person centred care presentation

Domain 2: Person-Centered Care

Descriptor: Person-centered care focuses on the individual within multiple complicated contexts, including family and/or important others. Person-centered care is holistic, individualized, just, respectful, compassionate, coordinated, evidence-based, and developmentally appropriate. Person-centered care builds on a scientific body of knowledge that guides nursing practice regardless of specialty or functional area.

Contextual Statement: Person-centered care is the core purpose of nursing as a discipline. This purpose intertwines with any functional area of nursing practice, from the point of care where the hands of those that give and receive care meet, to the point of systems-level nursing leadership. Foundational to person-centered care is respect for diversity, differences, preferences, values, needs, resources, and the determinants of health unique to the individual. The person is a full partner and the source of control in team-based care. Person-centered care requires the intentional presence of the nurse seeking to know the totality of the individual’s lived experiences and connections to others (family, important others, community). As a scientific and practice discipline, nurses employ a relational lens that fosters mutuality, active participation, and individual empowerment. This focus is foundational to educational preparation from entry to advanced levels irrespective of practice areas.

With an emphasis on diversity, equity, and inclusion, person-centered care is based on best evidence and clinical judgment in the planning and delivery of care across time, spheres of care, and developmental levels. Contributing to or making diagnoses is one essential aspect of nursing practice and critical to an informed plan of care and improving outcomes of care (Olson et al., 2019). Diagnoses at the system-level are equally as relevant, affecting operations that impact care for individuals. Person-centered care results in shared meaning with the healthcare team, recipient of care, and the healthcare system, thus creating humanization of wellness and healing from birth to death.

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Entry-Level Domain 2 Competencies

2.1 Engage with the Individual in establishing a caring relationship.

2.1a Demonstrate qualities of empathy.

2.1b Demonstrate compassionate care.

2.1c Establish mutual respect with the individual and family.

2.2 Communicate effectively with individuals.

2.2a Demonstrate relationship-centered care.

2.2b Consider individual beliefs, values, and personalized information in communications.

2.2c Use a variety of communication modes appropriate for the context.

2.2d Demonstrate the ability to conduct sensitive or difficult conversations.

2.2e Use evidence-based patient teaching materials, considering health literacy, vision, hearing, and cultural sensitivity.

2.2f Demonstrate emotional intelligence in communications.

2.3 Integrate assessment skills in practice.

2.3a Create an environment during assessment that promotes a dynamic interactive experience.

2.3b Obtain a complete and accurate history in a systematic manner.

2.3c Perform a clinically relevant, holistic health assessment.

2.3d Perform point of care screening/diagnostic testing (e.g. blood glucose, PO2, EKG).

2.3e Distinguish between normal and abnormal health findings.

2.3f Apply nursing knowledge to gain a holistic perspective of the person, family, community, and population.

2.3g Communicate findings of a comprehensive assessment.

2.4 Diagnose actual or potential health problems and needs.

2.4a Synthesize assessment data in the context of the individual’s current preferences, situation, and experience.

2.4b Create a list of problems/health concerns.

2.4c Prioritize problems/health concerns.

2.4d Understand and apply the results of social screening, psychological testing, laboratory data, imaging studies, and other diagnostic tests in actions and plans of care.

2.4e Contribute as a team member to the formation and improvement of diagnoses.

2.5 Develop a plan of care.

2.5a Engage the individual and the team in plan development.

2.5b Organize care based on mutual health goals.

2.5c Prioritize care based on best evidence.

2.5d Incorporate evidence-based intervention to improve outcomes and safety.

2.5e Anticipate outcomes of care (expected, unexpected, and potentially adverse).

2.5f Demonstrate rationale for plan.

2.5g Address individuals’ experiences and perspectives in designing plans of care.

2.6 Demonstrate accountability for care delivery.

2.6a Implement individualized plan of care using established protocols.

2.6b Communicate care delivery through multiple modalities.

2.6c Delegate appropriately to team members.

2.6d Monitor the implementation of the plan of care.

2.7 Evaluate outcomes of care.

2.7a Reassess the individual to evaluate health outcomes/goals.

2.7b Modify plan of care as needed.

2.7c Recognize the need for modifications to standard practice.

2.8 Promote self-care management.

2.8a Assist the individual to engage in self-care management.

2.8b Employ individualized educational strategies based on learning theories, methodologies, and health literacy.

2.8c Educate individuals and families regarding self-care for health promotion, illness prevention, and illness management.

2.8d Respect individuals and families’ self-determination in their healthcare decisions.

2.8e Identify personal, system, and community resources available to support self-care management.

2.9 Provide care coordination.

2.9a Facilitate continuity of care based on assessment of assets and needs. 

2.9b Communicate with relevant stakeholders across health systems.

2.9c Promote collaboration by clarifying responsibilities among individual, family, and team members.

2.9d Recognize when additional expertise and knowledge is needed to manage the patient.

2.9e Provide coordination of care of individuals and families in collaboration with care team.

Advanced-Level Domain 2 Competencies

2.1d Promote caring relationships to effect positive outcomes.

2.1e Foster caring relationships.

2.2g Demonstrate advanced communication skills and techniques using a variety of modalities with diverse audiences.

2.2h Design evidence-based, person-centered engagement materials.

2.2i Apply individualized information, such as genetic/genomic, pharmacogenetic, and environmental exposure information in the delivery of personalized health care.

2.2j Facilitate difficult conversations and disclosure of sensitive information.

2.3h Demonstrate that one’s practice is informed by a comprehensive assessment appropriate to the functional area of advanced nursing practice.

2.4f Employ context driven, advanced reasoning to the diagnostic and decision-making process.

2.4g Integrate advanced scientific knowledge to guide decision making.

2.5h Lead and collaborate with an interprofessional team to develop a comprehensive plan of care.

2.5i Prioritize risk mitigation strategies to prevent or reduce adverse outcomes.

2.5j Develop evidence-based interventions to improve outcomes and safety.

2.5k Incorporate innovations into practice when evidence is not available.

2.6e Model best care practices to the team.

2.6f Monitor aggregate metrics to assure accountability for care outcomes.

2.6g Promote delivery of care that supports practice at the full scope of education.

2.6h Contribute to the development of policies and processes that promote transparency and accountability.

2.6i Apply current and emerging evidence to the development of care guidelines/tools.

2.6j Ensure accountability throughout transitions of care across the health continuum.

2.7d Analyze data to identify gaps and inequities in care and monitor trends in outcomes.

2.7e Monitor epidemiological and system-level aggregate data to determine healthcare outcomes and trends.

2.7f Synthesize outcome data to inform evidence-based practice, guidelines, and policies.

2.8f Develop strategies that promote self-care management.

2.8g Incorporate the use of current and emerging technologies to support self-care management.

2.8h Employ counseling techniques, including motivational interviewing, to advance wellness and self-care management.

2.8i Evaluate adequacy of resources available to support self-care management.

2.8j Foster partnerships with community organizations to support self-care management.

2.9f Evaluate communication pathways among providers and others across settings, systems, and communities.

2.9g Develop strategies to optimize care coordination and transitions of care.

2.9h Guide the coordination of care across health systems.

2.9i Analyze system-level and public policy influence on care coordination.

2.9j Participate in system-level change to improve care coordination across settings.

MCA: Care planning, involvement and person-centred care

This section explores two key themes that are central to care planning within the MCA framework: involvement, and keeping the wishes of the person at the centre of their care and support. It emphasises that building relationships and good communication are critical to meaningful involvement.

Involving people in decisions about them

Involving people in decisions about their care is intrinsic to the principles of the MCA and should be evident in every care and support plan. Research on mental health and wellbeing demonstrates that involvement leads to improved service outcomes and enhances mental wellbeing. [9] People who use services and their carers are experts by experience. By bringing their knowledge and ideas, they give a fresh perspective on how their particular needs for care and support can best be met.

Providers and commissioners must challenge assumptions about how care plans are developed that limit the level of active involvement by the user. Supporting people to be involved in decisions about their care and treatment should be reflected in the ethos, management, policies and care practice of each service. All services should be able to show how they do this.

Meaningful involvement is based on a sharing of power between the person using the service and the provider. Involving people in designing their care plans means:

• having a conversation among equals who are working together to help one of them make a decision about their care and support
• that the person is considered as a whole in all aspects of their life
• that the plan belongs to the person, keeping them in control
• that the plan is only implemented or shared with others if the person gives consent (where they have capacity to do so).  

These are identified [10] as key elements in person-centred care planning for people with long-term conditions. They are, however, equally applicable to care planning for all adults in need of care and support:

…care planning is a conversation between the person and the healthcare practitioner about the impact their condition has on their life, and how they can be supported to best meet their health and wellbeing needs in a whole-life way. The care plan is owned by the individual, and shared with others with their consent. It is important that a discussion takes place, there is a record of it, and people know they have a plan.

Producing a shared written record of how the person will be cared for tells them (and others whom they wish to involve) what to expect. Giving this information clearly maintains the accountability of the service provider and enables people to raise any concerns about the care plan or its delivery.

What to look for

• The person or their family/friends are able to tell you how they were involved in developing the care and support plan and that they felt (and feel) listened to.
• The person and their chosen representative are aware of the care and support plan and have seen a copy.
• The care and support plan clearly explains how care and support will be delivered.

The next section considers how to create a care and support plan that follows the MCA principles.

Person-centred care and support plans

Each person’s needs and choices will be unique to them. This means that staff must do all they can to help the person convey their personal aspirations and goals, and the support they need. Creating the care plan with the person or their chosen representative will keep the focus on what is important to that individual and will enable their care and support to reflect this.

Designing an MCA-compliant care and support plan requires a cultural shift from ‘traditional’ models of care planning to  person-centred care planning . The key differences between the two are summarised in the table below (Table 1).

Table 1 Key differences between ‘traditional’ and person-centred care

Promoting involvement may mean orientating the person to the decision. For example, helping to orientate a person with dementia to the time and place relevant to the decision and filling in the gaps of their understanding. It might also include orientating a person’s beliefs concerning a decision. For example, helping someone who is depressed to hold onto positive values that were important to them when they were not so depressed. Ongoing work to reduce the effects of mental health conditions and maintain independence and control is vital to maximising a person’s capacity to make a decision.

Actively involving other people who are part of the person’s life will usually improve their care and support. Linking into a person’s existing support network will bring together all the information about them, so that their care and support are tailored to meet their specific needs and preferences. This will help to improve the user’s experience and promote their wellbeing, rather than merely responding to problems as they arise: ‘Being truly person centred is about recognising people within the full context of their lives and how they live them and not just focusing on their health conditions’. [10] The person’s wishes, thoughts and feelings should be routinely prioritised together with input from families and carers. 

