This paper aims to analyze assumptions about the central concept of "centering" patients and families in patient- and family-centered care (PFCC) research. It uses a structured problematization method to identify three main areas of assumptions in PFCC intervention research: 1) spatial assumptions that patients and families can be centered through proximity, 2) assumptions that care can be democratized by including patients and families, and 3) assumptions that centering is primarily a problem and accomplishment for nursing. The paper argues for adopting theoretical lenses that de-center individual actors to better account for complex relationships among multiple human and non-human actors in care practices.
By administering assessments and analyzing the results, targeted aTawnaDelatorrejs
By administering assessments and analyzing the results, targeted and individualized interventions can be determined to best serve the needs of students with disabilities. The actual implementation of the interventions provides teachers opportunities to collect data and gauge the effectiveness of the interventions in addressing documented student needs. Teachers can also gain important skills and knowledge on how to best advocate for practical classroom interventions. Teachers will also be able to collaborate with colleagues and families in mentoring students to take ownership of learning strategies.
Allocate at least 2 hours in the field to support this field experience,
Part 1: Assessment and Interventions
Select at least one student to whom you will administer the informal RTI assessment created in Clinical Field Experience A. Score the assessment and share the results with the student to increase understanding of his or her strengths and areas for improvement.
Collaborate with the certified special education teacher and the student to develop 2-3 interventions based on the student assessment data to support the student’s progress in the classroom. In addition, detail one intervention that can be incorporated at home with family support.
Use any remaining field experience hours to assist the teacher in providing instruction and support to the class.
Part 2: Reflection
In 250-500 words, summarize and reflect upon the following:
· Describe each intervention, including teacher, student, and family roles, where applicable.
· Your experiences administering the assessment, analyzing the results, and providing the student feedback on his or her performance.
· Explain how you expect the interventions you developed to meet the needs of the student, incorporating his or her assessment results in your response.
· Explain how you will use your findings in your future professional practice.
APA format is not required, but solid academic writing is expected.
This assignment uses a rubric. Review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
6
Annotated Bibliography
Student’s Name
Course
Instructor’s name.
Institutional Affiliation
October 7, 2021.
Annotated Bibliography
Ali, H., Ibrahem, S. Z., Al Mudaf, B., Al Fadalah, T., Jamal, D., & El-Jardali, F. (2018). Baseline assessment of patient safety culture in public hospitals in Kuwait. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-2960-x
The researchers conducted a cross-sectional study in 16 public hospitals in Kuwait using the Hospital Survey on Patient Safety Culture (HSOPSC). The study aimed to assess patient safety culture in public hospitals as perceived by hospital staff and relate the findings similar to regional and international ...
FIRST ASSIGNMENT
1
FIRST ASSIGNMENT
2
First Assignment
[Name]
[Course]
[Professor]
[Date]
Abstract
In a multi-cultural atmosphere, the management of ethics and principal decision management helps in serving just in a fair and square way. For the concerned metropolitan agency, a proper action plan will be used managing all the aspects including principle-based management and ethical decision making in a multicultural environment. Racial discrimination in the organization can be fought well by establishing discrimination-free hiring practices in the organization. The agency will be revising its business practices so that the lack of officers can be managed well.
Action plan to address community concerns
In recent years, many employers have embraced the idea of cultural diversity activities with the goal of making make a comprehensive work environment condition. Most experts concur that a differing workforce is a commendable yearning. In any case, social decent variety can offer ascent to moral issues that can be trying for chiefs and workers to determine. The agency has faced some issues over the past years including the concern of the society related to racial discrimination. Keeping in view the concerns of the society, the organization has aimed at coming up with some action plan so that the business practices can be improved and the concerns of the society can be addressed.
Family Knowledge about Palliative Care
Ernesto Pena Morgado
Ana G. Méndez
NR502: Research Proposal
February Session, 2019
Family Knowledge about Palliative Care
In the United States, the vast majority of palliative care is performed in the home. It is obvious that in this scenario the members of the family play a leading role. Most research related to palliative care in the United States does not describe the level of commitment of the patient and caregivers with such care. (Dillon, 2016).
In a study presented about "How home hospice facilitates patient and family engagement", his author, Dillon, describes how some caregivers cheered for instruction on how to manage their relatives palliative care in relation to the use of the comfort kit, including the management of morphine in relationship to be better prepared to relieve the pain of the patient (Dillon, 2016, pp.595). Another wife described how the education and holistic instruction provided was helpful in dealing with and understanding the care that would be provided to her husband. (Dillon, 2016).
The author concludes that offering instruction and education in relation to such difficult issues as helping to face death, has an important implication in the participation of the patient and the family in palliative care, and is the first necessary step to train patients and the family to make informed decisions (Dillon, 2016).
The hospita.
Respond to at least two of your colleagues in one or more of t.docxwilfredoa1
Respond
to at least
two
of your colleagues in one or more of the following ways:
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Validate an idea with your own experience and additional research.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
POST 1
According to Cleary and Hunt, (2011), recent studies have shown the majority of nursing doctoral candidates are female, clinically experienced, and in their 40s or 50s at the time of starting their PhD. Based on that criteria, this writer fits exactly into that criteria. It is noted that other disciplines tend to start doctoral training much earlier (Cleary & Hunt, 2011). As a practicing nurse of 30 years, most of it as an Associate Degree nurse the recognition of the PhD nurse was seen as a profession in a nursing league of their own. According to Michael and Clochesy, (2016), the PhD in nursing was predominant throughout the 20th century with members of the academic nursing community recognizing the need for the development of knowledge to inform practice and to promote the credibility of the profession. Nursing theorists such as Jean Watson and Patricia Benner were game changers in the industry of theoretical nursing. The ability in achieving higher levels of education and in conducting research are hallmarks of professionalism (Houser, 2018).
This writer has a passion for teaching students and wants to be the best instructor she can be. She chose to go down the path of the PhD in Nursing education to increase skills and knowledge to improve what is delivered to students every day. The PhD is being pursued to separate myself from the growing amount of DNP faculty that she works with daily. Being an alumni with Walden University for the MSN, it was an easy choice to pick Walden University for the terminal degree. Michael and Clochesy, (2016), states the PhD and DNP represent complementary and alternative approaches to the highest level of educational preparation in nursing. PhD programs prepare nurse scientists to conduct original research and to generate knowledge that may be broadly applicable or generalizable using advanced research designs and statistical evaluative methods. Conversely, DNP programs prepare students for advanced specialty practice at a high level of complexity with a concurrent focus on the development of knowledge and skills required for translation of evidence to improve health outcomes and health care delivery (Michael & Clochesy, 2016).
Michael and Clochesy, (2016), also states two of the main reasons for not completing a doctoral program are financial and family stresses. Strategic plans must include financial considerations (e.g., research costs), support systems and a systemic approach to the d.
PEER RESPONSES FOR Patient Outcomes and Sustainable ChangeQUES.docxpauline234567
PEER RESPONSES FOR Patient Outcomes and Sustainable Change
QUESTION: Reflecting on the "IHI Module PS 101: Introduction to Patient Safety," summarize why it is essential to improve patient safety. Use one of the articles from this week's topic Resources and describe the framework or theory that was used to improve the patient outcome. What outcome measures were identified and how did they align with the improvement project? Explain how the authors learned from the error or unintended events to ensure patient safety. Provide supporting evidence.
Dr. Mary Sizemore
Thank you for your response. You provided some good information regarding the quality of care and patient safety. In my practice, many facilities work to improve patient outcomes through the use of electronic health records to reduce errors with medication prescribing. Consider ordering a new medication for a patient. What are some measures you can take as a provider to reduce possible errors with the process?
Kristen Williams
Dec 2, 2022, 12:11 PM
The Institute for Healthcare Improvement (IHI) Module PS 101: Introduction to Patient Safety provides the structural foundation of the vital role patient safety has in a healthcare institution. High reliability was a central theme of the module. A culture of safety is when the employees share a central belief that a healthcare organization supports root cause analysis in patient care (Leape, 2021). It is a significant theme that humans have a predisposition to error, and it is vital to create systems and a safety culture to have a safe environment for patients. It is crucial to develop systems to track and analyze errors as they occur to improve future outcomes by creating safer systems.
When people interact with a healthcare system, they are often at their most valuable state. The number of people dying from medical errors in 2018 was equivalent to a daily jumbo crash (Leape, 2021). Our society would not stand for one plane crash a day, yet often a place whose purpose is to heal hurts. Although humans are prone to error, it is essential to create policies, procedures, and phycological safety to increase safety when people seek healthcare. A facility that commits to embedding safety into policy and procedures and a culture of phycological safety are often referred to as a high-reliability organization (HRO).
Education and empowerment of staff are essential components of building physical safety. Haley & Fritz (2019) used a framework of education and empowerment to improve the rate of urinary tract infections (UTI) in a long-term care (LTC) facility. Haley & Fritz (2019) assessed that evidenced-based signs and symptoms were not consistently utilized in obtaining urine samples to diagnose UTIs. A culture of safety examination showed improvement that could be made. Education and empowerment were done to improve the signs and symptoms used to initiate obtaining a urine sample (Haley & Fritz, 2019). Phycological safety is a vital found.
November-December 2013 • Vol. 22/No. 6 359
Beverly Waller Dabney, PhD, RN, is Associate Professor, Southwestern Adventist University,
Keene, TX.
Huey-Ming Tzeng, PhD, RN, FAAN, is Professor of Nursing and Associate Dean for Academic
Programs, College of Nursing, Washington State University, Spokane, WA.
Service Quality and Patient-Centered
Care
L
eaders of the U.S. Depart -
ment of Health & Human
Services (2011) urge providers
to improve the overall quality of
health care by making it more
patient centered. Patient-centered
care (or person-centered care) refers
to the therapeutic relationship
between health care providers and
recipients of health care services,
with emphasis on meeting the
needs of individual patients. Al -
though the term has been used
widely in recent years, it remains a
poorly defined and conceptualized
phenomenon (Hobbs, 2009).
Patient-centered care is believed
to be holistic nursing care. It pro-
vides a mechanism for nurses to
engage patients as active partici-
pants in every aspect of their health
(Scott, 2010). Patient shadowing
and care flow mapping were used to
create a sense of empathy and
urgency among clinicians by clarify-
ing the patient and family experi-
ence. These two approaches, which
were meant to promote patient-cen-
tered care, can improve patient sat-
isfaction scores without increasing
costs (DiGioia, Lorenz, Greenhouse,
Bertoty, & Rocks, 2010). A better
under standing of attributes of
patient-centered care and areas for
improvement is needed in order to
develop nursing policies that in -
crease the use of this model in health
care settings.
The purpose of this discussion is
to clarify the concept of patient-cen-
tered care for consistency with the
common understanding about pa -
tient satisfaction and the quality of
care delivered from nurses to
patients. Attributes from a customer
service model, the Gap Model of
Service Quality, are used in a focus
on the perspective of the patient as
the driver and evaluator of service
quality. Relevant literature and the
Gap Model of Service Quality
(Parasuraman, Zeithaml, & Leonard,
1985) are reviewed. Four gaps in
patient-centered care are identified,
with discussion of nursing implica-
tions.
Background and Brief
Literature Review
Patient-Centered Care
The Institute of Medicine (IOM,
2001a) and Epstein and Street (2011)
identified patient-centeredness as
one of the areas for improvement in
health care quality. The IOM (2001b)
defined patient-centeredness as
…health care that establishes a
partnership among practition-
ers, patients, and their families
(when appropriate) to ensure
that decisions respect patients’
wants, needs, and preferences
and that patients have the edu-
cation and support they require
to make decisions and partici-
pate in their own care… (p. 7)
Charmel and Frampton (2008)
defined patient-centered care as
…a healthcare setting in which
patients are encouraged to be
actively involved in their care,
with a physical environment
t.
November-December 2013 • Vol. 22/No. 6 359
Beverly Waller Dabney, PhD, RN, is Associate Professor, Southwestern Adventist University,
Keene, TX.
Huey-Ming Tzeng, PhD, RN, FAAN, is Professor of Nursing and Associate Dean for Academic
Programs, College of Nursing, Washington State University, Spokane, WA.
