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Narrative Review of International Research

Question:

Discuss about the Narrative Review of International Research.

Answer:

Introduction

Person-centred care is a care-giving plan in which the patient acts as an equal partner as the one who provides care and the patient helps the caregivers to plan, develop and monitor his needs. This care plan focuses on the patients and their families take decisions and develop care plan with the professionals to achieve better outcomes. Over the past decade, interventions to convert the healthcare and social services to person-centered plans have become evident. According to Dossey (2012), fusing of these aspects will help to improve the care quality, make people active in looking after themselves and let the patients get the care, when they need it.

Medical history- Grace Williams is a 75-year-oldwoman having some health disorders. She is living in sunshine bay aged care home from past seven months. She was unable to carry out her daily activities due to emphysema. Her medical history reveals that she used to be a smoker since she was 25 year old; However, she has quit smoking 6 months ago to contribute in the oxygen therapy she has been prescribed. She has visited hospitals multiple times due to Chronic Obstructive Pulmonary Syndrome (COPD). She is also suffering from Hypertension (HTN) and consumes anti-hypertensive Captopril 6.25mg BD. She consumes Salbutamol two puffs prn and uses Symbicort inhaler 2 puffs BD to overcome the COPD. Her latest health reports include high blood pressure (145/82), lowered pulse and respiration rate, and lowered oxygen consumption rate. Due to these medical conditions, she should avail person-centred care plan.

Holistic health assessment approach- According to Brownie and Nancarrow (2015), person centred care plan impacts the quality of care positively. This plan helps the patients to feel more satisfied and change their experience of care. Moreover, it encourages patient and their families to be a part of decision-making team including healthcare professionals. Hence, Professionals are able to understand the needs of the patient effectively. Furthermore, it not only allows the patient to interact with the healthcare professionals, but the staff of these healthcare units also gets a chance to understand a patient’s needs. They tend to support the patients they are providing care resulting in staff satisfaction (Olsson et al. 2013). The health condition of Grace Williams is not so good. She is facing difficulty in mobilization and unable to reach bathroom from her bed as well. Therefore, nursing intervention for this condition should be helping the patient with physical support. She should be provided with gait belt for her body balance and every door of her room should open with a push rather than pull. The nurses should also be aware of the technique of transferring a patient from bed to chair so that she can be taken to the other parts of the Aged home (Wright and Leahey 2012). Grace faces difficulty while lying down on the bed and hence prefers to sleep on the chair. Nursing intervention for this disorder should be treating her respiratory problems. She is suffering from dyspnoea and emphysema and patients in these disorders are unable to sleep. She should be regular to her oxygen therapy and her nutrition should not include cold food products (Weber and Kelley 2013).

Holistic health assessment approach is a process through which nurses are informed about the care that needs to be provided to the patient. Holistic care assessment include patients health data, reports and therapeutic interventions applied that enables the nurses to assess the further interventions they can use to improve the patient condition. Holistic care of patient includes fulfilment of their social, emotional, physiological, psychological, developmental and spiritual needs (Morton et al. 2017).

According to this holistic care approach, several factors need to be taken care of in case of Grace Williams. These factors are – comfort, hygiene, relieving her stress, her food and nutrition and everything she faces difficult to perform (British Medical Association 2013). As she is unable to walk from her bed to the washroom or other rooms, interventions should be taken to comfort her back and joints. Nurses should communicate with the patient before moving her from one place to another just to gain her co-operation. She should be provided with a moving and adjustable bed to maintain a good posture while sitting (Dossey et al. 2012). Hygiene is another important concern for grace as she is unwilling to take shower. For nurses it is challenging to make her shower on her shower chair. Intervention for this situation should include maintenance of hygiene around the patient so that no infection can affect her due to unhygienic surrounding. Nurses should wash her body and dry them thoroughly. She should be assisted for brushing her teeth always before and after she has eaten (Morton et al. 2017).

Importance of person centred care- As stated above, the term ‘person-centred care’ refers to different activities and principles, that are used by health and social service related organisations to deliver and monitor care that meets the needs of patients. It not only encompasses providing services that cater to the needs of patients, but also considers the values, desires, social circumstances and family situations of the concerned individual and works to formulate appropriate solutions (Rattray and McKenna 2012). The concept of person-centred care is still emerging and evolving. The importance of a certain healthcare facility to one person may be undesirable to another. This form of care involves being respectful and compassionate towards the individual, sharing healthcare decisions, providing emotional support, involving family members and taking into account the preferences and needs of an individual.

A key component of developing good quality healthcare is considered of utmost priority since the past decade. Person centred care is important because it works towards bringing an improvement in the service quality, helps people to get the care their health demands, makes people self-active in looking after themselves and reduces the pressure on health and social service. Results from research studies suggest that person-centred care significantly improves the health conditions of people and reduces the burden on the existing health services. Evidence suggests that if people are supported to look after themselves, their motivation gets improved and positive effects are observed on their eating habits and exercise activities (Gabriel and Normand 2012). The clinical outcomes and symptoms change on person-centred care intervention. This leads to a shift from the paternalistic model of patient-physician relationship where the doctor takes the role of a parent to determine what interventions will best promote patient health.

