Foundations of Nursing Practice 1A: Assignment 2: Person Centred Care Case Study

Question 1:
Who is Barbara? If you had to describe Barbara and Barbara’s situation to a
colleague what information would you include to ensure that you were utilising a
Person-Centred Care approach?

When describing a patient and their medical situation to a colleague, it is vital to provide all
medical information, the patient’s demographic (such as age, gender, occupation), as well as
using an all-inclusive approach to ‘ground’ a “philosophy of personhood”, essentially
meaning to include all aspects of the person’s life not limited to their illness (NARI, 2007).
PCC is more inclusive and considerate of what the patient wants, including them in the
decision-making process.

Thus, to ensure PCC is utilised when describing Barbara’s situation to a colleague, one must
include her demographic and past history (if possible), whilst including any needs of the
individual. Explicitly in regard to Barbara, this would be in the form of the following:

Barbara is an elderly female patient whose GP suggested she receive some heart tests.
She has dementia which affects her abilities to communicate. Talking about tests and not
including her in conversations can cause distress, so clear communication about the
intent of healthcare actions assists her cooperation. Talking about her previous work as a
headmistress is often calming. She has expressed her hunger, so a sandwich is on the
way.

Question 2:
Treating a person with dignity, compassion and respect is a key principle of Person-
Centred Care. Discuss if each element was or was not demonstrated in the video
and provide specific examples.

In order to achieve a PCC approach, patients must always feel comfortable in their
environment (Kitson, et al., 2013). Healthcare workers must acknowledge that the degree of
comfort for each patient differs, and as such, should constantly check that the individual is
okay in varying situations to uphold values of dignity, compassion and respect.

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 Foundations of Nursing Practice 1A: Assignment 2: Person Centred Care Case Study

Certain illnesses can be already intrusive to personal privacy and thus when a medical
professional is conducting specific tests or examinations, intimate and personal
vulnerabilities may be exposed, undermining personal dignity (Oosterveld-Vlug et al., 2014).
In the video, Barbara is exposed in the room with the doctor, nurse and another undisclosed
male. Barbara was not introduced to this person creating an unnecessarily stressful
environment. Being asked to remove her blouse caused more stress as such an intimate
moment of vulnerability was not given proper privacy.

In order to properly provide care for a patient, compassion and understanding situation is
vital.
When Barbara expressed that her food had been taken too early, the nurse offered to fetch her
something to eat, going the extra mile to ask her preference in sandwich, demonstrating her
understanding of Barbara’s situation, providing comfort to the patient. ‘Patients equate caring
with compassion’ (Clucas, Chapman & Lovell, 2019), a fundamental ideal representing the
empathy a patient must feel. The nurse’s offer of assistance in finding the bathroom
demonstrates her understanding and sensitivity of Barbara’s struggle through saying “These
signs can be really confusing sometimes”.

Respect can be expressed through simple acts of communication, seen through Jane’s efforts
to ask about Barbara’s past experience as a Primary School Headmistress. Showing Barbara
that she isn’t being seeing as an illness, but rather a human being with unique experiences
and memories, builds on the person-centred approach to care. Ensuring the patient
understands they are being seen and heard, improves the all-inclusive quality of the patients
care.

Question 3:
With reference to the evidence explain why providing care that encompasses
dignity, compassion and respect is important to patient safety.

With a foundation of dignity, compassion and respect, when practiced, all PCC would place a
higher emphasis on the patient and their wellbeing. Patient wellbeing encompasses a holistic
approach to health, so when the three principles of PCC are enacted upon, a domino effect is
created promoting patient safety.
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 Foundations of Nursing Practice 1A: Assignment 2: Person Centred Care Case Study

In regard to dignity, Barbara having to undress in front of unfamiliar men, created an

unnecessarily stressful situation risking her emotional state in which confusion had the
potential to cause physical harm or distress. Dementia causes major physical impairments
during the later stages of the condition (Dementia Australia, 2021)., with the person losing
their ability to walk stand or do ordinary tasks independently, with high fall rates.
Consequently, this undignified treatment of Barbara causing her significant distress, had the
potential to fluster and disorientate her, making her more vulnerable to falls than she already
is. Her overwhelmed portrayal demonstrates the likelihood of this situation occurring.

Prior to Barbara being offered a sandwich or help to the bathroom, her safety was again
compromised. Her disorientation when looking for the bathroom illuminates the implications
of dementia in ‘Memory Changes’ and ‘Mild Cognitive Impairment’ (MCI), and how this has
the potential to cause direct physical harm, such as falls - a major safety risk as elderly
populations are observing a steady increase in fall induced deaths (Kannus, Pakkari, Niemi &
Palvanen, 2010). The intervention of nurse Jane allowed Barbara to be taken care of and
directly looked after, ensuring her physical welfare ‘reflected through compassionate care’
(Henderson & Jones, 2017).