Service Quality and Patient-Centered
Care
L
eaders of the U.S. Depart -
ment of Health & Human
Services (2011) urge providers
to improve the overall quality of
health care by making it more
patient centered. Patient-centered
care (or person-centered care) refers
to the therapeutic relationship
between health care providers and
recipients of health care services,
with emphasis on meeting the
needs of individual patients. Al -
though the term has been used
widely in recent years, it remains a
poorly defined and conceptualized
phenomenon (Hobbs, 2009).
Patient-centered care is believed
to be holistic nursing care. It pro-
vides a mechanism for nurses to
engage patients as active partici-
pants in every aspect of their health
(Scott, 2010). Patient shadowing
and care flow mapping were used to
create a sense of empathy and
urgency among clinicians by clarify-
ing the patient and family experi-
ence. These two approaches, which
were meant to promote patient-cen-
tered care, can improve patient sat-
isfaction scores without increasing
costs (DiGioia, Lorenz, Greenhouse,
Bertoty, & Rocks, 2010). A better
under standing of attributes of
patient-centered care and areas for
improvement is needed in order to
develop nursing policies that in -
crease the use of this model in health
care settings.
The purpose of this discussion is
to clarify the concept of patient-cen-
tered care for consistency with the
common understanding about pa -
tient satisfaction and the quality of
care delivered from nurses to
patients. Attributes from a customer
service model, the Gap Model of
Service Quality, are used in a focus
on the perspective of the patient as
the driver and evaluator of service
quality. Relevant literature and the
Gap Model of Service Quality
(Parasuraman, Zeithaml, & Leonard,
1985) are reviewed. Four gaps in
patient-centered care are identified,
with discussion of nursing implica-
tions.
Background and Brief
Literature Review
Patient-Centered Care
The Institute of Medicine (IOM,
2001a) and Epstein and Street (2011)
identified patient-centeredness as
one of the areas for improvement in
health care quality. The IOM (2001b)
defined patient-centeredness as
…health care that establishes a
partnership among practition-
ers, patients, and their families
(when appropriate) to ensure
that decisions respect patients’
wants, needs, and preferences
and that patients have the edu-
cation and support they require
to make decisions and partici-
pate in their own care… (p. 7)
Charmel and Frampton (2008)
defined patient-centered care as
…a healthcare setting in which
patients are encouraged to be
actively involved in their care,
with a physical environment
t.
November-December 2013 • Vol. 22/No. 6 359
Beverly Waller Dabney, PhD, RN, is Associate Professor, Southwestern Adventist University,
Keene, TX.
Huey-Ming Tzeng, PhD, RN, FAAN, is Professor of Nursing and Associate Dean for Academic
Programs, College of Nursing, Washington State University, Spokane, WA.
Service Quality and Patient-Centered
Care
L
eaders of the U.S. Depart -
ment of Health & Human
Services (2011) urge providers
to improve the overall quality of
health care by making it more
patient centered. Patient-centered
care (or person-centered care) refers
to the therapeutic relationship
between health care providers and
recipients of health care services,
with emphasis on meeting the
needs of individual patients. Al -
though the term has been used
widely in recent years, it remains a
poorly defined and conceptualized
phenomenon (Hobbs, 2009).
Patient-centered care is believed
to be holistic nursing care. It pro-
vides a mechanism for nurses to
engage patients as active partici-
pants in every aspect of their health
(Scott, 2010). Patient shadowing
and care flow mapping were used to
create a sense of empathy and
urgency among clinicians by clarify-
ing the patient and family experi-
ence. These two approaches, which
were meant to promote patient-cen-
tered care, can improve patient sat-
isfaction scores without increasing
costs (DiGioia, Lorenz, Greenhouse,
Bertoty, & Rocks, 2010). A better
under standing of attributes of
patient-centered care and areas for
improvement is needed in order to
develop nursing policies that in -
crease the use of this model in health
care settings.
The purpose of this discussion is
to clarify the concept of patient-cen-
tered care for consistency with the
common understanding about pa -
tient satisfaction and the quality of
care delivered from nurses to
patients. Attributes from a customer
service model, the Gap Model of
Service Quality, are used in a focus
on the perspective of the patient as
the driver and evaluator of service
quality. Relevant literature and the
Gap Model of Service Quality
(Parasuraman, Zeithaml, & Leonard,
1985) are reviewed. Four gaps in
patient-centered care are identified,
with discussion of nursing implica-
tions.
Background and Brief
Literature Review
Patient-Centered Care
The Institute of Medicine (IOM,
2001a) and Epstein and Street (2011)
identified patient-centeredness as
one of the areas for improvement in
health care quality. The IOM (2001b)
defined patient-centeredness as
…health care that establishes a
partnership among practition-
ers, patients, and their families
(when appropriate) to ensure
that decisions respect patients’
wants, needs, and preferences
and that patients have the edu-
cation and support they require
to make decisions and partici-
pate in their own care… (p. 7)
Charmel and Frampton (2008)
defined patient-centered care as
…a healthcare setting in which
patients are encouraged to be
actively involved in their care,
with a physical environment
t ...
ABSTRACT Handover, or the communication of patient information be.docxransayo
ABSTRACT: Handover, or the communication of patient information between clinicians, is a fundamental component of health care. Psychiatric settings are dynamic environments relying on timely and accurate communication to plan care and manage risk. Crisis assessment and treatment teams are the primary interface between community and mental health services in many Australian and international health services, facilitating access to assessment, treatment, and admission to hospital. No previous research has investigated the handover between crisis assessment and treatment teams and inpatient psychiatric units, despite the importance of handover to care planning. The aim of the present study was to identify the nature and types of information transferred during these handovers, and to explore how these guides initial care planning. An observational, exploratory study design was used. A 20-item handover observation tool was used to observe 19 occasions of handover. A prospective audit was undertaken on clinical documentation arising from the admission. Clinical information, including psychiatric history and mental state, were handed over consistently; however, information about consumer preferences was reported less consistently. The present study identified a lack of attention to consumer preferences at handover, despite the current focus on recovery-oriented models for mental health care, and the centrality of respecting consumer preferences within the recovery paradigm.
INTRODUCTION Handover is the transfer of verbal and written communication of patient information between members of the health-care team. It is integral to the practice of all healthcare clinicians (Millar & Sands 2012). The Australian Commission for Safety and Quality in Health Care (ACSQHC 2011) recognizes the importance of handover in the continuum of health care, and acknowledges that information transferred between clinicians during the handover can directly affect the quality of care delivered to patients. Poor-quality handover practice has been linked to a number of unfavourable patient outcomes, including increased hospital stays, consumer dissatisfaction, delays in treatment, and other adverse clinical outcomes (Hill & Nyce 2010; Manser & Foster 2011; Siemsen et al. 2012; World Health Organization Collaborating Centre for Patient Safety
Solution
s (WHOCCPSS) 2007). In the present study, we report on the findings of a study that investigated handover between the crisis assessment and treatment team (CATT) and the inpatient psychiatric unit (IPU).
There is little in the published literature that reports on handover practices in acute psychiatric settings, and no previous research that has specifically investigated handover between the CATT and the IPU. The lack of studies in this area is concerning, given that in Australia and internationally, CATT service models are in wide use to facilitate community access to psychiatric assessment and care for people who are experien.
Of all the ways to influence health policy, using research to info.docxcherishwinsland
Of all the ways to influence health policy, using research to inform change has the dual appeal of sounding both straightforward and rigorous. However, reality intrudes in many forms to disrupt the otherwise common-sense connection between what we know, what we consider as policy and what we are doing. Different languages (academic versus political), disparate timeframes (deliberate versus opportunistic), and contrasting priorities (most rigorous versus good enough) often make translating research into policy an exercise in frustration. Just as basic scientists and clinical researchers grapple with the challenge of bringing innovations from bench to bedside, health services researchers must wrestle to make their work most relevant to policy realities in communities near and far.
Yet, this is a worthy—and potentially rewarding—pursuit. Evidence for such a claim is reflected in this supplement, which includes an array of approaches to bridging the gap between research and policy taken by current scholars and alumni of the Robert Wood Johnson Foundation Clinical Scholars program (RWJFCSP). Traditionally focused on training physicians in rigorous methods in biostatistics, clinical epidemiology, and health services research, as well as in other fields such as social sciences, the RWJFCSP has purposefully shifted over the past decade to emphasize the value of actionable research. Whether partnering with community members to conduct participatory research, or with policy makers to ensure that timely and relevant questions are being addressed, scholars are encouraged to consider how the results of their research will lead to short-term change and long-term progress. These research efforts encompass a broad variety of research methods, including qualitative and quantitative approaches, local and national data, and cutting-edge work involving community-based participatory research, multi-level hierarchical analyses, and dynamic multi-state modeling.
Given its leadership in the realm of research and policy, the RWJFCSP is the source of the lead or senior authors of all of the articles in this volume; the authors are either current scholars or alumni of the program. Of note, these articles do not reflect the entire sum of policy-relevant research conducted by RWJFCSP-connected investigators. Rather, these articles comprise a fraction of those submitted for inclusion in this supplement, and policy-relevant research by these authors and others with connections to the RWJFCSP appear in other journals as well.
The authors addressed important barriers to bridging the gap between research and policy. First, new evidence informs policy if it makes it into the hands of individuals who have a stake in what the data is measuring, and who are engaged in acting on the findings. Even the most rigorously conducted, widely cited manuscripts will have only marginal impact unless brought to life by potential change agents. Second, the evidence being generated may not be .
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
By administering assessments and analyzing the results, targeted aTawnaDelatorrejs
By administering assessments and analyzing the results, targeted and individualized interventions can be determined to best serve the needs of students with disabilities. The actual implementation of the interventions provides teachers opportunities to collect data and gauge the effectiveness of the interventions in addressing documented student needs. Teachers can also gain important skills and knowledge on how to best advocate for practical classroom interventions. Teachers will also be able to collaborate with colleagues and families in mentoring students to take ownership of learning strategies.
Allocate at least 2 hours in the field to support this field experience,
Part 1: Assessment and Interventions
Select at least one student to whom you will administer the informal RTI assessment created in Clinical Field Experience A. Score the assessment and share the results with the student to increase understanding of his or her strengths and areas for improvement.
Collaborate with the certified special education teacher and the student to develop 2-3 interventions based on the student assessment data to support the student’s progress in the classroom. In addition, detail one intervention that can be incorporated at home with family support.
Use any remaining field experience hours to assist the teacher in providing instruction and support to the class.
Part 2: Reflection
In 250-500 words, summarize and reflect upon the following:
· Describe each intervention, including teacher, student, and family roles, where applicable.
· Your experiences administering the assessment, analyzing the results, and providing the student feedback on his or her performance.
· Explain how you expect the interventions you developed to meet the needs of the student, incorporating his or her assessment results in your response.
· Explain how you will use your findings in your future professional practice.
APA format is not required, but solid academic writing is expected.
This assignment uses a rubric. Review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
6
Annotated Bibliography
Student’s Name
Course
Instructor’s name.
Institutional Affiliation
October 7, 2021.
Annotated Bibliography
Ali, H., Ibrahem, S. Z., Al Mudaf, B., Al Fadalah, T., Jamal, D., & El-Jardali, F. (2018). Baseline assessment of patient safety culture in public hospitals in Kuwait. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-2960-x
The researchers conducted a cross-sectional study in 16 public hospitals in Kuwait using the Hospital Survey on Patient Safety Culture (HSOPSC). The study aimed to assess patient safety culture in public hospitals as perceived by hospital staff and relate the findings similar to regional and international ...
FIRST ASSIGNMENT
1
FIRST ASSIGNMENT
2
First Assignment
[Name]
[Course]
[Professor]
[Date]
Abstract
In a multi-cultural atmosphere, the management of ethics and principal decision management helps in serving just in a fair and square way. For the concerned metropolitan agency, a proper action plan will be used managing all the aspects including principle-based management and ethical decision making in a multicultural environment. Racial discrimination in the organization can be fought well by establishing discrimination-free hiring practices in the organization. The agency will be revising its business practices so that the lack of officers can be managed well.
