Transcultural Nurse Views on Culture-Sensitive/Patient-Centered Assessment and Care Planning: A Descriptive Study

2021 ◽  
pp. 104365962110469
Author(s):  
Mary Curry Narayan ◽  
R. Kevin Mallinson
Keyword(s):  
Cultural Sensitivity ◽  
Daily Practice ◽  
Clinical Settings ◽  
Care Planning ◽  
Transcultural Nursing ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Expert Nurses ◽  
Qualitative Descriptive ◽  
Pragmatic Strategies

Introduction: Culture-sensitive (CS) and patient-centered (PC) care are considered essential to achieve high-quality equitable care. The purpose of this study was to determine how expert nurses incorporate CS/PC care into their assessment and care planning practices, especially for culturally diverse and marginalized patients. Methodology: Using a qualitative, descriptive design, we conducted a focus group at the October 2019 Transcultural Nursing Society Conference. Participants ( n = 9) discussed how they instilled cultural sensitivity and patient-centeredness into their assessment and care planning skills. Results: Participants revealed attitudes, knowledge, and skills associated with CS/PC assessment and care planning. They also identified specific strategies for translating CS/PC theory into assessment and care planning practices. Discussion: Three principles and many pragmatic strategies for incorporating CS/PC care into daily practice emerged from the data. Nurses may find these principles and strategies helpful in integrating CS/PC care into their daily care of patients in busy clinical settings.

Medische Communicatie in Onderzoek en Onderwijs

2007 ◽  
Vol 78 ◽  
pp. 25-35
Author(s):  
J.A.M. Harmsen ◽  
R.L. Hulsman ◽  
Ludwien Meeuwesen
Keyword(s):  
Communication Skills ◽  
Process Analysis ◽  
Daily Practice ◽  
Skills Training ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Centered Care ◽  
Cognitive Scripts ◽  
Pros And Cons ◽  
Conducting Research

While there is a long tradition of conducting research on medical communication, one may question in what way practicing physicians and courses for medical students will profit from it. The first part of our paper presents a short overview of 40 years of research, focusing on concepts of patient-centered care and shared decision-making. Pros and cons two co-existing traditions, process analysis and micro-analysis, are described. The second part of the paper presents the development of cognitive scripts in communication skills training in medical education. The differences between perspectives angles and educational perspectives are elaborated on. The third part of the paper describes the method and effects of the practical learning of new scripts for patient centeredness in the case of non-Western immigrant patients. Although education in communication skills definitely profits from research, daily practice seems to be much more complex, not in the least because of cultural differences.

Patient-Centered Care and Autonomy: Shared Decision-Making in Practice and a Suggestion for Practical Application in the Critically Ill

2019 ◽  
Vol 35 (11) ◽  
pp. 1352-1355
Author(s):  
Marianna V. Mapes ◽  
Peter A. DePergola ◽  
William T. McGee
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Critically Ill ◽  
Care Service ◽  
Clinical Care ◽  
Patient Centered Care ◽  
Practical Application ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Centered Care

Decision-making for the hospitalized dying and critically ill is often characterized by an understanding of autonomy that leads to clinical care and outcomes that are antithetical to patients’ preferences around suffering and quality of life. A better understanding of autonomy will facilitate the ultimate goal of a patient-centered approach and ensure compassionate, high-quality care that respects our patients’ values. We reviewed the medical literature and our experiences through the ethics service, palliative care service, and critical care service of a large community teaching hospital. The cumulative experience of a senior intensivist was filtered through the lens of a medical ethicist and the palliative care team. The practical application of patient-centered care was discerned from these interactions. We determined that a clearer understanding of patient-centeredness would improve the experience and outcomes of care for our patients as well as our adherence to ethical practice. The practical applications of autonomy and patient-centered care were evaluated by the authors through clinical interactions on the wards to ascertain problems in understanding their meaning. Clarification of autonomy and patient-centeredness is provided using specific examples to enhance understanding and application of these principles in patient-centered care.

