BASIS FOR MODERN HEALTH SERVICES
An Action Research Presented to the Graduate School of
Saint Paul University Philippines Mabini Street, Tuguegarao City (Capital)
Cagayan North 3500
In Partial Fulfillment of the Requirement in the Degree of Doctor of Philosophy in Nursing Science
PHILOSOPICAL BASES IN NURSING
By:
Roberto P. Lim, MSN, RN
Judith B. Lutrania, MAEd, MAN, LPT, RN Amriati Mutmainna, MSN, S.Kep., Ns
Darwin M. Viernes, MAN, LPT, RN
To:
Dr. Ma. Elizabeth Baua
July 27, 2024 Summer, A.Y. 2023-2024
PATIENT CENTERED CARE AND NURSING PRACTICES:
BASIS FOR MODERN HEALTH SERVICES
Introduction
Patient-centered care (PCC) is a fundamental principle in contemporary healthcare, which prioritizes the comprehensive care of people by acknowledging their distinct preferences, values, and requirements. This approach signifies a fundamental change from conventional models that prioritize healthcare providers to a more comprehensive framework where patients actively engage in making decisions about their own treatment. The development of PCC has been greatly impacted by the rising intricacy of healthcare systems and the escalating need for customized medical treatments.
Nursing practices are crucial in the execution of patient-centered care. Nurses often act as the main point of contact for patients, providing continuous care and acting as intermediaries between patients and other healthcare providers.
(Forstner, 2024). Nurses in this distinctive role possess a comprehensive understanding of patients' individual and medical backgrounds, which cultivates a therapeutic connection that is vital for successful Patient-Centered Care (PCC).
Research has demonstrated that incorporating patient-centered concepts into nursing practices leads to enhanced patient satisfaction, increased adherence to treatment programs, and improved overall health outcomes.
The notion of patient-centered care originated in the mid-20th century when the medical world acknowledged the shortcomings of a solely scientific approach. The
biopsychosocial model by Engel in the 1970s established the foundation for contemporary person-centered care (PCC) (Bolton, 2019). These frameworks emphasized the significance of taking into account psychological and social issues alongside medical ones while providing treatment to patients.
The current healthcare environment places even greater importance on Patient- Centered Care (PCC) due to regulatory reforms and accreditation regulations. The importance of Patient-Centered Care (PCC) in providing excellent healthcare has been emphasized by esteemed organizations like the Institute of Medicine (IOM) and the World Health Organization (WHO). The IOM's influential study, "Crossing the Quality Chasm," recognized PCC as one of the six fundamental objectives for enhancing the healthcare system. It promotes treatment that is considerate and adaptable to the unique choices, requirements, and principles of each patient (Engle, et.al., 2021).
Nursing education and training programs have adjusted to these developments by integrating Person-Centered Care (PCC) ideas into their curricula. This encompasses the instruction of communication skills, empathy, and cultural competency, all of which are crucial for comprehending and attending to the varied requirements of patients. Furthermore, there is a strong emphasis on multidisciplinary teamwork to ensure that every member of the healthcare team contributes to a unified and patient-centered approach.
The implementation of PCC in nursing encompasses several essential elements.
To begin with, proficient communication is crucial for comprehending patient
requirements and preferences (Ebrahimi, et.al., 2021). Nurses must possess proficiency in active listening, delivering concise information, and fostering an environment that encourages patients to articulate their concerns and inquiries (Grover, et.al., 2022). Furthermore, it is of utmost importance to protect patient autonomy. This involves actively engaging patients in the decision-making process and valuing their choices, even if they diverge from the advice of the healthcare professional. Furthermore, emotional support plays a crucial role in the context of PCC. Nurses offer solace, compassion, and comprehension, so mitigating patients' apprehensions and fostering confidence (Rassouli, et.al., 2022).
There are still substantial gaps in research when it comes to knowing how patient- centered care (PCC) is implemented and how beneficial it is within the healthcare system of the Philippines, despite the global focus on this approach. The healthcare infrastructure of the nation encounters distinctive obstacles, such limitations in resources, high ratios of patients to nurses, and inequalities in access to treatment, which might hinder the implementation of PCC principles.
The current research mostly concentrates on industrialized nations, resulting in a lack of localized studies that examine the socio-cultural, economic, and systemic issues unique to the Philippines. In addition, whereas national healthcare policies recognize the significance of PCC, there is a scarcity of empirical data on how these policies are implemented at the local level.
There is a lack of research on the incorporation of PCC (Patient-Centered Care) in nursing education and training. It is necessary to evaluate if the existing curricula effectively equip nurses to provide patient-centered care. Moreover, there is a
in diverse healthcare settings throughout the Philippines, encompassing both metropolitan hospitals and rural health clinics. Comprehending these results is vital for assessing the influence of PCC and pinpointing areas that need enhancement.
Furthermore, in order to properly customize patient-centered care (PCC) techniques, it is essential to thoroughly examine cultural subtleties, such as the dynamics of decision-making within families and the styles of communication between patients and healthcare providers. It is crucial to address these areas of research that are lacking in order to create strategies that will improve the quality of treatment, increase patient happiness, and guarantee that healthcare services in the Philippines are really tailored to the requirements and preferences of its varied population.
Theoretical Framework
The Person-Centered Nursing Framework (PCNF) developed by McCormack and McCance (O’Donell, 2021) provides a strong and all-encompassing structure that harmonizes perfectly with the concepts of patient-centered care (PCC) and nursing practices. This paradigm is specifically well-suited for this study, which seeks to enhance healthcare services in the Philippines. The study focuses on addressing the distinct requirements and preferences of patients, since this is crucial for increasing the quality of treatment.
The PCNF is constructed based on four fundamental elements: prerequisites, the care environment, person-centered processes, and outcomes. Every framework
offers a comprehensive guide for examining and enhancing nursing procedures to more closely adhere to PCC principles.