Action plan to address community concerns
In recent years, many employers have embraced the idea of cultural diversity activities with the goal of making make a comprehensive work environment condition. Most experts concur that a differing workforce is a commendable yearning. In any case, social decent variety can offer ascent to moral issues that can be trying for chiefs and workers to determine. The agency has faced some issues over the past years including the concern of the society related to racial discrimination. Keeping in view the concerns of the society, the organization has aimed at coming up with some action plan so that the business practices can be improved and the concerns of the society can be addressed.
Family Knowledge about Palliative Care
Ernesto Pena Morgado
Ana G. Méndez
NR502: Research Proposal
February Session, 2019
Family Knowledge about Palliative Care
In the United States, the vast majority of palliative care is performed in the home. It is obvious that in this scenario the members of the family play a leading role. Most research related to palliative care in the United States does not describe the level of commitment of the patient and caregivers with such care. (Dillon, 2016).
In a study presented about "How home hospice facilitates patient and family engagement", his author, Dillon, describes how some caregivers cheered for instruction on how to manage their relatives palliative care in relation to the use of the comfort kit, including the management of morphine in relationship to be better prepared to relieve the pain of the patient (Dillon, 2016, pp.595). Another wife described how the education and holistic instruction provided was helpful in dealing with and understanding the care that would be provided to her husband. (Dillon, 2016).
The author concludes that offering instruction and education in relation to such difficult issues as helping to face death, has an important implication in the participation of the patient and the family in palliative care, and is the first necessary step to train patients and the family to make informed decisions (Dillon, 2016).
The hospita.
Respond to at least two of your colleagues in one or more of t.docxwilfredoa1
Respond
to at least
two
of your colleagues in one or more of the following ways:
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Validate an idea with your own experience and additional research.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
POST 1
According to Cleary and Hunt, (2011), recent studies have shown the majority of nursing doctoral candidates are female, clinically experienced, and in their 40s or 50s at the time of starting their PhD. Based on that criteria, this writer fits exactly into that criteria. It is noted that other disciplines tend to start doctoral training much earlier (Cleary & Hunt, 2011). As a practicing nurse of 30 years, most of it as an Associate Degree nurse the recognition of the PhD nurse was seen as a profession in a nursing league of their own. According to Michael and Clochesy, (2016), the PhD in nursing was predominant throughout the 20th century with members of the academic nursing community recognizing the need for the development of knowledge to inform practice and to promote the credibility of the profession. Nursing theorists such as Jean Watson and Patricia Benner were game changers in the industry of theoretical nursing. The ability in achieving higher levels of education and in conducting research are hallmarks of professionalism (Houser, 2018).
This writer has a passion for teaching students and wants to be the best instructor she can be. She chose to go down the path of the PhD in Nursing education to increase skills and knowledge to improve what is delivered to students every day. The PhD is being pursued to separate myself from the growing amount of DNP faculty that she works with daily. Being an alumni with Walden University for the MSN, it was an easy choice to pick Walden University for the terminal degree. Michael and Clochesy, (2016), states the PhD and DNP represent complementary and alternative approaches to the highest level of educational preparation in nursing. PhD programs prepare nurse scientists to conduct original research and to generate knowledge that may be broadly applicable or generalizable using advanced research designs and statistical evaluative methods. Conversely, DNP programs prepare students for advanced specialty practice at a high level of complexity with a concurrent focus on the development of knowledge and skills required for translation of evidence to improve health outcomes and health care delivery (Michael & Clochesy, 2016).
Michael and Clochesy, (2016), also states two of the main reasons for not completing a doctoral program are financial and family stresses. Strategic plans must include financial considerations (e.g., research costs), support systems and a systemic approach to the d.
PEER RESPONSES FOR Patient Outcomes and Sustainable ChangeQUES.docxpauline234567
PEER RESPONSES FOR Patient Outcomes and Sustainable Change
QUESTION: Reflecting on the "IHI Module PS 101: Introduction to Patient Safety," summarize why it is essential to improve patient safety. Use one of the articles from this week's topic Resources and describe the framework or theory that was used to improve the patient outcome. What outcome measures were identified and how did they align with the improvement project? Explain how the authors learned from the error or unintended events to ensure patient safety. Provide supporting evidence.
Dr. Mary Sizemore
Thank you for your response. You provided some good information regarding the quality of care and patient safety. In my practice, many facilities work to improve patient outcomes through the use of electronic health records to reduce errors with medication prescribing. Consider ordering a new medication for a patient. What are some measures you can take as a provider to reduce possible errors with the process?
Kristen Williams
Dec 2, 2022, 12:11 PM
The Institute for Healthcare Improvement (IHI) Module PS 101: Introduction to Patient Safety provides the structural foundation of the vital role patient safety has in a healthcare institution. High reliability was a central theme of the module. A culture of safety is when the employees share a central belief that a healthcare organization supports root cause analysis in patient care (Leape, 2021). It is a significant theme that humans have a predisposition to error, and it is vital to create systems and a safety culture to have a safe environment for patients. It is crucial to develop systems to track and analyze errors as they occur to improve future outcomes by creating safer systems.
When people interact with a healthcare system, they are often at their most valuable state. The number of people dying from medical errors in 2018 was equivalent to a daily jumbo crash (Leape, 2021). Our society would not stand for one plane crash a day, yet often a place whose purpose is to heal hurts. Although humans are prone to error, it is essential to create policies, procedures, and phycological safety to increase safety when people seek healthcare. A facility that commits to embedding safety into policy and procedures and a culture of phycological safety are often referred to as a high-reliability organization (HRO).
Education and empowerment of staff are essential components of building physical safety. Haley & Fritz (2019) used a framework of education and empowerment to improve the rate of urinary tract infections (UTI) in a long-term care (LTC) facility. Haley & Fritz (2019) assessed that evidenced-based signs and symptoms were not consistently utilized in obtaining urine samples to diagnose UTIs. A culture of safety examination showed improvement that could be made. Education and empowerment were done to improve the signs and symptoms used to initiate obtaining a urine sample (Haley & Fritz, 2019). Phycological safety is a vital found.
November-December 2013 • Vol. 22/No. 6 359
Beverly Waller Dabney, PhD, RN, is Associate Professor, Southwestern Adventist University,
Keene, TX.
Huey-Ming Tzeng, PhD, RN, FAAN, is Professor of Nursing and Associate Dean for Academic
Programs, College of Nursing, Washington State University, Spokane, WA.
Service Quality and Patient-Centered
Care
L
eaders of the U.S. Depart -
ment of Health & Human
Services (2011) urge providers
to improve the overall quality of
health care by making it more
patient centered. Patient-centered
care (or person-centered care) refers
to the therapeutic relationship
between health care providers and
recipients of health care services,
with emphasis on meeting the
needs of individual patients. Al -
though the term has been used
widely in recent years, it remains a
poorly defined and conceptualized
phenomenon (Hobbs, 2009).
Patient-centered care is believed
to be holistic nursing care. It pro-
vides a mechanism for nurses to
engage patients as active partici-
pants in every aspect of their health
(Scott, 2010). Patient shadowing
and care flow mapping were used to
create a sense of empathy and
urgency among clinicians by clarify-
ing the patient and family experi-
ence. These two approaches, which
were meant to promote patient-cen-
tered care, can improve patient sat-
isfaction scores without increasing
costs (DiGioia, Lorenz, Greenhouse,
Bertoty, & Rocks, 2010). A better
under standing of attributes of
patient-centered care and areas for
improvement is needed in order to
develop nursing policies that in -
crease the use of this model in health
care settings.
The purpose of this discussion is
to clarify the concept of patient-cen-
tered care for consistency with the
common understanding about pa -
tient satisfaction and the quality of
care delivered from nurses to
patients. Attributes from a customer
service model, the Gap Model of
Service Quality, are used in a focus
on the perspective of the patient as
the driver and evaluator of service
quality. Relevant literature and the
Gap Model of Service Quality
(Parasuraman, Zeithaml, & Leonard,
1985) are reviewed. Four gaps in
patient-centered care are identified,
with discussion of nursing implica-
tions.
Background and Brief
Literature Review
Patient-Centered Care
The Institute of Medicine (IOM,
2001a) and Epstein and Street (2011)
identified patient-centeredness as
one of the areas for improvement in
health care quality. The IOM (2001b)
defined patient-centeredness as
…health care that establishes a
partnership among practition-
ers, patients, and their families
(when appropriate) to ensure
that decisions respect patients’
wants, needs, and preferences
and that patients have the edu-
cation and support they require
to make decisions and partici-
pate in their own care… (p. 7)
Charmel and Frampton (2008)
defined patient-centered care as
…a healthcare setting in which
patients are encouraged to be
actively involved in their care,
with a physical environment
t.
November-December 2013 • Vol. 22/No. 6 359
Beverly Waller Dabney, PhD, RN, is Associate Professor, Southwestern Adventist University,
Keene, TX.
Huey-Ming Tzeng, PhD, RN, FAAN, is Professor of Nursing and Associate Dean for Academic
Programs, College of Nursing, Washington State University, Spokane, WA.
Service Quality and Patient-Centered
Care
L
eaders of the U.S. Depart -
ment of Health & Human
Services (2011) urge providers
to improve the overall quality of
health care by making it more
patient centered. Patient-centered
care (or person-centered care) refers
to the therapeutic relationship
between health care providers and
recipients of health care services,
with emphasis on meeting the
needs of individual patients. Al -
though the term has been used
widely in recent years, it remains a
poorly defined and conceptualized
phenomenon (Hobbs, 2009).
Patient-centered care is believed
to be holistic nursing care. It pro-
vides a mechanism for nurses to
engage patients as active partici-
pants in every aspect of their health
(Scott, 2010). Patient shadowing
and care flow mapping were used to
create a sense of empathy and
urgency among clinicians by clarify-
ing the patient and family experi-
ence. These two approaches, which
were meant to promote patient-cen-
tered care, can improve patient sat-
isfaction scores without increasing
costs (DiGioia, Lorenz, Greenhouse,
Bertoty, & Rocks, 2010). A better
under standing of attributes of
patient-centered care and areas for
improvement is needed in order to
develop nursing policies that in -
crease the use of this model in health
care settings.
The purpose of this discussion is
to clarify the concept of patient-cen-
tered care for consistency with the
common understanding about pa -
tient satisfaction and the quality of
care delivered from nurses to
patients. Attributes from a customer
service model, the Gap Model of
Service Quality, are used in a focus
on the perspective of the patient as
the driver and evaluator of service
quality. Relevant literature and the
Gap Model of Service Quality
(Parasuraman, Zeithaml, & Leonard,
1985) are reviewed. Four gaps in
patient-centered care are identified,
with discussion of nursing implica-
tions.
Background and Brief
Literature Review
Patient-Centered Care
The Institute of Medicine (IOM,
2001a) and Epstein and Street (2011)
identified patient-centeredness as
one of the areas for improvement in
health care quality. The IOM (2001b)
defined patient-centeredness as
…health care that establishes a
partnership among practition-
ers, patients, and their families
(when appropriate) to ensure
that decisions respect patients’
wants, needs, and preferences
and that patients have the edu-
cation and support they require
to make decisions and partici-
pate in their own care… (p. 7)
Charmel and Frampton (2008)
defined patient-centered care as
…a healthcare setting in which
patients are encouraged to be
actively involved in their care,
with a physical environment
t.
November-December 2013 • Vol. 22/No. 6 359
Beverly Waller Dabney, PhD, RN, is Associate Professor, Southwestern Adventist University,
Keene, TX.
Huey-Ming Tzeng, PhD, RN, FAAN, is Professor of Nursing and Associate Dean for Academic
Programs, College of Nursing, Washington State University, Spokane, WA.
Service Quality and Patient-Centered
Care
L
eaders of the U.S. Depart -
ment of Health & Human
Services (2011) urge providers
to improve the overall quality of
health care by making it more
patient centered. Patient-centered
care (or person-centered care) refers
to the therapeutic relationship
between health care providers and
recipients of health care services,
with emphasis on meeting the
needs of individual patients. Al -
though the term has been used
widely in recent years, it remains a
poorly defined and conceptualized
phenomenon (Hobbs, 2009).
