PATIENT-CENTERED CARE
PATIENT-CENTERED CARE
Definition: Recognize the patient or designee as the source of control and full partner in providing
compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
Knowledge Skills Attitudes
Integrate understanding of multiple
dimensions of patient centered
care:
patient/family/community
preferences, values
coordination and integration of care
information, communication, and
education
physical comfort and emotional
support
involvement of family and friends
transition and continuity
Describe how diverse cultural,
ethnic and social backgrounds
function as sources of patient,
family, and community values
Elicit patient values,
preferences and expressed
needs as part
of clinicalinterview,
implementation of care
planand evaluation of care
Communicate patient values,
preferences and expressed
needs to other members
of health care team
Provide patient-centered care
with sensitivity and respect
for the diversity of human
experience
Value seeing health care
situations “through patients’
eyes”
Respect and encourage
individual expression of patient
values, preferences and
expressed needs
Value the patient’s expertise
with own health and symptoms
Seek learning opportunities
with patients who represent all
aspects of human diversity
Recognize personally held
attitudes about working with
patients from different ethnic,
cultural and social
backgrounds
Willingly support patient-
centered care for individuals
and groups whose values differ
from own
Demonstrate comprehensive
understanding of the concepts
of pain and suffering, including
physiologic models of pain and
comfort.
Assess presence and extent
of pain and suffering
Assess levels of physical and
emotional comfort
Elicit expectations of patient
& family forrelief of pain,
discomfort, or suffering
Recognize personally
held values and beliefs about
the management of pain or
suffering
Appreciate the role of the nurse
in relief of all types and
sources of pain or suffering
Initiate effective treatments to
relieve pain and suffering in
light of patient values,
preferences and expressed
needs
Recognize that patient
expectations influence
outcomes in management of
pain or suffering
Examine how the safety, quality
and cost effectiveness of health
care can be improved through the
active involvement of patients and
families
Examine common barriers to
active involvement of patients in
their own health care processes
Describe strategies to empower
patients or families in all aspects
of the health care process
Remove barriers to presence
of families and other
designated surrogates based
on patient preferences
Assess level of patient’s
decisional conflict and
provide access to resources
Engage patients or
designated surrogates in
active partnerships that
promote health, safety and
well-being, and self-care
management
Value active partnership with
patients or designated
surrogates in planning,
implementation, and evaluation
of care
Respect patient preferences for
degree of active engagement
in care process
Respect patient’s right to
access to personal health
records
Explore ethical and legal
implications of patient-centered
care
Describe the limits and
boundaries of therapeutic patient-
centered care
Recognize the boundaries of
therapeutic relationships
Facilitate informed patient
consent for care
Acknowledge the tension that
may exist between patient
rights and the organizational
responsibility for professional,
ethical care
Appreciate shared decision-
making with empowered
patients and families, even
when conflicts occur
Discuss principles of effective
communication
Describe basic principles of
consensus building and conflict
resolution
Assess own level of
communication skill in
encounters with patients and
families
Participate in building
consensus or resolving
Value continuous improvement
of own communication and
conflict resolution skills
Examine nursing roles in assuring
coordination, integration, and
continuity of care
conflict in the context of
patient care
Communicate care provided
and needed at each
transition in care
TEAMWORK AND COLLABORATION
Definition: Function effectively within nursing and inter-professional teams, fostering open
communication, mutual respect, and shared decision-making to achieve quality patient care.
