Document Type : Original Article
Authors
- . Firouzeh Charosaei
- . Shahnaz Rostami 1
- . Maryam Esmaeili 2
- . Shahram Molavynejad 1
- . Zohreh Vanaki 3
1 Nursing Care Research Center in Chronic Disease, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
2 Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
3 Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
Abstract
BACKGROUND: Patient‑centered care (PCC) is a cornerstone for health‑care professionals to
improve the quality of care they provide to patients with cardiac disease. However, implementation
of PCC programs has always accompanied with unpredictable challenges and obstacles. Therefore,
the present study was conducted to determine effective strategies for the implementation of PCC
from the perspective of patients and healthcare providers.
MATERIALS AND METHODS: The present research was a qualitative study using conventional content
analysis method in one of the university hospitals of Abadan University of Medical Sciences during
2019–2020. Purposive sampling was performed until data saturation was achieved. Data were collected
through four focused group discussions and 24 in‑depth semi‑structured interviews with 22 health‑care
providers and seven cardiac patients. Depending on the interview process and the responses of each
individual, the sequencing of questions was different from one participant to another. Data analysis was
performed continuously and concurrently with data collection, using a comparative method.
RESULTS: After data analysis, seven subcategories and three main categories were extracted. The
main categories included structural, process, and outcome strategies. The category of structural
strategies included subcategories of nursing care organization, application of appropriate motivational
mechanisms, and expansion of team coordination. Process strategies included three subcategories,
namely, promoting communication, respectful and compassionate care, and the development of
holistic care. Finally, the outcome strategy consisted of the subcategory of patient empowerment.
CONCLUSION: The practical strategies for the implementation of PCC in coronary care unit revealed
in this study were at structural, process, and outcome levels. Health‑care managers and administrators
can avail themselves of the findings of the present study to promote the quality care for cardiac care
unit patients and improve patient satisfaction.
Keywords
- Institute of Medicine Committee on Quality of Health Care in
A. Crossing the Quality Chasm: A New Health System for the
21st Century. Washington, DC, USA: National Academies Press; 2001.
2. Esmaeili M, Cheraghi MA, Salsali M. Explaining the context
of patient‑centered care in critical care units. J Holistic Nurs
Midwifery 2017;27(3):17‑26.
3. Driscoll A, Currey J, George M, Davidson PM. Changes in health
service delivery for cardiac patients: Implications for workforce
planning and patient outcomes. Aust Crit Care 2013;26(2):55‑7.
4. Shafipour V. Healing presence: Experiences and perceptions of
cardiac intensive care patients concerning the nurse presence.
Med Surg Nurs J 2015;3(4):177‑84.
5. Fremont AM, Cleary PD, Hargraves JL, Rowe RM, Jacobson NB,
Ayanian JZ. Patient‑centered processes of care and long‑term
outcomes of myocardial infarction. J Gen Intern Med
2001;16(12):800‑8.
6. Schoen C, Osborn R, Huynh PT, Doty M, Zapert K, Peugh J, et al.
Taking the pulse of health care systems: Experiences of patients
with health problems in six countries. Health Aff (Millwood)
2005;24 (Suppl 1) Web Exclusives: W5‑509‑25.
7. Sidani S, Collins L, Harbman P, MacMillan K, Reeves S,
Hurlock‑Chorostecki C, et al. Development of a measure to assess
healthcare providers’ implementation of patient‑centered care.
Worldviews Evid Based Nurs 2014;11(4):248‑57.
8. Rassouli M, Zamanzadeh V, Valizadeh L, Ghahramanian A,
Asghari E. Limping along in implementing patient‑centered care:
Qualitative study. NPT 2020;7(3):217‑25.
9. Sidani S, Reeves S, Hurlock‑Chorostecki C, van Soeren M, Fox M,
Collins L. Exploring differences in patient‑centered practices
among healthcare professionals in acute care settings. Health
Commun 2018;33(6):716‑23.
