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Shaban et al. BMC Nursing (2024) 23:480
https://doi.org/10.1186/s12912-024-02099-1 BMC Nursing
*Correspondence:
Marwa Mamdouh shaban
Marwa.mamdouh@cu.edu.eg
1Faculty of Nursing, Cairo University, Cairo, Egypt
2Community Health Nursing, Faculty of Nursing, Ain Shams University,
Cairo, Egypt
3Community Health Nursing, Faculty of Nursing- Cairo University, Cairo,
Egypt
4Department of Nursing, College of Applied Medical Sciences in Al-Kharj,
Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
5Gerontological Nursing Department, Faculty of Nursing, Zagazig
University, Zagazig, Egypt
6College of Nursing, Prince Sattam bin Abdulaziz University,
Al-Kharj 11942, Saudi Arabia
7Family and Community Health Nursing Department, Faculty of Nursing,
Port Said University, Port Said, Egypt
Abstract
Background Person-centered care (PCC) is critical in addressing the diverse health priorities of older adults. Nurses
play a pivotal role in implementing PCC, yet the nuances of the nurse-patient relationship in outpatient settings
remain underexplored. This study aimed to gain insights into nurses’ experiences, challenges, and strategies in caring
for older adults through the lens of PCC.
Methods A qualitative descriptive design was employed, involving semi-structured interviews with 12 registered
nurses from outpatient clinics serving older adults. Thematic analysis was conducted following the principles of
trustworthiness and credibility.
Results Five main themes emerged: (1)Understanding and Implementing Person-Centered Care (PCC) (2)
Experiences in Older Adult Care, highlighting the signicance of trust-building, adapting care approaches,
interdisciplinary collaboration, and emotional rewards; (3) Challenges in Care Delivery, including resource constraints,
navigating family dynamics, keeping up with medical advances, and emotional strain; (4) Impact on Care Quality,
encompassing consistency in care, patient satisfaction, professional development, and ethical considerations; and (5)
Coping Strategies, such as peer support, work-life balance, reective practice, and resilience building.
Conclusions The study underscores the complexities and rewards of the nurse-patient relationship in caring for
older adults in outpatient settings. Nurses face formidable challenges but employ various coping strategies to
maintain high-quality, person-centered care. Findings have implications for nursing practice, education, policy, and
future research, emphasizing the need for supportive environments, continuous professional development, and
recognition of the critical role nurses play in addressing the health priorities of the aging population.
Keywords Person-centered care, Nurse-patient relationship, Older adults, Outpatient settings, Qualitative research
Exploring the nurse-patient relationship
in caring for the health priorities of older
adults: qualitative study
MostafaShaban1, Huda HamdyMohammed1, FatmaGomaa Mohamed Amer2, Marwa Mamdouhshaban3*,
Hassanat RamadanAbdel-Aziz4,5 and Ateya MegahedIbrahim6,7
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Page 2 of 14
Shaban et al. BMC Nursing (2024) 23:480
Introduction
e concept of Person-Centered Care (PCC) is fun-
damental to enhancing the quality of healthcare, par-
ticularly in outpatient settings where nurses interact
frequently with older adults [1]. is approach not only
focuses on the medical needs of patients but also empha-
sizes understanding and respecting their personal val-
ues and preferences. However, effectively implementing
PCC requires a nuanced understanding of the dynamics
between nurses and patients, which is often overlooked
in research focused primarily on clinical outcomes [2].
Person-Centered Care (PCC) represents a paradigm
shift in healthcare delivery, where the focus is directed
toward the holistic understanding of patients as indi-
viduals with unique needs, preferences, and values [3].
Defined by the Health Foundation as “an approach to
care that consciously adopts the perspectives of indi-
viduals, families, and communities to ensure that patient
values guide all decisions” [4], PCC underscores the
importance of integrating the patient’s voice into the care
process [5]. is approach is particularly pivotal in geriat-
ric nursing, where the complexity of care needs demands
a comprehensive understanding that transcends mere
clinical interventions [6]. In caring for older adults, PCC
emphasizes the significance of addressing psychological,
social, and spiritual well-being alongside physical health,
thus advocating for a care model that is as diverse as the
patient population it serves [7].
Nurses, as the primary point of contact for patients, are
uniquely positioned to drive the adoption of PCC princi-
ples [8]. eir frontline role enables them to build thera-
peutic relationships that are essential for effective PCC,
allowing for a deeper understanding of patients’ needs
and preferences [9]. is shift towards PCC in nursing
has been supported by evidence linking PCC to bet-
ter patient outcomes, including reduced hospitalization
rates and improved chronic condition management [10].
Moreover, the emphasis on PCC has also led to greater
job satisfaction among nurses, as it aligns with a more
meaningful and rewarding approach to patient care [11].
Person-Centered Care (PCC) takes on a critical role in
the healthcare of older adults, a demographic uniquely
impacted by a spectrum of health challenges such as
chronic diseases, multimorbidity, and the natural process
of aging which can lead to functional decline [12]. is
necessitates a care approach that transcends traditional
medical treatment to embrace a more holistic view, rec-
ognizing the importance of psychological, social, and
spiritual well-being alongside physical health [13]. PCC,
in this context, demands a shift from a one-size-fits-all
model to a more nuanced and individualized care strat-
egy [14]. is approach not only aims to manage the
medical aspects of care but also to address the broader
dimensions of health, ensuring that the care plans for
older adults are tailored to their specific needs, prefer-
ences, and life circumstances [15].
e nurse-patient relationship is pivotal in the effec-
tive delivery of PCC to older adults [16]. It is through this
relationship that nurses can truly understand the unique
needs and preferences of each older adult, fostering a
foundation of trust and mutual respect [17]. is con-
nection is built on the principle of viewing each patient
not just as a recipient of care but as a partner in the care
process [18]. Nurses who practice PCC are committed
to listening to the stories of older adults, understanding
their life experiences, values, and preferences, and inte-
grating this knowledge into the planning and delivery of
care [19]. is relationship-centric approach empowers
older adults, actively involving them in making informed
decisions about their care and treatment options, thereby
supporting their autonomy and independence [20].
Addressing the health priorities of older adults through
Person-Centered Care (PCC) and the nurse-patient rela-
tionship requires an understanding of the complex and
varied needs of this population [21]. Older adults face a
wide range of health challenges, from managing chronic
conditions like diabetes and hypertension to address-
ing mental health issues such as depression, anxiety, and
dementia [22]. Additionally, promoting healthy aging—
which includes maintaining physical, social, and mental
well-being—is crucial [23]. ese diverse needs demand
a holistic approach to care, one that goes beyond treating
physical symptoms to address the full spectrum of factors
affecting an individual’s health [24].
