Person-centred Nursing Care Research Articles

The discourse of delivering person-centred nursing care before, and during, the COVID-19 pandemic: Care as collateral damage.

The global COVID-19 pandemic challenged the world-how it functions, how people move in the social worlds and how government/government services and people interact. Health services, operating under the principles of new public management, have undertaken rapid changes to service delivery and models of care. What has become apparent is the mechanisms within which contemporary health services operate and how services are not prioritising the person at the centre of care. Person-centred care (PCC) is the philosophical premise upon which models of health care are developed and implemented. Given the strain that COVID-19 has placed on the health services and the people who deliver the care, it is essential to explore the tensions that exist in this space. This article suggests that before the pandemic, PCC was largely rhetoric, and rendered invisible during the pandemic. The paper presents an investigation into the role of PCC in these challenging times, adopting a Foucauldian lens, specifically governmentality and biopolitics, to examine the policies, priorities and practical implications as health services pivoted and adapted to changing and acute demands. Specifically, this paper draws on the Australian experience, including shifting nursing workforce priorities and additional challenges resulting from public health directives such as lockdowns and limitations. The findings from this exploration open a space for discussion around the rhetoric of PCC, the status of nurses and that which has been lost to the pandemic.

How nurses use National Early Warning Score and Individual Early Warning Score to support their patient risk assessment practice: A fieldwork study.

To explore and describe how the National Early Warning Score (NEWS) and Individual Early Warning Score (I-EWS) are used and how they support nurses' patient risk assessment practice. A qualitative observational fieldwork study drawing on ethnographical principles was performed in six hospitals in two regions of Denmark in 2019. Data were generated from participant observations and informal interviews with 32 nurses across 15 different wards in the hospitals. A total of 180h of participant observation was performed. The observations lasted between 1.5 and 8 h and were conducted during day or evening shifts. NEWS and I-EWS supported nurses' observations of patients, providing useful knowledge for planning patient care, and prompting critical thinking. However, the risk assessment task was sometimes delegated to less experienced staff members, such as nursing students and healthcare assistants. The Early Warning Score (EWS) systems were often adapted by nurses according to contextual aspects, such as the culture of the speciality in which the nurses worked and their levels of competency. In some situations, I-EWS had the effect of enhancing nurse autonomy and responsibility for decision-making in relation to patient care. EWS systems support nurses' patient risk assessment practice, providing useful information. I-EWS makes it easier to factor the heterogeneity of patients and the clinical situation into the risk assessments. The delegation of risk assessment to other, less experienced staff members pose a risk to patient safety, which needs to be addressed in the ongoing debate regarding the shortage of nurses. The findings of this study can help ward nurses, hospital managers and policymakers to develop and improve strategies for improved person-centred nursing care.

Nurses' perceptions and beliefs related to the care of adults living with multimorbidity: A systematic qualitative review.

To identify and synthesise the available qualitative evidence on nurses' perceptions and beliefs related to the care of adults living with multimorbidity. The rising prevalence of adults living with multimorbidity has increased demand for health care and challenges nursing care. No review has been conducted to date of the studies of nurses' perceptions and beliefs related to the provision of care to guide policy makers, practitioners and further research to identify and deliver quality care for persons living with multimorbidity. Systematic review of qualitative studies conducted in line with the PRISMA checklist. Eight electronic publication databases and sources of grey literature were searched to identify original qualitative studies of the experience of nurses caring for adults with multiple chronic conditions with no restrictions on the date of publication or study context. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Data were extracted using the Joanna Briggs Institute standardised data extraction tool for qualitative research. Data synthesis was undertaken through meta-aggregation. Eleven qualitative studies were included in the review. All studies met eight or more of the 10 assessment criteria of the JBI Critical Appraisal Checklist for Qualitative Research. Four synthesised findings were generated from the aggregated findings: (i) the challenge of providing nursing care; (ii) the need to deliver holistic and person-centred nursing care; (iii) the importance of developing a therapeutic nurse-patient relationship, and (iv) delivering nursing care as part of an interprofessional care team. The complexity of multimorbidity and the predominant single-disease model of chronic care present challenges for the delivery of nursing care to adults living with multimorbidity. The nursing care of persons with multimorbidity needs to incorporate holistic assessment and person-centred care principles as part of a collaborative and interprofessional team approach. CRD42020186773.

