Investigating patient centered care in an acute older adult ward - a qualitative study

Ball, J

Abstract

This project investigates patient centred care on an acute older persons' unit in a NHS
Trust in the UK. It uses a method based on grounded theory, integrated with an
ethnographic approach to examine the knowledge, beliefs and behaviour of staff
working on an acute older persons' unit regarding patient centred care. The data was
gathered over a period of one year using interviews and participant observation.
The National Service Framework for Older People produced by the Department of
Health (DOH) is the first ever, comprehensive strategy to ensure fair, high quality,
integrated health and social care services for older people. It is a 10 year programme of
action linking services to support independence and promote good health, specialised
services for key conditions, and culture change so that all older people and their carers
are always treated with respect, dignity and fairness (DOH 2001). Patient-centred care
is central to this strategy, however Nolan & Davies (2002) suggest that patient-centred
care may not be the panacea that it is held up to be and may perpetuate, rather than
eliminate poor standards of care for older people. Nolan et al (2002) stated that
although 'patient-centred care' has challenged many negative stereotypes and lies at
the heart of the NSF for older people, it presents a rather limited vision. They instead
promote 'relationship-centred care' initially proposed by the Tresolini and Pew-Fetzer
Task Force (1994), this focuses on the relationships that form the context of care.
McCormack in his 2004 review observes that patient-centred practice is a recurring
theme in the gerontological nursing literature, there are many descriptive accounts of
attempts at developing patient-centred practice but in reality there are few studies that
identify the benefits of this way of working. He raises the question that perhaps good
quality care for older people and patient-centred care may indeed be the same thing,
suggesting that we shouldn't chase after an ideal of patient-centredness, but instead
strive for a constant state of 'becoming more patient-centred' in our practice.
Dewing (2004) looked at five frameworks that appear to promote patient-centredness
in nursing which for the for the most part, are all conceptual and all advocate the values of patient-centred care. Dewing questions the collective belief that
person-centred care is now being achieved when the degree to which practitioners
know the older person is actually very limited, claiming that this is exacerbated by the
limited vision of patient-centred care set out in the National Service Framework for
Older People. Dewing recommends further work into translating the complex
conceptual frameworks into ones that are meaningful to older people and the nurses
working with them. In her conclusion Dewing suggests that when frameworks are
used in a technical way, the older person and/or oneself is made to 'fit' into the
framework. The challenge of nursing older people in a patient or relationship-centred
way is often aggravated by trying to consciously and intentionally use frameworks. As
patient-centred care is the central philosophy around which services for older people
are being developed and how they are likely to develop in the future, it is prudent to
look at whether this way of caring translates from theory into practice and how it
affects the patient experience.
Semi-structured interviews were conducted with staff nurses and healthcare assistants
on the three wards on the older persons unit. 60 'personal memos' and field notes were
recorded in over 100 hours spent on the wards as a participant observer.
The interviews and field notes were analysed. Quotes and pertinent material that
related to each other were sorted by hand into eight initial categories. These categories
were analysed further and sorted into four final themes. The themes identified from
the data were used to form a descriptive analysis. The results of the study generated
insights into the nature of patient centred care in the acute care of older people. The
four major categories which emerged from the findings, are discussed and analysed in
this thesis. These were 'it's about the individual', 'if only we had time', 'it's 98%
relationships' and 'too posh to wash'.
The conclusions describe the factors affecting patient centred care and how these are
related to practice and policy. Evidence of patient centred care was observed on the
ward and also relationship centred care was recorded. While many nursing activities were consistent with patient centred care the study results also highlighted factors
influencing these activities and suggests opportunities to perhaps help improve
nursing practice. To ensure patient centred care remains at the core of nursing practice
on the OPU nurses should carry out ongoing assessment of patients needs in relation to
their care and try to encourage patients to participate actively in their care. From these
findings it is apparent that a patient centred approach would have to involve
practitioners having appropriate space and support to enable them to work in this
manner. This may require the provision of clinical supervision and training and space
for reflection on their work with older people. They themselves would need to feel
valued and recognised both by their colleagues and the organisation that they work
for.

Citation

Ball, J. Investigating patient centered care in an acute older adult ward - a qualitative study. (Dissertation). University of Salford

• Thesis Type: Dissertation
• Deposit Date: Aug 16, 2021
• Award Date: Jan 1, 2011