ADEA CCI Liaison Ledger

Perspective on Person-centered Care: Nursing Education

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Joanna DischThe ADEA CCI Liaison Ledger talks with Joanne Disch, Ph.D., RN, FAAN, Professor ad Honorem, University of Minnesota
School of Nursing


Liaison Ledger: What would need to change in nursing education (such as curriculum, accreditation, licensure, admissions standards) to produce graduates that are person-centered care providers?
Joanne Disch: Curriculum, accreditation, licensure and the like are secondary. The most profound change that has to occur first is attitudinal. Educators need to recognize that the nature of the relationship with the person and their family—however the person defines that—has to change. The person and their family have to become the source of control and full partners in care.

The relationship for decades, if not hundreds of years, has been a dependent one where the clinician—whether the nurse, the physician or the dentist—is the ultimate expert, and the person is the patient. We have to recognize, and really take to heart, that we are in a partnered relationship. We bring forward our clinical expertise and they bring forward their lifelong experience and understanding of what their values, their needs and their preferences are. The curriculum has to change to embody that whole philosophy if we want to produce person-centered care providers.

Liaison Ledger: Where does a health professions education association begin in trying to transform the faculty perspective from patient-centered to person-centered?
Joanne Disch: Organizations have to look at what is in their principles, their “essentials” (competency) documents, and make sure their documents reflect this shift. Organizations also need to offer training and development. Person-centered care requires a whole new skill set. When you’re going from your health professional being an expert who rules the decision-making process to being in a partnered relationship and having to provide information and context on how people make decisions that work for them, everything has to fall in line. The education-standard-setting bodies need to look to make sure they’re reinforcing that relationship and helping their constituents develop the necessary competencies.

Liaison Ledger: What does the nursing school of the future look like to you if the predominant model of practice is person-centered?
Joanne Disch: The nursing school of the future would take that concept and go one step further. If we’re talking about person-centered care, we should talk about student-centered learning. So, just as we’re talking about a partnered relationship with persons and their families, how you get there is by having a partnered relationship with students, and that means a student-centric, student-driven curriculum. We need to create individualized opportunities for students to learn and let them have more say in how they learn. Additionally, anything that relates to the curriculum should include the input of persons and their families—using more standardized patients or bringing families into the learning environment or getting students out into the community to learn firsthand from patients and their families about what they think they need. 

Responses from our authors
Andrew Spielman: Whatever comment about attitudinal change is coming from the nursing side, you can imagine that it is even more magnified when it comes to dental students, so there has to be an attitudinal change in the way they view the patient. Giving up control of the data is at the heart of another revolution that I think Dr. Disch is also alluding to. The professions—lawyers, accountants and whatnot—had a very privileged contract with society. Now with digitized information, that’s fraying. The professions are going to have to establish a different type of relationship with their clients—in our case the patient—and that needs to be more person-centered. The patients will demand it.

Muhammad Walji: I agree. The other market force will be the patient. There does seem to be more of a shift as patients have more and more information, which will drive us toward person-centered care.

Nadeem Karimbux: Many of the things that we’re talking about will take faculty time to develop as a skill in terms of being observational, giving feedback to students about behavior and attitudes. We will be charged with making sure that through faculty development we help faculty make the shift into providing feedback that is much more formative in nature rather than summative.

Andrew Spielman: As far as student-centered learning goes, it’s a fascinating idea. Everybody learns in different ways, at different speeds, different tracks. Dental schools have been very prescriptive. If we want to have multiple tracks going on for a class of students, one would have to imagine that digitized, augmented-reality and virtual-reality education will be widely available, but that’s like 30 years in the future in my mind.

Muhammad Walji: It’s worth mentioning that we feel that many of our dental schools are actually very student-centered, but in a different context. We’re trying to impart as much information and skills to our students as possible during their four years. That may not actually be the best thing for the individual patient.

 


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