Enhancing person-centred care through the development of a therapeutic relationship

Perceptions of Caring Behaviors among Patients and Nurses

The concept of caring is fundamental to nursing practice. The aim of this study was to investigate patients' and nurses' caring behaviors and the possible differences between the two groups. In this descriptive and comparative study, 310 patients and 329 nurses from six general hospitals from Greece completed the Caring Behaviors Inventory-16. The mean score of Caring Behaviors Inventory-16 for patients was 78.94 (±17.85) and for nurses 80.27 (±9.36). The items "Demonstrating professional knowledge and skills" (Mean: 5.45 ± 3.62) and "Treating my information confidentially" (Mean: 5.34 ± 1.06) were the most important caring behaviors while the items "Including me in planning care" (Mean: 4.36 ± 1.56), and "Treating me as an individual" (Mean: 4.55 ± 1.46) were the least important caring behaviors for patients. For nurses, the most important caring behavior was "Treating patients" information confidentially" (Mean: 5.43 ± 0.94) and the least important was "Returning to the patient voluntarily" (Mean: 4.57 ± 3.68). Significant differences were observed in items: "Attentively listening to me/the patient" (t = -2.05, p = 0.04), "Treating me/the patient as an individual" (t = -7.82, p = 0.00), "Being empathetic or identifying with me/the patient" (t = -2.80, p = 0.00), and "Responding quickly when I/the patient call (t = -2.01, p = 0.04). Respect, privacy, and dignity were the most important caring behaviors for nurses while for patients they were knowledge, skills, and safety.

Access to healthcare for people experiencing homelessness in the UK and Ireland: a scoping review

Background

People experiencing homelessness (PEH) have poorer physical and mental health than the general population. They are also more likely to have less access to healthcare. These processes of access can be better understood using Levesque’s access framework which addresses both supply (service provision) and demand (user abilities).

Methods

Following the Joanna Briggs Institute (JBI) guidelines, electronic peer-reviewed databases were searched in February 2022 for studies published since 2000 related to access to healthcare for PEH ages 16 and older in the United Kingdom (UK) and Ireland. Retrieved articles were screened and those eligible were selected for data extraction. Qualitative and quantitative studies were included.

Results

Fifty-six papers out of 538 identified were selected and aliased. Six main themes were identified: staff education, flexibility of systems, service coordination, patient preparedness, complex health needs and holistic care. These relate to the Levesque access framework.

Conclusions

Improving access to healthcare for PEH requires changes to how services are provided and how service-user abilities are supported.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08265-y.

The use of digital devices by district nurses in their assessment of service users

District nursing services are relentless in adapting to change and continuously seek different methods to improve the care they offer to service users. One of the relatively new changes where adaptation has been necessary is the use of digital devices to record assessments and work in real time. As documented in The NHS Long Term Plan (NHS) (2019), the NHS is being required to grow into the new digital age and, subsequently, district nurses (DNs) have needed to embrace the use of a paper-lite system. Although beneficial overall, the use of technology is a threat to the person-centred nursing approach used in assessment, which is the highest fundamental value in nursing. This article will seek to conceptualise the importance of a person-centred initial assessment with a service user who has either a long-term and/or a lifelong condition whilst considering the use of digital devices, benefits, and drawbacks of their use. It will emphasise the role of the DN, encompassing the multidisciplinary services throughout, whilst also considering any recommendations for further development.

A client-centered approach in home care for older persons - an integrative review

OBJECTIVE

To describe and synthesize client-centered care and service in home care for older persons.

METHODS

The study was an integrative review using the guidelines for literature reviews by the Joanna Briggs Institute. The research process followed the Whittemore and Knafl framework and PRISMA toolkit in the selection of eligible articles. The CINAHL, Medline, Scopus, Web of Science and Social Sciences abstracts were searched for articles published between January 2007 and May 2020 according to previously designed search strategies. In total, 24 articles were deemed relevant for an analysis using a thematic analysis.

RESULTS

The analysis resulted in four themes with sub-themes which revealed that client-centered care and service in home care consist of: 1) Clients' involvement in their own care; self-care, decision-making, satisfactory daily life, 2) Family members' and care partners' participation in care; family members' and care partners' commitment to care, family members' and care partners' competence in care, 3) Communication and co-operation; communication models, empowerment, partnership, and 4) Evidence-based service competence; delivery and organization of services, implementation of services, versatile clinical skills, quality outcomes and personnel wellbeing.

CONCLUSIONS

According to the results, achieving client-centered care and service in home care requires the realization of all of the above aspects. The practice of nursing must better identify all dimensions of client-centered care and take these into account in the delivery of home care services. KEY POINTS Client-centeredness is a fundamental value and the basis of nursing and care in home care provided for older persons This paper: deepens and structures the concept of client-centered care in the context of home care. assists professionals to understand the factors behind client-centered care within the home care environment. provides deeper understanding of the roles of the older person, family members, and the service system in developing client-centered services in home care for older persons.