What to look for in the care and support plan and other records

• What the person would like to achieve with their care and support, their goals and aspirations for the future.
• What is important to the person about how they live their life now: what they enjoy doing, their interests, likes and dislikes, who is important to them, who they like to see, and their preferred routines (such as when they like to get up and go to bed, whether they like a bath or a shower, etc.).
• Details of key life events and dates to assist with chronological orientation.
• How best to support and involve the person in decision-making.
• Essential information for continuity of care and for use in emergencies.
• Roles and responsibilities so that the person receives coordinated care and support to meet their needs.
• Where a person lacks capacity to express their choices, how their families and others who are interested in their welfare have been consulted.
• What outcome the person wants and any other options considered.
• The associated benefits and risks of each option.

The case of M, [11] from the Court of Protection, clearly illustrates the importance of care planning that takes account of the full context of a person’s life.

Practice example: the case of M

M, a 67-year-old woman, had a mild mental health problem and lacked capacity to decide where to live. She had substantial medical needs including diabetes, which was not well controlled. M was placed in a care home by the clinical commissioning group (CCG).  It considered this to be in her best interests because of the significant risks to her health if she returned home. However, M hated living in the care home and said that she wanted to leave or she would take her own life. While acknowledging these risks, the Court of Protection said that if M remained in the care home, she was entitled to ask, what for? The right to life and the state’s obligation to protect it is not absolute and the Court must have regard to the person’s own assessment of their quality of life. In M’s case, there was little to be said for a solution that attempted to preserve her daily life without meaning or happiness.

Involvement in the cycle of care and support planning

Involvement is not an isolated activity. Ongoing communication between commissioners, providers, users and their families/carers is fundamental to taking the right decisions at the right time. It enables decisions to be altered over time to reflect people’s changing needs.

Services must make sure that their staff have the knowledge and skills to  maximise involvement  as part of an ongoing conversation that takes place at all stages of the care and support planning process. For example:

• at the outset, when developing the plan of care for each person
• as part of the risk management process, including safeguarding
• each and every time care and support are provided
• when carrying out reviews
• through regular feedback about people’s experience of the service they receive.
• Evidence that staff ask people about their preferences each time they provide care or support – for example, whether they want to take their medicines now, whether they would like a cup of tea, coffee or a cold drink.
• Evidence that staff regularly ask the views of people using the service and/or their families about the care and support they receive and listen to what they say.
• Evidence of systems for reviewing care and support plans and obtaining feedback.

Relationships

Involvement in the care and support planning cycle is underpinned by the quality of the relationship between the person using the service and the social care professional: [12] ‘People who use services have emphasized the support that they gain from relationships based on warmth, empathy, reliability and respect’. [13]

Having the right care staff with sufficient time and the right training in communication skills is critical to building effective relationships. [5]

• Care staff talk to people in a respectful way.
• People say that staff are caring towards them and always treat them with respect.

Communication

Assumptions are often made about the capacity of people who have limited communication skills or sensory impairments. Yet we know that it is quite possible to discern what a person feels or wants from their gestures and facial expressions, tone and volume of voice, or body language and behaviours. Care staff may need to observe a person’s responses over a period of time to understand these non-verbal signals.

A  communication chart  is a good example of a person-centred approach that carefully looks for what each individual is trying to communicate, rather than making blanket assumptions. The authors of ‘Person centred thinking with older people’ [14] provide a useful worked example about eating, based on four questions:

• What is happening?  Food is being prepared.
• What is the person doing?  Shutting their lips tightly.
• What do we think this means?  Best guess – the person does not want food at the moment or wants a drink first.
• What should we do?  Offer a drink, gently encourage the person to eat, try shifting their mealtime to later in the day, maintain a record of food consumed and monitor.

Other ways to help a person communicate include the following:

• Making time to listen, to ask enough questions, to create opportunities for the person to tell their story in their own time, in their own way.
• Researching their previous wishes and finding out about their values.
• Providing all the relevant information in an accessible way – for example, in plain English, in clear writing, in Braille, in alternative languages, in pictures or in photographs, or a combination of these.
• Using a translator or other person/professional who understands the person’s communication style best.
• Addressing any sensory needs – does the person use a hearing aid, glasses, dentures; do they understand sign language?
• Involving family, friends or an advocate to provide support and reassurance.
• Choosing the right setting and time of day, considering whether the person may gain or regain capacity at a later date.
• Meeting with the person informally to explain the options and possible outcomes.
• Talking clearly, slowly, using straightforward, jargon-free language.

In order for care staff to successfully support people’s dignity and choices, they must do all they practically can to understand the meaning that users are trying to convey: ‘Having the power to communicate and to be understood is central to older people being able to have choice and control in their life – in fact, to have any quality of life at all’. [14]

• A description of any communication needs and how these will be met.
• Where the person has limited communication ability, other non-verbal communication methods that the person may use.
• How the person was supported to be involved in decisions about their care and support.

What else to look for

• Users have clean spectacles, dentures are fitted and hearing aids are working.
• Staff use different communication tools to meet people’s needs.
• Staff explain what is happening each time they offer care and support.
• Staff take time to listen to what people are trying to convey.

5 – House of Lords (2014) ‘Select Committee on the Mental Capacity Act 2005, 2014: Post-legislative scrutiny’, summary, p 1, London: The Stationery Office.

9 – Mersey Care NHS Trust (2007) ‘Increasing mental health and well-being: Involving service users and carers’, Liverpool: Mersey Care NHS Trust.

10 – Harvey, J. (2010) ‘Key elements of personalised care planning in long term conditions and personal health budgets’, London: HSA Press.

11 – M v The County Council and the Clinical Commissioning Group (CCG) and A. EWHC 3456 (COP) (Jackson, J.) 2013.

12 – Ashead, A., Beresford, P. and Croft, C. (2007) ‘Research findings from palliative care, social work and service users: Making life possible’, London: Jessica Kingsley Publishers.

13 – Beresford, P., Bewley, C., Branfield, F., Croft, S., Fleming, J., Glynn, M. and Postle, K. (2011) ‘Supporting people: Towards a person-centred approach’, Bristol University: Policy Press.

14 – Bowers, H., Bailey, G., Sanderson, H., Easterbrook, L. and Macadam, A. (2007) ‘Person centred thinking with older people’, Cheshire: HSA Press.

The Mental Capacity Act (MCA) and care planning report

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Article Contents

Introduction, conclusions, acknowledgements, author contributions, supplementary data, conflict of interest, data availability statement.

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The relationship between person-centred care and well-being and satisfaction with care of patients living with obesity

Handling Editor : Prof. Rosa Sunol.

• Article contents
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Paige I Crompvoets, Anna P Nieboer, Elisabeth F. C van Rossum, Jane M Cramm, The relationship between person-centred care and well-being and satisfaction with care of patients living with obesity, International Journal for Quality in Health Care , Volume 36, Issue 3, 2024, mzae078, https://doi.org/10.1093/intqhc/mzae078

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Person-centred care (PCC) is associated with improved patient well-being and higher levels of satisfaction with care but its impact on individuals living with obesity is not well-established. The main aim of this study was to assess the relationship between PCC and the physical and social well-being of patients living with obesity, as well as their satisfaction with care. This study is based on a cross-sectional, web-based survey administered among a representative panel of Dutch individuals living with obesity. The primary outcomes were physical and social well-being and satisfaction with care. The primary exposure was a rating of overall PCC, encompassing its eight dimensions. In addition, covariates considered in the analyses included sex, age, marital status, education level, body mass index, and chronic illness. The data from a total of 590 participants were analysed using descriptive statistics, correlation analyses, and multiple regression analyses. Among PCC dimensions, participants rated ‘access to care’ the highest (M 4.1, SD 0.6), while ‘coordination of care’ (M 3.5, SD 0.8) was rated lower than all other dimensions. Participants’ overall PCC ratings were positively correlated with their physical ( r  = 0.255, P  < .001) and social well-being ( r  = 0.289, P  < .001) and their satisfaction with care ( r  = 0.788, P  < .001), as were the separate dimension scores. After controlling for sex, age, marital status, education level, body mass index, and chronic illness in the regression analyses, participants’ overall PCC ratings were positively related to their physical ( β  = 0.24, P  < .001) and social well-being ( β  = 0.26, P  < .001), and satisfaction with care ( β  = 0.79, P  < .001). PCC holds promise for improved outcomes among patients living with obesity, both in terms of physical and social well-being, as well as satisfaction with care. This is an important finding, particularly when considering the profound physical, social, and psychological consequences associated with obesity. In addition to highlighting the potential benefits of PCC in the healthcare of individuals living with obesity, the findings offer valuable insights into strategies for further refining the provision of PCC to meet the specific needs of these patients.

The number of people living with obesity worldwide has nearly tripled since 1975 and continues to grow at a fast pace [1] . According to recent global estimates, obesity now affects more than a billion people worldwide [2] . Obesity is classified as a chronic, relapsing disease since it tends to persists over time, often requiring ongoing management due to the high probability of weight regain even after successful weight-loss attempts [3] . The development of obesity is usually a result of complex interactions among various genetic, behavioural, and environmental factors [4] . Obesity can have a strong impact on quality of life, with profound implications for the physical and social well-being of individuals [5] . These impacts are particularly notable for individuals living with more severe obesity and those managing multiple chronic conditions [6] .

The physical consequences of obesity can be significant, giving rise to a wide range of issues that can cause discomfort and hinder participation in physical or social activities [7] . Some of the commonly reported physical problems are difficulties with mobility, chronic pain, respiratory issues, skin conditions, fatigue, and poor sleep quality [ 7–10 ]. Furthermore, obesity serves as a major risk factor for the development or worsening of other chronic health conditions, including cardiometabolic diseases, musculoskeletal disorders, some types of cancer, and mental disorders, which further implicate health and well-being [ 10 , 11 ].

On top of physical challenges, many individuals living with obesity are subject to social stereotypes, prejudice, and unfair treatment because of their weight [12] . This phenomenon, known as weight stigma, seems to be most pervasive towards individuals living with severe obesity but it can affect anyone with excess body weight. Weight stigma is prevalent across many important life domains, such as personal relationships, education, employment, and healthcare [13] . Weight stigma can have detrimental effects on both physical and social well-being through various mechanisms, including increased exposure to stress, decreased quality and quantity of social relationships, compromised access to high-quality health care, and a decline in socio-economic status due to reduced opportunities and resources [14] . Moreover, perceiving weight stigma can trigger a weight-related social identity threat, causing individuals to become hyper-vigilant about potential rejection, resulting in social withdrawal, avoidance of health services, and other negative impacts on health and well-being [15] .

Healthcare systems often fall short in effectively addressing the well-being concerns of patients living with obesity [16] . The current approach to care for these patients often revolves around tackling acute medical problems and recommending measures for weight reduction. This limited focus often results in short-term solutions that fail to address any underlying issues affecting patients’ well-being and hindering their weight loss efforts. As a result, patients commonly express dissatisfaction with their care, experiencing it as fragmented and ineffective, as their broader well-being concerns remain insufficiently addressed [17] .

