Patient-Centered Care Concept Analysis

Patient-Centered Care Concept Analysis Assignment Requirements

This assignment presents a modified method for conducting a concept analysis of ONE concept found in a nursing theory.  The source of the concept for this assignment must be a published nursing theory. The selected concept is identified and then the elements of the analysis process are applied in order to synthesize knowledge for application within the model and alternative cases.  Non-nursing theories may NOT be used. The paper concludes with a synthesis of the student’s new knowledge about the concept. The scholarly literature is incorporated throughout the analysis. 

Only the elements identified in this assignment should be used for this concept analysis. 

Criteria for Content

1. Introduction

       The introduction substantively presents all following 4 (four) elements: 

• Identifies the role of concept analysis within theory development,
• Identifies the selected nursing concept,
• Identifies the nursing theory from which the selected concept was obtained, and
• Names the sections of the paper.

• Definition/Explanation of the selected nursing concept

This section includes:

• Defines/explains the concept using scholarly literature (a dictionary maybe used for this section ONLY, and additional scholarly nursing references are required), and
• Information about the concept as discussed by the theorist from the selected nursing theory is substantively presented.

A substantive discussion of this section with support from scholarly nursing literature is required.

• Concept comparison

This section includes a substantive description of the:

• The concept from the perspective of a non-nursing profession with scholarly support from the selected non-nursing profession.
• Explains the similarities for the selected concept between the nursing and selected non-nursing profession.
• Explains the differences for the selected concept between the nursing and selected non-nursing profession.

A substantive discussion of this section with support from scholarly nursing literature is required.

• Literature review

This section requires:

• A substantive discussion of at least 6 (six) scholarly nursing literature sources on the selected concept.
• Themes, ideas, and/or facts about the concept found in the reviewed sources are presented in an organized fashion.

Support from scholarly nursing literature is required.

              Please Note: Primary research articles about the selected nursing concept are the most useful resource for the literature review.

• Defining attributes

For this section:

• A minimum of THREE (3) attributes are required.

                A substantive discussion of this section with support from scholarly nursing literature is required.

Explanation:  An attribute identifies characteristics of a concept.  For this situation, the characteristics of the selected nursing concept are identified and discussed.

• Antecedent and Consequence

This section requires the identification of:

• 1 antecedent of the selected nursing concept, and
• 1 consequence of the selected nursing concept.

A substantive discussion of the element with support from scholarly nursing literature is required.

Explanation:  An antecedent is an identifiable occurrence that precedes an event.  In this situation, an antecedent precedes a selected nursing concept.

A consequence follows or is the result of an event.  In this situation a consequence follows or is the result of the selected nursing concept. 

• Empirical Referents

This section requires the identification of:

• 2 (two) empirical referents of the selected nursing concept.

A substantive discussion of the element with support from scholarly nursing literature is required.

Explanation:  An empirical referent is an objective ways to measure or determine the presence of the selected nursing concept.

• Model Cases

1 model case is created by the student and discussed substantively by demonstrating within the case each of the following areas:

• Definition,
• All identified attributes,
• Antecedent,
• Consequence, and
• Empirical referent or Measurement

Information from selected nursing theory is applied to the created model case. 

A substantive discussion of the element with support from scholarly nursing literature is required.

Explanation:  A model case is an example of the hypothetical individual who demonstrates all of the attributes, antecedents, consequences, and referents noted previously in this assignment. 

• Alternative Cases

This section requires:

• The identification of 2 (two)alternative cases correctly created and presented.  The two required alternative cases are:
• Borderline (absence of one or two of previously identified attributes of the selected nursing concept.
• Contrary (demonstrates the complete opposite of selected nursing concept)

                Applies information from selected nursing theory.

             A substantive discussion of the element with support from scholarly nursing literature is required.

Explanation:  Alternative cases represent the opposite of the model case.  For this assignment, two alternative cases are required.  These are:

• Borderline case which is a created case where one or two of the previously identified attributes are missing.
• Contrary case which is a created case that demonstrate the complete opposite of the selected nursing concept.

1. Conclusion

This section requires:

• Summarization of key information regarding:
  • Selected nursing concept,
  • Selected nursing theory, and
  • Concept analysis findings.

