Patient Centred Care: Analysis of Stroke Patient Interview Essay

This essay delves into the concept of Patient Centred Care (PCC) as a cornerstone of quality healthcare, as defined by The Australian College of Nursing. It examines the ethical underpinnings of PCC, emphasizing individual preferences, dignity, and therapeutic relationships. The essay presents a case study of a stroke survivor with upper limb hemiparesis, analyzing their understanding of the disease process and treatment, particularly the use of a wheelchair. The analysis explores the patient's perspective, ethical considerations like beneficence and autonomy, and the importance of communication, counselling, and user-centered design in enhancing patient engagement and therapy outcomes. Recommendations are provided to improve PCC implementation, including communication training for healthcare professionals, patient feedback surveys, and user-centered design to enhance the patient experience. The essay concludes that PCC requires a holistic approach that prioritizes patient needs and preferences, to improve the quality of care.

Running head: PATIENT CENTRED CARE
Patient Centred Care
Name of the Student
Name of the University
Author Note

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According to The Australian College of Nursing (ACN), the central tenet of
underpinning the delivery of quality care is defined by the approach of Person-centred care
or patient centred care (PCC). PCP deals with certain underlining ethical concept for
instance; it provides preference in treating each person as separate individuals while framing
the personalised care plan. Moreover, the concept of PCC also provides importance in
protecting patients’ dignity, right and preferences via maintaining a healthy and mutually
exclusive therapeutic relationship with the patient. Under this healthy relationship, the nurses
are required to design the care plan via taking a informed consent from the client. Some of
the notable benefits of the optimal application of PCC is reduced mortality rate following
cardiac arrest or myocardial infarction, decreases in the rate of hospital acquired infection and
hospital re-admission in aged care facilities (Australian College of Nursing 2014, p. 01).
This essay is based on the understanding of the PCC and underpinning the theoretical
knowledge. The essay highlights interview conducted with a cardiovascular stroke accident
(CVS) or stroke recovered patient with upper limb hemiparesis in regard to PCC. Upon
subsequent conduction of interview, the essay critically analyse PCC under the light of the
patient’s understanding and then reflects possible recommendation to refinement of PCC.
Case study overview
The respondent here have recovered stroke but is suffering from limb impairment that
is essential to therapeutic planning efforts in order to restore the function (Raghavan 2015,
pp. 599). Therefore the treatment is designed to target the impairment that is responsible for
the particular dysfunction at the given point of time (Raghavan 2015, pp. 599).
Analysis of the person understanding of the disease process and treatment

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The respondent is suffering from weakness or paralysis of the upper limb and this is
leading to delayed initiation and termination of the muscle contraction along with slowness in
developing forces (Raghavan 2015, pp. 599). Thus the respondent is unable to move. Thus in
regards to the PCC, the respondent is referred to avail wheel chair support for locomotion
(Morris and Morris 2012, pp. 347-354). However, the patient is finding the use of wheelchair,
demotivating as is gradually developing poor self-esteem (Gerling et al. 2014), pp. 2201-
2210). During the course of interview, the patient has also complained that this use of
wheelchair is done against his consent. He has also reported that he wish to stay bed-ridden if
he’s legs fail to function as usual. Under this circumstance it can be stated that the
expectations of people in health care is changing as they are now taking more autonomy in
their care (Mezzich and Miles 2011, pp. 20-21; Quill and Holloway 2012, pp. pp.541-543). In
this case study, patient was previously informed about his physiological condition and the
probable therapy plan however; patient is considering himself to be a passive recipient and is
unwilling to avail wheelchair option (Mezzich and Miles 2011, pp. 20-21). Here the use of
medical diagnosis going in the favour of the ethical rule of beneficience. Ethical rule of
beneficence promotes positive initiatives undertaken to help others (in this case the
respondent). However, this ethical principal is going against the rule of autonomy where
agreement to respect other’s right is given preference (Faith 2015, pp. 2-5; Mawere 2012, pp.
1). Although PCC promotes personalised care plan for the patients, it also give preference
towards elicting and respecting patients’ preferences while engaging them in the care
process (Australian Commission on Safety and Quality in Healthcare 2011, pp.8). So in order
to make the patient participate in the therapy plan whole-heartedly, nurses must “get inside
the skin of the concerned patient via listening to them while establishing dialogue with a view
to create therapeutic relationship in which the patient is the key partner of discussion. The
registered nurses should keep in mind that there is no place for the “one size fits all”