Figure 1. Person-Centered Nursing Framework (PCNF)
Prerequisites
This construct focuses on the attributes of the nurse, including their professional competence, interpersonal skills, and commitment to patient care. In the context of the Philippines, where nursing practices often face challenges such as high patient loads and limited resources, emphasizing the development of these
skills and attitudes through targeted training programs, mentorship, and continuous professional development. By investing in the foundational qualities of nurses, healthcare institutions can ensure that they are better equipped to deliver patient-centered care.
The Care Environment
The care environment includes the organizational culture, physical setting, and support systems that facilitate PCC. In many Philippine healthcare settings, infrastructural and systemic barriers can impede the delivery of high-quality care.
Action research can identify and address these barriers by examining the current state of healthcare facilities, the availability of necessary resources, and the organizational policies that influence nursing practices. Interventions might include redesigning care spaces to be more welcoming and comfortable for patients, improving the nurse-to-patient ratio, and fostering a supportive and collaborative work culture. By creating a conducive care environment, nurses are more likely to engage in practices that prioritize patient needs and preferences.
Person-Centered Processes
These processes refer to the interactions and activities that nurses engage in to deliver PCC. Key elements include effective communication, individualized care planning, and active involvement of patients in their care. In the Philippines, where cultural and social factors significantly impact healthcare delivery, it is essential to tailor these processes to meet the diverse needs of the patient population. Action
research can investigate how nurses currently communicate with patients, how care plans are developed and implemented, and how patients are involved in decision-making. By identifying gaps and testing new approaches, such as incorporating cultural competence training or developing tools for better patient engagement, nurses can refine their practices to ensure they are truly person- centered.
Outcomes
The final construct focuses on the outcomes of patient-centered nursing, which include improved patient satisfaction, better health outcomes, and enhanced quality of life. Measuring these outcomes in the Philippine context requires robust data collection and analysis methods. Action research can implement pilot programs that apply the PCNF and track key metrics to assess their effectiveness.
Feedback from patients and healthcare providers can inform iterative improvements, ensuring that the implemented changes are both practical and impactful.
The relevance of McCormack and McCance's PCNF to PCC and nursing practices is profound. By providing a clear framework that addresses both the internal attributes of nurses and the external factors influencing care delivery, the PCNF offers a holistic approach to enhancing PCC. In the Philippines, where healthcare challenges are multifaceted, this framework can guide action research efforts to systematically improve nursing practices and patient outcomes. By focusing on the core constructs of the PCNF, researchers and practitioners can develop targeted interventions that not only elevate the standard of care but also ensure that it is
needs of patients.
Statement of the Problem
1. To what extent do the nurse participants use patient-centered care?
2. What is the level of knowledge, attitude and skills of the participants in using patient-centered care?
3. What are the challenges encountered by the participants in utilizing patient centered care?
4. What are the recommendations of the participants in enhancing patient centered care?
5. What enhancements can be proposed on patient centered care?
Methodology
This study used the quantitative descriptive research design.
Participants of the Study
The participants were 65 staff nurses from two selected private hospitals in Santiago City. They were selected using both purposive and convenience sampling to which only nurses who render and experiences Patient – Centered care was recruited. Moreover, in the principle of autonomy, only those who agreed to be part of the study were included.
Instrumentation
The researchers used a combination of adapted and researcher made tool to gather the data. The Person-Centered Nursing Index (PCNI) Scale by McCormack and McCance was used to determine the extent of the participants use of the patient centered care. Researcher made tools were formulated after review of literatures was done and through consultation with nurse-managers within the city of Santiago. The questionnaires were pilot tested to clinical instructors who were assigned in the hospital and are on the frontline of patient-centered care.
Data Gathering Procedure
The researchers asked permission from the Director of the Nursing Service of the selected private hospitals. A copy of the objectives of the study was enclosed in the letter given to them. Upon permission was granted, the researchers proceeded with identifying the nurses who practices the PCC. Informed consent was obtained.
Only nurses who consented were included in the survey. A printed questionnaire was personally handed to them. The researchers personally floated them. Upon accomplishment of the tool, it was tallied, tabulized, analyzed and interpreted.
Data Analysis
This study employed descriptive statistics to analyze the data collected.
Frequency, Rank Distribution and Mean was used to gauge the answers of the respondents.
Results and Discussion
A. Extent the Nurse Participants Use Patient-Centered Care
Extent the Nurse Participants Use Patient-Centered Care as to its Prerequisites
Items Mean Interpretation
1. I am confident in my clinical skills and
knowledge. 3.23 Agree
2. I regularly update my professional skills and
knowledge. 3.73
Strongly Agree 3. I feel adequately trained to deliver patient-
centered care. 2.86 Agree
4. I am good at building trusting relationships
with patients. 3.18 Agree
5. I listen carefully to what patients have to
say. 3.11 Agree
6. I am sensitive to patients' emotional needs. 2.93 Agree 7. I always put the patients' needs first.
3.42
Strongly Agree 8. I am committed to providing the highest
quality care possible. 3.72
Strongly Agree 9. I advocate for my patients' needs and
preferences. 2.79 Agree
Average Mean 3.22 Agree
Table 1 presents the extent the nurse participants use patient-centered care as to its prerequisites.
The survey findings indicate a strong commitment among respondents to maintain professional development and delivering high-quality care, as evidenced by the highest mean scores for “I regularly update my professional skills and knowledge” at 3.73 and “I am committed to providing the highest quality care possible” at 3.72, both of which fall under "Strongly Agree." Additionally,
respondents also “Strongly agree” with “I always put the patients' needs first”, at a mean score of 3.42. However, the lower mean score of 2.79 for “I advocate for my patients' needs and preferences” suggests that while there is agreement on the need to advocate for patients, this aspect is less emphasized compared to others.
