Person Centered Care and the Social Determinants of Health

Framework Concepts and Program Outcomes: A Comprehensive Approach to Nursing Education

Nursing education benefits from framework that grounds students in theoretical knowledge while preparing them for the practical challenges in healthcare. Central to this framework are the metaparadigm concepts of nursing: person, nursing, health, and environment. These concepts combined give the nurse a holistic understanding necessary of care. This paper gives an organizing framework for nursing education, discusses the relationship between its concepts, and proposes program outcomes that align with the Joint Commission Hospital National Patient Safety Goals.

Framework Concepts

The framework consists of four concepts: person, nursing, health, and environment. These concepts are like the principles of nursing theory and practice. With them one can begin to develop a holistic approach to understanding the needs of patients.

Person

The concept of person in nursing refers to the patient as one who has physical, psychological, social, economic, and spiritual needs. Because people are not robots and are all unique in their needs and wants, it means that nurses must approach them with sensitivity and understanding (Oner et al., 2021). This is the basis for the person-centered approach, wherein nurses provide care that is respectful of and responsive to the needs of patients.

Nursing

Nursing is both a science and an art. Its aim is to promote health and restore health when necessary. This practice involves supporting patients, families, and communities with care and education. Nursing is motivated by compassion, supported by communication, and guided by the importance of realizing and meeting the needs of the person. Nurses should be advocates for patients, using their skill to assess, diagnose, comfort and intervene (Heck et al., 2022).

Health

Health is the well-being of the person, and like the person it too has physical, mental, spiritual, and social dimensions (Bozek et al., 2020). Health is a relative scale, but nurses support a patient’s health by educating about healthy behaviors, working to promote policies that support public health, and offering care services to communities to prevent illness or manage chronic conditions.

Environment

The environment includes all external factors that influence a person’s health and well-being—i.e., the physical, social, cultural, and economic conditions. A supportive environment is helpful for health, as it can either promote or act as a barrier to health goals. Nurses have to know the impact of environmental factors, such as pollution or the social determinants of health, and should work for preventive care to create safer, healthier environments for all (Johnson et al., 2022).

Relationship Between the Concepts

The relationship between the concepts of person, nursing, health, and environment is what goes into forming the holistic framework of nursing practice. These concepts relate because they all have to do with health, and health cannot be supported without taking into consideration all these concepts with a systems thinking kind of approach. For example, the health of a person is influenced by factors like lifestyle, diet, environment, and psychology. Nursing involves having an understanding of the person being cared for. Through this focus on the person, nurses can provide care that respects the patient’s values and needs. But it means gaining a sense of the whole person, the environment in which the person lives, and what the person values in terms of health.

The environment is going to affect health outcomes. Social determinants of health, like financial status, type of community (are there any green spaces? Is there reasonable access to care? Transportation services?), safety, etc., all play a part in influencing a person’s health. Nurses have to advocate for environmental changes that promote health and well-being, because of the fact that poverty and lack of access to healthcare do negatively impact health. Nursing practice is influenced by the environment in which care is provided, too. The physical setting, organizational culture, availability of resources, staffing all impact care quality. Nurses have to work within these environments to deliver care.

Program Outcomes

1. Identify Patients Correctly: Graduates will demonstrate proficiency in patient identification, using a combination of ID bands and verbal confirmation to ensure accurate patient identification and prevent errors in care delivery. This outcome aligns with the Joint Commission's goal of improving patient identification to enhance safety and care quality.

2. Improve Staff Communication: Graduates will exhibit effective communication and collaboration with colleagues, patients, and interdisciplinary healthcare team members. This includes the ability to convey critical information clearly and accurately, ensuring that all team members are informed and able to provide coordinated care.

3. Use Medicines Safely: Graduates will understand and apply the five R's of medication administration (right patient, right drug, right dose, right route, and right time) to ensure the safe and effective use of medicines. This outcome aligns with the Joint Commission's goal of reducing medication errors and enhancing patient safety.

4. Use Alarms Safely: Graduates will demonstrate the ability to respond appropriately to alarms, including call bells and vital sign monitors, ensuring that patients receive timely and effective interventions. This outcome supports the Joint Commission's goal of improving the management of clinical alarms to prevent harm.

5. Graduates will demonstrate the ability to integrate evidence-based practice into patient care, utilizing current research and clinical guidelines to inform decision-making. This outcome aligns with Essential I, II, and IV of the AACN Essentials, emphasizing the importance of scientific knowledge, organizational leadership, and scholarship in nursing practice. For Essential I, graduates will apply a solid foundation of scientific knowledge to enhance patient care and outcomes. Essential II: Graduates will exhibit leadership skills in organizational settings, focusing on improving care quality and patient safety. Essential IV: Graduates will demonstrate scholarship through critical thinking and research, contributing to the advancement of nursing practice.

6. Graduates will be advocates for human flourishing, promoting holistic care that supports the well-being and dignity of patients. They will also foster a spirit of inquiry, encouraging continuous learning and innovation in nursing practice. For Human Flourishing: Graduates will provide care that respects the individual’s needs, promoting autonomy, dignity, and well-being. For Spirit of Inquiry: Graduates will engage in lifelong learning, seeking to understand and apply new knowledge and innovations to improve patient care.

7. Graduates will integrate evidence into practice that aligns with the National Patient Safety Goals, so that patient care is delivered safely and effectively. For NPSG I: Graduates will accurately identify patients using two identifiers to improve patient safety. For NPSG III: Graduates will use medications safely, adhering to protocols that prevent errors in medication administration. For NPSG VI: Graduates will reduce healthcare-associated infections by implementing evidence-based practices in infection prevention and control.

Changes Based on Peer Collaboration

Peer collaboration played a significant role in refining the framework concepts and program outcomes. Feedback from peers highlighted the need to emphasize cultural competence and patient-centered care, leading to revisions in the definitions of "person" and "nursing." Additionally, peer discussions reinforced the importance of aligning program outcomes with current patient safety goals, ensuring that graduates are prepared to meet the demands of modern healthcare settings.