PCC plays a pivotal role in meeting these health priori-
ties by focusing on the unique needs and preferences of
each older adult [25]. is approach relies on a multidis-
ciplinary team of healthcare professionals, with nurses
often at the forefront, working collaboratively to provide
comprehensive care [26]. Such an approach not only
improves health outcomes but also enhances the quality
of life for older adults, making it a key strategy in the pro-
motion of healthy aging [27].
e emphasis on Person-Centered Care (PCC) has
highlighted the necessity of understanding the unique
environments in which healthcare is delivered [28].
While much of the literature has focused on inpatient
care, outpatient settings offer a distinct landscape for the
implementation of PCC [29]. Unlike inpatient settings,
where care is intensive and environments are controlled,
outpatient settings present unique challenges and oppor-
tunities for PCC [30]. ese include logistical constraints,
the necessity for streamlined communication, and the
importance of integrating care with patients’ daily lives.
Understanding these differences is crucial for tailor-
ing PCC approaches to meet the specific needs of older
adults in outpatient care [31]. Furthermore, outpatient
care settings often require a more collaborative approach
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Shaban et al. BMC Nursing (2024) 23:480
to healthcare, involving a network of primary care pro-
viders, specialists, and community resources to support
the patient’s health outside of the traditional hospital
environment [32]. is necessitates a distinct approach
to Person-Centered Care (PCC), one that emphasizes
continuity of care, patient education, and self-man-
agement support. Understanding and addressing these
unique challenges and opportunities are vital for devel-
oping and implementing effective PCC strategies tai-
lored to the needs of older adults in outpatient settings.
Additionally, it is crucial that providers listen carefully
to the patients’ wishes and preferences, ensuring that
their voices are central to the care planning process. is
patient-centered listening is fundamental to creating care
plans that truly reflect the individual needs and desires of
older adults, fostering a more collaborative and respect-
ful healthcare environment [31, 33, 34] .
Despite the myriad challenges, the opportunities for
enhancing care through Person-Centered Care (PCC)
are significant [35]. Leveraging technology and evi-
dence-based practices, nurses are uniquely positioned
to transform the care landscape for older adults. e
nurse-patient relationship, rooted in mutual respect and
understanding, is central to this transformation, enabling
nurses to advocate for and implement care strategies that
truly reflect the preferences and needs of older adults
[36]. PCC not only addresses diverse health priorities but
also establishes a new standard for compassionate, holis-
tic care in nursing practice, representing a significant step
forward in the pursuit of optimal health and well-being
for the aging population [15].
Aim of the study
e aim of this qualitative study was to explore the intri-
cate dynamics of the nurse-patient relationship in the
context of caring for older adults in outpatient settings,
with a specific emphasis on person-centered care (PCC)
practices. In our study, we explored the concept of PCC
as experienced and interpreted by outpatient nurses
working with older adults. Rather than imposing a rigid
definition, we sought to understand PCC through the
lens of the nurses, allowing their experiences and inter-
pretations to illuminate the multifaceted nature of PCC
in practice.
Research questions
1. What are the experiences, perceptions, and
challenges faced by nurses in building and
maintaining nurse-patient relationships while
delivering person-centered care to older adults in
outpatient settings?
2. What strategies and coping mechanisms do nurses
employ to navigate the complexities of caring for
older adults, promote their well-being, and maintain
high standards of person-centered care in outpatient
clinics?
Methods
Study design
is study employed a qualitative descriptive design,
deeply rooted in the epistemological frameworks of
naturalism and constructivism. Naturalism posits that
realities are multiple and subjective, while constructivism
emphasizes the interaction between the researcher and
the subject in shaping the findings [37, 38]. ese frame-
works were chosen for their ability to capture the com-
plex, lived experiences and nuanced interactions between
healthcare professionals and patients within the scope of
Person-Centered Care (PCC) [39].
To ensure methodological rigor and transparency, our
approach adhered closely to the Standards for Reporting
Qualitative Research (SRQR) guidelines. is adherence
facilitated a systematic and reflective inquiry into the
nurse-patient relationship, allowing for detailed explo-
ration and credible documentation of emergent themes
that authentically represent participants’ experiences
[40]. By integrating these epistemological principles,
we aimed to illuminate the subjective and often tacit
knowledge that informs the practice of PCC in nursing,
particularly in outpatient care settings [40]. . is meth-
odological framework was chosen for its ability to cap-
ture the complexity and variability of real-world nursing
practices, providing valuable insights into the delivery of
person-centered care.
Study setting
e study was conducted in outpatient clinics affiliated
to Zagazig university educational hospitals. ese clinics
were selected for their high volume of older adult patients
and the comprehensive nature of services they provide,
including management of chronic conditions, acute care,
and mental health services. is setting was chosen to
capture a broad spectrum of nurse-patient interactions
and the varied health priorities of older adults in envi-
ronments where they routinely seek care. e outpatient
clinic environment offers a unique context for examining
the nurse-patient relationship, as it encompasses both
episodic and ongoing care scenarios, providing a rich
backdrop for exploring how nurses navigate and priori-
tize the health needs of older adults in a setting charac-
terized by both continuity and immediacy of care.
Participants
A purposeful sampling technique was utilized to recruit
12 registered nurses from outpatient clinics for this
study. e participants were drawn from a diverse range
of specialties within the outpatient setting to ensure a
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Shaban et al. BMC Nursing (2024) 23:480
comprehensive understanding of the nurse-patient rela-
tionship in caring for older adults. Among the partici-
pants, 9 were females and 3 were males, reflecting the
gender distribution commonly observed in the nursing
profession. e ages of the participants ranged from 28
to 55 years, providing a broad perspective across differ-
ent stages of nursing careers. In terms of educational
background, the participants varied from holding diplo-
mas in nursing to advanced degrees, including bachelor’s
and master’s degrees in nursing. is diversity in educa-
tion levels contributed to a broad range of insights into
the practice of person-centered care, reflecting different
levels of training and perspectives on patient care.—this
seems redundant or could be synthesized into the first
paragraph. e study explicitly focused on registered
nurses who had direct patient contact in outpatient set-
tings, excluding those in administrative roles without
regular patient interactions or those working primarily
in inpatient settings. is focus ensured that the study
captured the nuances of the nurse-patient relationship in
the specific context of outpatient care for older adults.—
combine with the above paragraph.
e selection criteria ensured that each nurse had a
minimum of 5 years in the nursing field, with at least 3
years specifically dedicated to working in outpatient clin-
ics that serve a significant number of older adult patients.
is criterion was set to capture insights from nurses
who have had substantial interaction with the older
adult population and could provide detailed accounts of
their experiences and strategies in managing the health
priorities of this group. e nurses represented various
specialties critical to the comprehensive care of older
adults, including general medicine, chronic condition
management, geriatric care, and mental health services.
is variety allowed for a richer exploration of the nurse-
patient relationship across different health care needs of
older adults.
