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Describe the characteristics of patient-centered care AND the importance of each characteristic.

Describe the characteristics of patient-centered care AND the importance of each characteristic.

Describe the characteristics of patient-centered care AND the importance of each characteristic.

Patient-Centered

Care and Professional

Nursing Practice

Chapter 11

 

 

What is Patient-Centered Care (PCC)?

• Care that is respectful of and responsive to

individual patient preferences, needs, and

values and ensuring that patient values guide

all clinical decisions (IOM, 2001)

• Recognizes the patient or designee as the

source of control and full partner in providing

compassionate and coordinated care based on

respect for the patient’s preferences, values,

and needs (QSEN, 2014)

 

 

PCC Competency

• The nurse “will provide holistic care that

recognizes an individual’s preferences, values,

and needs and respects the patient or designee

as a full partner in providing compassionate,

coordinated, age and culturally appropriate,

safe and effective care” (Massachusetts

Department of Higher Education, 2010, p. 9)

 

 

Dimensions of PCC

• Respect for patients’ values, preferences, and

needs

• Coordination and integration of care

• Information, communication, and education

• Physical comfort

• Emotional support

• Involvement of family and friends

• Transition and continuity

• Access to care

 

 

Picker Principles of Patient-

Centered Care

Videos featuring patients “in their own words”

http://cgp.pickerinstitute.org/?page_id=1319

 

 

Components of Patient-Centered and

Family-Centered Care Delivery Models

• Coordination of care conference

• Hourly rounding by the nurse

• Bedside report

• Use of patient care partner

• Individualized care established on admission

• Open medical record policy

 

 

Components of Patient-Centered and

Family-Centered Care Delivery Models (cont.)

• Eliminating visiting restrictions in relation to

family members

• Allowing family presence with a chaperone

during resuscitation and other invasive

procedures

• Silence and healing environment

 

 

Communication as a Strategy to

Support PCC

• Communication is defined as the nurse

interacting “effectively with patients, families,

and colleagues, fostering mutual respect and

shared decision making, to enhance patient

satisfaction and health outcomes”

(Massachusetts Department of Higher

Education [2010], p. 27)

 

 

Empathetic Communication

• Behaviors that facilitate empathetic

communication include:

– Listening carefully and reflecting back a

summary of the patient’s concerns

– Using terms and vocabulary appropriate for the

patient

– Calling the patient by his or her preferred name

– Using respectful and professional language

 

 

Empathetic Communication (cont.)

• Behaviors that facilitate empathetic

communication include (cont.):

– Asking the patient what they need and

responding promptly to those needs

– Providing helpful information

– Soliciting feedback from the patient

– Using self-disclosure appropriately

– Employing humor as appropriate

– Providing words of comfort when appropriate

 

 

Nonempathetic Communication

• Behaviors can also hinder empathetic communication:

– Interrupting the patient with irrelevant information

– Using vocabulary that is either beneath the level of

the patient or not understandable to the patient

– Using language that may be perceived as

patronizing or demeaning

– Using nonprofessional language

 

 

Non-Empathetic Communication (cont.)

• Behaviors can also hinder empathetic communication

(cont.):

– Reprimanding or scolding the patient

– Preaching to the patient

– Providing the patient with inappropriate

information

– Asking questions at inappropriate times or giving

patient advice inappropriately

– Self-disclosing inappropriately

 

 

Kleinman’s Questions

• What do you think has caused your problem?

• Why do you think it started when it did?

• What do you think your problem does inside

your body?

• How severe is your problem? Will it have a

short or long course?

 

 

Kleinman’s Questions (cont.)

• What kind of treatment do you think you

should receive?

• What are the most important results you hope

to receive from this treatment?

• What are the chief problems your illness has

caused you?

• What do you fear most about your

illness/treatment?

 

 

Patient Education as a Strategy to

Support PCC

• Patient education is any set of planned

educational activities designed to improve

patients’ health behaviors and/or health status

 

 

Learning Domains

• Cognitive learning encompasses the

intellectual skills of knowledge acquisition,

comprehension, application, analysis, and

evaluation

• Psychomotor learning refers to learning skills

and performance of behaviors or skills

• Affective learning requires a change in

feelings, attitudes, or beliefs

 

 

Andragogy

• Letting learners know why something is

important to learn

• Showing learners how to direct themselves

through information

• Relating the topic to the learners’ experiences

• Realizing that people will not learn until they

are ready and motivated

 

 

Health Belief Model (HBM)

• According to HBM, the likelihood of acting in

response to health threat is dependent upon 6 factors:

– Person’s perception of the severity of the illness

– Person’s perception of susceptibility to the illness

– Value of the treatment benefits

– Barriers to treatment

– Costs of treatment in physical and emotional

terms

– Cues that stimulate taking action toward treatment

of illness

 

 

Social Learning Theory

• If a person believes he or she is capable of

performing a behavior (self-efficacy) and also

believes the behavior will lead to a desirable

outcome, the person is more likely to perform

the behavior

 

 

Social Learning Theory (cont.)

