® CrossMark ELSEVIER Available online at www.sciencedirect.com , ScienceDirect NURS OUTLOOK 64 (20r6) 352-366 NURSING OUTLOOK -www.nursingoutlook.org A proposed model of person-, family-, and culture-centered nursing care Maichou Lor, MS, RN*, Natasha Crooks, BSN, RN, Audrey Tluczek, PhD, RN, FAAN ARTICLE INFO Article history: Received 28 May 2015 Revised 6 January 2016 Accepted 28 February 2016 Available online 8 March 2016 Keywords: Concept analysis Cultural competency Family centered Patient centered Person centered University of Wisconsin-Madison, School of Nursing, Madison, WI ABSTRACT Background: For decades person-, patient-, family-centered, and culturally competent care models have been evolving and conceptualized in the literature as separate. To our knowledge, there has not been a systematic approach to comparing all four of these conceptual models of care. Purpose: To explicate and compare four conceptual care models: person-, patient-, family-centered, and culturally competent care. Methods: A comparative concept analysis informed by Rogers' evolutionary concept analysis was used to compare 32 nursing research on person-, patient-, family-centered care, and culturally-competent care published between 2009 and 2013. Results: Collective results of analyses of 32 nursing research articles found 12 attributes: collaborative relationship, effective communication, respectful care, holistic perspective, individualized care, inter-professional coordination, self-awareness, empowerment, family as unit of care, interpersonal relation- ships, cultural knowledge, and cultural skills. Antecedents included: lack of empirical evidence, poor patient outcomes, implementation problems, knowledge deficits, patient/parent emotional distress, poor patient-provider relationships, and health disparities. Consequences included: improved health-related outcomes, increased satisfaction, enhanced patient/family- provider relationships, reduced hospitalization, improved quality of life, improved quality of parent-child relationships, increased trust, enrollment in research, insights about biases, and appreciation for cultural differences. So- cial justice, advocated by scholars and national organizations, was absent from all studies. Conclusions: Findings informed the proposed blended conceptual care framework that embraces the attributes of each care model and includes social justice. Cite this article: Lor, M., Crooks, N., & Tluczek, A. (2016, AUGUST). A proposed model of person-, family-, and culture-centered nursing care. Nursing Outlook, 64(4), 352-366. http://dx.doi.org!10.1016/ j.outlook.2016.02.006. A clear understanding and articulation of concepts is essential to advance nursing knowledge and to effec- tively communicate within nursing research, educa- tion, and practice as well as across disciplines, (Bonis, 2013). Over the past few decades, four conceptualiza- tions of health ...

1. ®
CrossMark
ELSEVIER
Available online at www.sciencedirect.com ,
ScienceDirect
NURS OUTLOOK 64 (20r6) 352-366
NURSING
OUTLOOK
-www.nursingoutlook.org
A proposed model of person-, family-, and
culture-centered nursing care
Maichou Lor, MS, RN*, Natasha Crooks, BSN, RN, Audrey
Tluczek, PhD, RN, FAAN
ARTICLE INFO
Article history:
Received 28 May 2015
Revised 6 January 2016
Accepted 28 February 2016
Available online 8 March 2016
Keywords:
Concept analysis

2. Cultural competency
Family centered
Patient centered
Person centered
University of Wisconsin-Madison, School of Nursing, Madison,
WI
ABSTRACT
Background: For decades person-, patient-, family-centered, and
culturally
competent care models have been evolving and conceptualized
in the literature
as separate. To our knowledge, there has not been a systematic
approach to
comparing all four of these conceptual models of care.
Purpose: To explicate and compare four conceptual care models:
person-, patient-,
family-centered, and culturally competent care.
Methods: A comparative concept analysis informed by Rogers'
evolutionary
concept analysis was used to compare 32 nursing research on
person-, patient-,
family-centered care, and culturally-competent care published
between 2009
and 2013.
Results: Collective results of analyses of 32 nursing research
articles found 12
attributes: collaborative relationship, effective communication,
respectful
care, holistic perspective, individualized care, inter -professional
coordination,
self-awareness, empowerment, family as unit of care,
interpersonal relation-
ships, cultural knowledge, and cultural skills. Antecedents

3. included: lack of
empirical evidence, poor patient outcomes, implementation
problems,
knowledge deficits, patient/parent emotional distress, poor
patient-provider
relationships, and health disparities. Consequences included:
improved
health-related outcomes, increased satisfaction, enhanced
patient/family-
provider relationships, reduced hospitalization, improved
quality of life,
improved quality of parent-child relationships, increased trust,
enrollment in
research, insights about biases, and appreciation for cultural
differences. So-
cial justice, advocated by scholars and national organizations,
was absent
from all studies.
Conclusions: Findings informed the proposed blended
conceptual care framework
that embraces the attributes of each care model and includes
social justice.
Cite this article: Lor, M., Crooks, N., & Tluczek, A. (2016,
AUGUST). A proposed model of person-, family-,
and culture-centered nursing care. Nursing Outlook, 64(4), 352-
366. http://dx.doi.org!10.1016/
j.outlook.2016.02.006.
A clear understanding and articulation of concepts is
essential to advance nursing knowledge and to effec-
tively communicate within nursing research, educa-
tion, and practice as well as across disciplines, (Bonis,
2013). Over the past few decades, four conceptualiza-
tions of health care delivery have emerged that reflect
a shift in the health care delivery paradigm from a

4. paternalistic, disease-focused perspective to care
* ~,;;;~~~onding author: Maichou Lor, School of Nursing,
U~iversity of Wisconsin, Signe Skott Cooper Hall, 701
Highland Ave., Madison,
address: [email protected] (M. Lor).
nt matter © 2016 EI' . sevIer Inc. All nghts reserved.
<4U"'OK.LU16.02.0()6
NURS OUTLOOK 64 (20r6) 352 366 353
models that focuses on the needs, preferences, and
cultural values of the constituents of health care:
person-centered, patient-centered, family-centered,
and culturally competent care. Application of these
four conceptual care models tends to vary based on the
patient population or the environment in which care is
delivered. The term "patient centered" is typically used
in regard to recipients of services in tertiary care set-
tings (Morgan & Yoder, 2012), whereas "person
centered" is used in reference to nursing home resi-
dents (Brooker, 2007). "Family-centered" care is
generally preferred in interventions for pediatric pop-
ulations (American Academy of Pediatrics, 2012).
"Culturally competent" care is a term that calls for
customizing care for patient populations that share
one or more demographic characteristics, usually race,
ethnicity, language, or country of origin (Office of
Minority Health, U.S. Department of Health and
Human Services, 2015).
Many professional organizations and government
agencies advocate for institutional implementation

5. of these conceptual care models (American Academy
of Pediatrics, 2012; American Association of Colleges
of Nursing, 2008; American Nurses Association,
2015; Bloom, 2002; Chao, Anderson, & Hernandez,
2009; The Joint Commission, 2010). These concep-
tual care models are also recommended for inclusion
in undergraduate and graduate nursing curricula
(American Association of Colleges of Nursing, 2008;
American Nurses Association, 2015). Therefore, the
purpose of this article was to (a) describe the histor-
ical separate evolution of these four conceptual care
models, (b) report results of a concept analysis that
offers conceptual clarity about the use of each model
in current empirical nursing literature, (c) compare
models to identify conceptual similarities and dif-
ferences, and (d) discuss implications for blending
the models.
Historical Evolution of Models
Table 1 provides an overview of the historical evolution
of the four models. In summary, multiple disciplines
have contributed to the parallel evolution of each of
these four conceptual care models. Although the
models share several attributes, for example, unique-
ness of the "patient," importance of patient-provider
relationship, and emphasis on individualized care,
they remain mutually exclusive within the research
literature. In addition, person-, patient-, or family-
centered care models do not address power, privilege,
historical oppression, or cross-cultural patient-nurse
relationships. To our knowledge, there has been no
systematic approach to comparing these four care
models as conceptualized by nurse researchers.
Therefore, we conducted a comparative concept anal-
ysis to explicate the current state of these concepts

6. within nursing research and explore how similar or
different the models might be.
Methods
InclusionlExclusion Criteria and Data Sources
Table 2 details the search criteria, search terms, data-
bases, and article selection for each concept. Our
search included articles published by nursing re-
searchers, documented by authorship, reporting pri-
mary data, and published between 2009 and 2013. We
chose this time frame because previous concept ana-
lyses had been completed before 2009. We chose arti -
cles with nurse authors because our aim was to
explicate how the four conceptual care models have
been conceptualized in nursing science. The most
common reason for exclusion was that nurses were
not authors.
Analytic Procedures
The research team was comprised of content and
methodology experts. We followed the procedures of
Rodgers (2000) in the conduct of a separate concept
analysis for each of the four conceptual care models,
beginning with person-centered care, followed
sequentially by patient-centered care, family-centered
care, and culturally competent care. We selected con-
cepts significant to nursing, that is, four conceptual
care models, and performed database searches using
specific inclusion and exclusion criteria. Each
researcher independently identified the surrogate
terms, antecedents, attributes, and consequences in
each article. The team met weekly to discuss the codes
and reach group consensus about results. During our

7. analysis, we found that in the family-centered and
cultural competency articles, researchers identified
barriers to implementing care models. Therefore, we
added "barriers" as a category. Findings were entered
into matrices. We modified and refined codes and
matrices as new findings emerged from the analysis.
On completion of the analysis of the four conceptual
care models, we compared the results across the
models to identify distinguishing and overlapping
characteristics as recommended by Haase, Leidy,
Coward, Britt, and Penn (2000). Finally, we assimi-
lated the findings into a proposed blended model that
also included social justice.
Results
Sample Characteristics
Our sample consisted of 32 articles published from
2009 to 2013. Most of the 10 person-centered care
studies originated in Europe. The rest were from the
United States and Australia. Most of the patient-
centered care studies were performed in the United
States. Only one study of patient-centered care was
P
ri
nc
ip
le
s