Patient-centered care is believed
to be holistic nursing care. It pro-
vides a mechanism for nurses to
engage patients as active partici-
pants in every aspect of their health
(Scott, 2010). Patient shadowing
and care flow mapping were used to
create a sense of empathy and
urgency among clinicians by clarify-
ing the patient and family experi-
ence. These two approaches, which
were meant to promote patient-cen-
tered care, can improve patient sat-
isfaction scores without increasing
costs (DiGioia, Lorenz, Greenhouse,
Bertoty, & Rocks, 2010). A better
under standing of attributes of
patient-centered care and areas for
improvement is needed in order to
develop nursing policies that in -
crease the use of this model in health
care settings.
The purpose of this discussion is
to clarify the concept of patient-cen-
tered care for consistency with the
common understanding about pa -
tient satisfaction and the quality of
care delivered from nurses to
patients. Attributes from a customer
service model, the Gap Model of
Service Quality, are used in a focus
on the perspective of the patient as
the driver and evaluator of service
quality. Relevant literature and the
Gap Model of Service Quality
(Parasuraman, Zeithaml, & Leonard,
1985) are reviewed. Four gaps in
patient-centered care are identified,
with discussion of nursing implica-
tions.
Background and Brief
Literature Review
Patient-Centered Care
The Institute of Medicine (IOM,
2001a) and Epstein and Street (2011)
identified patient-centeredness as
one of the areas for improvement in
health care quality. The IOM (2001b)
defined patient-centeredness as
…health care that establishes a
partnership among practition-
ers, patients, and their families
(when appropriate) to ensure
that decisions respect patients’
wants, needs, and preferences
and that patients have the edu-
cation and support they require
to make decisions and partici-
pate in their own care… (p. 7)
Charmel and Frampton (2008)
defined patient-centered care as
…a healthcare setting in which
patients are encouraged to be
actively involved in their care,
with a physical environment
t ...
ABSTRACT Handover, or the communication of patient information be.docxransayo
ABSTRACT: Handover, or the communication of patient information between clinicians, is a fundamental component of health care. Psychiatric settings are dynamic environments relying on timely and accurate communication to plan care and manage risk. Crisis assessment and treatment teams are the primary interface between community and mental health services in many Australian and international health services, facilitating access to assessment, treatment, and admission to hospital. No previous research has investigated the handover between crisis assessment and treatment teams and inpatient psychiatric units, despite the importance of handover to care planning. The aim of the present study was to identify the nature and types of information transferred during these handovers, and to explore how these guides initial care planning. An observational, exploratory study design was used. A 20-item handover observation tool was used to observe 19 occasions of handover. A prospective audit was undertaken on clinical documentation arising from the admission. Clinical information, including psychiatric history and mental state, were handed over consistently; however, information about consumer preferences was reported less consistently. The present study identified a lack of attention to consumer preferences at handover, despite the current focus on recovery-oriented models for mental health care, and the centrality of respecting consumer preferences within the recovery paradigm.
INTRODUCTION Handover is the transfer of verbal and written communication of patient information between members of the health-care team. It is integral to the practice of all healthcare clinicians (Millar & Sands 2012). The Australian Commission for Safety and Quality in Health Care (ACSQHC 2011) recognizes the importance of handover in the continuum of health care, and acknowledges that information transferred between clinicians during the handover can directly affect the quality of care delivered to patients. Poor-quality handover practice has been linked to a number of unfavourable patient outcomes, including increased hospital stays, consumer dissatisfaction, delays in treatment, and other adverse clinical outcomes (Hill & Nyce 2010; Manser & Foster 2011; Siemsen et al. 2012; World Health Organization Collaborating Centre for Patient Safety
Solution
s (WHOCCPSS) 2007). In the present study, we report on the findings of a study that investigated handover between the crisis assessment and treatment team (CATT) and the inpatient psychiatric unit (IPU).
There is little in the published literature that reports on handover practices in acute psychiatric settings, and no previous research that has specifically investigated handover between the CATT and the IPU. The lack of studies in this area is concerning, given that in Australia and internationally, CATT service models are in wide use to facilitate community access to psychiatric assessment and care for people who are experien.
Of all the ways to influence health policy, using research to info.docxcherishwinsland
Of all the ways to influence health policy, using research to inform change has the dual appeal of sounding both straightforward and rigorous. However, reality intrudes in many forms to disrupt the otherwise common-sense connection between what we know, what we consider as policy and what we are doing. Different languages (academic versus political), disparate timeframes (deliberate versus opportunistic), and contrasting priorities (most rigorous versus good enough) often make translating research into policy an exercise in frustration. Just as basic scientists and clinical researchers grapple with the challenge of bringing innovations from bench to bedside, health services researchers must wrestle to make their work most relevant to policy realities in communities near and far.
Yet, this is a worthy—and potentially rewarding—pursuit. Evidence for such a claim is reflected in this supplement, which includes an array of approaches to bridging the gap between research and policy taken by current scholars and alumni of the Robert Wood Johnson Foundation Clinical Scholars program (RWJFCSP). Traditionally focused on training physicians in rigorous methods in biostatistics, clinical epidemiology, and health services research, as well as in other fields such as social sciences, the RWJFCSP has purposefully shifted over the past decade to emphasize the value of actionable research. Whether partnering with community members to conduct participatory research, or with policy makers to ensure that timely and relevant questions are being addressed, scholars are encouraged to consider how the results of their research will lead to short-term change and long-term progress. These research efforts encompass a broad variety of research methods, including qualitative and quantitative approaches, local and national data, and cutting-edge work involving community-based participatory research, multi-level hierarchical analyses, and dynamic multi-state modeling.
Given its leadership in the realm of research and policy, the RWJFCSP is the source of the lead or senior authors of all of the articles in this volume; the authors are either current scholars or alumni of the program. Of note, these articles do not reflect the entire sum of policy-relevant research conducted by RWJFCSP-connected investigators. Rather, these articles comprise a fraction of those submitted for inclusion in this supplement, and policy-relevant research by these authors and others with connections to the RWJFCSP appear in other journals as well.
The authors addressed important barriers to bridging the gap between research and policy. First, new evidence informs policy if it makes it into the hands of individuals who have a stake in what the data is measuring, and who are engaged in acting on the findings. Even the most rigorously conducted, widely cited manuscripts will have only marginal impact unless brought to life by potential change agents. Second, the evidence being generated may not be .
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. collaboration as central strategies for their practical application. This
conceptualisation underpins many initiatives across North America
intended to transform adult hospital care, ranging from organisational
policies and quality improvement strategies to efforts to change in-
dividual health care provider values and behaviours (American As-
sociation of Critical Care Nurses, 2019; Institute for Patient and
Family Centred Care & Canadian Foundation for Healthcare Im-
provement, 2015). Although there is broad uptake of the idea of
centring care on patients and families, it has been difficult to establish
an evidence base to both support PFCC initiatives and improve their
implementation (CADTH, 2015). Arguments for implementing PFCC
initiatives are broad and usually associated with improved quality of
care and safety, and enhanced patient satisfaction and experiences
(Park et al., 2018). These wide‐ranging benefits are described in a
PFCC curriculum developed by Emanuel et al. (2016) in consultation
with a range of patient safety stakeholders across Canada, including
quality assurance councils, hospitals and the American Patient Safety
Education Program. By prioritising patient and family involvement in
their own care, PFCC initiatives are also suggested to improve op-
erational efficiencies of health care by reducing the length of hospital
stays and readmissions, care transitions and discharge planning
(CADTH, 2015). However, it is unclear if these operational trends are
linked to other advances in hospital care, such as enhanced proce-
dural techniques, increased use of health informatics or develop-
ments in community care services.
Alongside these organisational logics, PFCC approaches to care
are justified as simply the ‘right’ thing to do and thus as a moral
obligation for health service providers (Millenson et al., 2016). In the
ethical discourses most often used, ‘centring’ care approaches are
argued for on the grounds that, by partnering and engaging with
families, health care providers will be more likely to respect patient
autonomy and choice (Igel & Lerner, 2016; Sedig, 2016). For example,
PFCC strategies, such as bedside rounding and bedside whiteboards,
are presented as effective means to encourage participation, in-
formation sharing and collaboration, thereby positioning patients as
experts on their lives and as having the right to choose their pre-
ferred health intervention (Emanuel et al., 2016). Additionally, most
stakeholder groups, including managers, physicians, nurses, patients
and family advisory groups support the idea that ‘good’ care is care
that involves the patient and family voice and satisfies their pre-
ferences (Kreindler, 2015). Although care providers and researchers
suggest various benefits, significant challenges are reported when
implementing PFCC initiatives and studying their effects within the
adult acute care setting.
1.1 | Implementation challenges
Research studies reporting barriers to implementing PFCC initiatives
describe challenges across organisational and individual care provider
levels despite decades of research and advocacy work (Lloyd
et al., 2018; Luxford et al., 2011; West et al., 2005). Administrative
hospital staff report barriers to implementing ‘centring’ care
strategies related to individual health care provider's limited experi-
ence and unsupportive attitudes, high workloads and time pressures
and constraints related to environmental resources (Lloyd et al.,
2018). These workload challenges, environmental constraints and
time pressures are also described by health care providers; however,
these are instead framed as issues relating to competing organisa-
tional priorities (Kiwanuka et al., 2019). While some challenges re-
lated to identified barriers are thought to be adequately addressed
through more education, many appear to be outside the control of
individual health care providers at the direct point of care (Bokhour
et al., 2018). For example, many health care providers state more
PFCC infrastructure is necessary to support its implementation
(Emanuel et al., 2016). Such infrastructure includes a variety of
structural and formal hospital processes, such as policies, materials or
technologies to support communication and information sharing,
or physical space for families to visit. Additional barriers, such as
traditional paternalistic care delivery models (Moore et al., 2017), lack
of scientific certainty to support PFCC (Goodridge et al., 2018) and
practices of tokenism where patients and families are present but not
actually engaged in care practices are also reported in the literature
(Kiwanuka et al., 2019).
1.2 | Theoretical challenges of PFCC
Researchers interested in developing solutions to address identified
barriers and challenges in the implementation of PFCC in acute care
are met with additional theoretical challenges, particularly a persis-
tent ambiguity and uncertainty related to describing and classifying
patient and family ‘centred’ care. Contemporary theories describing
the ‘centring’ of patients and families in care use somewhat diffuse
labels, including patient centred care, family centred care, person
centred care and PFCC. And although a number of concept analyses
have been undertaken in an attempt to differentiate and clarify these
‘centring’ care theories and approaches, they have had limited suc-
cess (Coyne et al., 2018; Morgan & Yoder, 2012; Smith, 2018). At the
same time, while many researchers continue to utilise various ‘cen-
tring’ care models interchangeably in their studies, others strongly
assert that there are important differences (Lines et al., 2015;
Starfield, 2011). For example, a literature review by Eklund et al.
(2019) suggests that the goal of patient‐centred care is a functional
life and the goal of person centred care is a meaningful life, and that
therefore these approaches should not be conflated. However,
Kokorelias et al. (2019) also synthesised literature through a scoping
review and recommended researchers consider developing a uni-
versal family centred care model with components from PFCC and
person centred care models to improve care. Although a study by
Hughes et al. (2008) is older, their work provides an informative and
descriptive history of the competing types of centring care ap-
proaches (e.g., family centred, patient centred, client centred). While
highlighting their diverse origins and intentions, Hughes et al. (2008)
suggest that all these approaches to care are linked by ‘an
implicit appeal to psychological or sociological theories of improved
2 of 10 | JUDGE AND CECI
3. interaction as psychosocial and ethical goods’ (p. 456). In this way, it
seems fair to observe that patient and family ‘centred’ care as an idea
has become significant for a range of stakeholders, despite carrying
diverse moral and ideological (e.g., professional or disciplinary) values
and practical meanings.
