Introduction

Patient-centered care underscores the importance of patient involvement in every aspect of healthcare, from engaging patients in conveying their needs, ensuring active partnership into commonly set goals, and practicing complete documentation reflecting patients’ experiences (Britten et al., 2017). This concept or person-focused care highlights the holistic view of the patient as an individual with autonomy to make active decisions about care (Zhao et al., 2016). Another concept is person-centered care which is Integrated health care services delivered in a setting and manner that is responsive to individuals and their goals, values, and preferences, in a system that supports good provider-patient communication and empowers individuals receiving care and providers to make effective care plans together.

In order to deliver patient- or person-centered care and practice the provision of holistic nursing, we need to have a thorough understanding of our adult patients across age groups (i.e., young adults, middle adults, older adults) and cultures. Thus, this module combines understanding the spectrum of adult clients using a person- and patient-centered lens.

Learning Outcomes

1. Discuss the concept of patient- and person-centered care.
2. Explain the various frameworks for assessing adult patients.

Learning Activities

This module is composed of asynchronous or self-directed activities - readings & a discussion forum. There will be no synchronous session for this module.

Read the following materials. 

These are made available through the links here. Remember that you are not limited by the resources listed and you are encouraged to read other materials related to the module concepts. However, these have been curated for you as baseline materials for discussion. Those marked with (*) are required reading.

On holism and person-centered care

1. Person- and Patient-Centered Care
   1. Britten, N., Moore, L., Lydahl, D., Naldemirci, O., Elam, M., & Wolf, A. (2017). Elaboration of the Gothenburg model of person-centered care. Health Expectations, 20(3), 407–418.*  
   2. Zhao, J., Gao, S., Wang, J., Liu, X., & Hao, Y. (2016). Differentiation between two healthcare concepts: Person-centered and patient-centered care.International Journal of Nursing Sciences, 3(4), 398–402.
   3. Moore, L., Britten, N., Lydahl, D., Naldemirci, Ö., Elam, M., & Wolf, A. (2017). Barriers and facilitators to the implementation of person-centered care in different healthcare contexts.Scandinavian Journal of Caring Sciences, 31(4), 662–673.  
2. Holism and the Holistic ApproachFrameworks for Nursing Assessment

   1. Frisch NC, Rabinowitsch D. What’s in a Definition? Holistic Nursing, Integrative Health Care, and Integrative Nursing: Report of an Integrated Literature Review. Journal of Holistic Nursing. 2019;37(3):260-272.*

3. Here's the link to the Australian Commission on Safety and Quality in Healthcare. This is a powerful resource on the topic and provides various concrete examples of how we can ensure person-centered care in our practice as individual providers and as members of larger institutions.

On Frameworks for Assessing Adult Clients

There are many frameworks or approaches used to ensure adequate assessment of a patient. Head-to-toe, focused, and body systems approaches are the most common ones. In particular, specific age groups with special considerations and focus have assessments that aim to address the uniqueness of the individual in that age group such as the comprehensive geriatric assessment. 

In the coming weeks, you will be applying comprehensive and focused assessment approaches to actual clients. How will this be different from the health assessment you learned in undergraduate nursing? As future nurses in advanced roles, you are expected to practice advanced assessment that can (1) determine the patient’s health status, (2) arrive at a diagnosis, (3) recognize the patient’s health risks, and identify data that will (4) support your clinical decision-making. Your assessment will be based on the health history, physical examination, and review of diagnostic exams.

You will need to integrate wellness dimensions into your assessments including the Physical, Emotional, Financial, Intellectual, Career, Social, Creative, Environmental, and Spiritual dimensions. Considering your potential practice area in primary care, you will also need to expound on screening for common acute and chronic conditions (e.g., hypertension, abuse, stroke, heart attack, exacerbations).

Lastly, integrating person-centeredness, patient safety, and cultural congruence are essential to quality assessment. You will be exploring these further in our discussion forum. 

Key Points and Related Reading:

1. How does the existing literature describe and present the APN nurse's core competencies for making general clinical assessments in primary health care? This was the study question posed in a 2024 review and identified three interrelated areas of core competencies on which APN nurses draw in performing general health assessments in primary health care. These include (1) ‘Collaborative, leadership, and management skills’ (2) ‘Person-centred nursing care skills’, and (3) ‘Academic and educational skills’. This interesting paper underscores that as APNs, nurses anchor their practice on understanding the individual needs of patients and tailoring their approach to establish their plan of care and overall approach to assisting patients. How do you see these core competencies developing in you throughout your graduate program? YOu may read the whole paper here - Søndergaard SF, Andersen AB, Frederiksen K. APN nurses' core competencies for general clinical health assessment in primary health care. A scoping review. Scand J Caring Sci. 2024; 38: 258–272. https://doi.org/10.1111/scs.13235
2. How can we best understand the needs of our patients and patient groups? This question was posed by the study group to understand the experience of older adult patients with chronic pain to aid in improving the quality of their care. They applied the Socioecological Model and examined an intersection of factors contributing to the experience of pain. Similarly, can you use this model to understand your adult patient? See the full article here -  McDermott K et al. (2024) Using the Socioecological Model to Understand Medical Staff and Older Adult Patients’ Experience with Chronic Pain: A Qualitative Study in an Underserved Community Setting, Journal of Pain Research, 3881-3895, DOI: 10.2147/JPR.S471477
3. How do we approach teaching our adult patients?  At the outset, adult learners should be easier to teach given their cognitive status and rich experiences. Further, as nurses, we should be able to relate to them better. Right? This blog - Applying Adult Learning Theories for Effective Patient Education - briefly discusses adult learning theories that would help us to capitalize on the adults' unique learning style and approach teaching towards better health outcomes using a more person-centered approach.

Participate in the Discussion Forum 3.

Crucial to applying person-centered care in assessment, and across care interactions and health management, is understanding the individual through a psycho-socio-cultural lens. Caring for adult Filipino clients necessitates an understanding of their traits, norms, values, belief systems, and their family. These, in turn, also require the awareness of our values, biases, and patterns when interacting with Filipino adult clients.

Here is the list of relevant reading material for this forum. You are not required to read all of them but please use them in responding to the forum question.

1. Enrile, A.L. (2024) Understanding the Psychology of Pilipinos. Psychology Today. September 2024.
2. Kawi, J., Fudolig, M., Serafica, R., Reyes, A. T., Sy, F., Leyva, E. W. A., & Evangelista, L. S. (2024). Health information sources and health-seeking behaviours of Filipinos living in medically underserved communities: Empirical quantitative research. Nursing open, 11(3), e2140.
3. Martinez, A. B., Co, M., Lau, J., & Brown, J. S. L. (2020). Filipino help-seeking for mental health problems and associated barriers and facilitators: a systematic review. Social psychiatry and psychiatric epidemiology, 55(11), 1397–1413.