Читать книгу Nursing and Health Interventions - Souraya Sidani - Страница 15

The less‐than‐optimal experiences with evidence‐based practice, the limited applicability of RCT‐derived evidence to practice, in combination with clients' demand for an approach to healthcare that reflects their individuality, values, and preference, have led to the resurgence of client‐centered care as the “core” of high‐quality healthcare (Beck et al., 2010; de Boer et al., 2013; Sidani & Fox, 2014; Van Belle et al., 2019; Vijn et al., 2018).

Client‐centeredness is an approach to healthcare familiar to health professionals. Professionals are instructed, socialized, and expected to deliver client‐centered care. Client‐centered care is applied at different levels. At the individual level, it involves the application of tailored and adaptive interventions addressing the presenting health problem or aiming to change health behaviors (Hekler et al., 2018) and personalized or precision medicine (Bothwell et al., 2016). At the group level, client‐centeredness is illustrated by family‐centered care or the provision of health interventions that are adapted to the demands and preferences of particular communities such as ethno‐cultural communities (Barrera et al., 2013; Netto et al., 2010). At the healthcare organization level, client‐centeredness involves the adaptation of evidence‐based interventions and practice guidelines to the local context (Harrison et al., 2010; Powell et al., 2017) and at the system level, it is reflected in patient engagement (McNeil et al., 2016).

In general, the application of client‐centered care involves: (1) a comprehensive and thorough assessment of the clients' condition to identify their health problems, beliefs, values and preferences; (2) collaboration and active participation of clients in prioritizing their problems, designing new or selecting available, evidence‐based interventions, and implementing the selected interventions (as is done in shared decision‐making); and (3) adaptation or tailoring of the intervention for consistency with clients' problems, beliefs, values, and preferences, as well as with their changing experiences of the health problem, and life circumstances, over time.

Cumulating evidence supports the benefits of client‐centered care. At the individual level, client‐centered care was found to improve clients' knowledge of their condition and treatment, experiences with healthcare, general health and well‐being. It also enhanced adherence to treatment; self‐efficacy in managing the health problem; and reduced health services use and cost (Barello et al., 2012; Fors et al., 2018; Hibbard & Greene, 2013; Ren et al., 2019; Vijn et al., 2018). Similarly, tailored interventions were reported to be more effective than non‐tailored ones (Hawkins et al., 2008; Richards et al., 2007). At the community level, providing culturally tailored interventions was associated with increased client satisfaction but not with improvement in health outcomes (Renzoto et al., 2013). At the healthcare organization and system level, client‐centered care contributed to the development of new and improved services (Mockford et al., 2012).

The provision of client‐centered care, the cornerstone of high‐quality healthcare (Van Belle et al., 2019), requires the availability of interventions with demonstrated appropriateness, acceptability, effectiveness, safety, and efficiency. Appropriate interventions are logical, reasonable, and sound treatments that address a specific health problem. This implies that the nature of the interventions, reflected in its active ingredients, is consistent with the nature of the health problem.

Acceptable interventions are desirable by clients expected to receive the interventions. Desirable interventions are perceived as consistent with the clients' beliefs about the health problem and its treatment, suitable to their lifestyle, safe and convenient to apply in their daily life (Sidani et al., 2018). Related to acceptability is the notion of cultural relevance of interventions; it refers to the congruence of the interventions' components, mode and dose of delivery, with the beliefs, values, and norms held by particular groups or ethno‐cultural communities (Barrera et al., 2013). Effective interventions produce the best health outcomes by activating the anticipated mechanism of action (Dalkin et al., 2015); that is, they induce changes in clients' cognition, skills, or behaviors that mediate improvements in the experience of the health problem, health, and well‐being. Safe interventions are associated with no or minimal risks or discomfort (Bonell et al., 2015). Efficient interventions are optimized in terms of content, delivery, and resources required for their implementation, to maximize health outcomes; that is, they yield the highest impact (i.e. large improvement in the outcomes in a large proportion of the population) within a reasonably short time period (i.e. speed of recovery) (Benedikt et al., 2016; Morin et al., 2014).

New approaches are needed to design and evaluate health interventions in ways that inform the application of client‐centeredness in practice. Approaches for designing (1) appropriate health interventions rely on generating a comprehensive understanding of the health problem (see Chapter 3) and identification of the intervention's active ingredients (see Chapter 4), which are integrated into the intervention theory (see Chapter 5); (2) acceptable interventions involve the engagement of clients in the design of interventions, the development of tailored or adaptive interventions (see Chapter 4), and the assessment of clients' perceived acceptability of interventions (see Chapter 11). Approaches for evaluating the effectiveness, safety, and efficiency of health interventions entail the recognition of the complexity of the real world (see Section 1.4) and use of a range of research designs and methods to find answers to the practice‐related questions listed in Section 1.2. The goal of intervention research is to generate evidence that is grounded in and useful to practice (Westfall et al., 2009), which is characterized as client‐centered.