• The concluding statements include self-reflection on the new knowledge gained about applying nursing theory to a professional issue or concern. 

Preparing the Assignment

Criteria for Format and Special Instructions

1. The paper (excluding the title page and reference page) should be at least 8, but no more than 10 pages. Points will be lost for not meeting these length requirements.
2. Title page, running head, body of paper, and reference page must follow APA guidelines as found in the 6^th edition of the manual. This includes the use of headings for each section of the paper except for the introduction where no heading is used.
3. The source of the concept for this assignment must be a published nursing theory.  Non-nursing (borrowed) theories may NOT be used. 
4. A minimum of 6 (six) scholarly references must be used.  Required textbooks for this course, and Chamberlain College of Nursing lesson information may NOT be used as scholarly references for this assignment.  A dictionary maybe used as a reference for the section titled “Definition/Explanation of the selected nursing concept”, but it is NOT counted as one of the 6 required scholarly nursing references.

 References are current – within a 5-year time frame unless a valid rationale is provided and the instructor has approved them.

• Ideas and information from scholarly, peer reviewed, nursing sources must be cited and referenced correctly.
• Rules of grammar, spelling, word usage, and punctuation are followed and consistent with formal, scientific writing.
• PLEASE note:  Do not rely on .com sites to identify the nursing theory as they do not provide accurate information in all cases.

Possible Concepts:  The following concepts are not required; students may select one of these concepts or find another concept.  Each selected concept must be associated with a nursing theory; the use of non-nursing (borrowed) theories is NOT allowed.  If you have any questions regarding your concept or the nursing theory, please consult with your faculty member for assistance.

Behavioral system

Boundary lines

Caring

Cleanliness of environment

Empowerment

Homeostasis

Noise

Open system

Palliative care

Patient Assessment

Patient Centered Care

Resources

Self-careSelf-care deficit

Activities of living

Actual caring occasion

Adaptation

Comfort

Compassion

Engagement

Leadership

Meaningfulness

Modeling

Nursing intuition

Pain

PatternTransaction

Solution

Patient-Centered Care Concept Analysis

Name

Institution

Course

Instructor

Date

Solution

Patient-Centered Care Concept Analysis

Introduction

            Concept analysis is an important part of nursing theory application as it allows for a deeper understanding of all the components that make up a given theory, and thus development of approaches that would define application of such theory. Theories are made up of various concepts and concept analysis allows for the identification of the unique traits of such concepts, providing researchers and practitioners with accurate operational definitions of each concept within a theory. In addition, through concept analysis, theoretical concepts that appear as ambiguous can be refined. This would allow for further understanding of a concept’s underlying concepts. This paper is going to analyze the concept of patient centered care in an acute care setting. This concept has been derived from the King’s theory of goal attainment, which emphasizes on the need of proper interaction between the patient and the care providers in order to facilitate attainment of healthcare goals. This paper is going to apply the Walker and Avant method of concept analysis, using eight sections, to reveal the inner skeleton of the concept as applied in the theory. These sections include definition on the concept, concept comparison, literature review, defining attributes, antecedent and consequence, empirical referents, model cases, and alternative cases.

Definition of concept

Patient-centered care is a concept that has been well embraced by both scholars and practitioners in the health care field, with a continuous understanding of the need for the patient to play a role in defining the course of the care that is offered to them (Epstein & Street Jr, 2011). As such, patient-centered care is defined as health care that is based on deeply respecting patients as living beings who are unique, and upholding the healthcare provider’s obligation to base their care on the terms provided by the patient. Thus, this concept defines patients as individuals within their own social worlds, respected, informed, listed to, and allowed to participate in their care throughout the healthcare process. Nevertheless, the concept insists that as much as the wishes of the patients ought to be honored, they should not be enacted mindlessly. Various concerns have been raised in relation to the impact of patient-centered care on evidence based practice, as the former focuses on the needs of the individual while the later focuses on the needs of the population. However, it is clear that for good patent outcome to be upheld, there is need for such care to be based on decisions that are valuable and meaningfully to the patient as such care is all about the patient as the center subject.  Both evidence-based practice and patient-centered care consider the science of particulars as much as the art of generalizations (Epstein & Street Jr, 2011).