Development of interview guide
e development of our interview guide was a meticu-
lous process influenced by established frameworks and
prior studies that explored the dynamics of nurse-patient
relationships within the framework of Person-Centered
Care (PCC). Specifically, the guide drew upon the foun-
dational work by Kitwood (1997) on person-centered
approaches in dementia care, which emphasizes under-
standing the individual’s perspective and adapting care
practices accordingly [25]. Additionally, we incorporated
insights from McCormack’s (2004) study on person-
centeredness in nursing homes, which provided valuable
structures for questioning techniques that elicit detailed
narratives about care experiences [41].
To tailor these frameworks to our specific research
context—outpatient clinics serving older adults—we
conducted a preliminary literature review to identify
gaps in existing studies, particularly focusing on the out-
patient setting’s unique challenges and opportunities.
Based on this review, our team crafted questions that
were designed to probe deeper into the specific experi-
ences of nurses in these settings. Questions were formu-
lated to explore themes such as the implementation of
PCC principles, the challenges faced in establishing trust
with older adults, and strategies for personalized care
planning.
e draft guide was then reviewed by a panel of experts
in qualitative research and geriatric nursing. eir feed-
back helped refine the questions to ensure they were
open-ended yet specific enough to elicit detailed and
relevant responses. e final interview guide was piloted
with a small group of nurses from a local outpatient clinic
to test the clarity and effectiveness of the questions.
Adjustments were made based on this pilot to ensure
that the questions were comprehensible and effectively
encouraged rich, informative dialogue.
Data collection
Data collection was conducted through face-to-face, in-
depth interviews using a semi-structured interview guide
specifically designed for this study (referenced in Table
S1), which was meticulously developed and reviewed
by language experts and co-authors to ensure compre-
hensiveness and relevance. Each interview was audio-
recorded and conducted in a private room within the
outpatient clinic, lasting approximately 45min to provide
a conducive environment for open sharing.
Interviews were conducted in both English and Ara-
bic, depending on participants’ preferences, with bilin-
gual experts ensuring accurate translation and integrity
of the data. e translation process involved a rigorous
two-step verification to capture linguistic nuances and
healthcare terminologies, ensuring that translated mate-
rials accurately reflected original statements.
In addition to interviews, data collection included
observational notes and document reviews. Notes cap-
tured immediate reflections and non-verbal cues, enrich-
ing the verbal data. Observations within outpatient
settings provided insights into the application of PCC,
focusing on non-verbal communications and environ-
mental interactions. All observational and interview data
were systematically analyzed alongside reviewed docu-
ments, such as care plans and clinic policies, to ensure a
comprehensive understanding of PCC practices and their
institutional alignment. Observations were conducted to
capture the non-verbal interactions and environmental
contexts of nurse-patient interactions. Specific behav-
iors, communication patterns, and care delivery practices
were noted. Observations focused on how nurses applied
PCC principles in real-time patient interactions.
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Shaban et al. BMC Nursing (2024) 23:480
Credibility of the study
In this study, the credibility of the findings was ensured
through data triangulation, integrating multiple sources
and methods to provide a comprehensive understand-
ing of Person-Centered Care (PCC) practices and nurse-
patient relationships. e three primary data sources
used for triangulation were:
1. Semi-structured interviews
• Core Data Source: In-depth, semi-structured
interviews with 12 registered nurses from
outpatient clinics were conducted. ese
interviews oered rich qualitative insights into the
nurses’ experiences, perceptions, and strategies in
delivering PCC to older adults.
•Purpose: e interviews were designed to explore
how nurses implement PCC, the challenges they
encounter, and the coping mechanisms they
employ. is data formed the foundation for
understanding the dynamics of the nurse-patient
relationship.
2. Document analysis
• Reviewed Documents: Documents such as
patient care plans, clinic policies, and guidelines
for implementing PCC were reviewed. ese
documents provided institutional context and
procedural frameworks for PCC practices.
•Purpose: Document analysis served to cross-
verify the qualitative data obtained from
interviews. It oered additional context and
perspective, highlighting how institutional
policies support or constrain PCC, thereby
complementing and contextualizing the interview
ndings.
3. Observational Data
• Observed Interactions: Observations focused
on real-time interactions between nurses and
older adult patients in outpatient settings.
ese observations captured non-verbal
communication, practical applications of PCC
principles, and immediate responses to patient
needs.
•Purpose: Observational data added an
experiential dimension to the study, enriching
the understanding of how PCC is practiced in
real-world settings. It provided concrete examples
of nurse-patient interactions, validating the
narratives obtained from interviews and the
procedural insights from document analysis.
To enhance the credibility and validity of the findings,
several methodological strategies were employed:
•Triangulation: Data from interviews, document
analysis, and observations were systematically
cross-veried to ensure consistency and
robustness. is process involved comparing and
contrasting information from each source to build a
comprehensive and reliable understanding of PCC
practices.
•Collaborative Analysis: e primary researcher
conducted data collection through interviews and
observations. Co-researchers participated in data
analysis, contributing diverse perspectives and
insights. is collaborative approach facilitated a
more nuanced interpretation of the data and helped
mitigate potential biases.
•Peer Debriefing: Regular peer debrieng sessions
were conducted with the research team to review
and validate the emerging themes and ndings. is
iterative process allowed for critical examination
and renement of the analysis, enhancing the study’s
credibility.
Data analysis
Data analysis for this study followed a thematic approach,
based on the framework proposed by Braun & Clarke
(2006) [42], involving six key phases: (1) Familiarization
with the data, (2) Generating initial codes, (3) Search-
ing for themes, (4) Reviewing themes, (5) Defining and
Table 1 Examples of how codes were clustered into subthemes
Subtheme Initial Codes Description
Dening Person-Centered Care Holistic approach mention,
Patient values emphasis
This subtheme encompasses nurses’ descriptions that formed a collective deni-
tion of PCC, emphasizing holistic, values-based care.
