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Person Centred Framework In Nursing

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Question:

Discuss about the Person Centred Framework in Nursing.
 
 

Answer:

Introduction

Personal centered frameworks in nursing have been considered as one of the most convenient approaches in providing care in both hospitals and outside hospital settings (Disch, 2012). It includes how nurses and other healthcare professionals involve patients as equal partners in developing, planning and monitoring care to ensure patients’ needs are met (Basch, 2016). This highly consists putting patients and their families in the centered of decision making giving them and their opinions in their care high priority, seeing them as experts of their own life and working alongside other healthcare workers so as to get the maximum possible best outcomes (Disch, 2012).

This does not just involve giving people whatever they need or providing health information, but also it involves considering people's values, culture, desires, lifestyles, social circumstances and religion (Greene, 2012). This means that a patient is seen as individual with capabilities of working together with nurses to develop and plan appropriate solutions in healthcare delivery (Disch, 2012).  Therefore, it can only be demonstrated by sharing ideas with the patients and helping them manage their health. Since personal centered care is not just about environment and health activities, nurses and patients have to use intellectual thinking about care, nurse to the patient relationship and the actual services available (Basch, 2016). This study tend to demonstrate various aspects of personal centered framework including components of personal centered framework, reasons why it is important in healthcare, its application in infection control, how it has been used to enhance hand hygiene  and its relation with practice development principles and CIP(Collaborative, Inclusive, and Participatory)

Person Centered Framework as used in Nursing Care

Making the patients involve in health care particularly in their health cases has proven to be a key component of developing high-quality healthcare (Greene, 2012).  According to health innovation network in 2015, personal centered care help the individual to get the care they need whenever they want, to be more active in taking care of their health and to improve the quality of services available (Greene, 2012). Other than that, the personally centered care has also shown and helps to minimize some of the possible pressures in social services and health care (Greene, 2012). In addition to that, a personal centered framework usually improves the experience people have in health care, leads to more healthy lifestyles, improves nurse and patients decision-making skills, lead to better health outcomes and improves professionalism and service of care (Greene, 2012).

The person-centered nursing framework consists of four major components (McCarthy et al., 2012). These include prerequisites that majorly deal with the nurses attributes, the care environment which consist the context in which delivery of care happens, personal centered process that include delivering of care using a range of activities and the expected outcomes which are the end results of a good personal centered care (McCarthy et al., 2012).

The prerequisites involve the attributes of the nurse which includes the development of interpersonal skills, being professionally competent, having a commitment to work, being able to show that she or he acknowledge patients beliefs and values and demonstrating self-understanding (Stephens, 2015). Professional competencies consist of nurse’s knowledge and skills in making decisions which include both physical and technical aspects of nursing care (Basch, 2016).  The nurse’s interpersonal skills demonstrate the ability of a nurse to be able to make therapeutic communications freely and work commitment shows that a nurse has the dedication to provide what is best for the patient (McCarthy et al., 2012).  According to Warfield and Manley in 1990, the acknowledging patient's beliefs and values and understanding oneself enables the nurse to deliver care in different cultural environments without bringing negative impacts to patients care (McCarthy et al., 2012).

 

The care of environment involves the context in which the care in delivered. This includes staff relationship, systems that support shared decision making, risk taking, and ability to innovate and power sharing (Page and Hamer, 2012).  According to various studies done by McCormack et al in 2002 and Rycroft Malone et al in the same year, there are various key characteristics of the context that enhances personal centered framework (Page and Hamer, 2012). This includes culture in the workplace, the organization commitments in using various evidence sources of quality of care to improve care delivery and the leadership quality delivered by nurses. In that case, the care environment normally can limit or facilitate the functionality of the person-centered process (Page and Hamer, 2012)

The person process involves delivering of care using a range of activities that include working with individual’s beliefs and values, being sympathetic, engaging each other, providing physical needs and making decisions that provide what is best for the patient (Disch, 2012). Understanding patient’s beliefs and values enable the nurse to know how various clients’ values their health and what they think is best for them (Reid, 2013).  This is much related to shared decision making where a nurse provides the patient with health education and information and help him to make a decision by himself choosing what in the best from the available solutions (Disch, 2012). The nurse-patient relationship dictates the quality of engagement. Full engagement is described when the patient and nurse are able to work together and are fully connected whereas partial engagement is described when nurse and patient are unable to work together or cannot fully understand each other. A competent and skilled nurse should be able to engage fully by adopting different patient’s situations (Reid, 2013).