An average mean of 3.22, categorized as "Agree," suggests that nurses typically employ patient-centered care methods, but their adherence to the necessary requirements may vary. The average score suggests that nurses have a favorable attitude towards implementing patient-centered care concepts. This implies that they know and respect the necessity of aligning their practice with these principles. However, it also suggests that there can be discrepancies or aspects where the execution of patient-centered care should be enhanced. This mean score indicates that although there is a strong basis in implementing patient- centered care, there is room for improvement in achieving consistent implementation and fixing any deficiencies in satisfying the requirements of patient-centered care.
A study conducted by McCormack and McCance (2019) highlights the importance of patient-centered care, which entails actively engaging patients in their own care and making treatment decisions that are in line with their preferences and values. They propose that although nurses are often dedicated to these values, the variation in compliance may be attributed to varying degrees of comprehension or resource accessibility.
Furthermore, Labrague et al. (2020) point out that obstacles like limited time and large patient loads might make it difficult to effectively advocate for patients.
Extent the Nurse Participants Use Patient-Centered Care as to Care Environment
Items Mean Interpretation
My workplace encourages teamwork and
collaboration. 2.85 Often
There is a strong culture of respect and dignity for
patients. 2.60 Often
My organization supports continuous learning and
development. 3.12 Often
The care environment is comfortable and
welcoming for patients. 3.11 Often
There are sufficient resources available to provide
quality care. 3.21 Often
The physical layout of my workplace supports
patient privacy. 3.45 Always
I have access to adequate support and resources
to perform my job. 2.73 Often
There is effective communication among
healthcare team members. 2.98 Often
I receive sufficient administrative support to deliver
patient-centered care. 3.20 Often
Average Mean 3.03 Often
According to the table, the statement "The physical layout of my workplace supports patient privacy" has the highest mean score of 3.45. This suggests that respondents regularly believe that their work environment is suitable for safeguarding patient privacy. This exemplifies a successfully executed element of patient-centered care, in accordance with Harris et al. (2020), who highlight the
significance of physical environments in protecting patient dignity and confidentiality.
On the other hand, the lowest average score of 2.60 for the statement "There is a strong culture of respect and dignity for patients" indicates that there is a more frequent but less strong perception of respect and dignity in patient contacts. The score indicates a possible area that may be improved in promoting a culture of respect, as emphasized by Gordon et al. (2019), who argue that developing a culture of respect is crucial for improving patient experiences and outcomes.
The mean average of 3.03, classified as "Often," indicates a generally good but sometimes fluctuating evaluation of workplace circumstances and endorsement of patient-centered treatment. This mean value suggests that although certain aspects, such as privacy and support, are highly respected, other areas such as collaboration and respect need more constant focus in order to properly promote patient-centered procedures, as observed by Baker et al. (2021).
Extent the Nurse Participants Use Patient-Centered Care as to Person-Centered Processes
Items Mean Interpretation
I provide clear and understandable information to
patients. 2.98 Often
I ensure that patients have the opportunity to ask
questions. 2.94 Often
I use active listening techniques in my interactions
with patients. 3.75 Always
I tailor care plans to meet the unique needs of
each patient. 3.11 Often
I involve patients in the development of their care
plans. 1.85 Sometimes
I regularly review and update care plans based on
patients' feedback. 1.79 Sometimes
I encourage patients to take an active role in their
care. 3.84 Always
I respect patients' decisions regarding their care. 3.45 Always I involve patients' families and friends in the care
process when appropriate. 3.28 Always
Average Mean 3.00 Often
According to the data presented in the table, the highest average score of 3.84 is associated with the statement "I encourage patients to take an active role in their care," which is interpreted as "Always." The impressive score for promoting patient involvement indicates that nurses excel at involving patients in their own care, which is in line with the perspective of McCormack and McCance (2017), who emphasize the importance of patient empowerment in delivering effective care. In the same way, a score of 3.75, indicating "Always" for the statement "I use active
listening techniques in my interactions with patients," demonstrates a strong commitment to active listening. This aligns with the research conducted by Kitson et al. (2020), which found that active listening improves patient satisfaction and the quality of care.
The lowest mean of 1.79 indicates that there is room for improvement in the area of regularly reviewing and updating care plans based on patients' feedback. There is a clear need for improvement in this area, as highlighted by Baker et al. (2021), who emphasize the importance of regular updates and feedback integration in providing personalized and responsive care.
With a mean of 3.00, which falls under the category of "Often," it seems that there is a generally positive approach to patient-centered care practices. However, it also suggests that there is room for improvement in terms of feedback-driven care planning and ongoing adjustments. This data highlights the significance of maintaining a harmonious combination of effective engagement strategies and systematic enhancements in care plan management.
Extent the Nurse Participants Use Patient-Centered Care as to its Outcomes
Items Mean Interpretation
1. I ensure that patients under my care report
high levels of satisfaction. 3.30 Always 2. I see to it that my patients feel valued and
respected during their interactions with
me. 3.01 Often
3. I know that my patients are satisfied with the information they receive about their
care. 2.74 Often
4. Patients experience improvements in their
health as a result of my care. 2.67 Often 5. Patients are able to manage their
conditions more effectively. 2.24 Sometimes 6. Patients achieve their personal health
goals. 2.19 Sometimes
7. Patients report an enhanced quality of life
due to my care. 1.92 Sometimes
8. Patients feel more empowered to make
decisions about their health. 2.96 Often 9. Patients experience a greater sense of
well-being. 1.87 Sometimes
Average Mean 2.54 Often
The table shows the results regarding patient-centered care and its impact on patient care and satisfaction from different perspectives. With a mean score of 3.30, which is interpreted as "Always" for the statement "I ensure that patients under my care report high levels of satisfaction," it is evident that there is a strong dedication to patient satisfaction. Based on the data, it appears that nurses consistently excel in providing care that not only meets patient expectations but
also enhances their overall satisfaction. This finding supports the argument made by Karaka and Durna (2019) that patient satisfaction is an important measure of quality care and is greatly impacted by the interactions between nurses and patients.
