A Concept Analysis of Person-Centered Care

Abstract

The term person-centered care (PCC) has been frequently used in the literature, but there is no consensus about its meaning. This article uses Walker and Avants's method of concept analysis as a framework to analyze PCC. A literature search was completed and data were collected using several search engines (CINAHL, Medline, PubMed, and Cochrane Review). The key words used were "individualized-care," "person-centered care," "patient-centered care," "client-centered care," and "resident-centered care." Attributes, antecedents, and consequences of PCC were identified. Empirical referents were provided to measure PCC from the perspective of the person receiving care and finally, a model case provides an exemplar of the concept.

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Journal of Holistic Nursing
http://jhn.sagepub.com/content/early/2011/07/15/0898010111412189
The online version of this article can be found at:
DOI: 10.1177/0898010111412189
published online 19 July 2011J Holist Nurs
Stephanie S. Morgan and Linda Yoder
A Concept Analysis of Person-Centered Care
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1
Journal of Holistic Nursing
American Holistic Nurses Association
Volume XX Number X
Month XXXX xx-xx
© 2011 AHNA
10.1177/0898010111412189
http://jhn.sagepub.com
jhn
A Concept Analysis
of Person-Centered Care
Stephanie Morgan, MSN, RN, FNP-BC
Linda H. Yoder, MBA, PhD, RN, AOCN, FAAN
The University of Texas in Austin School of Nursing
The term person-centered care (PCC) has been frequently used in the literature, but there is no consensus
about its meaning. This article uses Walker and Avants’s method of concept analysis as a framework to
analyze PCC. A literature search was completed and data were collected using several search engines
(CINAHL, Medline, PubMed, and Cochrane Review). The key words used were “individualized-care,”
“person-centered care,” “patient-centered care,” “client-centered care,” and “resident-centered care.”
Attributes, antecedents, and consequences of PCC were identified. Empirical referents were provided
to measure PCC from the perspective of the person receiving care and finally, a model case provides an
exemplar of the concept.
Keywords: concept analysis; person-centered; patient-centered; individualized care; client-centered;
resident-centered
Health care in America has been described as frag-
mented and impersonal (Institute of Medicine
[IOM], 2001). The traditional clinician-centered or
disease-focused medical model is being changed to
one in which care is customized to each person.
“Person-centered care” (PCC) has been recognized
as one of the critical elements needed in the rede-
sign of our nation’s health care system (IOM, 2001).
This is a monumental task for the traditional health
care setting where efficiency, standardization, and
architectural design were created to organize systems
around medical providers rather than patients.
PCC is an essential component of quality health
care delivery, and the concept is increasingly being
advocated and incorporated into the training of
health care providers (Lauver et al., 2002). The use
of PCC terminology is frequent, but the concept is
vague. Moreover, the practice of PCC is dependent
on the setting in which care is provided. This creates
confusion, influences the development of theory,
and affects the implementation of PCC practices.
Therefore, the purpose of this article is to provide a
concept analysis of PCC in the context of an inpatient
post–acute health care environment.
Literature Review
A literature search was completed and data were col-
lected using several databases (CINAHL, Medline,
PubMed, and Cochrane Review). No time period
was delimited in the search to capture the historical
evolution of this concept. The key words used were
“individualized-care,” “person-centered care,” “patient-
centered care,” “client-centered care,” and “resident-
centered care.” Related words describing care such
as “personalized” and “focused” also were included.
The initial search identified 17,751 citations. After
limiting the search to those written in English and
adjusting the age to an adult population (≥19 years),
the number was reduced to 3,666 citations. After
exclusions were applied to select only those articles
that contained the original key words in the title, the
total decreased to 217 citations. Abstracts from those
articles were reviewed, and 167 citations were removed
because they did not contain reference to the terms’
Authors’ Note: Please address correspondence to Stephanie
Morgan, MSN, RN, FNP-BC, The University of Texas in Austin
School of Nursing, 10001 Echo Hills Court, Austin, TX 78717;
e-mail: ssmorgan@me.com.
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2 Journal of Holistic Nursing / Vol. XX, No. X, Month XXXX
meaning or use in the body of the text. Finally, an
ancestry search was conducted from all the articles
retrieved to capture other key resources. A total of
50 articles were used in this concept analysis.
Similar Terms
In the literature, the word person in PCC is used
interchangeably with patient, client, and resident.
