SNPG903 Developments Nursing Care

Introduction:

Person centered care is one of the most successful ways of providing safe nursing care to patients. This is said so because this form of care focuses on treating patients as equal partners in providing healthcare. They involve them in planning, developing and monitoring the care given by the healthcare professionals (Brownie & Nancarrow 2013, pp-1). This type of care mainly puts the patients as well as their families at the center of the decisions and sees them as experts alongside that of the professionals so that the best outcome can be achieved. This type of care mainly consider desires, values, situations, social circumstances and lifestyles of the patients and visualizes patients as individual and  work in collaboration to develop appropriate solution (Vikstorm et al. 201, pp- 49-59). The main values of this type of care is that the healthcare professional needs to be compassionate and think about different aspects form the patients’ point of view alongside being respectful of the dignity and autonomy of the patients (Edvardsson, Sandstorm & Borrll 2014, pp- 1171). The following assignment will mainly show how prefect person centered framework when achieved by nurses can result in development of the care service delivery to the patients.

The care specialty where I work in:

An aged care service is mainly the form of healthcare services where nursing professionals always have to be on their toes as they need to care for elderly people. Elderly patients are mostly fragile and weak and therefore they might require support not only for the symptoms they suffer due to their co-morbidity but also due to their inability to perform their activities of daily lives (Van Haitisma et al. 2014, pp.34). Often aged care services have to handle patients suffering from dementia, Parkinson; diseases and several similar neurological disorders which make such patient totally dependent of the healthcare professionals for their support. In such cases, it becomes extremely important for the nurses to provide person centered care as the care requirements of different patients vary. Two patients suffering from dementia might have different care needs for the healthcare professionals and therefore the nurse cannot just apply traditional rule based care to them (Kogan et al. 2016, pp. 216). They need to identify specific needs of both of the patients and have to care for them individually. Therefore person centered care in aged care centers is extremely important to meet the demands of different patients and to increase patient satisfaction and hence the reputation of the organization.

Duties of nurses in patient centered care:

Researchers have provided their works which have helped in identifying the different aspects that remain associated with person centered care provided by nurses to aged patients. The most important aspect which is highly praised in this method of nursing care to old patients is that this care helps in respecting the values of the patients and put them in the center of the care (Li & Porock 2014, pp.1395). Not only that, the nurse in the aged care takes into accounts the preferences of the patients and help them to express their needs so that the needs can be met. The healthcare professions need to coordinate and integrate the caring in the treatment plan in such a way so that it meets all the care needs of the individual old patient that the nurse is attending to. In this type of care, the nurse works together with the patients to make sure that proper communication, information as well as education is maintained so that the patient is satisfied with the care provided to him (Kitson & Marshall 2013, pp.4). The nurse also makes sure that the patients are physically comfortable and safe. In many cases, restraints are used by nurses while caring for old patients with a risk of fall. Such a treatment is severely criticized by this method of nursing care as it harms the patient’s dignity and hampers safety concerns. Besides providing physically safe care to the patients, the nurse also provide emotional support to a large number of patients. Often it is seen that in many aged care services, old patients suffer from depression because due to loss of mobility, missing their families, loss of independence and others. Person centered care also ensures that they are emotionally empowered so that they remain mentally strong and thereby lead a proper quality life. This type of care is also highly appreciated by researchers as it often includes family and friends so that they do not feel loss of autonomy and right on their patients (Brooker & Latham 2015, p-256). Nurses of aged care often include family members in decision making processes and educate them to develop their health literacy.  They make sure that there is continuity between and within the services and thereby make sure that patients are having proper access to appropriate care when they require it (Roberts et al. 2015, pp.106).