8. -S
et
ti
n
g
s
A
tt
ri
b
u
te
s
P
sy
ch
ol
og
y
•
C
ar
l
R

9. og
er
s
(1
94
0'
s)
•
B
ro
ok
er
(
20
07
)
•
P
sy
ch
o
th
er

10. ap
y
m
o
d
el
i
n
v
o
lv
es
a
th
er
ap
eu
ti
c
re
la
ti
o

11. n
sh
ip
c
h
ar
ac
-
te
ri
ze
d
b
y
e
m
p
at
h
y
a
n
d
u

12. n
co
n
-
d
it
io
n
al
r
eg
ar
d
f
or
t
h
e
c
li
en
t
(R
og

13. er
s,
1
94
2;
1
95
6;
1
95
7)
.
•
C
ar
e
re
fl
ec
ts
v
al
u
e

14. o
f p
er
so
n
h
o
o
d
o
f i
n
d
iv
id
u
al
s
w
it
h
d
em

15. en
ti
a
w
h
o
d
es
er
v
e
re
sp
ec
t
an
d
d
ig
n
it
y

16. (B
ro
ok
er
,2
00
7)
.
•
P
o
st
--
ac
u
te
h
ea
lt
h
ca
re

17. ,
e.
g.
,
h
o
m
es
,
lo
n
g
-t
er
m
c
ar
e
se
tt
in
g
s
•

18. E
ac
h
in
d
iv
id
u
al
h
a
s
in
te
rn
al
r
e-
so
u
rc
es
f
ro

19. m
w
h
ic
h
s
lh
e
c
a
n
d
ra
w
a
n
d
f
in
d
w
ay
s

20. to
r
em
ed
y
p
er
so
n
al
d
if
fi
cu
lt
ie
s
(R
og
er
s,
1
95

21. 6;
19
57
;V
V
oo
dh
ea
d,
20
13
)
•
R
ec
o
g
n
it
io
n
th

22. a
t
al
l
h
u
m
a
n
b
e-
in
g
s
h
av
e
ri
g
h
ts
,
d
ig
n

23. it
y
,
an
d
c
a-
p
ac
it
y
f
or
c
o
g
n
it
io
n
a
n
d
e

24. m
o
ti
o
n
(B
ro
ok
er
,
20
07
).
•
H
ol
is
ti
c,
in
d
iv

25. id
u
al
iz
ed
,
re
sp
ec
t-
fu
l,
an
d
e
m
p
o
w
er
in
g
(
B

26. ro
ok
er
,
20
07
)
N
u
rs
in
g
&
M
ed
ic
in
e
•
F
lo
re
n

27. ce
N
ig
h
ti
n
g
al
e
ce
n
tu
ry
)
•
B
al
in
t
(1
96
9)

28. th
(m
id
-1
9
•
C
ar
e
m
o
d
el
fo
cu
se
s
o
n
"w
h

29. o
le
p
at
ie
n
t,
"
in
cl
u
d
in
g
p
sy
ch
o
lo
g
ic
al

30. an
d
p
h
y
si
ca
l
(B
al
in
t,
19
69
).
•
C
ar
e
in
v
o
lv

31. es
b
o
th
t
h
e
p
at
ie
n
t'
s
an
d
p
h
y
si
ci
an
's
a
g

32. en
d
a
(L
ev
en
st
ei
n,
M
cC
ra
ck
en
,
M
cV
V
hi
nn
ey
,
S
te

33. w
ar
t,
&
B
ro
w
n,
19
86
)
•
A
cu
te
c
ar
e
•
L
o
n
g

34. -t
er
m
p
at
ie
n
t-
p
ro
v
id
er
re
-
la
ti
o
n
sh
ip
s,

35. s
en
si
ti
v
it
y
t
o
t
h
e
p
a-
ti
en
ts
' p
sy
ch
o
lo
g
ic

36. al
n
ee
d
s,
p
er
so
n
al
b
el
ie
fs
,
a
n
d
m
o
ti
v
at

37. io
n
s
fo
r
im
p
ro
v
in
g
w
el
l-
b
ei
n
g
(
B
al
in
t,
19

38. 69
)
•
S
ix
a
tt
ri
b
u
te
d
:
(a
)
ex
p
lo
re
p
at
ie
n
t

39. il
ln
es
s
ex
p
er
ie
n
ce
,
(b
)
u
n
d
er
st
an
d
w
h
o

40. le
p
er
so
n
,
(c
)
fi
nd
c
o
m
m
o
n
g
ro
u
n
d
r
eg

41. ar
d
in
g
m
an
ag
em
en
t,
(d
)
in
co
rp
o
ra
te
p
re
v
en
ti

42. o
n
a
n
d
h
ea
lt
h
p
ro
m
o
ti
o
n
,
(e
)
en
h
an
ce

43. d
o
ct
o
r-
p
at
ie
n
t
re
la
ti
o
n
sh
ip
,
an
d
(f
)

44. b
e
re
al
is
ti
c
ab
o
u
t
p
er
so
n
al
li
m
it
at
io
n
s

45. (S
te
w
ar
t,
B
ro
w
n,
V
V
es
to
n,
M
cV
V
hi
nn
ey
, M
cV
V

46. ill
ia
m
,
&
F
re
em
an
,
19
95
)
•
F
iv
e
d
im
en
si
o
n
s:

47. "b
io
p
sy
ch
o
so
ci
al
p
er
sp
ec
ti
v
e,
p
at
ie
n
t-
as

48. -p
er
so
n
,
sh
ar
in
g
p
o
w
er
a
n
d
r
es
p
o
n
si
b

49. il
it
y
, t
h
er
ap
eu
ti
c
al
li
an
ce
,
an
d
d
o
ct
o
r-
as
-p

50. er
so
n
"
(M
ea
d
&
B
ow
er
s,
2
00
0)
•
P
er
so
n
al
iz
ed

51. ,
ta
rg
et
ed
,
ta
il
o
re
d
,
o
r
in
d
iv
id
u
al
iz
ed
c
ar

52. e
(L
au
ve
r
e
t
aI
.,
20
02
)
N
u
rs
in
g
&
M
ed
ic
in
e
•

53. F
lo
re
n
ce
N
ig
h
ti
n
g
al
e
(m
id
-1
9
ce
n
tu
ry
)
th

54. •
S
u
rg
eo
n
G
en
er
al
E
v
er
et
t
K
oo
p
(1
97
0'
s)

55. C
ar
e
m
o
d
el
a
d
v
o
ca
te
s
fo
r
fa
m
il
y
in
v

56. o
lv
em
en
t
in
t
h
e
c
ar
e
o
f
si
ck
lo
v
ed
o
n
es
(

57. Jo
lle
y
&
S
h
ie
ld
s,
2
00
9)
an
d
c
h
il
d
re
n
w
it
h

58. d
is
ab
il
it
ie
s
(
V
eI
ls
,
20
11
)
•
P
ed
ia
tr
ic
s
et

59. ti
n
g
s
•
S
ix
c
h
ar
ac
te
ri
st
ic
s:
(
a)
h
o
n
o
r
an

60. d
re
sp
ec
t
p
at
ie
n
t
an
d
f
am
il
y
p
re
f-
er
en
ce
s,

61. (
b)
i
n
d
iv
id
u
al
iz
e
ca
re
i
n
re
sp
o
n
se
t
o
p

62. at
ie
n
t
a
n
d
f
am
il
y
n
ee
d
s
an
d
c
u
lt
u
ra
l

63. v
al
u
es
,
(c
)
ta
il
o
r
h
ea
lt
h
i
n
fo
rm
at
io
n
t
o

64. m
e
e
t
li
n
g
u
is
ti
c
an
d
l
it
er
ac
y
n
ee
d
s,
(
d)

65. fa
m
il
y
s
u
p
p
o
rt
,
(e
)
p
ar
tn
er
w
it
h
fa
m
il

66. ie
s
in
p
ro
g
ra
m
d
ev
el
o
p
-
m
en
t,
a
n
d
(
f)
su
p

67. p
o
rt
f
am
il
ie
s
st
re
n
g
th
s
(A
m
er
ic
an
A
ca
d
em
y

68. o
f
P
ed
ia
tr
ic
s,
2
01
2)
•
D
ev
el
op
m
u
tu
al
ly

69. sh
ar
ed
g
o
al
s
w
it
h
p
ar
en
ts
w
it
h
s
h
ar
ed
r
e-

70. sp
o
n
si
b
il
it
y
,
p
ar
en
t
au
to
n
o
m
y
an
d
c
o

71. n
tr
o
l,
n
eg
o
ti
at
io
n
,
a
n
d
fa
m
il
y
s
u
p
p

72. o
rt
(
M
ik
ke
ls
en
&
F
re
d
er
ik
se
n
,
20
11
)
C
u
lt

73. u
ra
ll
y
C
o
m
p
et
en
t
C
ar
e
S
o
ci
al
V
V
or
k
&
P

74. sy
ch
ol
og
y
•
N
at
io
n
al
A
ss
o
ci
at
io
n
o
f
S

75. oc
ia
l
V
V
or
ke
rs
(
G
al
le
go
s,
T
in
d
al
l,
&
G
al
le

76. go
s,
2
00
8)
•
M
ad
el
ei
n
e
L
en
in
g
er
(
19
50
's
)
•

77. M
od
el
re
q
u
ir
es
c
u
lt
u
ra
ll
y
s
en
si
-
ti
v
e
an

78. d
r
es
p
ec
tf
u
l c
ar
e
fo
r
p
eo
p
le
o
f
al
l
cu
lt
u

79. re
s,
l
an
g
u
ag
es
,
b
el
ie
fs
,
v
al
u
es
,
cl
as
se
s,
r

80. ac
es
,
et
h
n
ic
b
ac
k
g
ro
u
n
d
s,
r
el
ig
io
n
s,
a

81. n
d
o
th
er
d
iv
er
si
ty
f
ac
to
rs
(
G
al
le
go
s,
T
in

82. d
al
l,
&
G
al
le
go
s,
2
00
8;
L
ei
n
in
g
er
&
M
cF
ar
la

83. n
d
,
20
06
)
•
T
ra
n
sc
u
lt
u
ra
l
n
u
rs
in
g
i
s
a

84. m
o
d
el
o
f
"h
u
m
an
c
ar
in
g
"
th
a
t
re
co
g
-
n
iz

85. es
u
n
iv
er
sa
l
a
n
d
c
u
lt
u
ra
ll
y
-
sp
ec
if
ic
p
er

86. sp
ec
ti
v
es
a
b
o
u
t
ca
ri
n
g
(L
ei
ni
ng
er
,
19
78
;

