To move patient centered interventions from a research innovation to a clinical practice reality requires that we considered the context within which care is provided. The purpose of this symposium summary is to place the examination of the concept of patient-centered interventions in the context of the existing health care delivery system. Two aspects of the contemporary health care environment, nurse staffing and information technology, influence the feasibility of delivering patient centered interventions.
Existing research supports that patient-centered informational interventions are acceptable to individuals and are likely to produce better outcomes than more general, standard approaches to care. Nursing resources required to deliver patient-centered intervention include the availability of a professional nurse to initiate the assessment of patients’ understandings of their health care situation, their values, beliefs, goals and perceived barriers, and to establish a plan to bring clinical interventions (e.g. verbal strategies, pharmacotherapeutics, and care management) to the situation. Thus, the nurse engaging in patient-centered interventions requires sophisticated critical thinking ability, robust planning, crafting, and implementation skills, sufficient time to conduct the assessment, a sufficiently-broad range of therapeutic options, the decision making authority to deploy resources, and the presence of companion team members to insure that realistic plans can be carried out.
The growing shortage of professional registered nurses leaves fewer nurses available to care for patients; in turn, remaining nurses must make judicious use of their time. Patient-centered interventions may appear excessively time-consuming, because of the up-front effort required to adequately assess the characteristics of the patient as a prelude to designing and delivering the intervention. Furthermore, nurses may experience mental burden due to the need to design individualized strategies that address the resources and needs of each person. However, papers presented in this symposium demonstrate that patient centered interventions may be more effective than standardized approaches, thereby justifying the demands they place on a diminishing human resource pool.
One way to assess the capacity of a nursing care delivery system to deliver patient centered interventions is to examine the group practice model of nursing. Evaluating the existence of a shared unit philosophy, the availability of the appropriate mix of skilled personnel, and the authority vested in the nurse as a decision maker on the care team provides clues to the potential of actually implementing patient centered interventions.
Computer and Information technologies, both unit-based and accessible from patients’ homes, can relieve some of the burden experienced in delivering patient centered interventions. Computer systems constructed with appropriate algorithms and clinical care routines can efficiently construct portfolios of approaches from profiles of individual patients. WWW-based informational, coaching, and peer-support strategies provide the nurse with an extensive repertoire of options for follow-up and after care support, thus allowing nurses to balance face-to-face interventions with those delivered via a computer network.
When the “patient” is a dyad or family, and requires care at home or in other places remote from hospitals and clinics, information technology may be of particular value. Computer tools allow for private interaction with each member of the dyad or family to receive while also permitting a group or clustered activities. Computer networks also permit various members of a dyad or family to engage in the interactions even when the members themselves are not in the same place together.
In spite of a rapidly changing human resource pool, information technology supports the migration of patient centered interventions from the research environment into many clinical care situations. Effective balancing of human resources and technological mechanisms can insure the delivery of patient-centered interventions in an environment of scarce human resources.
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