NR 501 Concept Analysis Essay
NR 501 Concept Analysis Essay
Chamberlain College of Nursing
NR 501: Theoretical Basis Advanced Nursing
Introduction
Nursing is a wonderful career. As a nurse, we do more than just pass medication, insert catheters, and fix burns and cuts. Nursing is becoming more involved in patient care. Nursing has gone from solving patient’s problems to enhancing patient’s involvement in their own care. There is becoming an increasing enhancement on centering care and empowerment for our patients. We are trying to offer our patients more information and involvement in their treatment and knowledge of their care. (Sitzman & Eichelberger, 2011) Care is more involved nowadays with the patient being the center focus. Allowing the patient to become more involved in their care is allowing our patient to have more control for their preferences, values, needs, and cultures.
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Purpose
Walker and Avant method will be used to discuss an analysis concept, using referenced articles to discuss more in depth patient centered care. Care centered around patients allows for more awareness and activity in their health care interventions and treatments (Scott, 2010). We live in a very diverse population and when providing care to our patients it is important that we take the differences in our patients very seriously. The diversity among patient populations in healthcare are becoming more of a problem in healthcare and these differences can alter the outcomes and goals for our patients.
Uses
Care centered around the patient is enhanced by communication between the healthcare provider and patient. Communication is used as a tool to allow patients to speak on their wants and needs involving their healthcare and treatment. With communication patient can better understand and participate in their care. It is important that communication facilitates an understanding with patient’s healthcare treatment options as well. Other terms to be used for patient include client or resident. The different terms differ according to where the person works (ex. Hospital, nursing home, etc.). However, the term is used does not change the way the care is delivered. Care advocating is individualized to each person without mention of the setting (Morgan & Yoder, 2011).
Literature Review
Morgan and Yoder wrote an article using Walker and Avant’s model theory to explore care centered on the patient. There were four main analyses that assist in patient centered care, those being the care should be individualized to the patient, respectful, empowering, and holistic in order to enhance the health outcomes of our patients. Care centered on the patient is one of the key components of excellent quality care. Quality care is invested more so now in training then before within the healthcare industry. Morgan and Yoder explained how centered care around the patient can affect health outcomes (Morgan & Yoder, 2011).
Lusk and Fater researched the enhancement in quality of care for healthcare. They discussed how patient centered care is important of six improvements in healthcare. (Lusk & Fater, 2013) Through this research it is unknown how much effectiveness nursing has on patient centered care in the quantitative form. Patient centered care is effective based on the research but more data is needs to determine how effective nursing is with this. Lusk and Fater (2013) found that ‘more research of implemented concepts may contribute to determining the effectiveness of patient-centered care practices by linking the defined behaviors and attributes to improved outcomes’.
Hagan and Donovan wrote an article using Avant and Walker theory to determine the self-advocacy concept. Hagan and Donovan (2013) stated that ‘developmental process to achieve personally relevant goals’ is an important concept. This research was not able to consider certain concepts such as loss of control, health literacy, and coping (Hagan & Donovan, 2013). There needs to be further research on the comparison on the concepts of conceptual and clinical differences (Hagan & Donovan, 2013). I was unable to find more literature reviews within the five-year time frame.
Defining Attributes
Morgan and Yoder (2011) describe defining attributes of patient centered care as empowering, holistic, respectful, and individualized. Empowerment enhances the patient to be self-confident and self-doing, which is important in patient care (Morgan & Yoder, 2011). Holistic requires treating the whole person in biologically, socially, spiritually and psychologically ways (Morgan & Yoder, 2011). Respect is always the center of any relationship, even in healthcare. Respect recognizes that the patient makes their own decisions regarding the goals in their healthcare (Morgan & Yoder, 2011). Individualization occurs when the specific concerns and needs are considered. We must engage the person in their knowledge and experience (Morgan & Yoder, 2011).
Antecedents and Consequences
Antecedents happen before the concept, while consequences happen due to the results of the concept (Morgan & Yoder, 2011). The patient who has stage IV cancer of the ovaries concluded two antecedents founded by Lusker and Fater, 2013; intervention needs and ability of the patient to handle her own care. With the two antecedents if one was not foretold then patient centered care could not be maintained. There is an important correlation between antecedents and attributes (Lusk and Fater, 2013). For a patient to have autonomy they must be able to follow along in their own care. Without participation autonomy is not possible. NR 501 Concept Analysis Essay
Empirical Referents
Hagan and Donavan (2013) discussed how “empirical referents are instances that by their existence demonstrate the occurrence of the concept”.
Lusk and Fater (2013) discussed how “empirical testing lies in the ability to measure the patient’s autonomy, perception of a caring attitude and perception of individualization of care”. Hagan and Donovan (2013) discuss two tools that enhance measuring patient centered care: Health Care Climate Questionnaire, which involves the patient’s perceptions and Schmidt Perception of Nursing Care Survey, which is a satisfaction tool for patients.
