Patient Centered Care

Definition

• Patient centered care is defined by the 2001 Institute of Medicine (IOM) Quality Chasm report as providing care that is respectful and responsive to individual patient preferences, needs, and values.

• It ensures that patient values guide all clinical decisions.

Picker Institute Principles

• Established in 1987, the Picker Institute created eight principles of person-centered care:

  • Individuals are seen as unique and encouraged to participate actively in their care.

  • Their needs and preferences are identified and respected.

• Client experiences are vital as they are regulatory and standard care concerns, measured through patient satisfaction surveys.

QPCC Client Rights

1. Access to reliable healthcare advice.

2. Treatment from trusted healthcare professionals.

3. Continuity of care.

4. Involvement of both family and caregivers.

5. Clear and understandable information and communication.

6. Respect for individual preferences and decision-making.

7. Empathy and respect toward individuals.

8. Consideration of clients' physical needs and environmental concerns.

• Client rights are legal guarantees retained even in healthcare settings, as identified by the American Hospital Association (AHA) in the Patient Care Partnership.

Nursing Role in Client Rights

Refusal of Treatment

• The Patient Self-Determination Act (PSDA) requires all clients to be informed of their right to accept or refuse care upon admission.

• Competent adults retain the right to refuse treatment or leave a healthcare facility without a prescription for discharge.

Nurses' Responsibilities

• Nurses must ensure clients understand their rights and protect them during care.

• Key areas include informed consent, refusal of treatment, advance directives, confidentiality, and information security.

• Regardless of age or care needs, every client retains the rights to:

  • Be informed about all aspects of care and participate in the decision-making process.

  • Accept, refuse, or modify their plan of care.

  • Receive care from competent individuals with respect.

• In cases of treatment refusal, clients sign a document acknowledging their understanding of the risks involved.

Advocacy in Nursing

Importance of Advocacy

• Advocacy is crucial for ensuring clients are informed, their rights respected, and they receive the appropriate level of care.

• If a client decides to leave a facility prematurely, the nurse must notify the provider and discuss potential risks.

• Nurses document what information was communicated to the client and the provider.

Client Information

• Clients should be made aware of:

  • Possible complications without treatment.

  • Risks of potential impairment or disability.

  • Possibility of death.

• If the client refuses to sign an Against Medical Advice (AMA) form, that refusal must also be documented.

• Advocacy includes supporting clients even against their decisions, particularly when they cannot advocate for themselves.

Nurses' Role in Advocacy

• Nurses must ensure clients are informed of their rights and maintain adequate information for health care decisions.

• They facilitate advocacy by mediating when others act against the client's best interests.

• Situations requiring advocacy include:

  • End-of-life decisions.

  • Access to healthcare.

  • Protection of client privacy.

  • Informed consent.

  • Responding to substandard practices.

Essential Components of Advocacy Skills

Skills Required for Advocacy

• Values including:

  • Informed consent: legal process for giving written permission for a procedure or treatment.

  • Assertiveness and caring.

  • Inclusivity of autonomy and respect for clients.

• Important aspects of informed consent include:

  • The reason for the procedure.

  • Benefits to the client.

  • Risks associated with treatment.

  • Alternatives to treatment.

Informed Consent Guidelines

Overview of Consent

• Consent is necessary for all care in healthcare facilities; implied consent suffices for routine nursing care.

• Nurses must assist in ensuring that informed consent has been properly obtained, particularly for invasive procedures.

• State laws regulate who can give consent, including provisions for emancipated minors.

Responsibilities of Nurses

• Nurses must witness signatures on consent forms and ensure comprehension of information.

• They should notify providers if clients have questions or need clarification about the procedure.

• Responsibilities include documenting the informed consent process and any related client queries.

Advance Directives

Purpose and Components

• Advance directives communicate client wishes regarding end-of-life care.

• Components include:

  • Living Will: outlines client's treatment wishes if incapacitated.

  • Durable Power of Attorney for Health Care: designates a surrogate to make decisions when the client cannot.

• Clients admitted to healthcare facilities must be inquired about their advance directives, per PSDA.

Nurses’ Role in Advance Directives

• Nurses provide information regarding advance directives and ensure client decisions are respected.

• They document the status and help clients formulate or clarify their advance directives in accordance with legal standards.

Confidentiality and Information Security

Importance of Confidentiality

• Clients have the right to privacy regarding healthcare information.

• Nurses must adhere to HIPAA regulations ensuring confidentiality in all communications.

• Violating client privacy can lead to legal repercussions including defamation claims.

Role of Nurses

• Nurses need to understand confidentiality rights and ensure compliance with HIPAA policies.

• They should inform the healthcare team of clients' advance directives while ensuring appropriate access to records.

Effective Communication and Collaboration

Communication Protocols

• Nurses must communicate in private settings to safeguard client information.

• Use of technology like e-mails or electronic records should adhere to HIPAA guidelines.

Interprofessional Collaboration

• Nurses coordinate care among various healthcare professionals to ensure effective treatment.

• Qualities essential for effective collaboration include:

  • Good communication and conflict resolution skills.

  • Leadership and critical thinking abilities.

Change Management Strategies in Nursing

Promoting Change

• To promote successful change in practices or policies, managers may use three key strategies:

  • Rational-empirical: using factual information to support changes.

  • Normative-re-educative: focusing on interpersonal relationships.

  • Power-coercive: using rewards to incentivize change.

Conclusion

• Effective nursing involves complex coordination within the interprofessional team while maintaining client autonomy and rights through advocacy, informed consent, and confidentiality.