On the other hand, the lowest mean score of 1.92, indicating that patients feel their quality of life has improved due to my care, highlights a significant difference in how care is perceived to affect patients' overall well-being. Based on this score, it seems that patients occasionally experience an improved quality of life. However, it is important to note that this improvement is not consistently observed. Uda and Bagolong (2023) also highlight the difficulty of translating care efforts into measurable improvements in patients' quality of life. This can be attributed to various factors such as the complexity of health conditions and limitations in care delivery.
The average mean score of 2.54 indicates a tendency towards positive patient outcomes and satisfaction. However, it also emphasizes the need for significant improvement in certain areas. The average score suggests that there is variation in the consistency and impact of the practice’s nurses use to enhance patient care, despite their frequent engagement in these practices. In their study, Doroteo, et.al, (2020) highlight the importance of consistently engaging with patients and continuously addressing their unique needs and preferences in order to achieve high patient satisfaction and positive outcomes.
Based on the data, it is evident that nurses excel in prioritizing patient satisfaction and making patients feel appreciated. However, there seems to be a discrepancy
outcomes, empowerment, and overall quality of life. The findings of this study are in line with the research conducted by Pekonen, et.,al., (2020). It is acknowledged that nurses excel in delivering care, but effectively translating this into tangible patient empowerment and health management necessitates the implementation of specific strategies and allocation of resources.
It is worth mentioning that the mean score of 2.67 for "Patients experience improvements in their health as a result of my care" and a mean score of 2.96 for
"Patients feel more empowered to make decisions about their health" highlight the importance of prioritizing patient-centered strategies that promote health improvements and empowerment. According to Strong, et.al., (2023), it is crucial to incorporate patient feedback into care plans, enhance support for self- management, and promote a more collaborative approach to care in order to achieve these outcomes.
In general, the data indicates a strong dedication to patient satisfaction and respect. However, there are areas that require improvement, such as health outcomes, quality of life, and patient empowerment.
Table 5
Summary of Patient-Centered Care Index
The Patient Centered Care Index Average
Mean Interpretation
Prerequisites 3.22 Often
The Care Environment 3.03 Often
Person-Centered Processes 3.00 Often
Outcomes 2.54 Often
OVERALL MEAN 2.95 Often
Based on the results of the Patient Centered Care Index, it seems that patient- centered care practices are “Often” implemented. However, there is still room for improvement to enhance these practices further. It appears that healthcare providers often exhibit behaviors and follow processes that are in line with the principles of patient-centered care. This includes involving patients in their care decisions, respecting their preferences, and creating a supportive environment for their care. Nevertheless, the fact that the mean score is not higher underscores discrepancies in the implementation of these practices.
It suggests that although the groundwork for patient-centered care is in place, there are still inconsistencies and room for improvement in all aspects. It is crucial to make enhancements to guarantee that patient-centered care is not merely practiced occasionally or often, but rather consistently and comprehensively integrated into all facets of healthcare delivery. To bridge these gaps, it may be beneficial to enhance the training of healthcare providers, foster better communication and collaboration among healthcare teams, and ensure that
approaches.
Striving for a greater level of consistency in patient-centered care can result in improved patient outcomes, increased patient satisfaction, and overall enhancements in the quality of care delivered. This interpretation is in line with the findings of McCormack and McCance (O’Donell,2021) when they proposed the Patient-Centered Care framework which highlight the significance of ongoing growth and a nurturing atmosphere to fully reap the advantages of patient-centered care.
B. The Level of Knowledge, Attitude and Skills of The Participants in Using Patient-Centered Care
Table 6
The Level of Knowledge of the Nurse-Participants in Using Patient-Centered Care
Items Mean Interpretation
1. I am familiar with the core principles of patient-centered care 2.59 Good 2. I understand the strategies for involving patients in their care decisions 3.21 Good 3. I am knowledgeable about how to address patients' emotional and
psychological needs. 1.98 Fair
4. I know the importance of respecting patients' cultural and personal
preferences 2.01 Fair
5. I can explain the benefits of patient-centered care to my colleagues. 3.15 Good 6. I understand the role of patient education in empowering patients to
participate in their care. 3.26 Excellent
7. I am aware of the different communication techniques that can enhance
patient engagement. 2.65 Good
8. I know how to assess patient needs and preferences effectively. 2.68 Good 9. I am familiar with the ethical considerations related to patient-centered
care. 2.94 Good
10. I understand the importance of interdisciplinary collaboration in
delivering patient-centered care. 2.51 Good
Average Mean 2.70 Good
different aspects of patient-centered care, showcasing a variety of familiarity and comprehension. The highest mean is 3.26, was incurred by “I understand the role of patient education in empowering patients to participate in their care”. It is evident that nurses possess a deep understanding of the significance of patient education in fostering patient engagement and self-management. According to Barry and Edgman-Levitan (2019), it is emphasized that patient education plays a vital role in empowering patients and enabling them to make well-informed decisions regarding their care.
On the other hand, the lowest mean score of 1.98 for "I am knowledgeable about how to address patients' emotional and psychological needs," suggests that nurses feel less confident in this area. Based on the given information, it appears that there is room for improvement in terms of training and resources to effectively address the emotional and psychological needs of patients. These aspects are crucial for providing a comprehensive approach to healthcare. Eklund, et.al., (2019) highlight the importance of tending to emotional and psychological needs in order to provide thorough patient-centered care.
The average mean score of 2.70, which is considered "Good," indicates that nurses have a generally positive self-assessment of their knowledge regarding patient-centered care. This average suggests that nurses have a strong grasp of fundamental principles and practical strategies, while also pointing out specific areas that require additional education and support.