‘Centredness’ as a goal (if not a practice) is also accepted and
endorsed across many health disciplines, including nursing (Interna-
tional Family Nursing Association, 2018), medicine (Igel &
Lerner, 2016), disability and rehabilitation (Leplege et al., 2007),
physical therapy (Bamm & Rosenbaum, 2008) and psychiatry (Allen &
Petr, 1998). But while these approaches appear to be more or less
similar, Kreindler (2015) demonstrates how self‐evident claims to
practice ‘centred’ care can also create intergroup conflict. For ex-
ample, if all stakeholders claim a version of ‘centredness’ is implicit in
their work, then challenges during implementation are typically
blamed upon other stakeholder groups. Kreindler (2015) suggests this
is in part due to multiple definitions and politics underpinning
‘centred’ care approaches. At the direct point of care, PFCC ap-
proaches by health care providers (e.g., nurses) typically stress
humanistic or shared decision‐making values, whereas health ad-
ministrators at the organisational level typically describe ‘centred’
approaches as policies and interventions that are designed with
consumer input (Kreindler, 2015). Physicians and nurses appear to be
hesitant about this increasingly consumerist patient identity, in part
because it changes the nature of their work from a professional
service highlighting dignity to a type of commercial transaction
(Kreindler, 2015). In summary, what seems most evident is that in-
itiatives aiming to ‘centre’ patients and families in care have laudable
goals and are strongly sought after. However, there are also long-
standing challenges to both implementing and studying the effects of
PFCC initiatives in hospital care. Furthermore, the meanings and
politics attached to the various ‘centring’ discourses remain fluid,
presenting further challenges for those attempting to study its effects
and improve care for patients and families. These concerns necessi-
tate critical scholarship to enhance knowledge development about
those practices that aim to ‘centre’ patients and families in hospital
care. In this context and given that extant research presupposes a set
of assumptions that enable ‘centredness of care’ to be conceptualised
and studied, it seems necessary to re‐examine how we come to know
that patients and families are ‘centred’ in care.
1.3 | History of ‘Centring’ discourse in health care
Researchers exploring the evolution of PFCC concepts commonly
report the idea of ‘centring’ originates from concerns within Western
paediatric hospital care settings. Throughout the early 1900s to mid‐
1950s, severely restricted hospital visitation policies were a point of
contention in American paediatric hospital care (Giganti, 1998).
Renshaw (2009) suggests psychological research describing ‘maternal
deprivation’ among hospitalised children led to early campaigning by
parents to protest visiting restrictions in American hospitals. Similarly,
Jolley and Shields (2009) state family centred discourses were
advocated for alongside the rise of psychoanalytical research after
World War II, which demonstrated the risk of psychological harm to
children and their parents if they were separated for long periods of
time. Psychological research has heavily influenced contemporary
understandings of ‘centred’ care for adult patient populations (e.g.,
see Rogers, 1959 early work on client centred theory).
The Institute for Patient and Family Centred Care (n.d.) also of-
fers a brief history of how PFCC emerged in unique ways across
different hospital settings, including critical care, maternity care, end
of life care, and again with the greatest emphasis on paediatric care.
While PFCC policies for paediatric populations were generally readily
adopted, endorsement of family involvement for adult patient po-
pulations took more time. This seems to be, in part, related to the
greater emphasis on an individualising patient‐centred discourse in
adult care. Ideas of patients as individualised subjects developed
during the latter half of the 20th century arising from concerns that
medical care treated patients as objects or things, rather than whole
persons (May, 1992). Rather than an ‘object’ or biological/patholo-
gical body to be worked on by health experts, the ‘inner or emotional
significance’ of the patient became of interest to health care provi-
ders (Hughes et al., 2008, p. 461). The Institute of Medicine's (2001)
Crossing the Quality Chasm report is also widely cited within PFCC
intervention studies as the turning point in the widespread im-
plementation of PFCC in all care settings. Although it is difficult to
pinpoint a single origin of ‘centring’ discourses, as various disciplines,
advocacy groups and contexts of care were instrumental in its
widespread adoption, concerns related to patient identity, risk and
the nature of hospital care practices influenced the organisation of
care and public desire to encourage greater patient and family in-
volvement or ‘centredness’ in hospital care.
2 | PROBLEMATISATION: A CRITICAL
REVIEW METHOD
A structured problematisation method, as developed by Alvesson and
Sandberg (2011, 2013), is utilised to identify and analyse assumptions
shaping and producing research practices intended to have effects on
the implementation and evaluation of PFCC. These assumptions are
important to examine because they inform how researchers con-
struct their object of inquiry and develop solutions to what are seen
as barriers to ‘centring’ patients and families in acute care settings.
Unlike traditional research review methods, which aim to synthesise
and appraise research findings to determine the ‘state’ of knowledge,
the purpose of the problematisation approach to identify and if ne-
cessary, challenge the assumptions underlying the construction of
research questions and the methods employed to answer them
(Alvesson & Sandberg, 2011). Thus, problematisation differs from
traditional literature syntheses because the review process is in-
tended to raise questions about the way research problems are
constructed within a field of study, particularly when efforts have
produced unsatisfactory results so that alternative research ques-
tions can be created and theorised. This approach is deliberately
JUDGE AND CECI | 3 of 10
4. more philosophical than most review methods, analysing how con-
temporary knowledge guiding PFCC intervention research has
evolved, as well as how PFCC as an object of study is methodolo-
gically and theoretically explored. And, perhaps most importantly, the
problematisation approach also encourages researchers to in-
vestigate the possibility of more effective and innovative con-
ceptualisations to inform future research practices.
Alvesson and Sandberg's (2011, 2013) problematisation method
is informed by Michel Foucault's practice of problematisation, often
described as a ‘movement of critical analysis in which one tries to
see how different solutions to a problem have been constructed’
(Foucault & Lotringer, 1996, p. 422). This iterative movement of
critical analysis is likened to a practice of ‘dialectical interrogation’, a
process of question raising undertaken through exploring the taken‐
for‐granted assumptions of a domain of literature against home and
alternative theoretical stances (Alvesson & Sandberg, 2013). To fur-
ther support critical analysis, Alvesson and Sandberg (2011) provide a
typology of assumptions as ‘heuristic support for identifying and
challenging assumptions’ in existing literature (p. 267). Root‐
metaphor, in‐house and ideological assumptions were utilised as
exploratory techniques in our analysis. These are not all‐
encompassing of this method, rather these types of assumptions
offer a starting point and language to build a structured and in‐depth
analysis. Furthermore, assumptions identified through Alvesson and
Sandberg's typology of assumptions are then examined in relation to
alternative theoretical stances and research approaches in the studies
of health care organisations and management. Alvesson and Sand-
berg's work focuses on improving challenges within organisation and
management studies, and their problematisation method has proven
useful for reconsidering longstanding problems requiring innovation
in health care (Ceci et al., 2018; Egan et al., 2016; Purkis &
Ceci, 2014; Symonds‐Brown et al., 2019).
2.1 | Constructing a search strategy
As described by Alvesson and Sandberg (2011), problematisation calls
for an extensive and methodical literature search, but not an ex-
haustive one. That is, we did not attempt to gather all the ‘centring’
care literature, such as in traditional systematic reviews. Instead, the
aim is to critically explore this broad body of literature and identify a
comprehensive sample of relevant research studies illustrating how
PFCC tends to be studied in adult acute care settings. Due to the
theoretical ambiguity across the ‘centring’ discourses, we use the
term PFCC as an umbrella term to include the following approaches
to ‘centring’ care: patient centred care, family centred care, care,
person centred care, and patient and family centred.
The following search strategy was developed in consultation
with a health sciences librarian: (Patient and family centred care or
FCC or PFCC or person centred care or patient centred care) AND
(adults or adult) AND (hospital or acute setting or inpatient or ward).
The CINAHL and MEDLINE databases were used initially, as their
contributions are predominantly from health disciplines. No date
parameters were applied to develop an understanding of when and
how research concerned with PFCC initiatives has evolved.
2.2 | Establishing boundaries of the PFCC
problematisation
Although we describe the problematisation method in a systematic
way, the actual process of constructing the boundaries of the review
and the analysis was iterative. For example, many studies simply
stated PFCC as an outcome or used ‘centred’ as a descriptor of some
other kind of intervention (e.g., nutrition programme or ventilator
weaning). There was the question of whether studies that used ‘in-
dividualized’ or patient ‘focused’ language should be considered sy-
nonymous with PFCC. We also debated including studies that
implemented tools such as bedside rounding or communication
whiteboards, but did not specifically foreground themselves as PFCC
interventions in our problematisation. While we recognise there are
relevancies across these areas and PFCC as ‘intervention’, they were
excluded from in‐depth reading. From our search strategy, we first
screened the title and abstract of the articles for any mention of
PFCC, person centred care or family centred care. Included texts
focused on acute care settings and adult patient populations. Full‐
text review resulted in the exclusion of those studies that did not
specify PFCC as an intervention in an adult acute care setting.
Google Scholar and Scopus database were used to identify a
sample of highly cited texts (i.e., more than 50 citations) from our
search. Highly cited texts offer key examples of shared assumptions
informing the field of PFCC intervention research. To supplement the
database search strategy for highly cited texts, the bibliographies of
highly cited texts were reviewed to identify historical papers, experts
within this field, and to trace how knowledge has developed. This
review process resulted in a sample of 23 studies for in‐depth ana-
lysis. The texts informing this analysis include empirical studies, re-
views and commentaries on PFCC intervention research. These are
considered dominant or ‘typical’ texts carrying the ‘norms’ and taken‐
for‐granted assumptions related to PFCC.
3 | ASSUMPTIONS UNDERLYING PFCC
INTERVENTION RESEARCH
We highlight three predominant areas within PFCC‐related inter-
vention research for problematising that are unique to the hospital‐
based care research we examined: A reliance on Vitruvian spatiality, a
concern with democratising care and the creation of ‘centring’ as
a problem for nursing. Identification and analysis of assumptions in-
forming research practices as an ‘outcome’ of our work differ
significantly from the outcomes of traditional literature reviews,
which typically present their findings as ‘gaps’ in knowledge. In our
case, we suggest that these sets of assumptions are very much
shaping PFCC intervention research practices and what is thought
possible for improving the care of patients and families in acute care.
4 of 10 | JUDGE AND CECI
5. These assumptions were identified through ongoing reflection, dia-
logic interrogation, and a particular interest in supporting the gen-
eration of more interesting research questions and knowledge
practices related to ‘centring’ patients and families in care. The fol-
lowing questions guided our problematisation and study analysis:
How do researchers come to know and study PFCC in adult acute
care? Are established standardised tools or frameworks used? What
outcomes are described as good? What solutions or paths forwards
are offered?
3.1 | Root‐metaphor: Establishing a ‘Centre’ of care
for patients and families
‘Centredness’ is an influential metaphor with symbolic references
related to the spatial (re)organisation of care for patients and families.
The image of a transcendental centre within care was foregrounded
across all the studies reviewed in this problematisation regardless of
the type of ‘centring’ theory implemented. However, this ‘centre’ is
described as occupied by different and somewhat competing entities,
such as persons (e.g., Edvardsson et al., 2008, 2009), patients (e.g.,
Berghout et al., 2015; Ferguson et al., 2013), or patients and their
families (e.g., Ciufo et al., 2011). Alvesson and Sandberg (2011) de-
scribe root‐metaphor assumptions as the broader images related to a
topic, such as the idea there is a ‘culture’ within organisations. The
idea of an organisational culture, suggesting shared or unified values,
has been critiqued by Alvesson and Spicer (2012) for being overly
rational. Practice‐based theorists, such as Nicolini (2016, 2017) and
Gherardi (2012) have taken the critique of studying ‘culture’ in or-
ganisations further, arguing traditional theoretical framings of orga-
nisational ‘culture’ overlook the sociomaterial practices that
accomplish, stabilise and interfere with organisational work. Nicolini
(2016) describes how abstract entities such as culture are simply
convenient summaries and warns against utilising them as re-
presentations. Instead, Nicolini (2017) recommends we consider the
effects and the technologies that produce abstract generalisations
such as ‘culture’. The metaphor of a ‘centre’ within health care is
similarly insidious, influencing how we discuss, intervene on, and
understand everyday hospital care activities for patients and families.