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approach in present day PCC (Mezzich and Miles 2011, pp. 20-21; Kitson et al. 2013, pp. 4-
15). So in order to make this target patient (the interview respondent) to belief in the use of
the wheel chair as the best fit for the therapy plan, the nurses are required to exert
competencies in the field of communication, assessment and counselling. Via the optimal
application of counselling, behaviour change strategies supporting the self-management of
illness along with wellness will be achieved (Mezzich and Miles 2011, pp. 20-21). Via doing
this, the patient will gradually understand the importance of wheelchair in the speedy
recovery of the after stroke impairment. This understanding will lead to the spontaneous
participation of the patient in the therapy and thereby helping him to recover fast (Storm and
Edwards 2013, pp. 313-327; Peabody 2015; pp. 868-1868).
Level of Improvement and engagement in the therapy plan
In response to second question it can be stated that, the act of exercise of the hands
has been undertaken in order to avoid the chances of learned non-use. Initially after the
occurrence of CVA or stroke, the affected individuals may not use the affected portion of the
upper limb and this is known as non-use (Raghavan 2015, pp. 599). Generally non-use may
result due to paralysis and weakness or sensory loss. However, as the time progress, this non-
use gradually becomes a habit and during the course of time, this habit gets transformed into
permanent physiological change and is termed as learned non-use. Here in learned non-use,
the individual is unable to move to incorporate functional activities with the particular part of
the body even though they are now physically fit to mover it (Raghavan 2015, pp. 599).
However, in this care, though the patient is participating in the therapy plan, he is anxious to
see some positive changes. When he is unable to view the same, he is getting frustrated and is
gradually losing hope on the treatment. Under this circumstance, therapy plan needs to be re-
designed in order to suit the patient care needs (Australian Commission on Safety and
Quality in Healthcare 2011, pp. 8-9). The redesigning must be done ready accessibility of the

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health information (Australian Commission on Safety and Quality in Healthcare 2011, pp. 8-
9). If the patients is provided with the medical data of his course of improvement and is made
to understand that though he is unable to manually experience the change in his hand
movements but the spasticity of the hand is actually improving via taking reference to the
medical records, his level of participation in the therapy will increase (Barry and Edgman-
Levitan 2012, pp. 780-781). The elements in the care environment that support PCC must be
modified like appropriate staff still mix along with the observance of the transformational
leadership promoting the development of the effective nurse team who work under the unique
traits of shared power and motivation and innovation (Lawrence and Kinn 2012, pp.295-326).
This innovation will bring change in the patient’s approach towards the monotonous therapy
and shift in the nurse roster will improvise change in the nursing care skills communication
approach that will help the patient to motivate and increase in the therapy participation
(Chaudoir, Dugan and Barr 2013, p.22). Apart from the nursing care centred innovation, the
organisation must also come forward in order to make further improvement in the PCC
(Australian Commission on Safety and Quality in Healthcare 2011, pp. 8-9). In this regard, it
will be the duty of the organisation officials to make positive approach towards the quality
improvement. Here quality improvement can be achieved via taking feedback from the
patients care experience along with clinical and operational data (Aiken et al. 2012, pp.
2012). All these data will act in collaboration to improvise the action plans. Like if the patient
is anxious or failing to see any positive results, it is the duty of the organisational bodies to
make refinement in the process of the exercise plan via working in sync with the healthcare
professionals.
Recommendation for the area of improvement
As per my understanding about the PCC care, it is the duty of the registered nurses to
place the patient’s need and interests at the core of their works. However, environmental

