Nurse navigators and person‐centred care; delivered but not valued?

Abstract

Positioning the individual at the centre of care (person‐centred care [PCC]) is essential to improving outcomes for people living with multiple chronic conditions. However, research also suggests that this is structurally challenging because health systems continue to adopt long‐standing, episodic care encounters. One strategy to provide a more cohesive, individualised approach to care is the implementation of the nurse navigator role. Current research shows that although PCC is a focus of navigation, such care may be hindered by the rigid, systematised health services providing siloed specialist care. In this paper, we utilised a case study method to investigate the experiences of a nurse navigator and patient. The nurse navigator and the patient participated in individual interviews, the transcripts of which were analysed using critical discourse analysis. Findings from a larger research project suggest that traditional measures (hospital avoidance, emergency department usage) which work as the service objectives of the nurse navigator service have the potential to stifle the delivery of PCC. The analysis from this case study supports the broader findings and further highlights the need for improved alignment between service objectives and the health and well‐being of the individuals utilising the services.

Referring high-risk individuals for lung cancer screening: A systematic review of interventions with healthcare professionals

“…The effectiveness of Nurse navigation is evident, as are the benefits of adequate training, shared decision-making and a structured, clear and well-understood referral process supported by the use of electronic system-incorporated prompts. However, despite the documented benefits of nurse navigation, implementation remains a challenge since patient-centred care is frequently impeded by the rigid, siloed structure of the health services, and this is an ongoing hurdle to overcome (Byrne et al , 2021). Notwithstanding this, the importance of careful patient navigation and oversight in achieving patient outcomes needs to be considered and emphasised in future studies.…”

A Heideggerian analysis of good care in an acute hospital setting: Insights from healthcare workers, patients and families

“…There are efforts to codesign care in ways that encompass the individuality of the person and are inclusive of their family. This orientation endeavours to disrupt episodic, siloed biomedical care (Angel, 2022; Byrne et al, 2021; White et al, 2021). Care partnerships between professionals and families have a significantly positive impact on families' perceptions of good care when family members' expertise about their loved one is recognised (Andersen et al, 2020; Quinney et al, 2018).…”

The discourse of delivering person‐centred nursing care before, and during, the COVID‐19 pandemic: Care as collateral damage

“…While this is a commendable notion, the operationalisation of PCC is often positioned with nurses, who have little authority to action the system‐wide changes needed to practice PCC. Indeed, recent research has suggested that PCC is more about maintaining the current, medically led system and changing the patient, more than it is about changing the system to meet the needs of individuals (Byrne, 2022).…”

“…Previous research in this area explored the existing tension between nurses' ability to deliver PCC in a system designed to maintain NPM efficiency, productivity and efficacy, and positioned PCC as a technology of compliance (Byrne, 2022), where individuals with chronic conditions are taught to care for themselves, omitting any genuine attempt to change system structures and models to meet their needs. The outcome of this previous research was a finding that PCC is often used as a way to ensure that people with chronic disease comply with societal norms, build self‐care skills and avoid ‘over’ using the hospital system.…”

“…That is, when PCC is used as a philosophy of chronic disease models of care, it positions the person as irresponsible and capable of managing their health better. A value judgement is often also associated with this, whereby an assumption is made that the persons living with chronic disease can, and want to, care for themselves and thus reduce their usage (and costs) of hospital services (Byrne, 2022). The investigation in this article expands on the previous research and examines the concept of PCC in the context of COVID‐19.…”