Nurses’ perceived barriers to the delivery of person‐centred care to complex patients: A qualitative study using theoretical domains framework

Abstract

Aims and Objectives To determine nurses’ perceived barriers to the delivery of person‐centred care to complex patients with multiple chronic conditions in acute care settings. Background Complex patients have multiple physical and mental health problems, and their life is also greatly affected by sociocultural and economic determinants of health. These patients require person‐centred care, but nurses often find it challenging to provide effective care to these patients due to their complex health needs. Design A descriptive qualitative design was used. The COREQ guidelines were followed for reporting. Methods Semi‐structured interviews were conducted with a purposive sample of 19 nurses in two hospitals. Data were analysed using deductive thematic analysis guided by the Theoretical Domains Framework, which entails 14 domains about factors affecting behaviours. Results The key barriers were identified under environmental context and resources, social influences, emotions, knowledge and skills domains. Deep‐rooted social issues delay patients’ health‐seeking and nurses’ abilities to understand patients’ needs and discern appropriate care. Interpersonal hostility influenced nurse–patient–families interactions, and doctor–nurses conflicts affected collaborative efforts towards optimal care. Conclusions Nurses’ perceived barriers to care were intertwined with the deep‐rooted social and cultural beliefs about nurses’ image, patients’ expectations and families’ preference for home remedies over specialised nursing care. These barriers to person‐centred care demonstrate an intricate interplay of personal, social and organisational issues and power struggles. Multifaceted implementation strategies targeting environmental context and resources, social influences, emotions, knowledge and skills domains may be beneficial to enable nurses to provide better person‐centred care to complex patients. Relevance to clinical practice Designing implementation facilitation teams, organising person‐centred care grand rounds, and allocation of stress management resources to address hostility, social‐cultural influences, and organisational barriers is essential. Nurses could focus on their self‐awareness and collaborative skills to address emotional and interprofessional conflicts.

Implementation strategies to promote compassionate nursing care of complex patients: An exploratory sequential mixed methods study

“…Rankings of implementation strategies were denoted as confirmed if the relevance was supported by the qualitative findings and the Q‐sort survey results. If quantitative results were inconsistent with the qualitative or vice versa, the ranking/finding was discordant (Younas, Inayat, et al, 2022; Younas, Pedersen, et al, 2022).…”

“…Previous research also demonstrated that addressing nurse burnout and distress is critical for the provision of compassionate care (Babaei & Taleghani, 2019; Valizadeh et al, 2016). This brings to attention the interplay of personal, interpersonal, and organizational factors that affect nurses' capability to provide compassionate care for marginalized patient populations (Tehranineshat et al, 2019; Younas, Inayat, et al, 2022; Younas, Pedersen, et al, 2022), indicating that greater efforts are required at the organizational level to support nurses in their compassionate care efforts.…”

“…Caring for complex patients can be challenging for nurses due to patient's condition, the work environment, level of support, staffing, and patient and family dynamics (Sieben‐Hein & Steinmiller, 2005). These challenges may affect nurses' capacities to provide compassionate care and require that they make efforts to gain a comprehensive understanding of patients' lives, and health and social care needs (Fulton, 2014; Younas, Inayat, et al, 2022; Younas, Porr, et al, 2022) and practice from a person‐centered and relational care approach (Kuluski et al, 2017; Rich et al, 2012). Complex patients are also vulnerable to the lack of compassion demonstrated by health professionals (Hartrick Doane & Varcoe, 2015; Manning & Gagnon, 2017).…”

Behavioural indicators of compassionate nursing care of individuals with complex needs: A naturalistic inquiry

“…These findings bring to attention the importance of self-awareness among nurses when they are caring for complex patients. Nurses must be reminded of the social determinants of health influencing healing and recovery (Porr, 2017), which will enhance their sensitivity to the multifaceted health and social care needs of complex patients (Younas et al, 2022). Nurses must be keenly aware of how pejorative attitudes can hinder the provision of compassionate nursing care for complex patients.…”

“…The health and illness of individuals with complex needs situates within broader sociocultural and economic environments. Increasingly recognised are the sociocultural determinants (e.g., poverty, education level, and access to resources) that can affect the ability of individuals with complex needs to manage their chronic conditions which may result in further deterioration of symptoms (Manning & Gagnon, 2017; Younas et al, 2022). Many individuals with complex needs experience homelessness, poverty, and are susceptible to drug and medication addictions (Arnold et al, 2020).…”