The Use of Empathic Communication During the COVID-19 Outbreak

As of May 13, 2020, the number of confirmed SARS-CoV-2 (novel corona virus, COVID-19) infections has risen to 4 300 000 worldwide, with over 1 300 000 confirmed cases in the United States. Various prediction models of spread indicate more hospitalization, increased ventilator use, and the shifting of medical resources to most efficiently serve the patient’s needs. Additionally, mitigation strategies such as monitoring for symptoms, social distancing, safer at home, and the wearing of masks caused our institution to implement significant operational changes to our usual practice. This included screening patients and staff for symptoms, rescheduling routine medical visits, postponing procedures, converting face-to-face visits to telephone or video visits, and changing visitor visit policies. In this article, we describe the various ways we deployed empathic communication messaging and resources across the institution during the COVID-19 pandemic.

Communicating with patients using a new vitamin B12 deficiency leaflet

The aim of this quality improvement project was to improve patients' knowledge about their vitamin B12 deficiency by developing an information leaflet and engaging nursing staff in providing this educational tool to patients with the condition. Following two 'plan, do, study, act' cycles to test and improve implementation of the leaflet, the nursing team met the goal of 100% compliance with providing educational information to patients. An increase in patient knowledge following provision of the leaflet was predicted, and achieved.

Cultural Competence in Home Healthcare Nursing: Disparity, Cost, Regulatory, Accreditation, Ethical, and Practice Issues

Home healthcare patients, who are members of minority, marginalized, or vulnerable patient populations, are at risk for healthcare disparities. Inadequate attention to the needs of the many different types of diverse patient populations seen by home health agencies could compromise an agency’s outcome indicators, reimbursement in value-based payment programs and responsibility to deliver equitable quality care. Culturally competent home health nurses may have a role in decreasing disparities and improving patient outcomes. This article discusses the incidence of disparities in home health care and highlights literature about the economic, regulatory, accrediting, policy, social justice, and ethical issues surrounding disparate and inequitable care for home healthcare patients. Patients in need of culturally competent care include those characterized by diversity related to race, ethnicity, language, religion, socioeconomic status, sexual orientation, gender identification, mental and physical disabilities, and stigmatized diagnoses (e.g., obesity and substance abuse). Home healthcare nurses who strengthen the cultural competence of their care may be able to decrease the incidence of disparate outcomes. By investing in the cultural competence of their home healthcare nurses, agencies may strengthen their commitment to their missions and the financial health of their agencies.

An overview of the role of the district nurse caring for individuals with complex needs

The role of the district nurse is imperative in the care of patients in a district nursing team's caseload. Through the role of care manager, district nurses are accountable for the overall coordination of the care patients receive. Their responsibilities include caring for acutely ill patients, those with long-term conditions and people who require end-of-life care, in addition to health promotion and patient education. They provide personcentred, preventive and coordinated care, which reduces unnecessary hospital admissions and enables patients who have a range of complex needs to remain at or return to home. In this article, a case study is used to provide an overview of the role and accountability of the district nurse in the care of patients who have complex needs.

Developing Person-Centered Care Through the Biographies of the Older Adult

BACKGROUND

A lack of specialized knowledge about providing health care to older people decreases their health outcomes and quality of life. This article presents an innovative learning strategy for preregistration nursing students to raise awareness of person-centered care of the older adult.

METHOD

This report is based on the authors' own experience and includes comments from students to the authors who taught the unit of study from 2010 to 2015, supported by current literature and theory discussing contemporary educational strategies.

RESULTS

Students came to value the older adult as a person to whom they could relate and the learning promoted person-centered care delivery. Although many students found this approach to learning to be challenging, student feedback demonstrated that the overall reception of the strategy was very positive.

CONCLUSION

This strategy facilitated learning to improve person-centered care and addressed negative attitudes toward older adults, which improved health outcomes and their quality of life. [J Nurs Educ. 2018;57(12):742-746.].

Improving equity and cultural responsiveness with marginalised communities: Understanding competing worldviews

AIM

To explore the impact of culture on health, healthcare provision and its contribution towards health inequity experienced by some marginalised communities.

BACKGROUND

Health inequity is a global issue, which occurs across and within countries, and is the greatest barrier to worldwide health and the development of the human race. In response to this challenge, there is an international commitment to ensure universal health coverage based on the fundamental principle that individuals should be able to access healthcare services they need. Despite this, there is clear evidence that indigenous and other cultural minorities such as New Zealand Māori and Gypsy Roma Travellers still experience far poorer health outcomes when compared to the majority population. Furthermore, when they do access health care, their experiences are often not positive and this in turn results in reluctance to access preventative health care, instead accessing health services much later, reducing treatment options and compounding higher mortality rates. What is often not explored or examined is the impact of the different cultural beliefs of individuals in these communities and the nurses caring for them.

