Concept Analysis: Patient-Centered Care (PCC)

Introduction

The current concept analysis paper focuses on patient-centered care (PCC). There is widespread consensus that PCC plays a crucial role in contributing to quality care. As a concept, PCC commenced with the dawn of the era of healthcare consumerism. Since the 1970s, numerous healthcare organizations, research agencies, regulatory bodies, and policymakers have embraced the notion of PCC (Leplege, Gzil, Cammelli, Lefeve, Pachoud, & Ville, 2007).

In addition, the use of the phrase “PCC” is common in several contexts with respect to the relationship between providers and patients. However, one of the main barriers to ensuring the effective implementation of the concepts relates to the vagueness in terms of its definition as well as its core components. As Austin (2011) explained, although PCC is an important concept in healthcare, it has no clear definition. PCC stems from Jean Watson’s human caring theory.

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The Walker and Avant (2005) method guided the concept analysis of PCC. According to Walker and Avant (2005), the concept is well described and mature because of the vast literature covering it. In addition, it offers a comprehensive description and clinical empirical evidence about the concept. Nevertheless, a closer look at the concept shows inconsistent definition as well as numerous rival implicit theories, which is the case with PCC.

The concept classification method that Walker and Avant (2005) recommended entails performing a literature review and content of analysis of literature relating to the concept. Moreover, the concept analysis process entails an analysis of the uses and attributes of the concept as well as its consequences and antecedents (Walker & Avant, 2005). To this end, the author performed a search for the term “PCC” in the abstract and/or titles of papers published in the English language in electronic databases such as PubMed, CINAHL, MEDLINE, PsycINFO, Google Scholar, Ebsco, and Cochrane Review.

The author identified the attributes, antecedents, and consequences associated with PCC. The concept analysis paper also outlines the empirical referents used in measuring patient-centered care from the viewpoint of the patient. Lastly, the paper outlined model cases.

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Aim

The current concept analysis aims at clarifying the meaning of the concept. Although PCC is a popular notion in healthcare, the lack of a clear definition of the concept hampers its effective implementation. Consequently, there is the need to perform a concept analysis of PCC in order to clarify the concept and facilitate its effective implementation in healthcare settings.

Literature Review

In literature, there are numerous discussions of PCC. Austin (2011) defined PCC as treating a patient as a unique person. In this respect, Austin (2011) considered PCC as a practice standard that places emphasis on respecting the patient as an individual. PCC requires health practitioners to take into consideration the view of the patient when making decisions regarding health care.

A limitation of Austin’s (2011) definition of PCC is that it fails to consider the health outcomes associated with patient-centered behaviors like respect for the preferences of the patient. Edvardsson, Varrailhon, and Edvardsson (2014) provided another definition of PCC, which emphasizes on the doctor-patient encounter typified by being responsive to the preferences and needs of the patient through the use of informed wishes made by the patient.

Kadey (2013) characterized PCC by shared decision making and information giving. In this respect, PCC involves perceiving illness and health that has an effect on the general wellbeing of an individual and trying to empower the patient through the expansion of his/her role with respect to their care. PCC requires healthcare practitioners to make sure that patients are well-informed, offer reassurance, comfort, support, and acceptance. For Kadey (2013), the goal of PCC is to promote healing and lessen suffering and injury.

The core philosophy espoused by PCC is that health professionals should have an understanding of the patient as an individual and not a collection of diseases (Kadey, 2013). PCC seeks to deliver care using diverse activities such as taking into account the values and beliefs of patients; the sympathetic presence of health practitioners; and satisfying the emotional and physical needs of patients. Taking into account the values and beliefs of patients is a core aspect of PCC in the sense that it fosters shared decision making as well as enables the involvement of the patient with respect to his or her care (Austin, 2011).

Patient-centered care draws upon the assumption that patients are well informed to determine their anticipations and wishes, and that they have the capability to make resolutions regarding their wants and needs. In addition, PCC seeks to educate patients regarding suitable health advice in order to empower them to make informed choices regarding their care. From the review of literature, the core characteristics of PCC include patient’s involvement in the care via shared decision making as well as dissemination of information and care individualizing (Leplege, Gzil, Cammelli, Lefeve, Pachoud, & Ville, 2007).

