Finkelman, Leadership and Management for Nurses: Core Competencies for Quality
Care, 3rd edition.
Chapter 9: Managing Patient-Centered Care
LEARNING OUTCOMES AND SUGGESTED CLASSROOM AND CLINICAL
ACTIVITIES
LEARNING OUTCOME 1
Explain how patient-centered care impacts the healthcare delivery system and nursing
care.
Suggestions and Strategies for Classroom Experience
• Ask students to discuss how healthcare providers can improve patient-centered
care, as identified by the Institute of Medicine.
Suggestions and Strategies for Clinical Experience
LEARNING OUTCOME 2
Analyze the implications of care planning, clinical reasoning and judgment, and
patient/family education on patient-centered care.
Suggestions and Strategies for Classroom Experience
• Debate the differences in care planning, clinical reasoning and judgment, and
patient/family education to patient-centered care.
Suggestions and Strategies for Clinical Experience
• Ask students to apply clinical reasoning and judgment in their practice. Discuss
with students.
LEARNING OUTCOME 3
Examine the relationship between self-management and patient-centered care.
Suggestions and Strategies for Classroom Experience
Suggestions and Strategies for Clinical Experience
• Ask students to include self-management in their care plans and then assess
outcomes related to self-management.
LEARNING OUTCOME 4
Apply the chronic illness model to a specific chronic illness and relate to patient-centered
care.
Suggestions and Strategies for Classroom Experience
• Use the Chronic Care Model website and apply model to a chronic illness such as
diabetes.
Suggestions and Strategies for Clinical Experience
LEARNING OUTCOME 5
Compare and contrast tools used to manage care such as a clinical pathway or practice
guideline so that care is more patient-centered.
Suggestions and Strategies for Classroom Experience
• Provide examples of pathways for students to analyze in small groups.
Suggestions and Strategies for Clinical Experience
• Ask students to search for a clinical guideline that would apply to an assigned
patient.
KEY CHAPTER CONCEPTS
1. Patient-centered care is the key competency around which the other four competencies
2. Healthcare delivery systems need to be “carefully and consciously designed to provide
care that is safe, effective, patient-centered, timely, efficient, and equitable. Such systems
3. Characteristics attributed to patient-centered care are; access to care, patient
4. Patients need to be active in the care planning process. Planning that is done separate
from the patient and then delivered as a final decision acts as a barrier to patient-centered
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5. Throughout the care process nurses need to actively use clinical reasoning and clinical
6. Clinical judgment requires that a nurse apply, analyze, and synthesize knowledge
considering the context. If done effectively it should allow the nurse to reflect on the
7. All patient and family education needs to focus on the individual patient and not just
provide broad information. Health literacy needs to be carefully monitored; patients must
8. Self-management support is the “systematic provision of education and supportive
9. “Patients currently do not have a central role in determining their care, one that fosters
11. The IOM identifies four areas that need improvement and lead to effective programs:
providers communicate and reinforce patients’ active and central role in managing their
12. Health promotion and disease and illness prevention are strategies that focus on
encouraging people to become partners in maintaining their own health. These are also
13. The three major health promotion and prevention methods used by healthcare
14. As insurers determine which preventive services to offer, cost-effectiveness is an
15. Nurses should take the following into consideration: Preventive services are
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16. Nursing needs to consider the impact of increasing chronic illness on its practice and
nursing delivery processes.
17. The chronic illness model focuses on an informed, activated patient who is supported
18. Examples of tools used to manage care are clinical pathways and clinical guidelines.
19. There is not one universally accepted definition for clinical pathway, but there are
some similar descriptors in the definitions. These are: provide guidelines for practice;
20. There are many advantages of using clinical pathways. The advantages relate to all of
21. Practice guidelines provide a systematic statement that assists providers in making
22. Practice guidelines focus more on general treatment for a specific illness or condition,
23. As more nurse practitioners enter private practice and clinics, they will need to review
24. Evaluation of the implementation of practice guidelines and pathways is important; to
25. Current issues and patient-centered care: HCO self-assessment of use of patient-
centered care, myths about patient-centered care, the Planetree Model, and influence of
the Joint Commission.
APPLYING LEADERSHIP AND MANAGEMENT
BSN and Master’s Essentials: Application to Content
Chapter identifies which Essentials apply to the chapter content. This information is
primarily for the instructor, but students should understand the how these nursing
education standards apply to the chapter content and the nursing profession.
My Hospital Unit: An Evolving Case Experience
Applying AONE Competencies
The AONE competencies for nurse leaders are found in Appendix A. Ask students to
identify which of the AONE competencies apply to the content in the chapter.
Engaging in the Content: Critical Thinking and Clinical Reasoning and Judgment
See Discussion Questions and Application Exercises at the end of the chapter. Online
options are noted.
Chapter Features: Case Study and Applying Evidence-Based Practice
The Chapter Features: Case Study and Applying Evidence-Based Practice features may
ADDITIONAL CASE
This case is not found in the textbook. It may be used for individual or team assignments:
written assignment and classroom or online team discussions. It may also be used as an
essay question for exams.
Case:
You are the nurse manager on a surgical unit. As part of your job you orient the nursing
faculty and students who come to the unit. Tomorrow a nursing faculty member who has
never practiced in the hospital or brought students to the hospital will come to your unit
with eight junior nursing students for their 3-hour orientation to the unit. The hospital
vision statement focuses on patient-centered care, and the unit strives to demonstrate that
patient-centered care is the expected focus of all care. You are reviewing your orientation
plans.
Questions:
1. What will you say about patient-centered care, and what examples will you give to
demonstrate how the unit’s staff implement patient-centered care?
2. What questions will you ask the students that would help you reinforce patient-
centered practice?
3. Why is it important for the nursing faculty and students to understand patient-centered
care and implications for the unit?