Person-Centered Care and Inter-Professional Practice - Case Study Example

Person-Centered Care and Interprofessional Practice Introduction: I am a first year nursing with comparatively young placement in a clinical ward. My basic idea about nursing practice is that it is too vast to understand in a small span of time, but that does not preclude observation and assimilation of facts and incidents in the ward where I have been placed. It is a happening place, and I feel I am too small to grasp everything, small in knowledge, and small in experience. I am going to state an event and analyse it from the perspective of a future practitioner to explore how care can be person-centered yet interprofessional and collaborative to result into an efficient care system that ultimately yields great results for the patient cared for. Incident: For purposes of confidentiality, the actual name or other identity-oriented details would not be explored, and a pseudonym for the patient has been used here. The patient is Tom, a 72-year-old male admitted to Medical-Surgical ward where I am currently placed. My preceptor assigned this patient to me. Tom is a patient with chronic obstructive pulmonary disease with diabetes mellitus who had been transferred here from Accident and Emergency Ward. He has residual paralysis as a result of stroke. As a result, Tom is disabled with a right-sided paralysis; he cannot move on or out of the bed; he needs assistance for repositioning. Over the top of it, he has incontinence due to paralysis of the bladder musculature, and for that reason, he has been catheterized. Although, he is a diabetic for a pretty long time, these acute events have resulted in repeated blood glucose testing and insulin administration. He seemed to have disliked insulin injections in the past and even now. His speech is not clear; he has problems communicating his needs. He has pain complaints, and he needs repositioning on the bed every two hours. His chronic obstructive pulmonary disease has perhaps resulted from his history of excessive smoking over the past years, and this, according to the physicians, is another complicating factor in his management. From the nursing perspective, Tom needed continuous care and monitoring. His psyche is disturbed, maybe due to economic burden on his family or may even be due to post-stroke depression. His inability to support himself, bladder catheter, insulin injections, many drugs, and a lack of social life in the hospital environment would have played roles in the composite and complicated picture that Tom presented. He looked depressed, irritated; he would have emotional lability, sometimes to the extent of extreme irritation when he would seek help, when he would have a severe bout of coughing with respiratory distress, when someone would approach him with blood sugar tests or insulin injection. He would object strongly to the catheter, would ask to remove it, would pull it, and would express doubts in capability and efficiency of the care professionals when told, perhaps, he will have to tolerate the catheter throughout his life. The Nurse's Role As a first year nurse, my role is limited in his care, except for making his beds; repositioning him on the bed; assisting him in sitting up, bathing, toileting, and feeding; and talking to him. As a result, I had enough time to observe the care of Tom and think about it. He was cared for by a multidisciplinary team of physicians and healthcare professionals: a neurophysician, a pulmonologist, an endocrinologist, a urologist, a physiotherapist, a respiratory therapist, and the team of senior nurses were involved in his care (Deber, R.B., 1996). As the youngest member of the team, it was a thrilling experience for me to be included in the team, but to be honest, I had hardly anything to say. I kept my thoughts to myself and took this opportunity to analyse Tom's care to explore whether a person-centric care in an interprofessional collaborative environment happened or not. I was present in the rounds, in the nursing care planning, and in the interdisciplinary meetings. This essay explores my experiences in my clinical placement while I was involved in Tom's care. Person-Centered Care: Person-centered care is a modern philosophy of care that is practiced and taught throughout the UK. Person-centered care is considered to be the best practice, but in reality, it is very difficult to implement. The difficulties arise due to many factors. The first of them is resistance to change from traditional ways of providing care. The resistance to change happens mainly due unacceptability of the reality that previous approaches to conventional care thought to be the most appropriate way of caring no longer holds good. Apart from this, nurses' personal beliefs, attitudes, and ways of working play roles in care. Despite these resistances and obstacles at implementation, person-centered care is rapidly coming up to be the method of choice of nursing care, both in the health and social cares (Allshouse, K.D., 1993). The basic concept of person-centered care springs from the philosophy that the suffering human being should be respected as human beings who have special needs. Standard modes of medical care that treats the disease may not necessarily treat the person, a person with a full and valued life. The conventional healthcare often fails to recognise the personhood of the patient. While considering the person out of the myriad of symptoms and signs of disease, it needs special philosophical understanding that it is not just the disease condition, the person suffering from it has a feeling, senses, choices, and a say about his disease and the way the care