Impacts of person centered care on patients in aged care:

Researchers are of the opinion that person centered care have a big impact on the quality of care which is provided to the aged care services (Zoffman et al. 2016, pp.400). It has been found that this type of care helps in improving the experiences of the old patients in the care services and make them feel more satisfied. The happier and satisfied the patients are, the better outcomes will be reflected on their health. This type of care also helps to encourage the old patients to lead a healthier lifestyle by educating them and developing their health literacy as per the level of their understanding. This healthier lifestyle includes exercising as well as making them understand the positive outcomes of eating healthy. This care also encourages the old patient to feel independent and important by encouraging them to be more involved in decision making about their care (Lines et al. 2015, pp.561). This help them to get the services and support that are appropriate for their needs. Researchers have found that it also has positive impacts on people’s health outcomes which even include their blood pressure. The healthcare professionals are also found to be more confidents and improve their satisfaction about the type of care that is provided to patients. Taking a holistic approach in assessing people’s needs and thereby providing effective care has been also one of the most important components that brings out positive outcomes. For all the above mentioned outcomes, this type o care is now highly appreciated not only in aged care homes but also in many community services and acute care services (Van Haitisma et al. 2014, pp.671).

Framework provided for person centered care:

Every nursing care should have a proper framework which needs to be incorporated in the practices. This framework basically help the nursing professionals as guidebook which help them to decide on the course of action and how to take initiatives so that the best care delivery I provided to the aged persons. McCormack (2006) has provided an important person centered framework which is highly followed by many nursing professionals for a large number of years. This framework mainly comprise of four important constructs which the nurses need to incorporate in their practices to ensure the delivery of the safest and best quality care. The first construct is the prerequisites which mainly focus on the attributes of the nurses which help the nurses in providing the best quality care. The second one is the care environment which mainly helps the healthcare professionals to focus mainly on the context in which the care is delivered. The third construct is the person centered process which helps by focusing on delivering the best care through a range of activities. The expected outcomes are the fourth construct which mainly focuses on the result of the effective person centered nursing.

First construct:

The first construct is called the prerequisites which mainly focus on the attributes of the healthcare professionals. It mainly includes the experts to be professionally competent with the proper development of the interpersonal skills. It involves being committed to the job at the same time of demonstrating clarity and values and knowing self. Being professionally competent mainly means practicing the knowledge, skills and attitude by the nurses so that they can properly negotiate the care options and also effectively provide holistic care (Entwistele & Watt 2013, pp.29). This mainly involves the nurses to make proper decisions and prioritizing care. The nurses need to develop proper interpersonal skills with the help of which they will be able to communicate with the patients at various levels successfully. The nurse needs to use effective verbal as well as non-verbal interactions by which they would be able to show personal concern for the situation of the patients and thereby engage in the commitment to find solutions mutually. Another important component that the nurse needs to incorporate is the skill to properly reflect their own activities and know their self. The nurses should make sense of their knowing and thereby becoming a person centered caregiver with the help of proper reflection, self awareness and thereby engagement with others (Laird et al. 2015, pp.1454). The nursing professionals should also try their best to maintain clarity of beliefs and values. The nurses need to be aware of the impact of the values as well as beliefs which are provided by professionals and received by the service users and thereby reconciling beliefs and values in ways which maintains person-centeredness. The nursing professionals should also maintain commitment to their jobs by properly demonstrating their commitment of individuals and team members to patients and their families. This can be done through intentional engagement with the patients and families which provide holistic evidence informed care (Sullivan et al. 2013, pp.165).

Second construct:

The second most important construct is called the care environment. In order to provide the best person centered care to that of the patients, nurses should make sure that proper skill mix is present. By the term proper skill mix, it means that proper initiatives need to be taken which ensure the proper ratio of the registered nurses and non registered nurses in the ward (Lopez et al. 2013, pp.763). A proper multidisciplinary team should be present which will have a range of staff who will have proper Knowledge and skills needed to meet all the care requirement for the old patients who are admitted to the aged care services. The next important component is the decision making systems. Organizational commitment should be ensured by each and every nurse so that proper collaborative, inclusive as well as participative ways of engaging within and between teams can be sired. The better the teamwork, the better is the decision making skills and hence this ensures safest and the best quality care for the old people. Moreover another important component for effective person centered care environment development is development of effective staff relationship (Sloanne et al. 2013, pp.1158). Researchers are of the opinion that better the effective staff relationships between the stakeholders of the care, better will be the interpersonal care connections among the staffs. This ensures achievement of holistic person centered care. For effective care environment, power sharing also play important role. To develop a proper person centered care environment in the wards, power sharing should be done in ways which do not promote conflicts (Parnell 2014, pg 1).  Non-dominant and non hierarchical relationships should be developed among working professionals. This will prevent exploitation of the individuals. In turn this will help in achievement of best mutually agreed outcomes through agreed values, goals, wishes and values. This will in turn ensure a comprehensive approach in treatment of patients ensuring person centered care. The next important factor for developing the proper care environment is to develop the physical environment (Flag 2015, pp.75).  Development of a proper healthcare environment is necessary which would help in balancing the aesthetics with function. This can be done by paying attention to the different design, dignity, safety, choice, sanctuary, universal access which would have the intention of the condition of the patient along with developing the patient, family and staff operational performance and outcomes. It is also important for the organization to take active initiatives to create care environment which ensures person centered care. Organizational systems when properly planned and introduced help to promote creativity, initiative, freedoms and safety of persons (Olssen et al. 2013, pp.456). This could be underpinned by proper governance framework which emphasizes culture, relationships, communication, values, accountability and thereby professional autonomy. The last component for developing effective care environment is the potential for innovation and risk taking. It is important for exercising professional accountability in decision making which thereby reflect a proper balance between the best available evidence, local information, professional judgment, family preferences and local information (Howrah, Warne & Haigh 2014, pp.340).

