The Role of Patient- Centered Care in Nursing

The Role of Patient- Centered Care in Nursing

Amanda J. Flagg, PhD, MSN, EdM, RN, ACNS-BC, CNE

KEYWORDS

� Patient-/family-centered care � Family at bedside � Bedside report � Holistic nursing � Patient satisfaction

KEY POINTS

� Patient-/family-centered care is key to patient satisfaction. � Inclusion of family and friends is needed for increased quality of care. � Use of a bedside report enhances quality of nursing care delivery.

SCENARIO

Nurse Smith, RN is running behind schedule. This is the third 12-hour shift on a 36-bed medical/surgical unit, and the change-of-shift-report has just been received for 7 patients assigned to her care. The night shift nurse has an appointment and needs to get home immediately. There is little time for questions or verifications of proce- dures such as early morning blood draws and catheter care necessities. Patient A is scheduled for surgery and is due to be transported at any moment. Problem: the pro- phylactic antibiotic he was to receive preoperatively has not yet arrived on the unit. Pa- tient B is sleeping, but his glucose reading was 60 at 6:30 AM. Patient C is crying because of poor control of her postsurgical incisional pain, but she is not due for medi- cation for another hour. Nurse Smith’s remaining 4 patients will require her already taxed attention to pull her in several other directions within the hour, and there are 2 admissions waiting in the emergency department. Nurse Smith has been assigned to one of them. And the story continues.

INTRODUCTION

This scenario depicts a multitude of challenges and is played out repeatedly in many acute care inpatient facilities across the nation. Nurses like Nurse Smith bear heavy patient loads with limited support systems and ever-increasing responsibilities in the care of patients, particularly those with chronic illness. Health care has become

Disclosure Statement: The author has nothing to disclose. School of Nursing, Middle Tennessee State University, Box 81, Murfreesboro, TN 37132, USA E-mail address: Amanda.Flagg@mtsu.edu

Nurs Clin N Am 50 (2015) 75–86 http://dx.doi.org/10.1016/j.cnur.2014.10.006 nursing.theclinics.com 0029-6465/15/$ – see front matter � 2015 Elsevier Inc. All rights reserved.

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progressively more complicated and highly technical and is perceived by many patients to be an impersonal and highly complex system.1 So where is the patient in all the chaos? How satisfied are patients with nursing care today? What aspects of patient care can be considered in improving the quality of that care that will allow the patient to be seen, heard, and cared for amidst all the noise?

PROBLEM

The effects of changes in the field of health care are reverberating in nursing, which requires the need for increased efficiency in the provision of care. This environment pushes even the most experienced nurse to become more task oriented and less patient focused in a sea of constant admissions and discharges with expectations that patients are to do most of their recovery either in a long-term rehabilitation unit or at home.2,3 The mantra “doing more with less and less” seems to be the quote of the day, every day. One form of response to these challenges has echoed in the literature of nursing and

other health care professions for several decades; the concept of patient-centered care (PCC). In fact, the Institute of Medicine has placed PCC as 1 of 6 objectives in the improvement of health care quality for the 21st century.4 So what is PCC and how does it involve nursing care?

Defining Patient-Centered Care

PCC has been depicted as a philosophy, a process, a model, a concept, and a part- nership that involves both the patient and health care provider (to include the nurse) arriving at some form of conclusion about the care and treatment of the patient’s condition.5–7 Although there are no definitive definitions of PCC, several attempts have been made to operationalize this concept. A summary of these efforts describing PCC are outlined in Box 1. Kjeldmand and colleagues12 acknowledged Mead and Bower’s13 early attempts to

describe PCC but suggested that the term patient-centeredness is central to

Box 1

Brief history of patient-centered care

Balint first described PCC in the mid-1950s as a concept of understanding patients as unique beings.8

There have been many references to PCC as a philosophy.9

a. Mead and Bower (2002) began to form a preliminary framework of patient centeredness as a method of delivering health care to patients by describing 5 distinct dimensions of PCC.10,11

1. Bio psychosocial perspective that takes into account the impact of social and psychological factors of illness

2. Patient as a unique individual that considers the patient’s personal understanding and meaning of illness

3. Sharing of power and responsibility that considers patients’ preferences for information and their participation in decision making

4. The therapeutic alliance that takes into account the development of common goals and the enhancement of a bond shared between patient and provider

5. Doctor/nurse as person aspect that addresses the awareness of personal qualities and subjective experiences of the provider within his or her practice setting.

