1. Narayan, Mary Curry PhD, RN, HHCNS-BC, CTN-A

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Patient-centered care is defined as respectful, individualized, culture-sensitive care that meets patients' individualized needs and preferences and their right to high-quality care (Institute of Medicine, 2001; Landers et al., 2016). Nursing has a long tradition of patient-centered care. Since Florence Nightingale, nurses have been trained to focus on the well-being of this person under their care in holistic ways (Nightingale, 1859). Nursing's Social Policy Statement: The Essence of the Profession (American Nurses Association, 2010) and the Code of Ethics for Nurses (American Nurses Association, 2015) make strong statements requiring nurses to put their patients at the center of their care. Patient-centered care is the core of nursing; it is not optional.


Patient-centered care is based on the relationship the nurse establishes with the patient-a relationship that honors the specialness of each patient through listening, compassion, and building trust. Relationship-building is more crucial for home health nursing than it is in many other settings as nurses are guests in patients' homes and the success of their recommendations and teaching are dependent upon the trust patients have in their nurses (Narayan, in press). Elements of patient-centered home health nursing include 1) caring about what the patient cares about; 2) assessment of all factors that affect the patient's health and well-being; and 3) adjusting standardized care plans to the patient's desired outcomes, unique lifestyle, and cultural preferences (Narayan, in press).


In a recent qualitative study, Narayan and Mallinson (2022) found home health nurses (N = 20) who worked for diverse agencies in diverse states in the United States identified many "potholes and roadblocks" to their ability to provide patient-centered care. Most felt that documentation and productivity demands, and some policies to achieve cost-efficiencies were squeezing the patient-centeredness out of their care. Although they recognized the need for these requirements and initiatives, the nurses were so time-pressured, they felt they didn't have time to provide patient-centered care in the way they thought they should. Most nurses in this sample exhibited some degree of moral distress because they couldn't meet their obligations to Medicare regulations, agency business goals, and their personal nursing values at the same time.


When national and agency home healthcare policies create barriers to patient-centered care, nurses need to advocate for and promote ways to maintain the patient-centeredness of their care. A balance between efficiency of care, documented proof of care, and patient-centered care must be found if nurses are going to deliver high-quality care to all home health patients. Unfortunately, in today's healthcare system, nurses have frequently been relegated to "following orders" versus bringing their insights about the patient experience and patient-centered values to the decision-making table. For high-quality care to be delivered "nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States" (Institute of Medicine., 2010, p. 4).


Nurses can amplify their advocacy voices and their effectiveness to affect healthcare policy by banding together with other nurses. One way nurses can do this is through their professional organizations. Many nursing specialties have strong professional organizations where member nurses have a voice in developing practice guidelines for their specialty. Think of the Hospice and Palliative Care Nurses Association or the Infusion Nurses Society among many others. Because these organizations are recognized as representing a nursing specialty, nurses strengthen their voice by pointing to the values and standards developed by their professional specialty's organization. Professional nurses enhance their power to achieve excellence in their specialty areas through their professional organizations.


To my knowledge, the International Home Care Nurses Organization (IHCNO; is the only organization that represents the specialty of nurses who provide care to patients in their homes. Incorporated as a nonprofit organization in 2017 by a small group of dedicated home health nurses, the IHCNO is still a developing organization. Its mission is to communicate and connect with home care nurses around the world who wish to promote excellent home care nursing. Through volunteer working groups, we seek to provide education, promote research, develop standards, and influence home health nursing policy. One important policy issue is home care nurses' ability to practice patient-centered care, so they can achieve a balance between their nursing values/best practices and national/agency priorities.


Medication helps protect insulin production in type 1 diabetes

NIH: In type 1 diabetes, the immune system attacks and destroys the cells in the pancreas, called beta cells, that make insulin. Type 1 diabetes is usually diagnosed in children and young adults, although it can appear at any age. In previous research, a team led by Dr. Anath Shalev from the University of Alabama at Birmingham found that a drug used to treat high blood pressure, called verapamil, protected beta cells and reversed diabetes in mouse models of type 1 diabetes. But how-and for how long-verapamil could protect beta cells wasn't clear. To better understand how verapamil slowed the progression of diabetes, the team analyzed blood samples from 5 of the study participants who received verapamil and 5 who received an inactive placebo. The researchers found that levels of 53 proteins changed in the blood after a year of verapamil treatment. One called chromogranin A (CHGA) changed the most over time, dropping substantially in people who received the drug. After a year of treatment, people who received verapamil had levels of CHGA and markers of immune activity that were similar to people without diabetes. They also had better production of insulin by their beta cells. In contrast, CHGA levels remained high in people who received the placebo. People who took verapamil needed less insulin. Those in the study who stopped treatment after a year needed more insulin to regulate blood sugar levels. The amount of insulin required by people who took the drug for a second year remained low and stable.




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Narayan M. (in press). What constitutes patient-centered care in home care? A descriptive study of home health nurses' attitudes, knowledge, and skills. Home Healthcare Now, 40(6).


Narayan M. C., Mallinson R. K. (2022). Home health nurses' journey toward culture-sensitive/patient-centered skills: A grounded theory study. Home Health Care Management & Practice, 34(1), 24-34.[Context Link]


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