DESIGN

This is a position paper drawing upon research experience with New Zealand Māori and Gypsy Roma Travellers. We critically review the experiences of health inequity of marginalised communities. It does so by examining how these communities may have a different world view to the nurses caring for them, and it is this lack of understanding and valuing of alternative worldviews that contributes to the poorer health outcomes both communities face.

CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE

As nurses work with many different individuals and groups, we have to find ways of ensuring a more embracing, culturally responsive healthcare environment which respects and values the beliefs of others.

The role of the district nurse in caring for patients with dementia

District nurses require a vast array of skills to enable effective care delivery for patients living with a diagnosis of dementia in the community setting. Complex care needs provide challenges for the provision and delivery of district nursing services, which must be overcome to provide patientcentred care. Demographic and financial constraints hamper service delivery and the availability of services; however, district nurses are required to use their problem solving skills and tacit knowledge to deal with these challenges. The Northern Ireland Single Assessment Tool (NISAT) uses a person-centred framework to provide a holistic approach to care. The case study reflects a holistic and person centred approach to care for a person with dementia by a district nursing student.

The role of the district nurse in Northern Ireland

A district nurse is an expert generalist practitioner who uses advanced clinical skills and knowledge to fulfil an ever-evolving role. The district nurse is accountable for the care planning, coordination and management of people with multi-faceted and intricate health care needs. In addition, an interprofessional approach to health and social care is required to enable the district nurse to co-ordinate care and enable patients to be cared for and remain within their homes. As the demand on primary and community services increases, care is further enriched by working in partnership with families, carers and voluntary service providers. The nurse patient relationship is the founding component for person-centred, holistic care. Through holistic assessment and shared decision making, co-produced care planning permits people to fundamentally take ownership of their health and enhances formal care provision. This case study reflects the role of the district nurse in Northern Ireland, through comprehensive assessment in clinical practice and highlights how a therapeutic relationship, being centred on the patient and shared decision-making impact positively on the care process.

The lived experience: Nurses' experience of caring for patients with a traumatic spinal cord injury

BACKGROUND

Nurses are involved in delivering care for patients following acute traumatic spinal cord injury throughout the entire care journey. An injury of this type is significant for the individual and their family and can be challenging for nurses delivering care for patients with life changing injuries, especially for nurses new to this setting. There is a lack of research that examines the experience of nurses caring for these patients in the acute setting.

METHOD

A hermeneutic phenomenological approach was used to understand the experience of nurses caring for patients in the acute setting who had sustained a traumatic spinal injury with associated neurological deficit. Using the phenomenological approach guided by the insight of Gadamer and Max Van Manen, participants with a broad range of experience were recruited and interviewed. The responses were transcribed into a text and subjected to hermeneutic analysis. Burnard's (1991) 14-step process and the hermeneutic approach were used to interpret and understand the phenomenon of interest.

CONCLUSION

The study highlights the experience and challenges of providing care to these individuals. Although patients had significant physical disabilities and were often dependent physically, the nurses' concerns were directed more towards fulfilling their psychological needs. Nurses identified grieving patients and felt their role was to provide realistic hope to motivate them. They felt an internal tension regarding desensitisation towards their patients, but this was often an internal protective mechanism to deal with the significance of the events surrounding these patients. Nurses new to this setting took time to learn the routines and manage the unique challenges effectively. Caring for these patients gave the nurses the opportunity to understand their patients and their families, and appreciate that both groups will fluctuate in their behavior throughout the acute process, as they adjust to grief and loss.

Nonpharmacological Management of Behavioral and Psychological Symptoms of Dementia: What Works, in What Circumstances, and Why?

Objective

Behavioral and psychological symptoms of dementia (BPSD) refer to the often distressing, noncognitive symptoms of dementia. BPSD appear in up to 90% of persons with dementia and can cause serious complications. Reducing the use of antipsychotic medications to treat BPSD is an international priority. This review addresses the following questions: What nonpharmacological interventions work to manage BPSD? And, in what circumstances do they work and why?

Method

A realist review was conducted to identify and explain the interactions among context, mechanism, and outcome. We searched electronic databases for empirical studies that reported a formal evaluation of nonpharmacological interventions to decrease BPSD.

Results

Seventy-four articles met the inclusion criteria. Three mechanisms emerged as necessary for sustained effective outcomes: the caring environment, care skill development and maintenance, and individualization of care. We offer hypotheses about how different contexts account for the success, failure, or partial success of these mechanisms within the interventions.

Discussion

Nonpharmacological interventions for BPSD should include consideration of both the physical and the social environment, ongoing education/training and support for care providers, and individualized approaches that promote self-determination and continued opportunities for meaning and purpose for persons with dementia.