In an attempt to better meet the support needs of individuals with complex chronic conditions, many health systems are now moving towards a person-centred approach in which care is tailored to the specific preferences, goals, and circumstances of each individual. The Institute of Medicine defines person-centred care (PCC) as ‘care that is respectful of and responsive to individual patient preferences, needs and values; and ensuring that patient values guide all clinical decisions’ [18] . Extensive research identified eight broad dimensions of PCC that capture what is generally most important to patients: respect for patients’ preferences, physical comfort, the coordination of care, emotional support, access to care, the continuity of care, the provision of information and education, and the involvement of family and friends [19] . A review of PCC and its outcomes in 2013 clearly showed that organizations investing in these dimensions report more positive outcomes, such as greater patient well-being and satisfaction with care [20] . While the review included studies in various care settings and patient groups (e.g. diabetes care, cancer patients), it lacked studies within the context of obesity. To date, there remains a scarcity of data on PCC in obesity management, resulting in limited knowledge of its impact on patients living with obesity. While there are some articles on PCC for the management of obesity, they primarily focus on childhood obesity or are limited to case studies [ 21 , 22 ]. Despite the anticipated benefits of PCC for patients living with obesity, the relationship between PCC’s eight dimensions and outcomes for this patient population remains unexplored.

This study aimed to address this knowledge gap by investigating the relationship between PCC and the physical and social well-being of patients living with obesity, as well as their satisfaction with care. Within a nationally representative sample, our objectives were to (i) explore participants’ experiences with PCC; (ii) determine bivariate associations of participants’ PCC experiences and background characteristics to their levels of physical well-being, social well-being, and satisfaction with care; and (iii) assess multivariate relationships between PCC experiences and participants’ levels of physical well-being, social well-being, and satisfaction with care, while controlling for background characteristics. We hypothesized that greater PCC would be positively related to all three primary outcome variables.

Study design

Our study was based on a cross-sectional, web-based survey administered by the Longitudinal Internet Studies for the Social sciences (LISS) panel ( https://www.centerdata.nl/en/liss-panel ). The panel is managed by Centerdata, an independent non-profit research institute affiliated with Tilburg University. The panel is based on true probability sample of households drawn from the Dutch population register by Statistics Netherlands. In 2022, the panel consisted of roughly 6500 individuals from about 4700 households. The panel members are compensated for participating in monthly web-based surveys, with necessary resources provided for households without a computer or internet access. The LISS panel abides by the European ‘General Data Protection Regulation (GDPR)’ and complies with all relevant ethical regulations. LISS participants give informed consent for the use of the collected data in scientific and policy-relevant research.

Setting and participants

The target population of the study were individuals aged 18 years or older with obesity, defined as a body mass index (BMI) of at least 30 kg/m 2 . In July 2022, the survey was distributed among all panel members meeting these criteria ( n  = 896), yielding a total of 732 responses (82% response rate). BMI was based on participants’ most recent weight and height measurements, retrieved from a longitudinal survey fielded in November and December of each year. We verified any outliers in the data, resulting in the exclusion of five cases with incorrect BMI values. Given our interest in participants’ experiences with PCC, 130 cases who indicated ‘I do not know/not applicable’ to all PCC-related items were excluded. Finally, an analysis of survey completion times led to the exclusion of seven cases who completed the questionnaire faster than was deemed possible for meaningful responses. The final sample included 590 participants, which was considered sufficient to detect small to medium effects with a 95% confidence level and 80% power.

To assess PCC, the survey included the 40-item person-centred obesity care instrument that assesses the eight dimensions of PCC (patient preferences, physical comfort, coordination of care, emotional support, access to care, continuity of care, information and education, and family and friends) among patients living with obesity [ 23 ]. The instrument is designed to be applicable across various care settings. Responses were given on a 5-point Likert scale from 1 (totally disagree) to 5 (totally agree). To minimize response bias, we allowed participants to select ‘I do not know/not applicable’ as well. Average dimension scores were calculated if ≥60% of the items were completed (all Cronbach’s α ≥0.87). Overall PCC ratings were calculated by averaging dimension scores for participants with at least five scores (Cronbach’s α  = 0.92). Scores ranged from 1 to 5, with higher scores indicating better PCC.

The primary study outcomes were well-being and satisfaction with care. Well-being was assessed using the 15-item Social Production Function Instrument for the Level of Well-being, which measures both physical (comfort and stimulation) and social well-being (status, behavioural confirmation, and affection) [24] . Responses were given on a 4-point Likert scale from 1 (never) to 4 (always). Scores were averaged separately for physical (Cronbach’s α  = 0.77) and social well-being (Cronbach’s α  = 0.83), with higher scores (range 1–4) indicating greater well-being.

Satisfaction with care was assessed using a 6-item version [25] of the Satisfaction with Stroke Care questionnaire [26] . This scale was originally developed to evaluate satisfaction with inpatient care among stroke patients but has since been used to assess general satisfaction with care among various patient populations. Minor adjustments were made to the items (e.g. replacing ‘doctors’ with ‘healthcare professionals’). The resulting items were: ‘I have received all the information I want about the causes and nature of my health condition(s)’, ‘The healthcare professionals have done everything they can to improve my situation’, ‘I am satisfied with the type of care and support they have given me’, ‘I have had enough care and support’, ‘I am happy about the effects of the care and support on the progression of my condition(s)’, and ‘I am satisfied with the care and support that was provided’. Responses were given on a 4-point Likert scale from 1 (totally disagree) to 4 (totally agree) and scores were averaged across items (Cronbach’s α  = 0.96), with higher scores (range 1–4) indicative of higher satisfaction with care.

In addition, we obtained information on participants’ socio-demographic profile (sex, age, marital status, education level) and BMI. Participants also reported on chronic illness using a validated inventory of 10 chronic conditions (e.g. type 2 diabetes or cardiovascular disease) and an option to disclose unlisted conditions [27] .

Data analysis

SPSS version 29 was used to perform the analyses. Dummy variables were created for marital status [living together with a partner (0), single (1)], education (low = primary or lower vocational, intermediate = secondary or intermediate vocational, high = higher vocational or university), and chronic illness [no chronic conditions (0), one or more chronic condition (1)]. Descriptive statistics included frequencies and percentages for categorical variables and mean and standard deviation for continuous measures. For continuous measures deviating from normality, the median and inter-quartile range is reported. To explore intragroup differences between PCC dimensions, a repeated measures ANOVA with Huynh–Feldt correction was performed, followed by Bonferroni-adjusted pair-wise comparisons. Bivariate associations among PCC and participants’ background characteristics, level of well-being, and satisfaction with care were identified using Pearson or Spearman correlation analysis, as appropriate. Correlations were classified as low ( r  ≈ 0.10–0.29), moderate ( r  ≈ 0.30–0.49), or high ( r ≈ ≥ 0.50). To investigate multivariate relationships among PCC and participants’ physical and social well-being and satisfaction with care, while controlling for background variables, multiple regression analyses were performed. Assumptions of linear models (linearity, homoscedasticity, multicollinearity, multivariate normality, spurious outliers) were assessed and no large violations were observed. Statistical significance was set at two-sided 0.05, and Bonferroni-adjusted alpha levels are reported for multiple comparisons. An analysis of missing values (items with a >5% ‘not applicable’ response) revealed that participants without comorbid conditions had more missing data on some care-related items. In addition to the standard complete-case analysis ( Supplementary Material 1 ), multiple imputations were used to estimate the overall association between PCC and participants’ physical and social well-being and satisfaction with care. The Markov Chain Monte Carlo algorithm was used to impute missing values 20 times with 50 iterations. Predictive mean matching was used as the imputation method.

Table 1 presents the descriptive statistics of the study sample. On a 1–5 scale, the mean overall PCC rating was 3.8 (SD 0.6). Participants rated ‘access to care’ (M 4.1, SD 0.6) the highest, followed by ‘patient preferences’ (M 4.0, SD 0.7), ‘physical comfort’ (M 3.9, SD 0.7), ‘continuity of care’ (M 3.8, SD 0.8), ‘information and education’ (M 3.8, SD 0.7), ‘family and friends’ (M 3.7, SD 0.8), ‘emotional support’ (M 3.7. SD 0.8), and ‘coordination of care’ (M 3.5, SD 0.8). A repeated measures ANOVA with Huynh–Feldt correction indicated significant differences in PCC scores across dimensions [ F (5.662, 3334.781) = 97.473, P  < .001]. Bonferroni-adjusted post-hoc comparisons revealed significant differences between most dimension scores, except those more closely aligned, such as patient preferences and physical comfort. Notably, participants rated ‘access to care’ significantly higher than all other dimensions, while ‘coordination of care’ was rated lower than all other dimensions (all P  < .001). On a 1–4 scale, mean physical and social well-being scores were 2.6 (SD 0.5) and 2.7 (SD 0.5), respectively. Lastly, on a 1–4 scale, the mean satisfaction with care score was 3.0 (SD 0.6).

Descriptive statistics of the study sample ( n  = 590).

Reported as mean (SD); median (interquartile range).

Diabetes, cardiovascular diseases, heart failure, lung diseases, cancer, arthrosis, osteoporosis, chronic joint inflammation, depression, anxiety, or any unlisted chronic illness.

Measured on a scale of 1–5.

Measured on a scale of 1–4.

Participants’ overall PCC ratings correlated positively with their levels of physical and social well-being and their satisfaction with care (all P  < .001). A low-to-moderate correlation was found between PCC and physical ( r  = 0.255) and social well-being ( r  = 0.289), whereas PCC and satisfaction with care were highly correlated ( r  = 0.788). Additionally, some of the background characteristics demonstrated low correlations with participants’ physical and social well-being, but not their satisfaction with care ( Table 2 ; all P  < .001). Participants’ age correlated positively with their physical ( r  = 0.145) and social well-being ( r  = 0.143), whereas single marital status correlated negatively with physical ( r  = −0.161) and social well-being ( r  = −0.170). BMI ( r  =−0.183) correlated negatively with participants’ physical well-being, as did the presence of one or more comorbid conditions (e.g. type 2 diabetes or cardiovascular disease; r  = −0.204).

Bivariate associations of patient characteristics and person-centred care to physical and social well-being and satisfaction with care among patients living with obesity.

Significant at Bonferroni adjusted α  = 0.007.

All PCC dimensions correlated significantly and positively with participants’ physical well-being, social well-being, and satisfaction with care (all P  < .001; Table 3 ). Correlations with physical well-being and social well-being were relatively low in magnitude, while correlations with satisfaction with care were high.

Bivariate associations of person-centred care dimensions to physical and social well-being and satisfaction with care among patients living with obesity.

Significant at Bonferroni adjusted α  = 0.006.

