Provide Patient-Centered

Care
Patient- Centered Care
 The first core competencies identified by
Institute of Medicine (IOM) for nurses and all
health professionals.
Patient- Centered Care (cont.)
 identify,
identify respect and care about patient’s
differences, values, preferences, and
expressed needs, relieve pain and suffering;
coordinate continuous care; listen to, clearly
inform, communicate with, and educate
patients; share decision making and
management; and continuously advocate
disease prevention, wellness, and promotion
of healthy lifestyles, including a focus on
population health. (IOM definition, 2003a, p.4)
Key Elements
 Special skills that are needed to
ensure patient-centered care
(IOM, 2003a, pp 52-53)

 Share power and responsibility with patients and

caregivers (family, significant others) (e.g. involve
the patient in care, make the patient the center of
care and decision making; work to increase patient
understanding, acceptance, and cooperation; help
caregivers as they provide care to family member
[education for patient and family]; support self
management; provide comfort and emotional
support; manage pain and suffering; relieve anxiety;
provide expert care to manage symptoms).
Special skills that are needed to ensure
patient-centered care (IOM, 2003a, pp 52-53)
 Communicate with patients in a shared and
fully open manner (e.g. patients have access
to information, communication with health
care providers (including nurses), and use of
technology to communicate).

 Take into account patient’s individuality,

emotional needs, values, and life issues (e.g.
culture, whole person).
Special skills that are needed to ensure
patient-centered care (IOM, 2003a, pp 52-53)
 Implement strategies to reach those who do
not present for care on their own, including
care strategies that support the broader
community (e.g. underserved members of
the community).

 Enhance prevention and health promotion

(e.g. population focus, risk factors, health
promotion, and prevention strategies).
Consumerism: How does it
impact Health Care and
Nursing?
 Consumerism in health care has become a
very important concept, and it relate directly
to patient-centered care.
Who are the Consumers or
Customers?
 Two major types of Consumers or Customers:
Customers

1. Macro Consumers- the major purchasers of care: the

government and insurers.
insurers They pay for care and thus
are consumers in that they have expectations of the
product (the care delivered) and can influence that
care.
2. Micro consumer- is the patient.
patient Patient families and
significant others, when they play a role in the patient’s
care and decision-making process, are also micro
consumers.
What is Customer-centered
health care?
- Means that the nurse must be more aware of
customer/patient needs. The patient may not
have all the information to make an informed
decision and may need the expertise of
healthcare professionals to meet his or her
needs.

- Nurses need to find a balance- meeting patient

needs, including patient, and respect patient’s
opinion.
Customer service goals that are
important in today’s healthcare
system/nursing:

1. Caring with compassion

2. Making sure caring comes across: Does the
caring come across to patients? Do nurses
say and do things that really do not support
caring?
 Customer service goals that are
important in today’s healthcare
system/nursing: (cont.)
1. Paying quality attention: The skill of presence
or mindfulness involves controlling attention.
This allows the persons (patient, family,
others) who are the receiving end to feel like
the center at that moment.
2. Reducing patient anxiety
3. Your personal calling: Are you committed to
improvement and caring, and how do you
demonstrate this in your practice?
Patient Self-Determination Act
of 1990
 Is a law that significantly had impact to patient
information and process.
 Information about health care directives
 It applies to all healthcare organizations that
receive Medicare or Medicaid reimbursement,
and because few healthcare organizations do
not receive this form or reimbursement, this
law applies to most healthcare organizations.
Patient Self-Determination Act
of 1990
 It requires that all these organizations or
providers give their patients certain
information that relates to confidentiality;
consent; the right to make medical decisions,
to be informed about diagnosis and
treatment, and to refuse treatment; and use of
advance directives.
Culture, Diversity and Disparities
in Health Care
Healthy People 2020
 This is the National Objectives for improving the
health of all Americans that was launch in
December 2010.

