnership opportunities. Results highlight the challenges to providing personalized care. We found that attendance at the clinic prompted self-care behaviors, however, patients wanted a more holistic, integrated, and consistent service that provided continuity of therapeutic relationships that involved them in decision-making and care planning. We conclude that the experience of patients in this study suggests this service model can enable patients to manage their health and improve well-being, however, while a person-centered philosophy may underpin service models, our research shows that ensuring this philosophy is born out in service delivery and recognized by patients is problematic. Therefore, service providers need to recognize the values and perspectives of patients, aligning these with the design and delivery of services.

Community perceptions of a biopsychosocial model of integrated care in the health center: the case of 4 health districts in South Kivu, Democratic Republic of Congo

BACKGROUND

Biopsychosocial care is one of the approaches recommended in the health system by the WHO. Although efforts are being made on the provider side to implement it and integrate it into the health system, the community dynamic also remains to be taken into account for its support. The objective of this study is to understand the community's perceptions of the concept of integrated health care management according to the biopsychosocial approach (BPS) at the Health Center of a Health District and its evaluation in its implementation.

METHODS

This cross-sectional study was done in six Health Areas belonging to four Health Districts in South Kivu, DRC. We conducted 15 semi-directive individual interviews with 9 respondents selected by convenience, including 6 members of the Development Committees of the Health Areas, with whom we conducted 12 interviews and 3 patients met in the health centers. The adapted Normalization MeAsure Development (NoMAD) tool, derived from the Theory of the Normalization Process of Complex Interventions, allowed us to collect data from November 2017 to February 2018, and then from November 2018 to February 2019. After data extraction and synthesis, we conducted a thematic analysis using the NoMAD tool to build a thematic framework. Six themes were grouped into three categories.

RESULTS

Initially, community reports that the BPS approach of integrated care in the Health Centre is understood differently by providers; but then, through collective coordination and integrated leadership within the health care team, the approach becomes clearer. The community encouraged some practices identified as catalysts to help the approach, notably the development of financial autonomy and mutual support, to the detriment of those identified as barriers. According to the community, the BPS model has further strengthened the performance of health workers and should be expanded and sustained.

CONCLUSIONS

The results of our study show the importance of community dynamics in the care of biopsychosocial situations by providers. The barriers and catalysts to the mechanism, both community-based and professional, identified in our study should be considered in the process of integrating the biopsychosocial model of person-centered health care.

Creating Whole Person Health Care Systems: Understanding Employee Perceptions of VAs Whole Health Cultural Transformation

Objective: Whole person health care, like that being implemented in the U.S. Veterans Health Administration (VHA), involves person-centered approaches that address what matters most to patients to achieve well-being beyond the biomedical absence of disease. As whole health (WH) approaches expand, their integration into clinical practice is predicated on health care employees reconceptualizing practice beyond find-it-fix-it medicine and embracing WH as a new philosophy of care. This study examined employee perspectives of WH and their integration of this approach into care. Design: We conducted a survey with responses from 1073 clinical and 800 nonclinical employees at 5 VHA WH Flagship sites about their perceptions and use of a WH approach. We used descriptive statistics to examine employees' support for WH and conducted thematic analysis to qualitatively explore their perceptions about this approach from free-text comments supplied by 475 respondents. Results: On structured survey items, employees largely agreed that WH was a valuable approach but were relatively less likely to have incorporated it into practice or report support within their organization for WH. Qualitative comments revealed varying conceptualizations of WH. While some respondents understood that WH represented a philosophical shift in care, many characterized WH narrowly as services. These conceptualizations contributed to lower perceived relevance, skepticism, and misgivings that WH diverted needed resources away from existing clinical services. Organizational context including leadership messaging, siloed structures, and limited educational opportunities reinforced these perceptions. Conclusions: Successfully transforming the culture of care requires a shift in mindset among employees and leadership alike. Employees' depictions didn't always reflect WH as a person-centered approach designed to engage patients to enhance their health and well-being. Without consistent leadership messaging and accessible training, opportunities to expand understandings of WH are likely to be missed. To promote WH transformation, additional attention is needed for employees to embrace this approach to care.