Third construct:

The third construct which a nursing professional also should provide importance to in order to provide a person centered care to the aged patients of the services is the person centered care processes. Out of this the very first component that the nurse should ponder upon is the person centered processes. The very first initiative is working effectively with the beliefs and values of the patients so that the patients feel that they are respected. The nurses should take initiatives of developing a clear idea about the patients’ values and thereby makes sense about what is happening with the patient socially, physically and emotionally. She should try to look from the perspective of the patients and should try to understand the psychosocial context as well as the social role (Barbosa et al. 2015, pp.713). All these will be helping the nurse to develop a therapeutic relationship with the patient where the patients will be an effective partner. The nurses should also actively involve the patient and his or her family members in the decision making process by properly considering the values, experiences, and concerns and future aspirations.  This will make the patients feel respected and honored for which they also have positive outcomes of the interventions on their health. The nurses also ensure that they should effectively engage with the patients to develop an effective partnership. The healthcare professionals should try to develop connectedness with the patients and others who are important to him. This form of connectedness will solely be based on the nurse aligning with the knowledge of the patients, their beliefs and values and cultural preferences (Zimmerman et al. 2014, pp.S1). The nurses should make sure that they should be empathetically present with the patients which would ultimately help in responding to the cues that will maximize the coping resources. This can be achieved by the nurse when she correctly recognizes the important agendas of the patient’s life.  Person centered care gets it completion in the aged care  when the healthcare professionals provides a holistic care to the elderly patients  with the help of integrating a comprehensive approach involving the integration of the psychological, physiological, socio-cultural, developmental as well as spiritual dimensions of the persons. As a result, the patients feel that the nurses are their true companions who feels the pain of such patients and trying their best to lessen them (Herlitz et al. 2016, pp.964).

Fourth construct:

The last construct in developing a person centered care plan for elderly patients is mainly the person centered outcomes. This needs to be kept in mind by the nurses so that they can prepare the interventions in ways which have the best outcomes on the patients making them live better lives. The nurses should ensure that the patients stay and experiences in the aged care center is not only good and satisfactory but had provided them a wonderful time with the professionals. An organization providing person centered care to its service users should always try to gain effective feedback from the service users about both their objective and subjective views on the care receive should be taken (Sullivan et al. 2013, pp.165). This would help in ensuring not only that particular patients; stay and experiences but would also help the nurses to develop their own skills and knowledge and provide better caring. Proper involvement in care of both the service users and the healthcare practitioners ensure active participation in care and partnership development for which the outcomes are not only better but also highly satisfying for both patients and the professionals.  The person centered care can only be achieved and demarcated as successful when service users become sure of their well being highly satisfied with the care provided by the healthcare professionals and at the same time the latter feel that they had been valued and been effective in providing utmost care possible. Besides, a proper healthcare culture also ensures proper person centered outcomes (Sloane et al. 2013, pp.1158).  A proper working environment is very crucial for the healthcare professionals so that they can provide the best care to the patients. The professionals should also have proper experiences of the workplace culture which would include decision making, proper bonding among the relationships of the staffs along with proper leadership. Innovation is also an important part of a proper working environment as it helps in enabling the professionals to deliver person centered care which enables flourishing.

