Person-Centered Care for Older Patients

This assignment explores the benefits of person-centered care in nursing practice, particularly for hospitalized older patients. It delves into how adopting a person-centered approach can positively influence nurses' attitudes and perceptions towards this vulnerable patient population. The assignment encourages critical analysis of existing literature and real-world examples to illustrate the effectiveness of person-centered care in enhancing the well-being and experience of older patients in hospital settings.

Running head: PERSON-CENTERED CARE
Person-centred care
Name of the Student
Name of the University
Author note

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In the provision of healthcare, ‘person-centred care’ (PCC) is the practice of patients’
caring and for their families in several ways that are valuable and meaningful for the individual
patient. According to Institute of Medicine (IOM), treatment provided to patients that is
responsive and respectful taking their values, needs and preferences into consideration where
values of patients guide throughout all clinical decisions (Feinberg 2014). National Safety and
Quality Health Service (NSQHS) Standards also explains that PCC is an important dimension
of safety and quality where healthcare delivery is responsive to preferences and needs of patients
(McCormack et al. 2012). In current literature, PCC is described as visit-based assessments that
involve communication with healthcare professionals playing an important role in building
relationships (Zhao et al. 2016). Therefore, the following essay uncovers the concept of PCC
through patient interview linked to NSQHS and Registered Nurse Standards for Practice.
PCC is different from patient centred care that former focuses on the accumulation of
knowledge from patients and family members about needs and preferences over time and
provides appropriate care regarding needs in the context of other needs (Carlström and Ekman
2012). Person-centred care demonstrates patient regarded as the person considering
circumstances and standpoint for decision-making process (Eaton, Roberts and Turner 2015).
This also extends beyond setting goals for the patient. PCC involves the doctor-patient encounter
style characterized by specific responsiveness to preferences and needs of the patients using
informed wishes guiding interaction, activity, information giving and participation in decision-
making.
PCC has health outcomes for patients and their family members. PCC interventions
enhance the quality of care and self-care behaviour performances. In a study conducted by
(Morgan and Yoder (2012) illustrated that communication that occurs during PCC is correlated

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with perceptions of patients helping them find common ground. Positive perceptions were found
to be associated with fact and better recovery from pain and discomfort. During a visit,
communication greatly influences the health of patients through perceptions especially when it is
achieved through common good improving their health status and increasing efficiency of care
and reduction of referrals and diagnostic tests. In a research, it was analysed that positive patient-
centred care in a primary setting is associated with a decrease in healthcare services utilization
(Munthe, Sandman and Cutas 2012). This is greatly associated with the reduction in annual
medical care charges that is an important outcome in PCC regarding medical visits. PCC has
demonstrated a practical style that emphasizes on patient activation and reduction in care
charges. Person-centred communication is associated with medical resources utilization
demonstrating that patients who are patient-centred and perceived their visits have few
diagnostic tests and referrals.
The patient was admitted with the initial injury at the right toe that needed longer time to
heal. The principles of PCC was applied in the given context to enhance the process of recovery.
PCC carry out in settings encompassing visits. Interaction or communication is involved
where the quality of interactions between healthcare professionals and patients that equate PPC
with communication skills. Among fundamental component in care PCC is characterized by
shared understanding, healing relationships, trust, emotional support, patient participation,
activation, enablement and informed choices (Wildevuur and Simonse 2015). This is depicted in
the patient interview that was undertaken during my current work placement at the rehabilitation
ward. I interviewed a patient, Mr ABC, a 69-year-old male patient who is suffering from right
below knee amputation (right BKA). The patient’s medical history depicts that there is non-
healing wound @ R> Leg, left 4th and 5th toe wound, type 2 diabetes mellitus (T2DM),