Spirituality in Critical Care: An Observational Study of the Perceptions of Professionals, Patients and Families, in Spain and Latin America

This research aims to describe the perspectives of health care professionals, patients, and family members regarding spiritual care options in intensive care units (ICUs). Participants were recruited consecutively from January to August 2019, during which time data collection was conducted. A total of 1211 Spanish-language questionnaires were collected from 41 ICUs in Spain and Latin America. Approximately 655 participants worked as ICU professionals (74.5% of these participants were women, and 47.5% were nurses). Additionally, 340 questionnaires were sent to patients' families, and patients completed 216 questionnaires; 59.7% of these participants were men, and their mean age was 59.4 years. Most (69.7%) of the critical care professionals considered this type of care to be a part of their profession, 50.1% did not feel competent to provide this type of care, and 83.4% felt that training in this area was necessary. Most families (71.7%) and patients (60.2%) felt that spiritual suffering occurred during their stay in the ICU. The results of this study suggest a perceived deficit in spiritual care in ICUs.

Voice of persons with a life-limiting illness in conversation with healthcare professionals: systematic review and meta-synthesis

BACKGROUND

Healthcare organisations are transforming the way care is delivered to people with a life-limiting illness with an increased focus on recognising the voice of the persons experiencing the illness and putting them in the centre of decision-making. However, the clinical practice remains largely based on the views of healthcare professionals and families or carers of the person with the illness.

OBJECTIVES

To synthesise the best available evidence on the experience of persons living with a life-limiting illness about expressing their voice during communication with healthcare professionals.

DESIGN

Systematic review and meta-synthesis.

DATA SOURCES

CINAHL, Embase, Medline, PsycINFO, ProQuest Dissertations and Theses.

REVIEW METHODS

A structured search was conducted to identify qualitative studies that reported on the experience of persons living with a life-limiting illness. The methodological quality of included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. The review was undertaken using the JBI and PRISMA guidelines.

RESULTS

The expression of the voice of persons living with a life-limiting illness is influenced by: (1) the uncertain future surrounding illness trajectory and prognosis; (2) what is known from experience, media, family and friends; (3) emotional and psychological factors and (4) control and personal autonomy.

CONCLUSIONS

In the early stages of a life-limiting illness, the voice of those experiencing the disease is not always audible. Instead, this voice is potentially present but silent and carried and promoted within healthcare professionals' values of accountability, professionalism, respect, altruism, equality, integrity and morality.

Person-centred care competence and person-centred care climate described by nurses in older people's long-term care-A cross-sectional survey

BACKGROUND

Person-centred care requires that nurses are competent in this approach to care. There may be an association between person-centred care competence and person-centred care climate, but it has not been demonstrated in the literature. This is the justification for the survey study to gain staff's perceptions of such a relationship.

OBJECTIVES

The aim of this study was to analyse the levels and associations between person-centred care competence and the person-centred care climate as assessed by professional nurses in long-term care settings for older people.

METHODS

A descriptive cross-sectional survey design with cluster sampling was used to recruit professional nurses of different levels from six long-term care institutions for older people. Data were collected using the Patient-centred Care Competency scale (PCC) and the Person-centred Climate Questionnaire staff version (PCQ-S) in September 2021 and analysed with descriptive and inferential statistics.

RESULTS

The mean score on the PCC was rated at a good level of 3.80 (SD 0.45), and the PCQ-S was rated at a good level of 3.87 (SD 0.53). The correlation between PCC and PCQ-S total scores (r = .37, p < .001) indicated that person-centred care competence and person-centred care climate were associated. No associations were detected between nurses' educational levels and PCC (p = .19) or PCQ-S (p = .13) or in terms of age or work experience.

CONCLUSIONS

The results provide insights into competence and climate levels of person-centred care and preliminary evidence of an association between nurses' assessed competence in person-centred care and the perceived person-centred care climate in long-term care. Nurses' individual characteristics did not appear to affect the level of person-centred care competence or climate. In the future professional nurses of different levels could benefit from effective continuing education in person-centred care. This study design serving for the future intervention study registered to the ClinicalTrials.goc NCT04833153.

Development of a Mixed Hypnosis and Music Intervention Program for the Management of Pain, Anxiety, and Wellbeing in End-of-Life Palliative Care

Background

The palliative care people present needs that can be partially met by complementary intervention. Approaches based on the use of hypnosis and music are increasingly being studied and have shown potential benefits on pain, anxiety, and wellbeing for many populations including those in palliative care.

Objective

This study aims to present the initial process of creating and refining a hypnosis and music intervention program intended for persons in palliative care, with a panel of experts of diverse relevant backgrounds. It also aims to evaluate its feasibility, preliminary acceptability, and content.

