Patient-centered Nursing Care Research Articles

Perceptions of Quality of Patient-Centered Nursing Care among Women with Breast Cancer

Purpose: This study aimed to investigate the quality of patient-centered nursing care (PCNC) among women with breast cancer at a cancer center in Seoul, Korea. Methods: In a cross-sectional survey design, 223 women with breast cancer were recruited from the oncology surgery unit. The Korean version of the oncology patients’ perceptions of the quality of nursing care scale, which is conceptualized in four sub-dimensions (individualization, proficiency, responsiveness, and coordination) was used for measurement. Data were analyzed using descriptive statistics and ANOVA. Results: The participants were all women, with a mean age of 51.3 years. The mean score of PCNC was high and significantly different from each other according to age group. Breast cancer women, who had mastectomy, were satisfied highly in terms of proficiency and responsiveness care, but less satisfied with individualization and coordination care than those of other women. Conclusion: The findings of this study show the quality of cancer nursing care, especially focusing on patient-centeredness, can be measured from the patients’perspective. The individualized and coordinated nursing care is considered to be the core of quality cancer care implying patient-centeredness. Based on the findings of this study, more research is necessary to explore the patients’ view of quality cancer care and to test the effects of PCNC within the context of comparative effectiveness.

A systematic review of instruments measuring patients' perceptions of patient-centred nursing care.

This systematic review identified and evaluated instruments measuring patients' perceptions of patient-centred nursing care. Of 2629 studies reviewed, 12 were eligible for inclusion. Four instruments were reported: The Individualized Care Scale, the Client-Centred Care Questionnaire, the Oncology patients' Perceptions of the Quality of Nursing Care Scale and the Smoliner scale. These instruments cover themes addressing patient participation and the clinician-patient relationship. Instruments were shown to have satisfactory psychometric properties, although not all were adequately assessed. More research is needed regarding test-retest reliability, convergent and discriminant validity, validity with known groups and structural validity using confirmatory factor analysis.

Sexual concerns of cardiac patients: Predictors and the influence of specific sexual activities

Addressing sexual concerns of cardiac patients is integral to comprehensive patient-centered nursing care, and instruments for use across cardiac populations are needed to promote this activity. Knowing the factors that contribute to sexual concerns provides insights that help to promote inclusion of assessment of relevant sexual activity and provide sexual counseling as a standard of care. This study examined demographic factors, comorbid conditions, and sexual activities as predictive of sexual concerns. Specific sexual activities and demographic variables were also examined for their relation to sexual concerns. This study was a sub-analysis of a cross-sectional observational study testing a regression model of factors that predicted sexual concerns in a broad sample of cardiac patients in the United States, using a self-report survey method. More comorbidities and types of sexual activities contributed to greater sexual concerns reported by respondents. Sexual activities resulting in overall sexual concerns included hugging/kissing, oral sex, and finger penetration. Non-Whites reported more sexual concerns, sexual fears, and symptoms related to sexual activity. Those who were not working/retired from employment reported significantly more sexual concerns and dysfunction, whereas, those who had a smoking/tobacco use history reported more sexual concerns, symptoms, and dysfunction. This study underscores that cardiac patients across a variety of diagnoses and comorbidities often experience sexual concerns, fears, symptoms, and dysfunction. The strongest predictors of sexual concerns were the number of cardiac and noncardiac comorbidities, thus illustrating the importance of a thorough assessment of these factors when examining sexual concerns of cardiac patients.

Collaborations Between Home Healthcare Agencies and Schools of Nursing

Home healthcare (HHC) agencies and schools of nursing (SONs) share the mutual goal of using evidence-based knowledge to deliver care while fostering a professionally stimulating environment. As HHC agencies strive to deliver clinically effective, cost-efficient, patient-centered nursing care, SONs use scholarly methods to develop sound practitioners with investigative skills. Collaborations have long existed between these two entities, but few studies describe how theory and practice meld in the ever-growing HHC arena. The purpose of this article is to highlight the need for such future collaborations and to summarize some of the successful collaborative methods used by schools and agencies. Additionally, the collaboration between one nonprofit HHC agency and a university-based SON is described along with the challenges and benefits to both partners.

Effects of Race and Language on Patient-Centered Cancer Nursing Care and Patient Outcomes

Nursing prides itself on the ability to advocate for patients. However, questions are raised in the National Health Care Disparities Reports from the Agency for Healthcare Research and Quality about how well nurses communicate with African Americans, Hispanics, and people who speak languages other than English. Our secondary analysis of patient data collected at an urban safety-net hospital oncology unit examined the relationships among race, language, patient-centered nursing care, and patient outcomes. Using path modeling techniques, findings indicate that patient-centered care and associated outcomes for African American/Black and Others differ from those for Whites. For the African American/Black and Others group, individualization played a more significant role in achieving a sense of well-being, optimism, and authentic self-representation. Patients who spoke a language other than English at home had different perceptions of their nurses' responsiveness; nurses' responsiveness in turn affected patients' trust in nurses. Future testing is recommended for relationships between patient-centered nursing care and patient outcomes in underserved populations.