“Don’t talk to them about goals of care”: Understanding disparities in advance care planning

2021 ◽  
Author(s):  
Deepshikha Charan Ashana ◽  
Noah D’Arcangelo ◽  
Priscilla K Gazarian ◽  
Avni Gupta ◽  
Stephen Perez ◽  
...  
Keyword(s):  
Native American ◽  
Ethnic Groups ◽  
Health Systems ◽  
Advance Care Planning ◽  
Religious Beliefs ◽  
Barriers And Facilitators ◽  
National Study ◽  
Care Planning ◽  
Patient Centered ◽  
Advance Care

Abstract Background Structurally marginalized groups experience disproportionately low rates of advance care planning (ACP). To improve equitable patient-centered end-of-life care, we examine barriers and facilitators to ACP among clinicians as they are central participants in these discussions. Methods In this national study, we conducted semi-structured interviews with purposively selected clinicians from six diverse health systems between August 2018 and June 2019. Thematic analysis yielded themes characterizing clinicians’ perceptions of barriers and facilitators to ACP among patients, and patient-centered ways of overcoming them. Results Among 74 participants, 49 (66.2%) were physicians, 16.2% were nurses, and 13.5% were social workers. Most worked in primary care (35.1%), geriatrics (21.1%), and palliative care (19.3%) settings. Clinicians most frequently expressed difficulty discussing ACP with certain racial and ethnic groups (African American, Hispanic, Asian, and Native American) (31.1%), non-native English speakers (24.3%), and those with certain religious beliefs (Catholic, Orthodox Jewish, and Muslim) (13.5%). Clinicians were more likely to attribute barriers to ACP completion to patients (62.2%), than to clinicians (35.1%) or health systems (37.8%). Three themes characterized clinicians’ difficulty approaching ACP (Preconceived views of patients’ preferences; narrow definitions of successful ACP; lacking institutional resources), while the final theme illustrated facilitators to ACP (Acknowledging bias and rejecting stereotypes; mission-driven focus on ACP; acceptance of all preferences). Conclusions Most clinicians avoided ACP with certain racial and ethnic groups, those with limited English fluency, and persons with certain religious beliefs. Our findings provide evidence to support development of clinician-level and institutional-level interventions and to reduce disparities in ACP.

Home Health Nurses’ Journey Toward Culture-Sensitive/Patient-Centered Skills: A Grounded Theory Study

2021 ◽  
pp. 108482232110278
Author(s):  
Mary Curry Narayan ◽  
Robert Kevin Mallinson
Keyword(s):  
Grounded Theory ◽  
Patient Centered Care ◽  
Home Health ◽  
Care Planning ◽  
Culturally Competent ◽  
Patient Centered ◽  
High Quality ◽  
Culturally Competent Care ◽  
Home Health Nurses ◽  
Centered Care

Introduction. Home health patients, who are members of minority and vulnerable groups, suffer disparate outcomes. Patient-centered care (PCC) and culturally-competent care (CCC) aim to facilitate high-quality, equitable care. How home health nurses incorporate PCC and CCC principles into their assessment and care-planning practices has not been -investigated. This study answers the question, “ What is the process by which home health nurses develop their culture-sensitive/patient-centered assessment and care planning skills?” Methods. Home health nurses (n= 20) were recruited into this grounded theory study from agencies around the United States via flyers, websites, and contacts. We conducted in-depth recorded interviews using a semi-structured interview guide to ask questions about nurses’ assessment and care-planning practices, their understanding of CCC and PCC principles, and facilitators/barriers to CCC and PCC practice. Results. Participants primarily gained their CCC and PCC assessment and care-planning skills through a “seat of your pants,” trial-and-error process, with little educational or agency assistance. They combined caring, diverse patient experiences, and critical, creative self-reflection on their experiences to gradually learn helpful, though not optimal, CCC and PCC strategies. However, they reported numerous barriers that discouraged or distressed them in their quest to deliver culturally-competent and patient-centered care. Only a few nurses demonstrated the resilience to overcome these challenges creatively and happily. Conclusion. If we accept that patient-centered care and culturally competent care are key elements of high-quality, equitable care, this grounded theory may help home healthcare clinicians, administrators, educators, and policy-makers identify impact points for enhancing CS/PC practices.