The results suggest that nurses possess a solid grasp of patient-centered care principles. However, there is room for improvement in terms of ongoing education, specifically in addressing emotional and psychological needs and respecting cultural preferences. Improving these areas can lead to better care and outcomes for patients.
The Level of Attitude of the Nurse-Participants in Using Patient-Centered Care
Items Mean Interpretation
1. I put importance to working collaboratively with interdisciplinary teams to provide patient-centered
care. 2.64 Agree
2. I feel that patient-centered care is essential for
providing high-quality healthcare. 2.79 Agree
3. I am motivated to adapt my practices to better
meet patients' individual needs. 3.54
Very Much Agree 4. I feel confident in my ability to implement patient-
centered care in my practice. 3.14 Agree
5. I believe that patient-centered care leads to better
patient satisfaction. 3.23 Agree
6. I believe that patient-centered care should be a
priority in all healthcare settings. 2.87 Agree 7. I feel that involving patients in their care can
sometimes slow down the care process. 1.95
Slightly Agree 8. I think that understanding a patient's life context is
crucial to providing effective care. 2.01
Slightly Agree 9. I believe that patient-centered care contributes to
better patient adherence to treatment plans. 2.87 Agree 10. I believe that implementing patient-centered care
requires additional training for all healthcare staff. 3.01 Agree
AVERAGE MEAN 2.81 Agree
The table presents the attitudes of nurse participants toward patient-centered care, with varying levels of agreement across different statements.
The highest mean of 3.54 for "I am motivated to adapt my practices to better meet patients' individual needs," which is interpreted as "Very Much Agree," suggests that nurses are strongly committed to customizing their practices to meet the unique needs of each patient. This indicates a high level of intrinsic motivation to participate in patient-centered care, which is consistent with Bolton, et.al. (2020), who emphasize the importance of specific attention in patient-centered approaches.
In contrast, the lowest mean score of 1.95 for "I feel that involving patients in their care can sometimes slow down the care process," which is interpreted as "Slightly Agree," indicates a slight trepidation that patient involvement may impede efficiency. This score suggests that nurses generally endorse patient-centered care; however, there are concerns regarding its potential impact on workflow.
Moody-Williams (2020) observe that patient-centered care may initially appear to be time-consuming; however, it ultimately results in more effective and satisfactory outcomes. This implies that these concerns may diminish with experience and enhanced processes.
The nurses' generally positive attitude toward patient-centered care is indicated by the average mean score of 2.81, which is interpreted as "Agree." This score suggests that there is a widespread consensus regarding the significance and value of patient-centered care in improving the quality of healthcare and patient satisfaction. The scores for the belief in the importance of patient-centered care for high-quality healthcare, confidence in the implementation of patient-centered care and its contribution to improved patient satisfaction which is 2.79, 3.14 and 3.23,
practices.
The findings indicate that nurses’ attitudes points to them being motivated and generally confident in the principles of patient-centered care, however, the study also acknowledge the challenges and need for further training. Enhancing training and addressing concerns about care efficiency could further strengthen the implementation of patient-centered practices, ultimately leading to better patient outcomes.
Table 8
The Level of Skill of the Nurse-Participants in Using Patient-Centered Care
Items Mean Interpretation
1.I communicate effectively with patients about their care options. 3.19 Good 2. I can develop individualized care plans based on patients' preferences and
needs. 2.78 Good
3. I integrate patients' cultural and personal preferences into their care. 2.71 Good
4. I routinely seek feedback from patients to improve their care experience. 2.07 Fair
5. I effectively involve patients' families in the care process when appropriate 2.78 Good 6. I am proficient in using motivational interviewing techniques to engage
patients. 3.24 Good
7. I can effectively manage conflicts that arise from differing patient and family
member opinions. 1.9 Fair
8. I routinely assess and document patients' preferences and values in their
care plans. 2.76 Good
9. I am skilled in coordinating with interdisciplinary teams to ensure holistic
care. 3.01 Good
10. I can adapt my communication style to meet the diverse needs of my
patients. 2.65 Good
Average Mean 2.71 Good
The self-assessed skills of nurse participants in delivering patient-centered care are presented in the table, with scores that reflect varying levels of proficiency.
The highest mean score of 3.24 for "I am proficient in using motivational interviewing techniques to engage patients," which is interpreted as "Good,"
suggests that nurses feel particularly competent in this area. Motivational interviewing is a critical approach to patient-centered treatment, as it enables
modifications. Chan and So (2021) emphasize the efficacy of motivational interviewing in enhancing health outcomes and fostering patient engagement.
In contrast, the lowest mean score of 1.90 for "I can effectively manage conflicts that arise from differing patient and family member opinions," which is interpreted as "Fair," indicates a significant gap in conflict management skills. This lower score suggests that, despite the fact that nurses may be proficient in other areas, the management of interpersonal conflicts continues to be a difficult aspect of patient- centered care. Mosadeghrad and Mojbafan (2019) underscore the significance of conflict resolution skills in healthcare, noting that unresolved conflicts can have a detrimental effect on patient satisfaction and care outcomes.
The average mean score of 2.71, which is interpreted as "Good," indicates that nurses generally have a positive self-assessment of their patient-centered care skills. This average suggests that nurses are self-assured in the majority of patient- centered care-related tasks, including the coordination of interdisciplinary teams to ensure comprehensive care and effective communication with patients regarding their care options. These results are consistent with Baek, et.al. (2023), who assert that the provision of high-quality patient-centered care is contingent upon the establishment of effective communication and collaboration.
Finally, the nurses exhibit robust abilities in numerous patient-centered care domains; however, there are specific areas, including conflict management and patient feedback, that necessitate additional training and development. Healthcare
organizations can improve the quality of patient-centered care, which in turn leads to improved patient satisfaction and outcomes, by addressing these gaps.
centered care?