Methods

To achieve the objectives, we followed ORBIT recommendations for the development and redesign of behavioral interventions (phase I a-b). Based on a meta-analysis, reference interventions were identified and then adapted to the target population. Twenty-two experts from different backgrounds were consulted to obtain their evaluation on the acceptability, feasibility, and content of the interventions.

Result

The various components of the program were deemed appropriate or very appropriate by over 80% of the experts. However, possible risks were raised related to some uncertainty about the reactions of individuals to the intervention. Several experts (32%) indicated potential adverse effects consisting of negative emotional experiences during the sessions. Modifications were proposed specifically to reduce or mitigate this risk. Over 90% of the experts considered that the revised program provides a safer and more appropriate intervention for palliative care persons.

Conclusion

A mixed intervention program with hypnosis and music has been developed and attained a high level of consensus by the experts. The proposed intervention is ready to be assessed for clinical efficacy in a pilot study (ORBIT Phase II).

Patient-centeredness in the multimorbid elderly: a focus group study

Background

 Patient-centeredness (PC) aims to adapt health care to the individual needs and preferences of patients. An existing integrative model of PC comprises several dimensions of PC which have not yet been investigated from the patients’ perspective. Older patients with multimorbidity represent a target group for patient-centered care, as their care needs are particularly complex and should be addressed individually. We aimed to assess the perspective that older patients with multimorbidity have of patient-centered care and to examine the transferability of the integrative model of PC to this specific population.

Method

We performed 4 guided focus group interviews with a total of 20 older individuals with multimorbidity. The focus group interviews were audio-recorded and transcribed verbatim. Patients’ statements were content-analyzed applying an a priori designed system of categories that included the dimensions of PC from the integrative model and the additional category ‘prognosis and life expectancy’, which had emerged from an initial literature search on aspects of PC specific to the multimorbid elderly.

Results

The new category ‘prognosis and life expectancy’ was confirmed and expanded to ‘individual care needs related to aging and chronic disesase’. All dimensions of our integrative PC model were confirmed for older patients with multimorbidity. Among these, we found that eight dimensions (individual care needs related to aging and chronic disease, biopsychosocial perspective, clinician-patient communication, essential characteristics of the clinician, clinician-patient-relationship, involvement of family and friends, coordination and continuity of care, access to care) were complemented by aspects specific to this target population.

Conclusions

The integrative PC model is applicable to the population of older patients with multimorbidity. For a population-specific adaptation, it might be complemented by the dimension ‘individual care needs in aging and chronic disease’, in conjunction with age-specific aspects within existing dimensions. Together with corresponding results from a Delphi survey, our adapted PC model will serve as the basis for a subsequent systematic review of instruments measuring PC in older patients with multimorbidity.

Trial registration

PROSPERO (https://www.crd.york.ac.uk/prospero; CRD42018084057; 2018/02/01), German Clinical Trials Register (www.drks.de; DRKS00013309; 2018/01/23).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02448-8.

Supportive care needs of men with prostate cancer after hospital discharge: multi-stakeholder perspectives

PURPOSE

This study explored the supportive care needs of men with prostate cancer (PCa) after hospital discharge based on the perceptions of multiple stakeholders.

METHODS

Eight semi-structured focus groups and three individual interviews were conducted between September 2019 and January 2020, with 34 participants representing men with PCa, primary and secondary healthcare professionals, and cancer organizations in western Norway. Data was analysed using systematic text condensation.

RESULTS

Four categories emerged: 1) men with PCa have many information needs which should be optimally provided throughout the cancer care process; 2) various coordination efforts among stakeholders are needed to support men with PCa during follow-up; 3) supportive care resources supplement the healthcare services but knowledge about them is random; and 4) structured healthcare processes are needed to improve the services offered to men with PCa. Variations were described regarding priority, optimal mode and timeliness of supportive care needs, while alignment was concerned with establishing structures within and between stakeholders to improve patient care and coordination.

CONCLUSIONS

Despite alignment among stakeholders' regarding the necessity for standardization of information and coordination practices, the mixed prioritization of supportive care needs of men with PCa indicate the need for additional individualized and adapted measures.

A practice-based model to guide nursing science and improve the health and well-being of patients and caregivers

AIMS AND OBJECTIVES

The purpose of this paper is to describe a model to guide nursing science in a clinical practice-based setting. Exemplars are provided to highlight the application of this nursing research model, which can be applied to other clinical settings that aim to fill evidence gaps in the literature.

