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Rules of Patient-Centered Care
Care is based on continuous health relationships.
Care is customized according to patient needs and values.
The patient is the source of control.
Knowledge is shared and information flows freely
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Direct Patient Care – The Practitioner Level
◦The ability of the health care team members to provide patient-centered care to each patient.
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The Organizational Level
◦The ability of an organization to operate as a patient-centered health care organization
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Health System Level
◦The ability of the health system at the local, state, and national levels to allow for patient-centered health care
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Who Are Our Consumers?
Macro Consumers
◦The government and health insurance companies
◦Major purchasers of health care
Micro Consumers
◦Patients and their families/friends/significant others
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Acute Illness
◦Severe symptoms
◦Relatively short-lived in duration
◦Can be fatal without intervention or non life-threatening – not require any treatment at all
◦Usually return to return to previous level of health
◦Complications may result in chronic conditions
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Chronic Illness
◦Often develop gradually
◦Require ongoing treatment
◦Continue for the duration of the patient’s life
◦Major shift in health care to focus on chronic illness
- ◦In U.S., increase of chronic illness related to sedentary lifestyles, obesity, and
- aging population
◦Conditions vary in severity and outcomes
◦Generally not an end point of regained health
◦May occur as periods of exacerbation and remission
◦In U.S., more people die from chronic illness than acute illness
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Emotional Response to Illness
- Many times health care providers focus too much on only the physical aspects of
- illness
- Emotional responses by the patient and family may be a greater challenge to manage than
- the illness
Severe emotional responses may impair treatment
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Stages of Illness
Disbelief and Denial
Irritability and Anger
Attempting to Gain Control
Depression and Despair
Acceptance and Participation
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The Sick Role
Culture often influences how a person responds to illness
Response to illness is learned as a child through observing parents
- The nurse must be able to provide culturally competent care to patients from many
- different cultural backgrounds
The nurse must remain non judgmental about the patient’s choices
- The patient’s perception of illness often influences the patient’s decisions to
- follow a prescribed treatment regimen.
◦Can be frustrating for the health care providers and the patient’s family
◦“Noncompliant” is not an acceptable term for patients
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Effect of Illness on the Health Care Provider
Caring for the chronically ill is a challenge
The focus of health care has long been to cure every ailment
The inability to cure the chronically ill is difficult for the health care provider
The nurse must recognize his/her own feelings in order to maintain a good nurse-patient relationship
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Illness Behaviors
Internal Influences
External Influences
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Internal Influences
Dependence vs. Independence
Coping ability
Hardiness
Resilience
Spirituality
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External Influences
Past experiences
Culture
Communication patterns
Personal space norms
Role Expectations
Values
Reaction to prescribed medications
◦Ethnopharmacology
Ethnocentrism
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Impact of Illness on Patients and Families
Behavioral and Emotional Changes
Changes in Family Roles
Disturbed Family Dynamics
Results in increased patient and family stress
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Family Response to Illness
Affected by:
◦Illness severity
◦Personality before illness
◦Suddenness
◦Extent and duration of lifestyle changes
◦Individual and family resources
◦Life-cycle stage of patient and family
◦Previous illness experiences
◦Social support
◦Religion
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Impact of Illness on Patients
Guilt
Anger
◦Safety concerns
Anxiety
◦Levels
Mild, Moderate, Severe, Panic
Stress
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Anxiety
Response to an actual or perceived threat
Signs and Symptoms
◦Increased heart rate, respiratory rate, blood pressure
◦Insomnia
◦Nausea and Vomiting
◦Fatigue
◦Sweat palms
◦Tremors
◦Restlessness
◦Irritability
◦Hopelessness
◦Inattention to surroundings
◦Forgetfulness
Nurse must be aware of his/her own feelings – anxiety is contagious!
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Stress
Results from factors that cause stress (stressors)
◦External (e.g. noise, heat, cold)
◦Internal (e.g. personal unrealistic expectations)
◦Interpersonal (conflicts with others)
The result of interactions between the individual and the environment
Illness is just one of many stressors that patients experience
Can result in physiologic responses
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Stress and Illness
A factor that may result in the development of illness
Stress may result in prolonged illness/delayed healing
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Coping With Stress
Recognize stressors
Eliminate as many stressors as possible
Relaxation techniques
◦Deep breathing
◦Muscle relaxation (massage)
◦Guided imagery
Patient Education
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Helping Families Cope
Assess the dynamics of the family
Recognize anxiety within families and attempt to reduce it
Keep the patient and family well informed
Some families may benefit from support groups
Assist the family in finding ways to manage guilt, anger, and resentment
- The nurse should recognize that families may express anger and distrust toward the
- health care team for being unable to cure the illness or eliminate negative
- outcomes
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Caregiver Stress
Common in families of patients with prolonged illnesses
Becomes difficult for family members to care for their ill family member
- Symptoms include: denial, anger, social withdrawal, anxiety, depression, irritability,
- lack of concentration, health problems
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Some positive experiences may result from a family caring for an ill member
◦Increased family closeness
◦Teamwork
◦Newly recognized individual and family strengths
◦New meanings and personal values
◦Increased flexibility in lifestyle
◦Changes in life priorities
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first IOM Core Competency
The priority of health care (nursing) is the patient (which includes the patient’s family, friends, significant other)
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