King’s System Theory Applied to Patient’s Experience

Introduction

A patient’s individual experiences of disease are essential in designing an appropriate treatment plan. Whereas a medical diagnosis or prognosis can reveal an illness, only a persistent investigation of the patient’s experiences can help the health care team understand the disease. In a patient-centered (PCC) model, a physician considers the patient’s views, feelings, or fears about his condition, opinion about the effect of the problem on his/her life, and expectations about the treatment (McComarck, Roberts, Meyer, Morgan & Boscart, 2012). The aim is to use the patient’s cues to understand what he/she is going through from his/her perspective. Since it incorporates patient views in decision-making, this approach leads to better outcomes in terms of patient and staff satisfaction and medical compliance. The purpose of this paper is to assess a patient’s experience with inpatient care using a nursing theory to determine the breakdowns in the PCC model. It will analyze the extent to which the clinical staff utilized the patient’s experiences in the planning, evaluation, and delivery of his care.

Assessment of the Care Experience

Overall, the patient seems to value the type of care he received in the hospital. He feels confident that the collaboration between the professionals ensured a judicious assessment of his illness. To some extent, the care received augured well with his goals, as the medical team was supportive, responded to his concerns, and provided him with information during his stay. He cites the medical staff’s reassurance and support as the best experience during his hospital stay. However, he also says that his wish to be discharged early was not granted. The patient seems to value home-based care and family caregivers. The medical team may have interpreted home-based care as disruptive to her recovery progress. However, the patient feels that his family can provide the best care, hence his desire for home-based care. This explains why he was anxious and stressed during his hospital stay.

The patient also seems to dislike the way decisions were made. He gives a lower rating of his experience at the hospital because he feels that the medical team seldom considered his perspectives and cultural factors in making decisions. Culture influences individual preferences for particular medical care and treatment. Therefore, the medical team should be sensitive to the patient’s cultural factors in order to provide patient-centered care.

Theory Application

Nursing Theory Identified

King’s system theory holds that a person’s interactions with “social systems influence behavior within the systems” (McCance, McCormack & Dewing, 2011, p. 7). It means that a person’s view and perspective, which develop from his/her interactions with external and internal environments, shape his or her behavior. In this view, the theory focuses on individual growth and self-concept; hence, it is a system-based model. The nursing process occurs within an interpersonal system (nurse-patient relationship) whose aim is to restore the health and functioning of the ‘whole person’ (Lown & Manning, 2011). Interactions between a patient and a nurse depend on how they perceive each other. The interactions develop into transactions, wherein the patient and nurse display behavior centered on common goals. Thus, through the interactions, a nurse and a patient influence each other’s behavior.

Relevancy of the Selected Theory to the Individual’s Healthcare Experience

Chang is a 72-year-old male who has a fever. He lives with his wife, who he describes as close and supportive. Four months ago, Chang underwent knee surgery and contracted bacteriemia, which was cured. He is now under antibiotic therapy to control a re-infection but seems anxious to go home. Based on King’s theory, the patient is a personal system interacting with the external and internal factors in the surroundings. The nurse’s interaction with the patient constitutes an interpersonal system. During the transaction process, the two share their perceptions, views, responses, and emotions. The nurse uses her perceptual skills to collect and interpret patient cues and behavior. However, she should share her interpretations with the patient, as perceptions are often subjective. According to the theory, the self is a subjective conception of one’s views, experiences, and beliefs. Thus, the nurse should pay attention to the patient’s cultural/spiritual beliefs.

Based on King’s framework, the aim of the interaction process is to identify patient goals. In this view, the patient should play a role in setting the goals. However, the nurse should guide the patient through this process because Chang lacks the resources to make sound decisions. Roseman, Osborne-Stafsnes, Amy, Boslaugh, and Slate-Miller (2013) note that the King’s system framework advises nurses to guide patients to set goals that reflect their “capabilities, limitations, priorities, and situation” (p. 6). In this case, Chang’s immediate goals are to reduce his fever and discomfort. A nursing assessment will reveal if these goals are congruent with the medical goals. In addition, the transaction requires the patient to participate in the attainment of the same goals.

