Patient centered care

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The following assignment will reflect on an experience from practice settings. It will consider and discuss the incident, which took place while on practice placement. The issues discussed will focus on defining who is a person and what it is person centred care. It will consider the responsibilities and roles of health professionals and how they meet the needs of the patient and how they deliver person centred care. The importance of communication in person centred care will be considered. Within this assignment the anonymity and confidentiality will be maintained. The Nursing and Midwifery Council (2004) Code of professional Conduct stated that confidential information obtained in the course of professional practice should not be disclosed without the consent of the patient or someone authorised to act on the patient’s behalf.

The patient was 77-year-old lady, Mrs. M. She was admitted to the ward with weight and appetite loss and she complained about severe headaches. After some investigations the diagnosis was made that the patient had got a brain tumour. Before the admission she was still active both physically and mentally. The patient had very supportive family, which visited her almost every day. It was an unsuspected diagnosis for all of them. She was referred to other hospital for radiology treatment and she went there several times. I was assisting the patient with personal hygiene that day and as we were talking, she asked me when her next radiology appointment was due and I said tomorrow, as it was given to me during handover in the morning. She was quite excited about it and she asked me to prepare her clothes for the next day.

Her condition was gradually deteriorating. She was more tired and less active especially after her radiology treatments. Later that day the ward round took place. As usual on the ward round there were quite a few health professionals participating; the consultant, the ward doctor, a few junior doctors, the nurse in charge and a student nurse. The consultant had to tell the patient the bad news that her radiology treatment was not giving the expected results and that the brain tumour was spreading and in consequence the radiology treatment was cancelled. At the time while the consultant was talking with the patient her privacy was hardly maintained, the curtains were not drawn; the consultant was standing at the beginning of the patient bed while she was sitting and he talking loudly enough that the other patient could hear him.

It took the consultant maybe three minutes to communicate the bad news and all the explanation, at times he asked her “do you understand what happened”, she answered “Yes, doctor” and so on. I was the last person to leave patient’s room after the consultation and she immediately asked me “so what time am going for my radiology tomorrow?” It was at that moment that I realised she did not understand what the consultant was actually trying to say. She did not understand that her brain tumour was spreading and that there was only limited treatment, which could be offered to her. Latter on the nurse in charge came back to the patient and spent time explaining to her what had been said previously.

The professionals involved with the care of Mrs. M did not particularly show the best implementation of person centred care, where was the protection of privacy, dignity and confidentiality? Use of empathetic body language was missing and the consultant who was standing above somebody who was sitting and feeling vulnerable is almost like an implementation of power. It was a ward round with a few professionals involved but no one actually realised that Mrs. M had not understood what was said. If the consultant knew the diagnosis why was it that the medical staff involved had not asked Mrs. M if maybe she would like to be with her family at that time?

Tschudin (2003) stated that nurse’s loyalty is to their patients, but must also respect the family (cited Collis 2006). However Mayers (1997) found that the majority of relatives would not want the patient to be informed of the prognosis, but would want to be informed if they were the patient. Why did it only take the consultant around three minutes to talk to the patient about her terminal diagnosis? However while the consultant was asking Mrs. M if she understood what he meant she always replied “yes, doctor I understand”. The consultant had limited contact with the patient and he did not realise that the patient had not understand him, perhaps if he spent a little bit more time with Mrs. M and treat her as an individual it will help him to actually understand the patient more and will build the caring relationship.

Patient centred care is a practice of respect and puts the patient in the central point of provided care, and treats each patient as a person. Automatically the question arises but who is a person? There is a lot of controversy around the definition of the word person because it can touch issues surrounding the beginning and ending of life and what a person is it can be quite a personal thing. There are as well personal and social values and beliefs involved in that description. While thinking of a person we should ask ourselves the question that is an embryo a person to us or that is a dead person still the person or is just the body.

During discussion in a seminar group we defined person as “a human being with the ability to grow and change physically, emotionally and socially – who can be defined by external influences both spiritual and familial. A person has unique characteristics encompassed by mind, body, soul and spirit, from conception to death and thereafter”. Another approach to a broad definition is taken by Joyce (1968) he states that a person should be defined as a ” being with capabilities or potentialities to know, love, desire, and relate to others in a self-reflective way” the important thing is the capability rather than any actual function (cited Binnie 1999).

Carl Rogers (1967) has made an influential contribution in defining person centred care (client centred care). Rogers idea of person centred care was to provide a relationship for the person with the therapist which will build feeling of security and confidence .The main characteristic of that relationship are ‘helping relationship’ where openness and genuineness are a part of the care and valuing of the patient as a person (cited Bennie 1999).

He showed the importance of the therapeutic potentials from the patient-nurse relationship and emphasised on the nurse’s personality, empathy towards the patient that will make nursing practice the patient centred practice. However Dewing and Pitchards (2000) stated “It is only possible to get to know the patient as a person if we choose to do this – it does not happen by chance” (cited Webster 2004). Patient centred care can be perceived as a care where person (patient, service user, client etc.) is valued where his autonomy, dignity and confidentiality are respected.

It is very important to remember that during the time patient’s stay in hospital and are being ‘cared for’ is a time when they can feel very vulnerable. The hospital environment for most of the patients is unpleasant, big and strange. Being in hospital itself is a frightening experience. A lot of patient’s experience feelings of anxiety during their stay in hospital and being treated like an object. As health professionals we need to know that positive impact of being treated like a person can promote well-being and the recovery process. It would be very difficult to deliver person centred care without creating an environment, which will value the equality, autonomy and fairness to improve patient’s care.

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