scholarly journals Parental Involvement Policies for Minors Seeking Abortion in the Southeast and Quality of Care

2021 ◽  
Author(s):  
Kari White ◽  
Subasri Narasimhan ◽  
Sophie A. Hartwig ◽  
Erin Carroll ◽  
Alexandra McBrayer ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Parental Involvement ◽  
Service Delivery ◽  
Quality Care ◽  
Health Service Delivery ◽  
Policy Implications ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Staff Members

Abstract Introduction Thirty-seven states require minors seeking abortion to involve a parent, either through notification or consent. Little research has examined how implementation of these laws affect service delivery and quality of care for those who involve a parent. Methods Between May 2018 and September 2019, in-depth interviews were conducted with 34 staff members involved in scheduling, counseling, and administration at abortion facilities in three Southeastern states. Interviews explored procedures for documenting parental involvement, minors’ and parents’ reactions to requirements, and challenges with implementation and compliance. Both inductive and deductive codes, informed by the Institute of Medicine’s healthcare quality framework, were used in the thematic analysis. Results Parental involvement laws adversely affected four quality care domains: efficiency, patient-centeredness, timeliness, and equity. Administrative inefficiencies stemmed from the extensive documentation needed to prove an adult’s relationship to a minor, increasing the time and effort needed to comply with state reporting requirements. If parents were not supportive of their minor’s decision, participants felt they had a duty to intervene to ensure the minor’s decision and needs remained centered. Staff further noted that delays to timely care accumulated as minors navigated parental involvement and other state mandates, pushing some beyond gestational age limits. Lower income families and those with complex familial arrangements had greater difficulty meeting state requirements. Conclusions Parental involvement mandates undermine health service delivery and quality for minors seeking abortion services in the Southeast. Policy Implications Removing parental involvement requirements would protect minors’ reproductive autonomy and support the provision of equitable, patient-centered healthcare.

scholarly journals Reframing the Medication Experience in Pharmacy Using Seminal Concepts of Patient-Centered Care—Implications for Practice

Pharmacy ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 9
Author(s):  
Brian Isetts ◽  
Anthony Olson ◽  
Jon Schommer
Keyword(s):  
Therapeutic Relationship ◽  
Secondary Analysis ◽  
Patient Centered Care ◽  
National Sample ◽  
Patient Specific ◽  
Structured Interviews ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Centered Care ◽  
Medication Experience

Team-based, Patient-Centered Care is essential to chronic disease prevention and management but there are differing ideas about the concept’s meaning across healthcare populations, settings and professions. This commentary’s objective is to empirically evaluate the theoretical relationships of the [a] Medication Experience, [b] Patient-Centeredness and other relevant component concepts from pharmaceutical care (i.e., [c] Therapeutic Relationship, [d] Patient-specific preferences for achieving goals of therapy and resolving drug therapy problems) so as to provide practice-based insights. This is achieved using a secondary analysis of 213 excerpts generated from in-depth semi-structured interviews with a national sample of pharmacists and patients about Patient-Centeredness in pharmacist practice. The four component concepts (i.e., a–d) related to the objective were examined and interpreted using a novel 3-archetype heuristic (i.e., Partner, Client and Customer) revealing common practice-based themes related to care preferences and expectations in collaborative goal setting, enduring relationships, value co-creation and evolving patient expectations during challenging medical circumstances. Most practice-based insights were generated within the Partner archetype, likely reflecting high congruence with pharmacist and patient responses related to the Medication Experience and Therapeutic Relationship. The practice-based insights may be especially useful for new practitioners and students accelerating their advancement in providing effective and efficient Patient-Centered Care.