The word ‘centre’ originates from the Greek term Kentron,
meaning sharp point and can refer to the stationary point on a
compass (Merriam Webster, n.d.). Historically the ‘centre’ of hospital
care has been described as disease or physician/health‐systems
centred (van der Eijk et al., 2013; Taylor, 2008). A ‘centre’ of care
suggests that there is a place from which all hospital care activities
originate or an area that is most important in relation to other hos-
pital actors or care activities. Thus, it appears that PFCC intervention
research presupposes hospital care practices should and can contain
a focal point, a carefully balanced and fixed position available to be
stably occupied and examined—most often this is the patient's body.
This idea of a fixed and stable centre has implications for the way we
think about how care occurs for patients and their families—and
though appealing, there are important limitations that become
apparent when this metaphor is carefully examined. To do this, we
draw on Haraway's (2008) critique of Leonardo da Vinci's Vitruvian
man, a powerful portrayal of the transcendental ‘centred’ body.
Across disciplines of art, science, medicine and sociology re-
searchers tend to view the world through the image of the Vitruvian
man or the ‘Man of Perfect Proportion’ as described by Haraway
(2008, p. 7). Haraway critiques this lens as overtly humanist in her
text, When Species Meet. With light humour, but also with strong
intent, Haraway literally draws a counter image to humanist thinking,
titled Leonardo da Vinci's Dog, as the centre of the universe. Through
this counter image, Haraway raises serious questions about the kinds
of relations we make and account for in the world when framed
through the constraints of anthropocentrism. In PFCC research, the
question becomes what relations or actors are made visible through
‘centring’ interventions and which actors and subjects are made
invisible?
In the PFCC intervention studies analysed here, the Vitruvian
lens creates knowledge that overwhelmingly emphasises in-
dividualisation and psychologisation of care. Many researchers
claimed ‘centring’ care theories would individualise care through the
strategies examined. Examples of such strategies included creating
tailored health care plans (Alharbi et al., 2012), involving patient
preference during discharge (Anthony & Hudson‐Barr, 2004), in-
corporating patient needs during medication administration (Bolster
& Manias, 2010), including patient perspective or voice when eval-
uating centred care (Bechel et al., 2000; Marshall et al., 2012; Rathert
et al., 2015) or developing PFCC education materials (Ferguson
et al., 2013). Efforts to individualise care through such PFCC inter-
ventions rest on a logic of supporting humanised care practices
raising a question of the alternative ethos PFCC interventions are
intended to work against. And it is the case that most PFCC inter-
vention studies commonly report traditional hospital care models as
problematic because they are too standardised (Alharbi et al., 2012),
task‐oriented (Ross et al., 2015), apply a ‘one‐size‐fits all’ approach to
care practices (Sidani, 2008, p. 24), or dehumanise or objectify the
persons receiving care (Coyle & Williams, 2001). These are important
problems to work against; however, the strategies for individualising
or humanising care are vague and limited to consideration of the
uniqueness, desires or personal resources of now ‘centred’ patients.
3.1.1 | Shortcomings of individualising and overly
psychologising care
A ‘centred’ body narrows the theoretical gaze of researchers studying
care, distracting researchers from the networks of social relations,
actors, and activities required to produce care practices. For instance,
the ‘centring’ of patients and families is perhaps most often oper-
ationalised within acute care settings through the creation of flexible
family presence policies (Ciufo et al., 2011). While open visitation
policies are an effective starting point to improve access and increase
human connection, hospital space is limited and highly contested.
PFCC researchers often presuppose that physical space (e.g., hospital
JUDGE AND CECI | 5 of 10
6. rooms or beds) is readily available for patients and families to occupy.
Yet as Rankin (2015) demonstrates through her ethnographic work in
hospital settings, ‘individualized’ space is actually created, monitored
and managed through a network of technologies that work to con-
stitute the character and possibilities of hospital care practices.
Rankin (2015) provides key empirical examples of technologies, in-
cluding bed management software, electronic charting and compu-
terised discharge planning that contribute to the ‘decentring’ of
patients, perhaps more so than events that occur in specific care
provider, patient and family relations and actions.
Rather than investigating the social and material realities of or-
ganising care for patients and families, PFCC research organised by
the Vitruvian lens tends to focus on what patients/families/staff
‘know’ within their minds about individualised or ‘centred’ care. For
example, PFCC research often reflects the assumptions that the pa-
tient's perspective should be the point of departure for hospital care
practices, and that this perspective and thus, the effectiveness of
‘centring’ interventions, can be best known through the use of vali-
dated psychometric tools. In our sample of intervention studies,
psychometric indicators included satisfaction measures (Coyle &
Williams, 2001; Ferguson et al., 2013; Martin et al., 1998;
Poochikian‐Sarkissian et al., 2010; Sidani, 2008), anxiety (Slatore
et al., 2012) and patient opinion surveys (Anthony & Hudson‐
Barr, 2004). While patient perspectives are valuable and high levels
of satisfaction should be sought, reliance on psychometric methods
appear to make invisible the noncognitive factors (e.g., space,
beds and virtual care environments) influencing care. Rankin (2003)
also argues that survey‐type methods commonly employed in PFCC
research can constrain the type of knowledge that can be accessed
because focused questions force specific answers from participants.
By examining the work of Rankin (2003, 2015) and the effects of
psychometric tools utilised to explore PFCC, it becomes evident that
the metaphor of a transcendental or ‘centred’ body makes invisible
the sociomaterial realities shaping ‘good’ care of patients and families.
3.2 | Ideological assumptions: Sharing power and
activating partnerships through PFCC
A key moral and political assumption within PFCC research is that
hospital‐based care decisions should be democratic, or that power
among patients, families and hospital staff should be shared through
activating egalitarian partnerships. Alvesson and Sandberg (2011)
describe ideological assumptions as the ‘various political, moral, and
gender‐related assumptions held about the subject matter’ (Alvesson
& Sandberg, 2011). The image of the Vitruvian man remains effective
in describing and analysing how notions of power within PFCC re-
search are typically attributed to a ‘centred’ body or an autonomous
human actor in care. For example, a patient survey study of person‐
centredness by Coyle and Williams (2001) suggests health care
providers maintain control over how patients are involved in care,
assuming a sovereign notion of power. To overcome concerns of a
transcendental individual controlling care decisions, the idea of
activating partnership is shared as the main solution across many
studies (Anthony & Hudson‐Barr, 2004; Bolster & Manias, 2010;
Rathert et al., 2015). However, empirical examples of how partner-
ships are ‘activated’ are not discussed in detail. The most concrete
example of power‐sharing was noted in Slatore et al's. (2012) diagram
of patient centred care. Slatore et al. (2012) display sharing power
and responsibility as a key tenant influencing patient centred care,
one that can be actualised through encouraging patient and provider
agreement on care plans. Assertions of sharing power with
‘centred’ bodies receiving care appear largely undertheorised in this
field of research and are simply justified as a moral imperative and
underscored by ‘democratic’ ideology.
3.2.1 | Limitations of ‘centredness’ as democratic
ideology
Although these ethical discourses of respecting autonomy and dig-
nity, by actualizing collaborative partnerships and sharing responsi-
bility appear ‘good’, they also obscure and overly simplify our
understanding of why and in what way power is distributed in care.
Armstrong (2014) offers an interesting account of how patients and
their families were not always seen as autonomous or agentic in
health care. Through a sociological lens, Armstrong (2014) shows
how concerns about rising health care costs, as well as behavioural/
psychological research in the 1980s (e.g., development of the Health
Belief Model) contributed to the development of the idea that pa-
tients and families should be active, motivated and responsible for
participating in their health care outcomes. PFCC intervention studies
similarly focus on improving the agential capacity of ‘centred’ bodies.
However, this sovereign notion of power conceals the network of
politics and technologies that promote or interfere with patient and
family involvement. For example, as described by Rankin (2015),
managerial technologies such as those employed to streamline pa-
tient discharge are implemented using the discourses of PFCC, but
these technologies do not necessarily improve the care experiences
of patients and families. Furthermore, while a democratic ideology is
morally persuasive, it conceals how PFCC care models are also clo-
sely tied to advances in ‘consumer’ identities of patients, which are
thought to support patient's rights as autonomous individuals (e.g.,
Bechel et al., 2000; Martin et al., 1998; Sharp et al., 2015). However,
as Rankin (2003) argues, patient satisfaction measures used to eval-
uate PFCC are related to a business model of health care delivery,
one commonly found in privatised health care facilities. Assumptions
related to individualising, psychologising and democratising care ap-
pear to draw upon one another and overlap significantly in PFCC
intervention research.
3.3 | Centring: An in‐house assumption for nursing
Researchers appear to overwhelmingly associate PFCC implementa-
tion as a ‘nursing problem’. This could be a result of our sampling
6 of 10 | JUDGE AND CECI
7. strategy, but most intervention studies were published in nursing
journals and recruited nursing staff as participants for surveys. We
conducted a backward and forward citation chain search on the in-
cluded articles to see how the ‘centring’ intervention research has
evolved. We note that researchers interested in ‘centring’ policies
and interventions frequently tend to evidence their previous research
and cite other like‐minded researchers, which demonstrates a strong
acceptance of in‐house assumptions. For example, recent person‐
centred research made reference to earlier works, such as Tom
Kitwood's (1997) person centred care model for people with
dementia and Gerteis et al. (1993) text, Through the Patient's Eyes:
Understanding and Promoting Patient‐Centred Care. Additionally, stu-
dies foregrounding ‘patient’ and ‘family’ identities frequently referred
to early work from the Picker Institute. During our review of PFCC
initiatives, we also noted many researchers had nursing backgrounds,
so it is not entirely surprising that the role of nurses in relation to
facilitating or improving PFCC is emphasised. McCormack and
McCance (2006) framework for person‐centred nursing was heavily
cited across many of the intervention studies. The creation of
‘centring’ discourses as a nursing problem is interesting, given that
‘centring’ theories foreground a team‐based and collaborative care
model (Esmaeili et al., 2014).
3.3.1 | ‘Centring’ a problem and accomplishment for
nursing
There is some tension between the philosophical emphasis on teamwork
within PFCC and the dominant nursing perspective within research stu-
dies. If we seriously consider patient and family ‘centredness’ as a team‐
based accomplishment, then the implications for PFCC implementation
must be broader than the current empirical focus on psychologising
hospital‐based nursing care of patients and families. May (1992) and May
and Purkis (1995) suggest that individualising care discourses can distract
from other kinds of work that nurses accomplish when providing care for
patients and their families. In a similar line of thinking, Allen (2015) draws
on the work of social scientists in the field of Science and Technology
Studies to explore how nurses accomplish care alongside human and
nonhuman actors. By utilising ethnographic methods that ‘de‐centre’ the
human body, Allen (2015) observes and describes how patient care tra-
jectories require a network of care activities, including documentation,
beds and transfer reports. Her analysis demonstrates that anthropo-
centric or overly humanist notions of nursing caregiving make invisible
other actors that are necessary for organising care for patients and fa-
milies in hospital settings.
4 | DISCUSSION: DECENTRING CARE
PRACTICES
Upon beginning this review, we became aware there is an abundance
of research on this topic, as evidenced by the growing number of
systematic, scoping and literature review type studies synthesising or
appraising the rigour of PFCC intervention research. We also ob-
served few empirical or review‐type studies that critically examine
extant knowledge practices related to ‘centring’ care for patients and
families. By critique we mean there is an overwhelming acceptance
that PFCC is generally a ‘good’ thing to introduce into everyday acute
care practices, despite the challenges and implementation barriers
continually identified in the research literature. Rather than en-
couraging critical research to explore why PFCC interventions are
difficult to implement and why theoretical ambiguity persists, re-
searchers reporting barriers typically call for more evidence‐based
measures and identify repetitive themes (e.g., overlooked populations
or inadequate PFCC theories) that require more precise definitions
and investigation. Alvesson and Sandberg (2011) describe this as
‘gap‐spotting’ research, where researchers create or identify knowl-
edge holes that need to be filled based on the presuppositions in-
forming a field of study. While gap‐spotting can accelerate
knowledge production on a specific topic, this approach to knowl-
edge can simply create more of the same kinds of research. In the
field of PFCC research, we have observed that this results in more
kinds of ‘centring’ theories and further theoretical ambiguity. For
example, Siouta and Olsson (2020) conducted a policy analysis of
patient centredness in Sweden and found ‘that contemporary nar-
ratives about centeredness are neither more, nor less, care seeker‐
centred than the narratives of yesteryear’ (p. 9). These authors, while
problematising current ‘centring’ policies, suggested a different kind
of person‐centred care, which does not particularly inspire more in-
teresting or innovative research in this field.