Acknowledging and valuing each patient’s perceptions and experiences is a crucial goal of PCC. The healthcare professional has to provide support to the patient, enabling him/her to adhere to their choices and preferences autonomously. Overall, PCC focuses on satisfying the needs of the patient.

Use

PCC is a multidimensional concept. In literature, the use of PCC is diverse. The first possible use of PCC is in mental health, whereby the approach to care focuses on using a holistic approach that considers the individual including his or her unique needs and experiences. In this respect, mental health practitioners used PCC in administering behavioral therapy to their patients (Leplege, Gzil, Cammelli, Lefeve, Pachoud, & Ville, 2007). The second possible use of PCC is in nursing care, which has been largely described in the literature review section above. In both mental and nursing care, it is evident that the emphasis is put on the patient as an individual.

The concepts related to PCC include caring, compassion, and nurturing. Caring is the core of nursing (Potter, Deshields, Berger, Clarke, Olsen, & Chen, 2013). In fact, caring is the characteristic that makes nurses unique. By caring, nurses seek to help the patient improve his/her health condition (Potter, Deshields, Berger, Clarke, Olsen, & Chen, 2013). The link between caring and patient-centered care is that caring depends on the individual needs of the patient and that it should reflect the patient’s culture (Wiklund Gustin & Wagner, 2013).

Just like PCC, the patient is central in caring. In addition, nurses can manifest caring by being aware and acknowledging the beliefs of the patient (Burtson & Stichler, 2010; Neff & Dahm, 2014). In addition, healthcare professionals can exhibit caring by providing support for patients (physically and emotionally) as is the case with PCC. Compassionate care entails healthcare professionals being mindful of the misfortune, suffering, and distress experienced by others and desiring to alleviate them (Potter, Deshields, Berger, Clarke, Olsen, & Chen, 2013). Compassion supplements PCC in the sense that patients believe that healthcare professionals acknowledge and act upon their concerns (Potter, Deshields, Berger, Clarke, Olsen, & Chen, 2013; Neff & Dahm, 2014).

In compassionate care, both the patient and the healthcare professional work towards the achievement of the best possible health outcome. When nurses exhibit compassion, patients feel that they are respected and cared for and believe that the nurses have their best interests at heart (Burtson & Stichler, 2010). Again, it is evident that the focus of compassion is on the patient, just like is the case with PCC. Therefore, it can be argued that caring and compassion supplement PCC. As a result, self-compassion training among nurses can increase patient satisfaction and contribute to PCC. Similarly, assertiveness training on patients enhances their communicative ability, which increases the likelihood of their needs being satisfied by healthcare professionals (Dennis, 2012).

Defining Attributes

Walker and Avant (2005) linked defining attributes to symptoms and signs and considered them crucial in differentiating concepts from other related concepts as well as in clarifying the meaning of a concept. The two defining attributes of PCC are patient and healthcare professional attributes. Patient attributes relate to the patient’s perception of care, involvement in care, cooperation, their beliefs and values, cooperation, and their views regarding the illness (Leplege, Gzil, Cammelli, Lefeve, Pachoud, & Ville, 2007).

Healthcare practitioner attributes relate to their personal characteristics, commitment, interpersonal, and professional skills. Based on these attributes, the process of PCC involves health practitioners working with the values and beliefs of patients; providing for the cultural, social, psychological and physical needs of patients; ensuring sympathetic presence; shared decision making; and engagement (patient-nurse relationship) (Edvardsson, Varrailhon, & Edvardsson, 2014).

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Model Cases

Case studies help in expanding further the concept of PCC. The model case study illustrates all the defining attributes associated with the concept. The author derived the case study in literature. The first case study involved pediatric patients in emergency care whereby the hospital used a holistic model characterized by children and parents being encouraged to be involved in the decision-making process regarding the care that children received (O'Malley, Brown, & Krug, 2008). The study showed that children reported reduced vomiting and nausea, improved pain control, improved timely discharge, reduction in unplanned medical consultations, and timely medical attention. Low costs of care and parental satisfaction were documented (O'Malley, Brown, & Krug, 2008).

