1. 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
  2. Direct Patient Care – The Practitioner Level
    ◦The ability of the health care team members to provide patient-centered care to each patient.
  3. The Organizational Level
    ◦The ability of an organization to operate as a patient-centered health care organization
  4. Health System Level
    ◦The ability of the health system at the local, state, and national levels to allow for patient-centered health care
  5. 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
  6. 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
  7. 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
  8. 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
  9. Stages of Illness
    Disbelief and Denial

    Irritability and Anger

    Attempting to Gain Control

    Depression and Despair

    Acceptance and Participation
  10. 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
  11. 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
  12. Illness Behaviors
    Internal Influences

    External Influences
  13. Internal Influences
    Dependence vs. Independence

    Coping ability



  14. External Influences
    Past experiences


    Communication patterns

    Personal space norms

    Role Expectations


    Reaction to prescribed medications


  15. 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
  16. Family Response to Illness
    Affected by:

    ◦Illness severity

    ◦Personality before illness


    ◦Extent and duration of lifestyle changes

    ◦Individual and family resources

    ◦Life-cycle stage of patient and family

    ◦Previous illness experiences

    ◦Social support

  17. Impact of Illness on Patients


    ◦Safety concerns



    –Mild, Moderate, Severe, Panic

  18. Anxiety
    Response to an actual or perceived threat

    Signs and Symptoms

    ◦Increased heart rate, respiratory rate, blood pressure


    ◦Nausea and Vomiting


    ◦Sweat palms





    ◦Inattention to surroundings


    Nurse must be aware of his/her own feelings – anxiety is contagious!
  19. 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
  20. Stress and Illness
    A factor that may result in the development of illness

    Stress may result in prolonged illness/delayed healing
  21. Coping With Stress
    Recognize stressors

    Eliminate as many stressors as possible

    Relaxation techniques

    ◦Deep breathing

    ◦Muscle relaxation (massage)

    ◦Guided imagery

    Patient Education
  22. 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
  23. 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
  24. Some positive experiences may result from a family caring for an ill member
    ◦Increased family closeness


    ◦Newly recognized individual and family strengths

    ◦New meanings and personal values

    ◦Increased flexibility in lifestyle

    ◦Changes in life priorities
  25. first IOM Core Competency
    The priority of health care (nursing) is the patient (which includes the patient’s family, friends, significant other)
Card Set
Patient Center Care