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relationship-centered care by acknowledging an ultimate synthesis of both the biomedical and real-world perspectives of both the patient and health care provider. So what is nursing’s stand on PCC?

Domains of Patient-Centered Care

Competencies for nursing were analyzed and redefined in 2007 by the Quality and Safety Education for Nurses (QSEN) project that redirected how nurses approach their profession.1 In this QSEN project, PCC was defined as a competency that recognizes the patient or designee as the source of control and full partner in providing compas- sionate and coordinated care. This care was based on respect for patients’ prefer- ences, values, and needs.1 Table 1 outlines additional key dimensions of PCC as it relates to nursing.1,4,14,15

Key Factors of a Patient-Centered Care Environment

There are 7 key factors that are imperative to the engagement, support, implementa- tion, and sustainment of PCC.16,17

� Leadership involvement, support, and buy-in � Strategic vision that is clearly defined and operationalized � Involvement of patients and their families and other support systems � Involvement of employees to include all health care providers � Evaluation of and feedback regarding process in place � Design of the physical environment to be supportive of patients, families, and staff

� Availability of technology that supports communication between patients and health care providers

Barriers to Patient-Centered Care

Although PCC is seen as a positive movement in the future of health care delivery, there are barriers that need to be recognized. Potential barriers include the following.

� No clear definition of PCC � Lack of educational programs supporting PCC for all health care providers � Fragmentation of care that focuses on the disease instead of the whole individual � Staff who are overworked experiencing shortages

Table 1 Sample of dimensions of patient-centered care and nursing

Source Dimensions

Gerteis et al,14 1993 Respect for patients, values, preferences, coordination and integration of care, information, communication, education, comfort, emotional support of family/friends, transition and continuity of care

Institute of Medicine,4 2001 Safety, effectiveness, timeliness, equity, and efficiency of care

Watson’s ten principles of human science and care15

Person-centered nursing conceptual framework: characteristics and attributes of the nurse, context in which care is provided, how care is given, outcomes of care.

QSEN Project, 20071 Patient as source of control, full partner in provision of compassionate care, respect for patient preference, values, and needs.

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� Continued dominance of the biomedical mode of practice (doctor and nurse know best)

� Financial costs of educating and recruiting adequate numbers of health care pro- viders in support of PCC

APPLICATION OF PATIENT-CENTERED CARE TO NURSING: HOLISTIC CARE

The philosophy of holistic nursing supports the tenants of PCC that are derived in part from Florence Nightingale who believed in the importance of her patients’ conditions through the interaction of their respective environment.18 Holistic nursing places emphasis on both the environment and treatment of the patient to include patients’ uniqueness as human beings along with their cultural views, values, and beliefs.18,19

Shared Similarities of Holistic Nursing and Patient-Centered Care

Holistic nursing also encourages nurses to reflect on their own self-care and to engage in PCC that includes the use of such skills as listening and questioning. Takase and Teraoka20 developed a competency scale to assess and measure Japanese nurses’ abilities to cope with ever-increasing complex scenarios similar to the scenario described earlier.20 The initial testing of this instrument found that 1 of the 5 themes was in full support of adopting ethically oriented practice to include the need for PCC nursing. The 5 themes identified shared similarities between nursing as a philos- ophy and principles of PCC. These similarities are summarized in Box 2. Holistic nursing values and beliefs are also reflecting of PCC philosophies. They are

summarized in Box 3. The combination of PCC and holistic nursing can benefit patients and nurses; how-

ever, the inclusion of patients and their families and friends is also considered a positive aspect of these philosophies based on the patients’ needs and desires to include them.

PATIENT-CENTERED CARE AND FAMILY-CENTERED CARE

Patient- and family-centered care (PFCC) extends the partnership of patients and health care providers to include families (and friends) at the discretion of the patient involved.21 The involvement of families encourages the sharing of knowledge and experience in the planning of nursing care for the enhancement and well being of the patient.22,23 Acute care facilities are engaging in PFCC in several ways to include the provision of the items listed in Box 4.