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attributes like inappropriate staff mix skills, lack of adequate funding or high treatment cost
and focus on disease based model or evidence based approach on the therapy plan creates
barrier towards the optimal implementation of the PCC (Australian College of Nursing 2014,
p. 01).
I also believe that the most effective ways to promote patient experience is to
improvise the patient-centred consultation styles (Wyer et al. 2014, pp. 881-889). The change
in the consultation styles can be achieved via proper communication training among the
healthcare professionals and via taking periodic patients’ feedback through surveys
performed in group or interviews taken individually. Strengthening of patient consultation
styles will help to cast a positive impact on the patient’s knowledge thus facilitating informed
decision making and active participation in the therapy plan.
In this ground I would like to specially highlight the communication training of the
healthcare professionals (Australian Commission on Safety and Quality in Healthcare 2010,
pp. 26-27). Proper communication skills will help the nurses to communicate information
about the therapy plan and medicines used to process of disease treatment. This will help to
improve the patient’s knowledge and understanding about the disease prognosis and thereby
increasing the level of participation while staying motivated (Pinto et al. 2012, pp. 77-78).
Moreover, this understanding increases patient’s confidence to undertake necessary actions in
relation to health. The impact of patient knowledge and informed decision making increases
further, when proper educational material comes in addition to verbal information of nurses. I
have also highlighted patients’ survey towards the process of effective application of PCC.
While conducting this interview I have understood that one-to-one communication with the
patient helps to understand the loopholes of the therapy plan and thus making provision for
the quality improvements in the therapy plan. However, patient feedback surveys need to

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properly planned and carefully implemented and must only be performed after taking active
consent from the patient (Manary et al. 2013, pp. 201-203).
Lastly I would like to recommend user centred design and redesign which is popular
both in US and UK. The aim of this design is to improvise the physical care environment in
order to improve patient’s experience of care. The user centred design is based on the
principles of environmental psychology which gives preference to the spatial design towards
promoting patient’s well-being and experience (Australian Commission on Safety and
Quality in Healthcare 2010, pp. 26-27).
Proposed theoretical framework of PCC from the survey
Source: Created by author
Thus from the above essay it can be concluded that PCC is an internationally
acclaimed approach of promoting quality health care. In PCC, “care is respectful and
responsive to individual preference of the patients’ values and needs while ensuring the
patient’s values is taken into consideration through clinical decision making. The prime
Step 1
Conduction of survey or interview with the patient
Step 2
Understanding the loopholes in the theray plan from patient's
perspectives
Step 3
Improvisiong of the plan on the basis of the survey like
counselling of the patients, user centered design and redesign
and educating patinet about the disease prognosis

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approach that must be undertaken to modify PCC include improvising communication styles
of the healthcare professionals, conducting proper surveys to understand the patients
experience and user catered design. Moreover, the interview conducted also highlights the
need of proper counselling of the patients in order to increase their participation in the
therapy.

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References
Aiken, L.H., Sermeus, W., Van den Heede, K., Sloane, D.M., Busse, R., McKee, M.,
Bruyneel, L., Rafferty, A.M., Griffiths, P., Moreno-Casbas, M.T. and Tishelman, C., 2012.
Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and
patients in 12 countries in Europe and the United States. Bmj, 344, p.e1717.
Australian College of Nursing (ACN) 2014, Person-centred Care: Position Statement,
Victoria, November, viewed 23 January 2018
<https://www.acn.edu.au/sites/default/files/advocacy/submissions/PS_Person-
centered_Care_C2.pdf>
Australian Commission on Safety and Quality in Healthcare 2011, Patient centred care,
Improving quality and safety through partnership with patients and consumers. viewed 23
January 2018 <
https://www.safetyandquality.gov.au/wp-content/uploads/2012/03/PCC_Paper_August.pdf>
Australian Commission on Safety and Quality in Healthcare, 2010. Patient-Centred Care:
Improving Quality And Safety By Focusing Care On Patients And Consumers. September,
viewed 23 January 2018. <
https://www.safetyandquality.gov.au/wp-content/uploads/2012/03/PCC_Paper_August.pdf>
Barry, M.J. and Edgman-Levitan, S., 2012. Shared decision making—the pinnacle of patient-
centered care. New England Journal of Medicine, 366(9), pp.780-781.
Chaudoir, S.R., Dugan, A.G. and Barr, C.H., 2013. Measuring factors affecting
implementation of health innovations: a systematic review of structural, organizational,
provider, patient, and innovation level measures. Implementation Science, 8(1), p.22.