Knowledge Skills Attitudes
Describe own strengths,
limitations, and values in
functioning as a member of a
team
Demonstrate awareness of own
strengths and limitations as a
team member
Initiate plan for self-development
as a team member
Act with integrity, consistency and
respect for differing views
Acknowledge own potential to
contribute to effective team
functioning
Appreciate importance of
intra- and inter-professional
collaboration
Describe scopes of practice
and roles of health care team
members
Describe strategies for
identifying and managing
overlaps in team member roles
and accountabilities
Recognize contributions of
other individuals and groups in
helping patient/family achieve
health goals
Function competently within own
scope of practice as a member of
the health care team
Assume role of team member or
leader based on the situation
Initiate requests for help when
appropriate to situation
Clarify roles and accountabilities
under conditions of potential
overlap in team member
functioning
Integrate the contributions of
others who play a role in helping
patient/family achieve health
goals
Value the perspectives and
expertise of all health team
members
Respect the centrality of the
patient/family as core
members of any health care
team
Respect the unique attributes
that members bring to a team,
including variations in
professional orientations and
accountabilities
Analyze differences in
communication style
preferences among patients
and families, nurses and other
members of the health team
Describe impact of own
communication style on others
Discuss effective strategies for
communicating and resolving
conflict
Communicate with team
members, adapting own style of
communicating to needs of the
team and situation
Demonstrate commitment to
team goals
Solicit input from other team
members to improve individual,
as well as team, performance
Initiate actions to resolve conflict
Value teamwork and the
relationships upon which it is
based
Value different styles of
communication used by
patients, families and health
care providers
Contribute to resolution of
conflict and disagreement
Describe examples of the
impact of team functioning on
safety and quality of care
Explain how authority
gradients influence teamwork
and patient safety
Follow communication practices
that minimize risks associated
with handoffs among providers
and across transitions in care
Assert own position/perspective
in discussions about patient care
Choose communication styles
that diminish the risks associated
with authority gradients among
team members
Appreciate the risks
associated with handoffs
among providers and across
transitions in care
Identify system barriers and
facilitators of effective team
functioning
Examine strategies for
improving systems to support
team functioning
Participate in designing systems
that support effective teamwork
Value the influence of system
solutions in achieving effective
team functioning
EVIDENCE-BASED PRACTICE (EBP)
Definition: Integrate best current evidence with clinical expertise and patient/family preferences and
values for delivery of optimal health care.
Knowledge Skills Attitudes
Demonstrate knowledge of basic
scientific methods and processes
Describe EBP to include the
components of research
evidence, clinical expertise and
patient/family values.
Participate effectively in
appropriate data collection
and other research activities
Adhere to Institutional
Review Board (IRB)
guidelines
Base individualized care
plan on patient values,
clinical expertise and
evidence
Appreciate strengths and
weaknesses of scientific bases
for practice
Value the need for ethical
conduct of research and quality
improvement
Value the concept of EBP as
integral to determining best
clinical practice
Differentiate clinical opinion from
research and evidence
summaries
Describe reliable sources for
locating evidence reports and
clinical practice guidelines
Read original research and
evidence reports related to
area of practice
Locate evidence reports
related to clinical practice
topics and guidelines
Appreciate the importance of
regularly reading relevant
professional journals
Explain the role of evidence in
determining best clinical practice
Describe how the strength and
relevance of available evidence
influences the choice of
interventions in provision of
patient-centered care
Participate in structuring the
work environment to
facilitate integration of new
evidence into standards of
practice
Question rationale for
routine approaches to care
that result in less-than-
desired outcomes or
adverse events
Value the need for continuous
improvement in clinical practice
based on new knowledge
Discriminate between valid and
invalid reasons for modifying
evidence-based clinical practice
based on clinical expertise or
patient/family preferences
Consult with clinical experts
before deciding to deviate
from evidence-based
protocols
Acknowledge own limitations in
knowledge and clinical expertise
before determining when to
deviate from evidence-based
best practices
QUALITY IMPROVEMENT (QI)
Definition: Use data to monitor the outcomes of care processes and use improvement methods to
design and test changes to continuously improve the quality and safety of health care systems.