The outcomes are the end results expected when an effective personal centered nursing is experienced which include care satisfaction, the creation of a good therapeutic environment, good collaboration among staffs, feeling of wellbeing, a well-transforming leadership and innovation is highly supported (Reid, 2013).  Patient satisfaction normally indicates a quality of care where patient are evaluated if they have demonstrated a good experience in care delivery (Reid, 2013).

Application of Person-centered framework in infection control and hand hygiene compliance

Infection control and prevention in both hospital and community setting is maximally about the individuals (Webster and Dewing, 2013). This means that, for a maximum prevention of infection, nurses has to focus on their care into patient-centered care so as to have high outcomes in health services (Basch, 2016). Empowering the patients to be in the centered for infection control in the process of care is not just giving treatment and explaining the risks the can have but it involves considering all individuals needs in all levels of care (Stephens, 2015). This start by designing the healthcare facility in such a way it provides maximum patient comfort and that avoid or protect the patients from various processes that promote infections (Lander, 2017). For example, designing a facility with adequate bed space to patient overcrowding that promotes infections transmission (Stephens, 2015). In addition, the patient should be provided with enough patient education and self-management skills so that they can be able to prevent infections by taking care of themselves (Nursing Knowledge Development and Clinical Practice, 2013).

For nurses to support an effective approach for a god infection control in hospital and support patient’s activities that minimize cross infection various aspects need to be considered (Nursing Knowledge Development and Clinical Practice, 2013). First, the health care team needs to take into consideration of the patients when developing hospital facilities, policies, and programs (Lander, 2017). In admission to hospital, the nurse should familiarize the patients with infection control strategies and skills required in order to facilitate both health care environment and patient protection (Makous, 2012). The other thing nurses need to do is that when doing any procedure, they should be able to discuss any risk associated with the management (Landers, 2017).  This can be done by encouraging the patient to disclose if they have any potential risk associated with the treatment of allergies to medication, explaining various infectious risks associated with the surgical operation and prolonged hospitalization (Stephens, 2015). In addition to that, providing opportunities for patients to identify and communicate about any risks the think for infection and using that information in providing feedback procedures like providing educational resources about infection prevention and control and informing the patients about hospital protocols concerning self-protection (Landers, 2017).
 


Hand hygiene has been recognized to be one of the most effective means that is currently used a common time to time method of preventing transmission of infections (Disch, 2012). Due to that reason, much emphasis has been placed on how to improve compliance especially by health care workers (Hart, Ford, and Shepherd, 2017). Evidence has shown that the patient’s flora and the hospital environment are the basic sources of many nosocomial infections (Lander, 2017). This insinuates that much effort has to be put to work toward making sure patient have enough hand hygiene (Disch, 2012). According to World Health Organization (WHO) in 2009, the prevalence of omission of hand hygiene has always been high and is still very high. This is due to the fact that, most hospitals do not include patients in a more directly personal centered initiative (Landers, 2017). This involves including the patients in a hand hygiene initiative and provides policies and recommendation that promote hand hygiene protocols in hospitals (Hart, Ford, and Shepherd, 2017)

The hospital should provide guidelines placed in all hospital wards as a demonstration of good hand hygiene procedures (Stephens, 2015). The patient should be taught the benefits of washing hands frequently and the hospital environment should be made in a way there are available resources that support the implementation of hand hygiene in practical areas (Hart, Ford, and Shepherd, 2017).  Research has shown that, when nurses wash frequently their hands in front of the patient, inform the patients they want to wash hand or they have washed hands before and after the procedure promotes and enhances patients urge of washing hands too (Hart, Ford, and Shepherd, 2017). The patient should not just be provided with guidelines, information, and resources needed for hand hygiene but the nurses should involve them in the process of washing hands steps by steps (Landers, 2017).

How person-centered framework relates with Practice Development principle

According to McCormack in 2002, practice development is a process that tends to be continuous in improvements towards maximizing the patient-centered care (Harrison and Frampton, 2016). This is major put into practice by helping the healthcare workers to develop their skills and knowledge so as to transform the culture and context of care (Makous, 2012). This means that there is a great relationship between the enablement of performances, systems facilitation plus overall change in care.

One principle of practice development suggests that, practice development is a complex methodology that should be used across all healthcare workers and involves both external and internal members (Makous, 2012). This means that for a good quality healthcare to occur, various members should be involved including the patient, family members, community and the healthcare team. Personal centered care suggests that patient is an important pillar care and should be included in decision-making process so as to make a collective solution (Harrison and Frampton, 2016). This can only be achieved if health care workers adopt and develop a quality personal centered framework (Stephens, 2015). The practice development principles argue that developing new methodologies that are complex involves not only a single intervention but a number of intervention from different of professional principles that involves developing, learning and transforming their practice in a way that can be sustained and effective (Harrison and Frampton, 2016).

