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Patient-/family-centered care is key to patient satisfaction.
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Inclusion of family and friends is needed for increased quality of care.
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Use of a bedside report enhances quality of nursing care delivery.
The Role of Patient-Centered Care in Nursing
Section snippets
Key points
Scenario
Nurse Smith, RN is running behind schedule. This is the third 12-hour shift on a 36-bed medical/surgical unit, and the change-of-shift-report has just been received for 7 patients assigned to her care. The night shift nurse has an appointment and needs to get home immediately. There is little time for questions or verifications of procedures such as early morning blood draws and catheter care necessities. Patient A is scheduled for surgery and is due to be transported at any moment. Problem:
Problem
The effects of changes in the field of health care are reverberating in nursing, which requires the need for increased efficiency in the provision of care. This environment pushes even the most experienced nurse to become more task oriented and less patient focused in a sea of constant admissions and discharges with expectations that patients are to do most of their recovery either in a long-term rehabilitation unit or at home.2, 3 The mantra “doing more with less and less” seems to be the
Application of patient-centered care to nursing: holistic care
The philosophy of holistic nursing supports the tenants of PCC that are derived in part from Florence Nightingale who believed in the importance of her patients’ conditions through the interaction of their respective environment.18 Holistic nursing places emphasis on both the environment and treatment of the patient to include patients’ uniqueness as human beings along with their cultural views, values, and beliefs.18, 19
Patient-centered care and family-centered care
Patient- and family-centered care (PFCC) extends the partnership of patients and health care providers to include families (and friends) at the discretion of the patient involved.21 The involvement of families encourages the sharing of knowledge and experience in the planning of nursing care for the enhancement and well being of the patient.22, 23 Acute care facilities are engaging in PFCC in several ways to include the provision of the items listed in Box 4.
PFCC is also mirrored in the
Family presence at the bedside and beyond
Family presence within the PFCC model extends to include not just presence in patient rooms during set visiting hours but during procedures that occur in inpatient and outpatient areas. Depending on the invasiveness of the procedure and patient and family preferences, several research studies have found positive aspects of such practice.26
One such procedure is the changing of dressings for severe burn injuries. Because of concerns of increased infection rates and the perception of family
Family presence during change-of-shift report
The presence of family during patient rounds may conjure images of gross violations of Health Insurance Portability and Accountability Act (HIPAA); however, if PFCC is to be respected, the inclusion of patient rounds requires that family presence be not only invited but encouraged. The following tenants are suggestions to consider.28, 29, 30, 31, 32, 33, 34, 35, 36
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Give patients and families a choice in engaging in rounds.
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Have nurses provide introductions (eg, night shift introduces the day
Family presence during codes
PFCC seems well suited in many health care situations but remains controversial in extreme interactions during lifesaving, resuscitative efforts. Hung and Pang24 studied family members who were present during successful resuscitative efforts of their loved ones using an interpretive phenomenological approach.24 Table 2 summarizes 10 themes that emerged from the data and family member comments reflecting the themes.
Evaluation—the ultimate scoring card
A trend is emerging in the literature associating patient satisfaction of care scores to the delivery of PFCC. Although there are multitudes of variables associated with these forms of measurement, several studies are emerging with such reports, and nursing is helping pave the way for such findings. A small sample of studies is provided in Table 3.
Although these articles represent studies exploring concepts of PFCC and patient satisfaction scores in the inpatient setting, outpatient areas are
Summary
Now that PCC, holistic nursing, PFCC, bedside rounds, and patient satisfaction scores have been addressed, let’s return to the scenario depicting Nurse Smith and her third day of duty to see how these concepts might benefit both the patients placed in Nurse Smith’s care and Nurse Smith’s practice. Using PFCC:
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Nurse Smith and the night shift nurse would be rounding together, exchanging reports at each patient’s bedside.28, 29, 30, 31, 32, 33, 34, 35, 36
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Any concerns or questions Nurse Smith would
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Disclosure Statement: The author has nothing to disclose.