An Innovative Off-Campus Infusion Suite Designed to Improve Experiences of Patients With Cancer

The Brooklyn Infusion Center of Memorial Sloan-Kettering Cancer Center was established in 2010 to better meet the needs of patients with cancer living in the Brooklyn neighborhood and surrounding areas. A multidisciplinary team comprising clinical, administrative, planning, and other representatives were charged to identify and develop a location that would provide oncology care for patients closer to home and improve the patients' experience. The primary objectives were to provide patient-centered care that accommodates the patients' preference to receive treatment closer to home and to take advantage of technology to establish processes that will provide safe, efficient, convenient, and high-quality care in a cost-effective manner. To achieve these objectives, no laboratory processing or pharmacy services were included in the plan for the Brooklyn location. This allowed the elimination of most of the challenges involved with same-day blood draws and chemotherapy orders. In addition, computer technology is used for teledermatology and other medical visits to maintain the continuity of the patients' care with their multidisciplinary teams at the Manhattan, NY, location. The data presented will illustrate how these processes have improved patients' experiences by reducing wait times for treatment, providing treatment closer to home, and implementing a truly patient-centered nursing care model.

The Royal Marsden Hospital Manual of Clinical Nursing Procedures – Eighth editionThe Royal Marsden Hospital Manual of Clinical Nursing Procedures – Eighth edition

This is much more than a book on clinical nursing procedures. It is a well written, comprehensive text that emphasises the importance of seeing nursing procedures as a fundamental aspect of patient-centred nursing care. These are identified not just as tasks, but as part of the whole experience for the patient.

Patient centeredness in terminologies: Coverage of health assets concepts in the International Classification of Nursing Practice

Health assets has emerged as an important concept in health care, representing patients’ strengths and perspectives, but has not received much attention in structured vocabularies or classification systems of nursing care to date. The purpose of this study was to explore the representation of health assets concepts in the International Classification of Nursing Practice® (ICNP). Concepts from a conceptual model of health assets were cross-mapped to the ICNP terminology system version 2.0. Thirty-three of 76 health assets concepts/terms were represented in the ICNP. However, several health assets categories and subcategories were missing or embedded in the descriptors of other ICNP concepts/terms. A number of ICNP terms did not include positive statements consistent with the health assets approach, and many terms reflected the objectiveness of a clinician’s perspective rather than a patient’s strength perspective. ICNP would benefit from the inclusion of additional health assets concept to reflect and support patient-centered nursing care as well as the patient’s empowerment and self-management of health.

Trust in Nurses Scale: construct validity and internal reliability evaluation

This paper is a report of the continued psychometric evaluation of the Trust in Nurses Scale. Qualitative analyses indicate that trust in nurses is critically important to adult patients. Instruments that distinctively measure this concept are lacking. A middle-range theory of patient-centred nursing care provided the theoretical basis for the Trust in Nurses Scale. Content validity was assessed by an expert panel and patient interviews. Construct validity and reliability were found acceptable using multi-trait/multi-item analysis techniques. These findings were previously reported. Construct validity and reliability of the Trust in Nurses Scale was assessed in 2007 using data collected during 2004-2005 from 187 hospitalized patients in a haematology-oncology setting. Trust in nurses (the latent factor) was operationalized by five items (manifest variables) using confirmatory factor analyses. Fit statistics included comparative fit index, Tucker-Lewis Index, root mean square error of approximation and the standardized root mean square residual. Internal consistency reliability was assessed using coefficient alpha. Both a five-item and a four-item version demonstrate acceptable psychometric properties. The five-item version met three fit statistics criteria. Fifty-nine per cent of the variance was explained. A four-item version met all fit statistics criteria. Sixty-six per cent of the variance was explained. Acceptable internal consistency reliability was found for both versions. Previous psychometric testing of the Trust in Nurses Scale provided evidence of the instrument's reliability, content validity and construct validity. The presented analyses further support construct validity. Thus, cumulative findings indicate that the instrument measures with a few items the underlying concept of trust.

Exploring a Culture of Caring

The delivery of patient-centered care is basic to a large midwestern healthcare institution's mission and highly valued by the department of nursing. Even so, nurses on one medical unit questioned whether caring behaviors were devalued in a technology-oriented environment of providing care. The nursing leadership on the unit responded to the inquiry by conducting a research study. This study explored the state of patient-centered nursing care on a medical unit as perceived by the nursing staff and patients, using Watson's Theory of Human Caring as a framework. The study utilized surveys for both nursing staff (n = 31) and patients (n = 62), and included a focus group of nursing staff (n = 8) to explore ideas for innovation. Both nurses and patients perceived a high level of caring on the unit. The overall theme from the focus group was that "caring begets caring," with 2 subthemes: "relationships of care" and "the context of caring." Caring for each other was identified as essential to keep staff energized and able to work lovingly with patients. Nursing leadership brought the research findings to all staff on the unit for discussion and implementation of structural support for the unit culture of caring.

