Patient-centered care

In nursing school, “patient-centered care” is as common a phrase as “ball is in your court” – everyone knows what it means but not everyone may know how to act on it or live it out in practice.  According to the IOM, patient-centered care is “Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.”  There are eight principles which define this concept, according to research conducted by the Picker Institute and Harvard Medical School, and they are as follows (from most basic to more advanced):

  1. Access to care – access to hospital and physician offices, transportation, ease of scheduling, clear instructions for referrals
  2. Continuity and transition – clear discharge instructions and access to support on a consistent basis
  3. Involvement of family and friends – involving family in decision making and education, supporting family as they assume caregiver responsibilities
  4. Emotional Support – comfort in terms of fear and anxiety, especially pertaining to physical status/prognosis, impact of illness of family and their normal life, and financial stress
  5. Physical Comfort – pain management, assistance with daily care, surroundings and environment
  6. Information and education – patient teaching
  7. Coordination and integration of care – coordination within all areas of the health care team without which the patient may feel overwhelmed and powerless
  8. Respect for patients’ values, preferences, and expressed needs – adhering to patients sexual, spiritual, and cultural needs with respect and sensitivity

As the principles progress, they require a higher level of interaction and intimacy with the patient.  The nurse is the number one most trusted profession consistently year after year.  This nurse-patient relationship and trust is essential to the effective treatment of patients and patient compliance.  However, many nurses often fall short in adhering to all the principles of patient-centered care.  On the surface, they can often be overlooked and it appears it is the center of focus of care.  On the floor, nurses are taxed with mountains of work, long hours, and little extra time.  Their concern becomes less focused on the patient as a human being and more on the tasks they need to complete and patient advocacy with the doctor in terms of care.  The patient can be overlooked as a human being, especially in terms of emotional support, physical comfort & assistance with daily care, true patient teaching, and coordination and integration of care.

I challenge you nurses out there to remember the patient is a person.  Spend time with the patient and talk with them to get an understanding of their worries.  Take your time teaching information so the patient understands and complies with all instructions.  Be sure outpatient and inpatient doctors are on the same page when discharge instructions are being made so the patient feels confident returning to their home and their regular doctor with their condition.  Finally – and the one thing I’m an expert at, given its 90% of what I do as a sophomore nursing student – be sure your patient is being respected and being properly taken care of when it comes to a.m. care and oral care.  Patient decency is all too often forgotten and patients sit there exposed receiving care when it isn’t necessary and oral care is often dismissed completely.  Remember these things when you are on the floor caring for someone’s parent, child, sibling, or friend.

(To read more about any of the above information, click here.)

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