Experiences of person-centred care - patients’ perceptions: qualitative study
Tóm tắt
Patient care models have been implemented and documented worldwide. Many studies have focused on features that hinder and facilitate the shift to such models, including the implementation process, staff involvement, resistance to new models and cultural dimensions. However, few studies have identified the potential effects of such new care models from a patient perspective. The aim of the present study was to investigate whether patients did in fact perceive the intentions of partnership in the new care model 1 year after its implementation. Sixteen participants were interviewed, selected from two wards in a medical department where a new care model had been implemented 1 year earlier. A directed deductive content analysis was selected. The aim of the directed approach to content analysis was to investigate to what extent the new care model had been implemented, using patients’ perspectives to describe the level of implementation. A coding framework was developed based on a theoretical paper that described the key features of the new care model. The implementation of person-centred care had clearly occurred to a large degree, even if some patients appeared not to have been exposed to the model at all. Aspects of the newly implemented care model were obvious; however, it was also clear that implementation was not complete. The analysis showed that patients felt listened to and that their own perception of the situation had been noted. Patients spontaneously expressed that they felt that the staff saw them as persons and did not solely focus on their disease. It was also stated that not every ailment or aspect of a patient’s illness needed to be addressed or resolved for open listening to be perceived as a positive experience. The findings indicate that even though some patients were not interested in participating and playing an active role in their own care, this might relate to a lack of understanding on how to invite them to do so and to increase their confidence. To change healthcare from a paternalistic system to care where patients are seen as partners may require pedagogical skills.
Tài liệu tham khảo
Longtin Y, Sax H, Leape LL, Sheridan SE, Donalson L, Pittet D: Patient participation: current knowledge and applicability to patient safety. Mayo Clin Proc. 2010, 85 (1): 53-62. 10.4065/mcp.2009.0248.
Ekman I, Swedberg K, Taft K, Lindseth A, Norberg A, Brink E, Carlsson J, Dahlin-Ivanoff S, Johansson I-L, Kjellgren K, Lidén E, Öhlén J, Olsson L-E, Rosén H, Rydmark M, Stibrant Sunnerhagen K: Person-centered care: ready for prime time. Eur J Cardiovasc Nurs. 2011, 10 (4): 248-251. 10.1016/j.ejcnurse.2011.06.008.
Nutting PA, Crabtree BF, Miller WL, Stange KC, Stewart E, Jaén C: Transforming physician practices to patient-centered medical homes: lessons from the National Demonstration Project. Health Aff. 2011, 30 (3): 439-445. 10.1377/hlthaff.2010.0159.
Coulter A, Ellins J: Patient-Focused Interventions: A Review of the Evidence. 2006, London, England: The Health Foundation and Picker Institute Europe, 7-20.
Landi F, Onder G, Russo A, Tabbacanti S, Rollo R, Federici S, Tua E, Cesari M, Bernabei R: A new model of integrated home care for the elderly: impact on hospital use. J Clin Epidemiol. 2001, 54 (9): 968-970. 10.1016/S0895-4356(01)00366-3.
Moons KG, Altman DG, Vergouwe Y, Royston P: Prognosis and prognostic research: application and impact of prognostic models in clinical practice. BMJ. 2009, 338 (606): 1487-1490.
Carlström ED, Ekman I: Organisational culture and change: implementing person-centred care. J Health Organ Manag. 2012, 26 (2): 175-191. 10.1108/14777261211230763.
Alharbi TS, Ekman I, Olsson L-E, Dudas K, Carlström E: Organizational culture and the implementation of person centered care: results from a change process in Swedish hospital care. Health Policy. 2012, 108: 294-301. 10.1016/j.healthpol.2012.09.003.
Alharbi T, Ekman I, Olsson L-E, Carlström E: The impact of organizational culture on the outcome of hospital care: after the implementation of person-centered care. Scand J Public Health. 2013, 8 (2–3): 294-301.
Gustafsson RÅ: Origins of authority: the organization of medical care in Sweden. Int J Health Serv. 1989, 19 (1): 121-133. 10.2190/K1RD-D03B-0NHH-H0WY.
Ågren B: Chain of care development in Sweden: results of a national study. Int J Integr Care. 2003, 3: 1-8.
Söder M: Swedish social disability research: a short version of a long history. Scand J Disabil Res. 2013, 15 (1): 90-107.
Saltman RB, Figueras R: Analyzing the evidence on European health care reforms. Health Aff. 1989, 17 (2): 85-108.