BACKGROUND

Nurse scientists are well positioned to develop new knowledge aimed at identifying global health solutions to multiple disparities. The generation and application of this knowledge are essential to inform and guide professional nursing practice. While a number of evidence-based practice models exist to guide the integration of literature findings and other sources of evidence into practice, there is a need for additional models that serve as a guide and focus for the conduct of research in distinct scientific areas in practice-based settings.

DESIGN

Model development and description.

METHODS

Mayo Clinic is a large, comprehensive healthcare system with a mission to address unmet patient needs through practice, research and education. PhD-prepared nurse scientists engage in practice-based research as an integral component of Mayo Clinic's mission. A practice-based nursing research model was developed with the intent to advance nursing research in a clinical setting.

RESULTS

The components of the Mayo Clinic Nursing Research model include symptom science, self-management science and caregiving science. The generation of nursing science is focused on addressing needs of patients with complex health conditions, inclusive of caregivers.

CONCLUSIONS

While clinical settings provide rich opportunities for the conduct of research, priorities need to be established in which to focus scientific endeavours. The Mayo Clinic Nursing Research model may be applicable to nurses around the globe who are engaged in the generation of knowledge to guide practice.

RELEVANCE TO CLINICAL PRACTICE

The Mayo Clinic Nursing Research model can be used by nurse scientists embedded in healthcare settings to address clinically relevant questions, advance the generation of new nursing knowledge and ultimately improve the health and well-being of patients and caregivers.

Continuing education interventions about person-centered care targeted for nurses in older people long-term care: a systematic review

BACKGROUND

Person-Centered Care is often seen as an indicator of quality of care. However, it is not known whether and to what extent person-centered care can be enhanced by continuing education interventions in older people's long-term care settings. This systematic review aimed to analyze and synthesize the existing research literature about person-centered care-based continuing educational interventions for nurses working in long-term care settings for older people.

METHODS

Five databases were searched 6/2019 and updated 7/2020; PubMed (Medline), CINAHL, PsycINFO, Cochrane and Eric using the keywords person-centered car* OR person-centred car * OR patient-centered car* OR client-centered car* OR tailored car* OR resident-centered car* OR individualized car* AND older* OR elder* OR old person* AND Long-Term Care OR Nursing home OR 24-h treatment OR long-term treatment. Twenty-seven full texts from 2587 initially retrieved citations were included.

RESULTS

The continuing educational interventions found were divided into five themes: person-centered interventions focusing on medication; interaction and caring culture; nurses' job satisfaction; nursing activities; and older people's quality of life. The perspective of older people and their next of kin about the influence of continuing education interventions were largely absent. The background theories about interventions, the measurements taken, and the clarity around the building blocks of the continuing-care interventions need further empirical verification. The pedagogical methods used were mainly quite behavioristic mostly lectures and seminars.

CONCLUSION

Most of person-centered care continuing education interventions are effective. Still more empirical research-based continuing education interventions are needed that include learner-centered pedagogical methods, with measurable outcomes that consider the opinions of older people and their next of kin. Continuing educational interventions for nurses need to be further developed to strengthen nurse's competence in person-centered care, job satisfaction and for better quality of care.

Barriers and facilitators in the implementation of bio-psychosocial care at the primary healthcare level in South Kivu, Democratic Republic of Congo

Background

In the Democratic Republic of Congo (DRC), healthcare services are still focused on disease control and mortality reduction in specific groups. The need to broaden the scope from biomedical criteria to bio-psychosocial (BPS) dimensions has been increasingly recognized.

Aim

The objective of this study was to identify the barriers and facilitators to providing healthcare at the health centre (HC) level to enable BPS care.

Settings

This qualitative study was conducted in six HCs (two urban and four rural) in South-Kivu (eastern DRC) which were selected based on their accessibility and their level of primary healthcare organization.

Methods

Seven focus group discussions (FGDs) involving 29 healthcare workers were organized. A data synthesis matrix was created based on the Rainbow Model framework. We identified themes related to plausible barriers and facilitators for BPS approach.

Results

Our study reports barriers common to a majority of HCs: misunderstanding of BPS care by healthcare workers, home visits mainly used for disease control, solidarity initiatives not locally promoted, new resources and financial incentives expected, accountability summed up in specific indicators reporting. Availability of care teams and accessibility to patient information were reported as facilitators to change.