Developing a stroke unit using the acute care for elders intervention and model of care.

The Acute Care for Elders (ACE) model of care is a multicomponent intervention that improves outcomes for older patients hospitalized for acute medical illnesses. Likewise, stroke units improve outcomes for patients with acute stroke, yet the descriptions of their structure and approach to stroke management are heterogeneous. The purpose of this article is to describe how implementing the ACE model of care, using a continuous quality-improvement process, can serve as a foundation for a successful stroke unit aimed at improving stroke care. The ACE intervention (a prepared environment, interdisciplinary team management, patient-centered nursing care plans, early discharge planning, and review of medical care) was amplified in a community teaching hospital for stroke-specific care by creating a stroke interdisciplinary team, evidence-based stroke orders and protocols, and a redesigned environment. Administrative data show that the ACE model can be successfully adapted to create a disease-specific program for stroke patients, having the potential to improve the process of care and clinical stroke outcomes.

Cancer patients' demographic characteristics and ratings of patient-centered nursing care.

To examine relationships between patients' demographic characteristics and patients' reports of patient-centered care. Secondary analysis of data (N = 423) from a study in the northeastern United States focused on the psychometric properties of the Oncology Patients' Perceptions of the Quality of Nursing Care Scale (OPPQNCS). The quality of four interpersonal nursing interventions, representing patient-centered nursing care, was measured with the OPPQNCS subscales. Patients' characteristics included race (White or non-White), sex, age, education, income, and hospitalization for cancer. Four separate ordinary least squares regression models were constructed. Hospitalization was inversely related to intervention quality in each model. Income was the only statistically significant characteristic for nonhospitalized patients, and only in the coordination model. For hospitalized patients, education was statistically significant in the coordination model, and income in the proficiency model. An interaction term for education and income was statistically significant in the responsiveness model, and a term for gender and education in the individualization model. Hospitalized patients' exposure to nursing care may indicate a wider range of care quality than for nonhospitalized patients, possibly accounting for the inverse relationship between hospitalization and patient-centered care. Groups identified at risk for lower quality care--minorities, women, elders, and people in low-income groups--did not report a lower level of patient-centered nursing care. Nurses' contributions to patient-centered care and care equity are important components of care quality, particularly for hospitalized cancer patients.

Improving Functional Outcomes in Older Patients: Lessons from an Acute Care for Elders Unit

Hospitalization often marks the beginning, and may be partially responsible for, a downward trajectory characterized by declining function, worsening quality of life, placement in a long term care facility, and death. At the University Hospitals of Cleveland, an Acute Care for Elders (ACE) unit that reengineered the process of caring for older patients (> or = 70 years of age) to improve functional outcomes was established in September 1990. The general principles of ACE included an approach to care guided by the biopsychosocial model and recognition of the importance of fitting the hospital environment to the patient's needs. The design of the intervention was consistent with principles of comprehensive geriatric assessment and continuous quality improvement. Care, which focused on maintaining function, was directed by an interdisciplinary team that considered the patient's needs both at home and in the hospital. The major components of the ACE Unit intervention included patient-centered nursing care (daily assessment of functional needs by nursing, nursing-based protocols to improve outcomes, daily rounds by a multidisciplinary team), a prepared environment, planning for discharge, and medical care review. In a randomized trial comparing ACE with usual care, patients receiving ACE had improved functional outcomes at discharge. The costs to the hospital for ACE unit care were less than for usual care. The functional status of ACE and usual care patients was similar 90 days after discharge. The ACE unit intervention is being expanded to preserve the improvements observed during the hospitalization in the outpatient setting. In addition, needs other than function which are critical to patients' long-term quality of life are being considered.

Patient-centred nursing care in a multi-racial society: the relevance of ethnographic perspectives in nursing curricula.

The aim of the paper is to demonstrate the importance of including cultural dimensions as a fundamental component of nursing curricula and to provide some indications as to how this may be achieved. The concept of 'institutionalized racism' is examined, with reference to the absence of the cultural dimension in nursing education, and it is suggested that nurses, as members of a 'caring profession', should be in the forefront in promoting mutual cultural understanding. The argument for promoting cultural awareness is developed in the context of individualized nursing care and the nursing process. The needs of ethnic minority learners are considered along with their potential role, and that of tutors, in breaking down barriers to the acceptance of cultural diversity. Some possible reasons for the failure to include ethnographic perspectives in nurse education programmes are postulated, and finally suggestions as to how this curriculum deficit may be rectified are made. The paper concludes that British nurse educators should ensure that the needs of learners and patients are better provided for in the future by directing more attention to ethnographic perspectives relating to learning and the provision of nursing care.