Student Name

Capella University

NURS-FPX8008 Person-Centered Care in Doctoral Practice

Professor name

Submission Date

Analyzing Person-Centered Care with Scientific and Theoretical Evidence

Person-centered care (PCC) is a focus of modern healthcare that encourages treatment of the whole individual, personalized care, and respectful treatment. By focusing on patient autonomy, shared decision-making, and compassionate communication, PCC in nursing is about collaboration, respect, and special caring (Nkhoma et al., 2022). Measurable improvements in patient outcomes and satisfaction can be gained by the scientific study of PCC. In addition to the four quantitative and four qualitative articles included in the paper, there are two nursing theories that relate and link PCC practices to statistical and experiential outcomes.

Identified Quantitative and Qualitative Articles for Person-Centered Care

Quantitative Research

The outcomes help to strengthen understanding of PCC efficacy in healthcare. The quantitative research results demonstrate PCC’s success in enhancing safety, satisfaction, and quality metrics. Yu et al. (2023) explored the relationship between PCC scores and patient outcomes in the inpatient setting. The study design was large cross sectional, in-patient survey. The outcomes assessed were self-reported physical and mental health, perceived need for hospitalization, and measures of care utilization. The authors noted that higher PCC scores were reported as being associated with improved self-reported physical and mental health and indicators of more appropriate service use. Limitations were that it was a cross-sectional design, limited to self-reported associations, and only sampled a single health system. A digital PCC training intervention compared to usual practice with measurement of staff and resident outcomes was performed by McDermid et al. (2022). The study design was a cluster randomized controlled trial (cRCT). Staff PCC competence, resident care indicators, and satisfaction measures were measured. The authors noted that the digital PCC training improved staff knowledge and skills and led to some resident-reported improvements compared to control clusters. There were a few limitations, such as the short follow-up window in some clusters, the possibility of contamination, and limited generalizability of the setting. Stanhope et al. (2021) assessed if implementing PCCP alters PCC delivery and downstream patient outcomes. A cluster randomized trial in community mental health clinics was used to design the study. Outcome measures included fidelity of PCC practices, engagement with PCC, and service use markers. The authors reported that training led to an increase in observable PCC behaviors and enhanced some factors of patient engagement and self-management, but there were mixed effects on hard clinical endpoints. Limitations included Implementation variability between sites; some outcomes were dependent on provider documentation. Pirhonen et al. (2020) evaluated the cost-effectiveness of PCC from a health care perspective. The study design was an economic evaluation (cost-utility) based on the data from trials of PCC in chronic heart failure. In terms of outcomes, QALYs, healthcare resource use, and cost per QALY were recorded. The authors described that in the study settings, PCC was either the dominant or cost-effective intervention for the targeted populations, compared to usual care. Transferability to other systems is unknown; some categories of costs were estimated based on local tariffs.

Qualitative Research

The qualitative component of the research investigates patient and staff experiences, focusing on the concepts of empathy, dignity and collaboration. Doherty et al. (2020) examined provider understanding, barriers/facilitators, and experience of a shift from a medical model to a PCC model. The study design was qualitative interviews with practitioners from the community mental-health services who were transitioning to PCC services. Whether providers measured this outcome by their own feedback or by their own observation of the process, therapeutic alliance and patient engagement scores were higher when PCC was meaningfully adopted; common barriers were workflow issues, documentation requirements, and role ambiguity. The limitations were provider-centered (less direct voice of the patient); local context influenced the experience. Lateef and Mhlongo (2022) examined the perception of the nurses about PCC and what they mean by PCC in healthcare environments. This study was designed as a qualitative study using semi-structured interviews/focus groups with the nurses working in the PHC centers. The outcomes that were reported by nurses were holistic, respectful, and tailored communication, which was correlated with patients’ trust, adherence, and better follow-up (i.e., improved engagement and perceived health behavior change). Limitations: Single country/PHC context; findings based on provider perceptions and not measured findings. Boström et al. (2020) described the role of nurses in experiencing PCC in a remote setting, and how this influences patient interactions and outcomes. This study used a qualitative interview study with the RNs who provide PCC over the telephone. The results that registered nurses shared consisted of an increased understanding of patients’ lifeworld’s through structured PCC phone visits, perceived improvements in patients’ self-efficacy and symptom management, and difficulties balancing protocol fidelity with patients’ variation. Limitations were that only a small number of nurses participated and that there was only an emphasis on the nurse’s rather than the patient’s direct experiences. Havana et al. (2023) have compiled and analyzed qualitative evidence of PCCs’ meaning to patients and their perception of outcomes. The study design was a qualitative meta-synthesis of studies exploring hospitalized patients’ experiences of the PCC model. Patients regularly link PCC to dignity, personal attention, more transparent communication, empowerment, and emotional well-being, and they believe that the PCC translates to trust, adherence, and less anxiety. The strength of secondary synthesis is determined by the quality of the primary studies and the context in which they are used.