Conclusion

This analysis highlighted major barriers that condition providers’ mindset and healthcare provision at the primary care level in South-Kivu. Accessibility to the information regarding BPS status of individuals within the community, leadership of HC authorities, dynamics of HC teams and local social support initiatives should be considered in order to develop an effective BPS approach in this region.

Person-Centered Care in a Tertiary Hospital Through Patient's Eyes: A Cross-Sectional Study

BACKGROUND

The current trend in healthcare systems around the world is moving towards a person (or patient)-centered care (PCC) model. While some healthcare organizations have only recently embraced the PCC approach, there is no evidence of person-centered care in Saudi hospitals. This study aimed to assess patients' perspectives on the climate of person-centered care and its associated factors in a tertiary hospital in Saudi Arabia.

METHODS

A cross-sectional study design was conducted in 16 inpatient departments at a tertiary hospital in Riyadh, Saudi Arabia. The validated version of the Person-centered Climate Questionnaire-Patient (PCQ-P) was distributed to 300 adult patients admitted to the hospital for more than 48 hours. The patients were interviewed face-to-face, using the PCQ-P. Descriptive and inferential statistical analysis were performed using SPSS (version 22; IBM, NY, USA).

RESULTS

A total of 300 questionnaires were completed. More than half (53%) were females; 39.7% aged 21-40 years; 72.7% married; 49% hold a high school diploma; and 67.4% unemployed. For route of admission into hospital, 39.8% of the respondents were admitted as elective or outpatient appointments, and 45% had been admitted for less than a week. Most patients (84.3%) reported that they preferred to be treated in a governmental hospital. Inpatients' overall mean PCQ-P score was 73 ± 9.988 out of 85. Results suggested significant associations between patient characteristics and their perspectives on person-centered care, such as age (P=0.005), gender (P<0.001), nationality (P=0.026), area of residency (P=0.001), route to admission (P=0.002), length of stay (P=0.003), and hospital preference (P=0.010).

CONCLUSION

Overall, patients' perspective on person-centered care seems positive. Patient and hospital characteristics could play an important role in shaping patients' perceptions of the climate of person-centered care domains.

Recognition and management of agitation in acute mental health services: a qualitative evaluation of staff perceptions

BACKGROUND

Agitation among patients is a common and distressing behaviour across a variety of health care settings, particularly inpatient mental health. Unless recognised early and effectively managed it can lead to aggression and personal injury. The aim of this paper is to explore the experiences of mental health nurses in recognising and managing agitation in an inpatient mental health setting and the alignment of these experiences with best practice and person-centred care.

METHODS

This study used a descriptive qualitative methodology. Semi-structured focus group interviews were conducted with 20 nurses working in a mental health unit in 2018. Nursing staff described their experiences of assessing and managing agitation. Descriptive and Thematic Analysis were undertaken of the transcribed focus group dialogue.

RESULTS

Nurses combined their clinical knowledge, assessment protocols and training with information from patients to make an individualised assessment of agitation. Nurses also adopted an individualised approach to management by engaging patients in decisions about their care. In keeping with best practice recommendations, de-escalation strategies were the first choice option for management, though nurses also described using both coercive restraint and medication under certain circumstances. From the perspective of patient-centred care, the care provided aligned with elements of person-centred care nursing care.

CONCLUSION

The findings suggest that clinical mental health nurses assess and manage agitation, with certain exceptions, in line with best practice and a person-centred care nursing framework.

The professional activities of nurse managers in Chinese hospitals: A cross-sectional survey in hunan province

OBJECTIVE

To explore nurse managers' perceptions of the frequency and importance of professional activities performed in their daily work in public hospitals in Hunan, China.

BACKGROUND

Nurse managers are responsible for the management of almost all nursing activities in Chinese hospitals. Understanding how nurse managers operationalize their role and their perceptions of the importance of each activity is essential for clarification of their role and the competencies required to perform it.

METHODS

A cross-sectional questionnaire survey.

RESULTS

A total of 1,371 nurse managers in Hunan Province completed the survey. Nursing quality/safety management and patient management were performed most frequently and perceived as most important. Nurse managers performed nursing information management frequently while perceiving it as less important. They seldom performed nursing research management and placed low value on it.

CONCLUSIONS

Patient-centred care remains central to nursing management. Nursing managers can create a leadership culture in their hospital settings that includes the effective management of information and facilitation of research knowledge to benefit nurse managers, staff and patients.

