Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

The Vital Blend of Clinical Competence and Compassion: How Patients Experience Person-Centred Care

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

The Vital Blend of Clinical Competence and Compassion: How Patients Experience Person-Centred Care

Article excerpt

Introduction

The provision of compassionate, person-centred care is very much at the forefront of contemporary health care. The concept, while not new, gained greater recognition with the work of Tom Kitwood (1997) in aged and dementia care as a way to address the dehumanisation of older people that occurred in long-term care. Kitwood theorised that the quality of care delivered to people with dementia was dependent upon nurses' beliefs about the patient's worth and value (Kitwood, 1997). Nurses who bestowed value on the person, recognised their personhood, were more likely to deliver person-centred care, whereas nurses who devalued the worth of a person with dementia were less likely to provide this level of care (Kitwood, 1997). Thus, person-centred care rested upon nurses' recognition of personhood, and for Kitwood (1997), was founded on a relationship based on respect and trust. Personhood is the status conferred upon a person; indeed recognition that they were a person worthy of respect and having value (Kitwood, 1997). Since this time, others have built on the concept and it is acknowledged that person-centred care aims to improve the patient's experience and provide good clinical care that aligns with the person's individual values and needs (McCance, Gribben, McCormack, & Laird, 2013). Person-centred care is consistent with the nursing profession's claim to holistic, individualised care and has been a fundamental aspect of nursing philosophy since the foundation of the profession (Wagner & Waite, 2010). Patients who receive person-centred care report increased satisfaction, have fewer adverse incidents, enjoy safer care and have better self-care abilities than those not receiving such care (Jorm, Dunbar, Sudano, & Travaglia, 2009; McCormack & McCance, 2006; Nolan, Davies, & Brown, 2006; Nolan, Davies, Brown, Keady, & Nolan, 2004; Price, 2006; Redman, 2008; Sidani, 2008; Spath, 2008). Nurses who deliver person-centred care report greater workplace satisfaction than other nurses do (Cunningham et al., 2008).

Unfortunately, some patients continue to experience suboptimal care, evidenced by their physical and emotional needs being unmet (Coward, 2013; Eriksson & Svedlund, 2007). A recent news report in Australia suggested that '45% of patients received substandard care' (Kerrin, 2012); another in the United Kingdom (UK) asked, 'Why have so many nurses stopped caring?' (Coward, 2013). Such shock headlines are particularly evident in the UK, where several high-profile inquiries such as the Mid-Staffordshire inquiry (Francis, 2013) have received much media attention. This inquiry arose from patient complaints of neglect, poor care, and even harm at the hands of clinicians, including nurses (Francis, 2013). However, this issue is not unique to the UK; many nurses worldwide will at least have worked alongside a colleague who fails to display empathy and caring toward patients (Darbyshire & McKenna, 2013). Dehumanisation of people possibly occurs in acute care settings as much as it does in long-term care settings, however, acute care has a number of unique challenges that might mean that humanising solutions proven to work in elder care may not necessarily be transferable. Some of these unique challenges include: fast throughput of patients, highly technical procedures, advancing scope of practice and the ever increasing burden of audits, measurement and meeting accreditation standards making a task-orientation impossible to diminish (ACSQHC, 2011; ACHS, 2013; Bertakis & Azari, 2011). In this climate there is a risk that the organisational priorities shift toward efficiency and away from person centredness.

Compassionate care is a key component of person centredness and regarded as fundamental to good nursing practice (Wagner & Waite, 2010). Indeed, many students of nursing cite altruistic or 'caring' motives for entering the profession (Eley, Eley, & Roger-Clark, 2010). …

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