Concept comparison

Patient-centered care has been widely embraced among psychiatrists, but with a distinct definition of the concept as compared to the nursing profession. Psychiatrists believe that patient centered care is about ensuring that the needs of the patient are catered for during the process of patient care (Hensley, 2012). This pushes these practitioners into carefully identifying the needs of the patient and enforcing decisions that met such needs. This is an approach that shares various similarities with the nursing approach to patient centered care. One such similarity is that in both cases, the patient is considered to be the focal point of the care, such that all the decisions made are centered on what is good for the patient. As such, patient values and beliefs are catered for throughout the care process. Another similarity is that the voice of the patient is heard in both cases, with the patient allowed to express their needs and beliefs. However, the major difference between patient centered care among psychiatrists and nurses is that by empowering the patients, nurses allow most of the decisions to be driven by the patients, assuming that the patients have the ability to make crucial decisions about their health, with the nurse only playing the role of the informant and facilitator. On the other hand, as much as the psychiatrists empower their patients to speak up and express their needs, the ultimate power to make the decisions relating to the patient’s health still lies in the hands of the psychiatrist, with the common belief that the patients lack the ability to make medical decisions or any other major decisions related to their health care (Hensley, 2012).

Literature review

Patient-centered care has been increasingly viewed as a way through which health care providers can achieve both improvements in the patient outcomes and reductions in the cost of care. Satisfaction rates and clinical outcomes of the patient can be improved through improving the nurse-patient relationship’s quality (Rathert, Wyrwich, & Boren, 2012). This allows the nurse to establish an environment through which the patient can open up to them and express himself or herself in a manner that will inform the nurse more about the patient’s needs. This approach has been seen to minimize the use of diagnostic testing, hospitalizations, prescriptions, and referrals as the patient is adequately managed according to their needs (Bertakis & Azari, 2011). Effective care is defined by consulting patients as opposed to banking on the nurse dependent standards or tools.

One of the major dogmas of patient-centered care lies with the idea that patients are well aware of how well their needs are being met by their health providers, and that such view correlates with patient satisfaction or outcome (Hudon, Fortin, Haggerty, Lambert, & Poitras, 2011). The perception of the patient in view of the care that they are receiving is a highly important aspect as it will determine how well they are receptive to a certain approach to care. As much as healthcare providers believe that they know everything concerning their patients, inaccurate assessment of the perception of the patient to the care offered to them in terms of what they consider important, how well the care is being delivered, and what factors contribute to outcome improvements would lead to poor patient outcomes (Luxford, Safran, & Delbanco, 2011). Patient-centered care allows health care providers to concentrate more on what matters to the patient as opposed to what the matter with the patient is. 

Another important tenet in patient-centered care involves the relationship between the health care providers, in this case the nurse, and the patient (Doss, DePascal, & Hadley, 2011). In cases where there is a poor relationship between the nurse and the patient, the health outcomes of the patient will be poor, and the two parties are likely to blame each other with the patient claiming that the nurse was not able to identify and care for the needs of the patient and the nurse claiming that the patient did not follow the care regime. As such, it is important for health care providers to understand that it is only through establishment of good relationships with the patients that they can be able to clearly understand their needs and work towards meeting them. These can be achieved through empathy and good communication (Wittenberg-Lyles, Goldsmith, & Ferrell, 2013). Patients who feel like they are partners in their own health care process are more likely to adhere to the care regime and be satisfied with the care provided, thus experience positive outcomes. Patients are more likely to perceive empathetic nurses as professional experts, trustworthy, and sharing with them enough information, an aspect that has a positive impact both on the compliance of the patient and their satisfaction.

Defining attributes

There is a general agreement among scholars and practitioners concerning the most important attributes of patient-centered care. The Institute for Family-Centered Care has established a model through which the attributes of patient-centered care can be identified and effected. According to the model established by the institute, family-centered or patient centered care forms an innovative method through which health care is planned, delivered and evaluated through partnerships that are mutually beneficial among patients, the health care providers, and their families. One of the important attribute of patient centered care is thus dignity and respect. In this case, health care providers are expected to listen to the choices and perspectives of the patients and their families and honor them (Barry & Edgman-Levitan, 2012). As such, the knowledge, beliefs, cultural backgrounds, and values of the patient should be incorporated during planning and implementing of care. Another important attribute is that of information-sharing, which requires health care providers to share and communicate unbiased and complete information with both the patients and their families in a manner that is useful and affirming. As such, the families and patients receive complete, accurate, and timely information that allows them to effectively take part in decision making and care. The third attribute is participation, where the patients are encouraged to take part in decision making and their care process at any level, receive full support in doing so from the health care providers (Barry & Edgman-Levitan, 2012).