Providing Person-Centered Care Individual preference ac-
commodation, Care plan
collaboration
This subtheme illustrates the strategies and approaches employed by nurses
to operationalize PCC, highlighting how they engage patients in their care and
ensure treatment plans reect personal preferences and life contexts.
Barriers to Person-Centered Care Time constraint frustration,
Resource limitation
Focuses on external factors that challenge the delivery of PCC, bringing attention
to systemic issues impacting the feasibility of fully implementing PCC practices.
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Shaban et al. BMC Nursing (2024) 23:480
naming themes, and (6) Producing the report as shown
in Table1.
1. Familiarization with the data
• Transcription and Initial Reading: Verbatim
transcriptions of the semi-structured interviews
were created by two trained researchers, capturing
the exact responses of the participants. Interviews
conducted in Arabic were simultaneously
translated into English by bilingual investigators.
To ensure the accuracy of the translations, an
independent research assistant cross-veried
selected English transcripts with the original
Arabic recordings.
•Immersion: e research team engaged in
multiple readings of the transcripts to become
thoroughly familiar with the content, noting initial
impressions and signicant patterns.
2. Generating initial codes
• Coding Process: Initial codes were generated
systematically across the entire dataset, focusing
on meaningful segments of text that captured
recurring themes and patterns. ese codes
represented key aspects of the participants’
experiences and perceptions regarding Person-
Centered Care (PCC) and the nurse-patient
relationship.
•Collaborative Effort: e coding process was
iterative and involved discussions among the
research team to rene and validate the initial
codes. is collaboration helped ensure that the
codes accurately reected the data.
3. Searching for themes
• Organizing Codes: Codes were then organized
into potential themes by grouping related codes
together. is phase involved looking for broader
patterns and relationships among the codes to
form coherent thematic categories.
•Initial eme Development: e team identied
several preliminary themes that encapsulated
signicant aspects of the data. ese themes
were discussed and rened to ensure they were
comprehensive and reective of the participants’
experiences.
4. Reviewing themes
• eme Refinement: e identied themes were
reviewed and rened by the research team to
ensure they accurately represented the data. is
process involved checking if the themes worked
in relation to the coded extracts and the entire
dataset.
•Consensus-Building: e team engaged
in collaborative discussions to resolve any
discrepancies in theme identication and
renement, fostering a consensus-driven
approach.
5. Defining and naming themes
• Finalizing emes: Each theme was dened and
named to clearly convey its essence and relevance
to the research questions. Detailed denitions
and descriptions were developed for each theme,
highlighting the core concepts and insights
derived from the data.
•Sub-emes: Where applicable, sub-themes
were identied to capture more specic aspects
of the broader themes, providing a nuanced
understanding of the data.
6. Producing the report
• Reporting: e nal phase involved producing
a comprehensive report of the ndings,
integrating the themes into a coherent narrative
that addressed the research objectives. e
report included direct quotes from participants
to illustrate and support the themes, ensuring
that the voices of the nurses were authentically
represented.
Ethical consideration
is study received approval from the Institutional
Review Board (IRB) of the Faculty of Nursing, Zaga-
zig University, Egypt, with the reference number ID:
ZU.NUR.REC#:085 in November 2023. Permissions
were also secured from the outpatient clinics where the
research was conducted. Informed consent was a prior-
ity. Participants received detailed explanations about the
study’s objectives, methods, and their rights, including
the right to withdraw at any time without any repercus-
sions. Specifically, for the physical observations of care
processes, participants were informed that their interac-
tions might be observed, noting how these observations
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Shaban et al. BMC Nursing (2024) 23:480
would be used solely for research purposes. ey were
assured that no personally identifiable information would
be recorded during these observations. To ensure confi-
dentiality and anonymity, each participant was assigned
a unique identifier. All personal information and obser-
vational data were securely stored and accessible only to
the research team. Rigorous measures were implemented
to safeguard this data from unauthorized access. Addi-
tionally, we took precautions to mitigate any potential
psychological discomfort during interviews and observa-
tions by providing immediate access to support services
and maintaining a respectful and non-intrusive observa-
tion process.
Results
Can the results be summarized more through the use of
a table and then only explaining the overarching themes
that incorporated the sub-themes?
e characteristics of participants (Table 2) demon-
strate the range in age from 28 to 58 years, and show-
casing a broad spectrum of experience that is likely to
influence their caregiving approaches and perspectives.
With a gender distribution predominantly female, reflect-
ing common nursing workforce demographics, the inclu-
sion of male nurses ensures a more comprehensive view
of nursing care dynamics. Educational backgrounds vary
from Diplomas to master’s Degrees, indicating a diverse
set of academic preparations that could impact person-
centered care practices. Experience levels in outpatient
settings range widely from 5 to 25 years, suggesting that
the study benefits from a mix of seasoned insights and
fresh perspectives. is diversity among participants is
crucial for a nuanced understanding of the complexities
surrounding the nurse-patient relationship and the deliv-
ery of care to older adults in outpatient settings.
In the exploration of nurse-patient relationships within
the context of caring for older adults in outpatient set-
tings, our study delved into the intricate dynamics that
shape these interactions. rough qualitative analysis,
we identified key themes and subthemes that capture
the essence of nurses’ experiences, the challenges they
encounter, and the strategies they employ to navigate
these challenges effectively (Table S2). e findings, dis-
tilled from in-depth interviews and observational data,
shed light on the multifaceted nature of providing per-
son-centered care to older adults. ese insights are cru-
cial for understanding how nurses adapt to and overcome
the complexities of their roles, ensuring that the care they
provide aligns with the health priorities and personal
preferences of older adults. e thematic results, sum-
marized in the subsequent table, offer a comprehensive
overview of the critical aspects of nursing care in outpa-
tient settings, highlighting the importance of trust-build-
ing, interdisciplinary collaboration, and the emotional
and professional growth of nurses.