10. Roberge D, Tremblay D, Turgeon MÈ, Berbiche D. Patients’ and
professionals’ evaluations of quality of care in oncology outpatient
clinics. Support Care Cancer 2013;21(11):2983‑90.
11. Ghane G, Esmaeili M. Status of patient‑centered care in health
system of Iran. Sci J Nurs Midwifery Paramed Fac 2019;4 (3):1‑5.
12. Ng GK, Leung GK, Johnston JM, Cowling BJ. Factors affecting
implementation of accreditation programmes and the impact of
the accreditation process on quality improvement in hospitals:
A SWOT analysis. Hong Kong Med J 2013;19(5):434‑46.
13. Rathert C, Wyrwich MD, Boren SA. Patient‑centered care and
outcomes: A systematic review of the literature. Med Care Res
Rev 2013;70(4):351‑79.
14. Nikfarid L, Rasouli M. Caring curriculum: A new paradigm in
nursing education. Iran J Nurs 2011;24(70):61‑71.
15. BahadoriM, RavangardR, AlimohammadzadehK. The accreditation
of hospitals in iran. Iran J Public Health 2015;44(2):295‑6.
16. Abbasi S, Tavakoli N, Moslehi M. Readiness of hospitals with
quality management systems based on Joint Commission on
accreditation standards. Health Inf Manag 2012;9(4):512‑26.
17. Brubakk K, Vist GE, Bukholm G, Barach P, Tjomsland O.
A systematic review of hospital accreditation: The challenges of
measuring complex intervention effects. BMC Health Serv Res
2015;15(1):280:1‑10.
18. Nyhof BB, Jameel B, Dunn S, Grace SL, Khanlou N, Stewart DE,
et al. Identifying strategies to implement patient‑centred care for
women: Qualitative interviews with women. Patient Educ Couns
2020;103(7):1422‑7.
19. Scholl I, Zill JM, Härter M, Dirmaier J. An integrative model of
patient‑centeredness‑A systematic review and concept analysis.
PLoS One 2014;9(9):e107828.
20. Graneheim UH, Lundman B. Qualitative content analysis in
nursing research: Concepts, procedures and measures to achieve
trustworthiness. Nurse Educ Today 2004;24(2):105‑12.
21. Polit DF, Beck CT. Nursing Research: Generating and Assessing
Evidence for Nursing Practice. 10th ed. Philadelphia: Wolters
Kluwer, Lippincott Williams & Wilkins; 2017.
22. Santana MJ, Manalili K, Jolley RJ, Zelinsky S, Quan H, Lu M. How
to practice person‑centred care: A conceptual framework. Health
Expect 2018;21(2):429‑40.
23. Nobahar M. Care quality in critical cardiac units from
nurses perspective: A content analysis. J Qual Res Health Sci
2014;3(2):149‑61.
24. Ahmadi F, Nobahar M, Alhani F, Falahi Khoshknab M.
Perspectives of retired nurses on factors that affect quality of
nursing care. Hayat 2011;17(1):24‑34.
25. Bentley SA, Tellis B, Michel KL, O’Connor P, Clarke C,
Keeffe JE. A consumer informed workshop can improve
knowledge and attitude to patient‑centered care among hospital
clinicians‑in‑training. J Educ Health Promot 2015;4(1):104.
26. Linschi A. Implementation of Patient‑Centered Care Into
Nursing Practice: A Qualitative Literature Review [Dissertation].
Yrkeshögskolan Novia: Novia University of Applied Sciences ; 2019.
27. Amrolahi Mishavan F, Memarian R, Vanaki Z. The effect of
participatory supervision program for nurses on patients’
satisfaction in medical‑surgical wards. Q J Ners Manag
2012;1(2):55‑62.
28. Heshmati Nabavi F, Memarian R, Vanaki Z. The effect of
implementing clinical supervision model on the patient education
outcomes. J Health Promot Manag 2012;1(3):28‑36.
