Home Health Nurses’ Journey Toward Culture-Sensitive/Patient-Centered Skills: A Grounded Theory Study

Abstract

Introduction. Home health patients, who are members of minority and vulnerable groups, suffer disparate outcomes. Patient-centered care (PCC) and culturally-competent care (CCC) aim to facilitate high-quality, equitable care. How home health nurses incorporate PCC and CCC principles into their assessment and care-planning practices has not been -investigated. This study answers the question, “ What is the process by which home health nurses develop their culture-sensitive/patient-centered assessment and care planning skills?” Methods. Home health nurses (n= 20) were recruited into this grounded theory study from agencies around the United States via flyers, websites, and contacts. We conducted in-depth recorded interviews using a semi-structured interview guide to ask questions about nurses’ assessment and care-planning practices, their understanding of CCC and PCC principles, and facilitators/barriers to CCC and PCC practice. Results. Participants primarily gained their CCC and PCC assessment and care-planning skills through a “seat of your pants,” trial-and-error process, with little educational or agency assistance. They combined caring, diverse patient experiences, and critical, creative self-reflection on their experiences to gradually learn helpful, though not optimal, CCC and PCC strategies. However, they reported numerous barriers that discouraged or distressed them in their quest to deliver culturally-competent and patient-centered care. Only a few nurses demonstrated the resilience to overcome these challenges creatively and happily. Conclusion. If we accept that patient-centered care and culturally competent care are key elements of high-quality, equitable care, this grounded theory may help home healthcare clinicians, administrators, educators, and policy-makers identify impact points for enhancing CS/PC practices.

Perspectives of older people and healthcare providers on implementing person-centred care for community-dwelling older people: a systematic review and qualitative meta-synthesis

“…Therefore, care service should pay attention to fostering best practice in mutual communication and construct the appropriate social relationships between the older people, family caregivers and health professionals, in order to improve quality care and meet their needs. In addition, it would be also useful to provide evidence-based training by combining experience with research literature to enhance professional competence for HCPs [14,33]. The evidence which is currently available on PCC interventions do not be necessarily used in daily clinical practice [34].…”

“…In light of this, this article explores the critical factors for implementing PCC in the community research domain. Studies have shown that HCPs acquire PCC assessment and care skills primarily through their own intuitive and trial-and-error processes, with little educational or institutional help [14,15]. Community doctors have highlighted the importance of their own personal resources and developing relationships with older people in shaping the PCC provided [16].…”

Ethical Considerations of Pay Per Visit

“…Minority and other vulnerable patients may need more time to achieve equitable outcomes. One potential cause of disparities is that nurses, eager to make as many visits as possible, don't invest adequate time in the care of vulnerable patients (Narayan & Mallinson, 2022). Examples include:…”

“…• patients who do not speak English, because interpreted conversations take longer; • patients who have low health literacy, because they need extra explanation during teaching; • patients with inequities in social determinates of health, because ameliorating deficits through additional nursing interventions and social work/community referrals takes additional time; • minority patients who have different values and lifestyles, because more time is needed to assess and understand the patient as a person so a care plan can be individualized to the patient's needs and preferences (Narayan & Mallinson, 2022).…”

Challenges to Patient-Centered Care in Home Health Nursing

“…In a recent qualitative study, Narayan and Mallinson (2022) found home health nurses ( N = 20) who worked for diverse agencies in diverse states in the United States identified many “potholes and roadblocks” to their ability to provide patient-centered care. Most felt that documentation and productivity demands, and some policies to achieve cost-efficiencies were squeezing the patient-centeredness out of their care.…”