Understanding and implementing person-centered care
(PCC)
Dening person-centered care
Nurses in our study articulated PCC as a multifaceted
approach that prioritizes understanding and integrating
the unique preferences, values, and needs of each patient
into their care. For instance, Participant N1 described
PCC as “seeing the person beyond their diagnosis, under-
standing their life outside the hospital walls, and weav-
ing that understanding into the fabric of our care.” is
definition underscores the shift from a disease-centric
to a holistic view of care. Participant N4 highlighted the
adaptability required in PCC, stating, “It’s about cus-
tomizing our approaches to align with each patient’s life
context, ensuring care is both respectful and responsive.”
ese definitions collectively paint PCC as an approach
that encompasses holistic, individualized care strategies,
emphasizing the integration of patients’ life stories and
preferences into the care process.
Table 2 Characteristics of Nurse Participants-not sure indiivudal detail is informative vs. an aggregate summary
Participant Age (Years) Gender Education Level Years of Nursing Experience in Outpatient Settings
N1 34 Female Bachelor’s Degree 10
N2 46 Female Master’s Degree 15
N3 39 Male Bachelor’s Degree 8
N4 58 Female Advanced Diploma 25
N5 30 Female Bachelor’s Degree 5
N6 58 Female Diploma 25
N7 44 Male Bachelor’s Degree 12
N8 49 Female Diploma 18
N9 37 Male Bachelor’s Degree 9
N10 41 Female Bachelor’s Degree 16
N11 28 Female Bachelor’s Degree 7
N12 53 Female Diploma 22
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Shaban et al. BMC Nursing (2024) 23:480
Barriers to person-centered car
While dedicated to implementing PCC, nurses identified
significant barriers, including time constraints, resource
limitations, and systemic challenges. Participant N2
expressed frustration over time constraints, “e biggest
challenge is time. It’s difficult to practice true PCC when
you’re seeing a high volume of patients with limited time
for each.” is sentiment highlights the tension between
the ideals of PCC and the realities of clinical practice.
Participant N8 underscored systemic issues, “Organiza-
tional policies and resource shortages often impede our
ability to offer personalized care.” ese comments reveal
the broader systemic and organizational obstacles to PCC
implementation. Despite these challenges, Participant N5
shared, “We get creative, find small ways to personalize
care within these constraints. It’s not easy, but it’s vital for
maintaining the essence of PCC.”
Experiences of caring for older adults
Building trust
In our study, nurses consistently highlighted the founda-
tional importance of building trust in the nurse-patient
relationship, especially when caring for older adults. is
trust facilitates open communication, allowing patients
to share their concerns, preferences, and life stories,
which in turn informs personalized care planning. For
example, Participant N2 shared a poignant experience:
“Building trust with Mr. X allowed him to share his fears
about aging and illness. It changed how we approached
his care plan.” is sentiment was echoed by Partici-
pant N8, who emphasized the gradual nature of building
trust: “Trust isn’t built overnight. It comes from consis-
tent, compassionate care and really listening to what our
patients value in their lives and health.” Further enrich-
ing this theme, Participant N6 remarked, “e moment
a patient feels truly understood, that’s when real heal-
ing begins. Trust is that bridge.” e convergence of
these experiences underscores the pivotal role of trust
in enhancing nurse-patient interactions, leading to more
effective and tailored care strategies.
Adapting care approaches
e necessity of flexibility and individualization in nurs-
ing care for older adults emerged as a critical theme.
Our participants discussed the importance of adapting
their care approaches to suit the diverse needs of older
patients. Participant N4 described this adaptability as
key: “Each patient is a unique puzzle. What works for
one may not work for another. We constantly adapt our
strategies to find what’s best for each individual.” Com-
plementing this perspective, Participant N11 highlighted
the necessity of adaptation in complex cases: “Adapt-
ing our approach is essential, especially when dealing
with complex cases. It’s about finding the right balance
that respects the patient’s lifestyle and preferences.” Par-
ticipant N3 further illustrated this point by saying, “Lis-
tening and adjusting to the patient’s feedback is crucial.
It’s about crafting care that aligns with their personal
journey and health goals.” ese narratives reflect the
nurse’s role in continually assessing and modifying care
plans, emphasizing personalized care that respects each
patient’s individuality.
Interdisciplinary collaboration
Nurses also stressed the value of interdisciplinary collab-
oration in providing PCC care to older adults. is col-
laborative approach ensures that all aspects of a patient’s
health are addressed. Participant N1 noted the impor-
tance of teamwork: “We work closely with dietitians,
physiotherapists, and social workers. It’s a team effort
to ensure our patients receive holistic care.” Participant
N9 added, “Collaboration with other disciplines helps us
address not just the physical, but also the emotional and
social needs of our patients.” Expanding on this, Partici-
pant N7 shared, “Integrating insights from different fields
brings a richness to the care plan that one discipline
alone can’t provide.” is theme highlights how health-
care professionals can offer a more holistic approach by
working together, addressing the physical, emotional, and
social health of older patients.
Emotional rewards
Lastly, the emotional rewards of working with older
adults were a theme that resonated deeply among the
nurses we interviewed. Participant N5 expressed the pro-
found satisfaction derived from their impact: “ere’s a
profound satisfaction in seeing the difference you can
make in someone’s life, even in small ways.” Participant
N10 reflected on the expressions of gratitude: “e thank
yous, the smiles, even the silent gratitude you feel from
a patient, it’s incredibly rewarding.” Additionally, Partici-
pant N12 captured the essence of this reward: “Knowing
you’ve helped someone navigate one of the most chal-
lenging phases of their life is a privilege.” ese reflec-
tions highlight the intrinsic satisfaction and fulfillment
nurses experience, underscoring the significant impact of
their work on the well-being and quality of life of their
patients.
Experiences in older adult care
Building Trust
Building trust is fundamental in the nurse-patient rela-
tionship, especially within the context of Person-Cen-
tered Care (PCC) for older adults. is trust fosters open
communication, enabling patients to share their con-
cerns, preferences, and life stories, which informs a more
personalized care approach. For example, Participant N2
shared, “Building trust with Mr. X was transformative;
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Page 9 of 14
Shaban et al. BMC Nursing (2024) 23:480
his openness about his aging fears significantly informed
our personalized care plan.” Participant N8 highlighted
the gradual nature of trust-building: “Trust is cultivated
through consistent, empathetic care, demonstrating gen-
uine interest in the patient’s values and life.” Participant
N6 further noted, “Feeling understood by a patient signi-
fies the beginning of real healing. Trust serves as that cru-
cial bridge.” ese examples illustrate how trust facilitates
effective PCC strategies, leading to tailored care solutions
that respect the individuality of each older adult.