87. M
ad
el
ei
ne
L
en
in
ge
r
C
ul
tu
ra
l
D
iv
er
si
ty
i
n
N

88. u
rs
in
g
P
ra
ct
ic
e,
2
01
0)
•
E
d
u
ca
ti
o
n
&
c
o
m

89. m
u
n
it
y
•
U
n
d
er
st
an
d
b
el
ie
fs
,
v
al
u
es
,

90. an
d
tr
ad
it
io
n
al
h
ea
lt
h
p
ra
ct
ic
es
o
f
d
iv
er
se

91. p
o
p
u
la
ti
o
n
s
(L
ei
ni
ng
er
,
19
98
).
•
In
cl
u
d
es

92. so
ci
al
ju
st
ic
e,
h
u
m
a
n
ri
g
h
ts
,
an
d
s

93. o
ci
al
d
et
er
m
in
an
ts
o
f
h
ea
lt
h
,
an
d
i
ss
u
es
o

94. f
p
o
w
er
a
n
d
p
ri
v
il
eg
e
(D
ou
gl
as
e
t
al
.,
20

95. 11
)
•
In
cl
u
d
es
s
el
f-
aw
ar
en
es
s,
c
u
lt
u
ra
l
k
n

96. o
w
le
d
g
e,
o
p
en
-m
in
d
ed
a
tt
i-
tu
d
es
,
an
d
c
u

97. lt
u
ra
ll
y
c
o
n
g
ru
en
t
b
eh
av
io
rs
(
D
ud
as
,
20
12

98. ).
•
In
cl
u
d
e
fa
m
il
ie
s,
co
m
m
u
n
it
ie
s,
an
d

99. h
ea
lt
h
s
y
st
em
s
(S
ah
a,
B
ea
ch
,
&
C
oo
pe
r,
2
00
8)

100. w
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NURS OUTLOOK 64 (20r6) 352-366 355
performed in Israel. Half of the family-centered care
studies were conducted in European countries; the rest
were from the United States, Canada, several African
countries, and Australia. Most culturally competent
care studies originated in the United States, one study

101. was from Spain, and one was from South Africa.
Study Designs
Most study designs were qualitative, particularly in the
family-centered care research (Bolster & Manias, 2010;
Coyne, O'Neill, Murphy, Costello, & O'Shea, 2011;
Coyne, 2013; Ho, 2009; Jomfeldt, Rask, Brunt, &
Svedberg, 2012; McLauglin et al., 2013; Mitchell,
Chaboyer, Burmeister, & Foster, 2009; Roets,
Rowe-Rowe, & Nel, 2012; Staniszewska et al., 2012;
Trajkovski, Schmied, Vickers, & Jackson, 2012). Three
researchers in patient-centered and culturally compe-
tent care used a mix of qualitative and quantitative
methods (Collins-McNeil et al., 2012; Haigh &
Ormandy, 2011; Walton, 2011). Studies across all con-
cepts involved quasiexperimental designs (Ailinger,
Martyn, Lasus, & Lima Garcia, 2010; Dudas et al.,
2013; Ekman et aI., 2012; Mitchell et al., 2009). Re-
searchers of person- and family-centered care used
cross-sectional designs (Edvardsson, Petersson,
Sjogren, Lindkvist, & Sandman, 2013; McCormack
et al., 2010; Sjogren, Lindkvist, Sandman, Zingmark, &
Edvardsson, 2012; Soury-Lavergne et al., 2011; Wil-
liams, Boyle, Herman, Coleman, & Hummert, 2012).
Surrogate Terms and Attributes
Surrogate terms are words considered synonymously
for the concept (Tofthagen & Fagerstrom, 2010). The
surrogate terms identified for the four concepts are
listed in Table 3. The term "family centered" was uni-
versally applied to that concept of family-centered
care, whereas the terms used to describe culturally
competent care were quite varied.

102. Attributes define or characterize the concept under
study (Tofthagen & Fagerstrom, 2010). The following 12
attributes were found across all four concepts. Table 3
lists the attributes by conceptual care model.
Collaborative relationship was the central attribute
endorsed by all four models of care. Such relationships
consisted of individual health care providers and
interprofessional care teams working in partnership
with the identified patient and his/her family in plan-
ning and implementing their care (Glass, Moss, & Ogle,
2012). Collaborative relationships are achieved by
providing patients/families "honest information"
about the patients' condition and related care (Mitchell
et al., 2009). In pediatric settings, collaboration also
meant including parents in their children's care
(Mitchell et al., 2009; Staniszewska et al., 2012;
Trajkovski et al., 2012). These relationships also
required nurturing partnerships with key community
stakeholders (Walton, 2011). Ekman et al. (2012)
";
l'
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n
T
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103. r
el
at
io
n
sh
ip
s
D
u
d
as
,
S
ch
au
fe
lb
er
g
er
;
&

104. S
w
ed
b
er
g
(
20
13
);
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k
m
an
,
e
t
al
.
(2
01
2)
;
G

105. la
ss
e
t
al
.
(2
01
2)
;
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cC
or
m
ac
k
e
t
al
.
(2
01
0)
;

106. W
il
li
am
s,
B
oy
le
,
K
.,
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er
m
an
,
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o
le
m
an
,
&
H

107. u
m
m
er
t
(2
01
2)
;
S
jo
g
re
n
e
t
al
.
(2
01
2)
E
ff

108. ec
tiv
e
co
m
m
u
n
ic
at
io
n
B
o
ls
te
r
&
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an
ia
s
(2

109. 01
0)
;
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o
le
m
an
&
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ed
v
en
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(2
01
3)
;
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d
v
ar
d

110. ss
o
n
e
t
al
.
(2
01
3)
;
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la
ss
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t
al
.
(2
01
2)
R
es

111. pe
ct
fu
l
ca
re
M
cC
or
m
ac
k
e
t
al
.
(2
01
0)
;
Jo
m
fe

112. ld
t
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t
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.
(2
01
2)
;
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il
li
am
s,
B
oy
le
,
K
.,
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er
m

113. an
,
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o
le
m
an
,
&
H
u
m
m
er
t
(2
01
2)
H
ol
is
tic
p

114. er
sp
ec
ti
v
e
M
cC
or
m
ac
k
e
t
aL
(
20
10
);
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d
v
ar

115. d
ss
o
n
,
P
et
er
ss
o
n
,
S
jo
gr
en
,
L
in
dk
vi
st
,
&

116. S
an
d
m
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(
20
13
);
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d
v
ar
d
ss
o
n
e
t
aI
.
(2
01

117. 0)
;
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cK
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w
n
e
t
aL
(
20
10
);
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jo
gr
en
e
t
al
.
(2
01

118. 2)
In
di
vi
du
al
iz
ed
c
ar
e
B
ol
st
er
&
M
an
ia
s
(2
01
0)

119. ;
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d
as
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t
al
.
(2
01
3)
;
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d
v
ar
d
ss
o
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120. et
er
ss
o
n
,
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jo
gr
en
,
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dk
vi
st
,
&
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an
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m
an

121. (
20
13
)
In
te
rp
ro
fe
ss
io
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c
o
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rd
in
at
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o

122. ls
te
r
&
M
an
ia
s
(2
01
0)
S
el
f-
aw
ar
en
es
s
B
ol
st
er

123. &
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an
ia
s
(2
01
0)
;
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o
le
m
an
E
m
p
o
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m
en
t

124. F
am
il
y
as
a
u
n
it
o
f
ca
re
In
te
rp
er
so
n
al
r
el
at

125. io
n
sh
ip
s
&
M
ed
v
en
e
(2
01
3)
;
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d
v
ar
d
ss
o
n

126. ,
P
et
er
ss
o
n
,
S
jo
gr
en
,
L
in
dk
vi
st
,
&
S
an
d

127. m
an
(
20
13
)
C
o
le
m
an
&
M
ed
v
en
e
(2
01
3)
;
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o
ls

128. te
r
&
M
an
ia
s
(2
01
0)
;
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m
fe
ld
t
e
t
al
.
(2
01
2)
;
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129. d
v
ar
d
ss
o
n
,
P
et
er
ss
o
n
,
S
jo
g
re
n
,
L
in
dk

130. vi
st
,
&
S
an
d
m
an
(
20
13
);
E
d
v
ar
d
ss
o
n
e
t a

131. l.
(2
01
0)
;
S
jo
g
re
n
e
t
al
.
(2
01
2)
w
U
1
0

132. '
'a
ti
e
n
t-
C
e
n
te
re
d
F
a
m
il
y
-C
e
n
te
re
d

133. C
u
lt
u
ra
ll
y
C
o
m
p
e
te
n
t
A
b
d
el
h
ad
i
&

134. D
ra
ch
-Z
ah
av
y
(
20
12
)
K
en
n
ed
y
(
20
12
);
M
cL
au
gh

135. li
n
e
t
al
.
A
n
d
er
so
n
&
F
ri
ed
em
an
n
(
20
10
);