Box 2

Shared nursing interactions using holistic care and PCC

1. Listening to patients’ questions, needs, and views

2. Communicating with patients to ensure understanding of their questions, needs, and views

3. Sharing questions, needs, and views with other members of health care teams

4. Establishment of therapeutic relationships with patients and significant others such as families and friends

5. Providing patients and families with needed education regarding their disease processes

6. Evaluating goals of care in accordance with patients’ and families’ wishes and abilities

7. Providing the best care possible using up-to-date knowledge, competencies, and empathic nursing practice

Box 3

Holistic nursing beliefs and PCC philosophies

1. Maintain up-to-date knowledge and competencies

2. Identify gaps in learning and knowledge

3. Reflect on practice

4. Observe objectively, yet compassionately

5. Promote health and well-being of self and others

6. Maintain balance both physically and mentally

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PFCC is also mirrored in the practice of decreasing the limitations placed on visiting hours in many facilities. Based on patient and family preference and ability, family members are encouraged to stay with patients overnight and are invited to be involved in some aspects of patient care. Even acutely ill patients are afforded less-restrictive visitation hours in such areas as the emergency department and intensive care units.24,25 Alternatively, with extended family visiting, consequences that require consideration include the potential of patient exhaustion, unrealistic expectations for perceived needs of patient and family members, and the potential overall effects of such visits on the progress of patient recovery.

FAMILY PRESENCE AT THE BEDSIDE AND BEYOND

Family presence within the PFCC model extends to include not just presence in patient rooms during set visiting hours but during procedures that occur in inpatient and outpatient areas. Depending on the invasiveness of the procedure and patient and family preferences, several research studies have found positive aspects of such practice.26

One such procedure is the changing of dressings for severe burn injuries. Because of concerns of increased infection rates and the perception of family members’ inability to tolerate observing their loved ones in times of duress, family members are usually not allowed to be present. This often leads to dissatisfaction of care and misperceptions of nursing and medical staff in the eyes of the patient and their loved ones. A study by Bishop and colleagues,27 found that family presence during a burn wound debridement actually had the opposite effect. In selected cases, patients experienced decreased levels of apprehension and pain. Conversely, another aspect of including family participation includes pediatric

patients. Under the auspices of PFCC, pediatric patients are included in this partner- ship, particularly in decision-making processes, regardless of their age, based on the extent of their ability and desire to be part of the planning of their care. The same invi- tation can be extended to the elderly, particularly those patients who have limited cognitive function yet are able to share in basic decision making.

Box 4

Patient- and family-centered care provisions

1. Family information packs concerning location and cafeteria hours

2. Posted photos of all staff members on each inpatient and outpatient unit

3. Resources assisting in the care of the patient at discharge

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FAMILY PRESENCE DURING CHANGE-OF-SHIFT REPORT

The presence of family during patient roundsmay conjure images of gross violations of Health Insurance Portability and Accountability Act (HIPAA); however, if PFCC is to be respected, the inclusion of patient rounds requires that family presence be not only invited but encouraged. The following tenants are suggestions to consider.28–36

� Give patients and families a choice in engaging in rounds. � Have nurses provide introductions (eg, night shift introduces the day shift nurse and staff).

� Use a circle formation if possible during a report to allow for eye contact to occur. � Use terminology that all parties can understand.

Benefits of Patient- and Family-Centered Care Rounds

� Increased patient and family satisfaction of care � Increased communication between patients and nurses � Decreased confusion regarding discharge planning and teaching � Opportunities for patient and family education � Opportunities for discussion and planning of patient care

Barriers to Patient- and Family-Centered Care Rounds

� Limited physical space based on patients’ room size and available areas for discreet conversations

� Nursing units’ buy-in and use of rounds (eg, are rounds audio-taped? Do nurses round together?)

� Time constraints with change-of-shift report � Potential for HIPAA violations of patient information

FAMILY PRESENCE DURING CODES

PFCC seems well suited in many health care situations but remains controversial in extreme interactions during lifesaving, resuscitative efforts. Hung and Pang24 studied family members who were present during successful resuscitative efforts of their loved ones using an interpretive phenomenological approach.24 Table 2 summarizes 10 themes that emerged from thedataand familymembercomments reflecting the themes.

