Person-Centered Care: Applying Framework to Patient Case Study

Introduction: Implementing NMC Guidelines in Geriatric Care

• Development of Person-centred nursing framework followed a series of systematic steps
• Different conceptual frameworks were compared and contrasted to develop the framework
• This is effective for nurses to provide holistic care
• The four major domains are prerequisites, care environment, person-centred processes and expected outcomes (McCormack and McCance, 2017)
• Applying these domains on the care plan for Frances Flores who experiences a fall and cut her forehead

Person-centred nursing care is an holistic approach that is followed by the nurses in order to provide a detailed framework which can be followed to provide a good care to the patients. In this case, the patient is Frances Flores, a years old lady, an ex-school teacher, who was brought to the emergency department as she fell and cut her forehead. Hence, the development of the care plan following the mentioned domains have been discussed further.

Prerequisites

• Focused on nursing attributes and professional competences
• Commitment to the job and development of interpersonal skills (McCance et al. 2021)
• Checks ability of the nurses to demonstrate their values and believes

In order to apply this domain in the nursing care practice it is important for the nurses to make sure that they have all the required knowledge and skills to provide the care. The initial assessment of Frances in this case was that she had a cut in her forehead and she is being reported to have memory loss. She was unable to remember her daughter's address or phone number. Apart from that, her loosely fitted clothes indicated that she was going through some weight loss. As per the nursing process model, Assessment is the first and most valuable step. Hence, to fulfil this domain, nurses must be attentive to the information that the patient or peers give and also they must have good communication skills to understand the event.

Prerequisites (Cont…)

• Compassion and empathy are two most important factors in this case
• Nurses must be aware of their limitations
• Using own professional experience to the patient care (Jobe, Lindberg and Engström, 2020)
• Developing strong relationship with the patient

In case of providing the best care to the patient, it is important for the nurses to develop a good relationship with them where patients trust them to follow their instruction. In the case of Frances, it can be seen that she is refusing to take any stick or support for walking while she is struggling a lot recently and also cut her head by falling. She uses furniture to walk around the house. In this case, the nurse can develop a good relationship with the patient by effective communication and thus she can be convinced to follow the self-care measures.

Care Environment

• Delivering the care to the patient is the key focus of this domain
• This should be included with the physical, cultural and social aspects of the patient
• Nursing capability to respect the socio-cultural aspects of the patient while providing the care (Fix et al. 2018)

As per the discussion of McCormack and McCane (2017), it is important for healthcare practitioners to develop an effective environment for the patient to make them comfortable and relaxed. In this regard, the physical environment of the care setup should be well-maintained, clean and hygienic. This is important for avoiding any kind of infection and quick healing of the patient. Apart from that, nurses must be empathetic enough to show respect to the cultural beliefs of the patients. Developing a respectful and supportive social environment can help to decrease the anxiety levels of the patient and motivate them for self-care.

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Care Environment (Cont…)

• Skills mentioned in the prerequisites domain are important for this domain as well
• Emotional resilience, professional development and self-awareness are the key to achieve this goal (Oppert, O'Keeffe and Duong, 2018)
• Also, nurses must follow the nursing code of practice in this regard

In order to show empathy to the patients, it is important for the nurses to maintain emotional resilience. In this regard, it is important for the nurses to develop their behavioural skills. In this case, in order to provide self care to Frances, it is important for the nurses to show them empathy. Apart from that, as the patient is refusing to follow the self-care practices, it is important for nurses to develop a safe and secure environment for the patient to make her rely on the treatment process. The care environment must be conducive and comfortable.

Person-centred Process

• This is included with a range of activities, diagnosis process, care planning, implementation process and patient evaluation
• These factors are mentioned by Nursing and Midwifery Council (NMC) (Nursing and Midwifery Council, 2018)
• As per this guidelines all the patients are unique and they must be provided with specialised care

As per the guidelines of NMC, nurses must follow a proper protocol while developing a care plan for the patients. This should be specific to the physical, mental and social attributes of the patient. They must be provided with a supportive care system where they can reveal themselves freely. Unique needs of the patients should be considered here while developing the care plan. Hence, assessment of the needs of the patient is the first step for the nurses to take. This assessment should be done with proper communication with the patient and thus providing them a safe and secure environment

Person-centred Process (Cont…)

• Nurses must communicate with Frances to understand her issues
• Her memory loss should be diagnosed properly
• Her children must be informed about her condition (Delaney, 2018)
• She should be provided with mental support and encouragement

In case of Frances flores, apart from fall, there are some major health concerns regarding her weight loss and memory loss. She has been reported to forget things from her daily life and also she was unable to remember her daughter's address and contact details. In this case, she was refusing to take any support for self-care while she has a nature of stumbling and fall. Hence, as per the guidelines of NMC, nurses must analyse the condition of the patient by communicating with her and her neighbours. Thus the living environment of the patient can be analysed. Apart from that, Frances's dignity should be maintained through the diagnosis process. As she is forgetting things and not in condition to make her own health decisions, nurses must contact her children to discuss the treatment plan specialised for Frances. She should be provided with treatment plans which should be aided to her daily schedule and she should be convinced for self-care practices as she lives alone. This is important to avoid legal compliances as well.