Nursing Theories

The quantitative outcome set is based upon Dorothea Orem’s self-care deficit nursing theory. Orem clearly associates nursing interventions with nursing self-transactions with measurable self-care capacities and health outcomes; several quantitative PCC trials assess patient self-efficacy, functional status, readmission, and resource-use constructs that align well with self-care capacities and measurable outcome measures (Hartweg & Metcalfe, 2021). Orem’s framework is useful for designing interventions that have measurable outcomes, such self-care indices, readmissions, and quality of life. The randomized control trails (RCTs), cluster trials, cost-utility analyses, and large surveys measure changes in patient self-management, health status, and resource use (McDermid et al., 2022; Pirhonen et al., 2020; Stanhope et al., 2021; Yu et al., 2023). The quality-of-life constructs were consistent with Orem’s focus on the ability to self-care and the system-level nursing actions, which could be operationalized and measured.

Jean Watson’s Theory of Human Caring is the theory supporting qualitative outcome set. Watson’s theory emphasizes transpersonal caring relationships, meaning, lived experience of caring, which are captured in qualitative studies such as the achievement of patient dignity, empowerment, and therapeutic relationships (Watson Caring Science Institute, 2025). Watson interprets the relational features of PCCs and how they lead to meaningful subjective results (empowerment, trust, perceived well-being), which are best explored qualitatively. The ontological domain, which was explored by Boström et al. (2020), Doherty et al. (2020), Havana et al. (2023), and Lateef and Mhlongo (202by using Watson’s caring theory, is the caring relationship, meaning, dignity, and perceived outcomes. The studies shed light on the mechanisms that may underlie the observed effects in quantitative trials, including trust, sharing of stories, and therapeutic presence.

Synopsis of Studies

The synopsis of quantitative research showed that the benefits of PCC were consistent in both patient-reported and clinical and economic outcomes, and could be measured. In a large cross-sectional study of 5,222 hospitalized patients, Yu et al. (2023) demonstrated that higher PCC scores were significantly associated with improved physical health (OR = 4.154, p < 0.001), improved mental health (OR = 5.642, p < 0.001), and greater perceived need for hospitalization (OR = 6.160, p < 0.001). McDermid et al. (2022) conducted a cluster randomized controlled trial with 16 nursing homes (45 staff members + 130 dementia residents) that demonstrated statistically significant benefits for resident well-being (t = 2.76, p = 0.007), resident engagement (t = 2.34, p = 0.02), and staff attitudes (t = 3.49, p = 0.001) when virtual coaching was added to the digital training. The cluster RCT by Stanhope et al. (2021) found that the training of PCC led to measurable, enduring provider behavior change with medium to large effect sizes (d = 0.71, 95% CI = 0.23–1.20) in an objective Person-Centered Care Planning measure at 12 months (b = 1.10, SE = 0.50, p = 0.03) and 18 months (b = 1.47, SE = 0.50, p = 0.01). Finally, a probabilistic sensitivity analysis revealed a 93% probability of cost-effectiveness at a willingness to pay threshold over 6 months, and economic modelling and trial data from Pirhonen et al. (2020) demonstrated that PCC positively affected health-related quality of life and lowered health costs over a 6-month period. All of these quantitative findings together demonstrate that PCC can enhance subjective health and engagement, can decrease resource utilization, and is cost-effective.

