NURS1103 Clinical Nursing Practice 1 |Patient Centred Nursing

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Patient-Centred Nursing PCN Framework

Person-centred nursing (PCN) framework has found great application in the nursing field and particularly in advanced practice nursing (APN). The framework was developed by the McCormack and McCance, the main focus being the person-centered exercise with aged people and the experiences of caring in nursing. Person-centeredness is a concept that has gained popularity for its established approach to service delivery in the healthcare systems. Many international healthcare policies and strategic plans are embedded within this framework. Person centred framework is derived from two philosophical frameworks; empirical research, and knowledge that comes with nursing care in the medical fields (McCormack and McCance 2006). The former focuses on work out with the elder people. Both of these frameworks are anchored on the principles of caring science which addresses on compassion to the patients, dignity, and respect for all. Person-centred nursing framework indicates a high degree with regard to individual concepts and consequently portrays a high degree of face validity. The framework was first published in the year 2006 and since then it has found a wide application worldwide; it has been tested in various circumstances and in different environments. McCormack and McCance (2010) describe PCN as “a lens that enables the operationalization of person-centred care and can be used to evaluate developments in practice and hence demonstrate outcomes.” This paper will focus on the patient-centered nursing framework and its application in the advanced practice nursing.

Patient centred nursing framework does not only provide a holistic working environment for nurses but also reduces the anxiety amongst the nurses in their call for service delivery and as such uphold patient involvement (Manley, Watts, and Cunningham 2011). However, its implementation is not that smooth as cultural differences and other personal contextual differences always pose a threat to its effective running. The framework is developed from systematic procedures of the already existing conceptual frameworks relating to person-centred nursing.

The theory has four main constructs and includes; prerequisites, care environment, person-centered processes and expected outcomes. Prerequisites focus on the desirable attributes by a nurse such as professional competency (education), excellent interpersonal skills, commitment to the job as well as being in a position to clearly illustrate beliefs and values necessary for the nursing profession. They are the basic attributes that any staff should possess and therefore act as the building blocks in developing professionals who are equipped to realize effective person-centred nursing practices (Kitson, Marshall, Bassett, and Zeitz 2013).

Care environment is concerned with the surroundings under which services are being delivered. The key areas of focus here are the systems that work together to facilitate shared decision making, appropriate skills by the nurse professionals, effective staff relations, sharing of power, supportive organizational systems as well as the potential for innovative methods and risk-taking abilities. Without a conducive environment, it would be truly difficult to realize the full potential of this framework. The main concept is that of person-centered processes which pose more emphasis on the process of delivering care to a patient.  It is the basic concept behind this theory (McCance, Gribben, McCormack, and Mitchell, 2010). Person-centered processes recommend that nurses work in cross-reference to the patient's beliefs and values and particularly their preferences. It also advocates for nurse-patient engagement, sharing decision making as well as meeting the physical needs of the patient. The expected outcome is the last domain and a central component of this framework. It works to see that effective results are achieved. This is only possible with satisfactory care, involvement, development of the general human well-being alongside devising a therapeutic environment (Plas and Lewis 2013).

It is clear that the success behind patient centred nursing framework relies on the success of each of the above constructs. For there to be outcomes, prerequisites must be taken into account while at the same time creating a conducive environment necessary for effective health care and to harbor the patient-centered activities and processes.

In advanced practice nursing, the framework has a prominent use where it acts as a guide to implementation studies and focuses on developing person-centred nursing from different contexts. Through this framework, nurses and other health practitioners have managed to identify relationships between the different concepts and new research areas. Studies have been conducted in residential care settings for the older people, in secondary and tertiary care systems, and in palliative and community care systems to help find how the frameworks integrate with these different healthcare settings (Leplege et al., 2012). Through these studies, practitioners have been able to recognize the fundamental elements in their practice for service delivery as well as promoting person-centred nursing.

To help in the implementation of this models, several instruments have been applied to help in identifying the key processes required for the efficient and successful running of the person-centred nursing practice. The commonly used tools include person-centred nursing index, workplace culture critical analysis tool and the famous context assessment index. The philosophy under which the framework is embedded is that of being a ‘person’ and is very consistent with the philosophy of human science which requires every participant to be human. The philosophy of human science is the basic foundation for a patient-centred nursing framework and advocates for human freedom, holism, choice and responsibility, relationships and the importance of time and space in every human context (Balik, Conway, Zipperer, and Watson 2011).

In conclusion, the patient centred nursing practice has found a wide application in the health sector and particularly in the nursing field. The framework constitutes four main domains, prerequisite, care environment, person-centred processes and expected outcomes. Person-centred nursing practice is well situated in a broader context in the nursing field as illustrated by its wide applicability across the different health care systems. This is also evident by how the different domains and constructs have remained stable over time. The relationship between the domains has been tested and verified through practice and research and this supports that prerequisites must first be identified followed by care processes in order to provide an effective care services to the patients. Since its publication in 2010, the framework has undergone some changes to improve its effectiveness and efficiency. Prerequisites are concerned with professionalism and skill level of the nurse while care environment aims at providing a conducive environment in which quality care can be realized. With daily improvements through research and practice, I believe the framework is here to stay and to improve the quality of service delivery.

References

Balik, B., Conway, J., Zipperer, L., & Watson, J. (2011). Achieving an exceptional patient and family experience of inpatient hospital care. IHI innovation series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement, 14.

Kitson, A., Marshall, A., Bassett, K., & Zeitz, K. (2013). What are the core elements of patient?centred care? A narrative review and synthesis of the literature from health policy, medicine and nursing. Journal of advanced nursing, 69(1), 4-15.

Leplege, A., Gzil, F., Cammelli, M., Lefeve, C., Pachoud, B., & Ville, I. (2012). Person-centredness: Conceptual and historical perspectives. Disability and Rehabilitation, 29(20-21), 1555-1565.

Manley K, Watts C & Cunningham G (2011) Principles of Nursing Practice: development and implementation. Nursing Standard 25, 35–37.

McCance, T., Gribben, B., McCormack, B., & Mitchell, E. (2010). Improving the patient experience by exploring person-centred care in practice. Final programme report. Belfast, Northern Ireland: Belfast Health and Social Care

McCormack B & McCance TV (2006) Development of a framework for person?centred nursing. Journal of Advanced Nursing 56, 472–479

McCormack B & McCance TV (2010) Person?Centred Nursing: Theory and Practice. Wiley?Blackwell, Oxford.

Plas JM & Lewis SE (2013) Person?Centered Leadership for Nonprofit Organizations: Management That Works in High Pressure Systems. SAGE Publications, Minnesota.