Conclusion and recommendation:

From the entire discussion above, it becomes quite clear that a person centered approach helps the organizations to provide services to the patients who are not only accessible, responsive and flexible but also help to meet the diverse needs as well as preferences of the people living in the healthcare service. This type of care is extremely suitable for aged care services as often such healthcare centers becomes the areas where large number of elderly patients remain admitted due to various ailments. Most of them mainly are chronic disorders and age related dependency that needs to be handled by healthcare professional very carefully. Different patients have different needs and considering the needs in preparing their interventions depending upon their preferences, values and beliefs are extremely important. These help in maintaining the autonomy and dignity of the patients and provide them with care that aligns with their preferences. This type of care helps in development of therapeutic relationship where the elderly people, besides feelings respected also finds a true companion in the healthcare professional as they not only care for their physiological aspects but also cares for their psychological, emotional, mental and social aspects of their lives. Four important constructs need to be followed by the nurse for ensuring perfect patient centered care to patients. These are the prerequisites, care environment, person centered processes and person centered outcomes. All these should be maintained by the nurse as a framework so that proper care can be provided. Therefore the recommendations for nurses who would be following this type of care are to learn strategies by which they can develop their communication skills. Communication skill is very important for striking effective relationship with the patients and help in knowing their beliefs and values. The second recommendation is that often providing person centered care requires a lot of dedication, physically, mentally, and emotionally. This may sometimes get tiring and therefore they should also find out alternative ways by which they can handle the stress effectively. The third recommendation would be to develop the skills of patience as handling elderly patients require lots of patience (Flagg 2015, pp79). Therefore, patience should be made a strong feature of person centered care for the elderly people so that a proper compassionate care can be provided to the patients ensuring them better quality lives.

References:

Barbosa, A., Sousa, L., Nolan, M. & Figueiredo, D., 2015. Effects of person-centered care approaches to dementia care on staff: a systematic review. American Journal of Alzheimer’s Disease & Other Dementias®,  Vol 30 No. (8), pp.713-722.

Brooker, D. & Latham, I., 2015. Person-centred dementia care: Making services better with the VIPS framework. Jessica Kingsley Publishers.

Brownie, S. & Nancarrow, S., 2013. Effects of person-centered care on residents and staff in aged-care facilities: a systematic review. Clinical interventions in Aging, 8, p.1.

Edvardsson, D., Sandman, P.O. & Borell, L., 2014. Implementing national guidelines for person-centered care of people with dementia in residential aged care: effects on perceived person-centeredness, staff strain, and stress of conscience. International Psychogeriatrics, Vol 26 No.(7), pp.1171-1179

Entwistle, V.A. & Watt, I.S., 2013. Treating patients as persons: a capabilities approach to support delivery of person-centered care. The American Journal of Bioethics, Vol 13 No.(8), pp.29-39.

Flagg, A.J., 2015. The role of patient-centered care in nursing. Nursing Clinics, Vol 50 No. (1), pp.75-86.

Herlitz, A., Munthe, C., Törner, M. & Forsander, G., 2016. The counseling, self-care, adherence approach to person-centered care and shared decision making: moral psychology, executive autonomy, and ethics in multi-dimensional care decisions. Health communication,  Vol 31 No. (8), pp.964-973.

Howarth, M., Warne, T. & Haigh, C., 2014. Pain from the inside: Understanding the theoretical underpinning of person-centered care delivered by pain teams. Pain management nursing, Vol 15 No.(1), pp.340-348.

Kitson, A., Marshall, A., Bassett, K. & Zeitz, K., 2013. What are the core elements of patient?centred care? A narrative review and synthesis of the literature from health policy, medicine and nursing. Journal of advanced nursing,  Vol 69 No (1), pp.4-15

Kogan, A.C., Wilber, K. & Mosqueda, L., 2016. Person?Centered Care for Older Adults with Chronic Conditions and Functional Impairment: A Systematic Literature Review. Journal of the American Geriatrics Society,  Vol 64 No.(1) pp. 216-218.

