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Implementation of Person-Centered Care (PCC)
PCC is conceptually defined, and major tenets have been identified. Global and local movements toward PCC are seen at theoretical and operationalized levels. Changes moving toward PCC in acute, long-term, and home and community-based care settings have been identified and include shifts in both how care is provided and the environments in which care takes place. Measurement of preferences can be accomplished using various standardized tools. The congruence between preferences for care and care provided continues to be an area where additional work is needed to understand how to achieve best practices. Nurses play an integral role in the implementation of PCC across settings and in involving both the patient and the family. Clinicians and researchers selecting a PCC framework must clearly outline and describe how they will measure PCC and evaluate the impact of any interviews.
BACKGROUND
A. Definition
PCC is generally defined as asking and allowing an individual to indicate his or her values and preferences that should then direct all healthcare choices and decisions to support not only their health-related goals, but all other personal goals as well to the fullest extent possible.
B. Attributes
I. Personalized Care Plan
II. Continued Assessment of Preferences and Care Plan
III. Interdisciplinary Team Care
IV. Team Leader or Gatekeeper for All Healthcare Information and Decisions Made
V. Care Coordination Across Healthcare Team Members
VI. Continued Communication Across All Team Members
VII. Continuing Education
VIII. Measurable Outcomes
HISTORY
PCC is rooted in psychology and is considered to be a more holistic concept than similarly used terms such as patient-centered care. In the 1980s, Thomas Kitwood advanced our understanding and acceptance of PCC in particular in persons with dementia. Kitwood proposed that PCC was the interaction between the individual’s health, social context, and environment and emphasized the need for communication and relationship building among all those involved in the care of the person; these are all tenets of the currently accepted definitions of PCC.
FEDERAL AND STATE INITIATIVES
At the federal level, PCC is supported by the Centers for Medicare & Medicaid Services. At the state and local levels, early adopters have included Kansas and Ohio with Promoting Excellent Alternatives in Kansas (PEAK) in 2002 and the Ohio Person-Centered Care Coalition (OPCCC) beginning in 2005. Evaluation of both of these programs continues.
NURSING STRATEGIES
A. Assessment of preferences and promoting congruence between preferences and care provided
B. Knowing the person by using “All About Me” or similar approaches
C. Engagement of the person in assessment, planning, and evaluation
D. Inclusion of family in assessment, planning, and evaluation, as desired by the person
E. Including the person and family in organizational planning/initiatives (e.g., committees, councils)
ORGANIZATIONAL MODELS AND APPROACHES
A. Acute Care
I. PCC shifts in acute care include changes in both organizational and nursing care delivery models and also changes to the physical environment and structure within these settings. Shifts in organizational and nursing models of care include a shift from task-oriented, fragmented care to primary care nursing delivery models. Environmental and structural changes include movements toward flexible designs, shared resources, and staff across hospital units.
B. Long-Term Care
I. Models of PCC in long-term care (LTC) began as a “culture-change” movement in the United States. Common culture-change models include The Pioneer Network, the Eden Alternative, and The Green House Project. The Pioneer Network is a national leader of person-centered practices in the United States. The Eden Alternative is focused on decreasing loneliness, helplessness, and boredom through elder-centered communities in LTC and also other settings. Transformation of long-term and postacute care settings to smaller, more homelike settings emphasizing quality of life and meaningful relationships is the crux of The Green House Project.
C. Home and Community-Based Care Services
I. The Patient-Centered Medical Home (PCMH) is the primary model used to promote patient-centered care in home and community-based care settings. In general, the PCMH emphasizes care coordination among interdisciplinary healthcare team members with a focus on care quality and safety.
EVALUATION OF EXPECTED OUTCOMES
A. PCC assessment initiated, including personal and medical background, preferences, values, and beliefs
B. Ongoing and transitional evaluation with person and family to describe preference congruence, engagement in decision-making, respect and dignity, and environment
C. Evaluation of the physical environment
D. Audits of personalized care plans to address preference congruence
E. Staff orientation includes importance of PCC, assessment of preferences, preference congruence, team-based care, including the person and family, and the focus on interpersonal communication with older adults, families, and other clinicians
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Updated: November 2020
Boltz PhD, RN, GNP-BC, FGSA, FAAN, M., Capezuti PhD, RN, FAAN, E., Zwicker DrNP, APRN, BC, D., & Fulmer PhD, RN, FAAN, T. T. (2020). Evidence-Based Geriatric Nursing Protocols for Best Practice (6th ed.). Springer Publishing. Retrieved November 4, 2020, from https://www.springerpub.com/evidence-based-geriatric-nursing-protocols-for-best-practice-9780826188144.html#description
Chapter 4: Sillner, A., & Behrens, L. (2021) Organizational Approaches to Promote Person-Centered Care. In M. Boltz, E. Capezuti, D. Zwicker & T. Fulmer (eds.). Evidence-Based Geriatric Nursing Protocols for Best Practice (6th ed. pp 27-41). New York: Springer.
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