A Qualitative Content Analysis of the Person-Centered Care Experienced by Critical Care Patients

중환자실 환자가 경험한 인간중심 간호에 관한 질적 내용분석

  • 홍희진 (부산대학교병원 외상중환자실) ;
  • 강지연 (동아대학교 간호학과)
  • Received : 2018.05.01
  • Accepted : 2018.05.19
  • Published : 2018.06.30

Abstract

Purpose : To explore the person-centered care (PCC) experienced by critical patients. Method : This qualitative study deductively examined the attributes of the PCC model proposed by Jakimowicz and Perry. The participants were 16 patients who were recently discharged from intensive care units at a university hospital. Data were collected through in-depth interviews and were analyzed using the deductive method of content analysis. Results : A total of 4 categories, 16 subcategories, and 33 codes were generated from 171 meaningful statements. The final 4 categories were "compassionate presence," "professional interaction," "outstanding competency," and "patient identity." These were consistent with the main attributes of Jakimowicz and Perry's model. However, most of the codes belonged to the "compassionate presence" and "patient identity" categories. Among the attributes of the model, "continuity of nursing," "therapeutic relationship," "expert knowledge," "clinical knowledge," "evidence-based intervention," and "patient's rights" were not derived as codes. Conclusion : These findings deepen the understanding of the PCC model from the patient's point of view. The main attributes of PCC identified in the current study can be applied to the development of practical guidelines for intensive care nursing. In addition, we recommend the development of a PCC measurement tool for critical care patients.