This variance depends on the context in which care
is provided. Hospitals use the term patient-centered
care whereas nursing homes use resident-centered
care. The intent of the care delivery, however, is con-
gruent among all, advocating that care should be
individualized around the person regardless of the
health care setting.
Historical Evolution
The concept of PCC has a long history and tradition
in health care. Lauver et al. (2002) argued that the
origins of this concept could be traced back to
Florence Nightingale, “who differentiated nursing
from medicine by its focus on the patient rather
than the disease” (p. 246). Carl Rogers, an American
psychologist, created the notion of person-centered-
ness in the early 1940s. The principles of his theory
were that each individual (a) possesses consider-
able qualities, (b) can draw strength from available
resources, and (c) can find a way to remedy difficulties
(Rogers, 1961).
The term patient-centered medicine was coined
by Balint in the 1960s, who proposed how physicians
should interact with their patients (Balint, 1968).
The emphasis was on understanding patients and
their unique circumstances as a way of providing
care. Since that time, several authors built on Balint’s
work and multiple dimensions of PCC have been
discussed in the literature. According to Lipkin,
Quill, and Napodano (1984), the person-centered
practitioner must have the basic knowledge, atti-
tude, and skills to provide PCC. The context of a
patient interview should be conducted in a way that
allows the patient to share his or her unique story
promoting trust and confidence, clarifying symptoms
and concerns, generating and testing hypotheses
that may include biological and psychosocial dimen-
sions of illness, and creating a foundation of genu-
ine trust for an ongoing relationship.
Stewart et al. (1995) suggested that for physi-
cians to be more person-centered, they needed to
gain an understanding of the patients and the dis-
eases or conditions through a process of addressing
both the patient’s and the physician’s agenda. Six
dimensions of PCC were identified: exploring the
experience of the illness, understanding the person
as a whole, agreeing to the plan for health care man-
agement, including prevention and promotion of
health, focusing on the doctor–patient relationship,
and being realistic about personal limitations. The
common theme in the work by both Lipkin et al.
(1984) and Stewart et al. (1995) was that interper-
sonal relationships between physicians and patients
are paramount to providing PCC.
The Picker-Commonwealth Program for Patient-
Centered Care began in 1987 to promote the move-
ment of patient-centeredness into a comprehensive
health care system as a way to delivering better health
care services. The focus was on patients’ needs, and
seven dimensions were identified:
(1) respect for patients’ values, preferences, and
expressed needs; (2) coordination and integration of
care; (3) information, communication, and education;
(4) physical comfort; (5) emotional support and alle-
viation of fear and anxiety; (6) involvement of friends
and family; and (7) transition and continuity. (Beach,
Saha, & Cooper, 2006, p. 2)
This program was the first to identify that PCC
should not only occur at the interpersonal level
between a care provider and patient but also at the
organizational level.
To further the evolution, Mead and Bower’s
(2000) review of the literature resulted in a clarifica-
tion of the dimensions of PCC. They created a con-
ceptual framework that included five dimensions of
person-centeredness. Their dimensions were “bio-
psychosocial perspective, patient as person, shared
power and responsibility, the therapeutic alliance,
and doctor as person” (Mead & Bower, 2000, p. 1088).
These authors recognized that person-centeredness
was a proxy for quality care and that key elements
included the ability of the practitioner to understand
the unique needs of each person and to create a
healthy interpersonal relationship.
In nursing, the interpersonal relationship between
the nurse and client has been described as the crux
of nursing (Peplau, 1997). The nurse–client rela-
tionship influences the quality of care provided, and
the goal of the interpersonal relationship is to support
the client’s overall health and well-being (Gastmans,
1998). However, an interpersonal relationship on its
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Concept Analysis of Person-Centered Care / Morgan, Yoder 3
own does not mean the relationship is person-
centered. Moreover, some would argue that the use
of the words such as patient or noncompliance
describes an interpersonal relationship as one where
the clinician assumes the authority, power, and control
(Ingram, 2009; Leplege et al., 2007; Slater, 2006).
In contrast, the practice of PCC creates an interper-
sonal relationship that shifts the focus from the cli-
nician to the person for whom care is being delivered,
thus giving control to that individual.