Antecedent

Antecedents are events that take place before the concept, in this case, before patient-centered care. Health care providers may not be able to efficiently offer their care without antecedents. The climate of the inpatient acute care setting is a major determining factor of the nurse’s ability to provide a patient in the same setting with patient-centered care. Both the cultural and physical health care environment define nursing care parameters and can either stifle of enforce the ability for the nurse to individualize care to a given patient (Epstein & Street Jr, 2011). One of the antecedents that creates an ample climate for patient-centered care is Shared Governance. For patient-centered care to be actualized, it is mandatory for changes in service delivery to be effected both at the organizational and individual levels. It is important for organizations to shift from the control and command leadership style to shared governance in order to create a culture for Patient centered care through their behaviors and attitudes.

Consequences

Consequences are any events that take place due to the concept. There are various consequences that can be linked to patient-centered care, one of which is “improved quality of care”. Quality health care involves the responsive, timely, and respectful delivery of services to the patients with consideration of their needs (Liu, Avant, Aungsuroch, Zhang, & Jiang, 2014). The relationship that exists between those receiving care and those providing it could be used as a measure of quality. Quality care goes beyond giving tasks to the therapeutic contribution that comes with each nurse-patient interactions.

Empirical referents

Empirical referents could be termed as the actual phenomena used to demonstrate a concepts occurrence. Patient-centered care is commonly measured from the patient’s perspective. As such, in an acute care setting, measuring patient-centered care delivery is vital for evaluating and improving the care of individual patients at the bedside. To measure the delivery of patient-centered care, two tools including the Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ) and the Person-Centered Climate Questionnaire (PCQ) can be used (Morgan & Yoder, 2011). Nevertheless, these tools are more focused on measuring the consequences and antecedents of patient-centered care. The PCQ is a 17-item instrument that is employed in measuring the level to which the inpatient-environment climate, in terms of culture, ambiance, and safety, is patient-centered. On the other hand, the PSNCQQ is a 19-item tool used in measuring how satisfied the patient is with the quality of care provided by the nurse (Morgan & Yoder, 2011).

Model case

Mrs. Mary Lumberg is a 45 year old woman who arrives at the hospital for rehabilitation after being involved in a serious accident that led to the death of her husband. There had two children together with her husband, who live in a different state. The nurse conducts an initial assessment, where she establishes that Mary is a teacher in a high school, a vegetarian, and a Christian. The patient insists that she would love to take on spiritual healing as she has not been able to forgive herself for the accident that took away her husband, given that she was the one driving at the time of the accident. Understanding the attribute of respect and dignity, the nurse asked the patient what she could do to assist with her spiritual healing, despite being an atheist herself. The patient asked the nurse to bring her a Bible, a crucifix and a picture of the Virgin Mary to set the climate for her prayers. The nurse brought all the items to the patient and left her to pray.

Understanding the attribute of participation, the nurse asked the patient to say what else she believed would help her heal, and the patient said that the presence of her children would be helpful. The nurse contacted Mary’s children and convinced them to come over and keep their mother company in the hospital for a while as it would help with her healing. Respecting the attribute of information sharing, the nurse shared information concerning the patient’s condition and options with both the patient and her children upon her consent, an aspect that allowed the patient to make further decisions concerning what would facilitate her healing. The antecedent in the case is that the hospital had established an environment for shared governance, in which the leaders have empowered the nurses to engage patients in patient-centered care in order to improve the quality of care. On the other hand, a major consequence of the patient-centered care was quick recovery for Mary and a shortened period of stay at the hospital. The nurse offered Mary with a 19-item Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ), which the nurse scored high in terms of the quality of service offered to the patient.