The use of supportive communication when responding to older people's emotional distress in home care - An observational study

Background

Responding to older people’s distress by acknowledging or encouraging further discussion of emotions is central to supportive, person-centred communication, and may enhance home care outcomes and thereby promote healthy aging. This observational study describes nursing staff’s responses to older people’s emotional distress, and identify factors that encourage further emotional disclosure.

Methods

Audio-recorded home care visits in Norway (n = 196), including 48 older people and 33 nursing staff, were analysed with the Verona Coding Definitions of Emotional Sequences, identifying expressions of emotional distress and subsequent provider responses. The inter-rater reliability (two coders), Cohen’s kappa, was >0.6. Sum categories of emotional distress were constructed: a) verbal and non-verbal expressions referring to emotion, b) references to unpleasant states/circumstances, and c) contextual hints of emotion. A binary variable was constructed based on the VR response codes, differentiating between emotion-focused responses and responses that distanced emotion. Fisher’s exact test was used to analyse group differences and determined variables included in a multivariate logistic regression analysis to identify factors promoting emotion-focused responses.

Results

Older people’s expressions of emotional distress (n = 635) comprised 63 explicit concerns and 572 cues. Forty-eight per cent of nursing staff responses (n = 638) were emotion-focused. Emotion-focused responses were observed more frequently when nursing staff elicited the expression of emotional distress from the patients (54%) than when patients expressed their emotional distress on their own initiative (39%). Expressions with reference to emotion most often received emotion-focused responses (60%), whereas references to unpleasant states or circumstances and contextual hints of emotion most often received non-emotion-focused responses (59%). In a multivariate logistic model, nursing staff’s elicitation of the emotional expression (vs patients initiating it) and patients’ expression with a reference to an emotion (vs reference to unpleasant states or contextual hints) were both explanatory variables for emotion-focused responses.

Conclusions

Emotion-focused responses were promoted when nursing staff elicited the emotional expression, and when the patient expression referred to an emotion. Staff responded most often by acknowledging the distress and using moderately person-centred supportive communication. More research is needed to establish generalizability of the findings and whether older people deem such responses supportive.

Obtaining service user feedback for student nurses in the community setting

Seeking service user feedback for student nurses who are engaged in community learning experiences is an important part of a mentor's role. This paper discusses what is currently advocated, the mentor's role in obtaining and managing feedback and makes recommendations to improve the process in the community practice setting.

Exploring the experiences of patients attending day hospitals in the rural Scotland: capturing the patient's voice

AIMS AND OBJECTIVES

To understand the meaning of person-centred compassionate care for people attending day hospitals in rural Scotland.

BACKGROUND

Increasing numbers of older people are living with chronic conditions and require support to live at home. Intermediate care services such as day hospitals can enable this. Much previous research about day hospitals focused on organisational aspects of care. This study set out to capture the voice of the patient using this service.

DESIGN

A descriptive qualitative study.

METHODS

Individual interviews were undertaken in participant's homes using emotional touchpoints as prompts to help patients discuss their experience of care within a day hospital (n = 15). Data were analysed using thematic analysis.

RESULTS

Four main themes were identified from the data: Relationships, Feeling Valued, Expectations and Perceived Benefits. The findings showed that relationships with staff and other patients were important. The patients also wanted to feel valued, and helping others was part of this. The patients had clear expectations of the service but had an acute awareness of the benefits of attending the day hospital such as coordination of their care. Overall, the patients were highly satisfied, felt that care was person-centred and recognised the advantages of remaining close to home.

CONCLUSIONS

At a time when enabling health and social care integration is a priority, this study provides insight into the patient perspective of intermediate care. The findings reveal what matters to patients cared for in the community and how this service can respond to this.

RELEVANCE TO CLINICAL PRACTICE

This study provides insight for healthcare practitioners caring for patients in the community and those responsible for planning and resourcing this service. It should also start a dialogue about how these services could be used more.

Modelling district nurse expertise

As changes in society and health provision mean that one in four people over the age of 75 will require nursing care at home, pre-registration adult nurse education increasingly prepares student nurses for a future career within the community. District nurses undertake complex, multidimensional health and social assessments and care in a non-clinical setting and work in partnership with patients and their significant others to promote practical and psychological coping mechanisms and self-care. The district nurse's first assessment visit is key to developing a therapeutic partnership and it is often during this visit that expertise in district nursing practice emerges. The holistic, contextual and dynamic aspects of nursing in the home setting can make district nursing expertise difficult to illustrate and demonstrate within the classroom setting. This article explores the ways in which an understanding of expertise development theory can enable the tacit expertise that occurs within the first assessment visit to be made visible to student nurses, using simulation and expert narrative as a pedagogical strategy.