Since the 2001 publication of IOM’s report
Crossing the Quality Chasm, there has been a surge
in publications about PCC. A concept analysis con-
cerning person-centeredness (Slater, 2006) and a
dimensional analysis of PCC (Hobbs, 2009) have
both contributed to the development of this con-
cept. Slater’s (2006) concept analysis identified the
health care environment as having an influence on
person-centered delivery of care. However, the
author did not identify it as an antecedent and no
clarification was provided as to how the environ-
ment affects PCC. The antecedents identified by
Slater were dignity, autonomy, respect, and thera-
peutic relationship; attributes identified were indi-
viduality, respecting values, and empowerment; and
consequences identified included improved health
outcomes and perceived improved relationship. Hobbs’s
(2009) dimensional analysis of patient-centered care
took a much broader approach. The focus was on
the acute care setting and the analysis identified
therapeutic engagement as the process for PCC. The
consequences included effective care, less suffering,
and met needs. The conclusion from the author was
that PCC is a complex concept that required more
clarification (Hobbs, 2009).
Definition of Person-Centered Care
The IOM (2001) defined PCC as “care that is
respectful and responsive to individual patient pref-
erences, needs, and values, and ensuring that patient
values guide all clinical decisions” (p. 49). McCormack
(2003) defined PCC as “the formation of a therapeu-
tic narrative between professional and patient that is
built on mutual trust, understanding and a sharing
of collective knowledge” (p. 203). Suhonen, Välimäki,
and Leino-Kilpi (2002) defined PCC as being com-
prehensive care that meets each patient’s physical,
psychological, and social needs. None of these defi-
nitions represent PCC in its entirety. Therefore,
for the purpose of this analysis, a combination of
these definitions will be used to provide the most
complete definition of this concept. PCC is a holistic
(bio-psychosocial-spiritual) approach to delivering care
that is respectful and individualized, allowing negotia-
tion of care, and offering choice through a therapeutic
relationship where persons are empowered to be
involved in health decisions at whatever level is desired
by that individual who is receiving the care.
Defining Attributes
Walker and Avant (2005) described attributes or
characteristics of a concept as the “heart of a con-
cept analysis” (p. 68). The goal is to identify the
attributes that are the most frequently associated
with the concept. Identifying the key characteristics
of the concept not only assists in clarifying a phe-
nomenon but also helps differentiate it from another
similar or related one (Walker & Avant, 2005).
Themes with common traits were collapsed to cap-
ture the essence of the attribute. The analysis of
PCC in a post–acute health care setting resulted
in the following defining attributes: (a) holistic,
(b) individualized, (c) respectful, and (d) empowering.
These characteristics appear consistently through-
out the literature concerning PCC and reflect the
essence of the concept. Visual representation of the
concept analysis components is found in Figure 1.
Holistic
Holistic care is described as a behavior that recog-
nizes and values whole persons as well as the inter-
dependence of their parts (McEvoy & Duffy, 2008).
The whole person is described as the biological,
social, psychological, and spiritual aspects of an
individual (McCormack, 2003). Providing holistic
care allows the clinician to better understand how
an illness affects the entire person and how to
respond to the true needs of an individual (Mead &
Bower, 2000). Care that focuses on biological illness
without considering the psychological or social
impact hampers healing and contributes to poor out-
comes (Suhonen, Välimäki, & Katajisto, 2000).
Individualized
The term individualized is the most frequently
acknowledged attribute of PCC. In a PCC environ-
ment, the clinician considers the unique needs
and the specific health concerns of the person to
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4 Journal of Holistic Nursing / Vol. XX, No. X, Month XXXX
provide customized interventions (McCance, 2003).
Individualization cannot be achieved without under-
standing the person’s life situation in addition to his
or her ability or desire to make decisions and take
control of his or her care (Suhonen et al., 2002;
Suhonen, Välimäki, & Leino-Kilpi, 2005). Personal
life situations include having knowledge about cul-
ture, beliefs, traditions, habits, activities, and pref-
erences (Suhonen, Välimäki, et al., 2005). According
to Edvardsson, Koch, and Nay (2009), individual-
izing care demonstrates appreciation of the unique
history and personality of people while recognizing
their perspectives and customizing care that best
meets their needs. Care should be organized by
patients’ personal needs and preferences instead of
institutional standards or routines, which Suhonen
et al. (2002) argued is the opposite of individual-
ized care because one size does not fit all (Leplege
et al., 2007).