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underwent Stents Triple Bypass in 2009, Coronary Artery Bypass Surgery (CABS) in 2006,
peripheral neuropathy, depression, hypertension and peripheral vascular disease (PVD). The
patient is under a detailed health plan with ongoing physiotherapy, occupational therapy (OT)
assessment, regular dressing of wound with more area infected on right side and monitoring of
4th & 5th toe wound provided with weaning dose of Pregabalin. The patient’s social background
depicted that he lived in a two-story building and was an ex-smoker until he gave up smoking in
2010. These details about the patient are important for patient-centred care in the provision of
care. Before interview, informed consent was taken from the patient to know about his
willingness to participate in the interview.
As the infection of the patient spread throughout the legs, it is essential to provide patient
centred care that was given to him in the orthopaedic ward. Hence, under the given situation,
Mr..ABC were given the patient cantered care that was needed in the aspects of preventing
further infection. As part of the PCC, the patient was given Knee Amputation treatment that are
provided by the multi-disciplinary team. Regular family meetings were also held, which ensured
that the family got proper information about the patient condition. They were also able to take
part in the part of decision making process. This is believed to be a part of the education that are
provided by the family as a part of the patient centred care. Through the education, it is also
possible to promote the heath related facts to the patient family.
Earlier, person-centred care was focused on the relationship between physician or care
team and patient. In case of MR ABC, the same was provided to deal with the issues of anxiety
and stress. This can also help to deal with the financial stress that are encountered by the family.
This relationship is still integral. However, changes to healthcare system have taken place where
broader factors are considered that also affect PPC and health experiences. The biopsychosocial

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model or framework as a paradigm that is used in PCC to understand the cultural and social
environment along with the psychological impact that environment has on an individual as
important as biological factors and genetics are important (McKay et al. 2012). This is the
reason he social background of Mr ABC was asked. This person-centred model suggests using
integrated patient knowledge within the ethical framework where patient's rights are respected
and inculcate them in their provision of care. Five conceptual dimensions have been identified in
biopsychosocial perspective comprising of patient as person, therapeutic alliance, and doctor as
person and sharing of power and responsibilities (Hebblethwaite 2013). This perspective is
crucial in understanding and honouring the needs and preferences of the patient and valuing their
rights. Concisely, ‘biopsychosocial model’ conceptualize illness and disorders as the interaction
between hierarchical levels from biological to social to psychological levels.
PCC uses five key principles; valuing people, autonomy, life experience, understanding
relationships and environment. Valuing people suggests that healthcare providers need to treat
individuals with respect and dignity and be aware of their supporting personal perspectives,
beliefs, values and preferences (Munthe, Sandman and Cutas 2012). The healthcare provider and
patient should listen to each other and work in partnership for designing and delivering
healthcare services. Autonomy is the provision of choice, and there is respect for choices that are
made that balances risks, rights and responsibilities. There is proper optimization of person’s
control as there is sharing of power and active participation in decision-making (Elwyn et al.
2012). This helps to maximize independence that is built on strengths, abilities and interest of
individuals. Life experiences are the support that is provided to patients supporting their sense of
self and understanding the importance of history of a patient until present-day experiences. This
is greatly evident in the interview where the past medical history of Mr ABC was taken into

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consideration as it determines the plan of care and their hopes for the future. There is also
understanding of relationships that make collaborative interactions between service provider and
user, between staffing levels and their carers. Through local community, social connectedness is
also promoted where one engages in meaningful activities. The environment encompasses
organizational values underpinning the PCC principles. There is responsive support making
healthcare provides responsive to individual needs. Organization-wide planning and efforts
strengthen individuals and enhance organizational learning. These factors greatly help to guide
PCC stimulating active consideration of person’s preferences, needs and active participation in
intervention selection, goal setting and have positive health outcomes.
PCC has been recognized as a broad concept in high-quality healthcare provision. There
should be safe, effective, timely, equitable and efficient quality of care for individuals by service
providers. Care given should be responsive and respectful enduring that every needs and
preference of individuals are governed. In the provision of quality of care, NSQHS suggests that
PCC should be provided to individuals at every level of care. Patient’s experiences about the
quality of care provided refer to the experience level where it is mandatory to provide care in
such a manner where it should be respectful by careful demonstration of effective
communication and sharing of information between service provider and user. The participation
of patients and their families is greatly encourages and supported. At the clinical level, patients
and their family advisors should also participate in the overall designing of services and
programs. The members of quality improvement should take active participation in the program
with redesigning of teams and participation in planning, implementation and evaluation of
change (Entwistle and Watt 2013). At the organizational level, it is quite mandatory to include
departments, services and programs for providing quality care. The patients and their families