IMPLICATIONS FOR NURSING MANAGEMENT

The results provide evidence for standardization of roles and job descriptions of nurse managers and for developing their knowledge and skills to ensure quality patient care.

The Impact of Previsit Contextual Data Collection on Patient-Provider Communication and Patient Activation: Study Protocol for a Randomized Controlled Trial

BACKGROUND

Patient-centered care is respectful of and responsive to individual patient preferences, needs, and values. To provide patient-centered care, clinicians need to know and incorporate patients' context into their communication and care with patients. Patient contextual data (PCD) encompass social determinants of health and patients' needs, values, goals, and preferences relevant to their care. PCD can be challenging to collect as a routine component of the time-limited primary care visit.

OBJECTIVE

This study aims to determine if patient-provider communication and patient activation are different for patient users and patient nonusers of an electronic health record (EHR)-integrated PCD tool and assess if the impact of using PCD on patient-provider communication and patient activation differs for Black and White patients.

METHODS

We describe a randomized controlled trial of a prospective cohort of non-Hispanic White and Black patients who receive primary care services at a midwestern academic health care system in the United States. We will evaluate whether providing PCD through a consumer informatics tool enhances patient-provider communication, as measured by the Communication Assessment Tool, and we will evaluate patient activation, as measured by the Patient Activation Measure for PCD tool users and nonusers. Furthermore, owing to racial disparities in care and communication, we seek to determine if the adoption and use of the tool might narrow the differences between patient groups.

RESULTS

The trial was funded in November 2017 and received local ethics review approval in February 2019. The study began recruitment in April 2019 and enrollment concluded in October 2019 with 301 participants. The analysis was completed in May 2020, and trial results are expected to be published in winter 2020.

CONCLUSIONS

Recently, there has been increased attention to the role of health information technology tools to enable patients to collaborate with providers through the sharing of PCD. The adoption of such tools may overcome the barriers of current EHRs by directly engaging patients to submit their contextual data. Effectively, these tools would support the EHR in providing a more holistic understanding of the patient. Research further supports that individuals who have robust digital engagement using consumer informatics tools have higher participation in treatment follow-up and self-care across populations. Therefore, it is critical to investigate interventions that elicit and share patients' social risks and care preferences with the health care team as a mechanism to improve individualized care and reduce the gap in health outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03766841; https://clinicaltrials.gov/ct2/show/NCT03766841.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/20309.

The Hidden Curriculum and Integrating Cure- and Care-Based Approaches to Medicine

Although current literature about the “cure versus care” issue tends to promote a patient-centered approach, the disease-centered approach remains the prevailing model in practice. The perceived dichotomy between the two approaches has created a barrier that could make it difficult for medical students and physicians to integrate psychosocial aspects of patient care into the prevailing disease-based model. This article examines the influence of the formal and hidden curricula on the perception of these two approaches and finds that the hidden curriculum perpetuates the notion that “cure” and “care” based approaches are dichotomous despite significant changes in formal curricula that promote a more integrated approach. The authors argue that it is detrimental for clinicians to view the two approaches as oppositional rather than complementary and attempt to give recommendations on how the influence of the hidden curriculum can be reduced to get a both-cure-and-care-approach, rather than an either-cure-or-care-approach.

Attributes associated with person-centered care competence among undergraduate nursing students

Person-centered care is widely recognized as a promising practice to improve patient care quality. However, little is known about the competencies of nursing students who are essential to providing high-quality person-centered care. In this study, relevant attributes, including professional nursing competence, empathy, and self-awareness, were examined in relation to person-centered care competence among South Korean nursing students while controlling for individual characteristics, including age, gender, religion, and academic performance. Data were collected from 213 senior students enrolled in four nursing schools in South Korea from November 15 to 30, 2017. The mean age of the nursing students in the sample was 23 years. Data were analyzed using multiple regression analyses while accounting for the students nested in their schools. Professional nursing competence and empathy were strongly associated with person-centered care competence among nursing students. Of the five aspects of professional nursing competence, human understanding and communication skills were the most likely to be associated with person-centered care competence. Moreover, there were few variations across nursing schools in the levels of professional nursing competence. Our findings corroborate the importance of developing better communication skills and empathy to improve and maintain person-centered care competence among nursing students who belong to a new generation.

Scoping review of the person-centered literature in adult physical rehabilitation

PURPOSE

To describe the amount, range, and key characteristics (e.g., publication years, methods, topics) of the person-centered rehabilitation literature in adults with physical impairments.