Keywords

References

  1. Aro, I., Pietila, A. M., & Vehvilainen-Julkunen, K. (2012). Needs of adult patients in intensive care units of Estonian hospitals: a questionnaire survey. Journal of Clinical Nursing, 21(13-14), 1847-1858. https://doi.org/10.1111/j.1365-2702.2012.04092.x
  2. Baumgarten, M., & Poulsen, I. (2015). Patients' experiences of being mechanically ventilated in an ICU: a qualitative metasynthesis. Scandinavian Journal of Caring Sciences, 29(2), 205-214. https://doi.org/10.1111/scs.12177
  3. Cabrini, L., Landoni, G., Antonelli, M., Bellomo, R., Colombo, S., Negro, A., . . . Zangrillo, A. (2015). Critical care in the near future: patient-centered, beyond space and time boundaries. Minerva Anestesiologica, 82(5), 599-604.
  4. Davidson, J. E., Powers, K., Hedayat, K. M., Tieszen, M., Kon, A. A., Shepard, E., . . . Armstrong, D. (2007). Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004-2005. Critical Care Medicine, 35(2), 605-622. https://doi.org/10.1097/01.CCM.0000254067.14607.EB
  5. Ekman, I., Wolf, A., Olsson, L. E., Taft, C., Dudas, K., Schaufelberger, M., & Swedberg, K. (2012). Effects of person-centred care in patients with chronic heart failure: The PCC-HF study. European Heart Journal, 33(9), 1112-1119. https://doi.org/10.1093/eurheartj/ehr306
  6. Elliott, D., Davidson, J. E., Harvey, M. A., Bemis-Dougherty, A., Hopkins, R. O., Iwashyna, T. J., . . . Needham, D. M. (2014). Exploring the scope of post-intensive care syndrome therapy and care: engagement of non-critical care providers and survivors in a second stakeholders meeting. Critical Care Medicine, 42(12), 2518-2526. https://doi.org/10.1097/CCM.0000000000000525
  7. Elo, S., & Kyngas, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107-115. https://doi.org/10.1111/j.1365-2648.2007.04569.x
  8. Gill, P. S. (2013). Patient engagement: an investigation at a primary care clinic. International Journal of General Medicine, 6, 85-98.
  9. Guba, E. G., & Lincoln, Y. S. (1981). Effective evaluation: Improving the usefulness of evaluation results through responsive and naturalistic approaches. San Francisco, CA: Jossey-Bass Publishers.
  10. Hudon, C., Fortin, M., Haggerty, J. L., Lambert, M., & Poitras, M. E. (2011). Measuring patients' perceptions of patient-centered care: a systematic review of tools for family medicine. Annals of Family Medicine, 9(2), 155-164. https://doi.org/10.1370/afm.1226
  11. Jakimowicz, S., & Perry, L. (2015). A concept analysis of patient-centred nursing in the intensive care unit. Journal of Advanced Nursing, 71(7), 1499-1517. https://doi.org/10.1111/jan.12644
  12. Johnson, P. (2004). Reclaiming the everyday world: how long-term ventilated patients in critical care seek to gain aspects of power and control over their environment. Intensive and Critical Care Nursing, 20(4), 190-199. https://doi.org/10.1016/j.iccn.2004.05.001
  13. Kang, J., & Suh, E. E. (2015). Perceptions of quality of patient-centered nursing care among women with breast cancer. Perspectives in Nursing Science, 12(2), 115-123. https://doi.org/10.16952/pns.2015.12.2.115
  14. Kim, Y., Min, J., Lim, G., Lee, J., Lee, H., Lee, J., . . . Lee, Y. J. (2017). Transcultural adaptation and validation of the family satisfaction in the intensive care unit questionnaire in a Korean sample. Korean Journal of Critical Care Medicine, 32(1), 60-69. https://doi.org/10.4266/kjccm.2016.00962
  15. Kelly, F. E., Fong, K., Hirsch, N., & Nolan, J. P. (2014). Intensive care medicine is 60 years old: the history and future of the intensive care unit. Clinical Medicine, 14(4), 376-379. https://doi.org/10.7861/clinmedicine.14-4-376
  16. Lof, L., Berggren, L., & Ahlstrom, G. (2006). Severely ill ICU patients recall of factual events and unreal experiences of hospital admission and ICU stay-3 and 12 months after discharge. Intensive & Critical Care Nursing. 22(3), 154-166. https://doi.org/10.1016/j.iccn.2005.09.008
  17. Mitchell, M. L., Coyer, F., Kean, S., Stone, R., Murfield, J., & Dwan, T. (2016). Patient, family-centred care interventions within the adult ICU setting: an integrative review. Australian Critical Care, 29(4), 179-193. https://doi.org/10.1016/j.aucc.2016.08.002
  18. Morgan, S., & Yoder, L. H. (2012). A concept analysis of person-centered care. Journal of Holistic Nursing, 30(1), 6-15. https://doi.org/10.1177/0898010111412189
  19. O’Connell, E., & Landers, M. (2008). The importance of critical care nurses’ caring behaviours as perceived by nurses and relatives. Intensive and Critical Care Nursing, 24(6), 349-358. https://doi.org/10.1016/j.iccn.2008.04.002
  20. Price, A. M. (2013). Caring and technology in an intensive care unit: an ethnographic study. Nursing in Critical Care, 18(6), 278-288. https://doi.org/10.1111/nicc.12032
  21. Sagong, H., & Lee, G. E. (2016). Person-centered care and nursing service quality of nurses in long-term care hospitals. Journal of Korean Academy of Community Health Nursing, 27(4), 309-318. https://doi.org/10.12799/jkachn.2016.27.4.309
  22. Sidani, S., & Fox, M. (2014). Patient-centered care: clarification of its specific elements to facilitate interprofessional care. Journal of Interprofessional Care, 28(2), 134-141. https://doi.org/10.3109/13561820.2013.862519
  23. Siow, E., Wypij, D., Berry, P., Hickey, P., & Curley, M. A. (2013). The effect of continuity in nursing care on patient outcomes in the pediatric intensive care unit. Journal of Nursing Administration, 43(7-8), 394-402. https://doi.org/10.1097/NNA.0b013e31829d61e5
  24. Slatore, C. G., Hansen, L., Ganzini, L., Press, N., Osborne, M. L., Chesnutt, M. S., & Mularski, R. A. (2012). Communication by nurses in the intensive care unit: qualitative analysis of domains of patientcentered care. American Journal of Critical Care, 21(6), 410-418. https://doi.org/10.4037/ajcc2012124
  25. Storli, S. L., Lindseth, A., & Asplund, K. (2008). A journey in quest of meaning: a hermeneutic-phenomenological study on living with memories from intensive care. Nursing in Critical Care, 13(2), 86-96. https://doi.org/10.1111/j.1478-5153.2007.00235.x
  26. Vahedian-Azimi, A., Ebadi, A., Jafarabadi, M. A., Saadat, S., & Ahmadi, F. (2014). Effect of massage therapy on vital signs and GCS scores of ICU patients: a randomized controlled clinical trial. Trauma Monthly, 19(3), e17031.
  27. Venetis, M. K., Robinson, J. D., Turkiewicz, K. L., & Allen, M. (2009). An evidence base for patientcentered cancer care: a meta-analysis of studies of observed communication between cancer specialists and their patients. Patient Education and Counseling, 77(3), 379-383. https://doi.org/10.1016/j.pec.2009.09.015
  28. White, D. B., Cua, S. M., Walk, R., Pollice, L., Weissfeld, L., Hong, S., . . . Arnold, R. M. (2012). Nurse-led intervention to improve surrogate decision making for patients with advanced critical illness. American Journal of Critical Care, 21(6), 396-409. https://doi.org/10.4037/ajcc2012223
  29. Wikstrom, A. C., Cederborg, A. C., & Johanson, M. (2007). The meaning of technology in an intensive care unit-an interview study. Intensive & Critical Care Nursing, 23(4), 187-195. https://doi.org/10.1016/j.iccn.2007.03.003
  30. Yi, Y. H., Son, Y. J., Kang, J. Y., Kim, B. J., Kim, J. Y., Lee, Y. M., . . . Ha, Y. K. (2017). Critical care nursing courses in bachelor of science in nursing programs: present and future directions. Journal of Korean Critical Care Nursing, 10(3), 1-8.