The 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
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.
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.
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
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.