The included covariates together explained 11% and 7% of the variance in participants’ physical ( R 2 adj  = 0.11) and social well-being ( R 2 adj  = 0.07), respectively (both P  < .001). The covariates did not explain any of the variance in satisfaction with care. The addition of PCC in the models explained an additional 4% ( R 2 adj  = 0.15), 7% ( R 2 adj  = 0.14), and 62% ( R 2 adj  = 0.62) of the variance in physical well-being, social well-being, and satisfaction with care, respectively ( Table 4 ). In the adjusted models, PCC was positively related to all primary outcomes: physical well-being ( β  = 0.24), social well-being ( β  = 0.26), and satisfaction with care ( β  = 0.79, all P  < .001). Additionally, age ( β  = 0.14) and chronic illness ( β  = −0.21) were significant covariates for physical well-being, whereas age ( β  = 0.15) and single marital status ( β  = −0.16) were significant covariates for social well-being (all P  < .001). Marital status and BMI showed significant associations with physical well-being in the bivariate analysis, but not in the adjusted multivariate analysis.

Relationships of patient characteristics and person-centred care to physical and social well-being and satisfaction with care among patients living with obesity.

Reference group = high education.

Adjusted R 2 covariates = 0.11.

Adjusted R 2 covariates = 0.07.

Adjusted R 2 covariates = 0.00.

Statement of principal findings

This study aimed to (i) explore the PCC experiences of patients living with obesity; (ii) determine bivariate associations of participants’ PCC experiences and background characteristics to their physical and social well-being and satisfaction with care; and (iii) assess multivariate relationships between participants’ PCC experiences and levels of physical and social well-being and satisfaction with care, while controlling for background characteristics. In a representative national sample, we found a high association of participants’ PCC experiences to their satisfaction with care, and low-to-moderate associations to their levels of physical and social well-being. In the adjusted multivariate analysis, we found positive relationships between PCC and all primary outcomes. This study thus showed that among patients living with obesity, experiencing greater PCC was related to increased satisfaction with care and greater physical and social well-being.

Interpretation within the context of the wider literature

We found a stronger association between PCC and satisfaction with care compared to physical and social well-being. This difference is understandable when considering the nature of the different constructs. Previous research shows that satisfaction with care is primarily determined by health service characteristics [28] . While many studies have explored person-related factors in this context, the results have been inconclusive due to high variability in the findings. In our study, none of the background variables serviced as significant for patients’ satisfaction with care. In contrast, the physical and social well-being of individuals is shaped by a broad range of factors [24] . It is therefore not surprising that we found several links between patients’ background variables—such as age, marital status, and chronic illness—and their well-being outcomes. Interestingly, even after accounting for these variables, we still found a positive relationship between PCC and both physical and social well-being, suggesting that PCC may be an effective strategy for improving these patients’ well-being outcomes. This is an important finding, given the profound physical, social, and psychological implications of obesity, which can vary greatly among individuals.

Participants rated coordination of care lower compared to other PCC dimensions. Effectively addressing obesity poses certain challenges due to its multifactorial nature and the broad range of clinical presentations and associated comorbidities. This lower rating may reflect the challenges and shortcomings in the integration and organization of care services, which are frequently reported by patients living with obesity [29] . As a consequence of poor coordination, patients may experience fragmented care, where healthcare professionals from different disciplines involved in the care delivery struggle to communicate and collaborate effectively. This, in turn, can lead to critical issues such as missed information, misdiagnoses, and misunderstandings about the patients’ needs and preferences. Furthermore, our findings suggest that there may be room for improvement in other dimensions of care, such as the provision of emotional support and the involvement of family and friends. Current best practice in treating obesity prioritize long-term, sustainable changes, in which addressing psychosocial factors is considered a critical component [11] . Finally, participants in our study rated access to care higher than other dimensions. This could indicate that in this setting, few barriers were experienced in terms of accessing healthcare services. This contrasts with a recent study in England, where access to care was particularly low among people living with overweight and obesity, highlighting the variability in healthcare experiences across different geographical areas [30] . Notably, both studies found a lower rating for emotional support, suggesting that this may be an overlooked aspect of obesity care, warranting greater attention from healthcare providers and policymakers.

Strengths and limitations

There were several strengths and limitations. First, the cross-sectional design of this study does not permit the establishment of causal relationships, warranting further research to evaluate the outcomes of PCC for patients living with obesity. Dynamic relationships between PCC and patients’ well-being and satisfaction with care cannot be excluded. Second, the study reported an average BMI of 33.4 (SD 3.9) kg/m 2 , but lacked information regarding waist circumference, an important marker of the amount of abdominal fat mass. This mean BMI suggests that the majority of participants fell into the categories of first- or second-class obesity. While this distribution aligns with that of the broader population, ensuring greater applicability of our findings, it is important to note that many studies have demonstrated that the consequences of obesity are most significant for those living with the most severe forms of obesity. Therefore, further investigation into how PCC relates to patient outcomes within this specific subgroup could reveal valuable insights. Furthermore, since this study relied on self-reported data, there was potential for reporting bias. To mitigate this risk, several measures were implemented. Outliers in BMI, for example, were cross-referenced, and participants were given the option to answer ‘I do knot know/not applicable’ for certain items to enhance the data’s reliability. Despite these limitations, there is sparse data on PCC for patients living with obesity, and this study is the first to document the importance of the eight dimensions of PCC for these important patient outcomes.

Implications for policy, practice, and research

By considering the diverse circumstances of each individual, PCC allows for a more comprehensive understanding of patients and their support needs. Our findings suggests that such an approach holds promise for more effective care and improved outcomes among patients living with obesity. However, further research is necessary to establish causal relationships and gain deeper insights into the benefits and potential mechanisms through which PCC can positively influence the well-being and care experiences of patients living with obesity.

The current study suggests that addressing issues that stand in the way of coordinating and integrating health services may be particularly beneficial for improving the care for patients living with obesity, as well as enhancing other aspects of PCC, such as the provision of emotional support. These insights could be used by healthcare professionals and policymakers aiming to improve obesity care.

In a cross-sectional, web-based survey among individuals living with obesity, we demonstrate that PCC is associated positively with both physical and social well-being, as well as with satisfaction with care. These findings are important given the considerable impact of obesity on the well-being of those living with obesity. The results underscore the potential benefits of prioritizing person-centred approaches in the healthcare of individuals living with obesity and provide valuable insight for improving the delivery of PCC to this specific patient population.

The authors would like to thank all the individuals who participated in the study.

Paige I. Crompvoets (Conceptualization, Design & coordinaton, Statistical analyses, Data interpretation, Writing—original draft), Anna P. Nieboer (Conceptualization, Design & coordinaton, Statistical analyses, Data interpretation, Writing—original draft), Elisabeth F. C. van Rossum (Conceptualization, Design & coordinaton, Data interpretation, Writing—original draft), Jane M. Cramm (Conceptualization, Design & coordinaton, Statistical analyses, Data interpretation, Writing—original draft).

Supplementary data is available at IJQHC online.

None declared.

This work was supported by the Erasmus School of Health Policy & Management.

The data that support this research were acquired through the LISS (Longitudinal Internet Studies for the Social Sciences) panel ( https://www.centerdata.nl/en/liss-panel ). Currently, the data are not yet available but will be accessible upon request from the LISS Data Archive once the research project is finalized. Users must comply with the data usage policies outlined by the LISS Data Archive.

GBD 2015 Obesity Collaborators , Afshin   A , Forouzanfar   MH  et al.    Health effects of overweight and obesity in 195 countries over 25 years . N Engl J Med   2017 ; 377 : 13 – 27 . doi: https://doi.org/10.1056/nejmoa1614362

Google Scholar

NCD Risk Factor Collaboration (NCD-RisC) . Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults . Lancet   2024 ; 403 : 1027 – 50 . doi: https://doi.org/10.1016/S0140-6736(23)02750-2

Burki   T . European Commission classifies obesity as a chronic disease . Lancet Diabetes Endocrinol   2021 ; 9 :418. doi: https://doi.org/10.1016/S2213-8587(21)00145-5

van der Valk   ES , van den Akker   ELT , Savas   M  et al.    A comprehensive diagnostic approach to detect underlying causes of obesity in adults . Obes Rev   2019 ; 20 : 795 – 804 . doi: https://doi.org/10.1111/obr.12836

Kolotkin   RL , Meter   K , Williams   GR . Quality of life and obesity . Obes Rev   2001 ; 2 : 219 – 29 . doi: https://doi.org/10.1046/j.1467-789X.2001.00040.x

Stephenson   J , Smith   CM , Kearns   B  et al. . The association between obesity and quality of life: a retrospective analysis of a large-scale population-based cohort study . BMC Public Health   2021 ; 21 : 1 – 9 . doi: https://doi.org/10.1186/s12889-021-12009-8

Forhan   M , Gill   SV . Obesity, functional mobility and quality of life . Best Pract Res Clin Endocrinol Metab   2013 ; 27 : 129 – 37 . doi: https://doi.org/10.1016/j.beem.2013.01.003

Kelly   BT Caples   SM . Sleep and obesity. In: Kushida   CA (ed.), Encyclopedia of Sleep and Circadian Rhythms , 2nd edn. Amsterdam, the Netherlands : Elsevier , 2023 , 289 – 95 .

Google Preview

Yosipovitch   G , DeVore   A , Dawn   A . Obesity and the skin: skin physiology and skin manifestations of obesity . J Am Acad Dermatol   2007 ; 56 : 901 – 16 . doi: https://doi.org/10.1016/j.jaad.2006.12.004

Dai   H , Alsalhe   TA , Chalghaf   N  et al. . The global burden of disease attributable to high body mass index in 195 countries and territories, 1990–2017: an analysis of the Global Burden of Disease Study . PLoS Med   2020 ; 17 : 1 – 19 . doi: https://doi.org/10.1371/journal.pmed.1003198

Yumuk   V , Tsigos   C , Fried   M  et al.    European guidelines for obesity management in adults . Obes Facts   2015 ; 8 : 402 – 24 . doi: https://doi.org/10.1159/000442721

Puhl   RM , Lessard   LM , Himmelstein   MS  et al. . The roles of experienced and internalized weight stigma in healthcare experiences: perspectives of adults engaged in weight management across six countries . PLoS One   2021 ; 16 : 1 – 20 . doi: https://doi.org/10.1371/journal.pone.0251566

Puhl   RM , Heuer   CA . The stigma of obesity: a review and update . Obesity   2009 ; 17 : 941 – 64 . doi: https://doi.org/10.1038/oby.2008.636

Major   B Tomiyama   AJ Hunger   JM . Chapter 27: The negative and bidirectional effects of weight stigma on health. In: Major   B , Dovidio   JF , Link   BG (eds.), The Oxford Handbook of Stigma, Discrimination, and Health . New York, NY, USA : Oxford University Press , 2017 , 499 – 519 .

Hunger   JM , Major   B , Blodorn   A  et al. . Weighed down by stigma: how weight-based social identity threat contributes to weight gain and poor health . Soc Personal Psychol Compass   2015 ; 9 : 255 – 68 . doi: https://doi.org/10.1111/spc3.12172

Rand   K , Vallis   M , Aston   M  et al.    “It is not the diet; it is the mental part we need help with.” A multilevel analysis of psychological, emotional, and social well-being in obesity . Int J Qual Stud Health Well-being   2017 ; 12 :1306421. doi: https://doi.org/10.1080/17482631.2017.1306421

Alberga   AS , Edache   IY , Forhan   M  et al. . Weight bias and health care utilization: a scoping review . Prim Health Care Res Dev   2019 ; 20 :e116. doi: https://doi.org/10.1017/S1463423619000227

Institute of Medicine (US) Committee on Quality of Health Care in America . Crossing the Quality Chasm: A New Health System for the Twenty-First Century . Washington, DC : National Academies Press , 2001 .