Adapting care approaches
Flexibility and individualization are essential in adapt-
ing care approaches under PCC. Nurses emphasized
the importance of customizing care to meet the unique
needs of each older adult. As Participant N4 noted,
“Every patient presents a distinct puzzle,” underscoring
the need for bespoke care strategies. Participant N11 dis-
cussed the complexity of adaptation: “Particularly with
complex cases, finding a care balance that honors the
patient’s lifestyle and preferences is paramount.” Partici-
pant N3 added, “Actively responding to patient feedback
is key to aligning care with their personal health journey.”
ese insights highlight how adaptive strategies are cru-
cial in developing care plans that are truly person-cen-
tered, reflecting each patient’s specific preferences and
health goals.
Interdisciplinary collaboration
Interdisciplinary collaboration plays a vital role in achiev-
ing comprehensive PCC by addressing the multifaceted
needs of older adults. Nurses pointed out that team-
work across disciplines enhances the quality of care by
integrating diverse professional insights. Participant N1
noted, “Collaboration across disciplines is fundamen-
tal,” indicating the collective effort required for holistic
care. Participant N9 explained, “Working alongside dieti-
tians, physiotherapists, and social workers allows us to
meet the physical, emotional, and social health needs of
our patients.” Participant N7 added, “e integration of
diverse professional insights enriches the care plan, offer-
ing a multi-dimensional approach to patient well-being.”
ese perspectives demonstrate how collaborative prac-
tices support PCC, ensuring a holistic approach that cov-
ers all aspects of patient health and well-being.
Emotional rewards
Engaging in PCC with older adults brings significant
emotional rewards for nurses. e fulfillment from mak-
ing a meaningful difference in a patient’s life is profoundly
satisfying. As Participant N5 reflected, “e satisfac-
tion from making a tangible difference in someone’s life
is immense.” Participant N10 emphasized the personal
impact of gratitude: “e appreciation, whether through
words or smiles, is deeply rewarding.” Participant N12
summarized this sentiment, “Assisting someone through
a challenging phase of their life is not just a duty but a
privilege.” ese reflections capture the intrinsic rewards
of nursing, highlighting how PCC enhances the quality
of life for older adults and provides personal and profes-
sional fulfillment for nurses.
IV-Impact on Care Quality
Consistency in care
Achieving consistency in care within outpatient settings,
amidst resourced constraints and emotional strain, is
vital for embodying Person-Centered Care (PCC). Par-
ticipants highlighted the challenges of fluctuating patient
volumes and diverse health conditions impacting care
uniformity. Participant N1 noted, “Striving for consistent
care for every patient is our goal, but resource limitations
often hinder this, impacting our ability to tailor care to
individual patient preferences—a core aspect of PCC.”
Participant N9 emphasized the importance of consis-
tency to quality care and patient satisfaction, a sentiment
echoed by Participant N2, who discussed the difficulty
of balancing immediate needs with long-term care con-
tinuity, underscoring the effort to align care with each
patient’s health priorities and personal preferences.
Patient satisfaction
e foundation of patient satisfaction in outpatient care
is the quality of the nurse-patient relationship, integral
to PCC. Participant N2 shared, “When I take the time
to really listen to my patients and understand their con-
cerns, they feel valued and are more satisfied with their
care.” Similarly, Participant N5 noted, “Patients often
tell me how much they appreciate being treated as indi-
viduals, not just another case. is personal connec-
tion makes a big difference in their satisfaction.” ese
insights underscore the importance of personalized,
attentive care in enhancing patient satisfaction within the
PCC framework. Participants described how personal
attention and respect during each interaction signifi-
cantly affect patients’ satisfaction. For example, Partici-
pant N5 said, “Being seen and heard elevates patient
satisfaction, reflecting our commitment to understanding
and incorporating their preferences and values into care.”
Participant N11 added insights on building trust through
respect, understanding, and care, crucial for patient-cen-
tered practice. Participant N4 highlighted how trust and
rapport, established through PCC strategies like active
listening and shared decision-making, encourage adher-
ence to care plans.
Professional development
Nurses emphasized the crucial role of continuous learn-
ing in enhancing person-centered care (PCC). ey
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Shaban et al. BMC Nursing (2024) 23:480
shared specific examples illustrating how ongoing profes-
sional development translates into improved patient out-
comes and more effective care strategies: Participant N3:
Highlighted the impact of a recent workshop on geriatric
communication strategies: “After attending a workshop
on effective communication with older adults, I imple-
mented techniques like using simpler language and allow-
ing more time for responses. is change significantly
improved my interactions with patients who have cog-
nitive impairments, making them feel more understood
and valued.” Participant N7: Described the application
of new skills from a training program on chronic disease
management: “e chronic disease management train-
ing I completed provided me with updated protocols for
diabetes care. I started using patient-centered approaches
to create personalized diabetes management plans,
which led to better adherence to treatment regimens and
improved glycemic control in my patients.” Participant
N10: Discussed the benefits of learning about the latest
advancements in PCC through continuing education:
“Continuing education on the latest PCC advancements
taught me about incorporating patients’ life histories into
care planning. is knowledge helped me develop more
holistic and individualized care plans, which have been
particularly effective in managing complex cases involv-
ing multimorbidity.” ese examples underscore the
importance of professional growth in adapting care prac-
tices to reflect the latest PCC advancements, ensuring
that nurses can effectively meet the diverse and complex
needs of older adults in outpatient settings. Continuous
learning equips nurses with the skills and knowledge to
apply innovative PCC approaches, ultimately leading to
improved patient satisfaction and care quality.
Ethical considerations
Ethical dilemmas are particularly prevalent in outpa-
tient settings and require careful navigation to uphold
Person-Centered Care (PCC) principles. ese dilemmas
often involve balancing patient autonomy, family wishes,
and clinical guidelines to ensure high-quality care. N6
described a situation where an older patient with demen-
tia wanted to continue living independently, despite
safety concerns raised by family members. “We had to
balance the patient’s wish for autonomy with the family’s
concern for safety,” N6 explained. e ethical challenge
was in respecting the patient’s desire while ensuring their
safety, which was resolved through a compromise of
enhanced home care support. Participant N8 recounted
an instance where a patient with multiple chronic condi-
tions refused a recommended treatment due to personal
beliefs. “We faced the challenge of respecting the patient’s
autonomy and belief system while trying to advocate for
what we believed to be the best clinical course,” N8 noted.
e team respected the patient’s decision after providing
comprehensive information on the potential risks and
benefits of the treatment, ensuring informed consent.
