Patient-centred care: reality or rhetoric?

A concept analysis of patient-centred nursing in the intensive care unit

AIM

To report an analysis of the concept of patient-centred nursing in the context of intensive care.

BACKGROUND

Clarification of patient-centred nursing in the intensive care unit is important because consensus definition of this concept is lacking. The severely compromised physiological state of these people and the sequelae of this differentiate patient-centred nursing in intensive care from that occurring in other hospital settings. While the broad concept has been analysed, it has not been examined in the context of intensive care.

DESIGN

Concept analysis.

DATA SOURCES

CINAHL, PsycINFO, Medline and PubMed databases (2000-2014) were searched. Peer-reviewed papers were identified and reference lists of relevant articles searched.

METHODS

Walker and Avant's eight-stage approach was used.

RESULTS

Patient-centred nursing in the intensive care unit incorporates antecedents of a physiologically compromised patient requiring biomedical intervention, a professional and competent nurse and organizational support. The concept's defining attributes entail maintenance of patient identity by a compassionate and professional nurse exercising biomedical expertise. Consequences include patient satisfaction, positive patient experience, nurse job satisfaction and better nurse workforce retention.

CONCLUSION

Patient-centred nursing in intensive care is differentiated from other healthcare areas by the particular characteristics of critically ill patients, the critical care environment and the challenging bio-psycho-social demands made on intensive care nurses. Effective patient-centred nursing in this environment promotes beneficial outcomes for patients, nurses and healthcare service. Decision-makers and policymakers should support critical care nurses in this challenging role, to maintain delivery of patient-centred nursing and grow an effective nursing workforce.

The patient's experience of early discharge following total hip replacement

BACKGROUND

Strategies within the public health system to curtail costs, increase efficiency and service utilisation have resulted in reduced hospital stays following elective orthopaedic procedures. Although there are advantages that support the concept of early discharge from hospital, very little is known about how patients manage the transition from hospital to home.

AIM

The aim of this qualitative study was to describe the post-discharge experience of elderly patients following primary total hip replacement (THR).

METHODS

Ten patients, six women and four men, provided descriptions of their experience. Data were collected by face-to-face interviews and the analysis process was based on Giorgi's phenomenological scientific methodology (Giorgi, 1994, 1997, 2000).

RESULTS

The analysis of the data resulted in four themes, namely; an inadequate assessment of suitable adaptive aids and personal needs; personal frustration; coping with the physical and mobility and limited social interaction.

CONCLUSION

Findings from this study demonstrated a need to review the discharge process and implement strategies to prepare patients for the stressors that the participants in this study encountered as a result of their early discharge.