Gerteis   M , Edgman-Levitan   S , Walker   JD  et al. . What patients really want . Health Manage Q   1993 ; 15 : 2 – 6 .

Rathert   C , Wyrwich   MD , Boren   SA . Patient-centered care and outcomes: a systematic review of the literature . Med Care Res Rev   2013 ; 70 : 351 – 79 . doi: https://doi.org/10.1177/1077558712465774

Kalra   S , Kapoor   N , Kota   S  et al. . Person-centred obesity care - techniques, thresholds, tools and targets . Eur Endocrinol   2020 ; 16 : 11 – 3 . doi: https://doi.org/10.17925/EE.2020.16.1.11

Fastenau   J , Kolotkin   RL , Fujioka   K  et al. . A call to action to inform patient-centred approaches to obesity management: development of a disease-illness model . Clin Obes   2019 ; 9 :e12309. doi: https://doi.org/10.1111/cob.12309

Crompvoets   PI , Nieboer   AP , van Rossum   EFC  et al.    Perceived weight stigma in healthcare settings among adults living with obesity: A cross‐sectional investigation of the relationship with patient characteristics and person‐centred care . Health Expect   2024 ; 27 :e13954. doi: 10.1111/hex.13954 .

Nieboer   A , Lindenberg   S , Boomsma   A  et al.    Dimensions of well-being and their measurement: the Spf-Il scale . Soc Indic Res   2005 ; 73 : 313 – 53 . doi: https://doi.org/10.1007/s11205-004-0988-2

Kuipers   SJ , Cramm   JM , Nieboer   AP . The importance of patient-centered care and co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the primary care setting . BMC Health Serv Res   2019 ; 19 :13. doi: https://doi.org/10.1186/s12913-018-3818-y

Boter   H , De Haan   RJ , Rinkel   GJE . Clinimetric evaluation of a satisfaction-with-stroke-care questionnaire . J Neurol   2003 ; 250 : 534 – 41 . doi: https://doi.org/10.1007/s00415-003-1031-2

O’Halloran   J , Miller   GC , Britt   H . Defining chronic conditions for primary care with ICPC-2 . Fam Pract   2004 ; 21 : 381 – 6 . doi: https://doi.org/10.1093/fampra/cmh407

Batbaatar   E , Dorjdagva   J , Luvsannyam   A  et al. . Determinants of patient satisfaction: a systematic review . Perspect Public Health   2017 ; 137 : 89 – 101 . doi: https://doi.org/10.1177/1757913916634136

Mold   F , Forbes   A . Patients’ and professionals’ experiences and perspectives of obesity in health-care settings: a synthesis of current research . Health Expect   2013 ; 16 : 119 – 42 . doi: https://doi.org/10.1111/j.1369-7625.2011.00699.x

Flint   SW , Leaver   M , Griffiths   A  et al. . Disparate healthcare experiences of people living with overweight or obesity in England . EClinicalMedicine   2021 ; 41 :101140. doi: https://doi.org/10.1016/j.eclinm.2021.101140

Author notes

• body mass index procedure
• chronic disease
• marital status
• patient-centered care
• personal satisfaction

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Exploring documentation in Person‐centred care: A content analysis of care plans

Doris lydahl.

1 Department of Sociology and Work Science, University of Gothenburg, Gothenburg Sweden

Nicky Britten

2 University of Exeter Medical School, Exeter UK

3 Sahlgrenska Academy, University of Gothenburg, Gothenburg Sweden

4 Centre for Person‐Centred Care, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg Sweden

5 Department of Anaesthetics, Surgery and Intensive Care, Sahlgrenska University Hospital, Östra, Gothenburg Sweden

6 Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo Norway

Öncel Naldemirci

7 Department of Social Work, Umeå University, Umeå Sweden

Helen Lloyd

8 School of Psychology, University of Plymouth, Plymouth UK

Birgit Heckemann

Associated data.

The data that support the findings of this study are available from the corresponding author, [BH], upon reasonable request.

Person‐centred care is a growing imperative in healthcare, but the documentation of person‐centred care is challenging. According to the Gothenburg Framework of Person‐centred Care, care should be documented in continuously revised care plans and based on patients’ personally formulated goals and resources to secure a continuous partnership.

This study aimed to examine care plans produced within a randomised controlled trial that tested a person‐centred care intervention in older people with acute coronary syndrome. Nurses with training in the theory and practice of person‐centred care had written the care plans.

We conducted a secondary analysis of care plans developed in a randomised controlled trial for assessing person‐centred care in patients with acute coronary syndrome (Myocardial Infarct [MI] or unstable angina pectoris). The study sample included 84 patients, with three care plans for each patient from inpatient (T1), outpatient (T2) and primary care (T3), that is, a total of 252 care plans. We conducted a descriptive quantitative content analysis of the care plans to examine the reported patients' life‐world and medical/health resources and goals.

The analysis illustrates the differences and overlaps between life‐world and medical/health goals and resources. The documented goals and resources change over time: life‐world goals and resources decreased with time as medical/health goals and resources documentation increased.

Conclusions

This paper illustrates that in the setting of a randomised controlled trial, nurses with training in person‐centred care recorded fewer life‐world and more medical/health goals over time. Placing life‐world goals at the top of the goal hierarchy enables alignment with medical/health goals. Further research should explore whether the goals and resources documented in care plans accurately reflect patients' wishes as they transition along the care chain.

Trial registration: Swedish registry, Researchweb.org, ID NR 65 791.

What does this research add to existing knowledge in gerontology?

The documentation of life‐world and medical/health goals and resources is variable and changes over the course of a patient's journey.

What are the implications of this new knowledge for nursing care with older people?

The differences between life‐world and medical/health goals require more consideration. Patients' resources that support their recovery and goal attainment should also receive more attention.

How could the findings be used to influence policy or practice or research or education?

Person‐centred care training should highlight the differences between goals and resources and how to record these more clearly and assertively.

1. INTRODUCTION

Internationally and across all healthcare settings, providing person‐centred care is a growing imperative (Britten et al., 2017 ), not least in older people nursing (Dewing, 2008 ; Kindblom et al., 2021 ; Sundler et al., 2020 ). Tailoring care to the patient's individual wants and needs and jointly setting goals are essential to person‐centred care (Ekman et al., 2011 ).

In 2011, Ekman et al. ( 2011 ) developed the Gothenburg Framework for Person‐centred Care (gPCC) at the University of Gothenburg (Sweden). The gPCC, which has been widely implemented (Britten et al., 2017 ; Ekman et al., 2021 ; Håkansson Eklund et al., 2019 ), consists of three routines that facilitate the initiation, integration, and safeguarding of person‐centred care in daily clinical practice. The first routine involves initiating a partnership with the patient by eliciting the patient narrative, that is, the person's account of their illness, symptoms, and impact on their life. Especially important for this routine is identifying the patient's own resources (Ekman et al., 2011 ). The second routine concerns working the partnership through shared decision‐making and establishing personally formulated and commonly agreed goals . Person‐centred care represents a shift from solely medically oriented goals as it includes the patient's personal goals in shared care planning (Ekman et al., 2011 ; Jansson et al., 2018 ). These personal goals are life‐world goals based on the everyday world shared with others. The life‐world includes family life, culture, and social life; but excludes organised or institution‐driven aspects (Barry et al., 2001 ). A qualitative interview study with researchers working with the gPCC found that healthcare professionals often heard patients speak more about life‐world goals than biomedical goals (Britten et al., 2017 ). Life‐world goals included, for example, activities like picking mushrooms in the forest, digging a potato patch, or walking the dog, as well as personal goals such as having a job or a partner (Britten et al., 2017 ).

The third gPCC routine safeguards the partnership by documenting the narrative, the resources and the agreed goals in a shared care plan (Ekman et al., 2011 ). Care planning should be based on patients' own personally formulated goals and resources and needs to be discussed and, if necessary, revised continuously (Britten et al., 2020 ). Indeed, Berntsen et al. ( 2015 ) argue that patients have the moral and legal right to have their life‐world goals placed at the top of the ‘goal hierarchy’. Goal documentation should be adapted to changes in the patient's goals over time and across different care settings, for example, when moving from hospital to outpatient care. Reviewing and adjusting patient goals support continuity of care. Goal documentation can also enable a discussion of care on a ‘new level’ that actively includes the patient's expertise and resources (Wolf et al., 2017 ). Arguably, the role of documentation is essential to person‐centred care.

Yet research shows that person‐centred documentation is a substantial challenge because patient records are legal records firmly embedded in healthcare structures and rooted in biomedical traditions. Current patient records comprise patient diagnosis, treatment and care planning, delivery and outcomes (Blair & Smith, 2012 ). Their primary purpose is to ensure communication between healthcare professionals rather than patient–healthcare professional communication.

Although person‐centredness is a quality criterion in documentation (Jefferies et al., 2010 ), integrating person‐centred care aspects such as goal‐setting challenges current medical and nursing documentation (Britten et al., 2017 ; Dellenborg et al., 2019 ; Heckemann et al., 2020 ; Sefcik et al., 2020 ). Existing documentation systems and structures often fail to prompt and support person‐centred documentation (Broderick & Coffey, 2012 ; Gyllensten et al., 2020 ). Structured, template‐style documentation that focuses on the medical problem contributes to improving patient care (Björvell et al., 2003 ) because it facilitates clinical auditing and evaluation (Saranto & Kinnunen, 2009 ). However, the dialogical or narrative elicitation (Ekman et al., 2011 ) that is essential in person‐centred care is often less structured. Person‐centred care elicitation includes the patient's personal experience and exceeds the focus on medical problems. As a result, person‐centred care documentation is often fragmented, poorly developed, and lacking in various settings, including, for example, older people out of hospital settings, ageing migrant communities or coronary care (Ebrahimi et al., 2021 ; Moore et al., 2017 ).

Moreover, nursing documentation often fails to go beyond the descriptions of the routine aspects of care (Frank‐Stromborg & Christensen, 2001 ). Patients' psychosocial concerns and the details of the clinical communication are often lacking (Broderick & Coffey, 2012 ). In a similar vein, medical documentation in shared patient records lacked person‐centred content, and physicians often used terminology and abbreviations that were inaccessible to patients (Heckemann et al., 2020 ). This is particularly problematic in collaborative goal setting and its documentation, which are essential in person‐centred care (Ekman et al., 2011 ; Jansson et al., 2018 ). Person‐centred goals combine medical and patients' personal goals and resources, documented in plain language. Continued collaborative goal setting is important for patients with chronic conditions yet to date an under‐researched area that requires further development (Vermunt et al., 2017 ). To our knowledge, there are no previous studies examining goal documentation across the patient trajectory, yet the continuity of care is essential, particularly in chronic illness. This study broadens the knowledge base about longitudinal goal‐setting documentation through a secondary analysis of nursing care plans. Registered Nurses (RNs) who had received person‐centred care training developed the care plans within a randomised controlled trial. The trial assessed the effects of a person‐centred care intervention in patients with acute coronary syndrome (ACS) (myocardial infarction or angina pectoris), which is most common in older patients (Fors et al., 2015 ). The analysis enabled us to investigate longitudinal, person‐centred goals and resource documentation in a clinical trial.

