Real world challenges in delivering person-centred care: A community-based case study

Abstract

Community nurses face many challenges when trying to practice evidence based, person-centred care. Ongoing concerns regarding the impact of the 2013 Francis Report (Ford and Lintern 2017) suggest that individualised and holistic care is an impossible dream; one made harder when the client appears uncooperative. This paper presents a case study which sets out how some of these challenges were met in a potentially difficult situation experienced by a student nurse and her mentor in practice, in which the student was supported to further examine and explore issues that may have influenced the situation. In this instance the solution came with the recognition that the client had expertise and knowledge that needed to be taken into account alongside that of the nurses looking after him. His care became a partnership, not an imposition of expertise; a principle which is transferrable to many other situations. Underpinning it was the recognition of our shared humanity; where lies the essence of truly holistic care. Student nurses learning this, through the guidance and support of their mentor.

“What matters to you?” A longitudinal qualitative study of Norwegian patients’ perspectives on their pathways with colorectal cancer

“…Despite the importance of managing the interpersonal process, however, it is often ignored in the evaluation of health care. Perhaps part of the reason it is ignored is that it is quite challenging to implement PCC in clinical practice (Riding et al, 2017). One way of moving towards the goal of PCC may thus be to start by increasing the focus and understanding of the concept of the patient pathway, since the way we understand the world and act in the world are based on our concepts (Lakoff & Johnson, 1980).…”

“…Stange (2009) highlighted this issue when he quoted Osler, writing "it is more important to know what sort of person has a disease than to know what sort of disease a person has" (p. 102). It is therefore clear that the ideology of providing PCC is old, but the challenge of embedding it in everyday clinical practice still persists (Naldemirci et al, 2017;Riding, Glendening, & Heaslip, 2017). For example, a study found that doctors who were courteous often still systematically avoided dealing with the personal topics that patients brought up, even when they could be relevant to diagnosis and treatment (Agledahl, Gulbrandsen, Førde, & Wifstad, 2011).…”

Models and frameworks that enable nurses to develop their public health practice—A scoping study

“…They were especially important in initially engaging clients as it was recognised that many of the groups PHNs work with often do not access services and are variously described as “hard to reach” or “seldom heard” (Cotton, 2015; Noonan, Galvin, Doody, & Jomeen, 2017). Once engagement has been achieved, encouraging sustained contact and motivating clients to make lifestyle changes were also viewed as a relationship‐building skill needed by the public health nurse (Astbury, Shepherd, & Cheyne, 2017; Olsen et al, 2017; Riding, Glendening, & Heaslip, 2017).…”

“…Whether this related to clients’ satisfaction with the service or what public health nurses perceived to be important in the delivery of any model or framework, the way public health nurses interacted with clients was seen to be fundamental to their success. This orientation or approach to practice involves being person‐centred, culturally sensitive, using good communication skills and building therapeutic relationships (Feather, Carter, Valaitis, & Kirkpatrick, 2017; Laholt, Guillemin, McLeod, Olsen, & Lorem, 2017; Noonan et al, 2017; Riding et al, 2017; SmithBattle, Lorenz, & Leander, 2013).…”

A Literature Review on People-Centered Care and Nursing Practice in Primary Health Care Setting

“…By recognizing that each person is different with preferences and personality, putting these factors in the heart of nursing care is essential (Borbasi, Galvin, Adams, Todres, & Farrelly, 2013;Hemingway, Scammell, & Heaslip, 2012;Todres, Galvin, & Holloway, 2009). However it should be understood also that competing priorities can in many ways intervene and prevent quality and fully humanized care (Riding, Glendening, & Heaslip, 2017).…”