Morgan and Yoder (2011) discuss how they used four tools to measure care centered around the patient: The Person-Centered Climate Questionnaire (PCQ) which only focuses on the antecedents, Patient Satisfaction with Nursing Care Questionnaire (PSNCQQ) focuses on the consequences, Patient-Centered Inpatient Scale (P-CIS) and Functional Independence Measurement (FIM). Through their research, they could achieve results but more research is needed before specific outcomes are known (Morgan & Yoder, 2011). NR 501 Concept Analysis Essay
Model Case
A model case has all the definitions of a concept (Lusk & Fater) Lusk and Fater (2013) used a model case involving patient centered care. A woman finished chemotherapy for ovarian cancer. She had stage IV cancer and the prognosis was poor. Her life expectancy was limited along with treatment options. She was given the options of radiation, surgery and hospice. There was a discussion about the treatment options with the nurse. She had prior experience with these options and the nurse kept in mind her culture, religious background, preferences and knowledge of hospice (Lusk & Fater, 2013) The nurse noticed that through information and discussion the patient needed more education regarding her options. The nurse used active listening for the concerns the patient had and the information was clarified and the patient was allowed ample amount of time to go over what was discussed before making an informed decision. The goals regarding her healthcare regimen were discussed with the patient. Education was given to enhance participation regarding her treatment. After time to consider her treatment options the nurse discussed the patient’s decision. With all questions answered, needs discussed, values respected, and patient knowledgeable on all aspects of care, patient centered care was attained. Defining attributes of patient centered care are supportive of the patient and behaviors.
Alternative Cases
A contrary case demonstrates the opposite of the nursing concept. An example case discusses Anne a cancer patient (Hagan & Donovan, 2013). This patient felt that her symptoms were becoming worse due to the chemotherapy and she just wanted to get things back to normal. Through the feelings, the patient did not want to create a plan to make her life the way it was before the chemotherapy. The patient felt that she was not getting the support from her doctor and thus a “normal life” was not going to be possible. Through miscommunication and a lack of trust between the patient and healthcare provider caused the patient to be blinded in her healthcare. The chemotherapy side effects were treatable but Anne did not feel the urgency by her healthcare provider to treat them. The patient did not gather information and the healthcare provider did not try to help the patient either. Patient centered care could not be completed.
The borderline case differs in that multiple attributes are different in some way. Once a NP decided to head over the patient census of an infant care outpatient clinic. The clinic served more of those that did not have much money and increase rate of teen pregnancy. There was a reputation for the patients to miss appointments based on different circumstances, which had a negative effect on patient’s long tern health outcomes. The NP implemented the secretary making same day phone calls as a reminder for the patient, and offering assistance with transportation such as bus tickets/vouchers. After implementation, an evaluation was made based on outcomes of the patients. The outcome showed there was an increase in attendance from the mothers, a decreased in negative patient outcomes, and more availability to attend o each patient in a timely manner. (Hagan & Donovan, 2013) NR 501 Concept Analysis Essay
Conclusion
Nursing is about caring for every aspect of the patient. It is about beneficence for the patient and planning care so that the patient can participate in their own care and have the outcome they desire. By allowing patients more participation in their healthcare, confidence is enhanced, allowing the patient to feel more aware of their options and plan. When the patients are uncertain of their goals and treatment it is our duty as the healthcare provider to offer all resources and thoroughly discuss them so that the patient can make an informed decision on their healthcare plan. Respect and support for our patients helps enhance healthcare outcomes. When there is open communication regarding healthcare options and treatments, patients gain more autonomy regarding their healthcare (Ruben and Tinetti, 2012). Ruben and Tinetti (2012) discuss how with the patient’s own selection of health outcomes combined with treatment options discussed with the healthcare provider, optimal healthcare is achieved. NR 501 Concept Analysis Essay
References
Dabney, B. W., & Tzeng, H. (2013). Service Quality and Patient-Centered Care. MEDSURG Nursing, 22(6), 359-364.
Hagan, T. L., & Donovan, H. S. (2013). Self-Advocacy and Cancer: A Concept Analysis. Journal of Advanced Nursing, 69(10), 2345-2359. Retrieved from doi: 10.1111/jan.12084 NR 501 Concept Analysis Essay
Lusk, J. M., & Fater, K. (2013). A Concept Analysis of Patient-Centered Care. Nursing Forum, 48(2), 89-97. doi: 10.1111/nuf.12019
Morgan, S., & Yoder, L. H. (2011). A Concept Analysis of Person-Centered Care. Journal of Holistic Nursing, 1-10. doi:10.1177/0898010111412189
Ruben, D. B., & Tinetti, M. E. (2012). Goal-Oriented Patient Care — An Alternative Health Outcomes Paradigm. The New England Journal of Medicine, 366, 777-779. doi: 10.1056/NEJMp1113631
Scott, A. (2010). Quality lessons. Patient-Centered Care Vital to Outcomes, Cost. Modern Healthcare, 40(46), 22.
Sitzman, K. L., & Eichelberger, L. W. (2011). Understanding the work of nurse theorists: A creative beginning. (2nd ed.). Sudbury, MA: Jones and Bartlett. NR 501 Concept Analysis Essay