Participant N12 highlighted an ethical dilemma involving
a patient whose family insisted on aggressive treatment
contrary to the patient’s expressed wishes for palliative
care. “We navigated this by facilitating a family meet-
ing where the patient’s preferences were clearly com-
municated and respected,” N12 shared. is approach
helped align the care plan with the patient’s values while
addressing family concerns through open dialogue.
V-coping strategies supporting PCC
Peer support
e complexity of delivering PCC, which requires deep
understanding and adaptation to each patient’s unique
needs and preferences, heightens the value of peer sup-
port among nurses. Participant N2 highlighted the
emotional relief provided by sharing experiences with
colleagues: “Discussing challenging cases with a col-
league helps us find new ways to approach patient care,
ensuring we stay true to our PCC values.” Participant N8
noted the structured support from peer groups: “Our
support groups focus on creative problem-solving in
PCC, sharing strategies that respect patient autonomy
and preferences.” is collaborative environment is cru-
cial for nurses, allowing them to share PCC strategies and
maintain emotional and professional resilience.
Reective practice
Reflection is a powerful tool for nurses, enabling them
to assess and refine their approach to PCC. Participant
N1 described using reflection to enhance patient inter-
actions: “Reflecting on patient feedback has helped me
better understand their preferences, which is central to
PCC.” Participant N9 uses journaling to process experi-
ences, aiding in the development of more empathetic and
patient-centered care strategies.
Resilience building
e demands of delivering PCC in outpatient settings
necessitate resilience. Participant N3 found mindful-
ness meditation helpful for maintaining focus on patient
needs, even in stressful situations. Participant N7 shared
the benefits of resilience workshops: “Learning stress
management techniques has improved my ability to
adapt care plans according to patient preferences, a key
aspect of PCC.” is focus on resilience supports nurses
in consistently applying PCC principles, even when faced
with challenges.
Discussion
is qualitative study offers invaluable insights into the
intricate dynamics and challenges that shape the nurse-
patient relationship within the context of caring for older
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Shaban et al. BMC Nursing (2024) 23:480
adults in outpatient settings. By amplifying the voices of
experienced nurses, our findings illuminate the multifac-
eted nature of delivering person-centered care (PCC) to
this vulnerable patient population. e thematic analysis
sheds light on the lived experiences of nurses, the obsta-
cles they confront, and the strategies they employ to nav-
igate these complexities—all while striving to uphold the
principles of PCC and address the diverse health priori-
ties of older adults.
In our exploration of Person-Centered Care (PCC) in
outpatient settings, this study illuminates the nuanced
ways in which nurses navigate the delicate balance
between addressing health priorities and enhancing the
quality of life for older adults. While the focus on man-
aging chronic conditions and immediate health concerns
is paramount, our findings underscore the equally criti-
cal endeavor of enhancing patients’ holistic well-being.
Nurses, through their application of PCC principles,
actively consider the broader aspects of older adults’
lives, integrating concerns related to emotional, social,
and spiritual well-being into their care plans.
Moreover, the findings reveal that the strategies
employed by nurses to adapt care approaches and engage
in interdisciplinary collaboration have profound impli-
cations for patients’ quality of life. By tailoring care to
reflect each individual’s preferences and involving a spec-
trum of healthcare professionals, nurses ensure that care
plans are both comprehensive and conducive to enhanc-
ing well-being beyond the clinical domain [43]. ese
insights enrich the discourse on PCC by demonstrat-
ing that the concept extends far beyond the confines of
individualized medical treatment. Rather, PCC embod-
ies a holistic approach that considers the entirety of the
patient’s life context, emphasizing the importance of
quality of life as a pivotal component of care [44].
e significance of trust as a foundational element in
the nurse-patient relationship emerges as a resounding
theme. Nurses emphasize the paramount importance of
building trust, recognizing it as a catalyst for effective
communication, collaborative care planning, and ulti-
mately, improved health outcomes. is finding resonates
with existing literature that highlights trust as a crucial
determinant of patient satisfaction, adherence to treat-
ment regimens, and overall quality of care [45–47]. Nota-
bly, the process of trust-building is an ongoing endeavor,
requiring consistent, empathetic, and patient-centered
interactions, as emphasized by participants in our study
[48]. is underscores the need for healthcare systems
and institutions to foster environments that promote and
value the nurturing of nurse-patient trust [49].
e subtheme of adapting care approaches emerges
as a central tenet of PCC in the care of older adults.
Nurses acknowledge the inherent diversity among this
patient population, acknowledging that a one-size-fits-all
approach is inadequate in addressing the complexities
of aging and associated health challenges. is finding
aligns with the principles of PCC, which emphasize the
importance of tailoring care to individual needs, pref-
erences, and values [50]. By continually adapting their
strategies, nurses strive to provide care that respects the
uniqueness of each older adult, ultimately enhancing
patient outcomes and satisfaction [51].
Interdisciplinary collaboration arises as a pivotal
theme, reflecting the multifaceted nature of caring for
older adults [52]. Nurses recognize the invaluable con-
tributions of diverse healthcare professionals, including
dietitians, physiotherapists, social workers, and mental
health specialists, in addressing the physical, emotional,
and social dimensions of health [53]. is finding reso-
nates with the growing body of literature advocating
for interdisciplinary care models as a means to provide
comprehensive, holistic support for older adults [54]. By
embracing a collaborative approach, nurses can leverage
the collective expertise of the healthcare team, ensuring
that care plans encompass the full spectrum of an older
adult’s health priorities [55].
e emotional rewards of caring for older adults
emerge as a poignant and motivating aspect of the nurse-
patient relationship. Nurses derive profound satisfac-
tion and fulfillment from witnessing the positive impact
of their care, be it through explicit expressions of grati-
tude or the subtle yet palpable sense of appreciation from
patients and their families [56]. is finding aligns with
previous studies that have explored the intrinsic rewards
of nursing, particularly in the context of geriatric care
[57]. e emotional rewards documented in our study
serve as a powerful reminder of the profound significance
of nursing’s role in improving the quality of life for older
adults, reinforcing the value and meaning inherent in this
profession [58].
Our study makes several significant contributions to
the literature on Person-Centered Care (PCC) in outpa-
tient settings, particularly in the context of nursing care
for older adults. While existing research has extensively
explored PCC within inpatient settings, our work extends
this discourse by illuminating the unique challenges and
strategies inherent in outpatient care. One of the key
contributions of this study is the detailed exploration of
how nurses navigate the complexities of implementing
PCC with limited resources and within the constraints
of outpatient environments. Unlike previous studies that
primarily focus on the conceptualization and benefits of
PCC, our findings offer a pragmatic look into the adap-
tive strategies nurses employ to maintain PCC principles
despite these challenges.