2.1. Study context

The data for this secondary analysis derives from a clinical trial conducted by researchers affiliated with the Gothenburg Centre for Person‐Centred Care (Fors et al., 2015 ). The trial enrolled 199 participants with ACS treated at two coronary care units at Sahlgrenska University Hospital between June 2011 and February 2014. The intervention group comprised 89 patients who received a person‐centred care plan in addition to usual care. The care plan was co‐created during their hospital stay (T1), updated in outpatient care (4 weeks after discharge) (T2) and in primary care (8 weeks after discharge) (T3).

‘Usual’ care for acute heart disease in Sweden follows the Socialstyrelsens (National Board of Health and Welfare) evidence‐based guidelines for cardiac care (Socialstyrelsen, 2018a ). In addition to pharmacological and medical measures, the guidance includes recommendations for changing health‐related risk factors. Patient education through specially trained nurses (‘heart school’) is vital to ensure that the patient follows the treatment, undergoes regular weight checks, and participates in decisions about medical treatment (Socialstyrelsen, 2018a ).

Registered nurses and patients developed the first person‐centred care plan (T1) within 24 h after admission to the hospital ward. At T2 and T3, RNs and physicians trained in person‐centred interviewing reviewed the initial care plan and updated it in collaboration with the patient. The care plans included information on (a) medical/health and personal (life‐world) patient goals, (b) how to achieve these goals, (c) patients’ resources and (d) support needs (see Figure ​ Figure1 1 ).

Person‐centred care plan

The person‐centred training comprised lectures, seminars and workshops about the theory and practice of the Gothenburg framework for Person‐centred Care (gPCC). In addition, healthcare professionals learned about formulating and executing gPCC plans. In addition, RNs participated in four 3‐h sessions with case examples and tutoring to ensure they adhered to the gPCC approach during the intervention (Fors et al., 2015 ).

2.2. Sampling and analysis

The intervention arm of the RCT included 89 patients; however, care plans for five patients were missing from the data set. Therefore, our study sample included 84 patients, with three care plans per patient from inpatient, outpatient and primary care visits, giving a total of 252 care plans.

DL and BH transcribed the care plans into excel spreadsheets and repeatedly read them to familiarise themselves with the content. All authors met three times to discuss and review a deductive coding framework. The coding framework comprised two of the key aspects of the gPCC: resources and goals (Table ​ (Table1 1 ).

Coding frame for goals and resources

We built on the definition and operalisation of the concept ‘life‐world’ by Barry et al. ( 2001 ) to define codes for medical/health and life‐world goals and resources. Medical/health goals were biomedical and not necessarily connected to the patient's life‐world.

Based on the coding framework, we conducted a deductive quantitative content analysis. The codes were treated as categorical variables and each entry was assigned value (medical/health = 1, life‐world = 2 and missing = 0). Data were imported into SPSS for a descriptive analysis of goals and to examine shifts over time. BH and DL discussed and chose examples to illustrate these changes.

2.3. Ethics

The Regional Ethical Review Board (DNr 275‐11) approved the original RCT study. The application included the option to conduct secondary analyses of the documentation material. The study conformed to the principles of the Declaration of Helsinki. When extracting the data, we assigned anonymous Case‐IDs to all patients. Identifying information such as name or social security number were excluded from the dataset.

The results are presented in two sections as follows: goals and resources. We provide a quantitative summary of the data over three time points followed by qualitative data extracts that illustrate the nature of the goals or resources.

3.1. Section one: Goals

The RNs had written the care plans. There was no indication of whether patients confirmed the stated goals as reflective of their own narrative, wishes and needs. The goals were documented in plain language, with little use of medical jargon. Still, there were abbreviations such as VC (vårdcentral = Primary Healthcare Centre) or FaR (fysisk aktivitet på recept = Physical activity on prescription). These abbreviations are standard and widely used in Swedish healthcare.

The descriptive analysis of the longitudinal data showed that the reporting of goals decreased over time. At T1, the RNs had recorded either life‐world or medical/health goals in most care plans ( n  = 84). At T3, the number of missing goals had increased ( n  = 12). Still, most care plans contained goals ( n  = 72). The focus of the reported goals shifted with fewer life‐world goals over time ( n  = 56 at T1; n  = 43 at T2; n  = 32 at T3) and more medical/health goals ( n  = 28 at T1; n  = 30 at T2; n  = 40 at T3) (Figure ​ (Figure2 2 ).

Number of documented goals, T1‐T3

Many medical/health goals were in line with evidence‐based guidelines and concerned health factors such as smoking, weight loss, physical activity and stress (Socialstyrelsen, 2018a , 2018b ). In contrast, life‐world goals concerned areas such as the patients' social role or family and ethical or spiritual issues (Schellinger et al., 2018 ), and thus, extended beyond medical/health, guideline‐driven goals. However, medical/health goals may represent life‐world goals when connected to the patients' social life or role.

In the following paragraphs, we provide examples of documentation of both kinds of goals for older persons.

3.1.1. Life‐world goals

The excerpt below illustrates the integration of life‐world and medical/health goals. This patient wished to resume his social role as a bookbinder and return to his previous hobbies. The medical/health goal (physical exercise) was linked to the patient's life‐world goals: returning to cycling. Across all time points, the focus in care planning remained on life‐world goals (Table ​ (Table2 2 ).

Life‐world goals of a male patient, 61 years old

This example illustrates the maintenance of life‐world goals and medical/health goals across all time points (Table ​ (Table3 3 ).

Life‐world and health goals of a male patient, 74 years old

This example shows that medical/health and life‐world perspectives can exist parallel and are seemingly disconnected throughout this patient's care trajectory.

The focus on life‐world goals was not maintained in all care plans (Figure ​ (Figure2). 2 ). The example below illustrates how the focus on life‐world goals vanished over time.

3.1.2. From life‐world to medical/health goals

At T1, we found a mix of life‐world (writing a book, living a long life, travelling with the son) and medical/health goals (being more physically active). At T2, the documentation became scant, and the focus shifted towards medical/health goals. The care plan stated that goals were ‘as previously’, and there was no follow‐up on the progress towards the previously stated life‐world goals. Instead, the health goal—to increase physical activity—was revisited (Table ​ (Table4 4 ).

Changing goals of a male patient, 74 years old

The shift towards medical/health goals became more evident at T3, where the sole documented goal concerns a return to previous physical strength.

3.1.3. Medical/health goals

Some care plans did not include a life‐world goal but featured medical/health goals from T1 to T3. The example below illustrates this focus on medical/health goals (weight reduction and physical fitness). In these cases, the RNs possibly paid less attention to life‐world goals, or the patient had no desire to share their life‐world goals (Table ​ (Table5 5 ).

Health goals of a male patient, 72 years old

3.2. Section two: Resources

The RNs documented patient resources that supported the agreed goals. About half of the reported resources had a connection to the patient's life‐world at T1 ( n  = 48). However, there was a shift towards reporting fewer life‐world resources ( n  = 48 at T1; n  = 28 at T2; n  = 23 at T3) and more medical/health resources ( n  = 36 at T1; n  = 39 at T2; n  = 46 at T3) from T1 to T3 (Figure ​ (Figure3 3 ).

Number of documented resources, T1‐T3

We found that many of the documented resources were medical/health resources concerning the patient's efforts and abilities to achieve their goals. These included physical activities and abilities (e.g. living healthy) and mental abilities or states (e.g. a positive attitude towards recovery). Life‐world resources pertained to the patient's social support network (for example, a general sense of feeling supported by a spouse or friends). Some care plans reported a lack of physical or mental resources, preventing goal achievement. These included physical barriers such as pain and fatigue or negative /unresourceful mental states such as feelings of depression, anxiety and stress.

The following paragraph provides examples of patients' life‐world and medical/health resources.

3.2.1. Life‐world resources

The example below illustrates the link between the life‐world and health resources, which we commonly found in our analysis. The documented resources depict a patient with a positive attitude (with ‘no depressive thoughts’) and a tight social network including children and grandchildren. This link between life‐world and health resources is seen at T1 and T2, while the care plan at T3 only includes ‘being positive’ as a health resource (Table ​ (Table6 6 ).

Life‐world and health resources of a male patient, 72 years old

The following example includes more details about the patient's social network. The patient has comprehensive support and previous experience of giving and receiving support in difficult times (Table ​ (Table7 7 ).

Life‐world resources of a female patient, 64 years old

3.2.2. Medical/health resources

Some care plans featured medical/health resources from T1 through to T3 (Table ​ (Table8 8 ).

Health resources of female patient, 70 years old

Many patients wish to get better and return to life before a disruptive event, such as getting ill (Bury, 1982 ). However, the example above does not connect to the patient's life‐world, and the resources are more ‘standalone’.

4. DISCUSSION

This article offers two important insights about life‐world and medical/health goals and resource documentation in person‐centred care plans for older people with acute coronary syndrome. First, the analysis illustrates the overlaps and differences between life‐world and medical/health goal and resource reporting. Second, it demonstrates that documented goals and resources change over time.

Our analysis showed that many medical/health goals aligned with evidence‐based guidelines (Socialstyrelsen, 2018a , 2018b ). However, these goals do not necessarily reflect the person's own wishes and preferences, and RNs may have steered patients towards these practical guideline‐based goals. This is reflective of two issues. First, our findings confirm a lack of knowledge regarding collaborative goal setting (Vermunt et al., 2017 ) and documentation, even in staff trained in person‐centred care. Second, healthcare professionals prioritise medical/health goal setting because it is a legal obligation. Healthcare professionals who fail to set medical/health goals may be liable to legal prosecution (Berntsen et al., 2015 ). Accordingly, it is currently in the healthcare professional's self‐interest to comply with legal‐professional requirements rather than prioritise person‐centred principles (Berntsen et al., 2015 ). This might explain RNs' tendency to uphold stable and familiar routines rather than test newly acquired practices (Naldemirci et al., 2017 ).