is delivered. This philosophy is now a well- established one in all areas of nursing care. National Health Services now recommend that care should be planned and designed according to the needs of the patients. While translated into nursing care in the social or healthcare setting like hospitals, the purpose and goal of nursing care is to provide holistic health and care to the patient as a person, families, carers, and communities (Brown, J., Weston, W., & Stewart, M., 1995). While considering a patient and his humanhood, it is important to consider the personhood of the individuals. Individuals have their capacity of though resulting in decision making, even if it is simple or rudimentary. They have free will, ability to make rational analysis, and capability of taking appropriate actions. In healthcare situations, when a patient like Tom is dependent on other's instructions, help, and care in a interdisciplinary team-care approach, it is the freedom to take actions that is most affected. In a healthcare situation, the patient is not privy to liberty or total independence, but a professional management of the issues arising out of it may ensure maintenance of his personhood; he must be made to believe that he is a valued individual, appropriately cared for (Campbell, T., 1998). Tom, for instance, has lost his freedom of movement; he is certainly not able to make free decisions; he must have lost is ability to think rationally; and he would not be able to take a free action. Despite his paralysis, his resistance to much required insulin injection, the necessity of bladder catheter, there should be no barrier to respect the person within Tom. Once this is respected, the individualized care directed towards Tom's individual needs would certainly produce the desired therapeutic effects out of a care plan. While thinking about Tom's care, I found that Tom is often referred to as "the old man in room 6 with stroke and diabetes". This is not unnatural in a task-oriented environment in a busy hospital ward; there are many needs to be attended to. As a result, the wishes of Tom may be precariously neglected, and very often, the individual is known by the condition that he is suffering from (Fearing, V.G. and Clark, J., 2000). This is a drift from ideal person-centered care where staff decides what would be best for Tom. Taking the example of Tom's bathing routine, the staff decides the time for Tom's bathing. These decisions were evidently made to fit a timetable directed by the workload of the staff, not by the desire of Tom to bathe at a certain time. For smooth running of the establishment some kind of routine is essential, but that has no necessity to preclude Tom's wishes and choices. It is not desirable for us to accept for granted that Tom's wishes are irrational, and he does not have his share of participation in his care. When delivering a person- centered care, the first happening thing would be for the staff to keep off the traditional way of thinking that staff knew best what is right or what is wrong (Biley, F., 1989). A theoretical analysis of this simple basic level of care administration reveals some basic components of person-centered nursing care. The services should fit peoples' needs, not fitting the person around the provided service. The care plan should ensure that they receive an appropriate care package, which meets their individual needs and enables them to make their choices about their care. The client, therefore, would participate actively in decision making and goal setting, and the outcomes would need to be evaluated from the perspective of the client. This would demand effective communication with the client and involvement of the family in care. The caring staff must provide emotional support to the patient, and emotional support can be just a mechanical drill of theoretical education if the "person" within the patient is not explored and communicated to (Brown, S.J., 1999). To achieve this in a care setting where a multidisciplinary team and interprofessional relationship are involved, there must be allowance of flexibility, coordination, and continuity of care. Above all, the management must be directed towards achieving the physical comfort of the patient; the caregivers must have a sharp eye towards the fact that treatment may become more painful than the disease itself (Burchell, H. and Jenner, E.A., 1996). From my personal perspective, this is very easy to say about person-centered care, but it is very difficult to implement and evaluate such care in reality. The care planning can be done with the patient's active involvement, but it is difficult and time consuming to assess the care from the client's perspective. It is seemingly more difficult to ensure a response out of client-feedback, since the system is too busy and loaded to be able to register a response. The question of accessibility to care is a big one, and in the hospital clinical care setting, the workload is such that often the client needs to wait for a prolonged period of time to access any service (Carroll, L., Sullivan, F.M., and Colledge, M., 1998). Coordination and continuity can be ascertained by interdisciplinary approach in case of Tom since multiple professionals are involved in his care, and the system and organization is supposed to provide support to such an innovative care plan (Carroll, T.L., 1999). At Tom's level, Tom can be actively involved in managing his own care in partnership with the service providers, and at the nurses' level, the care plan would strive to incorporate Tom's perspectives into the provisions of care. As a result, the informed participation of the patient is the central theme