Respectful
Being respectful also is an important attribute of
PCC and is frequently referred to as a “right” and
the driving force behind this concept (McCormack,
2003). The right to be treated with respect allows
for individuals to be recognized as competent to
make decisions about their own care (Leplege et al.,
2007). Patients are increasingly regarded as active
health care consumers and have the right to choices
in their service and care (Mead & Bower, 2000).
Offering choices in care recognizes and respects the
inherent value of each individual, supports a per-
son’s strength and abilities, and encourages human
freedom (Rader & Lavelle, 2008). Respect for basic
choices in daily routines includes preferences about
food and meal times, who visits and when, waking
and sleep times, privacy, and bathing (Kantor, 2008).
Empowering
Empowerment is an equally important attribute. It
encourages autonomy and self-confidence, two impor-
tant factors when an individual is most vulnerable
(Suhonen et al., 2000). Self-confidence promotes
self-determination, which facilitates the person’s
participation in decision making. Participating in
care decisions concerning treatment suggests that
individuals have input into their own care (Suhonen
et al., 2000) and can result in individuals perform-
ing, by themselves, various types of self-treatment
that a few years ago would have only been performed
Figure 1. Antecedents, Attributes, and Consequences of Person-Centered Care in a Post–Acute Health Care Environment
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Concept Analysis of Person-Centered Care / Morgan, Yoder 5
by a trained health care provider (Leplege et al., 2007).
Strategies such as assisting an individual to learn
and obtain information, supporting the individual’s
choices, and effective communication and negotia-
tion are needed for a person to genuinely feel empow-
ered to be involved in health care decisions (McCarthy
& Freeman, 2008).
Antecedents
Walker and Avant (2005) described antecedents as
events that occur prior to the concept. Without the
antecedents, caregivers will not be able to provide
PCC effectively. Evidence exists recognizing the health
care climate of an inpatient setting as the primary
determining factor of influence on the ability of
nurses to provide care that is centered on the per-
son (Edvardsson et al., 2009). The health care
environment (physical and cultural) dictates the
parameters for nursing care and either fosters or
stifles the ability for care to be individualized to
each client. Within the health care environment,
the antecedents that create a person-centered cli-
mate include (a) vision and commitment, (b) orga-
nizational attitudes and behaviors, and (c) shared
governance.
Vision and Commitment
The context of the care environment has the greatest
impact on the operationalization of PCC practices
(Douglas & Douglas, 2005; Edvardsson et al., 2009;
Hobbs, 2009; McCormack, 2003). Within the built
environment, the climate and culture created by
organizational leaders supports the committed vision
of PCC. There are links between environmental
characteristics and patient health outcomes (Rader
& Lavelle, 2008). Moreover, the environmental cul-
ture can influence a person’s health by influencing
the behaviors, actions, and interactions of the staff
providing the care (Rader & Lavelle, 2008). This
influence can be as subtle as communication through
images, symbols, and metaphors. Because the type
of care delivered is dependent on the contextual set-
ting, a nurse’s ability to provide care is constrained
within the specific contexts and the resources avail-
able (Hobbs, 2009). Therefore, a culture that values
respect, empowerment, and choice for patients and
staff is paramount.
Organizational Attitudes and Behaviors
McCormack and McCance (2006) asserted that for
PCC to occur, changes in service delivery are required
at both individual and organizational levels. Hobbs
(2009) suggests that organizations need to be less
focused on the command and control style of leader-
ship and more on shared governance. Organizational
leaders set the tone for the cultural environment by
their attitudes and behaviors. The philosophy of put-
ting the relationship before the task when planning
care sets the stage for a PCC culture (Rader &
Lavelle, 2008). Kramer et al. (2009) stressed that
staff cannot control practice or engage in activities
related to PCC at the bedside unless the same sanc-
tion and endorsement for activities exists at the orga-
nizational level. This is referred to this as “rule
orientation” (McCormack, 2003). Rule orientation is
the ability to determine when and how to deviate
from the established norms and standards when
the situation dictates. This requires nurses to believe
they can balance patient values and organizational
values in care delivery (McCormack, 2003). Lack of
support by organizational leaders to create a PCC
culture prevents nurses from incorporating personal-
ized care into their daily care practice.