This article reports a secondary analysis of care plans from a randomised controlled trial. Since RNs trained in person‐centred care wrote the care plans, they may not reflect routine clinical practice settings. Notwithstanding the controlled nature of the setting, our analysis demonstrated that the documentation of life‐world goals decreased over time, and the documentation of medical/health goals increased. RCT studies are designed to show the effect of an intervention between selected study groups. The controlled nature of the study context and the selected study population often precludes the direct transfer of RCT results to real‐world settings. Previous research shows that patients recruited to clinical trials usually have better outcome measures than non‐participants. Research shows that adherence to the study protocol (regardless if an intervention or placebo) is independently associated with outcomes (Granger et al., 2005 ; Rogers et al., 2021 ). This, combined with the attention of carefully trained RNs, might suggest that in non‐trial settings, the analysis of care plans might reveal similar results, if not greater attrition of life‐world goals. This assumption supports previous research that underscores the difficulty in sustaining person‐centred care over time (Ekman et al., 2021 ; Naldemirci et al., 2017 ).

Life‐world goals may relate to patients' social, cultural or personal lives. Therefore, they are more difficult to describe as they extend beyond the realm of the more clearly defined medical/health goals. However, the boundaries are fluid: medical/health goals may become life‐world goals if they are aligned with the patient's wishes, needs or preferences. This alignment is critical: Berntsen et al. ( 2015 ), who propose a goal hierarchy, argue that goals can be aligned by prioritising the patient's health rather than medical goals. Our analysis shows this type of aligned goal setting that places health goals at the top of the ‘goal hierarchy’. For example, the evidence‐based recommendation to pursue regular physical exercise becomes a life‐world goal if the patient can connect it with a favourite pastime, such as cycling. Still, our analysis also demonstrates that medical/health and life‐world goals do not always overlap. This may point towards a need to discuss goal hierarchies in person‐centred care training.

Our analysis shows that the reporting of resources followed the same pattern as the reporting of the goals. From T1 to T3, fewer life‐world resources were recorded, while medical/health resource reporting increased. The biomedical paradigm regards the patient in isolation, while person‐centred care sees the patient as an individual in a social context of relationships with family, friends and colleagues (Dewing, 2008 ; Kitwood, 1997 ). However, life‐world resources such as a supportive partner or a strong social network can play an important role in achieving desired goals.

We can only speculate why goal and resource reporting shifted over time. The care plans were our sole data source, and we did not have access to additional data about the communication between patients and the RNs. However, the shifts may point to a changing tone in the communication, and they may not necessarily be related to fading person‐centred care and life‐world orientation. Previous research shows that patients tend to be more receptive to clinicians' guidance in setting goals once a sense of ease and trust is established (Edvardsson et al., 2005 ; Wolf et al., 2017 ); hence, medicalised language and content may occur. In contrast, Broderick and Coffey ( 2012 ) saw an increase in person‐centred documentation over time. This may be due to different settings. Our study analysed patient records from different settings (inpatient, outpatient clinic and primary care clinic), while Broderick and Coffey ( 2012 ) examined care records from a long‐term setting. Long‐term care offers patients and staff the time and space to get to know each other as ‘persons’; this might be more difficult on a care trajectory that includes several settings.

In our analysis of the care plans, we did not know whether the life‐world goals and resources were recorded in the patients' own words or whether the RNs interpreted the patients' narratives. Nursing documentation may feature the patient's voice, the nurses' view of the patient's thoughts or situation, or the mutual view of the relationship (Laitinen et al., 2010 ). Our sample does not enable us to draw conclusions about the perception of the relationship between patients and RNs. The relationship and discussion of goals and resources may have been more person‐centred than the notes reveal. Patients may not be used to or encouraged to talk about life‐world goals, as healthcare professionals struggle to elicit these (Wolf et al., 2017 ). Likewise, patient‐related factors can hamper life‐world goal elicitation. Person‐centred care encourages healthcare professionals to see patients as persons, to talk to them like partners, rather than talking about or above them (Britten et al., 2017 ). However, patients may have been socialised into taking a passive role or may not be familiar with collaborative goal setting (Wolf et al., 2017 ). Other patients may prefer to leave the care decisions to clinicians (Chewning et al., 2012 ) or agree with clinicians to avoid challenging their authority or make undue demands on their time (Joseph‐Williams et al., 2014 ).

In a previous study (Naldemirci et al., 2017 ), we underscored that narrative‐inducing questions did not immediately lead to the 2021 of life‐world goals because many patients were not used to telling stories and setting goals. Patients tended to articulate generic goals like ‘being healthy’. We also observed that asking follow‐up questions enabled RNs to identify specific life‐world goals more easily. Follow‐up questions could be, for example: ‘ Ok, what would you like to do when you are healthy again?’ ‘ Would you like to be able to spend more time in your garden when you go home?’ (Naldemirci et al., 2017 , 2020 ).

However, the concept of ‘resources’ is even less well‐established than ‘goals’ in healthcare. ‘Resources’ are a distinctive aspect of person‐centred care, as the patient is regarded as a ‘capable person’ (Ekman et al., 2011 ). To date, patients' resources are rarely considered in clinical communication (Naldemirci et al., 2020 ) and what exactly could and should be considered a patient resource is not defined in previous literature.

Our analysis shows that even under the controlled conditions of an RCT testing person‐centred care, the alignment of goals with resources was unclear and inconsistent. This emphasises the value of asking follow‐up questions such as ‘What can help you achieve this goal?’ to help patients identify the resources they need. Our findings indicate that the elicitation of goals and resources should be more strongly emphasised in person‐centred care training.

Ekman et al. ( 2021 :3) propose that future research in person‐centred care should ‘describe and evaluate different forms of health plans, including those recorded and written only by patients and relatives'. This is one of the first papers to make a secondary analysis of the content of care plans over time (an exception is Jansson et al., 2018 ). Whatever their limitations, care plans are the basis for ongoing care. As such, they should reflect the perspectives of both healthcare professionals and patients alike (Heckemann et al., 2020 ).

4.1. Limitations and recommendations

This study builds on an analysis of care plans generated within an RCT and written by RNs trained in person‐centred care. Therefore, the documentation may not be representative of usual care as it was part of a clinical trial pathway. We were unable to interview RNs and patients to triangulate our results. Moreover, we could not explore whether the life‐world goals and resources we identified were mutually agreed upon or merely based on the RNs' interpretation of the patient narrative. In particular, the study highlights that further research is needed to achieve continued person‐centred care documentation along a care pathway that involves different care levels.

This study raises questions regarding person‐centred care documentation, such as what prevents healthcare professionals from focusing on the life‐world of their patients, or, at a more abstract level, to which degree the concept of person‐centredness is compatible within the current framework of medical treatment. Future qualitative studies should address these questions. Despite its limitations, our analysis adds much insight as few studies address the actual content of person‐centred care plans.

5. CONCLUSION

This paper reports a secondary analysis of care plans for older persons from a randomised controlled trial evaluating a person‐centred care intervention in patients with acute coronary syndrome. Nurses with training in the theory and practice of person‐centred care had written the care plans. We found both overlaps and differences between life‐world and medical/health goals and resources. We also demonstrated that documented goals and resources change over time. However, we need to know more about whether the goals and resources documented in care plans accurately reflect the wishes of older patients and if similar results can be found in real‐world data. Placing life‐world goals at the top of the ‘goal hierarchy’ will enable alignment with medical/health goals, as this will tap into people's motivation and increase chances that supportive behaviours will be adopted during the recovery after a cardiac event.

6. IMPLICATIONS FOR PRACTICE

Life‐world and medical/health goals differ, both require consideration in person‐centred care planning. Patients’ resources that support their recovery and goal attainment are important, but not sufficiently considered in person‐centred care.

AUTHOR CONTRIBUTIONS

Birgit Heckemann: Conceptualisation, methodology, data curation, investigation, formal analysis, project administration, supervision, visualisation, writing (original draft preparation; review and editing) (shared lead). Doris Lydahl: Conceptualisation, methodology, data curation, investigation, formal analysis, project administration, supervision, writing (original draft preparation; review and editing) (shared lead). Axel Wolf: Conceptualisation, methodology, formal analysis, validation, writing (original draft preparation; review and editing). Helen Lloyd: Conceptualisation, methodology, formal analysis, validation, writing (original draft preparation; review and editing). Nicky Britten: Conceptualisation, methodology, formal analysis, validation, writing (original draft preparation; review and editing), Writing (original draft preparation; review and editing). Öncel Naldemirci: Conceptualisation, methodology, formal analysis, validation, writing (original draft preparation; review and editing).

CONFLICT OF INTEREST

The authors have no conflict of interest to declare.

ACKNOWLEDGEMENTS

The authors would like to acknowledge the University of Gothenburg Centre for Person‐centred Care for funding this project. We thank Analisa Avila, ELS, of Edanz Group ( https://en‐author‐services.edanzgroup.com/ac ) for editing a draft of this manuscript.

Lydahl, D. , Britten, N. , Wolf, A. , Naldemirci, Ö. , Lloyd, H. , & Heckemann, B. (2022). Exploring documentation in Person‐centred care: A content analysis of care plans . International Journal of Older People Nursing , 17 , e12461. 10.1111/opn.12461 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

