The results of this pilot study are promising. The validity of the questionnaire needs further testing.

The purpose of this study is to explore client-nurse interaction from a client perspective with respect to client-centered care. A grounded theory study was conducted with Dutch clients who were chronically ill and receiving home care. Data were collected by focus interviews with 8 client informants, participatory observations with 45 clients, and semistructured interviews with 6 clients. The core category actual interaction was identified. Six patterns of actual interaction were distinguished. Changes in actual interaction could be related to changes in desired participation by the client and in allowed client participation by the professional. From the client's perspective, client-centeredness means congruence between desired and allowed participation. Congruence was experienced with consent, dialogue, and consuming. Congruence is not necessarily synonymous with promoting patient participation or with doing as the client wants. Ongoing attentiveness, responsiveness, promotion of client autonomy, and being a critical caregiver are recommended.

In the Netherlands confusion is signalled about the introduction of new care concepts like demand-oriented care. The aim of this article is to explore the phenomenon 'interaction aimed at care tailored to the client demand' as seen by expert clients: patients and their family caregivers. Focus interviews were held with expert patients and expert family caregivers of the 'Dutch Council of the Chronically ill and the Disabled'. Grounded theory methodology was used to analyse the results. Recognition by the professional of client values underlying their demand (uniqueness, comprehensiveness, continuity of life, fairness and autonomy) and underlying the care-relationship (equality, partnership and interdependence) emerged as central element within the interaction. Feelings of recognition with the client seem to reinforce autonomy, self-esteem and participation. Recognition was optimally felt in a dialogue. Four professional competencies could be identified related to recognition: attentiveness (ongoing actions to know and understand the patient); responsiveness (active, committed and responsible care guided by respect of patient identity); being a critical partner in care (giving and grounding professional opinion and discuss boundaries); being a developer of client competencies (facilitating and developing client participation within care). The findings offer possibilities to operationalize care concepts aimed at tailored care. Further research aimed at refining and testing the hypothesis developed is recommended.

No abstract

The aim of this study was to evaluate a learning programme for Dutch community nurses and auxiliary nurses aimed at the development of competencies with respect to client‐centred care for chronically ill clients. The study was guided by the Kessels's Eight‐fields model. Several stakeholders, including clients, participated in the development, execution and evaluation of the programme. The concept of client‐centred care, client goals and competencies for nurses were identified systematically. Competencies identified were a care‐process in dialogue, enabling client participation and dealing with tensions. Principles of development of competencies were applied in the design of learning activities. The programme was evaluated at three levels: learning processes; performance of competencies in practice; and perceived client‐centredness by clients. Three home‐care organizations were involved in the evaluation study. In total, 175 employees participated in the basic module and 34 nurses and auxiliary nurses participated in the advanced module. In total, 107 chronically ill clients were involved in the study, of which 50 in the evaluation group and 57 in a group checking for selection bias. Findings indicate a positive impact on two of the evaluation levels: learning processes and the performance of nurse's competencies in practice. No statistical impact was found on clients 2 months after the end of the programme. The process evaluation provided knowledge concerning pre‐conditions for learning processes and performance of competencies in practice. The study concludes that it seems that a change towards client‐centred care has been initiated. Client‐centred care encompasses more, however, than competence development in individual nurses. A corporate approach is recommended, encompassing the support of the primary process of client‐centred care by the entire care organization. Further research aimed at the implementation of client‐centred care is recommended.