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need to be encouraged to be fully active participants in organizational committees for designing
and working of facilities for patient safety, patient or family education, quality improvement and
research. At the environmental level, patients and their family members’ perspectives are taken
into consideration informing local, federal, state policy agencies for program development. The
reimbursements and expectations are set and incentives development encouraging and supporting
engagement of individuals and their families in clinical decision making process in healthcare at
all levels (Safetyandquality.gov.au 2012).
PCC is greatly informed by Australian College of Nursing (ACN) and Nursing and
Midwifery Board of Australia (NMBA) standards that promote professional behaviour and
effective communication by nurses and midwives while communicating with the patient. Under
the Principle 2 of person-centred care by ACN, there is recognition of power imbalances
between nurse and person professional relationship in addressing the issue of supportive and
collaborative practice in clinical-decision making (Safetyandquality.gov.au 2010). There should
also be effective communication between service provider and user regarding health literacy. In
PCC, health literacy between nurse and person is important and therefore, should avoid practices
enhancing health literacy. For supporting shared-decision making, nurses should take PCC
approach for the management of person's concerns in a consistent manner by preferences and
values of person. There should be safe nursing practice that is supported by shared-decision
making in the provision of care. The PCC model is based on healthcare provider’s knowledge,
confidence and understanding of collaborative care in planning for person. ACN believes that
PCC principle is central tenet that underpins delivery of health and nursing care. This nursing
standard states that every person should be treated as an individual and it is nurses’ moral duty to

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protect person’s dignity. While providing care, nurses should respect the preferences and rights
of person (Ross, Tod and Clarke 2015).
As person-centred communication is involved in PCC, there should be development of
therapeutic relationship between care recipients and care providers that are based on mutual
understanding and trust. The ability of a nurse in delivering PCC is determined by their
attributes, nursing practice and care environment. There should be well-developed interpersonal
skills, commitment to person care, self-awareness and professional values. Nurses should also
demonstrate professional competence like skills, knowledge, values, attitudes and judgment.
They should empower person in making informed decisions and care planning providing holistic
care. Care environment elements should support PCC having appropriate staff mix and
transformational leadership enabling effective nursing teams’ development with shared power,
supportive workplace and effective organizations. Concisely, ACN supports healthcare
organizations in designing and implementing policies that support PCC achieving balance
between quality of care and economic imperatives (Pope 2012).
From the above discussion, it can be concluded that PCC is a high priority where the
person is involved in the provision of care providing the high quality of healthcare. The
provision of care put people at central tenant improving the quality of healthcare services
available. This model takes into consideration people needs and preferences while providing care
and empower them to become more active in decision-making process. The discussion also
explains that PCC improves the quality of care and promote safety by improving the health of
people and reducing the burden of disease. The core elements of PCC include access to care and
practices conducive towards patient experiences emerged from medical, nursing and health
policy literature. PCC is built on biopsychosocial model taking social, psychological and

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biological levels into consideration concerning health. ACN also believed in PCC and nursing
practice is built on this philosophy of emphasizing and strengthening individuals in the provision
of care.
References
Carlström, E.D. and Ekman, I., 2012. Organisational culture and change: implementing person-
centred care. Journal of health organization and management, 26(2), pp.175-191.
Eaton, S., Roberts, S. and Turner, B., 2015. Delivering person centred care in long term
conditions. Bmj, 350, p.h181.