136. (2
01
3)
;
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it
ch
el
l
e
t
al
.
(2
00
9)
;
W
al
to
n
(
20
11
)

137. R
oe
ts
e
t
al
.
(2
01
2)
;
S
ou
ry
-
L
av
er
gn
e
e
t
aL
(

138. 20
11
);
T
ra
jk
o
v
sk
i
e
t
aL
(
20
12
)
A
b
d
el
h
ad

139. i
&
D
ra
ch
-Z
ah
av
y
(
20
12
)
K
en
n
ed
y
(
20
12
);
M
cL

140. au
gh
li
n
e
t
al
.
A
il
in
ge
r
e
t
aL
(
20
10
);
C
ol
li
ns

141. -
(2
01
3)
;
S
ta
n
is
ze
w
sk
a
e
t
aI
.
M
cN
ei
l
e
t
aL

142. (
20
12
);
H
aw
al
a-
(2
01
2)
;
T
ra
jk
o
v
sk
i
e
t
al
.
(2

143. 01
2)
D
ru
y
&
H
ill
(
20
12
);
H
o
(2
00
9)
;
K
el
le
y
(2

144. 01
1)
R
ad
w
in
,
L.
C
ab
ra
l,
&
W
il
ke
s
(2
00
9)
M
it

145. ch
el
l
e
t
al
..
20
09
;
R
oe
ts
e
t
al
.
K
el
le
y
(2
01
1)

146. ;
H
aw
al
a-
D
ru
y
&
H
ill
(2
01
2)
;
T
ra
jk
o
v
sk
i
e

147. t
al
.
(2
01
2)
(2
01
2)
;
W
al
to
n
(
20
11
)
Z
c::
A
b

148. d
el
h
ad
i
&
D
ra
ch
-Z
ah
av
y
(
20
12
)
K
en
n
ed
y
(
20

149. 12
);
M
cL
au
gh
li
n
e
t
aL
~
C
f}
(2
01
3)
;
R
oe
ts
e

150. t
aL
(
20
12
);
0
S
ta
n
is
ze
w
sk
a
et
a
L
(
20
12
);

151. c:: >-l
T
ra
jk
o
v
sk
i
e
t
al
.
(2
01
2)
r<
0 0 '"
R
ad
w
in

152. ,
L.
C
ab
ra
l,
&
W
il
ke
s
(2
00
9)
C
oy
ne
e
t
a
t
(2
01

153. 1)
;
M
it
ch
el
l
e
t
al
.
0
-i'
-
(2
00
9)
; S
ta
n
is
ze
w
sk

154. a
e
t a
L
(
20
12
)
tv
0 0
R
ad
w
in
,
L.
C
ab
ra
l,
&
W

155. il
k
es
(
20
09
)
C
oy
ne
e
t
al
.
(2
01
1)
w
A
b
d
el

156. h
ad
i
&
D
ra
ch
-Z
ah
av
y
(
20
12
)
W
al
to
n
,
20
11
;
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157. aw
al
a-
D
ru
y
&
H
ill
U
l
(2
01
2)
tv
I
w
0
0

158. C
oy
ne
(
20
13
);
C
oy
ne
e
t
al
.
(2
01
1)
;
W
al
to
n
(
20

159. 11
)
S
ou
ry
-L
av
er
gn
e
e
t
al
.
(2
01
1)
C
oy
ne
(
20
13

160. );
C
oy
ne
e
t
al
.
(2
01
1)
;
A
ll
in
ge
r
e
t
al
.
(2
01
0)

161. ;
A
n
d
er
so
n
&
M
cL
au
gh
li
n
e
t
aL
(
20
13
);
R
oe

162. ts
F
ri
ed
em
an
n
(
20
10
)
e
t
al
.
(2
01
2)
;
S
ta
n
is

163. ze
w
sk
a
e
t
al
.
(2
01
2)
;
T
ra
jk
o
v
sk
i
e
t
al
.
(2
01

164. 2)
H
o
(2
00
9)
;
A
il
in
ge
r
e
t
aL
(
20
10
)
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165. ~ .$
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NURS OUTLOOK 64 (2or6) 352-366 357
described three phases of partnerships: initiating,
working, and safeguarding.
Effective communication was described as a contin-
uous process involving verbal or nonverbal exchanges
of information between all health care providers and
patients (Coyne et al., 2011; McLaughlin, Melby, &
Coates, 2013). Ho (2009) suggested that effective
communication requires reflective listening with a
sense of empathy, recognizing, and understanding
nonverbal cues of communication, such as eye contact,
gestures, and facial expressions and feelings. Kelley
(2011) described effective communication as requiring
clinicians to establish trust with patients, actively
listen, use simple language, adopt an unhurried
demeanor, and assess the patient's beliefs, fears, tone
of voice, and style of speech. Kelley (2011) suggested
that matching the provider race and gender to that of
the patient improves communication. In addition,
written materials need to be understandable to those
with low literacy levels, visually appealing, and un-
cluttered (Ho, 2009).
Respectful care was characterized as being responsive

166. to and accepting of the person's beliefs and values,
acting in a caring, sympathetic manner (McCormack
et al., 2010), and being polite and affirming (Williams
et al., 2012). Respectful interactions with patients and
their families were characterized as sensitive and
compassionate (Staniszewska et al., 2012). Respectful
care required being open-minded about patient or
family beliefs, values, or practices that are different
from one's own (Hawala-Druy & Hill, 2012; Kelley,
2011).
A holistic perspective referred to planning and deliv-
ering care based on knowledge of the multiple facets of
the person and their family (Kennedy, 2012;
McLaughlin et al., 2013; Roets et al., 2012; Trajkovski
et al., 2012). These facets include social, cultural, psy-
chological, and spiritual as well as physical needs. A
holistic perspective also involved recognizing the in-
dividual's wishes and attending to individual stressors
(Roets et al., 2012; Trajkovski et al., 2012).
Individualized care consisted of tailoring care plans
and care delivery to the needs and wishes of patients
and/or their families. Such care included providing
psychosocial support to the family and physical care to
the patient (Mitchell et al., 2009; Staniszewska et al.,
2012). In pediatric settings, individualized care
required "getting to know" parents and their prefer-
ences (Bolster & Manias, 2010; Trajkovski et al., 2012)
and involving parents in their children's physical care,
for example, bathing and combing hair (Mitchell et al.,
2009; Staniszewska et al., 2012). In residential settings
for the elderly, it involved residents taking part in
normative activities, for example, making coffee, tak-
ing outdoor walks, playing games, or attending reli-
gious services (Edvardsson et al., 2013). Coyne et al.

167. (2011) described "negotiated care" that involved an
iterative exchange of information between families
and nurses to reach mutually agreeable goals and
related care. This process required nurses to remain
358 NURS OUTLOOK 64 (20r6) 352-366
flexible and nonjudgmental. Individualized care was
associated with patients having a sense of well-being
and trust; "responsive care" was associated with pa-
tients having trust in nurses (Radwin, Cabral, & Wilkes,
2009).
Interprofessional coordination required mUltiple disci -
plines to work together as a synergistic team and to
comprehensively address patient and family needs
(Coyne et aI., 2011). Bolster and Manias (2010) noted
that effective communication among team members is
critical for optimal teamwork.
Self-awareness required self-reflection to gain an
understanding of one's own assumptions and become
open to beliefs and values different than one's own
(Abdelhadi & Drach-Zahavy, 2012; Bolster & Manias,
2010; Coleman & Medvene, 2013; Edvardsson et aI.,
2013; Hawala-Druy & Hill, 2012; Walton, 2011). In
describing self-awareness, Hawala-Druy and Hill
(2012) recommended that nurses also gain an under-
standing of how intersecting patient identities and
institutionalized social injustices contribute to health
inequities.
Empowerment of patients and families was accom-
plished by providing patients or their caregivers

168. important health information and encouraging them
to participate in the patient's care, for example, medi-
cation administration, to assure that they had acquired
the competence and confidence to successfully
perform the task at home (Bolster & Manias, 2010).
Empowerment was also associated with assuring ac-
cess to care, providing adequate health information,
and involving patients, families, and communities in
care (Coyne, 2013; Coyne et aI., 2011; Soury-Lavergne
et aI., 2011; Walton, 2011).
Viewing the family as a unit of care meant considering
the psychosocial needs of the entire family and the
identified patient. This attribute was especially
important in pediatric or culturally diverse populations
(Ailinger et aI., 2010; Anderson & Friedemann, 2010;
Coyne, 2013; Coyne et aI., 2011; McLaughlin et aI.,
2013; Roets et aI., 2012; Staniszewska et aI., 2012;
Trajkovski et aI., 2012).
Interpersonal relationship involved establishing trust,
listening to family life stories, and coming to know the
family within the social context of their lives beyond
the health care setting (Bolster & Manias, 2010;
Trajkovski et aI., 2012). Such relationships were said
to evolve over time with repeated contacts (Bolster &
Manias, 2010).
Cultural knowledge meant gaining an understanding
and appreciation for culturally specific beliefs and
health care practices as well as factors contributing to
cultural values (Ailinger et aI., 2010; Anderson &
Friedemann, 2010; Collins-McNeil et aI., 2012;
Hawala-Druy & Hill, 2012; Ho, 2009; Kelley, 2011;
~alton, 2011). An example was knowledge about reli-
gIous practices (Ho, 2009). Some authors also advo-