The second model case study is in Memorial Hermann Hospital located in Houston Texas at the neuro-trauma unit. Since most of the patients in the unit are mostly unconscious, the nurses are not in a position to gather information regarding the views of their patients. As a result, the unit asks family members relevant questions by inviting them to dinner (Institute for Healthcare Improvement, 2015). These two cases are model case studies since they illustrate all the attributes associated with patient-centered care.

Alternative Cases

An example of a related case study is family-centered care, whereby the planning of care focuses on the whole family rather than the individual only. As a result, all members of the family are regarded as recipients of care services. A contrary case study is medical-centered care, whereby the patient is perceived as a collection of diseases, not as a person. Medical-centered care does not have any attributes associated with PCC.

Antecedents and Consequences

According to Walker and Avant (2005), antecedents refer to attributes or events that precede the occurrence of a concept. With respect to PCC, one antecedent is a supportive and healthy work environment (Burtson & Stichler, 2010). In order to develop PCC, it is imperative for healthcare institutions to establish an environment in which the most important asset for the organization – its workforce – feels valued and respected, and treated with the same dignity that institution requires its employees to accord families and patients (Coetzee & Klopper, 2010).

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Essentially, caregivers have to feel cared for PCC to flourish. Karl, Harland, Peluchette, & Rodie (2010) emphasized the significance of recruiting, training, assessing, and supporting healthcare professionals committed to PCC. Achieving high levels of employee engagement and commitment requires direct involvement of employees with respect to designing and executing patient-centered processes. It is essential for the healthcare organization to be not only patient-centered but also human-centered in the sense that all stakeholders, such as front line staff and managers, take part in the development and implementation of care systems that are both responsive and effective (Burtson & Stichler, 2010; Coetzee & Klopper, 2010).

Therefore, when PCC is looked at in terms of patient satisfaction, it is evident that healthy work environments contribute to patient satisfaction (Edvardsson, Varrailhon, & Edvardsson, 2014). Since patient satisfaction is a measure of PCC, it is positively related to employee satisfaction. In other words, nurses who are engaged and committed (satisfied) are likely to practice PCC, which in turn contributes to patient satisfaction. Thus, PCC is crucial to both patient and employee satisfaction. Employers are responsible for creating healthy work environments to foster PCC in order to achieve high levels of employee and patient satisfaction.

Consequences denote the incidents and events likely to occur because of the concept. With respect to PCC, the likely positive consequences include improved care quality, cost reduction, care continuity, compliance with treatment, physiological and psychological comfort among patients as well as an increase in professional and family satisfaction. Negative consequences are likely to occur when PCC is not practiced including patient discomfort, sentinel events, near miss, and never events.

A potential danger of PCC is the likelihood of patient preferences being inconsistent with their actual treatment requirements. For instance, a physician who agrees to a patient request for needless antibiotics is likely to satisfy the patient; however, the inappropriate prescription may not result in positive health outcomes.

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Empirical Referents

Empirical referents refer to quantifiable ways of illustrating the concept’s occurrence. The first empirical referent for patient-centered care is consultation care measure (CCM) developed by Stewart, Brown, Weston, and Freeman (2003) based on the relationship between patients and doctors. CCM measures partnership and communications, health promotion, personal relationship, positive and precise approach to the problem, and interest in effect on life. The second empirical referent is the Instrument on Doctor-Patient Communication skills developed by Campbell, Lockyer, Laidlaw, and MacLeod (2007) that evaluates the illness and disease experience of the patient and patient-doctor relationship.

Conclusion

The concept analysis of PCC has a number of implications for practice and research in nursing. With respect to research, it is important to note that there is no criterion used for defining better health outcomes in PCC. For instance, a patient may be contented with the doctor’s communication although the disease is worsening. In other words, research is needed to delineate the desirable health outcomes of the concept. With respect to practice, the concept analysis paper has outlined the factors contributing to PCC which should be incorporated in healthcare practice. It can also be concluded that PCC presents a dilemma for healthcare practitioners owing to the fact that the ultimate reference point is the patient, who may be wrong when determining his/her needs.

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