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Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., Cording,
E., Tomson, D., Dodd, C., Rollnick, S. and Edwards, A., 2012. Shared decision making: a model
for clinical practice. Journal of general internal medicine, 27(10), pp.1361-1367.
Entwistle, V.A. and Watt, I.S., 2013. Treating patients as persons: a capabilities approach to
support delivery of person-centered care. The American Journal of Bioethics, 13(8), pp.29-39.
Feinberg, L.F., 2014. Moving toward person-and family-centered care. Public Policy & Aging
Report, 24(3), pp.97-101.
Hebblethwaite, S., 2013. " I Think That It Could Work But...": Tensions Between the Theory and
Practice of Person-Centred and Relationship-Centred Care. Therapeutic Recreation
Journal, 47(1), p.13.
McCormack, B., Borg, M., Cardiff, S., Dewing, J., Jacobs, G., Janes, N., Karlsson, B., McCance,
T., Mekki, T.E., Porock, D. and Van Lieshout, F., 2015. Person-centredness-the'state'of the
art. International Practice Development Journal, 5.
McKay, R., McDonald, R., Lie, D. and McGowan, H., 2012. Reclaiming the best of the
biopsychosocial model of mental health care and ‘recovery’for older people through a ‘person-
centred’approach. Australasian Psychiatry, 20(6), pp.492-495.
Morgan, S. and Yoder, L.H., 2012. A concept analysis of person-centered care. Journal of
Holistic Nursing, 30(1), pp.6-15.
Munthe, C., Sandman, L. and Cutas, D., 2012. Person centred care and shared decision making:
implications for ethics, public health and research. Health Care Analysis, 20(3), pp.231-249.

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Munthe, C., Sandman, L. and Cutas, D., 2012. Person centred care and shared decision making:
implications for ethics, public health and research. Health Care Analysis, 20(3), pp.231-249.
Pope, T., 2012. How person-centred care can improve nurses’ attitudes to hospitalised older
patients. Nursing Older People, 24(1), pp.32-37.
Ross, H., Tod, A.M. and Clarke, A., 2015. Understanding and achieving person‐centred care: the
nurse perspective. Journal of clinical nursing, 24(9-10), pp.1223-1233.
Safetyandquality.gov.au. (2010). Patient-Centred Care: Improving Quality and Safety By
Focusing Care On Patients And Consumers. [online] Available at:
https://www.safetyandquality.gov.au/wp-content/uploads/2012/01/PCCC-DiscussPaper.pdf
[Accessed 18 Jan. 2018].
Safetyandquality.gov.au. (2012). National Safety and Quality Health Service Standards. [online]
Available at: https://www.safetyandquality.gov.au/wp-content/uploads/2012/01/PCCC-
DiscussPaper.pdf [Accessed 18 Jan. 2018].
Wildevuur, S.E. and Simonse, L.W., 2015. Information and communication technology–enabled
person-centered care for the “big five” chronic conditions: scoping review. Journal of medical
Internet research, 17(3).
Zhao, J., Gao, S., Wang, J., Liu, X. and Hao, Y., 2016. Differentiation between two healthcare
concepts: Person-centered and patient-centered care. International Journal of Nursing
Sciences, 3(4), pp.398-402.

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Appendix
Q1- What brought you to the hospital?
A- I am suffering from toe wound and BKA
Q2- Do you have any past medical history?

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A- I am suffering from HTN and T2DM
Q3- Did you undergo any surgery in the past?
A- Yes, I underwent Stents Triple Bypass in 2006 and CABS in 2009
Q4- Where do you live?
A- I stay in two story house
Q5- Do you have any kind of addictions?
A- Earlier I was a smoker until I quit in 2010
Q6- Any other co-morbid condition that you suffer from?
A- I suffer from peripheral neuropathy
Q7- Any ongoing medications?
A- I consume weaning dose of Pregablin.
Q8- Any ongoing medical treatment?
A- Yes, I undergo physiotherapy; regular dressing is done for my wound with consistent
monitoring of my left 4th & 5th toe wound.
Q9- Describe your current problem that you are experiencing?
A- I am suffering from Non-Healing wound @ R> Leg, left 4th and 5th toe wound and right
BKA.
Q10- Are you in touch with your family?

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A- Yes, I access phone to talk to them
Q11- Is your family involved in your care?
A- Yes, my son and nephew help me a lot and visit me daily to the ward.