At the core of national and local efforts to improve the quality of healthcare is the concept of patient- and family-centered care. This is not a new concept; but rather one that could be viewed as receiving more talk than action in practice, in large part because there is no consistent agreement as to what patient- and family-centered care really is. Definitions and concepts within the patient-centered-care conceptual frameworks vary. Patient- and family-centered care is generally understood to be an approach in which patients and their families are considered integral components of the healthcare decision making and delivery processes. Berwick (2009) has asserted that patient- and family-centered care is a dimension of quality in which care is individualized and customized to patients and families, and in which they, not clinicians, have control over healthcare decisions. To effectively realize true patient- and family-centered care throughout all care-delivery sites and among all clinicians, however, we as healthcare providers essentially need to reconfiguring patient and clinician relationships.
In this issue, six articles have been brought together to share some unique insights into the challenges and impact of putting patient- and family-centered care into everyday practice. Key topics discussed include defining patient- and family-centered care (or person-centered care); describing essential components of patient-centered care; and developing strategies to educate clinicians regarding effective, patient-centered care.
McCance and colleagues emphasize the complexity and multidimensionality of the concept of ‘patient-centered’ in their article, “An Exploration of Person-Centeredness in Practice,” and bring this concept into the context of nursing practice. The authors describe the concept of person-centeredness and propose a person-centered nursing framework that emphasizes nursing competencies and a person-centered-care process that both engages the patient and yields person-centered outcomes. They then describe how the framework has been used in two different countries.
Deborah Small and Robert Small describe both the process and the tools they have very systematically developed to implement a new patient- and family-centered care model throughout a large, complex healthcare system. In “Patients First! Engaging the Hearts and Minds of Nurses with a Patient-Centered Practice Model” they explain how they have engaged clinicians throughout the system and are guiding them as they implement this new patient- and family-centered nursing practice model
The challenge of practicing and sustaining patient- and family-centered care is further discussed by McCormack and colleagues in “Developing Person-Centered Care: Addressing Contextual Challenges Through Practice Development.” McCormack and colleagues describe how they focused on environmental factors as they implemented person-centered care among elderly residents. In evaluating the effects of this new care model they found that nurses gained increased satisfaction in the non-technical aspects of providing care, several resident outcomes improved, the relationships between nurses and residents were strengthened.
Carver and Jessie bring the concepts of medical home and patient–centered care together in a case study of an integrated health system in “Patient-Centered Care in a Medical Home,” emphasizing the achievement of high quality healthcare. Using the National Committee for Quality Assurances’ (NCQA) conceptualization of a medical home, the authors describe what was involved in redesigning primary healthcare practices to facilitate the adoption of the medical home model as part of an initiative for providing accountable care and achieving NCQA recognition. Key steps included strengthening organizational leadership, imbedding a culture of improvement, and utilizing the electronic medical record.
An important aspect of successfully practicing patient- and family-centered care, namely cultural competence, is described by Campinha-Bacote in “Delivering Patient-Centered Care in the Midst of a Cultural Conflict: The Role of Cultural Competence.” The author utilizes her model of cultural competence to present a framework for nurses to use in providing individualized, culturally competent care.
Smith Stoner, in “Teaching Patient-Centered Care During the Silver Hour,” explores some of the complexity and multidimensionality of patient-centered care by describing a strategy for teaching students about patient-centered, end-of-life care. Using the Silver Hour as a teaching tool for nursing students caring for dying patients, the author describes an interdisciplinary, holistic approach to the five dimensions of person-centered care.
In all, we can be encouraged that a concept so inherent to nursing practice, that of patient- and family-centered care, is being led and evaluated by nursing leaders. As several of the authors point out, patients and clinicians want patient- and family-centered care, but the current structure and reimbursement mechanisms of healthcare challenge us to achieve this care in every day clinical practice. The most significant challenge with institutionalizing patient- and family-centered care may be that both nurses and patients want to have a voice, yet their roles in working together are not clearly understood. It may be that we will not achieve patient- and family-centered care, and truly have patients integrated into the decision-making process, until the concept of patient- and family-centered care is consistently understood and clinician roles clarified and redefined.
The journal editors invite you to share your response to this OJIN topic addressing Patient-Centered Care either by writing a Letter to the Editor or by submitting a manuscript that will further the discussion of this topic which has been initiated by these introductory articles.
Ronda G. Hughes, PhD, MHS, RN, FAAN
Berwick, D. M. (2009). What ‘patient-centered’ should mean: confessions of an extremist. Health Affairs, w555-565. Retrieved May 23, 2010 from http://www.ncmhcso.org/downloads/berwick-ha-w555.pdf