Person-centred interactions between nurses and patients during medication activities in an acute hospital setting: Qualitative observation and interview study
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Abstract
There is increasing emphasis on person-centred care within the literature and the
health care context. It is suggested that a person-centred approach to medication
activities has the potential to improve patient experiences and outcomes.
This study set out to examine how nurses and patients interact with each other during
medication activities in an acute care environment with an underlying philosophy of
person-centred care.
A qualitative approach was used comprising naturalistic observation and semi-structured
interviews.
The study setting was an acute care ward with a collaboratively developed philosophy
of person-centre care, in an Australian metropolitan hospital.
Eleven nurses of varying levels of experience were recruited to participate in observations
and interviews. Nurses were eligible to participate if they were employed on the study
ward in a role that incorporated direct patient care, including medication activities.
A stratified sampling technique ensured that nurses with a range of years of clinical
experience were represented. Patients who were being cared for by participating nurses
during the observation period were recruited to participate unless they met the following
exclusion criteria: those less than 18 years of age, non-English speaking patients,
and those who were unable to give informed consent. Twenty-five patients were observed
and 16 of those agreed to be interviewed.
The results of the study generated insights into the nature of interactions between
nurses and patients where person-centred care is the underlying philosophy of care.
Three major themes emerged from the findings: provision of individualised care, patient
participation and contextual barriers to providing person-centred care. While the
participating nurses valued a person-centred approach and perceived that they were
conducting medication activities in a person-centred way, some nurse-patient interactions
during medication activities were centred on routines rather than individualised patient
assessment and management. These interactions were based on nurses' perceptions of
what was important for the patient and did not provide opportunities for patient participation.
Two main contextual barriers in relation to a person-centred approach to medication
activities were identified as multidisciplinary communication and time constraints.
While some nurse-patient interactions during medication activities were consistent
with the principles of person-centred care, the study results highlighted factors
that influence the nature of these interactions, and identified opportunities to improve
nursing practice. To ensure person-centred care is applied to medication activities,
nurses should undertake ongoing assessment of patients' needs in relation to their
medications and encourage opportunities for increased patient participation.
Crown Copyright 2009. Published by Elsevier Ltd. All rights reserved.