169. cate~ for considering multiple intersecting identities as
Important component of cultural knowledge
& Hill, 2012; Walton, 2011).
Cultural skills involved incorporating cultural
knowledge and self-awareness into clinical practice
(Walton, 2011). These skills require effective cross-
cultural communication and capacities for building
partnerships at the individual and community levels
(Walton, 2011).
As noted in Table 3, the concepts ofperson-, patient-,
and family-centered care as well as culturally compe-
tent care shared the attributes of collaborating in part-
nership with patient and/or family, communicating
effectively, and acting in a respectful and caring way.
Person-, patient-, and family-centered care included
viewing patients holistically, individualizing care, and
coordinating interprofessional care as attributes.
Person-centered, patient-centered, and culturally
competent care recognized developing self-awareness
as an attribute. Empowering patients, families, and/or
communities and viewing family as a unit of care were
attributes espoused by family-centered and culturally
competent care. Forming interpersonal relationships
was shared by person-centered, patient-centered, and
culturally competent care. Gaining cultural knowledge
and developing culturally congruent, responsive
behavioral skills were unique to culturally competent
care.
Antecedents
Antecedents are events or phenomena that have been
previously associated with the concept (Tofthagen &

170. Fagerstrom, 2010). In this analysis, antecedents
included factors researchers cited as a rationale for
conducting their studies.
Person- and Patient-Centered Care
The most common reasons for person- and patient-
centered care were poor patient health outcomes
(Ekman et aI., 2012; Edvardsson, Fetherstonhaugh, &
Nay, 2010; Edvardsson et aI., 2013; Glass et aI., 2012;
}omfeldt et aI., 2012; Williams et aI., 2012; Radwin
et aI., 2009; Dudas et aI., 2013) and paternalistic
patient-provider relationships (Coleman & Medvene,
2013; Jomfeldt et aI., 2012; Williams et aI., 2012;
Slatore et aI., 2012). Conditions that preceded and
prompted person- or patient-centered care studies
included lack of empirical support (Edvardsson et aI.,
2010; Bolster & Manias, 2010; Ekman et aI., 2012;
Haigh & Ormandy, 2011; Abdelhadi & Drach-Zahavy,
2012; McCormack et aI., 2010; McKeown, Clarke,
Ingleton, Ryan, & Repper, 2010). Other reasons for
initiating person-centered care included concerns
about quality of life (Edvardsson et aI., 2013), incon-
gruence between person-centered philosophy and
task-oriented patient care (Bolster & Manias, 2010),
nurse-patient interaction is not person-centered
based (Bolster & Manias, 2010; Coleman & Medvene,
2013), and need for more creative ways to embrace a
person-centered framework (McKeown, Clarke,
Ingleton, Ryan, & Repper, 2010). Other reasons for
• conducting studies of patient-centered care included
NURS OUTLOOK 64 (2016) 352-366 359

171. high cost of care services, for example, intensive care
services at the end of life (Radwin, Ananian, Cabral,
Keeley, & Currier, 2011), poor organization and de-
livery of care (Haigh & Ormandy, 2011), and inconsis-
tent findings of relationships between experience and
adverse nurse-sensitive events (Radwin et al., 2009).
Family-Centered Care
The three most common antecedents for family-
centered care research included (a) lack of empirical
evidence in particular settings (Coyne, 2013; Coyne
et al., 2011; Kennedy, 2012; McLaughlin et al., 2013;
Soury-Lavergne et al., 2011; Trajkovski et al., 2012), (b)
unmet psychological needs of family members
(McLaughlin et al., 2013; Mitchell et al., 2009; Roets
et al., 2012), and (c) professionals having difficulty
integrating family-centered care into practice (Coyne,
2013; Coyne et al., 2011; McLaughlin et al., 2013;
Mitchell et al., 2009; Staniszewsk et al., 2012;
Trajkovski et al., 2012). Other reasons for implement-
ing the study included the high incidence of emotional
distress associated with having loved ones requiring
intensive critical care (Roets et al., 2012; Soury-
Lavergne et al., 2011; Trajkovski et al., 2012), parent
reports of being marginalized during their children's
hospitalizations (Mitchell et al., 2009; Staniszewsk
et al., 2012), and controversies surrounding family-
witnessed resuscitation (McLaughlin et al., 2013).
Culturally Competent Care
The most common antecedents for culturally compe-
tent care research were (a) health disparities (Ailinger
et al., 2010; Anderson & Friedemann, 2010; Collins-
McNeil et al., 2012; Hawala-Druy & Hill, 2012; Kelley,
2011; Walton, 2011), (b) lack of empirical evidence
demonstrating the importance of culturally competent

172. care (Ailinger et al., 2010; Anderson & Friedemann,
2010; Walton, 2011), (c) insufficiency of culturally
competent education leading to potential bias or in-
justices in care (Hawala-Druy & Hill, 2012; Walton,
2011), (d) limited availability of interpreters or bilin-
gual nurses (Ailinger et al., 2010; Ho, 2009), and (e)
inadequate knowledge of diseases in minority pop-
ulations (Ailinger et al., 2010; Collins-McNeil et al.,
2012). The objectives of Healthy People 2020 and the
objectives of Institute of Medicine were mentioned as
antecedents (Ailinger et al., 2010; Hawala-Druy & Hill,
2012). Other antecedents included the growing need for
culturally competent education because of the
increasingly diverse and growing U.S. population
(Hawala-Druy & Hill, 2012) and the growing need for
family health education worldwide (Anderson &
Friedemann, 2010).
In summary, the literature on all four conceptual
care models identified lack of empirical evidence as an
antecedent. The person- and family-centered care re-
searchers noted poor patient outcomes or unmet needs
of patients as antecedents. Culturally competent and
family-centered care research was associated with
difficulty integrating care models and providers'
insufficient education about these concepts. Culturally
competent care researchers also mentioned the
growing need for family health education as an ante-
cedent, which is connected to family-centered care.
Patient's emotional distress was an antecedent unique
to the family-centered care literature. The quality of
patient-provider relationships was only mentioned as
an antecedent in person-centered research. Cultural
competency researchers frequently identified health
disparities and language barriers as antecedents that

173. were not mentioned in the studied involving the other
three care models.
Consequences
Consequences are what happen as a result of the
phenomena under study (Tofthagen & Fagerstrom,
2010). In this analysis, consequences were the find-
ings associated with the implementation of the care
model.
Person- and Patient-Centered Care
Person-centered interventions were associated with
improved health-related outcomes, for example, pa-
tient self-care, health goal attainment, and lifestyle
(Glass et al., 2012), and less ambiguity and uncertainty
in illness (Dudas et al., 2013). Person-centered care was
also associated with shorter hospital stays, improved
functionality, and reduced hospital readmission in pa-
tients (Ekman et al., 2012). One study reported residents
who reported higher person-centered scores had
significantly higher quality of life and cognitive scores
than those who had not (Edvardsson et al., 2013;
McKeown et al., 2010). Studies also revealed that
person-centered care increased communication, satis-
faction, and improved relationships between providers
and patients (Coleman & Medvene, 2013; Williams et al.,
2012; Jomfeldt et al., 2012). Of the five patient-centered
studies, only one study reported consequences
(Radwin et al., 2009). Radwin et al. (2009) reported that
patient-centered interventions were positively related
to subsequent desired health outcomes, defined as
sense of well-being. For example, responsiveness and
proficiency of nurses were positively related to patients'
trust in nurses, and individualization was positively
associated to subsequently authentic self-

174. representation, optimism, and a sense of well-being.
Family-Centered Care
Reports from family members and nurses showed that
family-centered care was associated with a high qual-
ity of care (Coyne, 2013; Coyne et al., 2011; Mitchell
et al., 2009). Several studies highlighted facilitators of
family-centered care. Kennedy (2012) noted that get-
ting to know the child/patient results in effective
communication, trust, informed decision-making, and
collaborative teamwork. In another study, neonatal
intensive care unit nurses reported that family-
centered care helps parents become confident and
competent caretakers which promotes bonding with
360 NURS OUTLOOK 64 (2016) 352-366
Societal Factors
-Community resources
-Social services
-Health insurance
-Public policy
-Social justice
Institutional Factors
-Philosophy
-Policies
-Staff education
-Staffing model
-Social justice
Figure 1 - Person-, family-, and culture-centered nursing care

175. model.
their sick newborns (Trajkovski et al., 2012). One study
showed that 24-hr family-friendly visitation policies
and family member participation in patient care ten-
ded to be more common in pediatric than those in adult
intensive care units (Soury-Lavergne et al., 2011). Staff
education and training in family-centered principles
and practices were associated with significantly greater
family satisfaction with care than a control group
(Mitchell et al., 2009). Acute intensive care settings
posed unique challenges to the delivery of family-
centered care. Roets et al. (2012) identified 15 specific
family stressors that need to be addressed in pediatric
intensive care units: child's medical procedures, child's
appearance, inadequate overwhelming conflicting in-
formation about child, role ambiguity, child's pain and
discomfort, medical equipment, fear for child's life,
sense of helplessness, changes in child's behavior,
physical and emotional separation from child, sudden,
unexpected changes or seriousness of child's condi-
tion, complexity of health care system, separation from
family, and support when a child in the unit dies.
Neonatal intensive care unit nurses expressed a need
for institutional guidelines in support of family-
centered care (Trajkovski et al., 2012). Emergency
nurses identified a need for more education to
competently address the emotional needs of families
during and after the resuscitation of a loved one
(McLaughlin et al., 2013).
Culturally Competent Care
~onsequences of culturally competent care included
mcreased enrollment of African Americans in studies
2011), improved medication adherence