• Four methods for enhancing efficacy

expectations:

– Performance accomplishments

– Vicarious experience or modeling

– Verbal persuasion

– Interpretation of physiological state

 

 

The Patient Education Process

• Assessment

• Planning

• Implementation

• Evaluation

 

 

Assessment of Learning Needs

• What information does the patient need?

• What attitudes should be explored?

• What skills does the patient need to know?

• What factors may be barriers?

• Is the patient likely to return home?

• Can the caregiver handle the care?

• Is the home situation appropriate?

• What kinds of assistance will be required?

 

 

Other Variables in the Patient

Education Process

• Learning styles

• Readiness to learn

• Health literacy

– “The degree to which individuals have

the capacity to obtain, process, and

understand basic health information and

services they need to make appropriate

health decisions” (IOM, 2004, p. 31)

 

 

Ask Me 3™ Questions

• What is my main problem?

• What do I need to do?

• Why is it important for me to do this?

ED/AU: Trademark symbol needed?

 

 

Ask Me 3® Video

 

https://youtu.be/B3EB-icaNKQ

 

ACTS

• Assess

• Compare

• Teach 3/Teach back

• Survey

 

 

Readability of Written Materials

• Written materials for patients with low health

literacy skills should be fifth grade level or

below

• Several readability formulas are available to

determine the grade level of materials (Flesch,

1948; Fry, 1968; McLaughlin, 1969)

• SMOG formula

 

 

Planning

• Nurse responsible for guiding the process through

the use of goals and objectives

• Objectives for patient education are stated as

behavioral objectives

– Performance

– Conditions

– Criteria

• Learning objectives should be specific, measurable,

and attainable

 

 

Implementation

• Learning activities need to be consistent with

learning objectives

• Using varied learning activities can make

learning more fun and more effective

– Examples include lecture, demonstration,

practice, games, simulation, role play,

discussion, and self-directed learning

 

 

Criteria for Judging Patient

Education Materials

• Material contains the information that the

patient wants

• Material contains the information that the

patient needs

• Patient understands and uses the material as

presented

 

 

Patient Education with Older

Adults: Age-Related Barriers

• Cognitive changes:

– Changes in encoding and storage of

information

– Changes in the retrieval of information

– Decreases in the speed of processing

information

 

 

Patient Education with Older

Adults: Age-Related Barriers (cont.)

• Visual changes:

– Smaller amount of light reaches the retina

– Reduced ability to focus on close objects

– Scattering of light resulting in glare

– Changes in color perception

– Decrease in depth perception and peripheral

vision

 

 

Patient Education with Older

Adults: Age-Related Barriers (cont.)

• Changes in hearing:

– Reduced ability to hear sounds as loudly

– Decrease in hearing acuity

– Decrease in ability to hear high-pitched

sounds

– Decrease in ability to filter background

noise

 

 

Strategies to Accommodate for Age-

Related Barriers: Cognitive

• Slow the pace of presentation

• Give smaller amounts of information

• Repeat information frequently

• Reinforce verbal teaching with audiovisuals,

written materials, and practice

• Reduce distractions

• Allow more time for self-expression

 

 

Strategies to Accommodate for Age-

Related Barriers: Cognitive (cont.)

• Use analogies and examples from everyday

experience to illustrate abstract information

• Increase meaningfulness of content

• Teach mnemonic devices and imaging

techniques

• Use printed materials and visual aids that are

age specific

 

 

Strategies to Accommodate for

Age-Related Barriers: Visual

• Make sure glasses are clean and in place

• Use printed materials with 14- to 16-point font

and serif letters

• Use bold type on printed materials and do not

mix fonts

• Avoid use of dark colors with dark backgrounds

but instead use large, distinct configurations

with high contrast

 

 

Strategies to Accommodate for

Age-Related Barriers: Visual (cont.)

• Avoid blue, green, and violet to differentiate

type, illustrations, or graphics

• Use line drawings with high contrast

• Use soft white light to decrease glare

• Light should shine from behind learner

• Use color and touch to help differentiate depth

• Position materials directly in front of learner

 

 

Strategies to Accommodate for

Age-Related Barriers: Hearing

• Speak distinctly

• Do not shout

• Speak in a normal voice or lower pitch

• Decrease extraneous noise

• Face person directly while speaking at a distance

of 3 to 6 feet

• Reinforce verbal teaching with visual aids or

easy-to-read materials

 

 

Cultural Considerations

• Adapt information to be more specific and use more relevant terminology

• Create descriptions or explanations that fit with different people’s understandings of key concepts

• Incorporate a group’s cultural beliefs and practices into the program content and process

 

 

Evaluation

• Measuring the extent to which the patient has

met the learning objectives

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