Person-centeredness as a concept in health care delivery has poor and conflicting definitions over the years, but considered one of the best ways of health care delivery in which patients are valued as individuals (Winfield et al. 1996). Slater (2006) contends that most health care providers use person-centredness interchangeably with other terms that have different connotations.
In recent extensively reviewed literature of McCormack and McCance (2010), person-centred nursing was identified as a practice in which there is formation of therapeutic relationship between patients/families and nurses on the basis of mutual trust. Similarly, Brilowski and Wendler (2005), declared that a therapeutic relationship is central to the concept of person-centred nursing and has some similar elements of care to that of person-centred nursing, such as working with attitudes and feelings, accepting the other, dealing with variability and purposeful action which when put into practice enhances efficient care delivery.
Anderson (1998) considered a person’s values, beliefs and life story as an important means of making informed autonomous decisions about a person which is consistent with holistic approach to person-centred care.
It has been identified in the literature (Binnie & Titchen 1999) that person-centred nursing provide a holistic health care which tends to minimize anxiety among nurses and uphold patient involvement in the care process; however culture and other contextual difficulties exist that influence its effective implementation. In spite of all the attributes of person-centred nursing, it has been suggested that the term is difficult to measure Jones 2006; McCormack & McCance 2010.
The Person-centred Nursing (PCN) framework has been developed through a systematic procedure of interrelating existing conceptual frameworks to person-centred nursing and other health care literature. This framework has four (4) indirectly related areas (constructs); prerequisites, care environment, person- centred processes and expected outcomes resulting from person-centred nursing (McCormack & McCance 2006).
The PCNI has consequently been developed and used to measure the relationship between factors in the framework (Slater 2006). However, the statistical evidence obtained is limited to acute hospital settings. In addition, the PCNI has been developed in tandem with the theory (conceptual framework) and there have been modifications in the theory over time since its development. Coupled with these issues, the PCNI is a lengthy questionnaire. As a result, the PCNI does not completely map onto the theoretical framework. It is therefore necessary to develop and test an instrument explicitly based on the theoretical framework.
AIMS/OBJECTIVES
The aims of this research are to:
Systematically develop an instrument (PCNI) to measure person- centredness based on an extensive literature review and dialogue with experts in the field of person-centredness;
Examine the PCNI usability across 5 clinical settings in each of the 5 Trusts in Northern Ireland;
Test the psychometric properties of the PCNI;
Explore practice environment factors important to nurses and service users from different clinical settings;
Modify the PCNI to accommodate the views of all nurses and service users while maintaining its brevity and appropriateness;
Use the PCNI to gauge change in clinical settings where person-centred practice is being developed.
METHODOLOGY
The study will consider development and testing of an instrument that is capable of measuring change in practice setting as they develop person-centredness. A mixed methods approach will be used to explore and test factors relevant to the practice environment. Mixed methods by definition, uses qualitative and quantitative modes of data collection. This method would be used in order to answer sufficiently different aspects of research questions posed in the study. Delphi and Nominal Group Techniques will be used in focus groups as a qualitative method in the study. The Delphi technique will be used for ranking and reaching consensus on the suitability of definitions of factors in the constructs of the person-centred nursing framework. The Nominal Group Technique will be employed to generate items on each of the factors defined which will be used to design a questionnaire for the study. In the quantitative method, cross sectional design will be employed. This design will collect information from nurses in the different clinical settings by use of questionnaire, at a specified time period for analysis.
STRAND 1: DEVELOPMENT OF INSTRUMENT
FOCUS GROUPS
THE DELPHI TECHNIQUE
To ensure face and content validity of definitions, a Delphi Technique comprising 21 international experts in the field of person-centred nursing will be used to reach consensus on definition of factors in the person-centred nursing conceptual framework in three rounds of exploration of a predetermined list of seventeen (17) items from three (3) constructs-(Prerequisites, Care Environment and Care Process), in the Person-Centred Nursing theoretical framework.
NOMINAL GROUP TECHNIQUE (NGT)
A focus group comprising United Kingdom based International experts will then be employed using Nominal Group technique (NGT) to generate items for each of the definitions on which consensus was reached. Items generated will be collated and given out to the expert panel of the Delphi group to examine its consistency with the definitions. Those found to be less focused on the definitions will be discarded. Fifty-one (51) refined items-three for each factor will be collated into a pre-designed questionnaire consisting of three broad constructs; Care process- 15, Prerequisites-15, and Care environment- 21 items for pilot testing.
STRAND 2: PILOT TESTING OF QUESTIONNAIRE
The questionnaire will be distributed to a sample of nurses in one clinical setting drawn from one Trust for pilot testing as a step towards the main survey. The clinical setting use in the piloting will not be part of the main survey. Questionnaires piloted will be collated, and critically examined item by item for clarity, ambiguity and clear understanding of certain terminologies used in the wording of the items. The pilot testing will help the researcher refine the questionnaire based on findings for the main study.
STRAND 3: MAIN SURVEY
Five stratified clinical settings shall be drawn from each of the five health and social care Trusts in Northern Ireland. The clinical settings will be stratified to ensure homogeneity within each stratum in respect of professional specialization and heterogeneity between strata in terms of different areas of specialization. All nurses in each clinical setting shall be selected from the five strata based on the
criteria of being (i)Registered Nurse (ii) work full time (iii) Be in the clinical setting for at least 6months (iv) Willing to participate.
Questionnaires will be administered on one occassion to nurses within and across Trusts with a deadline of two weeks to return the questionnaire and a week of follow-up visit to retrieve questionnaires not returned. Questionnaires collected shall be collated and categorised by construct and clinical setting for data analysis. Final amendments/refinements will be made to the questionnaire as necessary.
DATA ANALYSIS
Data retrieved from the questionnaire will be collated into a complete sample for further analysis. Exploratory factor analysis and path analysis will be used in the data analysis. The exploratory factor analysis will analyse the factor structure of the PCNI. Path analysis diagram will be constructed and used to:
(i) Examine a model for the complete sample.
(ii) Examine the differences between clinical settings and organisations.
(iii) Examine the relationship between factors and person-centredness
STRAND 4: USABILITY STUDY
The PCNI will be used in one selected clinical setting considered to have engaged in a programme of practice development to become more person-centred. The instrument will be administered to nurses in this clinical setting at two different time points; pre-intervention and post-intervention. Data collected at the pre-intervention phase will be modelled into path diagram to examine relation between factors. Based on findings the post intervention phase will be carried out to monitor the progress of person-centred nursing practice in the clinical setting. Changes that occur over time will be examined and discussed.
ETHICAL CONSIDERATIONS
Documents have already been prepared for Ethical approval from the University of Ulster Ethics Filter Committee, Research Governance in each Trust and Approval from Integrated Research Application System-IRAS (ORECNI) by March 2010.