The practice development recommends the use of methodologies and activities that would bring a change by ensuring there are high levels of engagement thus improving the culture and context of practice (Adams, 2015). This is one of the major characteristics that is crucial in personal centered framework. For nurses and patients to work in way that would bring better outcomes, engagement is crucial (Harrison and Frampton, 2016). Nurses use interpersonal skills in various contexts to make sure there are high levels of understanding between patients and nurses thus improving the therapeutic relationships (Adams, 2015). According to a study by McCormack in 2007, there are various methods that can be used in practice development suggest for high levels of engagement and patient interaction to occur. This includes ethical processes agreement, making and identifying the roles of a nurse and patient, having a continuous and reflective learning and being person-centered (Adams, 2015).

 

Similar to the personally centered framework, practice development advocates that nurses and other healthcare workers require developing, learn and have enough knowledge and skills so as to become self-sufficient professionals (Journal of Client-centered Nursing Care CrossMark Policy, 2016).  This can be achieved by use of various methods which include clarifying values and workplace cultures, developing a shared vision, critical intent and participatory engagement, having god communication strategies, giving space for new ideas, developing self-concept skills, implementing various activities involve in health care and evaluating the consistent of outcomes (Journal of Client-centered Nursing Care CrossMark Policy, 2016). These methods help a nurse to integrate the self-sustaining skills of learning in practice, evades development and usage and in a content evaluation of practice change. This, in turn, promotes innovation which is crucial in bringing changes in healthcare (Park et al., 2014). 

There are a various set of skills required in practice development so as to make a nurse to adopt smoothly person-centered framework (Adams, 2015). These can also be regarded as professional competencies. This includes developing effective knowledge and skills, establishing and developing effective cultures that involve a  leadership that is transformational, adopting skills that involve reflective practices, using ad developing policies, evaluating self and other working team members and helping the various individuals achieve the above skills (Adams, 2015).

The major focus and intention of enabling the nurses to develop skills need to be used in practice development methods in the day to day practice or in a clinical context is facilitation (Disch, 2012).  According to Kitchen in 2000, skilled facilitation has been stated as one of the most effective ways of enabling learning in practice and evidence use thus facilitating person-centered nursing (Disch, 2012).  In addition to that, the effectiveness and effective care environment and culture are archived if the health care team works together (Ward, 2012). 

The use of CIP (Collaborative, Inclusive, and Participatory) principle in person-centered framework

The CIP principle suggests that, for proper person-centered nursing, various aspects of care need to be addressed (Ward, 2012).  One is the collaboration of all stakeholders that are involved in health care or in providing a solution for patient betterment (Adams, 2015). There are two major types of collaboration which include patient to nurse collaboration and interprofessional collaboration (McCarthy et al., 2012). Nurses must work together with other nurses and medical health workers so as to provide better solutions for healthcare (Park et al., 2014). This includes sharing knowledge and skills, experiences, resources and ideas in formulating and developing plans intended to improve patients wellbeing. Healthcare workers have also to collaborate with the patient, family, and community when making health decisions (Disch, 2012).

The personally centered framework is all about the patient and family involvement in patient care. This means that the client has the authority to participate in decision-making process (Park et al., 2014). Empowering the family and patient in a participatory skill like patient’s education, encouraging the patient to come up with ideas, and implementing patient’s ideas and decisions have proved to provide a high quality of care (Park et al., 2014). Patients should also be allowed to take part in policy making and implementation. Areas, where individuals who are allowed to take part in policies making have demonstrated to have high levels of satisfaction thus better outcomes, are experienced (Park et al., 2014).

Person-centered nursing is an inclusive framework that involves various components. These include health care systems and the care environments, healthcare workers and the patients (McCarthy et al., 2012). The health care system and the context in which the care is delivered should support patient involvement and participation. The health care workers should have enough knowledge and skills which promote the care delivery which is client centered (McCarthy et al., 2012).  This should not only include treatment and give information to patients but also involve the patients in all levels of delivery. Patients should understand that, it is their duty to be involved in sharing decision which concerns their health care.