of this concept. The ideal collaborative carer would, thus, demonstrate respect for the client as an individual, involve the client in decision making, advocate with and for the person in meeting their needs, and would pay value and recognition to client's experience and knowledge. This was very much feasible in the interprofessional approach of care to Tom as far as my experience goes. When it talks about an interprofessional care, the person-centered care should revolve around the patient, rather than the departments or the professionals concerned (Chewning, B. and Sleath, B., 1996). Applied to nursing care, the nursing should look into the physical, social, emotional, and spiritual needs of the patient and should include close and mutual collaboration of the patient and the professionals involved in care process. Lack of interdisciplinary care strategies in the organizational level would create a barrier to realization of the philosophy of client-centered care at the organizational level. The goal is to create a caring, dignified, and empowering environment in which the patient will direct his care (Deber, R.B., Kraetschmer, N., and Irvine, J., 1996). Taking this concept on Tom's case, active involvement in care planning with due honour and recognition of his self would call up on his own resources to speed the healing process. A paralysed patient like Tom who has many associated morbidities would naturally feel depressed in the condition of illness that he is suffering from. His limitations would be considered by himself as his drawbacks. The best way to improve his performance in such an environment is to arouse his "person" that will influence his mind and body. The nurse can ensure autonomy of the patient and offer the patient a choice. A nurse can win the patient's cooperation by an empathetic communication skill and by affording information to the patient about his illness. The patient can be encouraged by the nurse to make a choice about his care. It should be demonstrated by all the professionals to the patient that all involved in care is very much expectant about a collaborative care with the patient on the other end of the stick. It is to be proved that everyone in the care team is looking forward to hear from the patient as he himself has now to assume responsibility of his care (Ellers, B., 1993). As far as Tom's disability is concerned, his participation in physiotherapy and respiratory therapy can be ascertained by his participation in establishing a goal for himself. Given many options and adequate information, he can decide or select his treatment modality and be a part of the outcome. He can participate in the preventative part of his medical regime, thus ensuring success in maintenance and continuance of therapeutic measures to lead to a sustained and gradually progressive outcome. In planning such therapeutic modality keeping person in the core, the nurse is in the best position to consider the client's role, interests, culture, and environment. The nurse while offering such management would consider the patient's needs, values, culture, and would be flexible enough not to impose her own on the patient's choices. The thing to remember is that if the nurse desires a complete person-centered care, the nurse needs to provide services in an effective and timely manner (Eubanks, P., 1990). There are many barriers for an effective realization of such care. As is the case often, a joint exploration of the disease and experience is a time-consuming affair, and it happens very rarely. The load of work precludes the dictum of seeing the patient as an individual. Seeing the patient as a case for the day most of the time leads to temporary unawareness about the patient's history and current situation of helplessness. As a result, the shift of power from the healthcare professionals to the patient happens with great difficulty. Negotiation of goals through involvement of the patient in discussions and by providing options almost never happens (Gage, M., 1994). The idealistic outcomes of person- centered care as a result leads to ineffective and insufficient problem explanation, priority statement, and demarcation of roles of the professional and the patient, resulting in substandard health promotion and disease prevention. Blaming the system would not be sufficient if the nurses do not practice exploring the context of the disease and its effects on the patient's life, if the nurses do not become great communicators and if they do not know the art of emotional healing. Interprofessional Work in Person-Centred Practice: If the key philosophy of person-centered care is paying respect to personhood of a client and establishing a relationship of care and the individual, then it is important to recognize that best relationships are reciprocal. To create, appreciate, and sustain such a relationship, all involved should understand the accurate balance between the independence, dependence, and interdependence. Interdependence is, therefore, a pivotal concept in making person-centered care a success. This stresses on not only a negotiating relationship between the patient and the nurse, it also stresses on another very important concept- a healthy relationship between the patient and other team members of an interprofessional team (Gerteis, M. and Roberts, M.J., 1993). The practitioners should account for multiple voices in a caregiving team. It is not just relationship between the patient and the family members and the healthcare professionals; it also entails due and careful consideration of the way the nurse and others relate to the other professions involved in the patient's care. Most of the problems in a