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Introduction
The treatment results are inextricably linked with the patient’s condition and emotional attitude to fight the disease and recover. Therefore, the role of nurses in monitoring and providing patient care that meets their needs is essential. The contemporary nursing theory focuses on developing individualized and flexible care practices responsive to “the patient’s health concerns, beliefs, and contextual variables” (Kwame & Petrucka, 2021, p.1). However, institutional, communicative, behavioral, and other barriers to the interaction between a nurse and a patient complicate the implementation of patient-centered care (Kwame & Petrucka, 2021). Thus, nurses are vital to creating and delivering patient-centered care and should be trained in strategies and practices for its application.
Providing Patient-Centered Care
Improving communication with patients and developing flexible approaches to healthcare play an essential role in modern medicine. Modern health care and nursing theory are moving away from “traditional, paternalistic, provider-centric, and disease-focused approaches” to patient-centered care (PCC) (Bokhour et al., 2018, p.1). PCC is an umbrella term for new approaches that ensure that patients’ preferences, desires, and experiences are integrated “into every phase of medical consultation, treatment, and follow-up.” (Bokhour et al., 2018, p.1). Implementing new organizational practices in nursing, together with a strong management commitment to shaping a new strategic vision, significantly improves the hospital experience for patients (Bokhour et al., 2018). The introduction and development of PCC is a work in progress, as different studies explore different strategies for reforming traditional patient care practices.
PCC is care that focuses on the patient and provides them with the opportunity to become a participant in the treatment process and not a passive object. Goldfarb et al. (2017) meta-analysis showed that PCC and patients’ inclusion in the treatment process leads to improved ICU costs, family and patient satisfaction and mental health, and medical goal achievement. People do not evaluate the experience of being in the hospital regarding the quality of treatment, as they cannot understand the complex medical details (Goldfarb et al., 2017). They estimate healthcare on non-technical aspects – communication with medical staff and how the patient feels heard.
The PCC idea includes several key elements that change the traditional health care approach. Firstly, PPC is respect for the patient’s values, preferences, and needs, maintaining a dialogue with them, and high-quality communication, in which the medical worker must ensure that the patient understands the ongoing processes (Kwame & Petrucka, 2021). Secondly, creating a collaboration with the patient and their family members makes them active participants in the recovery process (Kwame & Petrucka, 2021). Third, educational activities are essential to maintain treatment outcomes, disease control, and prevention (Kwame & Petrucka, 2021). All participants must be involved, from hospital management and medical staff to patients and their families.
Barriers to Patient-Centered Care
Many barriers and practices are identified that cause complication in transitioning to a new type of medical care. Firstly, there are institutional barriers within the healthcare system associated with a shortage and overload of medical personnel. Moreover, the healthcare system focuses on the tasks and conducting of medical procedures, not on the patient and his needs (Kwame & Petrucka, 2021). Nursing managers’ influence and management styles are crucial in encouraging or discouraging PCC (Kwame & Petrucka, 2021). Therefore, nursing managers should pay attention to training staff in communication techniques.
Other implementation difficulties to PCC include communication, personal, behavior, and environment-related barriers. Communication issues involve language differences, poor communication skills, and communication difficulties for patients with severe physical or mental conditions (Kwame & Petrucka, 2021). Environmental barriers are associated with unsatisfactory conditions inside a ward or hospital – noise, difficulties with navigating, an uncomfortable room, etc. (Kwame & Petrucka, 2021). Personal and behavioral barriers arise because nurses are human beings with personalities, beliefs, and attitudes that may conflict with the patient’s worldview (Kwame & Petrucka, 2021). Nursing managers must understand that sometimes there is a personal clash of communication styles in which it is worth replacing a worker rather than provoking a conflict.
Health Care Policies Effect on Patient-Centered Care
The authority of nursing practice comes from legislation, regulatory body, employers, and clients. First, nurses must be aware of the legislative documents such as the Health Profession Act or the Health Information Act that outline the responsibilities of healthcare workers (Ortiz, 2018). Nurses must know the legislation as it is an unbreakable basis for health care provision, and it cannot be changed at the patient’s request. Second, regulatory colleges influence nurses’ education, standards, and codes of ethics, creating differences in their scope of practice (Ortiz, 2018). Thirdly, employers obligate nurses to fulfill the professional requirements prescribed in the contract. It means, for example, that despite a nurse’s training, according to the norms of the organization, they will not be able to perform procedures that nurses cannot do in the organization. All these legislative, regulatory factors and barriers, on the one hand, complicate PCC implementation, but on the other hand, create a framework and boundaries for collaboration between the patient and healthcare professionals.