Patient Activation and its Predictors in Hospitalized Older Adults in Singapore

BackgroundPatient activation is critical in hospitalized older adults preparing for discharge as it enhances their ability to self-care at home. Little is known about how person-centred care and demographic predictors could influence activation in Asian patients. AimsTo explore patient activation and its predictors in hospitalized older adults in Singapore. MethodsMulti-centre cross-sectional survey of hospitalized older adults. Multivariable analysis conducted with age, gender, education, socioeconomic status, functional dependency and perception of person-centred care as potential predictors to patient activation. Results300 older adults were surveyed, 65% were at the top two levels of activation. Perception of person-centred nursing care was the strongest predictor with the largest effect on patient activation, (β=0.22, b=3.48, 95% CI:1.70–5.26, p<0.001). Other predictors were age, education, income and independence in care. ConclusionOur study highlights the importance of person-centred nursing care in raising patient activation in hospitalized older adults, enhancing their capacity to self-care.

Implementation and evaluation of a training programme to promote the development of professional competences in nursing: A pilot study

BackgroundClinical narratives may be used as a means to improve the acquisition of clinical competences. Even though there are studies that recognize the potential value of clinical narratives to promote nursing professional development, there is no evidence that shows their value as a tool to improve nurses' competences to provide person-centred nursing care. PurposeTo evaluate the preliminary efficacy of narratives for the development of three nursing professional competences —respect, intentional presence and knowing the person— for providing person-centred care. MethodUsing a pre-post quasi-experimental design, a pilot study with a total of 34 nurses enrolled in a training course of nursing specialization was conducted between September 2016 and June 2017. All the nurses received a multi-component intervention based on the Critical Reflective Inquiry model. The strategies of this programme consisted of writing three narratives, attending two masterclasses, participating in a discussion group, and participating in a face-to-face interview. The NarratUN Evaluation tool was used to assess the outcomes. Changes among nurses were analysed using the Wilcoxon signed Rank test. ResultsThe difference in the means between the pre- and post-intervention scores were statistically significant for respect [0.59 (95% CI 0.23–0.95; p = 0.001)], intentional presence [0.75 (95% CI 0.32–1.17; p < 0.0001)] and knowing the person [0.62 (95% CI 0.25–0.99; p = 0.001)]. The difference in the mean score for use of the narrative and reflection also increased significantly [0.65 (95% CI 0.32–0.98, p < 0.001)]. ConclusionsThe use of narratives combined with other reflective strategies (masterclass sessions and discussion groups) proved to be effective for the development of professional competences of nurses.

Getting the fundamentals right: assisting patients with eating and drinking

Compassion and effective communication are widely regarded as essential elements of quality person-centred nursing care, but these can be difficult to demonstrate during mealtimes. Elizabeth Semerdzhieva and Bernie Reid discuss the best techniques and approaches

Spiritual care by nurses in curative oncology: a mixed-method study on patients' perspectives and experiences.

AimsSpirituality can be important in adjusting to the experience of cancer and its medical treatment. Since nurses have frequent contact with patients, they seem to have a unique role in providing spiritual care. Nurses consider spiritual care important; however, little is known about how patients in a curative setting experience and value spiritual care. Therefore, this study aimed to give insight into patients’ experiences with and opinions about spiritual care as provided by nurses in curative cancer care.MethodsThis is a national, multicentre mixed‐methods study, combining a quantitative approach using questionnaires (n = 62) and a qualitative analysis of semi‐structured interviews (n = 61). Nonparametric tests were used for quantitative data, and qualitative data were analysed inductively.FindingsMost patients rarely received spiritual care by nurses. If spiritual care was provided, it mainly consisted of noticing problems and referring to other professionals. This appeared to be dependent on certain ‘triggers’, such as age. Structural discussions on spirituality with a nurse were experienced rarely. This was explained by, among other factors, the hospital setting. Yet, the majority (79%) of patients found the attention to spirituality sufficient or very good. Furthermore, a majority (58%) viewed spiritual care as a nursing task: nurses should notice spiritual problems and refer to other professionals, though extensively discussing patients’ spirituality was neither considered nurses’ task nor capability.ConclusionsAttention to spiritual care in a curative setting, though not so much desired by most patients, should be pursued, because of its importance in performing person‐centred nursing care and its positive impact on patients’ health. By training nurses in offering spiritual care in proactive and ‘nonactive’ (accepting) ways, spiritual care could be structurally offered in clinical practice in personalised forms. Since younger and less spiritual patients are not much satisfied with spiritual care by nurses, they need special attention.

'There's more to a person than what's in front of you': Nursing students' experiences of consumer taught mental health education.