multidisciplinary care plan arise from differences of opinion between professional colleagues who feel "nobody asked me" or "no one listened to me or acknowledged me". Nursing here needs to pay more attention to other disciplines and their says, coming out of a self-absorbed attitude. To have an effective person-centered care, like a nurse-patient relationship, interaction between different disciplines is likely to thrive when a partnership based on mutual respect is created in order to result into a reciprocal, complimentary, and symmetrical interrelationship in a milieu that provokes meaningful involvement of all (Johnston, C.L., and Cooper, P.K., 1997). Failure to do this will lead to disharmony and confusion in that instead of resulting in a unified environment of total and holistic care, it tends to develop multiple environments with varied goals. In Tom's care, the neurophysician, pulmonologist, endocrinologist, and the urologist had all their parts. Along with that, the physiotherapist and the respiratory therapist had their parts to play. All these interacting professionals had their nursing instructions. To become a successfully patient centric one, the nursing care should be one unified. A unified nursing care is possible only when the nurse comes out of the nursing barrier and starts to envisage things from Tom's point of view. This viewpoint has another advantage. In the multidisciplinary meetings, any conflicting concept of management can be analysed and nurses' input incorporated to generate a final common pathway of care (Jones, R.A., 1997). Thus, effective teamwork can result in improved quality of person-centered care in the most effective way. A successful interprofessional team will have a clear purpose and great communication and coordination among the members. If the all the members are aware of their roles and protocols in care, if all the members actively participate as the patient, if the team recognises each member's professional and personal contribution, recognise the benefits of interdependence and working together, and if the accountability becomes a collective responsibility with patient at the centre and his needs the driver of the team force, this is the most beneficial system of care in the present setting. The task of the team will be determined by the needs of the patient as an individual with the patient and his family considered as very important team members. Professional knowledge and its execution in care become important with the complexity of the patient's condition, and the more complex it is, the more it demands increasing participation of varied groups. In this context, the interrelationship becomes the most demanding issue. Reference List Allshouse, K.D., (1993). Treating Patients As Individuals. In. Gerteis, M., Edgman-Levitan, S., Daley, L., & Delbanco, T. (Eds.), Through the Patient's Eyes. (pp. 19-44). San Francisco: Jossey-Bass Publishers. Biley, F., (1989). Treatment And Care: Patient Participation In Decision Making. Senior Nurse, 9(10), pp. 23-24. Brown, S.J., (1999). Patient-Centered Communication. Annual Review of Nursing Residents, 17: pp. 85-104. Brown, J., Weston, W., & Stewart, M., (1995). The First Component: Exploring Both the Disease and the Illness Experience. In M. Stewart, J. Brown, W. Weston, I. McWhinney, C. McWilliam, & T. Freeman (Eds.), Patient-Centered Medicine: Transforming The Clinical Method. (pp. 31-42). London: Sage Publication. Burchell, H. and Jenner, E.A., (1996). The Role Of The Nurse In Patient-Focused Care: Models Of Competence And Implications For Education And Training. International Journal of Nursing Studies, 33(1), pp. 67-75. Campbell, T., (1998). Patient-Focused Care: Primary Responsibilities Of Research Nurses. British Journal of Nursing, 7(22), pp. 1405-1409. Carroll, T.L., (1999). Multidisciplinary Collaboration: A Method for Measurement. Nursing Administration Quarterly, 23(4), pp. 86-90. Carroll, L., Sullivan, F.M., and Colledge, M., (1998). Good Health Care: Patient And Professional Perspectives. British Journal of General Practice, 48(433), pp.1507-1508. Chewning, B. and Sleath, B., (1996). Medication Decision-Making And Management: A Client-Centered Model. Social Science and Medicine, 42(3), pp. 389-398. Deber, R.B., (1996). Shared Decision Making In The Real World. Journal of General and Internal Medicine, 11(6), pp. 377-378. Deber, R.B., Kraetschmer, N., and Irvine, J., (1996). What Role Do Patients Wish To Play In Treatment Decision Making Archives of Internal Medicine, 156(13), pp.1414-1420. Ellers, B., (1993). Innovations In Patient-Centered Education. In Gerteis, M., Edgman-Levitan, S., Daley, L., & T. Delbanco (Eds.), Through the Patient's Eyes. (pp. 96-117). San Francisco: Jossey-Bass Publishers. Eubanks, P., (1990). Nursing Restructuring Renews Focus On Patient-Centered Care. Hospitals, 64(8), pp. 60-62. Fearing, V.G. and Clark, J., (2000). Individuals in Context. A Practical Guide To Client-Centered Practice. (1st ed.). Thorofare, NJ: Slack Incorporated. Gage, M., (1994). The Patient-Driven Interdisciplinary Care Plan. Journal of Nursing Administration, 24(4), pp. 26-35. Gerteis, M. and Roberts, M.J., (1993). Culture, leadership, and service in the patient-centred hospital . In Gerteis, M., Edgman-Levitan, S., Daley, L., & T. Delbanco (Eds.), Through the Patient's Eyes. (pp. 227-259). San Francisco: Jossey-Bass Publishers. Johnston, C.L., and Cooper, P.K., (1997). Patient-Focused Care: What Is It Holistic Nursing Practice, 11(3), pp. 1-7. Jones, R.A., (1997). Multidisciplinary Collaboration: Conceptual Development As A Foundation For Patient-Focused Care. Holistic Nursing Practice, 11(3), pp. 8-16. Read More