Reconciling evidence‐based medicine and patient‐centred care: defining evidence‐based inputs to patient‐centred decisions

Evidence‐based and patient‐centred health care movements have each enhanced the discussion of how health care might best be delivered, yet the two have evolved separately and, in some views, remain at odds with each other. No clear model has emerged to enable practitioners to capitalize on the advantages of each so actual practice often becomes, to varying degrees, an undefined mishmash of each. When faced with clinical uncertainty, it becomes easy for practitioners to rely on formulas for care developed explicitly by expert panels, or on the tacit ones developed from experience or habit. Either way, these tendencies towards ‘cookbook’ medicine undermine the view of patients as unique particulars, and diminish what might be considered patient‐centred care. The sequence in which evidence is applied in the care process, however, is critical for developing a model of care that is both evidence based and patient centred. This notion derives from a paradigm for knowledge delivery and patient care developed over decades by Dr. Lawrence Weed. Weed's vision enables us to view evidence‐based and person‐centred medicine as wholly complementary, using computer tools to more fully and reliably exploit the vast body of collective knowledge available to define patients’ uniqueness and identify the options to guide patients. The transparency of the approach to knowledge delivery facilitates meaningful practitioner–patient dialogue in determining the appropriate course of action. Such a model for knowledge delivery and care is essential for integrating evidence‐based and patient‐centred approaches.     

Nurses' Perspectives of Encouraging Clients' Care‐of‐Self in a Short‐Term Rehabilitation Unit Within a Long‐Term Care Facility

This article presents a study conducted on a short‐term rehabilitation unit in a long‐term care facility. The purpose of the study was to explore, through qualitative methods, nurses' perspectives of encouraging clients to care for themselves. Although the literature suggested that encouraging self‐care does not occur, the findings of this study showed that nurses have a broader view than what is currently known in nursing as “self‐care.” Potential impediments to nursing practice were overcome by the development of nurse‐client relationships through which the nurses encouraged clients in what is described throughout this study as “care‐of‐self” Rehabilitation nurses play an important role in helping clients to integrate and reclaim the care of their emerging new selves. Care‐of‐self may be critical to clients not only in reaching their outcome goals for discharge but also in maintaining outcomes beyond discharge.     

A systematic review of instruments measuring patients′ perceptions of patient‐centred nursing care

This systematic review identified and evaluated instruments measuring patients' perceptions of patient‐centred nursing care. Of 2629 studies reviewed, 12 were eligible for inclusion. Four instruments were reported: The Individualized Care Scale, the Client‐Centred Care Questionnaire, the Oncology patients' Perceptions of the Quality of Nursing Care Scale and the Smoliner scale. These instruments cover themes addressing patient participation and the clinician–patient relationship. Instruments were shown to have satisfactory psychometric properties, although not all were adequately assessed. More research is needed regarding test–retest reliability, convergent and discriminant validity, validity with known groups and structural validity using confirmatory factor analysis.     

Patient‐centred care through a broader lens: Supporting patient autonomy alongside moral deliberation

Patient‐centred care (PCC) is an essential component of high‐quality healthcare and shared decision‐making is its cornerstone. Yet, integrating the principles of PCC into healthcare practice is not always straightforward and shared decision‐making can be complicated and ethically demanding. While ethicists and academics routinely debate moral aspects of clinical care, such discussion among clinicians is less overt. In this paper, we use Emmanuel et al.’s deliberative model to provide a practical framework for considering ethical aspects of PCC and shared decision‐making. The model encourages us to appreciate PCC through a broader lens and consider patient autonomy alongside other moral obligations such as justice and the equitable distribution of finite resources. The model can be used by healthcare providers, patients and caregivers to facilitate dialogue and moral deliberation regarding the merit of their preferences and values; in this way, individualised care can be delivered without compromising other important ethical obligations.     

Patient‐tailored self‐management intervention for older adults with hypertension in a nursing home

Aims and objectives. This study was to evaluate the effects of a patient‐tailored self‐management intervention on (1) blood pressure control and (2) self‐care behaviour, exercise self‐efficacy and medication adherence among Korean older hypertensive patients in a nursing home. Background. Little is known about whether a patient‐tailored self‐management for nursing home residents with hypertension is likely to advance the care of this growing population worldwide. Design. A non‐equivalent comparison group design. Methods. Forty‐seven patients (23 and 24 in the intervention and comparison groups, respectively) participated in the study. No one withdrew during the eight‐week study period. Hypertensive patients in the intervention group received health education and tailored individual counselling for eight weeks to enhance the self‐management. Results. The mean age of patients was 77·4 years. Patients were on hypertensive medications for 11·8 years; only 36 of them took medications without assistance. The baseline comparisons of the patients with and without 8‐week intervention did not differ for clinical and demographic variables and outcome measures. Blood pressure decreased when comparing the baseline to eight weeks later from baseline; moreover, blood pressure was significantly reduced only in patients who received the intervention. Self‐care behaviour and exercise self‐efficacy significantly increased over time only in those who were in the intervention group. However, no significant difference was observed in medication adherence between the two groups. Conclusions. Patient‐tailored self‐management intervention was a practical approach for decreasing blood pressure and increasing self‐care behaviour in older hypertensive patients in a nursing home. Further studies are needed to validate these findings using a larger sample with long‐term follow‐up. Relevance to clinical practice. A patient‐tailored intervention is feasible not only to empower nursing home residents with hypertension for their care, but also to offer a qualified training and guidelines to nursing home staffs, expanding their professional competence in clinical practice.