176. et ~1" 2010), and increased acceptable and
mterventions in minority populations'
(CollinS-McNeil et al., 2012). Ho (2009) found that pre-
dominantly white health care providers and culturally
diverse patients differed in communication style,
beliefs, values, and cultural customs which can
contribute to cross-cultural misunderstanding. Stu-
dents who received education in cultural competence
developed increased self-awareness, open-minded-
ness, appreciation for cultural differences, problem-
solving skills, appreciation for the role of families in
holistic patient care, skills in interprofessional collab-
oration, and a repertoire of family interventions
(Anderson & Friedemann, 2010; Walton, 2011). Cultural
competence education helped students broaden their
perspectives, heightened their awareness of their own
culture, including biases and stereotypes, and
increased their appreciation of team collaboration and
mutual respect of professional roles (Hawala-Druy &
Hill, 2012).
In summary, collectively, results showed improved
health-related outcomes including self-management
and mental health, for example, reduction of stress,
patient and family satisfaction, and patient- and
family-provider relationships. Person-centered care
also reduced the length of patient hospitalizations or
readmissions and improved patient functioning and
quality of life. Family-centered care was believed to
improve the quality of care and parent-child re-
lationships. Culturally competent care implemented
with members of historically oppressed racial/ethnic
groups increased their trust of health researchers and
Willingness to participate in research. Cultural

177. competence education helped students gain insights
about their socially constructed biases and an appre-
ciation for cultural differences. This review also
amplified certain prerequisites for successful
NURS OUTLOOK 64 (2or6) 352-366 361
Table 4 - Intersecting Identities on Continuum of Privilege-
Disadvantage
Identity
Age
Sex
Gender
Sexual orientation
Race/ ethnicity
Historical factors
Abilities
Education
Language
Health literacy
Income
Religion/spirituality
Adult
Male
Privileged
Congruent gender
Heterosexual
White/European descent

178. Historical privilege
Abled body and mind
High
English
High
High
JudeO-Christian
implementation of these models. Most notable were
institutional support and staff education.
A Proposed Person-, Family-, and Culture-Centered
Nursing Care Model
Given our findings of favorable outcomes associated
with each conceptual care model, similar attributes
among the models, and the importance of the
nonoverlapping attributes, we assert that merging
these models into a blended care model that in-
corporates social justice could potentially (a) foster
scientific discourse and collaboration across spe-
cialties, for example, geriatrics and pediatrics, acute
and residential care, majority and underrepresented
populations; (b) exert a synergistic benefit on patient,
family, and community health outcomes; and (c) take
the guesswork out of which model to apply to which
patient population under which circumstances.
Although the literature reveals several blended care
models, for example, Tucker's patient-centered
culturally sensitive health care model (Tucker,
Marsiske, Rice, Jones, & Herman, 2011), there are no
known nursing care models that blend all four con-
ceptual models of care. Therefore, we propose a
blended nursing model of person-, family-, and
culture-centered care that could be universally applied

179. to all people across all settings. The following discus-
sion describes the components and philosophical un-
derpinning of this blended model.
As illustrated in Figure 1, the proposed model builds
on existing models of care to include the person
receiving care, their family, and their culture,
comprised on intersecting identities. We chose "per-
son" rather than "patient" to emphasize the person-
hood of those for whom we serve within health care
systems. The term "patient" is setting bound, tYEically
used in hospitals or clinics, whereas the goal of health
care is to address individual and family health care
needs across settings. The term "person" encompasses
all the unique attributes of a human being that
contribute to his/her personhood (McCormack, 2004).
Cassel (1982) describes the different facets of a person ,
Disadvantaged
Children and elderly
Female
Nonconforming or transgender
Lesbian/gaylbisexual/questioning (LGBQ)
Underrepresented groups
Historical trauma
Disability/cognitive impairment/mental illness
Low
Limited English proficiency or first language is not
English
Low
Low
Non-Western religions
as having a personal history, cultural background, so-

180. cial roles, interpersonal relationships, political views,
personal life, perceived future, and a transcendental or
spiritual self.
Individuals tend to live within social units that
they consider to be their family. Families are char-
acterized as interdependent social systems that serve
to meet the affective, sociocultural, economic,
developmental, and physical needs of members
(Friedman, Bowden, & Jones, 2003). We agree with
Wright and Leahey (2013) that "the family is who they
say they are" (p. 55). Families mayor may not include
biologically or legally related members, multiple
generations, or individuals who reside together. We
contend that, regardless of the age of the identified
patient, his/her family should be considered in the
assessment and intervention plan. Including the
family in care can help providers: (a) understand the
person's proximal social context, (b) enlist support in
meeting the patient's care needs, (c) gage the impact
of the patient's health on the family's functioning,
and (d) identify other family members in need of
services (Friedman et aI., 2003).
The concept of holistic perspective espoused by
person-, patient-, and family-centered care models
suggests that nurses need to consider various aspects
of a person's identity in assessment, care planning,
and care delivery. Therefore, the proposed blended
model draws from theories of intersectionality with
the supposition that mUltiple aspects of one's identi-
ties contribute to one's personal sense of culture
(Crenshaw, 1991; Davis, 2008; Hancock, 2007). Culture
reflects patterns of beliefs, values, behavior, knowl-
edge, and experience that are collectively held by a
particular group in response to the sociopolitical

181. context and passed from one generation to the next
(Hofstede, 1980; Lederach, 1995). Put simply, culture is
"a way of life" (Griswold, 2012; Long, 1997). Each in-
dividual's worldview is shaped by his/her affiliation
with various intersecting sociocultural groups and
internalized identities (Viruell-Fuentes, Miranda, &
Abdulrahim, 2012). Thus, individuals self-define the
meaning of culture.
362 NURS OUTLOOK 64 (2016) 352-366
Recent research (Bauer, 2014; Veenstra, 2013) has
documented relationships between intersecting iden-
tities and health outcomes. Intersectionality is defined
as coexisting identities, categories, and experiences
that include, but are not limited to race, gender, class,
and sexual orientation (Hancock, 2007). The interaction
of underrepresented identities has been associated
with limited access to care, health inequality, and
power differentials in patient-provider relationships
(Davis, 2008; Hancock, 2007). Determining which
identities are most salient to the person's health needs
to be performed in partnership with the patient and/or
family. These identities can fall anywhere along a
continuum of privilege-disadvantage that is grounded
in a social justice perspective illustrated in Table 4. Our
Western health care system is based on the beliefs,
values, and practices of the privileged majority culture
of the United States. Therefore, the more identities that
a person has at the disadvantaged end of the contin-
uum, the more nursing support and advocacy that
person and family will likely require within the health
care system and the community. Assessment of
individual and family needs relative to privilege-

182. disadvantage facilitates tailored interventions and so-
cially just care that can promote health equity. Nurses
need to assess the impact of these interesting identities
to optimize the quality of care.
Nurse and Interprofessional Team Attributes
The blended model incorporates the 12 attributes
identified in the concept analysis. These attributes are
essential to establishing and maintaining the core
attribute, collaborative relationships. In accordance
with the American Association of Colleges of Nursing
(2008) and the American Nurses Association Code of
Ethics (2015), we added social justice. Social justice is
based on the following principles: (a) the fair and
equitable access to and delivery of services, (b) recog-
nition and reduction of power differentials, (c) atten-
tion to social determinants of health, (d) creation of
institutions policies and procedures that promote
health equity, (e) protection of human rights, and (f)
support of human development and self-actualization
(Buettner-Schmidt & Lobo, 2011). We contend that so-
cial justice is a prerequisite for quality nursing care and
essential to advancing health equity. Socially just
public policies are critical to making health resources
equitably available to all communities. Institutional
policies that reflect a philosophy of social justice are
likely to support staffing models, practitioners' skills,
and programming that address health disparities. A
major deficit in person-, patient-, and family-centered
care models is the absence of social justice: There-
fore, we positioned social justice as an important
component of the proposed blended model at the so-
cietal, institutional, and individual levels. In so doing,
this model offers a framework for examining new and
innovative ways to incorporate social justice in nursing

183. science, education, and practice.
Collaborative Relationship
Within the blended model, attammg an accurate
diagnosis and prescribing appropriate treatment are
predicated on the premise that nurses nurture collab-
orative relationships based on mutual trust. Collabo-
rative relationships involve reciprocal interpersonal
connections among all parties (the provider, individ-
ual, and family) and are essential to successful imple-
mentation of person-, family-, and culture-centered
nursing care (PFCC). Nurses need to engage in a
continuous process of developing the attributes of
PFCC. The person and family must feel comfortable
communicating their concerns and preferences to
nurses who are sensitive to their needs. Nurses need to
partner with the person and their family in working
toward mutually shared health goals. This reciprocal
relationship is a continuous process of learning about
the person's intersecting identities. Such relationship
building can involve trial and error and not always
knowing what to say or what to do. Cross-cultural re-
lationships are not prescriptive; they are about getting
to know the person over time through open and honest
exchanges. This ongoing therapeutic relationship is
the channel through which centered care is adminis-
tered and desired health outcomes are attained.
Institutional Factors
Within this blended model, we acknowledge institu-
tional factors that are prerequisites for the capacity to
implement the person-, family-, and culture-centered
care. Several studies reviewed in this analysis pointed
to organizational support as essential to successful

184. implementation of person-centered, patient-centered,
family-centered, and culturally competent care. Such
support included adopting policies, procedures, and
staffing models that facilitate centered care; providing
formal training for entire teams of providers; and
designing physical facilities to accommodate a holistic
inclusive care model that meets the needs of identified
patients and their families (Abdelhadi & Drach-
Zahavy, 2012; Coyne et al., 2011). Nursing staff educa-
tion needs to include family theory, communication
skill building, and patient teaching methods (Coyne
et al., 2011). We advocate that institutional policies
and staff development initiatives reflect philosophies
that promote socially just care and attain health
equity.
Societal Factors
Societal factors can affect patients' and families' ca-
pacities to access, engage in, and follow through with
prescribed treatment, thus affecting health outcomes.
In the blended model of care, societal factors include
health insurance, public policy, social services, com-
munity resources, and transportation (Dixon, 2000;
Marmot & Wilkinson, 2005; World Health
Organization Commission on Social Determinants of
NURS OUTLOOK 64 (2016) 352-366 363
Health, 2008). When social and cultural environments
are altered for better or worse, disease rates also
change accordingly (Marmot & Wilkinson, 2005). Thus,
to promote socially just care and attain health equity
for all persons, health programs must incorporate