Supporting the involvement of patients and families in care in
acute care settings is a critical undertaking and responsibility; how-
ever, our analysis of key assumptions informing PFCC research sug-
gests current approaches to knowledge development in this area may
be less effective than hoped for. Knowledge development is con-
strained by the dominance of the Vitruvian lens, a metaphor for
centring practices, which leaves to one side the multiple social and
material realities of hospital care practices that may actually be
shaping the contexts of care. As we described above, theorists with
both nursing (e.g., Janet Rankin and Davina Allen) and sociological
backgrounds (e.g., Carl May and David Armstrong) provide interesting
and alternative theoretical lenses to understand the challenges and
politics of sustaining good hospital care practices for patients
and families. Although not as well cited, a group of researchers
studying the implementation of patient centred care in Italy utilise
ethnographic methods and practice‐based approaches (Liberati
et al., 2015), and in their work seem more able to account for the
social, material and relational networks that centre and decentre
patients and families in hospital‐based care practices. For example, in
an ethnographic study of patient‐centred care on a hospital ward,
Liberati et al. (2013) describe the complexity of sharing power in care
by highlighting inconsistencies between organisational policies and
the everyday practices of care. In another study, Gorli et al. (2017)
utilise the theoretical framing of Actor Network Theory to attend to
the material effects of health care redesign, specifically highlighting
relations between physical space and the capacities engendered for
JUDGE AND CECI | 7 of 10
8. patient ‘centredness’. For example, when hospital space was rear-
ranged to actualise PFCC and centralise care functions, in part to
save costs and create more efficient use of resources, both patients
and clinicians were disoriented—everything looked the same. The
new aesthetics made it harder for patients and families to find their
physicians and vice‐versa. What is significant about these alternative
theoretical approaches is that, by shifting our gaze from the Vitruvian
‘centre’, and from an analysis of care that involves mainly or only
human actors, our understandings of how care is accomplished in
hospital settings are much expanded. Research efforts that try to
account for these heterogeneous actors in care seem more likely to
develop new knowledge that might improve care practices for pa-
tients and families in hospitals.
5 | CONCLUSION AND FUTURE
RESEARCH RECOMMENDATIONS
Meaningful involvement of patients and families in hospital‐based
care is an important goal, one that seems more likely to be achieved if
researchers are able to broaden the theoretical lenses through which
such care practices are studied. Contemporary studies aiming to
‘centre’ patients and families through PFCC initiatives have shown
there are significant and longstanding barriers. While these studies
have been critical in demonstrating that there are significant con-
cerns related to dehumanisation of care and undermining of the
voices of patients and families, research practices that rely on the
assumptions described in this paper appear to constrain knowledge
development in this field and also limit the exploration of potentially
more creative lines of action. Alternative theoretical lenses, such as
those described through reference to Rankin's (2015) and Allen's
(2015) work, are warranted. Practice‐based studies and ethnographic
methods work not so much to decentre care or patients, but to more
accurately locate patients and families in networks of care with
multiple actors—both human and nonhuman—that require critical
attention for their effects.
CONFLICT OF INTERESTS
The authors declare that there are no conflict of interests.
DATA AVAILABILITY STATEMENT
Data available on request from the authors and also available in article
supplementary material (see PRISMA) (Supplementary information).
ORCID
Harkeert Judge http://orcid.org/0000-0003-3147-4244
Christine Ceci https://orcid.org/0000-0002-8503-5928
REFERENCES
Alharbi, T. S. J., Ekman, I., Olsson, L.‐E., Dudas, K., & Carlström, E. (2012).
Organizational culture and the implementation of person centered
care: Results from a change process in Swedish hospital care. Health
Policy, 108(2–3), 294–301. https://doi.org/10.1016/j.healthpol.
2012.09.003
Allen, D. (2015). The invisible work of nurses: Hospitals, organisation and
healthcare. Routledge. https://doi.org/10.4324/9781315857794
Allen, R. I., & Petr, C. G. (1998). Rethinking family‐centered practice.
American Journal of Orthopsychiatry, 68(1), 4–15. https://doi.org/10.
1037/h0080265
Alvesson, M., & Sandberg, J. (2011). Generating research questions
through problematization. The Academy of Management Review,
36(2), 247–271. https://doi.org/10.5465/AMR.2011.59330882
Alvesson, M., & Sandberg, J. (2013). Constructing research questions: Doing
interesting research. SAGE. https://doi.org/10.4135/9781446270035
Alvesson, M., & Spicer, A. (2012). A stupidity‐based theory of
organizations. Journal of Management Studies, 49(7), 1194–1220.
https://doi.org/10.1111/j.1467-6486.2012.01072.x
American Association of Critical‐Care Nurses. (2019). Cain, C., & Miller, J.
(Eds.) AACN scope and standards for progressive and critical care
nursing practice. American Association of Critical‐Care Nurses.
Anthony, M. K., & Hudson‐Barr, D. (2004). A patient‐centered model of
care for hospital discharge. Clinical Nursing Research, 13(2), 117–136.
https://doi.org/10.1177/1054773804263165
Armstrong, D. (2014). Actors, patients and agency: A recent history.
Sociology of Health & Illness, 36(2), 163–174. https://doi.org/10.
1111/1467-9566.12100
Bamm, E., & Rosenbaum, P. (2008). Family‐centered theory: Origins,
development, barriers, and supports to implementation in
rehabilitation medicine. Archives of Physical Medicine and
Rehabilitation, 89(8), 1618–1624. https://doi.org/10.1016/j.apmr.
2007.12.034
Bechel, D., Myers, W., & Smith, D. (2000). Does patient‐centered care pay
off? The Joint Commission Journal on Quality Improvement, 26(7),
400–409. https://doi.org/10.1016/s1070-3241(00)26033-1
Berghout, M., Van Exel, J., Leensvaart, L., & Cramm, J. M. (2015).
Healthcare professionals' views on patient‐centered care in
hospitals. BMC Health Services Research, 15(1), 385. https://doi.
org/10.1186/s12913-015-1049-z
Bokhour, B. G., Fix, G. M., Mueller, N. M., Barker, A. M., Lavela, S. L.,
Hill, J. N., Solomon, L. J., & Lukas, C. V. (2018). How can healthcare
organizations implement patient‐centered care? Examining a large‐
scale cultural transformation. BMC Health Services Research, 18(1),
Art. 168. https://doi.org/10.1186/s12913-018-2949-5
Bolster, D., & Manias, E. (2010). Person‐centred interactions between
nurses and patients during medication activities in an acute hospital
setting: Qualitative observation and interview study. International
Journal of Nursing Studies, 47(2), 154–165. https://doi.org/10.1016/
j.ijnurstu.2009.05.021
Canadian Agency for Drugs and Technologies in Health (CADTH). (2015).
Patient‐ and family‐centered care initiatives in acute care settings: A
review of the clinical evidence, safety and guidelines. https://www.
cadth.ca/patient-family-centered-care-initiatives-acute-care-
settings
Ceci, C., Symonds Brown, H., & Judge, H. (2018). Rethinking the
assumptions of intervention research concerned with care at home
for people with dementia. Dementia, 19(3), 861–877. https://doi.
org/10.1177/1471301218790037
Ciufo, D., Hader, R., & Holly, C. (2011). A comprehensive systematic
review of visitation models in adult critical care units within the
context of patient‐ and family‐centred care. International Journal of
Evidence‐Based Healthcare, 9(4), 362–387. https://doi.org/10.1111/
j.1744-1609.2011.00229.x
Coyle, J., & Williams, B. (2001). Valuing people as individuals:
Development of an instrument through a survey of person‐
centredness in secondary care. Journal of Advanced Nursing, 36(3),
450–459. https://doi.org/10.1046/j.1365-2648.2001.01993.x
8 of 10 | JUDGE AND CECI
9. Coyne, I., Holmström, I., & Söderbäck, M. (2018). Centeredness in
healthcare: A concept synthesis of family‐centered care, person‐
centered care and child‐centered care. Journal of Pediatric Nursing,
42, 45–56. https://doi.org/10.1016/j.pedn.2018.07.001
Edvardsson, D., Sandman, P.‐O., & Rasmussen, B. (2008). Swedish
language person‐centred climate questionnaire—patient version:
Construction and psychometric evaluation. Journal of Advanced
Nursing, 63(3), 302–309. https://doi.org/10.1111/j.1365-2648.
2008.04709.x
Edvardsson, D., Sandman, P. O., & Rasmussen, B. (2009). Construction and
psychometric evaluation of the Swedish language person‐centred
climate questionnaire—staff version. Journal of Nursing Management,
17(4), 790–795. https://doi.org/10.1111/j.1365-2834.2009.01005.x
Egan, M. Y., Kessler, D., Ceci, C., Laliberté‐Rudman, D., McGrath, C.,
Sikora, L., & Gardner, P. (2016). Problematising risk in stroke
rehabilitation. Disability & Rehabilitation, 38(23), 2334–2344.
https://doi.org/10.3109/09638288.2015.1123304
van der Eijk, M., Nijhuis, F. A. P., Faber, M. J., & Bloem, B. R. (2013).
Moving from physician‐centered care towards patient‐centered care
for Parkinson's disease patients. Parkinsonism and Related Disorders,
19(11), 923–927. https://doi.org/10.1016/j.parkreldis.2013.04.022
Eklund, J. H., Holmström, I. K., Kumlin, T., Kaminsky, E., Skoglund, K.,
Hoglander, J., Sundler, A. J., Condén, E., & Meranius, M. S. (2019).
“Same same or different?” A review of reviews of person‐centered
and patient‐centered care. Patient Education and Counseling, 102(1),
3–11. https://doi.org/10.1016/j.pec.2018.08.029
Emanuel, L. L., Taylor, L., Hain, A., Combes, J. R., Hatlie, M. J., Karsh, B.,
Lau, D. T., Shalowitz, J., Shaw, T., & Walton, M. (2016). Module 7a:
Patients as partners: Engaging patients and families: Patient and family
centered care. The Patient Safety Education Program—Canada
Curriculum. https://www.patientsafetyinstitute.ca/en/education/Patient
SafetyEducationProgram/PatientSafetyEducationCurriculum/
Documents/Module%2007A%20-%20Patients%20as%20Partners%20-
%20Patient%20and%20Family%20Centred%20Care.pdf
Esmaeili, M., Ali Cheraghi, M., & Salsali, M. (2014). Barriers to patient‐
centered care: A thematic analysis study. International Journal of
Nursing Knowledge, 25(1), 2–8. https://doi.org/10.1111/2047-3095.
12012
Ferguson, L. M., McMurtry, J., Ward, H., Card, S., & Sheppard, S. (2013).
Putting the “patient” back into patient‐centred care: An education
perspective. Nurse Education in Practice, 13(4), 283–287. https://doi.
org/10.1016/j.nepr.2013.03.016
Foucault, M., & Lotringer, S. (1996). Foucault live: (Interviews,
1961–1984). Semiotext(e).
Gerteis, M., Edgman‐Levitan, S., Daley, J., & Delbanco, T. L. (1993).
Through the patient's eyes: Understanding and promoting patient‐
centered care. Jossey‐Bass.
Gherardi, S. (2012). How to conduct a practice‐based study: Problems and
methods. Edward Elgar Publishing.
Giganti, A. W. (1998). Families in pediatric critical care: The best option.