C. The Challenges Encountered by The Participants in Utilizing Patient Centered Care
Table 9
The Challenges Encountered by the Participants in Utilizing Patient Centered Care
Items Mean Interpretation
1. I often do not have enough time to provide patient-
centered care due to heavy workloads. 3.41
Very Much Agree 2. The shortage of nursing staff makes it difficult to
implement patient-centered care. 3.56
Very Much Agree 3. I have not received sufficient training in patient-
centered care practices. 2.64 Agree
4. Administrative tasks reduce the time I can spend on
patient-centered care. 3.34
Very Much Agree 5. The culture in my workplace does not prioritize
patient-centered care. 2.54 Agree
6. There are insufficient resources (e.g., equipment,
materials) to deliver patient-centered care effectively. 2.01 Slightly Agree 7. I do not receive enough support from management to
practice patient-centered care. 2.74 Agree
8. Hospital policies and procedures do not facilitate
patient-centered care. 3.54
Very Much Agree 9. Poor communication within the healthcare team
hinders patient-centered care. 2.5 Agree
10. The physical layout of the hospital makes it difficult
to provide patient-centered care. 1.72 Disagree
11. High patient expectations make it challenging to meet
their needs consistently. 2.72 Agree
12. Lack of cooperation from patients makes it difficult to
implement patient-centered care. 3.65
Very Much Agree 13. The diversity of patient backgrounds and needs
poses challenges for patient-centered care. 3.28
Very Much Agree 14. Insufficient time to educate patients about their care
hinders patient-centered care. 3.46
Very Much Agree 15. Managing complex patient cases makes it difficult to
maintain a patient-centered approach. 2.56 Agree 16. Emotional burnout affects my ability to provide
patient-centered care. 1.93 Slightly Agree
17. Difficulty in maintaining work-life balance impacts my
patient-centered care practices. 1.78 Slightly Agree
18. Low job satisfaction affects my motivation to practice
patient-centered care. 3.64
Very Much Agree 19. High levels of stress hinder my ability to deliver
patient-centered care. 3.57
Very Much Agree 20. Lack of confidence in my clinical skills makes it
challenging to practice patient-centered care. 2.53 Agree
Average Mean 2.86 Agree
The table provides an overview of the challenges nurse participants face in implementing patient-centered care, with scores indicating the extent of these challenges.
The most significant obstacle is made apparent by the highest mean score of 3.65 for "Lack of cooperation from patients makes it difficult to implement patient- centered care," which is interpreted as "Very Much Agree." This discovery implies that patient non-cooperation is a significant impediment to the provision of care that is customized to the unique requirements of each patient, thereby impeding the ability of nurses to provide effective care. This is consistent with the assertion of Chegini, et.al. (2021), who emphasize the importance of patient engagement in
a lack of cooperation can have on care processes.
The lowest mean score of 1.72 for "The physical layout of the hospital makes it difficult to provide patient-centered care," which is interpreted as "Disagree,"
suggests that the physical environment is not perceived as a significant barrier to providing patient-centered care. This implies that the hospital's structural components, including its design and architecture, are generally sufficient to support patient-centered care practices (Amato, et.al., 2022).
The average mean score of 2.86, which is interpreted as "Agree," indicates that nurses generally perceive significant obstacles in the implementation of patient- centered care. The nurse participants encounter numerous substantial obstacles to the implementation of patient-centered care, such as patient non-cooperation, personnel shortages, elevated stress levels, and time constraints. It is imperative to address these challenges by improving resource allocation, providing supportive management, and providing continuous training in order to improve the quality and effectiveness of patient-centered care.
D. The Recommendations of the Participants in Enhancing Patient Centered Care
Table 10
The Recommendations of the Participants in Enhancing Patient Centered Care
Items
Frequency
of Mention Rank 1. Provide regular training sessions and
workshops focused on patient-centered care
practices. 32 1
2.Offer programs to improve nurses' communication skills, emphasizing active
listening and empathy. 8 9
3. Promote better collaboration and
communication among different healthcare
team members. 12 8
4. Ensure adequate nurse-to-patient ratios to
allow for more personalized and attentive care. 26 3 5. Provide necessary resources and equipment
to support patient-centered care initiatives. 18 6 6. Regularly collect and act on patient feedback
to improve care practices and policies. 16 7 7. Implement programs to address nurse
burnout and promote mental health and well-
being. 28 2
8. Cultivate a workplace culture that values and
prioritizes patient-centered care. 24 4
9. Implement and utilize technology solutions (e.g., electronic health records, telehealth) to
support patient-centered care. 4 10
10. Adjust scheduling to ensure nurses have enough time to engage with patients
meaningfully. 22 5
centered care.
"Regular training sessions and workshops" is the most frequently mentioned, with 32 mentions. Programs that address nurse fatigue are mentioned 28 times, and assuring adequate nurse-to-patient ratios is mentioned 26 times. There are 24 mentions of the importance of fostering a workplace culture that prioritizes patient- centered care, and 22 mentions of the importance of adjusting scheduling to facilitate meaningful patient engagement. They both rank highly. Although less frequently mentioned, it is essential to provide the requisite resources (18 mentions) and capture patient feedback (16 mentions) on a regular basis. The essential but less prioritized tasks of fostering collaboration among healthcare team members (12 mentions) and enhancing communication skills (8 mentions) are both crucial. The implementation of technology solutions with four mentions is the lowest-ranked, suggesting a need for improved integration.
These findings align with Carthon, et.al., (2020), who emphasize the importance of continuous professional development and a supportive work environment in promoting patient-centered care. A supportive work environment and continuous professional development are essential for the promotion of patient-centered care.
