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Patient-centered health education

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					    Patient-
centered health
   education
    2009.3.26



                  1
              Outline
• What is “patient-centered” & Why?
 什麼是以病人為中心?為什麼?

• Proposed dimensions of patient-
  centered care以病人為中心的面向
• Transition from standardized to
  patient-centered intervention從標準化的介
 入措施到以病人為中心的措施




                                        2
What is “patient-
centered” & Why?




                3
• Primary care providers have
  traditionally relied on persuading
  patients to change through
  “informational power” (sharing facts
  about health and illness) and “expert
  power” (using professional
  credentials)傳統基層醫療保健提供者透過資訊的權力及專
 家的權威來說服病人作改變



                                          4
• Patient-centered interventions (PCIs)
  are those interventions that are
  altered to address selected patient
  characteristics (e.g., beliefs, habits,
  or goals).以病人為中心的介入措施為強調個別的病人特性




                                        5
• The origins of patient-centered care
  can be traced to Florence Nightingale,
  who differentiated nursing from
  medicine by its focus on the patient
  rather than the disease.
以病人為中心的起源自南丁格爾,區別護理與醫學的差別在關心病人而
 非疾病




                                       6
  Major issues for scholars,
 researchers, and clinicians
• Describing the critical dimensions of
  interventions that constitute patient
  centeredness
• Delineating how to provide
  interventions that are patient
  centered (appropriate means, timing,
  and focus of delivery)
• Testing whether such interventions
  actually improve patient outcomes.
                                      7
• The patient centered can be defined
  in general as the extent to which
  clinicians select and deliver
  interventions mindful of and
  responsive to individual and family
  characteristics, such as affective
  states, beliefs, goals, and resources.
以病人為中心可以被定義為臨床工作者在選擇與傳遞介入措施時,在意
 且回饋個體與家庭的特性,如情緒狀態、信念、目標與資源。


                                           8
     A corresponding set of
      standards for Patient
          centeredness
• Humanity人性
• Right權利
• Ways of coping因應的方式
• Control over life and death of a
  patient and of that patient’s family個
  體與家庭對生死的控制感

                                          9
• Implicit in their work is the idea that
  the nurse must have knowledge of a
  patient’s views and decisions in order
  to deliver person-centered care
護理人員必須認識病人的觀點,及其決定,以達到以病人為中心的照顧。




                                        10
• Radwin similarly proposed that
  central to the provision of
  individualized interventions is
  knowing the patient, which involves
  purposeful action by nurses to seek
  understand patients’ experiences,
  behaviors, feelings, and perceptions.
認識病人,指護理人員有目的的行動以了解病人的經驗、行為、感覺與
 感受。


                                      11
     Related concepts
• Consumer centered以消費者為中心
• Client centered以個案為中心
• Women centered以婦女為中心




                             12
• PCIs have been well received, and in
  some studies they have been
  associated with improved health
  outcomes.
• 以病人為中心的介入措施為病人所接受滿
  1可以改善病人的健康結果。



                                     13
  Proposed
dimensions of
   patient-
centered care


                14
  Mead and Bower (2000)
• Having a biopsychosocial perspective
• Seeing patients as persons
• Sharing power and responsibility
• Creating a therapeutic alliance
• Viewing doctors as persons
持生、心與社會的觀點、待人的方式對待病人、分享權力與責任、創造
 治療性的結盟、視醫生為一般的人。




                                     15
  Gerteis and colleagues (1993)
 Picker Institute scholars (1997)
• Respect for patient values, preferences, and
  needs尊重病人的價值觀與偏好、需求
• Coordination of care services within a given
  setting協調照顧服務
• Adequacy and relevance of educational
  information適當與切題的衛教訊息
• Ready access to health practitioners and
  services臨床執業者與服務的可及性
• Physical comfort生理的舒適
• Emotional support情緒的支持
• Appropriate involvement of family and friends 家屬參與



• Continuity of care across settings持續性照護       16
   Lutz and Bower (2000)
• Two type of patient-centered care:
• One kind taking up the organization
  of health care services around
  particular patients’ needs (defined by
  health professionals)以病人的需要組織健康照護服務


• The other focusing on understanding
  patients’ needs, preferences, beliefs,
  and expectations (defined from
  patient’s perspective).
                        了解病人的需要、偏好、信念與期待




                                           17
    A common theme on
    patient-centered care
• A respect for and integration of
  individual differences when delivering
  patient care, and an underlying value
  is the intent to improve aspects of
  patients’ health, broadly defined
提供服務時,尊重並整合個別的差異,重要的價值為改善病人廣義的健
 康




                                      18
 Transition from
standardized to
patient-centered
  intervention



               19
        A historical text
• The growing dissatisfaction with the
  small effect sizes seen in
  intervention research對介入措施的效果不滿意
• The perceived disconnect between
  nursing as practiced and nursing as
  studied研究與實務脫節
• The development of the
  transtheoretical model of health
  behavior跨理論模式的發展
                                         20
  Kinds of patient-centered
     interventions (PCIs)
• PCIs differ in the number of patient
  characteristics on which such
  intervention are customized and also
  may differ in the type of patient
  characteristics addressed (patients’
  beliefs or goals), the degree to which
  content is customized, and the
  medium of delivery (mail, phone, in
  person, or computer-based)

                                       21
A personalized intervention
• Is one in which the name of a person
  or a single characteristic may be
  invoked.
• Example is letters addressed to
  patients in which patients are asked
  to engage in a recommended health
  behavior.


                                     22
     A target intervention
• Is an intervention customized to match
  characteristics of a group or people who
  share sociodemographic (e.g., gender) or
  behavioral characteristics (e.g., not
  engaging in a recommended health
  behavior)
• Are delivered to all members of a group
  who share a single or multiple
  characteristics (health promotion or
  screen)
                                             23
    A tailored intervention
• Each person receives an intervention
  customized to the characteristics that
  she or he uniquely expresses.
• Participants are assessed on
  variables with a larger number of
  possible values such as beliefs or
  attitudes, resulting in a large number
  of possible alternative messages.
  (BSE)

                                      24
        An individualized
          intervention
• Is highly customized to a particular
  individual and that person’s situation.
• It is possible that no two patients
  would be exposed to identical
  content.




                                       25
Conclusions


              26
            References
• Lauver, D. R., Ward S. E., Heidrich,
  S. M., Keller, M. L., Bowers, B. J.,
  Brennan, P. F., Kirchhoff, K. T., Wells,
  T. J. (2002) Patient-centered
  interventions, Research in Nursing &
  Health, 246-255.



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