Shared Governance
Shared governance is described by Porter-O’Grady
(2003) as shared decision making between line staff
and organizational leaders. Shared governance empow-
ers direct care workers to become part of the decision-
making process (Burger et al., 2009). Brown and
Miller (2003) refer to this as decentralizing decision
making, explaining that when the administrator or
unit manager makes decisions regarding a person’s
care, staff members are not able to personalize the
care they provide and PCC decreases. Therefore,
input and feedback from staff who work at the bed-
side is critical for decisions regarding changes to
policies and procedures, redesigning the physical
environment, and determining the effect of changes
on daily workflow (Burger et al., 2009).
Consequences
Consequences are events that occur as a result of the
concept (Walker & Avant, 2005). Although the conse-
quences, or outcomes, of PCC were identified, there
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6 Journal of Holistic Nursing / Vol. XX, No. X, Month XXXX
were minimal descriptions of what was meant by each
consequence, and it was unclear how one consequence
was differentiated from another. However, the three
primary consequences identified for patients were
(a) improved quality of care, (b) increased satisfaction
with health care, and (c) improved health outcomes.
Improved Quality of Care
According to Donabedian (1980), the quality of care
provided to an individual in a health care setting is
dependent on three elements: structure, process,
and outcomes. The structure reflects the physical
environment, the process reflects the nurse–client
interaction, and the outcomes reflect health care
status at discharge. Quality health care has also
been described as responsive, respectful, timely, and
performed by staff with confidence (Huycke & All,
2000). Blumenthal (1996) emphasized that the pri-
mary measurement of quality care is the interper-
sonal relationship between those providing care and
those receiving care. Giving quality care is more than
just providing a task. The therapeutic contribution
provided within each interaction is the aspect on which
quality care is measured (Kitson, 1986). Care that
is more person-centered improves the quality of care
experienced because its focus is not on task completion
but personal customization (McCormack, 2003).
Increased Satisfaction
With Health Care
Satisfaction with the health care experience in a
post–acute health care setting is influenced by sev-
eral elements, including the (a) expectations of care,
(b) quality of the care provided, (c) physical setting,
and (d) services available within the setting (Suhonen,
Leino-Kilpi, & Välimäki, 2005). However, nursing
care has been identified as the strongest predictor of
patient satisfaction with the overall health care expe-
rience (Laschinger, Hall, Pedersen, & Almost, 2005).
PCC improves satisfaction because interactions are
tailored to the unique needs of each person and
includes the individual in health care decisions, both
of which have been identified as critical elements to
improving satisfaction in an inpatient health care
environment (McCormack & McCance, 2006).
Improved Health Outcomes
Health outcomes encompass a person’s functional
status and overall well-being (Haffer & Bowen, 2004).
The importance of functional status is related to a
person’s role function and therefore is unique to
each individual. Functional status includes the abil-
ity to carry out activities of daily living, such as loco-
motion, communication, eating, bathing, dressing,
transferring, and toileting (Kanaan, 2000). Although
not important to all persons, it can include the par-
ticipation in life situations and society, such as work-
ing outside of the home, hobbies, and maintaining a
household (Kanaan, 2000). The specific role func-
tion of an individual is a key driver for determining
the importance of functional status and quality of life
(Guyatt, Feeny, & Patrick, 1993). Although func-
tional improvement in general is important to the
overall measurement of health outcomes, it is only
important if the person recovering perceives it
as improving role function in their life. Well-being is
the subjective measure regarding how a person feels
about his or her life (Harter & Gurley, 2008). Diener
(2005) describes well-being as how a person evalu-
ates his or her life, including both the positive and
negative experiences. Measuring the health outcomes
of individuals in a post–acute health care setting
contributes to understanding the effects of the health
care practices and interventions received in that
environment (National Institutes of Health, 2005).
Nurses who provide PCC contribute to increasing
the individual’s feelings of well-being, which in turn
improves the person’s functional abilities (McCormack
& McCance, 2006). Because role function, functional
ability, and well-being are specific to each individual,
a person-centered environment allows the outcomes
to be defined by the individual receiving care.
Empirical Referents
Empirical referents are described by Walker and
Avant (2005) as groups of actual phenomena that
demonstrate the occurrence of the concept. PCC is
typically measured from the perspective of the per-
son receiving care. Measuring delivery of PCC in a
postacute, inpatient environment is critical for
assessing and improving individualized care at the
bedside. There were four instruments identified in
the literature used to measure PCC in a postacute
inpatient setting. However, the Person-Centered
Climate Questionnaire (PCQ; Edvardsson et al.,
2009) and the Patient Satisfaction with Nursing
Care Quality Questionnaire (PSNCQQ; Laschinger
et al., 2005) did not measure the core concept of
PCC as described in this analysis and focused more
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Concept Analysis of Person-Centered Care / Morgan, Yoder 7
on the antecedents and consequences of PCC.