Laird, E.A., McCance, T., McCormack, B. & Gribben, B., 2015. Patients’ experiences of in-hospital care when nursing staff were engaged in a practice development programme to promote person-centredness: A narrative analysis study. International journal of nursing studies,  Vol 52 No.(9), pp.1454-1462.

Li, J. & Porock, D., 2014. Resident outcomes of person-centered care in long-term care: A narrative review of interventional research. International journal of nursing studies,  Vol 51 No(10), pp.1395-1415.

Lines, L.M., Lepore, M. & Wiener, J.M., 2015. Patient-centered, person-centered, and person-directed care: they are not the same. Medical care,  Vol 53 No.(7), pp.561-563.

Lopez, R.P., Mazor, K.M., Mitchell, S.L. & Givens, J.L., 2013. What is family-centered care for nursing home residents with advanced dementia?. American Journal of Alzheimer’s Disease & Other Dementias®,  Vol 28 No (8), pp.763-768.

McCormack, B. & McCance, T.V., 2006. Development of a framework for person?centred nursing. Journal of advanced nursing,  Vol 56 No. (5), pp.472-479.

McCormack, B., 2004. Person?centredness in gerontological nursing: an overview of the literature. Journal of clinical nursing, Vol 13 No. (s1), pp.31-38.

Olsson, L.E., Jakobsson Ung, E., Swedberg, K. & Ekman, I., 2013. Efficacy of person?centred care as an intervention in controlled trials–a systematic review. Journal of clinical nursing,  Vol 22 No.(3-4), pp.456-465.

Parnell, T.A., 2014. Health literacy in nursing: Providing person-centered care. Springer Publishing Company.

Roberts, G., Morley, C., Walters, W., Malta, S. & Doyle, C., 2015. Caring for people with dementia in residential aged care: successes with a composite person-centered care model featuring Montessori-based activities. Geriatric Nursing,  Vol 36 No.(2), pp.106-110.

Sloane, P.D., Zimmerman, S., Chen, X., Barrick, A.L., Poole, P., Reed, D., Mitchell, M. & Cohen, L.W., 2013. Effect of a person?centered mouth care intervention on care processes and outcomes in three nursing homes. Journal of the American Geriatrics Society,  Vol 61 No (7), pp.1158-1163.

Sullivan, J.L., Shwartz, M., Burgess Jr, J.F., Peköz, E.A., Christiansen, C.L., Gerena-Melia, M. & Berlowitz, D., 2013. Person-centered care practices and quality in Department of Veterans Affairs nursing homes: Is there a relationship?. Medical care, Vol 51 No (2), pp.165-171.

Van Haitsma, K., Abbott, K.M., Heid, A.R., Carpenter, B., Curyto, K., Kleban, M., Eshraghi, K., Duntzee, C.I. & Spector, A., 2014. The consistency of self-reported preferences for everyday living: Implications for person-centered care delivery. Journal of gerontological nursing, Vol 40 No (10), pp.34-46.

Van Haitsma, K., Crespy, S., Humes, S., Elliot, A., Mihelic, A., Scott, C., Curyto, K., Spector, A., Eshraghi, K., Duntzee, C. & Heid, A.R., 2014. New toolkit to measure quality of person-centered care: Development and pilot evaluation with nursing home communities. Journal of the American Medical Directors Association,  Vol 15 No(9), pp.671-680.

Vikström, S., Sandman, P.O., Stenwall, E., Boström, A.M., Saarnio, L., Kindblom, K., Edvardsson, D. &  Borell, L., 2015. A model for implementing guidelines for person-centered care in a nursing home setting. International psychogeriatrics, Vol 27 no.(1), pp.49-59.

Zimmerman, S., Shier, V. & Saliba, D., 2014. Transforming nursing home culture: Evidence for practice and policy. The Gerontologist, 54(Suppl_1), pp.S1-S5.

Zoffmann, V., Hörnsten, Å., Storbækken, S., Graue, M., Rasmussen, B., Wahl, A. & Kirkevold, M., 2016. Translating person-centered care into practice: a comparative analysis of motivational interviewing, illness-integration support, and guided self-determination. Patient Education and Counseling, Vol 99 no (3), pp.400-407.