Knowledge Skills Attitudes
Describe strategies for learning
about the outcomes of care in the
setting in which one is engaged in
clinical practice
Seek information about
outcomes of care for
populations served in care
setting
Seek information about
quality improvement projects
in the care setting
Appreciate that continuous
quality improvement is an
essential part of the daily
work of all health
professionals
Recognize that nursing and other
health professions students are
parts of systems of care and care
processes that affect outcomes for
patients and families
Give examples of the tension
between professional autonomy and
system functioning
Use tools (such as flow
charts, cause-effect
diagrams) to make processes
of care explicit
Participate in a root cause
analysis of a sentinel event
Value own and others’
contributions to outcomes of
care in local care settings
Explain the importance of variation
and measurement in assessing
quality of care
Use quality measures to
understand performance
Use tools (such as control
charts and run charts) that
are helpful for understanding
variation
Identify gaps between local
and best practice
Appreciate how unwanted
variation affects care
Value measurement and its
role in good patient care
Describe approaches for changing
processes of care
Design a small test of change
in daily work (using an
experiential learning method
such as Plan-Do-Study-Act)
Practice aligning the aims,
measures and changes
involved in improving care
Value local change (in
individual practice or team
practice on a unit) and its
role in creating joy in work
Appreciate the value of what
individuals and teams can to
do to improve care
Use measures to evaluate
the effect of change
SAFETY
Definition: Minimizes risk of harm to patients and providers through both system effectiveness and
individual performance.
Knowledge Skills Attitudes
Examine human factors and
other basic safety design
principles as well as commonly
used unsafe practices (such as,
work-arounds and dangerous
abbreviations)
Describe the benefits and
limitations of selected safety-
enhancing technologies (such
as, barcodes, Computer
Provider Order Entry, medication
pumps, and automatic
alerts/alarms)
Discuss effective strategies to
reduce reliance on memory
Demonstrate effective
use of technology and
standardized practices
that support safety and
quality
Demonstrate effective
use of strategies to
reduce risk of harm to
self or others
Use appropriate
strategies to reduce
reliance on memory
(such as, forcing
functions, checklists)
Value the contributions of
standardization/reliability to safety
Appreciate the cognitive and
physical limits of human
performance
Delineate general categories of
errors and hazards in care
Describe factors that create a
culture of safety (such as, open
communication strategies and
organizational error reporting
systems)
Communicate
observations or concerns
related to hazards and
errors to patients,
families and the health
care team
Use organizational error
reporting systems for
near miss and error
reporting
Value own role in preventing errors
Describe processes used in
understanding causes of error
and allocation of responsibility
and accountability (such as, root
cause analysis and failure mode
effects analysis)
Participate appropriately
in analyzing errors and
designing system
improvements
Engage in root cause
analysis rather than
blaming when errors or
near misses occur
Value vigilance and monitoring (even
of own performance of care
activities) by patients, families, and
other members of the health care
team
Discuss potential and actual
impact of national patient safety
resources, initiatives and
regulations
Use national patient
safety resources for own
professional
development and to
focus attention on safety
in care settings
Value relationship between national
safety campaigns and
implementation in local practices and
practice settings
INFORMATICS
Definition: Use information and technology to communicate, manage knowledge, mitigate error, and
support decision making.
Knowledge Skills Attitudes
Explain why information and
technology skills are essential for
safe patient care
Seek education about
how information is
managed in care settings
before providing care
Apply technology and
information management
tools to support safe
processes of care
Appreciate the necessity for all
health professionals to seek
lifelong, continuous learning of
information technology skills
Identify essential information that
must be available in a common
database to support patient care
Contrast benefits and limitations of
different communication
Navigate the electronic
health record
Document and plan
patient care in an
electronic health record
Value technologies that support
clinical decision-making, error
prevention, and care
coordination
technologies and their impact on
safety and quality
Employ communication
technologies to coordinate
care for patients
Protect confidentiality of
protected health information in
electronic health records
Describe examples of how
technology and information
management are related to the
quality and safety of patient care
Recognize the time, effort, and skill
required for computers, databases
and other technologies to become
reliable and effective tools for
patient care
Respond appropriately to
clinical decision-making
supports and alerts
Use information
management tools to
monitor outcomes of care
processes
Use high quality electronic
sources of healthcare
information
Value nurses’ involvement in
design, selection,
implementation, and evaluation
of information technologies to
support patient care
REFERENCES 1 Institute of Medicine. Health professions education: A bridge to quality. Washington DC: National
Academies Press; 2003.
2 Cronenwett, L., Sherwood, G., Barnsteiner J., Disch, J., Johnson, J., Mitchell, P., Sullivan, D.,
Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55(3)122-131.