Moreover, the instrument used to measure the
antecedents, PCQ, measures the effect of the ante-
cedents and not the antecedents directly. The com-
bined synergy from the antecedents creates the
person-centered health care climate and the cli-
mate is what the client experiences. The science
regarding PCC is still emerging, and although these
instruments capture some of the attributes identi-
fied in this concept analysis, more work is still
needed to test and refine current instruments and
develop additional ones to measure PCC. The entire
list of instruments that could be used to measure
the PCC, antecedents, and consequences are sum-
marized in Table 1, with reliability and validity sum-
marized in Table 2.
Four of these instruments (PCQ, ICS, P-CIS,
and PSNCQQ) have been used to measure the con-
cept of PCC in primary acute care settings in
Sweden, Finland, Australia, and Canada. None of
these instruments have been used in a post–acute
health care setting in the United States; therefore,
further testing is needed to build on findings from
these international studies and to strengthen the
implementation and practice of PCC in the United
States.
Model Case
The following is an exemplar of PCC because it
demonstrates all the defining attributes of the con-
cept. Mr. Trent was admitted to a rehabilitation
center for therapy after an automobile accident left
him severely injured and killed his best friend. The
admitting nurse was expecting Mr. Trent when he
arrived and escorted him (via wheelchair) to his pri-
vate room. The nurse had received a report from the
hospital prior to Mr. Trent’s arrival and was aware of
the medical circumstances surrounding his need for
rehabilitation. During the initial assessment, the
nurse inquired about Mr. Trent’s occupation, reli-
gious preferences, and interests. Mr. Trent explained
he was an accountant for a local sporting goods
chain, practiced Buddhism, was a vegetarian, and
enjoyed being outdoors often. He talked about his
recent hospital experience, the kind staff and clean
environment; however, he expressed frustration with
all the rules and the loss of control with his life. At
the end of the nurse’s assessment, Mr. Trent began to
cry. He explained the loss of his best friend in the
accident and his inability to focus on spiritual healing.
The nurse sat by his bedside and listened while
Mr. Trent described the accident. The nurse encouraged
Table 1. Instruments Used to Measure PCC
Instrument Author
Concept
Elements Description of Instrument
Person-Centered Climate
Questionnaire (PCQ)
Edvardsson, Koch, and
Nay (2009)
Antecedent 17-item instrument used to measure the extent to which
the climate (ambiance, culture, and safety) of the
inpatient setting is person-centered
Individualized Care Scale
(ICS)
Suhonen, Leino-Kilpi, and
Välimäki (2005)
PCC 40-item instrument used to measure how nursing
interventions support a patient’s individual
characteristics, personal life situation, and decisional
control over care during a hospital stay
Patient-Centered Inpatient
Scale (P-CIS)
Coyle and Williams (2001) PCC 20-item instrument developed to capture the client’s
experience of “personal identity threat” in the health
care setting
Patient Satisfaction with
Nursing Care Quality
Questionnaire (PSNCQQ)
Laschinger, Hall,
Pedersen, and Almost
(2005)
Consequences 19-item instrument designed to measure satisfaction
with the quality of nursing care
Short Form-36 (SF-36) Gandek, Sinclair, Kosinski,
and Ware (2004)
Consequences 36-item survey that measures eight domains of health
that fall into two categories (physical health and
mental health): physical functioning, role limitation
due to physical health, bodily pain, general health
perceptions, vitality, social functioning, role limitations
due to emotional problems, and mental health
Functional Independence
Measurement (FIM)
Unsworth (2001) Consequences 10-item scale used by the staff to measure independent
performance in self-care, sphincter control, transfers,
locomotion, communication, and social cognition at
admission and discharge
Note: PCC = person-centered care.
