Thursday, February 26, 2015

Renewed Interest in Patient-Centered Care

Patient-centered care is not a new idea. It was quite popular when I was in nursing school in the mid 1970's. It's what drove me out of hospital-based care and into home health care within three years of graduation. I wasn't able to make the difference I wanted to make because we couldn't achieve patient-centered care.

Reemergence of Patient-Centered Care
Nurse Blog CarnivalNow as we are mandated to cut and manage the soaring costs of healthcare and improve outcomes all at the same time, the importance of patient-centered care is reemerging. To a new generation of nurses and health care professionals it is new and exciting, and to those of us familiar with it, we are once again inspired. I hope this time around it really catches fire. I know that it has been integral to quality home health and hospice care for decades and one of the reasons they are thriving industries today.

So what is the fuss all about? It's not that complex, but I still believe hospitals will struggle to achieve patient-centered care wholeheartedly just because there simply is not, and probably never will be, adequate staffing and nurse-patient ratios. Perhaps if the concept begins to prove to lower costs and improve outcomes, administrators will see the light and make some changes. Yes, I know I'm a dreamer. But think of the impact we could have on wellness and preventative care if all nurses had the opportunity to practice true patient-centered care!

Integrating the Whole Patient into the Plan of Care
Patient-centered care means whole-patient care. This is why it works well in home health and hospice. The nurse (and the care team) meets the patient, his family, his caregivers, his pets, and despite the best HIPAA efforts, often his nosy neighbors. With a glimpse into the patient's home and environment we get to see his true lifestyle, culture, traditions, beliefs, superstitions, fears, wants, desires, and all of what makes up this patient. In the physician's office, clinic, ER, or hospital room we only see small parts of the picture.

The home health or hospice nurse becomes the eyes and ears of the physician often to learn why the patient is non-committal or non-compliant; why the treatment is not effective; why the patient is not improving. In that sterile environment of the hospital he thrived. But back home he has his whole-person lifestyle to contend with. The plan of care has to include these factors.

Empowering Patients
Patient-centered care means we need to examine and consider all of the components of the patient. The patient's values, cultural traditions, social circumstances, financial matters, family situations, and personal preferences have to become an integral part of the plan of care.

Once we meet and see the whole patient, patient-centered care involves:
  • providing coordination of care and open communication with all members of the team including the patient and designated family members  
  • providing support and empowering the patient to take responsibility
  • providing ready access to information and care 
  • the autonomy to make decisions without judgement
As we educate the patient and monitor the plan of care we have to include all of these factors in order to help guide the patient and empower him to understand his health status, his options and the benefits and risks without bias or judgement. We have to give the patient the information and the right to make informed choices and then the guidance to help him achieve the best outcomes possible under the circumstances. Again we cannot judge or present bias; only information and options as we move forward with the plan of care.

The Institute of Medicine (IOM) and the Institute for Healthcare Improvement have conducted many studies on patient-centered care and the results show improved patient outcomes, higher quality health care, and a higher level of patient engagement. All of these will lead us to a much improved overall health status and eventually help to contain and lower the staggering costs of health care.

How is patient-centered care working in your job? 

This post was written as part of the Nurse Blog Carnival. More posts on this topic can be found at Big Red Carpet Nursing. Find out how to participate.


Resources:
Patient-centered care
Patient-Centered Care: What it Means and How to Get There
Chasing the Quality Chasm



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