There are some practical reasons that emphasise on the importance of adopting person-centred care. Growing evidences suggest that self-management support and shared decision making improves care quality, patient experience and health outcomes. When patients are supported with long-term conditions that help them in self-healthcare management, clinical outcomes get enhanced significantly. Self-management approaches have been found to increase clinical outcomes in patients suffering from diabetes, asthma, heart disease, hypertension, stroke, cardiac failure, cancer and other diseases. The likelihood of using emergency hospital services becomes less when a collaborative effort is taken to manage healthcare. A person-centred care plan increases the chances of showing compliance to proper medications and treatment interventions (Li and Porock 2014). Moreover, patients who get the support and opportunity to take part in decision making related to their care, in partnership with the concerned health professionals show more satisfaction. They display an increased tendency to select treatments based on their preferences rather than their physicians. This leads to adoption of less invasive treatments.

A literature review of 7 studies that aimed to investigate the job satisfaction of healthcare personnel who deliver person-centred care showed positive effects on job demands at psychogeriatric wards, general job satisfaction, less emotional exhaustion and burnouts and increased a feeling of personal accomplishment among healthcare professionals (Pol‐Grevelink, Jukema and Smits 2012). A range of studies have been conducted that illustrate the effect of eprson0-centred approaches on reducing service usages.

A Cochrane review that included 36 trials based in self-management showed that agenda setting and self-monitoring of health status largely reduced episodes of hospitalisations, unscheduled doctor visits, accident and emergency department visits and day offs from schools or work (Graverholt, Forsetlund and Jamtvedt 2014). Another importance of this approach is that it ensures that the health services are based on the convenience and preference of the individual, which in turn provides a value for money. All healthcare practitioners need to accept a plethora of initiative and approaches (Barry and Edgman-Levitan 2012). According to the Francis Report, quality of care shows disastrous results if the nurses and the organisations fail to place the interests and needs of their patients in their work core.

Conclusion

Thus, it can be concluded from the discussion that in order to provide person-centred care to the patient Grace Williams, the nurses should work in teams and be committed to incorporate the principles of valuing the patient, treating her as an individual, looking at objects from her perspective, developing therapeutic relationship on mutual trust and administering interventions based on her needs. The nurses and physicians will have to manage issues such as care routines and organisational policies that arise in the aged care centre. By educating the staff on the philosophy of person-centred care, developing good communication among them and providing them with collaborative work relationship and transformational leadership, the accountability of Grace for person-centred care will improve.

References

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.

British Medical Association, 2013. Health and environmental impact assessment: an integrated approach. Routledge.

Brownie, S. and Nancarrow, S., 2013. Effects of person-centered care on residents and staff in aged-care facilities: a systematic review. Clinical interventions in Aging, 8, p.1.

Dossey, B.M., Certificate, C.D.I.N.C., Keegan, L. and Co-Director International Nurse Coach Association, 2012. Holistic nursing. Jones & Bartlett Publishers.

Gabriel, S.E. and Normand, S.L.T., 2012. Getting the methods right—the foundation of patient-centered outcomes research. New England Journal of Medicine, 367(9), pp.787-790.

Graverholt, B., Forsetlund, L. and Jamtvedt, G., 2014. Reducing hospital admissions from nursing homes: a systematic review. BMC health services research, 14(1), p.36.

Li, J. and Porock, D., 2014. Resident outcomes of person-centered care in long-term care: A narrative review of interventional research. International journal of nursing studies, 51(10), pp.1395-1415.

Morton, P.G., Fontaine, D., Hudak, C.M. and Gallo, B.M., 2017. Critical care nursing: a holistic approach. Lippincott Williams & Wilkins.

Olsson, L.E., Jakobsson Ung, E., Swedberg, K. and Ekman, I., 2013. Efficacy of person‐centred care as an intervention in controlled trials–a systematic review. Journal of clinical nursing, 22(3-4), pp.456-465.

Pol‐Grevelink, A., Jukema, J.S. and Smits, C.H.M., 2012. Person‐centred care and job satisfaction of caregivers in nursing homes: a systematic review of the impact of different forms of person‐centred care on various dimensions of job satisfaction. International journal of geriatric psychiatry, 27(3), pp.219-229.

Rattray, J. and McKenna, E., 2012. Person‐centred care in intensive care: a myth or reality?. Nursing in critical care, 17(5), pp.225-226.

Weber, J.R. and Kelley, J.H., 2013. Health assessment in nursing. Lippincott Williams & Wilkins.

Wright, L.M. and Leahey, M., 2012. Nurses and families: A guide to family assessment and intervention. FA Davis.

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