METHOD

Following the published scoping review protocol, papers were identified through: three major databases, snowball searches and expert consultation. Two independent reviewers have identified English-language papers on adult person-centered rehabilitation according to six pre-defined inclusion categories - theoretical, quantitative and qualitive research papers are included; and then have extracted their key characteristics (e.g., aims, methods, participants). Descriptive statistics, regression and content analyses were used to synthesize the results.

RESULTS

Of 5912 deduplicated records initially screened, 170 papers were included: 136 empirical, including 13 systematic reviews. Empirical papers had data from 15264 clients and 4098 providers, in total. Yearly publications grew significantly from 2009 to 2018 (r² = 0.71; b = 1.98: p < 0.01). Publications were unevenly distributed by countries (e.g., United States' publications per population was 44 times lower than New Zealand's). Most papers focused in more than one profession, setting-type or health conditions. Finally, many empirical papers (n = 67) studied implementation of person-centered rehabilitation approaches, including its effect.

CONCLUSION

This scoping review synthesizes key characteristics and publication trends in the person-centered rehabilitation literature on adults with physical impairments, a growing but unchartered territory thus far. This large and diverse body of literature can ground further person-centered rehabilitation practices and research, including toward building a transdisciplinary, trans-service model of person-centered rehabilitation.Implications for rehabilitationThe person-centered rehabilitation literature on adults with physical impairments, especially the empirical one, has been growing significantly over time, despite inequitably distributed per countries.Rehabilitation stakeholders, including practitioners, have a growing amount of literature in which they can rely for the operationalization and implementation of person-centered rehabilitation approaches into routine practice.Based on our work, person-centered rehabilitation emerges as a practice requirement that cuts across professional and other rehabilitation silos.

Factors that may promote the learning of person-centred care: an ethnographic study of an implementation programme for healthcare professionals in a medical emergency ward in Sweden

While person-centred care has gained increasing prominence in recent decades as a goal for healthcare systems, mainstream implementation remains tentative and there is a lack of knowledge about how to develop person-centred care in practice. This study therefore aimed to explore what may be required in order for person-centred care programmes to be successful. The study used an ethnographic method of data collection. This consisted of closely following an implementation programme on a medical emergency ward in a Swedish hospital. Data consisted of participant observation and informal interviews with healthcare providers and their management leaders while they were in the process of training to use person-centred care. These interlocutors were using action learning methods under the guidance of facilitators. Our findings revealed that although the programme resulted in some of the processes that are central for person-centred care being developed, organisational factors and a lack of attention to ethics in the programme counteracted these positive effects. The study highlights the importance of facilitating mechanisms to produce desired results. These include management leaders' learning about the dynamic and collective nature of learning processes and change. They also include allowing for inter-professional dialogue to enable managers and professionals to reflect deeply on professional boundaries, disciplinary knowledge and power relations in their teams. Teamwork is essential for the development of person-centred care and documentation, in accordance with this specific implementation programme, is also indispensable. The space for inter-professional dialogue should also accommodate their various perspectives on the aims of care and organizational reality.

Stepping outside the consultation room. On nurse-patient relationships and nursing responsibilities during a type 2 diabetes walking project

AIMS

To examine the care practices of nurses during the organization of 20 weeks of walking sessions for people with type 2 diabetes and to reflect on implications for nurse-patient relationships and nursing responsibilities in the provision of physical activity (PA) care.

DESIGN

Qualitative, ethnographic study.

METHODS

Almost 70 hr of field work was completed by participant observations and informal conversations with nurses and participating patients of two different walking groups (April-October 2016). Analysis of field notes followed an inductive holistic-content approach, using both within-case and across-case analysis.

RESULTS

The analysis revealed four main themes related to the nurses' care practices: (a) organizational efforts; (b) combining group and individual care; (c) stepping in- and outside the patient mode; and (d) implications back inside the consultation room. Underlying these themes was a process of relational development, both with and among patients.

CONCLUSION

Stepping outside the consultation room seems to offer more space for patients' lifeworld narratives and contribute to more continuous and person-centred care. However, it also raises new questions about the provision of PA care and nursing responsibilities in this.

IMPACT

Current nursing repertoires for PA counselling in type 2 diabetes care are insufficient and might be extended by organizing walking sessions for patients. Related nursing care practices impacted relationships both with and among participating patients. These have consequences for boundaries of both nursing responsibilities and care provision.