Furthermore, this study contributes to the literature by
providing insights into the specific coping mechanisms
nurses utilize to sustain their well-being and professional
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Page 12 of 14
Shaban et al. BMC Nursing (2024) 23:480
satisfaction while delivering PCC. is aspect of our
research underscores the critical link between nurse
well-being and the quality of patient care, highlighting
the importance of supporting nursing staff in their roles.
Additionally, our work sheds light on the nuanced ways
in which nurses build trust and engage in reflective prac-
tices to enhance the delivery of PCC, offering concrete
examples that can inform training and development pro-
grams aimed at bolstering PCC in outpatient settings.
Limitations of the study
is qualitative study provides insights into the nurse-
patient relationship for older adults in outpatient set-
tings but has several limitations. Conducted in a specific
geographic region, the findings might not apply univer-
sally due to varying cultural and healthcare contexts. e
focus on nurses’ perspectives, excluding those of older
adults and their families, may limit the comprehensive-
ness of the results. e small sample size of 12 nurses
may not fully represent diverse nursing experiences,
and reliance on self-reported data could introduce bias.
Additionally, its cross-sectional design captures only a
temporal snapshot of the dynamics within nurse-patient
interactions, limiting the understanding of their evolu-
tion over time.
Implications of the study
e study’s findings emphasize the need for trust-
building, adaptive care strategies, and interdisciplinary
collaboration in nursing practice. Healthcare organiza-
tions should foster environments that support effective
person-centered care and professional development for
nurses. Educational programs must enhance training
in communication, ethical decision-making, and fam-
ily dynamics management. Policymakers should ensure
adequate resources and support for nurses to improve
care for the growing population of older adults. Future
research should expand on these findings with longi-
tudinal studies and broader participant perspectives to
develop targeted interventions that enhance both nurse-
patient relationships and overall care quality.
Recommendations
Based on our findings, several concrete recommenda-
tions can be made for practice, research, and education
in the field of nursing, particularly within the context of
Person-Centered Care (PCC) for older adults in outpa-
tient settings.
Practice
Our study underscores the importance of continu-
ous professional development in PCC practices tailored
specifically to outpatient care. Healthcare institutions
should consider implementing regular training sessions
that focus on enhancing communication skills, empa-
thy, and the understanding of the unique needs of older
adults. Additionally, developing policies that encourage
more time for nurse-patient interactions can improve
the implementation of PCC, leading to better patient
outcomes.
Research
Future research should explore the implementation of
PCC in varied healthcare settings to compare how dif-
ferent environments influence the effectiveness of these
practices. Investigating the applicability of our findings in
rural versus urban settings, or in specialized settings such
as dementia care, could provide deeper insights into the
adaptability and scalability of PCC strategies.
Education
Educational curricula for nursing students should incor-
porate modules that emphasize the theoretical and prac-
tical aspects of PCC. is could include case studies
drawn from real-world settings that illustrate both suc-
cessful and challenging aspects of applying PCC prin-
ciples. Additionally, simulation-based training could be
used to prepare students to handle complex situations
involving older adults, enhancing their readiness for real-
world challenges.
Transferability of ndings
While the findings from our study are grounded in the
context of outpatient clinics, the insights regarding the
dynamics of nurse-patient relationships and the chal-
lenges of implementing PCC have potential applicability
to other settings. However, it is important to consider
the specific cultural, organizational, and resource-based
differences that might affect the transferability of these
practices. Researchers and practitioners should carefully
evaluate the context-specific factors in their own settings
before adopting the recommendations from this study.
By addressing these recommendations, we can enhance
the quality of nursing practice, enrich the educational
experiences of nursing students, and guide future
research towards areas that will maximize the impact of
PCC across diverse healthcare environments.
Conclusion
is qualitative study provides key insights into the
nurse-patient relationship and the delivery of person-
centered care to older adults in outpatient settings. It
highlights the importance of trust-building, effective
communication, and adaptive care strategies tailored to
the diverse needs of older adults. e research empha-
sizes the crucial role of interdisciplinary collaboration
in managing complex health priorities and underscores
the challenges nurses face, such as resource constraints,
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Page 13 of 14
Shaban et al. BMC Nursing (2024) 23:480
family dynamics, emotional strain, and the need for con-
tinuous professional development.
e study reveals that coping strategies like peer
support, maintaining work-life balance, engaging in
reflective practice, and resilience-building are vital for
enhancing both nurse well-being and the quality of care.
ese findings have significant implications for nursing
practice, education, policy, and research, urging health-
care organizations to create environments that support
strong nurse-patient relationships and comprehensive,
person-centered care.
Despite its limitations, including geographic specificity
and reliance on self-reported data, the study contributes
valuable perspectives to the understanding of caregiving
in geriatric outpatient settings. As the population of older
adults grows, the role of nurses in providing person-cen-
tered care is increasingly essential. is study calls for
healthcare systems to acknowledge and support nurses’
critical contributions, ensuring that the aging popula-
tion receives the compassionate, individualized care they
need to improve their quality of life.
Supplementary Information
The online version contains supplementary material available at https://doi.
org/10.1186/s12912-024-02099-1.
Supplementary Material 1
Supplementary Material 2
Acknowledgements
Appreciation is given to all faculty members of the Department of
Rheumatology and Rehabilitation, School of Medicine, Qasr Al-Ainy, Cairo
University for their help to conduct this research., and special thanks to
Dr.Reem Hamdy: Professor of Immunology, Rheumatology, and Rehabilitation,
Qasr Al-Ainy Faculty of Medicine, for her valuable guidance and support.
Author contributions
MS, MMS, AM, HHM, MAA, HRA, and FGMA contributed to the study
conception and design, and Material preparation. All authors read and
approved the nal manuscript.
Funding
Open access funding provided by The Science, Technology & Innovation
Funding Authority (STDF) in cooperation with The Egyptian Knowledge Bank
(EKB).
Data availability
The datasets generated during and/or analyzed during the current study are
available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
The Faculty of nursing, Zagazig university ethical and research committee
granted formal approval. IRB number: ZU.NUR.REC#:085, Informed consent to
participate was obtained from all of the participants in the study.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Received: 20 February 2024 / Accepted: 17 June 2024
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