 It identifies four major goals for the health of U.S

citizens, one of which emphasizes cultural
diversity: “ Achieve health equity, eliminate
disparities, and improve the health of all groups”.
Culture, Diversity and Disparities
in Health Care
Healthy People 2020
 This goal also indicates that providers
throughout the healthcare system, including
nurses, need to know more about culture, as
indicated in the definition of patient-centered
care.
Culture
 Culture is the social behavior and norms
found in human societies.
 is the accumulated store of shared values,
ideas (attitudes, beliefs, values and norms),
understandings, symbols, material
products, and practices of a group of
people (IOM, 2003b, p.522).
Culture (cont.)
 Culture and language may influence the
following (HHS, 2008a):
• Health, healing, and wellness belief systems
• Patient/consumer perception of causes of illness
and disease
• Patients /consumer behaviors and their attitudes
toward health care providers.
• Provider perceptions and values.
Cultural Competence
 Competence is defined as having the
capacity to function effectively as an
individual and as an organization within the
context of the cultural beliefs, behaviors,
and needs presented by consumers and
their communities (Anderson, Scrimshaw,
Fullilove, Fielding, & Normand, 2003, pp.
68-69).
Cultural Competence
 The IOM describes three conceptual
approaches to cross-cultural education
(IOM, 2003b, pp.3-4):
1. Focus on attitudes (cultural sensitivity/
awareness approach),
2. Knowledge (multicultural/categorical
approach),
3. Skills (cross-cultural approach)
Disparities in Health Care
 Defined as “racial or ethnic differences in the
quality of healthcare that are not due to access-
related factors or clinical needs, preferences,
and appropriateness of intervention” (IOM,
2003b, pp.3-4).
- Two issues that determines the existence of
disparities in health as identified by IOM:
1. How the healthcare system functions and the legal
and regulatory issues that may make it difficult for
the patients to get equal care;
2. Presence of discrimination at the patient provider
level.
Disparities in Health Care
 Discrimination is defined as “differences
in care that result from bias, prejudices,
stereotyping and uncertainty in clinical
communication and decision making”
(IOM, 2002b, p.4).
Disparities in Health Care
 Related terminologies:
• Bias:
Bias Predisposed point of view.
• Ethnicity‫ األصل العرقي‬: Shared feeling of belonging to a
group-peoplehood.
• Ethnocentrism‫ النزعة العرقية‬: Belief that one’s group or
culture is superior to others.
• Prejudice:
Prejudice Making assumptions or judgments about
the beliefs, behaviors, needs, and expectations of
patients or other healthcare staff of a different cultural
background than one’s own because of emotional
beliefs about the population; involves negative
attitudes toward the different group.
Disparities in Health Care
 Related terminologies:
- Race:
Race A biological designation of a group;
belonging to the group based on biological factor
(s).

- Stereotyping: This is a “process by which

people use social groups (such as sex and
race) to gather, process, and recall
information about the other people…these
are labels” (IOM, 2002b, p.475).
Disparities in Health Care
 Two major factors that impact results of disparities
in health care among people of ethnic minorities:
1. Inadequate access to care: Barriers to care can result
from economic, geographic, linguistic, cultural, and
healthcare financing issues.
2. Substandard quality of care: Even when minorities
have similar levels of access to care, health insurance,
and education, the quality and intensity of health care
they receive are often poor. Lower quality care has
many causes, including patient-provider
miscommunication, provider discrimination,
stereotyping, and prejudice.
Disparities in Health Care
 Quality of care is usually rated on four
measures:

a. Effectiveness
b. Patient safety
c. Timeliness
d. Patient centeredness
Disparities in Health Care
 Disparities in health status and health outcomes can be
categorized as the following (Peters & Elsters, 2002):
1. Individual factors:
factors
- Socio-demographic characteristics (e.g., age,
race/ethnicity, gender)
- Socio-economic status (e.g., income, occupation, and
education)
- Personal characteristics (e.g., disabilities, rural or
urban residency & sexual orientation).
- Cultural norms & values, literacy levels, familial
influences, environmental and occupational exposures,
and patient preferences for care and treatment.
Disparities in Health Care
2. Healthcare system factors:
- Insurance status and affordability
- Transportation and geographic barriers to needed
services
- Health beliefs, attitudes and level of self-
confidence in complying with treatment
- Racial concordance of patient and physician
- Cultural preferences for less invasive procedures
- Provider bias, racism and discrimination.
Strategies to Overcome
Disparities
 Disparity issues require that all healthcare
professionals actively consider patient values
and preferences (a critical component of
patient-centered care).

 Monitoring data on disparities is important to

assist in identifying current status and to
develop and improve effective interventions to
reach desired outcomes.
Patient Advocacy

 Advocacy means that the nurse is active in

respecting the patient and patient rights and
ensuring that the patient has the education
to understand treatment and care needs.
Support is given to the patient and family; if
the patient makes a treatment decision
based on information given to him or her, the
nurse does not judge the patient’s decision
even though he or she may disagree with it.