 

Conclusion

A personally centered framework is one of the most convenient approaches to providing care in hospital and outside community settings.  This involves how nurses and other healthcare professionals consider patients as equal partners in developing, planning and monitoring care of the patient. Other than that, personal centered care normally improves the experiences different individuals have in health care, leads to more healthy lifestyles, improves nurse and patients decision-making skills, lead to better health outcomes and improves professionalism and service of care. There are four major components of personal centered care which include prerequisites that consist the nurse’s attributes, the care environment which deals with the context in which delivery of care occurs, a personal centered process which involves delivering of care using a range of activities and the expected outcomes which are the results of personal centered care.  Practice development has been defined as processes that continuously work to improves and maximize the patient-centered care. Therefore, there is a great relationship between, enablement of performances, systems facilitation and the overall change in care. Personal centered care can be applied in the prevention of infection, in that nurses has to empower the patients to be in the centered for infection control in the process of care which is not just giving treatment and explaining the risks the can have but it involving all individuals needs in all levels of care. Hand hygiene compliance is one of the best infection control practice that should be highly centered towards patients. This can be done by including the patients in a hand hygiene initiative and provides policies and recommendation that promote hand hygiene protocols in all health care settings. Nurses and other health care workers should provide guidelines and the placed in all hospital which demonstrates good hand hygiene procedures as a method of hand hygiene promotion. Similar to the personal centered framework, practice development principles indicates that nurses and other healthcare workers require to develop, learn and have enough knowledge and skills so as to become self-sufficient professionals. The CIP principle recommends that, for a good patient-centered care, health care should be inclusive, patients should be allowed in decision making and all health care providers should collaborate with the patient to provide better solutions for care.

 

References

Adams, J. (2015). Theories Guiding Nursing Research and Practice – Making Nursing Knowledge Development Explicit, Cancer Nursing Practice, 14(2), pp.11-11.

Basch, E. (2016). Toward a Patient-Centered Value Framework in Oncology. JAMA, 315(19), p.2073.

Disch, J. (2012). Patient-centered care/student-centered learning. Nursing Outlook, 60(6), pp.340-341.

Dellinger, E. (2016). Prevention of Hospital-Acquired Infections. Surgical Infections, 17(4), pp.422-426.

Greene, S. (2012). A Framework for Making Patient-Centered Care Front and Center. The Permanente Journal.

Harrison, J. and Frampton, S. (2016). Resident-Centered Care in 10 U.S. Nursing Homes: Residents’ Perspectives. Journal of Nursing Scholarship, 49(1), pp.6-14.

Hart, T., Ford, S. and Shepherd, E. (2017). Promoting hand hygiene in clinical practice. [online] Nursing Times. Available at: https://www.nursingtimes.net/promoting-hand-hygiene-in-clinical-practice/5063464

Horowitz, H. (2017). Infection control III: Infection prevention and control as mediators. American Journal of Infection Control.

How Does Patient-Centred Care Relate to Infection Prevention and Control? | National Health and Medical Research Council. [online] Available at: https://www.nhmrc.gov.au/book/australian-guidelines-prevention-and-control-infection-healthcare-2010/a3-2-how-does-patient-ce

Isaacs, D. (2012). Hand washing. Journal of Paediatrics and Child Health, 48(6), pp.457-457.

Journal of Client-centered Nursing Care CrossMark Policy. (2016). Journal of Client-centered Nursing Care, 0(0).

Landers T, e. (2017). Patient-centered hand hygiene: the next step in infection prevention. - PubMed - NCBI. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22546268

Makous, N. (2012). Technology, Reform, and Personal Medical Care. The Patient: Patient-Centered Outcomes Research, 3(3), pp.173-177.

McCarthy, G., Cornally, N., Moran, J. and Courtney, M. (2012). Practice nurses and general practitioners: perspectives on the role and future development of practice nursing in Ireland. Journal of Clinical Nursing, 21(15-16), pp.2286-2295.

Nursing Knowledge Development and Clinical Practice. (2013). Nursing Philosophy, 9(4), pp.279-280.

Page, S. and Hamer, S. (2012). Practice development in health care – where are we now?. Practice Development in Health Care, 3(4), pp.189-191.

Park, T., Chira, P., Miller, K. and Nugent, L. (2014). Living Profiles: an example of user-centered design in developing a teen-oriented personal health record. Personal and Ubiquitous Computing, 19(1), pp.69-77.

Reid, C. (2013). Developing a research framework to inform an evidence base for person-centered medicine: keeping the person at the centre. European Journal for Person Centered Healthcare, 1(2), p.336.

Stephens, J. (2015). A participatory learning model and person-centered healthcare: moving away from “one hand clapping”. European Journal for Person Centered Healthcare, 3(3), p.279.

Ward, M. (2012). Practice Development in NursingPractice; Development in Nursing. Nursing Standard, 19(37), pp.36-36.

Webster, J. and Dewing, J. (2013). Growing a practice development strategy for community hospitals. Practice Development in Health Care, 6(2), pp.97-106.

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