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VA New England Healthcare System

 

Veterans' Healthy Living, Winter 2014

Patient-Centered Nursing Care

"Patient centered care" is more than a frequently used term among VA employees. It is truly individualized care - different ways of treating each VA patient—that can make an enormous difference in your overall health.

Laurel Radwin, RN, Ph.D., Nurse Researcher, knows this better than almost anyone does. Her college dissertation years ago, as well as a number of research studies which she has since led, examined different aspects of patient-centered nursing care.

"I’ve learned that the nursepatient relationship is really important," she explains. "For example, cancer patients have expressed in studies how muchthey valued their nurses being attentive and caring. They like being treated as partners in the healing process."

Study results tend to back up the importance of nurse-patient relationships, even after patients leave the hospital.

"Patients in a Boston medical center who rated their nursing care highly were more likely to achieve good outcomes," Radwin says. "They were more likely to feel optimistic that they made the right choices, and they had a sense of well-being that things were going to be okay. A secondary analysis showed they were also less likely to be readmitted to the hospital."

Nurse smiling at a patient

So how is it possible to determine a patient’s view of being well cared for by nurses? In a 1999 study, patients characterized excellent care as when the nurse used their professional knowledge,attended to continuity of care and care coordination, were attentive, treated the patient with individualized care, developed a partnership with the patient, established rapport, and were caring. Radwin actually developed a scale to measure the quality of nursing care—a scale that has been translated into around 35 languages.

"It measures care individualization," she explains. "In other words, does the patient feel treated as a person instead of just a number or a diagnosis? Does the nurse use good profes-sional knowledge? Is the care coordinated? We can then link those aspects to outcomes."

Along with studies of patient-centered cancer care, Radwin has examined care in the medi-cal intensive care unit (ICU). She says nurses are expert decision-makers medically, but they also see the family standing at the patient’s bedside.

"In a critical care area like ICU or CCU where nurses tend to have fewer patients, they can really get to know that individual and the family.They see what happens after physician rounds, and they help the patient or family deal with the news they just received. Nursing contributes to so much that we are not accounting for," she adds. "If you create the kind of environment where good nursing care can happen through all kinds of different work environments, then people are going to have better healthcare experiences."

In the future, Radwin hopes to study the effects of patient centered care beyond an inpatient setting. She said, "I’d like to help determine how VA can maintain quality patient centered care and the related good outcomes when, for example, a Veteran with cancer is released from the hospital but must seek follow-up treatment from a number of different VA facilities. What challenges do we face in providing individualized care as people go to different settings? How can we best use our resources to serve these Veterans with cancer? That’s something we can make the most of if we understand it better."