Strategies for Collaborating with Patients
The theory of collaborative communication strategies allows nurses to learn how to respond to the behavior of the patient and family members to achieve the best understanding and result. Nurses need to be able to establish personal contact with the patient, channel his negative emotions, and create an environment for involving a person in the treatment process (Kwame & Petrucka, 2021). Building trust and supporting collaboration are at the heart of patient-centered care.
In a study by Alhalal. et al. (2020), nurses from public hospitals in Saudi Arabia were presented with new communication techniques that encouraged them to focus on the condition of their patients. The nurses also had to explain the treatment process in plain language and ask the patient if they had concerns or questions (Alhalal et al., 2020). The study’s results showed that not only did the experience of the patient’s stay in the hospital improve, but the level of emotional stress among medical workers also decreased (Alhalal et al., 2020). Therefore, the creation of a collaborative environment had a positive effect on stress levels among all participants.
In their article, Kwame & Petrucka (2021) proposed person-centered care and communication continuum, in which they put forward the idea of actively including the patient in treatment control. Healthcare professionals are encouraged to ask patients open-ended questions such as “What’s important to you?” The purpose of such questions is to identify the needs and concerns of people that the system itself cannot address. Moreover, this will provide information about what additional programs, projects, or third-party resources patients need in a particular situation. For instance, nurses working with overweight patients created a nutrition course based on patient difficulties rather than textbook information (Kwame & Petrucka, 2021). In addition, they provided information about support groups, valuable resources, applications, and accessible opportunities to increase physical activity.
Therefore, to create a satisfying patient experience, nurse managers must pay attention to their stress levels and workload and train their staff in communicative techniques. Achieving change may require hiring additional staff and workers who exclusively spend time with patients and their families and provide educational and support services for them (Ortiz, 2018). Nursing managers should make an effort to increase collaboration between all medical staff and patients who should be involved in the treatment process. It is also important to adjust the decision-making process at the intersection of medical guidelines and laws, the code of ethics, the organization’s requirements, and the patient’s needs.
Nursing Code and Ethical Decision Making
Nurses carry out most of the work of caring for patients, contact their relatives, and are primarily responsible for implementing PCC. The positive relationship between the nurse and the patient is therapeutic and built on a collaborative environment between the healthcare system and the person (Kwame & Petrucka, 2021). As a result, it is difficult to overestimate the role of nurses, who are simultaneously forced to act by the regulations and the code of ethics, and on the other hand, to be the patient’s advocates.
PCC involves withdrawing the patient from a passive state, which means that ethical questions arise for medical personnel in finding a balance between the patient’s desires and medical guidance. In communicating with patients, nurses should be guided by autonomy, beneficence, justice, and non-maleficence and help patients make the most informed decisions. However, healthcare professionals should also draw boundaries and inform patients about hospital regulations, possible restrictions, and procedures.
Conclusion
Modern medicine recognizes the importance of the patient’s emotional state in the course of treatment and their relationship with medical professionals. Therefore, nursing theory puts forward the ideas of patient-centered care, focusing on the patient’s needs and involving them in treating and maintaining health. PCC is a relatively new approach and there are a number of barriers to its implementation, including institutional issues and restrictions imposed by healthcare policies. However, studies show that the use of PCC is beneficial for patients and medical staff. Nursing managers should provide specific training on how to create a collaborative environment to ensure the continued spread of PCC. It is on nurses that the task of caring for patients falls, therefore they are a central link in the process of changing care methods to more humane and patient-centered.
References
Alhalal, E., Alrashidi, L. M., & Alanazi, A. N. (2020). Predictors of patient‐centered care provision among nurses in acute care setting. Journal of Nursing Management, 28(6), 1400-1409.
Bokhour, B. G., Fix, G. M., Mueller, N. M., Barker, A. M., Lavela, S. L., Hill, J. N., Solomon, J. L. & Lukas, C. V. (2018). How can healthcare organizations implement patient-centered care? Examining a large-scale cultural transformation. BMC Health Services Research, 18(1), 1-11.
Goldfarb, M. J., Bibas, L., Bartlett, V., Jones, H., & Khan, N. (2017). Outcomes of patient-and family-centered care interventions in the ICU: A systematic review and meta-analysis. Critical Care Medicine, 45(10), 1751-1761.
Kwame, A., & Petrucka, P. M. (2021). A literature-based study of patient-centered care and communication in nurse-patient interactions: Barriers, facilitators, and the way forward. BMC Nursing, 20(1), 1-10.
Molina-Mula, J., & Gallo-Estrada, J. (2020). Impact of nurse-patient relationship on quality of care and patient autonomy in decision-making. International Journal of Environmental Research and Public Health, 17(3), 835.
Ortiz, M. R. (2018). Patient-centered care: Nursing knowledge and policy. Nursing Science Quarterly, 31(3), 291-295.
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