Barriers to Family Presence During Codes

Itzhaki and colleagues37 noted that, in general, lay individuals tended to be more positive toward family presence in a code situation than clinical, staff particularly when the patient survived. Women, both family and clinicians, tended to reflect more negatively in situations in which profuse bleeding was present and resuscitative efforts failed. Box 5 summarizes barriers that could prevent families from witnessing resuscitation efforts of their family members.

Interventions Used to Embrace and Sustain Patient- and Family-Centered Care

A core competency identified in several studies that supports PFCC is that of commu- nication.38,39 The following communication strategies are recommended by the Mas- sachusetts Department of Higher Education Nurse of the Future Competency Committee.40

� Verbal, written, and electronic versions should be clear and concise. � Auditory, visual, and tactile forms are important components.

Table 2 Ten themes with examples of participants’ responses

Theme Response

1. Emotional connectedness to the patient “I was allowed to hold his/her hand”

2. Provision of support to the patient “I could talk to him/her”

3 Maintaining relationship with patient “I was allowed to hold his/her hand”

4 Knowing the patient and health conditions “I could relate aspects of his/her health”

5. Keeping informed of what was going on “I knew what was being done to save this life”

6. Being engaged in what was going on “Watching reassured me the right things were being done”

7. Providing information to the resuscitation team

“Could provide the names of medications he/she was taking”

8. Perceived (in)appropriateness “I was not allowed in the ICU, I felt helpless, alone, discarded”

9. Perceived inconvenience “I might be in the way of the doctors and nurses—should I be here?”

10. Perceived prohibition “The door said no entry unless given permission—I just wanted to be there but I don’t break rules”

Adapted from Hung M, Pang, MC. Family presence preferences when patients are receiving resus- citation in an accident and emergency department. J Adv Nurs 2010;67(1):56–7.

B

B

T

F

F v

F

T

S

S p

L

A i g

Patient-Centered Care 81

� Nurses’ own communication styles have an impact on the receivers’ end of the message.

� Effects of communication can evoke many forms of influence to include spiritual, emotional, and cultural characteristics.

� The right time and setting are imperative considerations. � The receiver, often the patient or family, should be assessed regarding their abil- ity and readiness to communicate.

ox 5

arriers to family presence during codes

he patient prefers that family not be present during code situations.

amily members prefer not to or are afraid to observe.

amily members may be concerned or lose control by becoming inconsolable or physically or erbally challenging.

amily members require attention that would detract from patient care.

here is limited physical space in acute care units.

taff feels family presence is not appropriate.

taff feels anxious, judged, or concerned with family reactions to their responses under ressure of code situations.

imited staff is available to allow for adequate support of family witnesses.

dapted from Itzhaki M, Bar-Tal Y, Barnoy S. Reactions of staff members and lay people to fam- ly presence during resuscitation: the effect of visible bleeding, resuscitation outcome and ender. J Adv Nurs 2011;68(9):1967–77.

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� Barriers should be observed and considered. � Rapport should be established between parties. � Opportunities for questions should be provided. � Assessment of both verbal and nonverbal behavior should be noted. Building communication competence leads to PFCC delivery models that increase

patient care satisfaction and staff retention and recruitment, decrease length of stay and ED visits, and decrease medication errors.41 PFCC delivery model components are listed in Box 6. A few facilities are engaging in the concept of PFCC by participating in the Planet-

ree’s PCC Hospital Designation Program. Under this model, facilities must adhere to 50 criteria placed under 11 categories to receive such recognition.42 The 11 categories facilities must meet are as follows.

� Structures and functions needed for development, implementation, and mainte- nance of PCC

� Human interactions � Patient education and access to information � Family involvement � Nutrition program � Healing environment � Arts program to include animal visitation � Spirituality and diversity � Integrative therapies to include alternative therapies � Healthy communities—a plan geared toward the needs of the community at large � Measurement—use of patient/family satisfaction scores as examples

Box 6

Components of Patient- and family-centered care delivery models

1. Coordination of care conference—meeting with all specialties to include patient and family to discuss plan of care initiating discharge planning

2. Hourly rounding (once per hour)—includes pain, elimination, and positioning needs along with other patient/family concerns