DATA AVAILABILITY STATEMENT

• Barry, C. A. , Stevenson, F. A. , Britten, N. , Barber, N. , & Bradley, C. P. (2001). Giving voice to the lifeworld. More humane, more effective medical care? A qualitative study of doctor‐patient communication in general practice . Social science & medicine , 53 ( 4 ), 487–505. 10.1016/s0277-9536(00)00351-8 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Berntsen, G. K. R. , Gammon, D. , Steinsbekk, A. , Salamonsen, A. , Foss, N. , Ruland, C. , & Fønnebø, V. (2015). How do we deal with multiple goals for care within an individual patient trajectory? A document content analysis of health service research papers on goals for care . British Medical Journal Open , 5 ( 12 ), e009403. 10.1136/bmjopen-2015-009403 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Björvell, C. , Wredling, R. , & Thorell‐Ekstand, I. (2003). Improving documentation using a nursing model . Journal of Advanced Nursing , 43 ( 4 ), 402–410. 10.1046/j.1365-2648.2003.02751.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Blair, W. , & Smith, B. (2012). Nursing documentation: Frameworks and barriers . Contemporary Nurse , 41 ( 2 ), 160–168. 10.5172/conu.2012.41.2.160 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Britten, N. , Ekman, I. , Naldemirci, Ö. , Javinger, M. , Hedman, H. , & Wolf, A. (2020). Learning from Gothenburg model of person centred healthcare . BMJ , 370 , m2738. 10.1136/bmj.m2738 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Britten, N. , Moore, L. , Lydahl, D. , Naldemirci, O. , Elam, M. , & Wolf, A. (2017). Elaboration of the Gothenburg model of person‐centred care . Health Expectations , 20 ( 3 ), 407–418. 10.1111/hex.12468 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Broderick, M. C. , & Coffey, A. (2012). Person‐centred care in nursing documentation . International Journal of Older People Nursing , 8 , 309–318. 10.1111/opn.12012 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bury, M. (1982). Chronic illness as biographical disruption . Sociology of Health & Illness , 4 ( 2 ), 167–182. 10.1111/1467-9566.ep11339939 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Chewning, B. , Bylund, C. L. , Shah, B. , Arora, N. K. , Gueguen, J. A. , & Makoul, G. (2012). Patient preferences for shared decisions: A systematic review . Patient Education and Counseling , 86 ( 1 ), 9–18. 10.1016/j.pec.2011.02.004 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Dellenborg, L. , Wikström, E. , & Erichsen, A. A. (2019). Factors that may promote the learning of person‐centred care: an ethnographic study of an implementation programme for healthcare professionals in a medical emergency ward in Sweden . Advances in Health Sciences Education , 24 ( 2 ), 353–381. 10.1007/s10459-018-09869-y [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Dewing, J. (2008). Personhood and dementia: Revisiting Tom Kitwood's ideas . International Journal of Older People Nursing , 3 ( 1 ), 3–13. 10.1111/j.1748-3743.2007.00103.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Ebrahimi, Z. , Patel, H. , Wijk, H. , Ekman, I. , & Olaya‐Contreras, P. (2021). A systematic review on implementation of person‐centered care interventions for older people in out‐of‐hospital settings . Geriatric Nursing , 42 ( 1 ), 213–224. 10.1016/j.gerinurse.2020.08.00 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Edvardsson, J. D. , Sandman, P. O. , & Rasmussen, B. H. (2005). Sensing an atmosphere of ease: A tentative theory of supportive care settings . Scandinavian Journal of Caring Sciences , 19 ( 4 ), 344–353. 10.1111/j.1471-6712.2005.00356.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Ekman, I. , Ebrahimi, Z. , & Olaya Contreras, P. (2021). Person‐centred care: Looking back, looking forward . European Journal of Cardiovascular Nursing , 20 ( 2 ), 93–95. 10.1093/eurjcn/zvaa025 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Ekman, I. , Swedberg, K. , Taft, C. , Lindseth, A. , Norberg, A. , Brink, E. , & Sunnerhagen, K. S. (2011). Person‐centered care—ready for prime time . European Journal of Cardiovascular Nursing , 10 ( 4 ), 248–251. 10.1016/j.ejcnurse.2011.06.008 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Fors, A. , Ekman, I. , Taft, C. , Björkelund, C. , Frid, K. , Larsson, M. E. , & Swedberg, K. (2015). Person‐centred care after acute coronary syndrome, from hospital to primary care—a randomised controlled trial . International Journal of Cardiology , 187 , 693–699. 10.1016/j.ijcard.2015.03.336 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Frank‐Stromborg, M. , Christensen, A. , & Elmhurst, D. (2001). Nurse documentation: Not done or worse, done the wrong way–part I . Oncology Nursing Forum , 28 ( 4 ), 697–702. [ PubMed ] [ Google Scholar ]
• Granger, B. B. , Swedberg, K. , Ekman, I. , Granger, C. B. , Olofsson, B. , McMurray, J. J. , & Pfeffer, M. A. (2005). Adherence to candesartan and placebo and outcomes in chronic heart failure in the CHARM programme: Double‐blind, randomised, controlled clinical trial . The Lancet , 366 ( 9502 ), 2005–2011. 10.1016/S0140-6736(05)67760-4 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Gyllensten, H. , Björkman, I. , Jakobsson Ung, E. , Ekman, I. , & Jakobsson, S. (2020). A national research centre for the evaluation and implementation of person‐centred care: Content from the first interventional studies . Health Expectations: An International Journal of Public Participation in Health Care and Health Policy , 23 ( 5 ), 1362–1375. 10.1111/hex.13120 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Håkansson Eklund, J. , Holmström, I. K. , Kumlin, T. , Kaminsky, E. , Skoglund, K. , Höglander, J. , & Summer Merenius, M. (2019). Same same or different? A review of reviews of person‐centred and patient‐centred care . Patient Education and Counseling , 1 , 3–11. 10.1016/j.pec.2018.08.029 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Heckemann, B. , Chaaya, M. , Jakobsson Ung, E. , Olsson, D. S. , & Jakobsson, S. (2020). Finding the person in electronic health records. A mixed‐methods analysis of person‐centered content and language . Health Communication , 37 , 418–424. 10.1080/10410236.2020.1846275 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Jansson, I. , Fors, A. , Ekman, I. , & Ulin, K. (2018). Documentation of person‐centred health plans for patients with acute coronary syndrome . European Journal of Cardiovascular Nursing , 17 ( 2 ), 114–122. 10.1177/1474515117718415 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Jefferies, D. , Johnson, M. , & Griffiths, R. (2010). A meta‐study of the essentials of quality nursing documentation . International Journal of Nursing Practice , 16 ( 2 ), 112–124. 10.1111/j.1440-172x.2009.01815.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Joseph‐Williams, N. , Elwyn, G. , & Edwards, A. (2014). Knowledge is not power for patients: A systematic review and thematic synthesis of patient‐reported barriers and facilitators to shared decision making . Patient Education and Counseling , 94 ( 3 ), 291–309. 10.1016/j.pec.2013.10.031 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kindblom, K. , Edvardsson, D. , Boström, A. M. , & Vikström, S. (2021). A learning process towards person‐centred care: A second‐year follow‐up of guideline implementation . International Journal of Older People Nursing , e12373 , 10.1111/opn.12373 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kitwood, T. M. (1997). Dementia reconsidered: The person comes first . Open University Press. [ Google Scholar ]
• Laitinen, H. , Kaunonen, M. , & Astedt‐Kurki, P. (2010). Patient‐focused nursing documentation expressed by nurses . Journal of Clinical Nursing , 19 ( 3–4 ), 489–497. 10.1111/j.1365-2702.2009.02983.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Moore, L. , Britten, N. , Lydahl, D. , Naldemirci, Ö. , Elam, M. , & Wolf, A. (2017). Barriers and facilitators to the implementation of person‐centred care in different healthcare contexts . Scandinavian Journal of Caring Sciences , 31 ( 4 ), 662–673. 10.1111/scs.12376 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Naldemirci, Ö. , Wolf, A. , Elam, M. , Lydahl, D. , Moore, L. , & Britten, N. (2017). Deliberate and emergent strategies for implementing person‐centred care: A qualitative interview study with researchers, professionals and patients . BMC Health Services Research , 17 ( 1 ), 527. 10.1186/s12913-017-2470-2 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Naldemirci, Ö. , Britten, N, , Lloyd, H. , Wolf, A. (2020). The potential and pitfalls of narrative elicitation in person‐centred care . Health expectations : an international journal of public participation in health care and health policy , 23 ( 1 ), 238–246. 10.1111/hex.12998 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Rogers, J. R. , Liu, C. , Hripcsak, G. , Cheung, Y. K. , & Weng, C. (2021). Comparison of clinical characteristics between clinical trial participants and non‐participants using electronic health record data . JAMA Network Open , 4 ( 4 ), e214732. 10.1001/jamanetworkopen.2021.4732 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Saranto, K. , & Kinnunen, U. (2009). Evaluating nursing documentation‐research designs and methods: Systematic review . Journal of Advanced Nursing , 65 ( 3 ), 464–476. [ PubMed ] [ Google Scholar ]
• Schellinger, S. E. , Anderson, E. W. , Frazer, M. S. , & Cain, C. L. (2018). Patient self‐defined goals: Essentials of person‐centered care for serious illness . American Journal of Hospice and Palliative Medicine , 35 ( 1 ), 159–165. 10.1177/1049909117699600 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Sefcik, J. S. , Madrigal, C. , Heid, A. R. , Molony, S. L. , Van Haitsma, K. , Best, I. , & Kolanowski, A. (2020). Person‐centered care plans for nursing home residents with behavioral and psychological symptoms of dementia . Journal of Gerontological Nursing , 46 ( 11 ), 17–27. 10.3928/00989134-20201012-03 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Socialstyrelsen . (2018a). Nationella riktlinjerför hjärtsjukvård. Stöd för styrning och ledning . [National guidelines for cardiac care. Support for management]. Socialstyrelsen. [ Google Scholar ]
• Socialstyrelsen . (2018b). Nationella riktlinjerför hjärtsjukvård. Vetenskapligt underlag. Bilaga . [National guidelines for cardiac care. Scientific evidence]. Socialstyrelsen. [ Google Scholar ]
• Sundler, A. J. , Hjertberg, F. , Keri, H. , & Holmström, I. K. (2020). Attributes of person‐centred communication: A qualitative exploration of communication with older persons in home health care . International Journal of Older People Nursing , 15 ( 1 ), e12284. 10.1111/opn.12284 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Vermunt, N. , Harmsen, M. , Westert, G. P. , Olde Rikkert, M. , & Faber, M. J. (2017). Collaborative goal setting with elderly patients with chronic disease or multimorbidity: A systematic review . BMC Geriatrics , 17 ( 1 ), 167. 10.1186/s12877-017-0534-0 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Wolf, A. , Moore, L. , Lydahl, D. , Naldemirci, Ö. , Elam, M. , & Britten, N. (2017). The realities of partnership in person‐centred care: a qualitative interview study with patients and professionals . British Medical Journal Open , 7 ( 7 ), e016491. 10.1136/bmjopen-2017-016491 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

Rachel Lee McKenna

Psychiatrist , md, my practice at a glance.

MD Support, LLC

1110 Pinellas Bayway South

Saint Petersburg, FL 33715

• Individual Sessions $450
• Pay by ACH Bank transfer, American Express, Cash, Discover, Health Savings Account, Mastercard, Paypal, Visa, Wire

Qualifications

• Verified by Psychology Today License: Florida / ME118618 Rachel Lee McKenna
• In Practice for 15 Years
• Board Certification by General Psychiatry
• Certificate from American Board of Psychiatry and Neurology 2013
• Certificate from American Board of Child and Adolescent Psychiatry 2014
• University of Missouri Kansas City , Graduated 2009

Specialties and Expertise

Top specialties.

• Bipolar Disorder
• Alcohol Use
• Anger Management
• Asperger's Syndrome
• Behavioral Issues
• Coping Skills
• Developmental Disorders
• Dissociative Disorders (DID)
• Eating Disorders
• Emotional Disturbance
• Family Conflict
• Impulse Control Disorders
• Medication Management
• Mood Disorders
• Obsessive-Compulsive (OCD)
• Oppositional Defiance (ODD)
• Peer Relationships
• Relationship Issues
• Self Esteem
• Self-Harming
• Sleep or Insomnia
• Substance Use
• Suicidal Ideation
• Thinking Disorders
• Trauma and PTSD
• Women's Issues

6 Endorsements

Client Focus

Participants, communities, treatment approach, types of therapy.

• Applied Behavioral Analysis (ABA)
• Cognitive Behavioral (CBT)
• Emotionally Focused
• Family / Marital
• Family Systems
• Interpersonal
• Mindfulness-Based (MBCT)
• Motivational Interviewing
• Person-Centered
• Prolonged Exposure Therapy
• Psychodynamic
• Reality Therapy
• Strength-Based
• Structural Family Therapy
• Trauma Focused

Primary Location

Nearby areas.

• Saint Petersburg, FL