Expected Outcomes

• This demonstrate the ultimate goal of the care plan (Cloninger, 2020)
• This is included with health improvement of the patients, satisfaction of the patient and family and the healthcare cost
• This outcomes must consider the ethical and legal aspects of the care plan as well

While developing a person centred care, the expected outcomes should be clear to the caregivers as the planning and implementation should be targeted to those outcomes. In general, care plans should be developed in order to provide satisfaction to the patient and their family. Also, it should be ensured that the plan is effective to provide better health and well-being to the patient. Any kind of legal or ethical issues should be avoided as the outcomes may be affected if there is any glitch or breach of nursing guidelines.

Expected Outcomes (Cont…)

• As Frances is not fully stable to take or approve decision, in this case her children will be contacted for informed decision making (Cardiff, McCormack and McCance, 2018)
• Expected outcomes will be conveyed to them and transparency will be maintained
• As Frances is forgetting things, nurses will ensure that her medical data has been kept confidential

One of the key aspects of person-centred care is to develop an informed care plan for the patient. In this case, the decision is taken after discussing with the patient and their family. Hence, the expected outcomes should be predefined and must take feedback from the patient party. Another target of expected outcomes is to control the healthcare cost. As in this case, Frances is not in condition for a sound decision making process, her children must be contacted for this purpose. Also, it should be ensured that the data of the patient is kept confidential after the treatment is over.

Conclusion

• Nursing skills and knowledge are the key
• Must follow the NMC guidelines
• Informed decision making should be considered
• Data breach and confidentiality should be ensured
• Nurses must be empathetic and respectful towards the patient and her values

After this discussion of the four domains of Persconcentreed nursing mode, it can be stated that nurses must be skilled enough to show empathy and respect towards the patient while developing good professional bonding where patients can rely on nurses' decisions. The informed care process must follow NMC guidelines and make sure that patient data is kept secure. Previous work experience and knowledge can help the nurses to develop this specialised care for Frances Flores considering her living conditions.

References

• Cardiff, S., McCormack, B. and McCance, T. (2018). Person-centred leadership: a Relational Approach to Leadership Derived through Action Research. Journal of Clinical Nursing, [online] 27(15-16), pp.3056–3069. doi:https://doi.org/10.1111/jocn.14492.
• Cloninger, C.R. (2020). Person-centred integrative care. Journal of Evaluation in Clinical Practice, 17(2), pp.371–372.
• Delaney, L.J. (2018). Patient-Centred Care as an Approach to Improving Health Care in Australia. Collegian, [online] 25(1), pp.119–123. doi:https://doi.org/10.1016/j.colegn.2017.02.005.
• Fix, G.M., VanDeusen Lukas, C., Bolton, R.E., Hill, J.N., Mueller, N., LaVela, S.L. and Bokhour, B.G. (2018). Patient-centred care is a way of doing things: How healthcare employees conceptualize patient-centred care. Health expectations : an international journal of public participation in health care and health policy, [online] 21(1), pp.300–307. doi:https://doi.org/10.1111/hex.12615.
• Jobe, I., Lindberg, B. and Engström, Å. (2020). Health and social care professionals' experiences of collaborative planning-Applying the person?centred practice framework. Nursing Open, 7(6). doi:https://doi.org/10.1002/nop2.597.
• McCance, T., McCormack, B., Slater, P. and McConnell, D. (2021). Examining the Theoretical Relationship between Constructs in the Person-Centred Practice Framework: A Structural Equation Model. International Journal of Environmental Research and Public Health, 18(24), p.13138. doi:https://doi.org/10.3390/ijerph182413138.
• McCormack, B. and McCance, T. (2017). Person-centred Practice in Nursing and Health Care : Theory and Practice. 2nd ed. Chichester, West Sussex: Wiley Blackwell.
• Nursing and Midwifery Council (2018). The Code: Professional Standards of Practice and Behaviour for nurses, Midwives and Nursing Associates. [online] NMC. Available at: https://www.nmc.org.uk/standards/code/.
• Oppert, M.L., O'Keeffe, V.J. and Duong, D. (2018). Knowledge, facilitators and barriers to the practice of person-centred care in aged care workers: a qualitative study. Geriatric Nursing, 39(6), pp.683–688. doi:https://doi.org/10.1016/j.gerinurse.2018.05.004.