Klavus J, Vohlonen I, Kunnunen J, Koistinen V, Virtanen M: Evaluating health care financing in a highly decentralized beveridge model. Health. 2012, 4 (11): 1046-1952. 10.4236/health.2012.411160.
Crummer MB, Carter V: Critical pathways: the pivotal tool. J Cardiovasc Nurs. 1993, 7 (4): 30-37. 10.1097/00005082-199307000-00004.
World Health Organization World Alliance for Patient Safety: Global Patient Safety Challenge 2005–2006: Clean Care is Safer Care. 2005, Geneva: World Health Organization
World Health Organization: The Vienna Recommendations on Health Promoting Hospitals. 1997, Copenhagen: WHO Regional Office for Europe
Pollitt C, Bouckaert G: Public Management Reform: A Comparative Analysis. 2004, New York: Oxford University Press
Socialdepartementet: Vårdval i primärvården, Prop. 2008/09:74. [http://www.regeringen.se/content/1/c6/11/71/76/18be3b95.pdf]
Socialdepartementet: Vårdval i Sverige, SOU 2008:37. [http://www.regeringen.se/content/1/c6/10/29/06/103be5e1.pdf]
Dunér A, Nordström M: The roles and functions of the informal support networks of older people who receive formal support: a Swedish qualitative study. Ageing Soc. 2007, 27 (1): 67-85. 10.1017/S0144686X06005344.
Emanuel EJ, Emanuel LL: Four models of the physician-patient relationship. JAMA. 1992, 267 (16): 2221-2226. 10.1001/jama.1992.03480160079038.
Kizer KW: Establishing health care performance standards in an era of consumerism. JAMA. 2001, 286 (10): 1213-1217. 10.1001/jama.286.10.1213.
Henderson S: Power imbalance between nurses and patients: a potential inhibitor of partnership in care. J Clin Nurs. 2003, 12 (4): 501-508. 10.1046/j.1365-2702.2003.00757.x.
Eldh AC, Ekman I, Ehnfors M: Conditions for patient participation and non-participation in health care. Nurs Ethics. 2006, 13 (5): 503-514. 10.1191/0969733006nej898oa.
Say R, Murtagh M, Thomson R: Patients’ preference for involvement in medical decision making: a narrative review. Patient Educ Couns. 2006, 60 (2): 102-114. 10.1016/j.pec.2005.02.003.
Levinson W, Kao A, Kuby A, Thisted RA: Not all patients want to participate in decision making: a national study of public preferences. J Gerontol Intern Med. 2005, 20 (6): 531-535.
Marshall SS, Haywood KK, Fitzpatrick R: Patient Involvement and Collaboration in Shared Decision-Making: A Review. 2005, Oxford: National Centre for Health Outcomes Development
Makoul G, Clayman ML: An integrative model of shared decision making in medical encounters. Patient Educ Couns. 2006, 60 (3): 301-312. 10.1016/j.pec.2005.06.010.
Attree P, Morris S, Payne S, Vaughan S, Hinder S: Exploring the influence of service user involvement on health and social care services for cancer. Health Expect. 2010, 14 (1): 48-58.
Laugharne R, Priebe S, McCabe R, Garland N, Clifford D: Trust, choice and power in mental health care: experiences of patients with psychosis. Int J Soc Psychiatry. 2012, 58 (5): 496-504. 10.1177/0020764011408658.
Groene O: Patient centredness and quality improvement efforts in hospitals: rationale, measurement, implementation. Health Aff. 2011, 23 (5): 531-537.
Alharbi T, Carlström E, Ekman I, Olsson L-E: Implementation of person-centred care: management perspective. J Hosp Adm. 2014, 3 (3): 107-120.
Légaré F, Stacey D, Graham ID, Elwyn G, Pluye P, Gagnon MP, Frosch D, Harrison MB, Kryworuchko J, Pouliot S, Desroches S: Advancing theories, models and measurement for an interprofessional approach to shared decision making in primary care: a study protocol. BMC Health Serv Res. 2008, 3 (8): 2-
Weston WW: Informed and shared decision-making: the crux of patient centered care. Can Med Assoc J. 2001, 165 (4): 438-439.
Olsson L-E, Karlsson J, Ekman I: The integrated care pathway reduced the number of hospital days by half: a prospective comparative study of patients with acute hip fracture. J Orthop Surg Res. 2006, 1 (3): 1-17.
Hsieh H, Shannon S: Three approaches to qualitative content analysis. Qual Health Res. 2005, 15 (9): 1277-1288. 10.1177/1049732305276687.
Mayring P: Qualitative content analysis. A Companion to Qualitative Research. 2004, London: SAGE
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