Alternative cases

Borderline Case

Lorenzo, a 65 aged man has been admitted to the acute care unit after surviving a plane crash. However, the crash left him paralyzed and unable to walk. The patient is in shock and cannot understand why he is the only one that has suffered such an outcome. The nurse assigned to the patient uphold the attribute of information sharing in patient-centered care and informs the patient of his condition and the various options that are available. The nurse engages the patient in a counselling session, through which she notices that the patient wishes that his wife and daughter be informed of his condition. The physician asks the nurse to call the patient’s family and inform them of his condition. The nurse calls the family but fails to carry on the will of the patient and lies to the family that Lorenzo is in perfect health and is only undergoing counseling at the hospital, upholding her belief that telling them the truth will hurt them. The family immediately visits the hospital only to discover that the patient has been paralyzed. The family feels offended as the nurse dishonored the value of trust within the family and lied to them and they even request for a change in the attending nurse.

Contrary Case

Bob is a 29 years old male that was admitted to the acute care unit with stage-four cancer. The nurse assigned to bob used information from the emergency room regarding the patient’s assessment to record her own assessment and did not assess the patient, terming Bob as a highly sensitive patient that she did not want to offend, and so thought avoiding communication would prevent such offenses. Bob was having difficulties in breathing as a complication of his condition, one that the nurse did not notice, and hence Bob did not receive help that would have otherwise eased his suffering. It is only after Bob’s Doctor came that he realized the problem and offered Bob treatment. Two days later, Bob was discharged, with the doctor noting that Bob’s difficulty in breathing was what had led to his hospitalization and if the nurse was attentive would have noticed it. Bob reported the nurse to the hospital’s administration, claiming that she had not cared for her the way she should have, an aspect that led to his extended hospitalization.

Conclusion

It is clear from this paper that patient-centered care is an important part of the King’s theory of goal attainment and out to be upheld in order to facilitate quality healthcare. Health care providers can utilize attributes of dignity and respect, information sharing, and encouraging patient participation as a basis on which to establish their bedside practice approaches. The leaders within the health care organizations can use antecedents such as shared governance to establish a climate of patient-based care. In addition, employing empirical referents in measuring patient-centered care practice is important in validating the philosophy of the organization and the fact that patient-centered care positively influences health outcomes.

References

Barry, M. J., & Edgman-Levitan, S. (2012). Shared Decision Making — The Pinnacle of Patient-Centered Care. The New England Journal of Medicine, 366, 780-781.

Bertakis, K. D., & Azari, R. (2011). Patient-Centered Care is Associated with Decreased Health Care Utilization. Journal of the American Board of Family Medicine, 24(3), 229-239.

Doss, S., DePascal, P., & Hadley, K. (2011). Patient-Nurse Partnerships. Nephrology Nursing Journal, 38(2), 115-124.

Epstein, R. M., & Street Jr, R. L. (2011). The Values and Value of Patient-Centered Care. Annals of Family Medicine, 9(2), 100–103.

Hensley, M. A. (2012). Patient-Centered Care and Psychiatric Rehabilitation: What’s the Connection? International Journal of Psychosocial Rehabilitation, 17(1), 135-141.

Hudon, C., Fortin, M., Haggerty, J. L., Lambert, M., & Poitras, M.-E. (2011). Measuring Patients’ Perceptions of Patient-Centered Care: A Systematic Review of Tools for Family Medicine. Annals of Family Medicine, 9(2), 155-164.

Liu, Y., Avant, K. C., Aungsuroch, Y., Zhang, X.-Y., & Jiang, P. (2014). Patient outcomes in the field of nursing: A concept analysis. International Journal of Nursing Sciences, 69–74.

Luxford, K., Safran, D. G., & Delbanco, T. (2011). Promoting patient-centered care: a qualitative study of facilitators and barriers in healthcare organizations with a reputation for improving the patient experience. International Journal of Quality in Healthcare, 1-6.

Morgan, S. S., & Yoder, L. (2011). A Concept Analysis of Person-Centered Care. Journal of Holistic Nursing, 1-10. doi:10.1177/0898010111412189

Rathert, C., Wyrwich, M. D., & Boren, S. A. (2012). Patient-Centered Care and Outcomes: A Systematic Review of the Literature. Medical Care Research and Review.

Wittenberg-Lyles, E., Goldsmith, J., & Ferrell, B. (2013). Oncology nurse communication barriers to patient-centered care. Clinical Journal of Oncology Nursing, 17(2), 152-158.