Results of the qualitative research analysis identified mechanisms and lived experience outcomes that provide some explanation for those quantitative outcomes. Using focus groups and thematic analysis, Doherty et al. (2020) created a dynamic tensions model, reflecting how providers perceive the transition from a traditional medical model to PCC reporting, including improvement of the therapeutic alliance. In a qualitative action research study conducted in 30 centers, Lateef and Mhlongo interviewed nurses to determine their perspectives and identified the positive themes (outcome-driven care, improved communication, perceived improvements in adherence and follow-up) and negative themes (staff shortages, infrastructure limits, and lack of enforcement) that restrict the implementation of PCC. Boström et al. (2020) interviewed four mature RN’s who had experience in PCC by phone with patients and found that PCC by phone helped the RN’s gain insight into the patient’s lifeworld and led to the need for supervision and redefinition of the role. Havana et al. (2023) systematic review of qualitative studies (10 included studies) identified the following five analytical themes: presence of professional; patient involvement; receiving information; patient–professional relationship; being seen as a person, and found that PCC is not fully developed in hospitals but when it exists patients experience more dignity, empowerment, information and reduced anxiety. The relational mechanisms consistently have been identified in qualitative results as those that lead to improving the patient experience.

Literature Review Synthesis

In both the qualitative synthesis and quantitative trials, the subjective and objective results from the patient seem to be improved with PCC. Boström et al. (2020) and Havana et al. (2023) claimed that meaningful listening, individualized care plans, and shared decision-making enhanced the nurse-patient relationship and improved patient satisfaction. In the same way, Yu et al (2023) found that active collaboration with providers leads to increased self-efficacy around health condition management. Pirhonen et al (2020) and Stanhope et al (2021) measured functional performance, symptom burden, and readmission/hospital days in several quantitative studies that found that when PCC is implemented with fidelity, there are measurable benefits. The studies reported satisfaction scores, functional status, and readmission rates as the most frequently used quantitative endpoints of the effectiveness of PCC. These trials were also supported by economic assessments that demonstrate the cost-effectiveness of PCC by minimizing avoidable readmissions and better use of resources (Pirhonen et al., 2020). Doherty et al. (2020) and McDermid et al. (2022) reported that although competence was improved among providers and some job satisfaction, the added workload and documentation requirements were a challenge for sustainability. This is a repeated dichotomy between the humanistic advantages of PCC and the bur denary consequences on healthcare providers’ structures. Qualitative investigations give insights into these outcomes and can be used to find out how these outcomes are achieved. The real drivers of positive outcomes are relational active listening, co-interpretation of patient goals, and collaborative partnerships, as stated by Doherty et al. (20,0); Havana et al. (2023), and Lateef and Mhlongo (2022). Interpersonal mechanisms offer a key explanation for the improvements in patient-reported outcomes and clinical outcomes found in quantitative trials despite the fact that these interpersonal processes are not easily quantifiable directly. Stanhope et al. (2021) also found that having staff from different disciplines buy-in to and have consistent team practices were key to maintaining PCC fidelity and to seeing measurable clinical or economic benefits. That this is the case is supported by Boström et al. (2020) and Doherty et al. (2020), who identified that a patient-centered ethos within care teams, demonstrated through communication scripts, shared care plans and handovers that included the patient’s views, enhanced the patient’s experience and staff satisfaction. On the flip side, teams that were not united, either in terms of values or their communication, generated conflicting messages or lost patient trust, with poorer outcomes. The “active” benefit of PCC demonstrated in trials requires team-level structures, such as common documentation templates, collective training, leadership support, and dedicated time for partnership activities.

Conclusion

Overall, the PCC is a key component of contemporary nursing care, playing a crucial role in improving the quality of patient care and their overall health outcomes. Effective PCC-related strategies increase trust, engagement, and clinical outcomes. Reviewing quantitative and qualitative studies again confirms that PCC is a framework for evidence-based care that focuses on results and compassion. The PCC remains a key model for providing safe, respectful, and person-centered health care.