scholarly journals Delivering Personalized Care at a Distance: How Telemedicine Can Foster Getting to Know the Patient as a Person

2021 ◽  
Vol 11 (2) ◽  
pp. 137
Author(s):  
Janet Record ◽  
Roy Ziegelstein ◽  
Colleen Christmas ◽  
Cynthia Rand ◽  
Laura Hanyok
Keyword(s):  
New Technologies ◽  
Office Visit ◽  
Modern Technology ◽  
Office Visits ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Personalized Care ◽  
High Satisfaction

The promise of precision medicine is based on the use of new technologies to better characterize patients by defining individuals in the areas of genomics, proteomics, metabolomics and other aspects of biologic variability. Wise application of modern technology can similarly transform health visits with patients, allowing for better characterization of the patient’s individual life circumstances than possible in a traditional office visit. The use of, and experience with, telemedicine have increased significantly during the COVID-19 pandemic. Patients and clinicians report high satisfaction with telemedicine, and the quality of communication and patient-centeredness experienced in this setting are both rated highly. In this article, we explore the benefits offered by telemedicine in facilitating personalized care with particular focus on telemedicine delivered by video platforms. We propose strategies and skills specific to the effective implementation of personalized telemedicine, drawing on literature in patient-centered communication and home visits. While traditional in-person office visits continue to offer important opportunities such as thorough physical examination and the potential for enhanced non-verbal communication, telemedicine offers many important advantages that can facilitate the process of getting to know the patient as a person.

scholarly journals An Analysis of Methodologies That Can Be Used to Validate if a Perioperative Surgical Home Improves the Patient-centeredness, Evidence-based Practice, Quality, Safety, and Value of Patient Care

2013 ◽  
Vol 119 (6) ◽  
pp. 1261-1274 ◽  
Author(s):  
Thomas R. Vetter ◽  
Nataliya V. Ivankova ◽  
Lee A. Goeddel ◽  
Gerald McGwin ◽  
Jean-Francois Pittet
Keyword(s):  
Perioperative Care ◽  
Healthcare Delivery ◽  
Standard Of Care ◽  
The United States ◽  
Surgical Patients ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Perioperative Surgical Home ◽  
Future Demands ◽  
Evidenced Based

Abstract Approximately 80 million inpatient and outpatient surgeries are performed annually in the United States. Widely variable and fragmented perioperative care exposes these surgical patients to lapses in expected standard of care, increases the chance for operational mistakes and accidents, results in unnecessary and potentially detrimental care, needlessly drives up costs, and adversely affects the patient healthcare experience. The American Society of Anesthesiologists and other stakeholders have proposed a more comprehensive model of perioperative care, the Perioperative Surgical Home (PSH), to improve current care of surgical patients and to meet the future demands of increased volume, quality standards, and patient-centered care. To justify implementation of this new healthcare delivery model to surgical colleagues, administrators, and patients and maintain the integrity of evidenced-based practice, the nascent PSH model must be rigorously evaluated. This special article proposes comparative effectiveness research aims or objectives and an optimal study design for the novel PSH model.

The Patient-Centered Medicine as the Theoretical Framework for Patient Engagement

2016 ◽  
pp. 25-39 ◽  
Author(s):  
Borghi Lidia ◽  
Galli Federica ◽  
Vegni Elena Anna Maria
Keyword(s):  
Patient Engagement ◽  
Theoretical Framework ◽  
Medical Epistemology ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Present Contribution ◽  
Patient Centered Medicine ◽  
Chronic Disorders ◽  
Theoretical Frame

The present contribution will describe the origin, development and main characteristics of the patient-centered medicine; the literature on patient-centeredness, in particular in the field of chronic disorders, will be discussed and the importance of this approach underlined; arguments about the importance of patient-centered medicine as theoretical frame founding and supporting the concept of patient engagement will be highlighted, considering that only within this medical epistemology the patient's engagement can find a full and complete expression.

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