185. ecological approaches to individual and community
assessments and interventions.
Based on our concept analysis, several conditions
were found to impede implementation of several care
models. In one study, parents of hospitalized children
reported lack of clarity about their roles, whereas
nurses reported short staffing which precluded offer-
ing families choices. Thus, barriers to family-centered
care included poor nurse-parent communication and
staffing problems that led to over-reliance on parents
for children's care (Coyne, 2013; Coyne et aI., 2011). The
most commonly identified barrier to culturally
competent care was differences between patients' and
health care providers' cultural values and customs,
language, or communication styles (Ailinger et aI.,
2010; Ho, 2009). Other factors included mistrust of
research by minority populations due to historical
factors and socioeconomic conditions, for example,
transportation problems and patient work schedules
(Kelley, 2011). The most commonly identified barriers
to patient-centered care were related to organization
and delivery of care staffing levels, for example short
staff, disruptive duties including telephone calls and
multidisciplinary team meetings, communication
barriers, and poor layout of the ward (Haigh &
Ormandy, 2011).
Evaluation of the Proposed Model
The application of the proposed model to research,
education, and clinical practice warrants empirical
evaluation.
Research
Although empirical evidence continues to support the

186. efficacy of each conceptual care model analyzed in this
study, additional research is needed to validate the
proposed blended person-, family-, and culture-
centered nursing care framework. Specifically, in-
struments are needed to operationalize the constructs
of the proposed model in ways that will provide clarity
and consistency across studies and health disciplines.
Process research (e.g., video-taped observations of
patient-providers interactions) could help identify and
describe nursing activities in this care model that are
typically invisible (e.g., culturally respectful care). The
results of this comparative concept analysis revEFaled a
lack of nurse researchers and the use proximal health-
related outcomes that reflected subjective opinions of
patients, family members, or providers rather than
actual patient health outcomes. Therefore, future
nursing research needs to examine clinical outcomes
that resulted from the proposed care model.
Clinical
The proposed model is designed to be relevant to
various popUlations regardless of their age, racial!
ethnic/cultural background, health status, and care
environment. Quality improvement initiatives could be
developed to evaluate institutional readiness and
possible barriers to implementation of this care model.
For example, clinicians and researchers can
collaborate in the development of measures to assess
practitioners' knowledge of and attitudes toward
adopting evidence-based practices that involve deliv-
ering person-, family-, and culture-centered nursing
care. In addition, clinicians could also assess their or -
ganization's level of readiness (e.g., institutional re-
sources, staff attributes, and organizational climate) to
fully implement the proposed blended model.

187. Education
The proposed model could be incorporated into un-
dergraduate- and graduate-level curricula. This model
is currently being integrated into the concept-based
undergraduate programming in our school of nursing.
At the graduate level, the concepts and attributes of
this care model could easily lend themselves to
doctoral studies. For example, the first author of this
article is currently testing the relationship component
of this model among older adult Hmong as a part of her
doctoral study.
Limitations and Implications for Research
We acknowledge several limitations of our compara-
tive concept analysis. First, the number of the articles
reviewed was small, and there were only five articles
on patient-centered care. However, we summarized
seminal work published before 2009 in the Historical
Evolution of Models section. Second, some articles,
for example, family-centered care and cultural
competency care, focused on provider perceptions of
outcomes, rather than patient outcomes. Finally, we
acknowledge that there are other conceptual care
models not reviewed for this article. We limited our
focus to four conceptual models that seem to have
been most enduring over time.
Goals of Healthy People 2020 (Office of Disease
Prevention and Health Promotion, u.S. Department of
Health and Human Services, 2015) call for improve-
ment in the quality of health care, access to health
care, health-related quality of life, health communi-
cation, and achievement of health equity. The report
emphasizes the importance of addressing the social
determinants of health and modalities of social justice

188. to accomplish these goals. Although professional or-
ganizations and scholars advocate for social justice
within the context of health care, this concept is
noticeably absent from the research related to models
of health care delivery. Furthermore, there is no clear
evidence that these models actually advance health
equity. Additional nursing research is vital to clearly
364 NURS OUTLOOK 64 (2016) 352-366
operationalize the implementation of social justice at
multiple levels including, but not limited to social
policy, institutional procedures, and individual clinical
practices. It is of paramount importance that such
research evaluates the impact of existing and new care
models, for example, proposed blended models, on
population-based health equity.
Conclusion
Our findings showed that a very small portion of recent
person-centered, patient-centered, family-centered, or
culturally competent research was conducted by
nurses. Most of the outcomes measured were proximal
to the care delivery, for example, patient satisfaction,
rather than health outcomes per say or health equity.
Although person-centered, patient-centered, family-
centered, and culturally competent care are concep-
tualized in the research literature as distinctly different
models, this comparative concept analysis suggests
these models have evolved to become more alike than
different. However, social justice remains conspicu-
ously absent from the research on all four care models.
Therefore, we advocate for merging these care models

189. into a single-blended conceptual framework that in-
corporates social justice at the societal, institutional,
and individual levels. This framework can be univer-
sally applied to all recipients of health care across all
settings. Given that empirical evidence continues to
support the efficacy of each conceptual care model
analyzed, the proposed blended person-, family-, and
culture-centered framework holds promise for
improving health care outcomes and achieving health
equity. Additional research is needed to validate that
premise.
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208. For my sons
and the next generation of tech-savvy managers
vii
CONTENTS
PREFACE xv
ACKNOWLEDGMENTS xvii
PA RT O N E — Information Governance Concepts,
Defi nitions, and Principles 1p
C H A P T E R 1 The Onslaught of Big Data and the
Information Governance
Imperative 3
Defi ning Information Governance 5
IG Is Not a Project, But an Ongoing Program 7
Why IG Is Good Business 7
Failures in Information Governance 8
Form IG Policies, Then Apply Technology for Enforcement 10
Notes 12

209. C H A P T E R 2 Information Governance, IT Governance, Data
Governance: What’s the Difference? 15
Data Governance 15
IT Governance 17
Information Governance 20
Impact of a Successful IG Program 20
Summing Up the Differences 21
Notes 22
C H A P T E R 3 Information Governance Principles 25
Accountability Is Key 27
Generally Accepted Recordkeeping Principles® 27
Contributed by Charmaine Brooks, CRM
Assessment and Improvement Roadmap 34
Who Should Determine IG Policies? 35
Notes 38
PA RT T W O — Information Governance Risk Assessment
and Strategic Planning 41g g
C H A P T E R 4 Information Risk Planning and Management
43
Step 1: Survey and Determine Legal and Regulatory
Applicability

210. and Requirements 43
viii CONTENTS
Step 2: Specify IG Requirements to Achieve Compliance 46
Step 3: Create a Risk Profi le 46
Step 4: Perform Risk Analysis and Assessment 48
Step 5: Develop an Information Risk Mitigation Plan 49
Step 6: Develop Metrics and Measure Results 50
Step 7: Execute Your Risk Mitigation Plan 50
Step 8: Audit the Information Risk Mitigation Program 51
Notes 51
C H A P T E R 5 Strategic Planning and Best Practices for
Information Governance 53
Crucial Executive Sponsor Role 54
Evolving Role of the Executive Sponsor 55
Building Your IG Team 56
Assigning IG Team Roles and Responsibilities 56
Align Your IG Plan with Organizational Strategic Plans 57
Survey and Evaluate External Factors 58

211. Formulating the IG Strategic Plan 65
Notes 69
C H A P T E R 6 Information Governance Policy Development
71
A Brief Review of Generally Accepted Recordkeeping
Principles® 71
IG Reference Model 72
Best Practices Considerations 75
Standards Considerations 76
Benefi ts and Risks of Standards 76
Key Standards Relevant to IG Efforts 77
Major National and Regional ERM Standards 81
Making Your Best Practices and Standards Selections to Inform
Your IG Framework 87
Roles and Responsibilities 88
Program Communications and Training 89
Program Controls, Monitoring, Auditing and Enforcement 89
Notes 91
PA RT T H R E E — Information Governance Key
Impact Areas Based on the IG Reference Model 95p

212. C H A P T E R 7 Business Consideratio ns for a Successful IG
Program 97
By Barclay T. Blair
Changing Information Environment 97
CONTENTS ix
Calculating Information Costs 99
Big Data Opportunities and Challenges 100
Full Cost Accounting for Information 101
Calculating the Cost of Owning Unstructured Information 102
The Path to Information Value 105
Challenging the Culture 107
New Information Models 107
Future State: What Will the IG-Enabled Organization Look
Like? 110
Moving Forward 111
Notes 113
C H A P T E R 8 Information Governance and Legal Functions
115

213. By Robert Smallwood with Randy Kahn, Esq., and Barry
Murphy
Introduction to e-Discovery: The Revised 2006 Federal Rules of
Civil Procedure Changed Everything 115
Big Data Impact 117
More Details on the Revised FRCP Rules 117
Landmark E-Discovery Case: Zubulake v. UBS Warburg 119
E-Discovery Techniques 119
E-Discovery Reference Model 119
The Intersection of IG and E-Discovery 122
By Barry Murphy
Building on Legal Hold Programs to Launch Defensible
Disposition 125
By Barry Murphy
Destructive Retention of E-Mail 126
Newer Technologies That Can Assist in E-Discovery 126
Defensible Disposal: The Only Real Way To Manage Terabytes
and Petabytes 130
By Randy Kahn, Esq.
Retention Policies and Schedules 137
By Robert Smallwood, edited by Paula Lederman, MLS
Notes 144

