V. Seven Concepts that are 'Key' to Client Centered Practice
The work of Law et al. (1995) relates seven concepts that are stated to be 'key to client centered practice' as follows:
(1) Autonomy and Choice
(2) Partnership & Responsibility
(4) Contextual Congruence
(7) Respect for diversity. (McCormack, 2003, p.1)
VI. Patient and Informal Expertise and Knowledge
The work of Loeb, et al. (2003) entitled: "Supporting Older Adults with Multiple Chronic Conditions" states that nurses "have studied the experience of chronic illness within relational and social contexts, depicting persons who live with chronic illnesses as active agents of their own health." (p.3) This view involves the individual as "active agents of their own health…" who "develop expertise both in awareness of their bodily responses and in managing the self-care required by their unique types of chronicity." (Loeb, et al., 2003, p.4) It is stated that the patient's expertise "often reaches a level that exceeds that of their professional health care provider." (Loeb, et al., 2003, p.3)
According to Loeb, et al. "engaging in life…" is a strategy that can be effectively used in diverting the individual's attention "away from the challenges of chronicity toward a life filled with purposeful, activities." (2003, p.4) Loeb et al. states that findings in the study include "a number of coping strategies used to mediate the effects of multiple chronic conditions." Some of those strategies are the following:
(1) need for formal expertise of healthcare providers who have a 'critically evaluative attitude.'
(2) the experiential process of living with multiple chronic conditions was identified as a means of acquisition of informal expertise.
(3) Information gained through peers was preferred to information provided by professional health care workers;
(4) however, individuals did desire a partnered relationship with members of the health care team;
(5) A desire existed among participants to make informed health care decisions because it promoted their personal sense of empowerment.
(6) Finally, the need for health care workers to acknowledge the informal knowledge and expertise of patients. (Loeb, 2003, p.5)
McCormack (2003, p.5) states that health care provision which is based upon autonomy and choice is of the nature that makes the assumption that the opinion of the patient will be sought, that the patient's values will be respected and that the patient's dignity will be maintained.
VII. Nursing Role
The role of the nursing professional within the framework described in this study is one has the patient as the central and primary consideration in all health care treatment regimens and protocols. The patient is an active partner, a collaborator, and the knowledge of the patient is given due consideration and provided with acknowledgement by the health care nurse as the nurse understands that the patient is likely the best source of information about their sickness and the accompanying symptoms, issues, and challenges. The nursing professional plays the role of mediator effectively assisting the patient with negotiating the various agencies and programs that may provide assistance to the patient and their family.
Summary and Conclusion
This work has examined issues related to Gerontological nursing insofar as the role of the nurse in treating elderly patients and has clearly demonstrated that the gerontological population can benefit greatly from nursing professionals taking an active role in mediating and advocating for this population assisting them with negotiating their own health care and the environment in which they receive and monitor their own health care regimen. For those patients who are actively involved in their own health care, it is likely that these individuals are a treasure trove of information relating to their specific and generally multiple and chronic conditions and while their information and knowledge is expertise that has been informally gained nonetheless this expertise serves to well inform the nursing practice.
McCormack, Brendan (2006) Development of a framework for person-centered nursing. Journal of Advanced Nursing. Vol. 56 Issue 5. Blackwell Publishing.