3. Bedside report—completed at the bedside with family and friends present at discretion of patient or patient advocate

4. Initializing and use of patient care partner (when available)—a family member, friend, or volunteer in full support of patient’s needs and desires

5. Individualized care—Established at admission, to include preferred name, priority of care, learning style, and care partner selection

6. Open medical record policy—allowing patients to document their views at their discretion

7. Opening visiting restrictions—driven by patient or family as applicable in a variety of settings

8. Family presence during resuscitation and other procedures—at discretion of patient as applicable

9. Silence and healing—inviting the patient and family to assess noise level in their environment and to report any discomfort of such to the nurse

Adapted from Hunter R, Carlson E. Finding the fit: patient centered care. Nurs Manage 2014;45:39–43.

Table 3 Sample of studies centered on patient satisfaction

Article Findings

Improving patient satisfaction with nursing communication using bedside shift report33

Patient satisfaction rate increased from 75% to 87.6%

Patients’ perspective on person-centered participation in healthcare: a framework analysis5

General attention and interest was felt by patient

Patients felt respected Patients felt trust

Efficacy of person-centered care as an intervention in controlled trials—a systematic review43

Many studies included the concept of PCC but only a few were actually practicing the model

Effects of patient-centered care on patient outcomes: an evaluation44

Patients are demanding more active roles in their care

Implementation of PCC increased pt. satisfaction with care

Patient satisfaction as an outcome of individualized nursing care30

Positive correlations were found between individualized care and patient satisfaction.

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EVALUATION—THE ULTIMATE SCORING CARD

A trend is emerging in the literature associating patient satisfaction of care scores to the delivery of PFCC. Although there are multitudes of variables associated with these forms of measurement, several studies are emerging with such reports, and nursing is helping pave the way for such findings. A small sample of studies is provided in Table 3. Although these articles represent studies exploring concepts of PFCC and patient

satisfaction scores in the inpatient setting, outpatient areas are now being included in PFCC models. Most outpatient clinics have associated the reduction of clinic wait times to patient satisfaction scores. Michael and colleagues,45 also studied the effect of wait times patients experienced in the examination room on satisfaction of overall care.45 These aspects of care have been identified as key points of interest for patients and clinicians but there are many other variables that require further study within this context of health care delivery. Wolff and Roter31 suggested that older patients suffering with chronic illness are

more likely to be accompanied to an outpatient visit by either family or friends. They hypothesized that the addition of family members invokes a positive aspect of care by aiding the patient-provider partnership, the exchange of information regarding patient status, and by including family in the decision-making processes. Their study, a meta-analytical review, found that the presence of family should be further studied in hopes of isolating those factors that facilitate decision-making processes. Care of patients with acute and chronic illnesses can be enhanced by understanding the communication processes deemed central to changing health care delivery systems toward a more patient/family focus.

SUMMARY

Now that PCC, holistic nursing, PFCC, bedside rounds, and patient satisfaction scores have been addressed, let’s return to the scenario depicting Nurse Smith and

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her third day of duty to see how these concepts might benefit both the patients placed in Nurse Smith’s care and Nurse Smith’s practice. Using PFCC:

� Nurse Smith and the night shift nurse would be rounding together, exchanging reports at each patient’s bedside.28–36

� Any concerns or questions Nurse Smith would have could be efficiently addressed by the night shift nurse, the patient, and a family member if present (based on patient permission).

� Patients’ concerns could also be more fully acknowledged, such as patient B’s glucose level, and patient C’s pain control.

� Nurse Smith’s other patients will hear the report on their situations and be given reassurances that Nurse Smith will return after attending to the immediate needs of her first 3 patients. Any requests from these less-critical patients can be answered by appropriately trained delegated personnel.

� A communication board located in each patient room can be updated to include Nurse Smith’s name and contact information.46

� Hourly rounds will minimally include the checking of patients’ pain, elimination, and position changes particularly for those requiring complete, high-level care. Nurse Smith will always ask if there are other concerns or questions.47

� Nurse Smith also has the right to ask for additional assistance if the patient load does not allow for all other competencies of nursing care to be carried out according to such examples as QSEN standards, facility policies and proce- dures, and her Professional Nurse Practice Act.1

PFCC does not occur in a vacuum. To function, all health care members from administration to environmental services are part of a team whose central focus is the patient. Nurse Smith is part of a team inclusive of not only health care providers but also the patient, his or her family, and other support systems. Drawing on all parties’ experiences to provide care to the patient can only enhance the quality and safety of care that is so critical and so needed yet continues to be so challenging.