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Faith, K.E., 2015. Addressing issues of autonomy and beneficence in the treatment of eating
disorders. National Eating Disorder Information Centre, 6, pp.1-6.
Gerling, K.M., Miller, M., Mandryk, R.L., Birk, M.V. and Smeddinck, J.D., 2014, April.
Effects of balancing for physical abilities on player performance, experience and self-esteem
in exergames. In Proceedings of the 32nd annual ACM conference on Human factors in
computing systems (pp. 2201-2210). ACM.
Kitson, A., Marshall, A., Bassett, K. and Zeitz, K., 2013. What are the core elements of
patient‐centred care? A narrative review and synthesis of the literature from health policy,
medicine and nursing. Journal of advanced nursing, 69(1), pp.4-15.
Lawrence, M. and Kinn, S., 2012. Defining and measuring patient‐centred care: an example
from a mixed‐methods systematic review of the stroke literature. Health Expectations, 15(3),
pp.295-326.
Manary, M.P., Boulding, W., Staelin, R. and Glickman, S.W., 2013. The patient experience
and health outcomes. New England Journal of Medicine, 368(3), pp.201-203.
Mawere, M., 2012. Critical reflections on the principle of beneficence in biomedicine. Pan
African Medical Journal, 11(1).
Mezzich, J. and Miles, A., 2011. The third Geneva Conference on Person-Centered
Medicine. International Journal of Person Centered Medicine, 1(1), pp.6-9.
Morris, R. and Morris, P., 2012. Participants’ experiences of hospital-based peer support
groups for stroke patients and carers. Disability and rehabilitation, 34(4), pp.347-354.
Peabody, F.W., 2015. The care of the patient. Jama, 313(18), pp.1868-1868.

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Pinto, R.Z., Ferreira, M.L., Oliveira, V.C., Franco, M.R., Adams, R., Maher, C.G. and
Ferreira, P.H., 2012. Patient-centred communication is associated with positive therapeutic
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right balance in patient care. Obstetrical & Gynecological Survey, 67(9), pp.541-543.
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Rehabilitation Clinics, 26(4), pp.599
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intentions and implementation challenges. Psychiatric Quarterly, 84(3), pp.313-327.
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Appendix
Interview Questions and answers
Question 1
How long have you been in hospital?
1 week
Question 2
What has caused your hospital admission?
Stroke
Question 3
How are you feeling now? After recovering from stroke? Are you facing any difficulty in
regards to the treatment?
My life after stroke has changed altogether. I was a healthy living man, and now see, I am
physically challenged. To add to my mental pain, the health care professionals have
prescribed me to use wheel chair. However, moving in a wheel chair, getting dragged by
others is hurting my self-esteem. I am feeling like I am living at the mercy of others. When
they have informed me that they are opting for wheel chair, I have protested and told them I
would better remain bed-ridden than using wheel chair. But they told it is good for my health,
as I need to keep my muscles in movement. But I do not see any positive benefit out of it.
Question 4
Do you have any other complain in regards to the therapy plan?

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The registered nurse comes every morning as request me to lift my hand. She told me that it
is for my own good; otherwise my hand will become permanently impairment. However,
even after three days, I do not find any sensation in my hands and while asked to move my
hand, I find it extremely difficult. I always remain scared during morning in the anticipation
that now only the nurse will come and will ask me to do the hand exercise
Question 5
Are your family is aware about your treatment regime
Yes they are aware of my treatment regime as they consult with the doctors and the nurses
after the visiting hours get over.
Question 6
Have you informed them about your problem that you are facing while taking the therapy?
Yes
Question 7
What have they advised you?
They have told me to abide by the therapy plan as they have consulted with the doctors and
have found that this is best possible therapy for me in order to get speedy recovery
Question 8
Have the doctors informed you about the importance of the therapy as they have did to your
family members?
No
Question 9

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Question 10
Are you aware of your present health condition?
No. I feel hopeless as it is 1 week past time in this hospital am I am still bed ridden. The
doctors give exercise, physiotherapy and other medicines by I am loosing hope for my
recovery. As I am not aware regarding why these medicines are given and why these
exercises are prescribed.