214. C H A P T E R 9 Information Governance and Records and
Information Management Functions 147
Records Management Business Rationale 149
Why Is Records Management So Challenging? 150
Benefi ts of Electronic Records Management 152
Additional Intangible Benefi ts 153
Inventorying E-Records 154
Generally Accepted Recordkeeping Principles® 155
E-Records Inventory Challenges 155
x CONTENTS
Records Inventory Purposes 156
Records Inventorying Steps 157
Ensuring Adoption and Compliance of RM Policy 168
General Principles of a Retention Scheduling 169
Developing a Records Retention Schedule 170
Why Are Retention Schedules Needed? 171
What Records Do You Have to Schedule? Inventory and Classifi
cation 173

215. Rationale for Records Groupings 174
Records Series Identifi cation and Classifi cation 174
Retention of E-Mail Records 175
How Long Should You Keep Old E-Mails? 176
Destructive Retention of E-Mail 177
Legal Requirements and Compliance Research 178
Event-Based Retention Scheduling for Disposition of E-Records
179
Prerequisites for Event-Based Disposition 180
Final Disposition and Closure Criteria 181
Retaining Transitory Records 182
Implementation of the Retention Schedule and Disposal of
Records 182
Ongoing Maintenance of the Retention Schedule 183
Audit to Manage Compliance with the Retention Schedule 183
Notes 186
C H A P T E R 10 Information Governance and Information
Technology Functions 189
Data Governance 191
Steps to Governing Data Effectively 192

216. Data Governance Framework 193
Information Management 194
IT Governance 196
IG Best Practices for Database Security and Compliance 202
Tying It All Together 204
Notes 205
C H A P T E R 11 Information Governance and Privacy and
Security Functions 207
Cyberattacks Proliferate 207
Insider Threat: Malicious or Not 208
Privacy Laws 210
Defense in Depth 212
Controlling Access Using Identity Access Management 212
Enforcing IG: Protect Files with Rules and Permissions 213
CONTENTS xi
Challenge of Securing Confi dential E-Documents 213
Apply Better Technology for Better Enforcement in the
Extended Enterprise 215

217. E-Mail Encryption 217
Secure Communications Using Record-Free E-Mail 217
Digital Signatures 218
Document Encryption 219
Data Loss Prevention (DLP) Technology 220
Missing Piece: Information Rights Management (IRM) 222
Embedded Protection 226
Hybrid Approach: Combining DLP and IRM Technologies 227
Securing Trade Secrets after Layoffs and Terminations 228
Persistently Protecting Blueprints and CAD Documents 228
Securing Internal Price Lists 229
Approaches for Securing Data Once It Leaves the Organization
230
Document Labeling 231
Document Analytics 232
Confi dential Stream Messaging 233
Notes 236
PA RT F O U R — Information Governance for
Delivery Platforms 239y

218. C H A P T E R 12 Information Governance for E-Mail and
Instant Messaging 241
Employees Regularly Expose Organizations to E-Mail Risk 242
E-Mail Polices Should Be Realistic and Technology Agnostic
243
E-Record Retention: Fundamentally a Legal Issue 243
Preserve E-Mail Integrity and Admissibility with Automatic
Archiving 244
Instant Messaging 247
Best Practices for Business IM Use 247
Technology to Monitor IM 249
Tips for Safer IM 249
Notes 251
C H A P T E R 13 Information Governance for Social Media
253
By Patricia Franks, Ph.D, CRM, and Robert Smallwood
Types of Social Media in Web 2.0 253
Additional Social Media Categories 255
Social Media in the Enterprise 256
Key Ways Social Media Is Different from E-Mail and Instant

219. Messaging 257
Biggest Risks of Social Media 257
Legal Risks of Social Media Posts 259
xii CONTENTS
Tools to Archive Social Media 261
IG Considerations for Social Media 262
Key Social Media Policy Guidelines 263
Records Management and Litigation Considerations for Social
Media 264
Emerging Best Practices for Managing Social Media Records
267
Notes 269
C H A P T E R 14 Information Governance for Mobile Devices
271
Current Trends in Mobile Computing 273
Security Risks of Mobile Computing 274
Securing Mobile Data 274
Mobile Device Management 275
IG for Mobile Computing 276

220. Building Security into Mobile Applications 277
Best Practices to Secure Mobile Applications 280
Developing Mobile Device Policies 281
Notes 283
C H A P T E R 15 Information Governance for Cloud
Computing 285
By Monica Crocker CRM, PMP, CIP, and Robert Smallwood
Defi ning Cloud Computing 286
Key Characteristics of Cloud Computing 287
What Cloud Computing Really Means 288
Cloud Deployment Models 289
Security Threats with Cloud Computing 290
Benefi ts of the Cloud 298
Managing Documents and Records in the Cloud 299
IG Guidelines for Cloud Computing
Solution

221. s 300
Notes 301
C H A P T E R 16 SharePoint Information Governance 303
By Monica Crocker, CRM, PMP, CIP, edited by Robert
Smallwood
Process Change, People Change 304
Where to Begin the Planning Process 306
Policy Considerations 310
Roles and Responsibilities 311
Establish Processes 312
Training Plan 313
Communication Plan 313
Note 314

222. CONTENTS xiii
PA RT F I V E — Long-Term Program Issues 315g g
C H A P T E R 17 Long-Term Digital Preservation 317
By Charles M. Dollar and Lori J. Ashley
Defi ning Long-Term Digital Preservation 317
Key Factors in Long-Term Digital Preservation 318
Threats to Preserving Records 320
Digital Preservation Standards 321
PREMIS Preservation Metadata Standard 328
Recommended Open Standard Technology-Neutral Formats 329
Digital Preservation Requirements 333
Long-Term Digital Preservation Capability Maturity Model®

223. 334
Scope of the Capability Maturity Model 336
Digital Preservation Capability Performance Metrics 341
Digital Preservation Strategies and Techniques 341
Evolving Marketplace 344
Looking Forward 344
Notes 346
C H A P T E R 18 Maintaining an Information Governance
Program
and Culture of Compliance 349
Monitoring and Accountability 349
Staffi ng Continuity Plan 350
Continuous Process Improvement 351
Why Continuous Improvement Is Needed 351

224. Notes 353
A P P E N D I X A Information Organization and Classifi
cation:
Taxonomies and Metadata 355
By Barb Blackburn, CRM, with Robert Smallwood; edited by
Seth Earley
Importance of Navigation and Classifi cation 357
When Is a New Taxonomy Needed? 358
Taxonomies Improve Search Results 358
Metadata and Taxonomy 359
Metadata Governance, Standards, and Strategies 360
Types of Metadata 362
Core Metadata Issues 363
International Metadata Standards and Guidance 364

225. Records Grouping Rationale 368
Business Classifi cation Scheme, File Plans, and Taxonomy 368
Classifi cation and Taxonomy 369
xiv CONTENTS
Prebuilt versus Custom Taxonomies 370
Thesaurus Use in Taxonomies 371
Taxonomy Types 371
Business Process Analysis 377
Taxonomy Testing: A Necessary Step 379
Taxonomy Maintenance 380
Social Tagging and Folksonomies 381

226. Notes 383
A P P E N D I X B Laws and Major Regulations Related to
Records Management 385
United States 385
Canada 387
By Ken Chasse, J.D., LL.M.
United Kingdom 389
Australia 391
Notes 394
A P P E N D I X C Laws and Major Regulations
Related to Privacy 397
United States 397
Major Privacy Laws Worldwide, by Country 398
Notes 400

227. GLOSSARY 401
ABOUT THE AUTHOR 417
ABOUT THE MAJOR CONTRIBUTORS 419
INDEX 421
xv
PREFACE
I
nformation governance (IG) has emerged as a key concern for
business executives
and managers in today’s environment of Big Data, increasing
information risks, co-
lossal leaks, and greater compliance and legal demands. But few
seem to have a clear
understanding of what IG is; that is, how you defi ne what it is
and is not, and how to
implement it. This book clarifi es and codifi es these defi

228. nitions and provides key in-
sights as to how to implement and gain value from IG programs.
Based on exhaustive
research, and with the contributions of a number of industry
pioneers and experts, this
book lays out IG as a complete discipline in and of itself for the
fi rst time.
IG is a super-discipline that includes components of several
key fi elds: law, records
management, information technology (IT), risk management,
privacy and security,
and business operations. This unique blend calls for a new breed
of information pro-
fessional who is competent across these established and quite
complex fi elds. Training
and education are key to IG success, and this book provides the
essential underpinning
for organizations to train a new generation of IG professionals.
Those who are practicing professionals in the component fi
elds of IG will fi nd
the book useful in expanding their knowledge from traditional fi
elds to the emerging
tenets of IG. Attorneys, records and compliance managers, risk

229. managers, IT manag-
ers, and security and privacy professionals will fi nd thi s book a
particularly valuable
resource.
The book strives to offer clear IG concepts, actionable
strategies, and proven best
practices in an understandable and digestible way; a concerted
effort was made to
simplify language and to offer examples. There are summaries
of key points through-
out and at the end of each chapter to help the reader retain
major points. The text
is organized into fi ve parts: (1) Information Governance
Concepts, Defi nitions, and
Principles; (2) IG Risk Assessment and Strategic Planning; (3)
IG Key Impact Areas;
(4) IG for Delivery Platforms; and (5) Long-Term Program
Issues. Also included are
appendices with detailed information on taxonomy and metadata
design and on re-
cords management and privacy legislation.
One thing that is sure is that the complex fi eld of IG is
evolving. It will continue

230. to change and solidify. But help is here: No other book offers
the kind of compre-
hensive coverage of IG contained within these pages.
Leveraging the critical advice
provided here will smooth your path to understanding and
implementing successful
IG programs.
Robert F. Smallwood
xvii
ACKNOWLEDGMENTS
I
would like to sincerely thank my colleagues for their support
and generous contribu-
tion of their expertise and time, which made this pioneering text
possible.