Legal Implications of Patient-Centered Care

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Background: The objective of this scoping review is to determine whether person-centred care (CCP) has a relational and ethical perspective in its quest to ensure high-quality and safe health care. To do this, we must first link the existing literature on CCP and relational ethics. In this regard, the specific characteristics that define PCC and relational ethics were identified. Dimensions of the CCP include: patient-provider alignment, improved health outcomes, improved patient safety, individual expectations, integrating patients into the environment, patient as person, patient as an active part of society, dialogue and interaction, exchange of experiences, and documentation of the patient`s (person) story. The relational ethics framework includes the following actions: mutual respect, commitment, embodied knowledge, environment and uncertainty. The M/P CCFP is a six-step approach. It has been influenced by the dimensions of patient-centred care offered by the Picker Commonwealth program for patient-centred care launched in 1987 [8]. Picker-Commonwealth derived its categories from patient focus groups, emphasizing their importance in an ethical context, stating that «respect for the individuality of patients is the foundation of humane medical care» [2]. The Picker-Commonwealth categories were described in a 2001 report by the Institute of Medicine (now the National Academy of Medicine), which stated that patient-centred care is one of the six goals of a twenty-first century health care system [9]. Moreover, as the founder of the Institute for Healthcare Improvement, Donald Berwick, has pointed out, the patient-centred approach is «a distinct dimension of health care quality» [10]. However, while the articles reviewed showed that the functions and pillars of the CCP are assumed through relational ethical acts, the way CCP is practiced seems to be lacking for some authors, and for others, CCP seems to be closer to the relational ethics framework. Therefore, CCP cannot be understood or practiced in its entirety within the relational ethical framework, so much so that Rockwell (59) criticized PCC in residential care facilities as remaining in the biomedical model and concluded and recommended expanding the focus on relational care. This means that PCC does not always fully embrace relational ethical components.

This observation also results from review articles in which, for example, the relational ethical action of uncertainty was not recurrent and the other actions. Based on these assumptions, the purpose of this scoping review is to examine whether or not PCC has a relational and ethical perspective in its quest to provide quality and safe health care. The research questions that guided this article are: (i) To what extent is person-centred care linked to relational ethics? and (ii) what is the value of PCC as an ethical approach to better and safer health care? Meehan H; Royal United Hospitals Bath. RUH End-of-Life Care Annual Report: April 2014-March 2015. 10 September 2015. Retrieved 30 November 2015. Berwick DM. What «patient-centered» should mean: the confession of an extremist.

Aff Health (Millwood). 2009;28(4):W555. University of California, San Francisco Benioff Children`s Hospital. Family-centred care. Retrieved 24 November 2015. Define, measure and maintain a patient-centered culture. Airplane; January 2013:3.

Retrieved 30 November 2015. Based on the latest research and guidelines [1, 4, 10, 14], these strategies for effective patient- and family-centered care are proposed: Reed P, Conrad DA, Hernandez SE, Watts C, Marcus-Smith M. Innovation in Patient-Centered Care: Lessons from a Qualitative Study of Innovative Health Organizations in Washington State. BMC Fam Pract. 2012;13:120. As medical care becomes more collaborative and the focus is on holistic care for patients and their sources of support, the principles of PFCC are now commonly taught to medical residents [14, 15]. For example, to be recognized by the Magnet Recognition Program developed by the American Nurses Credentialing Center, hospitals must implement family-centered care [16]. Not only for pediatrics, but also for patients of all ages, patient and family-centered care applies and can be practiced in any health care facility and at any health care point. The Joint Commission`s proposals include providing discharge instructions that meet the patient`s needs, informing patients about their rights, and identifying patients` dietary restrictions that affect treatment [1]. Empowering patients, aligning care with patients` needs and values, and providing information to patients and their families are other IOM recommendations that support the PFCC [8]. Hospital Care Committee; Institute for Patient and Family Centred Care.