Ongoing training guarantees that nurses are well-versed in the most recent information and abilities to effectively address the diverse requirements of patients, thereby promoting improved clinical competence, empathy, and communication.
Enhanced job satisfaction and reduced fatigue are the results of a supportive work environment that is defined by a culture that prioritizes patient-centered practices,
adequate personnel, and resources. This environment enables nurses to deliver more personalized and focused care.
In the same manner, Kim, et.al. (2020) reinforce the importance of nurse fatigue and sufficient personnel in improving the quality of care. Regular training and a supportive culture are essential for the enhancement of patient-centered practices, ensuring that nurses are endowed with the requisite skills and resources to provide effective, personalized, and empathetic care.
Proposed Enhancement of Patient-Centered Care
In order to improve patient-centered care, there are several suggestions that can be made to create a more effective, empathetic, and efficient healthcare experience.
1. Integrating advanced technologies, such as electronic health records (EHRs), telehealth, and patient portals, can greatly enhance the delivery of patient-centered care. Electronic health records (EHRs) enhance the management of patient information, promoting improved communication among healthcare providers and facilitating well-informed decision-making.
Telehealth provides patients with increased access to care, especially for those in remote or underserved areas. Patient portals enable individuals to take an active role in managing their health by granting them access to their medical records, test results, and communication tools with their healthcare team.
is crucial to customize care plans to address the specific requirements, preferences, and values of every patient. This ensures that treatment methods are not only medically efficient but also in line with the patient's individual objectives and way of life. This approach promotes increased patient engagement, adherence to treatment, and overall satisfaction with the care provided.
3. In addition, it is crucial to enhance patient and family education in order to enhance patient-centered care. Offering thorough and clear information on diagnoses, treatment options, and self-care strategies empowers patients to make informed decisions and actively engage in their own care. It is crucial to develop educational materials that are sensitive to different cultures and easily understandable by diverse populations. This is necessary to bridge the gap in health literacy and to ensure that all patients are well-informed.
4. Effective communication skills training for healthcare providers is also crucial. Being able to effectively communicate is crucial for providing patient-centered care. It is important for training programs to prioritize skills such as active listening, empathy, and clear, respectful dialogue. By honing these abilities, healthcare professionals can cultivate deeper connections with patients, handle concerns with greater efficiency, and foster a more nurturing care atmosphere.
5. Utilizing a multidisciplinary approach can greatly improve the quality of patient-centered care. Collaboration among different healthcare professionals, such as physicians, nurses, social workers, and mental health specialists, guarantees a comprehensive approach to meeting all of a patient's needs. Teams with diverse expertise can collaborate to create comprehensive care plans, exchange knowledge, and offer well-rounded assistance, leading to better results and patient contentment.
6. In addition, it is essential to include patients in decision-making processes.
Shared decision-making models enable patients to take an active role in their healthcare, allowing them to make decisions that align with their personal values and preferences. Using tools like decision aids can make this process easier by giving patients straightforward and unbiased information about their choices and possible results.
7. Consistently evaluating and addressing patient feedback is crucial for ongoing enhancement in patient-centered care. Introducing methods for patients to share their thoughts, like surveys or focus groups, enables healthcare organizations to pinpoint areas that need improvement and make the necessary changes to enhance the overall care experience.
8. Ultimately, fostering an environment of empathy and dignity in healthcare settings can have a profound effect on providing care that prioritizes the needs of patients. Promoting a compassionate and considerate approach from healthcare professionals creates a nurturing atmosphere that values
physical well-being.
By incorporating these improvements, healthcare systems can prioritize patient- centered care, resulting in better outcomes, higher patient satisfaction, and a more comprehensive approach to health and well-being. These enhancements include utilizing technology, tailoring care to individual needs, enhancing education, facilitating effective communication, encouraging collaboration among different healthcare disciplines, involving patients in decision-making, addressing feedback, and promoting compassion.
Summary of Findings
Based on the results of the study, the following findings are presented:
1. As to the extent the nurse participants use patient-centered care, it is
“Often” implemented. The "Often" implementation of patient-centered care by nurse participants implies that while they regularly apply PCC principles, there is room for improvement to ensure more consistent and comprehensive integration. This suggests that while patient-centered practices are a routine part of care, achieving a higher standard remains a goal.
2. As to the level of knowledge, attitude and skills of the participants in using patient-centered care, it was found out that the nurse-participants’
knowledge is good which means that are knowledgeable on PCC but
they still need more training and additional information on it so they can apply it to the fullest.
As to their attitudes toward PCC, it was found out that they “Agree” with its use or implementation in their areas of assignment. They are motivated to adapt their practices to better meet patients' individual needs.
As to the skills on the application of PCC, the participants rated themselves as
“Good”. When participants rate their skills in applying Patient-Centered Care (PCC) as "Good," it suggests that they have a strong sense of confidence and effectiveness in integrating PCC principles into their practice. Nevertheless, this rating also implies that there is potential for improvement in order to reach a higher standard of patient-centered practices.
3. In terms of the challenges encountered by the participants in utilizing patient centered care, it was found out that the lack of cooperation from patients makes it difficult for them to implement patient-centered care. However, they do not find the hospital layout as a hindrance to the PCC.
4. As to the recommendations of the participants in enhancing patient centered care, most of them suggests to provide regular training sessions and workshops focused on patient-centered care practices.
Conclusions
Based on the findings of the study, the following conclusions are drawn.
1. Patient Centered Care is used by nurses in hospitals.
very positive.
3. The most challenging part of its implementation is on the cooperation of the patient and family members.
4. The foremost recommendation made by the nurses is for further training and workshops to be made available to them.
Recommendations
In light of the conclusions drawn, the following recommendations are hereby proposed:
1. To advocate for patients' needs and preferences in patient-centered care, nurses should actively listen, respect the patients’ values, involve them in decision-making, and tailor treatment plans to align with their personal goals and preferences.