REFERENCES

1. Sherwood G, Zomorodi M. A new mindset for quality and safety: the QSEN com- petencies redefine nurses’ roles in practice. Nephrol Nurs J 2014;41(1):15–23.

2. Dabney BW, Tzeng HM. Service quality and patient-centered care. Medsurg Nurs 2013;22(6):359–64.

3. Lusk JM, Fater K. A concept analysis of patient-centered care. Nurs Forum 2013; 48(2):89–98.

4. Institute of Medicine. To err is human: building a safer health system. Washington, DC: National Academies Press; 2000.

5. Thórarinsdóttir K, Kristjánsson K. Patients’ perspectives on person-centered participation in healthcare: a framework analysis. Nurs Ethics 2014;21(2):129–47.

6. Burman ME, Robinson B, Hart AM. Linking evidenced-based nursing practice and patient centered care through patient preferences. Nurs Adm Q 2013; 37(3):231–41.

7. Kitson A, Marshall A, Bassett K, et al. What are the core elements of patient- centered care? A narrative review and synthesis of the literature from health policy, medicine, and nursing. J Appl Nutr 2012;69(1):4–15. http://dx.doi.org/ 10.1111/j1365-2648.2012.06064.x.

8. Balint M. The doctor, his patient, and the illness. London: Pitman Medical; 1964.

Patient-Centered Care 85

9. Lewin SA, Entwistle V, Zwarenstein M, et al. Interventions for providers to promote a patient-centered approach in clinical consultations (Review). Cochrane Database Syst Rev 2005;(4):CD003267.

10. Mead N, Bower P. Patient-centered consultations and outcomes in primary care: a review of the literature. Patient Educ Couns 2002;48:51–61.

11. Slatore CG, Hansen L, Ganzini L, et al. Communication by nurses in the intensive care unit: qualitative analysis of domains of patient-centered care. Am J Crit Care 2012;21:410–8.

12. Kjeldmand D, Holmstrom I, Rosenqvist U. How patient centered am I? A new method to measure patient-centeredness. Patient Educ Couns 2006;62(1):31–7.

13. Mead N, Bower P. Patient-centeredness: a conceptual framework and review of the empirical literature. Soc Sci Med 2000;51:1087–110.

14. Gerteis M, Edgman-Levitan S, Daley J, et al. Through the patient’s eyes: under- standing and promoting patient-centered care. San Francisco (CA): Jossey- Bass; 1993.

15. Watson J, Lea A. The caring dimensions inventory (CDI): content, validity, reli- ability and scaling. J Appl Nutr 1997;25(1):87–94.

16. Schaller D. Patient-centered care: what does it take?. Washington, DC: Picker Institute, Oxford and Commonwealth Fund; 2007.

17. Pelzang R. Time to learn: understanding patient-centered care. Br J Nurs 2010; 19(14):912–7.

18. Lange B, Zahourek RP, Mariano C. A legacy building model for holistic nursing. J Holist Nurs 2014;32(2):116–26.

19. Mariano C. An overview of holistic nursing. Imprint 2005;52:48–51. 20. Takase M, Teraoka S. Development of the holistic nursing competence scale.

Nurs Health Sci 2011;13:396–403. 21. Duran C, Oman KS, Jordan J, et al. Attitudes toward and beliefs about family

presence: a survey of healthcare providers, patients’ families, and patients. Am J Crit Care 2007;16(3):270–80.

22. Nykiel L, Denicke R, Schneider R, et al. Evidence-based practice and family presence: paving the path for bedside nurse scientists. J Emerg Nurs 2010; 37(1):9–16.

23. Ciufo D, Hader R, Holly C. A comprehensive systematic review of visitation models in adult critical care units within the context of patient and family centered care. Int J Evid Based Healthc 2011;9:362–87.

24. Hung M, Pang MC. Family presence preference when patients are receiving resuscitation in an accident and emergency department. J Appl Nutr 2010; 67(1):56–67. http://dx.doi.org/10.1111/j1365-2648.2010.05441.x.