29. Mahmoodi Shan G, Alhani F, Ahmadi F, Kazemnejad A. Ethics
in nurses’ lifestyle: A qualitative study. Med Ethics History Med
2009;2(4):63‑78.
30. Esmaeili M, Cheraghi M A, Salsali M. Barriers to patient‑centered
care: A thematic analysis study. Int J Nurs Knowl 2014;25 (1):2‑8.
31. Valizadeh S, Haririan H. Nurses work motivation: A big challenge
for health system; A review article. Prev Care Nurs Midwifery J
2016;5(2):56‑64. - 32. McCormack B, Dewing J, McCance T. Developing person‑centred
care: Addressing contextual challenges through practice
development. Online J Issues Nurs 2011;16(2):3.
33. Nobahar M. Professional errors and patient safety in intensive
cardiac care unit. J Holistic Nurs Midwifery 2015;25(77):63‑73.
34. Danial Z. Effect of total quality management in determining
the educational needs of critical wardsnurses. J Crit Care Nurs
2009;2(3):117‑20.
35. Goulart BF, Camelo SHH, Simões ALdA, Chaves LDP. Teamwork
in a coronary care unit: Facilitating and hindering aspects. Rev
Esc Enferm USP 2016;50(3):482‑9.
36. Peikes D, Chen A, Schore J, Brown R. Effects of care coordination
on hospitalization, quality of care, and health care expenditures
among Medicare beneficiaries: 15 Randomized trials. JAMA
2009;301(6):603‑18.
37. van der Cingel M, Brandsma L, van Dam M, van Dorst M,
Verkaart C, van der Velde C. Concepts of person‑centred care:
A framework analysis of five studies in daily care practices. Int
Pract Dev J 2016;6(2):1‑17.
38. Nkrumah J, Abekah‑Nkrumah G. Facilitators and barriers of
patient‑centered care at the organizational‑level: A study of three
district hospitals in the central region of Ghana. BMC Health Serv
Res 2019;19(1): 1‑11.
39. Nikmanesh P, Kavosi Z, Sadeghi A, Yusefi AR. Effect of
communication skills training of nurses on patient satisfaction
about nursing services in hospitals affiliated to shiraz university
of medical sciences. Hospital 2018;17(2):59‑70.
40. Epstein RM, Street RL Jr. The values and value of patient‑centered
care. Ann Fam Med 2011;9(2):100‑3.
41. Morgan S, Yoder LH. A concept analysis of person‑centered care.
J Holist Nurs 2012;30(1):6‑15.
42. Smith S, Dewar B, Pullin S, Tocher R. Relationship centred
outcomes focused on compassionate care for older people within
in‑patient care settings. Int J Older People Nurs 2010;5(2):128‑36.
43. Sidani S, Collins L, Harbman P, Hurlock‑Chorostecki C,
MacMillan K, Reeves S, et al. A description of nurse practitioners’
self‑report implementation of patient‑centered care. Eur J Person
Cent Healthc 2015;3(1):11‑8.
44. Lateef AM, Mhlongo EM. Trends in patient‑centered care in South
West Nigeria: A holistic assessment of the nurses perception of
primary healthcare practice. Glob J Health Sci 2020;12 (6):1‑73.
45. Hedayati B. The effect of implementation of family‑centered
empowerment model on the self‑esteem of the old people with
hypertension. J Educ Health Promot 2015;4(1):74.
46. Jerofke T, Weiss M, Yakusheva O. Patient perceptions of
patient‑empowering nurse behaviours, patient activation
and functional health status in postsurgical patients with
life‑threatening long‑term illnesses. JAdv Nurs 2014;70(6):1310‑22.
47. Aujoulat I, d’Hoore W, Deccache A. Patient empowerment in
theory and practice: Polysemy or cacophony? Patient Educ Couns
2007;66(1):13‑20.
)