2. To effectively address patients' emotional and psychological needs, the nurses should prioritize empathetic communication, active listening, and supportive counseling. They should create a safe space where patients feel heard, validated, and encouraged to express their feelings.
3. The patients should be involved in their care to enhance outcomes despite potential slowdowns in the delivery of healthcare. Engaging them ensures informed decisions, boosts compliance, and fosters trust, ultimately leading to more efficient and personalized care over time.
4. To manage conflicts between patients and family members, nurses should practice active listening, mediate discussions with empathy, and facilitate collaborative problem-solving, ensuring all perspectives are considered and maintaining a focus on patient well-being.
5. Encourage patient cooperation in patient-centered care by actively involving them in planning for their care, clearly explaining treatment options, and addressing their concerns appropriately. The nurse should build a trusting relationship and foster open communication.
6. Promote the use of technology solutions like electronic health records and telehealth by highlighting their benefits for patient-centered care, such as improved communication, accessibility, and personalized treatment. Provide training and support to ensure seamless integration.
7. Future researchers should explore the impact of integrating advanced technology in patient-centered care, focusing on patient outcomes, satisfaction, and efficiency. They should investigate barriers to adoption and strategies to enhance technology’s effectiveness in diverse healthcare settings.
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APPENDICES
Research Instrument Name (Optional)
Directions: Put a check mark on the column that best describe your response using the legend below.
A. Extent of the Use of PCC
4 3.25 - 4.00 Always 3 2.50 - 3.24 Often 2 1.75 - 2.49 Sometimes 1 1.00 - 1.74 Never
Items 4 3 2 1
Prerequisites
I am confident in my clinical skills and
knowledge.
I regularly update my professional skills
and knowledge.
I render care adequately because I am
trained to deliver patient-centered care.
I build trusting relationships with patients.
I listen carefully to what patients have to
say.
I am sensitive to patients' emotional
needs.
I always put the patients' needs first.
I am committed to providing the highest
quality care possible.
preferences.
The Care Environment
I encourage teamwork and collaboration in
my workplace
There is a strong culture of respect and
dignity for patients.
My organization supports continuous
learning and development.
The care environment is comfortable and
welcoming for patients.
There are sufficient resources available to
provide quality care.
The physical layout of my workplace
supports patient privacy.
I have access to adequate support and
resources to perform my job.
There is effective communication among
healthcare team members.
I receive sufficient administrative support
to deliver patient-centered care.
Person-Centered Processes
I provide clear and understandable
information to patients.
I ensure that patients have the opportunity
to ask questions.
I use active listening techniques in my
interactions with patients.
I tailor care plans to meet the unique
needs of each patient.
I involve patients in the development of
their care plans.
I regularly review and update care plans
based on patients' feedback.
I encourage patients to take an active role
in their care.
I respect patients' decisions regarding their
care.
I involve patients' families and friends in
the care process when appropriate.
Outcomes
I ensure that patients under my care report
high levels of satisfaction.
I see to it that my patients feel valued and respected during their interactions with
me.
I know that my patients are satisfied with the information they receive about their
care.
Patients experience improvements in their
health as a result of my care.
Patients are able to manage their
conditions more effectively.
Patients achieve their personal health
goals.
Patients report an enhanced quality of life
due to my care.
Patients feel more empowered to make
decisions about their health.
Patients experience a greater sense of
well-being.
B.1 Knowledge
4 3.25 - 4.00 Excellent
3 2.50 - 3.24 Good
2 1.75 - 2.49 Fair
1 1.00 - 1.74 Poor
Items Mean Interpretation
1. I am familiar with the core principles of
patient-centered care 2.59 Good
2. I understand the strategies for
involving patients in their care decisions 3.21 Good 3. I am knowledgeable about how to
address patients' emotional and
psychological needs. 1.98 Fair
4. I know the importance of respecting patients' cultural and personal
preferences 2.01 Fair
5. I can explain the benefits of patient-
centered care to my colleagues. 3.15 Good 6. I understand the role of patient
education in empowering patients to
participate in their care. 3.26 Excellent 7. I am aware of the different
communication techniques that can
enhance patient engagement. 2.65 Good
8. I know how to assess patient needs
and preferences effectively. 2.68 Good 9. I am familiar with the ethical
considerations related to patient-
centered care. 2.94 Good
10. I understand the importance of interdisciplinary collaboration in
delivering patient-centered care. 2.51 Good
B.2 Attitudes
4 3.25 - 4.00 Very Much Agree
3 2.50 - 3.24 Agree
2 1.75 - 2.49 Slightly Agree
1 1.00 - 1.74 Disagree
Items 4 3 2 1
1. I put importance to working
collaboratively with interdisciplinary teams
to provide patient-centered care.
2. I feel that patient-centered care is essential for providing high-quality
healthcare.
3. I am motivated to adapt my practices to
better meet patients' individual needs.
4. I feel confident in my ability to implement patient-centered care in my
practice.
5. I believe that patient-centered care
leads to better patient satisfaction.
6. I believe that patient-centered care should be a priority in all healthcare
settings.
7. I feel that involving patients in their care can sometimes slow down the care
process.
8. I think that understanding a patient's life context is crucial to providing effective
care.
contributes to better patient adherence to
treatment plans.
10. I believe that implementing patient- centered care requires additional training
for all healthcare staff.
B.3 Skills
4 3.25 - 4.00 Excellent
3 2.50 - 3.24 Good
2 1.75 - 2.49 Fair
1 1.00 - 1.74 Poor
Items 4 3 2 1
1.I communicate effectively with patients
about their care options.
2. I can develop individualized care plans
based on patients' preferences and needs.
3. I integrate patients' cultural and
personal preferences into their care.
4. I routinely seek feedback from patients
to improve their care experience.
5. I effectively involv