Holistic and person-centred nursing care is commonly regarded as fundamental to nursing practice. These approaches are complementary to recovery which is rapidly becoming the preferred mode of practice within mental health. The willingness and ability of nurses to adopt recovery-oriented practice is essential to services realizing recovery goals. Involving consumers (referred herein as Experts by Experience) in mental health nursing education has demonstrated positive impact on the skills and attitudes of nursing students. A qualitative exploratory research project was undertaken to examine the perspectives of undergraduate nursing students to Expert by Experience-led teaching as part of a co-produced learning module developed through an international study. Focus groups were held with students at each site. Data were analysed thematically. Understanding the person behind the diagnosis was a major theme, including subthemes: person-centred care/seeing the whole person; getting to know the person, understanding, listening; and challenging the medical model, embracing recovery. Participants described recognizing consumers as far more than their psychiatric diagnoses, and the importance of person-centred care and recovery-oriented practice. Understanding the individuality of consumers, their needs and goals, is crucial in mental health and all areas of nursing practice. These findings suggest that recovery, taught by Experts by Experience, is effective and impactful on students' approach to practice. Further research addressing the impact of Experts by Experience is crucial to enhance our understanding of ways to facilitate the development of recovery-oriented practice in mental health and holistic and person-centred practice in all areas of health care.

‘Sweet dreams’: an evidence-based approach to effective sleep hygiene maintenance for people with an intellectual disability

Sleep is an essential activity of daily living that is often overlooked in approaches to caring for people with intellectual disabilities (IDs). Poor sleep, insomnia or disrupted sleep can have wide-ranging effects on the health and well-being of people with ID resulting in many adverse consequences.This article outlines the main challenges that people with ID may have initiating and sustaining sleep, explains the nature, prevalence and causes of sleeping problems they experience and discusses a variety of assessments of sleeping issues. It also examines sleep maintenance, management and sleep hygiene approaches to support this cohort using a person-centred nursing care plan and concludes with some suggestions for sleep maintenance and hygiene. Good sleep hygiene should form a central element of caring for people with ID and this article offers suggestions about care planning approaches to enable good quality sleep experiences for people with ID.

Learning from narrative to understand the person-centred experience in neonatal nursing: A literature review

IntroductionWithin healthcare, narrative can be a compelling way to teach professionals about patient experience and foster a more humanistic, person-centred understanding of care. The neonatal nursing field is a speciality with specific learning needs relating to the neonate within the family centred context that requires a person-centred understanding of the parent experience. Little has been investigated or written about how narrative can inform teaching and learning about person-centred care in this area. ObjectivesTo identify key literature that explores the narratives of parents or nurses with a view to evaluating their value for enhancing learning about person-centred nursing care in the neonatal field. DesignA literature review was undertaken focussing on qualitative research exploring parent's or nurse's experience through narrative and learning from that experience within neonatal care. Data sourcesThe databases identified as most suitable to their relevance to nursing were accessed through EBSCO host and a local University consolidated library search system. Review methodsPrimary, Boolean and advanced searches on key terms were performed. Purposive sampling of the literature was used and inclusion and exclusion criteria were applied. A final selection of nine studies was put forward for review. FindingsAnalysis of the selected literature found that attention to the narratives of both parents and nurses in the neonatal field revealed important insights into the lived experiences of this often challenging environment. This offers opportunities to open up professional practice for discussion providing an effective vehicle for students and nurses to learn about and discuss these experiences in the neonatal field. This in turn can offer a more compassionate, person-centred approach to the care of neonates, parents and staff in this area. ConclusionThere is a place for the integration of narrative in the form of storytelling into teaching and learning strategies that capture the experience of those within the neonatal field that can be used to support education about person-centred neonatal nursing care.

Operating theatre nurses’ experiences of teamwork for safe surgery

The aim of this study was to describe operating theatre nurses’ experiences of teamwork within the surgical team in regard to achieving patient safety. Safe surgery for patients is based on teamwork in a safe modus between the members in the surgical team. Operating theatre nurses contribute to safe surgery by professional perioperative nursing activities and by participation in teamwork in the surgical team. A qualitative descriptive design using narrative interviews with 16 operating theatre nurses in Sweden was chosen for increased understanding of their experiences of teamwork in regard to achieving patient safety. The findings are presented in three themes, illustrating teamwork in regard to achieving patient safety between the operating theatre nurses’ and other professionals in everyday situations. From the operating theatre nurses’ narrated experiences of teamwork, person-centred nursing care, interdependent collaboration and familiarity of the professionals’ skills contributed to safe surgery. A brief meeting, unfamiliarity of professionals’ skills, uncontrolled tantrums and experiences of exclusion were experienced as counteractive to patient safety. The operating theatre nurses managed demanding situations by diverse strategies to restore patient safety.

