1. A Correlation Between The Therapeutic Nursing Approach and Quality Patient Outcomes: An Integrative Literature Review
Isabel Galang, MS, DePaul University
Advisor: Dr. Elizabeth Hartman
Background
Purpose
Results
Nursing Implications
Patient-centered care
Therapeutic nursing approach strongly emphasized
Individualized, holistic approach
Respects and empowers patient decisions about their care
Considered superior to task-centered care
Task-centered care
Focuses on anticipated work a nurse has throughout the day
Therapeutic communication
Used in patient-centered care to establish a therapeutic relationship
To be effective, nurses and patients must both be actively engaging in communication
Quality patient outcome examples
Less anxiety, decreased pain and symptoms
Rise in patient satisfaction, cooperation with staff, and compliance
Identify barriers to the implementation of patient-centered care
Identify effective strategies used in patient-centered care and research
When utilized, patient-centered care observed to produce quality patient outcomes
Decrease in pain, agitation, anxiety, and depression
Increase in quality of life, patient compliance, medication adherence, patient satisfaction with care, and improvement in self-management of care
Compared to task-centered care, more positive outcomes are seen
A 2011 study reported an increase in patient satisfaction, in knowledge about and compliance with breastfeeding during and after hospitalization, and significantly lower postpartum disorders in hospitalized pregnant patients who received patient-centered care (Wan et al.)
Barriers
Commonly seen: staff shortages, lack of knowledge and education of patient-centered care, health beliefs of patients and clinicians, and time constraints
Major barriers: ineffective and missed opportunities for communication
Strategies
Daily practice of patient-centered care
Transformation into a patient-centered medical home
Major strategy: training or educational program
Findings stress importance of patient-centered care and how it affects patients and their outcomes
Nurses should watch how they communicate with patients and their colleagues and change upon self-reflection if needed
Nursing schools can teach students patient-centered care skills as part of fundamental nursing knowledge while at clinical
Can make nurses aware of how their actions make a huge impact
Methods
Integrative Literature Review
Articles searched for in CINAHL, ProQuest Nursing Alliance Health Source, and PubMed
Keywords used: nursing, patient- OR person-centered care, task-oriented care, therapeutic communication, quality clinical outcomes, and barriers
Twelve articles ultimately reviewed
Conclusion
Patient-centered care produces more quality patient outcomes than task centered care
The use of patient centered care should be increased
Nurses should consider:
How their actions make an impact on patients and their families
How not using patient-centered care could impact how role is perceived by patients
Future studies
Focus on other factors involved in patient-centered care such as socioeconomic status
How patient-centered care can be implemented in settings universally and long-term
More studies on task-centered care vs. patient-centered care
Discussion
Effective interpersonal therapeutic communication is needed to combat barriers
Nursing behaviors such as introducing oneself, giving purpose for entering the room, sharing support, praising the client, and smiling = positive outcomes
Nursing behaviors such as commanding, disapproving, ignoring = negative outcomes
An training or educational program for staff including nurses could improve the use of patient-centered care
One study saw a drop in behaviors such as commanding from 20.5% to 2.4% (Boscart, 2009).
Staff training and implementation, time, and dedication are needed
Problem Statement
Task-centered care is sill prevalent
Why? Dominance of biomedical model, inclination of healthcare systems to focus on task-centered care, and nurse’s inability to want or give patient-centered care
Patients did not want to bother nurse or felt less important than nurse’s tasks
Poor outcomes seen with task-centered care
Increased anxiety, pain, and physical discomfort
Misunderstandings about nurse’s role in patient care