Evaluation and Critical Reflection

The Level of Patient-Centered Care the Individual Received

The focus of the PCC model is on the unique personal experiences that affect health outcomes. An article by Altringer (2011) recommends that physicians should explore patients’ ideas about the cause of the illness as well as their concerns, expectations, and fears about the care being provided. In Chang’s case, aspects of patient-centered care manifest in the diagnosis of the illness, where the team sought his opinion about the cause of the disease. His view was that he contracted an infection through the wound on his knee. However, the team did not consider his concerns and expectations in formulating the medical care. For instance, he did not participate in the decision to transfuse him with blood. Additionally, they did not consider the patient’s cultural and ethnic factors in recommending the treatments, nor did they honor his desire to recuperate at home, where he thought he would receive emotional support.

The Importance of the Meaning and Significance of a Patient’s Experience

Patients provide important insights into the nature of their illnesses. A patient’s experience with a condition facilitates quality care that results in better health outcomes (Broderick & Coffey, 2013). Most importantly, the involvement of patient ideas about the illness enhances the physician’s understanding of the condition. It allows providers to deliver care that is “respectful and responsive to individual patient preferences, values, and needs” (Cassel & Guest, 2012, p. 809). A diagnosis of a chronic condition can heighten anxiety and fear in a patient. The medical care system may appear impersonal to the patient. Thus, an exploration of a patient’s experience with the health care system yields essential information for providing care that is responsive to his preferences.

The revisions in providing patient-centered care to the individual

In Chang’s case, his request for an early discharge is an indication that the health care system was not responsive to his emotional state. As his nurse, the writer would have involved the patient’s views in decision-making to promote comfort-oriented care. Additionally, the writer would address the cultural barriers to building an effective nurse-patient relationship. Establishing patient trust through open and honest communication can help reveal the stressors underlying his feelings. In addition, the writer would have discussed with the family about the patient’s medical care. Besides facilitating decision-making, family caregivers can help allay any fears and concerns that affect patient outcomes.

The Role of the Nurse Advocate in Coordinating Inter-Professional Care for the Individual

Chang’s medical care involved an inter-professional team comprising of a physician, specialists, and a nurse. The nurse coordinated inter-professional collaboration in the assessment and treatment of the patient. She consulted an orthopedic surgeon to determine whether the infection was being caused by the wound on his knee. She collaborated with the labs in running the blood tests and the imaging of his knee. She was also involved during the assessment. The family contributed important data about the patient’s medical history.

The Role of the Nurse in the Provision of Patient-Centered Care

Understanding the patient’s care experience is essential in quality care delivery. In the PCC model, a nurse plays an essential role in providing support, coordinating inter-professional care, and communicating with the patient’s family during care delivery. The writer has learned that nurses, as professionals closest to the patient, are better placed to help with goal setting and care planning to achieve the desired goals. Thus, besides coordinating care, nurses also help gather the views of patients and incorporate them into care planning and delivery models.

Conclusion

Patient-centered care involves patient experiences during care planning, delivery, and assessment. In Chang’s case, a nurse-coordinated partnership involving different professionals facilitated his diagnosis and treatment. An important finding of this analysis is that cultural factors play a role in determining a patient’s satisfaction with health care. Chang was anxious to go home because the health care system was less responsive to his needs. Therefore, incorporating patient ideas into care delivery and planning is essential in promoting its quality.

References

Altringer, B. (2011). The emotional experience of patient care: a case for innovation in health care design. Journal of Health Services Research Policy, 15(3), 174-177

Broderick, M., & Coffey, A. (2013). Person-centered care in nursing documentation. International Journal of Older People Nursing, 8(4), 309-318.

Cassel, C., & Guest, J. (2012). Choosing wisely: helping physicians and patients make smart decisions about their care. Journal of American Medical Association, 307(17), 801-812.

Lown, B., & Manning, F. (2011). The Schwartz Center Rounds: Evaluation of an Interdisciplinary Approach to Enhancing Patient-Centered Communication, Teamwork, and Provider Support. Academic Medicine, 85(6):1073-1081

McCance, T., McCormack, B., & Dewing, J. (2011). An exploration of person-centredness in practice. Online Journal of Issues in Nursing, 16(2), 1-14.

McComarck, B., Roberts, T., Meyer, J., Morgan, D., & Boscart, V. (2012). Appreciating the ‘person’ in long-term care. International Journal of Older People Nursing, 7(4), 284-294.

Roseman, D., Osborne-Stafsnes, J., Amy, C., Boslaugh, S., & Slate-Miller, K. (2013). Early Lessons From Four’ Aligning Forces For Quality’ Communities Bolster The Case For Patient-Centered Care. Healthy Affairs, 32(2), 1-8.

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