Patients' outcomes related to person-centred nursing care in radiation oncology: A case study

PurposeThe aim of this case study is to describe patients' responses to nursing care following the implementation of a person-centred model in a radiation oncology department. MethodAn instrumental case study design utilised surveys to collect data on a range of key patient outcomes: patient satisfaction (PSS), informational issues (RSEP), quality of life (FACT_G), comfort (RTCQ), and emotional status (HADS). This occurred at the beginning of, and twelve months following, the implementation of the new model of care. ResultsThis study demonstrated that, although adverse effects of radiotherapy continue to affect patient well-being in the latter part of their course of radiation therapy, patients continue to be satisfied with nursing care. There were significant differences between groups in perceptions of the care environment and the use of the nurse as an acknowledged source of information are noteworthy, since these variables were key targets of the new model of care. The finding that nurses were seen by the post-implementation cohort as more likely to be a source of information is an important indicator that the nurses' presence was noted by patients, and they generally reported high levels of functioning despite undergoing a curative course of radiotherapy. ConclusionThe person-centred nursing approach in the radiotherapy setting has contributed to some improvements in the provision of patient care. Aspects of this study may assist in planning further nursing interventions for patients undergoing radiotherapy for cancer, and continue to enhance the contribution of the radiation oncology nurse to improved patient outcomes.

BEING A PARENT ON DIALYSIS: A LITERATURE REVIEW

This literature review explored the extant literature to further our understanding of the experience of being a parent on dialysis. Keywords used to search the literature were haemodialysis, hemodialysis, chronic kidney disease, end stage renal disease, parent and experience. Databases searched included CINAHL, Medline, Wiley/Blackwell, EBSCOHost, Web of Science, Pubmed and ProQuest. Years included were 1999-2009. Seventeen primary research articles (sixteen qualitative, one mixed methods) met the search criteria with only one on parents undergoing dialysis. The experience of the parent on dialysis has rarely been explored in the literature. Related research has indicated important themes including: restricted lives; relationships; adjustment; consequences and future outlook. More should be known about challenges that face parents who receive dialysis. This review established an urgent need for further research to determine the experiences and needs of this population to provide empirical, person-centred nursing care.

Applying skills and knowledge: principle of nursing practice f

This is the seventh article in a nine-part series describing the Principles of Nursing Practice developed by the Royal College of Nursing (RCN) in collaboration with patient and service organisations, the Department of Health, the Nursing and Midwifery Council, nurses and other healthcare professionals. The article discusses Principle F, the application of skills and knowledge to person-centred nursing care.

Struggling to retain living space: patients’ stories about living with advanced chronic obstructive pulmonary disease

This paper is a report of a study of the experience of living with advanced chronic obstructive pulmonary disease and long-term oxygen therapy when living alone. Chronic obstructive pulmonary disease affects an increasing number of people. Breathlessness, fatigue and dejection are common symptoms during the last years of life. Repeated qualitative interviews with four participants were conducted over an 8-month period in 2008. The data comprised 17 interviews, 15 telephone conversations and various field notes. A phenomenological hermeneutical method was used to interpret the text. The analysis resulted in two main themes and five sub-themes. The first main theme, Being subordinated to the sick body, implies that the body, assistive devices and entrusting oneself to the hands of others can both extend and restrict the living space. The second main theme, Protecting significant values of identity, encompasses both the struggle to maintain self-image and the awareness of one's own death. Living alone with advanced chronic obstructive pulmonary disease is a challenging and complex phenomenon. The everyday life was characterized by a struggle to keep autonomy during a time of increasing dependency and need for help. A person-centred nursing care, built upon peoples' own experiences, may be one way to promote identity and dignity in patients even when they are close to death.

End-of-Life care for older people in the acute hospital setting

Hospital-based staff members, particularly nurses, provide the majority of end-of-life care for older people. Older patients who are dying in hospital have complex end-of-life care needs as a result of increased risk of drug reaction, iatrogenic disease and comorbidity, which are often superimposed on pre-existing mental or physical deficits. This article discusses the challenges faced by nurses who wish to provide effective end-of-life care in the hospital setting. It examines the difficulty nurses experience providing such care in the face of their limited training and experience related to end-of-life care. The importance of nurses recognising when a patient is dying and accepting that fact without a demoralising sense of failure is discussed, along with the need for open and inclusive conversations about death and dying, involving the dying patient, the patient’s family and the multidisciplinary team. The need to provide person-centred nursing care via the use of an integrated care pathway specifically designed for dying patients and adapted to the hospital setting is discussed. Conflicts of interest: none