A ‘quasi-experimental’ study suggested that patients who received PCC, experienced better
medical care (Jakobsson et al., 2019), including improvements in pain relief and vital signs
such as blood pressure. Respect seen in the nurses’ open conversation with Barbara about her
previous occupation, allows Barbara to feel more comfortable and trusting in the RN’s care.
Barbara is at ease knowing the RN has her best interests at heart, and is comfortable opening
up to her, allowing healthcare professionals to further understand the extent of her medical
situation furthering her safety.

Question 4:
How did this video make you feel about the care Barbara receive?

Although the video showed clear examples in which principles of PCC were upheld, it
unfortunately highlighted times in which PCC was dismissed. Understanding Barbara’s
anxieties and her reservations to ask for help made me not only feel sad for her experience,
but for all elderly patients who may not ask for help due to the stress of being a ‘burden’.
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I was able to see from Barbara’s perspective the business of hospital environments and how it
can be off-putting to some patients, whether the way the receptionist neglected her concerns
and queries about why she was in the hospital or the fast-paced blurring of jobs completing
by many different individuals,
With personal experience of dementia first-hand, the reality of the situation struck an
emotional chord. The thought of Barbara going through this alone was extremely sad to
witness. It was disheartening to see how much of a burden Barbara believed herself to be and
how much she didn’t want to intrude on the busy healthcare workers. I was ashamed
watching the way healthcare professionals, especially nurses, dismissed Barbara (and her
concerns), talking through and over her.

However, seeing the difference Jane made was pleasing and seeing the instant relaxation of
Barbara when in her care. I was delighted and hopeful that all carers might act with such
empathy and rapport.

Question 5:
If you were the nurse caring for Barbara in this scenario describe 3 strategies that
would enable you to deliver nursing care that is person-centred.

 Strategy 1: Active Participation in Care: Aftercare

Ensuring the patient is actively involved in their own care and the maintenance of their health
is fundamental to ensure the delivery of PCC.

As Barbara is a sufferer of dementia, a concern as an RN would be future care and treatment.

The video showed that she lived alone and as there may be safety risks of her living alone and
isolated from help, the RN must explore her situation to ensure Barbara doesn’t lose her
feelings of independence. The RN should ask about Barbara’s needs and wants, to
accommodate whilst ensuring that her medical needs are also met. This would include
inquiring about her family or immediate connections to determine who is available to help
her when needed, as well as providing devices, such as fall alert.

 Strategy 2: Respect: Physician of Same Gender

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Each patient has the upmost right to be treated with respect and dignity. Respect, in this
setting, relates to personal privacy, confidentiality of health information, being treated
without discrimination. It is the role of the RN to act out these values of respect towards the
person in the deliverance of healthcare.
As proposed by the Institute of Medicine (2001), improvements in health care should aim to
be based on ‘individual patient preferences’ being both ‘effective and safe’. As such, it is the
RN’s responsibility that Barbara is comfortable when tests are being conducted as there are
several positive links between the quality of care and patient safety. The video demonstrated
the unease she was exposed to when having tests done, therefore a strategy to introduce
should be asking the patient (in this case Barbara), if they would prefer a female doctor to
perform the physical exam. A 2018 Cardiovascular Institute survey disclosed that 46% of
women opt for a female physician with 48% without distinct preference, demonstrating how a
practitioner of the same gender can influence care, and thus its safety. RNs should recognise
this as a major concern for some patients, acting accordingly by asking patients directly to
meet emotional and physical needs. Some conditions make it challenging for the patient to
communicate their needs and wants directly and as such, PCC can aid RNs in finding suitable
ways for the person to communicate their concerns to maximise quality of care. This comfort
and confidence in service provided by RN’s builds trust and mutual respect, with the patient
trusting RNs in what’s best for them.

 Strategy 3: Good Communication

Communication is central to PCC with many ways in which it can be hindered. RNs should
become aware of these factors, ensuring to adapt care if signs of lacking communication
arise. Communication does not only refer to language and potential language barriers, but the
two-way communication between the patient and the RN, with the forefront being patient
understanding. RNs should explain information about care and condition, including treatment
options and prognosis. Exemplary communication between both parties initiates a respectful
relationship between RN and patient.

Barbara’s relationship with her RN allows trust and confidence, paralleled with the anxious
state she is in with the doctor highlighting the inconsistency and lack of communication. As
such, a strategy to increase communication from both parties would be to have the RN be the
main form of contact. This would allow Barbara to ask questions she might have been too

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afraid to ask the doctor directly in a more welcoming setting. The RN is a window allowing
the patient to feel at ease and ensuring all information is provided.

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