Pediatric Nursing, 24(3), 261–265. https://www.ncbi.nlm.nih.gov/
pubmed/9987428ggigant
Goodridge, D., Henry, C., Watson, E., McDonald, M., New, L.,
Harrison, E. L., Scharf, M., Penz, E., Campbell, S., & Rotter, T. (2018).
Structured approaches to promote patient and family engagement in
treatment in acute care hospital settings: Protocol for a systematic
scoping review. Systematic Reviews, 7(1), Art. 35. https://doi.org/10.
1186/s13643-018-0694-9
Gorli, M., Scaratti, G., Galuppo, L., & Liberati, E. G. (2017). The patient
centered organizational model in Italian hospitals: Practical
challenges for patient engagement. In I. Management Association
(Ed.), Healthcare ethics and training: Concepts, methodologies, tools,
and applications (pp. 290–308). IGI Global. https://doi.org/10.4018/
978-1-5225-2237-9.ch012
Haraway, D. J. (2008). When species meet. University of Minnesota Press.
Hughes, J., Bamford, C., & May, C. (2008). Types of centredness in health
care: Themes and concepts. Medicine, Health Care, and Philosophy,
11(4), 455–463. https://doi.org/10.1007/s11019-008-9131-5
Igel, L. H., & Lerner, B. H. (2016). Moving past individual and “pure”
autonomy: The rise of family‐centered patient care. AMA Journal of
Ethics, 18(1), 56–62. https://doi.org/10.1001/journalofethics.2016.
18.1.msoc1-1601
Institute for Patient and Family Centered Care. (2017). Advancing the
practice of patient‐and family‐centered care in hospitals. https://
www.ipfcc.org/resources/getting_started.pdf
Institute for Patient and Family Centred Care (n.d.). Understanding the
historical context for visiting policies. https://www.ipfcc.org/
bestpractices/Understanding-Historical-Context.pdf
Institute for Patient and Family Centred Care & Canadian Foundation for
Healthcare Improvement. (2015). Better together: A change package
to support the adoption of family presence and participation in acute
care hospitals and accelerate healthcare improvement. https://
www.cfhi-fcass.ca/sf-docs/default-source/patient-engagement/
better-together-change-package.pdf?sfvrsn=9656d044_4
Institute of Medicine. (2001). Crossing the quality chasm. National
Academies Press. https://doi.org/10.17226/1002
International Family Nursing Association. (2018). IFNA position statement on
graduate family nursing education. https://internationalfamilynursing.org/
2018/06/28/graduate-family-nursing-education/
Jolley, J., & Shields, L. (2009). The evolution of family‐centered care.
Journal of Pediatric Nursing, 24(2), 164–170. https://doi.org/10.
1016/j.pedn.2008.03.010
Kitwood, T. (1997). Dementia reconsidered: The person comes first. Open
University Press.
Kiwanuka, F., Shayan, S. J., & Tolulope, A. A. (2019). Barriers to patient
and family‐centred care in adult intensive care units: A systematic
review. Nursing Open, 6(3), 676–684. https://doi.org/10.1002/
nop2.253
Kokorelias, K. M., Gignac, M. A. M., Naglie, G., & Cameron, J. I. (2019).
Towards a universal model of family centered care: A scoping
review. BMC Health Services Research, 19(1), 564. https://doi.org/10.
1186/s12913-019-4394-5
Kreindler, S. A. (2015). The politics of patient‐centred care. Health Expectations,
18(5), 1139–1150. https://doi.org/10.1111/hex.12087
Leplege, A., Gzil, F., Cammelli, M., Lefeve, C., Pachoud, B., & Ville, I. (2007).
Person‐centredness: Conceptual and historical perspectives.
Disability and Rehabilitation, 29(20‐21), 1555–1565. https://doi.
org/10.1080/09638280701618661
Liberati, E. G., Gorli, M., & Scaratti, G. (2015). Reorganising hospitals to
implement a patient‐centered model of care: Effects on clinical
practice and professional relationships in the Italian NHS. Journal of
Health Organization and Management, 29(7), 848–873. https://doi.
org/10.1108/JHOM-07-2014-0129
Liberati, E. G., Scaratti, G., & Mara, G. (2013). Whose hospital is this? The
potentialities of the ethnographic lens for investigating patient
centred care. Conference Proceedings, 29th European Group for
Organizational Studies Colloquium: Bridging Continents, Cultures and
Worldviews, Montreal.
Lines, L. M., Lepore, M., & Wiener, J. M. (2015). Patient‐centered, person‐
centered, and person‐directed care. Medical Care, 53(7), 561–563.
https://doi.org/10.1097/mlr.0000000000000387
Lloyd, B., Elkins, M., & Innes, L. (2018). Barriers and enablers of patient
and family centred care in an Australian acute care hospital:
Perspectives of health managers. Patient Experience Journal, 5(3),
55–64. https://doi.org/10.35680/2372-0247.1270
Luxford, K., Safran, D. G., & Delbanco, T. (2011). Promoting patient‐
centered care: A qualitative study of facilitators and barriers in
healthcare organizations with a reputation for improving the patient
JUDGE AND CECI | 9 of 10
10. experience. International Journal for Quality in Health Care, 23(5),
510–515. https://doi.org/10.1093/intqhc/mzr024
Marshall, A., Kitson, A., & Zeitz, K. (2012). Patients' views of patient‐
centred care: A phenomenological case study in one surgical unit.
Journal of Advanced Nursing, 68(12), 2664–2673. https://doi.org/10.
1111/j.1365-2648.2012.05965.x
Martin, D. P., Diehr, P., Conrad, D. A., Davis, J. H., Leickly, R., &
Perrin, E. B. (1998). Randomized trial of a patient‐centered hospital
unit. Patient Education & Counseling, 34(2), 125–133. https://doi.org/
10.1016/s0738-3991(97)00089-x
May, C. (1992). Nursing work, nurses' knowledge, and the subjectification
of the patient. Sociology of Health & Illness, 14(4), 472–487. https://
doi.org/10.1111/1467-9566.ep10493107
May, C., & Purkis, M. E. (1995). The configuration of nurse‐patient
relationships: A critical view. Research & Theory for Nursing Practice,
9(4), 283–295.
McCormack, B., & McCance, T. V. (2006). Development of a framework
for person‐centred nursing. Journal of Advanced Nursing, 56(5),
472–479. https://doi.org/10.1111/j.1365-2648.2006.04042.x
Merriam Webster (n.d.). Center. In Merriam‐Webster.com dictionary. Re-
trieved from https://www.merriam-webster.com/dictionary/center
Millenson, M. L., Shapiro, E., Greenhouse, P. K., & DiGioia, A. M. (2016).
Patient‐ and family‐centered care: A systematic approach to better
ethics and care. American Medical Association Journal of Ethics, 18(1),
49–55. https://journalofethics.ama-assn.org/article/patient-and-family-
centered-care-systematic-approach-better-ethics-and-care/2016-01
Moore, L., Britten, N., Lydahl, D., Naldemirci, Ö., Elam, M., & Wolf, A.
(2017). Barriers and facilitators to the implementation of person‐
centred care in different healthcare contexts. Scandinavian Journal of
Caring Sciences, 31(4), 662–673. https://doi.org/10.1111/scs.12376
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
Nicolini, D. (2016). Is small the only beautiful? Making sense of ‘large
phenomena’ from a practise‐based perspective. In A. Hui, T.
Schatzki, & E. Shove (Eds.), The nexus of practices connections:
Constellations, practitioners (pp. 98–113). Routledge.
Nicolini, D. (2017). Practice theory as a package of theory, method and
vocabulary: Affordances and limitations, Methodological reflections
on practice oriented theories. Springer Verlag.
Park, M., Giap, T., Lee, M., Jeong, H., Jeong, M., & Go, Y. (2018). Patient‐
and family‐centered care interventions for improving the quality of
health care: A review of systematic reviews. International Journal of
Nursing Studies, 87, 69–83. https://doi.org/10.1016/j.ijnurstu.2018.
07.006
Poochikian‐Sarkissian, S., Sidani, S., Ferguson‐Pare, M., & Doran, D.
(2010). Examining the relationship between patient‐centred care
and outcomes. Canadian Journal of Neuroscience Nursing, 32(4),
14–21.
Purkis, M. E., & Ceci, C. (2014). Problematising care burden research.
Ageing & Society, 35(7), 1410–1428. https://doi.org/10.1017/
S0144686X14000269
Rankin, J. M. (2003). ‘Patient satisfaction’: Knowledge for ruling hospital
reform—an institutional ethnography. Nursing Inquiry, 10(1), 57–65.
https://doi.org/10.1046/j.1440-1800.2003.00156.x
Rankin, M. J. (2015). The rhetoric of patient and family centred care: An
institutional ethnography into what actually happens. Journal of
Advanced Nursing, 71(3), 526–534. https://doi.org/10.1111/jan.12575
Rathert, C., Williams, E. S., McCaughey, D., & Ishqaidef, G. (2015). Patient
perceptions of patient‐centred care: Empirical test of a theoretical
model. Health Expectations, 18(2), 199–209. https://doi.org/10.
1111/hex.12020
Renshaw, M. (2009). ‘Family‐Centred Care’ in American hospitals in late‐
Qing China. In G. Mooney, & J. Reinarz (Eds.), Permeable walls:
Historical perspectives on hospital and asylum visiting (pp. 55–80).
Rodopi.
Rogers, C. R. (1959). A theory of therapy, personality, and interpersonal
relationships as developed in the client‐centered framework. In S.
Koch (Ed.), Psychology: A study of a science (Vol. 3, pp. 184–256).
McGraw Hill.
Ross, H., Tod, A. M., & Clarke, A. (2015). Understanding and achieving
person‐centred care: The nurse perspective. Journal of Clinical
Nursing, 24(910), 1223–1233. https://doi.org/10.1111/jocn.12662
Sedig, L. (2016). What's the role of autonomy in patient‐ and family‐centered
care when patients and family members don't agree? AMA Journal of
Ethics, 18(1), 12–17. https://doi.org/10.1001/journalofethics.2016.18.1.
ecas2-1601
Sharp, S., McAllister, M., & Broadbent, M. (2015). The vital blend of clinical
competence and compassion: How patients experience person‐
centred care. Contempory Nurse, 52(2–3), 300–312. https://doi.org/
10.1080/10376178.2015.1020981
Sidani, S. (2008). Effects of patient‐centered care on patient outcomes: An
evaluation. Research & Theory for Nursing Practice, 22(1), 24–37.
https://doi.org/10.1891/1541-6577.22.1.24
Siouta, E., & Olsson, U. (2020). Patient centeredness from a perspective of
history of the present: A genealogical analysis. Global Qualitative
Nursing Research, 7, Art. 2333393620950241. https://doi.org/10.
1177/2333393620950241
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 patient‐
centered care. American Journal of Critical Care, 21(6), 410–418.
https://doi.org/10.4037/ajcc2012124
Smith, W. (2018). Concept analysis of family‐centered care of hospitalized
pediatric patients. Journal of Pediatric Nursing, 42, 57–64. https://
doi.org/10.1016/j.pedn.2018.06.014
Starfield, B. (2011). Is patient‐centered care the same as person‐focused
care? The Permanente Journal, 15(2), 63–69. https://doi.org/10.
7812/TPP/10-148
Symonds‐Brown, H., Ceci, C., Duggleby, W., & Purkis, M. E. (2019). Re‐
thinking the nature of day programs for people with dementia:
Implications for research. Dementia, 20(1), 326–347. https://doi.org/
10.1177/1471301219884429
Taylor, K. (2008). Paternalism, participation and partnership: The evolution
of patient centeredness in the consultation. Patient Education and
Counselling, 74(2), 150–155. https://doi.org/10.1016/j.pec.2008.
08.017
West, E., Barron, D. N., & Reeves, R. (2005). Overcoming the barriers to
patient‐centred care: Time, tools and training. J Clin Nurs, 14(4),
435–443. https://doi.org/10.1111/j.1365-2702.2004.01091.x
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How to cite this article: Judge, H., Ceci, C. (2021).
Problematising assumptions about ‘centredness’ in patient
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