25. Ewart L, Moore J, Gibbs C, et al. Patient and family centered care on an acute adult cardiac ward. Br J Nurs 2014;23(4):213–8.

26. Bradford KK, Kost S, Selbst SM, et al. Family member presence for procedures: the resident’s perspective. Ambul Pediatr 2005;5(5):294–7.

27. Bishop SM, Walker MD, Spivak IM. Family presence in the adult burn intensive care unit during dressing changes. Crit Care Nurse 2013;33(1):14–23.

28. Timonen L, Sihvonen M. Patient participation in bedside reporting on surgical wards. J Clin Nurs 2000;9:542–8.

29. Woodward JL. Effects of rounding on patient satisfaction and patient safety on a medical-surgical unit. Clin Nurse Spec 2009;23(4):200–6.

30. Suhonen R, Papastavrou E, Efstathiou G, et al. Patient satisfaction as an outcome of individualized nursing care. Scand J Caring Sci 2011;26:372–80. http://dx.doi. org/10.1111/j1471-6712.2011.00943.x.

Flagg86

31. Wolff JL, Roter DL. Family presence in routine medical visits: a meta-analytical review. Soc Sci Med 2011;72:823–31.

32. Blakley D, Kroth M, Gregson J. The impact of nurse rounding on patient satisfac- tion in a medical-surgical hospital unit. Medsurg Nurs 2011;20(6):327–32.

33. Radtke K. Improving patient satisfaction with nursing communication using bedside shift report. Clin Nurse Spec 2013;27(1):19–25.

34. Ferguson LM, Ward H, Card S, et al. Putting the ‘patient’ back into patient- centered care: an education perspective. Nurse Educ Pract 2013;13:283–7.

35. Santiago C, Lazar L, Jiang D, et al. A survey of the attitudes and perceptions of multidisciplinary team members towards family presence at bedside rounds in the intensive care unit. Intensive Crit Care Nurs 2013;30:13–21.

36. Subramony A, Hametz PA, Balmer D. Family-centered rounds in theory and prac- tice: an ethnographic case study. Acad Pediatr 2014;14:200–6.

37. Itzhaki M, Bar-Tal Y, Barnoy S. Reactions of staff members and lay people to family presence during resuscitation: the effect of visible bleeding, resuscitation outcome and gender. J Appl Nutr 2011;68(9):1967–77.

38. Boykins AD. Core communication competencies in patient centered care. ABNF J 2014;25:40–5.

39. Simmons SA, Sharp B, Fowler J, et al. Implementation of a novel communication tool and its effect on patient comprehension of care and satisfaction. Emerg Med J 2013;30(5):363–70. http://dx.doi.org/10.1136/emermed-2011-200907.

40. Massachusetts Department of Higher Education Nurse of the Future Competency Committee. Nurse of the future nursing core competencies. Boston: Maassachu- setts Department of Higher Education; 2010.

41. Hunter R, Carlson E. Finding the fit: patient centered care. Nurs Manage 2014;45: 39–43.

42. Frampton SB, Guastello S. Patient-centered care: more than the sum of its parts. Am J Nurs 2010;110(9):49–53.

43. Olsson LE, Jakobsson E, Swedberg K, et al. Efficacy of person-centered care as an intervention in contolled trials – a systematic review. J Clin Nurs 2012;22: 456–65. http://dx.doi.org/10.1111/jocn.12039.

44. Sidani A. Effects of patient-centered care on patient outcomes: an evaluation. Res Theory Nurs Pract 2008;22(1):24–37. http://dx.doi.org/10.1891/0889-7182. 22.1.24.

45. Michael M, Schaffer SD, Egan PL, et al. Improving wait times and patient satis- faction in primary care. J Healthc Qual 2013;35(2):50–60.

46. Signh S, Fletcher KE, Pandl J, et al. It’s the writing on the wall: whiteboards improve inpatient satisfaction with provider communication. Am J Med Qual 2011;26(2):127–31. http://dx.doi.org/10.1177/1062860610276088.

47. Ford BM. Hourly rounding; a strategy to improve patient satisfaction scores. Medsurg Nurs 2010;19(3):188–91.