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8 Journal of Holistic Nursing / Vol. XX, No. X, Month XXXX
Table 2. Reliability and Validity of Instruments
Instrument Reliability and Validity Reference
PCQ Construct validity estimated in two factors explaining 65% of total variance Edvardsson, Koch, and
Nay (2009)
Cronbach’s alpha of total scale (.90) and subscales—safety (.96) and
hospitality (.89)
Item–total correlations ranging between .37 and .80
Test–retest reliability: intraclass correlations of .7
ICS Content validity was established by a critical ROL and four expert analyses;
face validity was assessed by patient’s views
Suhonen, Leino-Kilpi, and
Välimäki (2005)
Construct validity was established using a series of factor analysis, structural
equation modeling, and correlations of predicted relationships between the
dimensions and construct components
Pearson’s correlation coefficients ranged from .88 to .93 between the
subscales and the total domain for ICA and ICB
Internal consistency reliability of ICA a = .94 and ICB a = .93; the three
subscales had as from .85 to .90
P-CIS Reliability and validity information not presented NA
PSNCQQ Construct validity was established through exploratory factor analysis and
confirmatory factor analysis
Laschinger, Hall, Pedersen,
and Almost (2005)
Cronbach a = .97; item–total correlations were high, ranging from .61 to .89
SF-36 Internal consistency and test–retest reliability range from .89 to .94 for
physical health and from .74 to .91 for mental health; factor analysis of two
factors accounted for 81.5% of the total variance
Ware and Kosinski (2001)
FIM Cronbach a on admission FIM = .99 and discharge FIM = .91 Hsueh, Lin, Jeng, and
Hsien (2002)
Spearman correlation on admission FIM = .74 and discharge FIM = .92
Interclass correlation on admission FIM = .55 and discharge FIM = .86
Note: PCQ = Person-Centered Climate Questionnaire; ICS = Individualized Care Scale; P-CIS = Patient-Centered Inpatient Scale;
PSNCQQ = Patient Satisfaction with Nursing Care Quality Questionnaire; SF-36 = Short Form-36; FIM = Functional Independence
Measurement.
him to participate in grief counseling. He explained
that he needed his room to be a place of healing.
The nurse knew the importance of holistic care with
healing and wanted to involve Mr. Trent in his
recovery. Not being a Buddhist, the nurse asked
Mr. Trent to explain what was needed. He asked if
he could create a shrine for his Buddha with an
offering bowl and incense. Other than the burning
of incense, his request was easily honored. The
nurse explained the safety concern about burning
incense and Mr. Trent agreed, explaining that he
would use the items without lighting them.
This case exemplifies the attributes of PCC. The
nurse approached Mr. Trent’s care from a holistic
and individualized perspective by inquiring about his
preferences and recognizing the importance of his
spiritual connection to healing. His decision for
spiritual healing was respected by honoring his reli-
gious beliefs. Moreover, he was empowered to par-
ticipate in his recovery when the nurse inquired about
how to create the healing environment specifically
tailored to him. The nurse listened and personalized
the setting after identifying the safety concern (light-
ing the incense) illuminating the point that the tra-
ditional health care setting can be personalized to
the individual needing care if the organizational climate
is appropriate.
Conclusion
This article described the concept of PCC by pre-
senting the relevant historical evolution of the concept,
its defining attributes, antecedents, consequences,
empirical referents, and a model case. Providing
clarity about PCC will allow for improvement in the
delivery of PCC in the post–acute health care envi-
ronment. Caregivers can use the attributes (holistic,
individualized, respectful, and empowering) as a
foundation for practice at the bedside. Organizational
leaders can use the antecedents of the concept to
create and sustain a PCC climate. Moreover, using
at UNIV OF TEXAS AUSTIN on July 23, 2011jhn.sagepub.comDownloaded from

Concept Analysis of Person-Centered Care / Morgan, Yoder 9
empirical referents to measure the practice of PCC
is the key to validating that the organization’s philoso-
phy is congruent with PCC practice and that PCC
has a positive effect on health outcomes.
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Stephanie Morgan is a Doctoral Candidate at the University of
Texas at Austin School of Nursing. She is a Board Certified
Family Nurse Practitioner with over 20 years experience in
Executive Nursing Management. She is currently the Vice
President of Clinical Services for Remington Medical Resorts, a
post-acute, short-stay skilled nursing and rehabilitation health
care company.
Dr. Yoder is an Associate Professor and the Director for the
Nursing Administration Concentration at The University of
Texas at Austin School of Nursing. She has over 30 years expe-
rience as a nurse and she was recently selected as a Robert
Wood Johnson Executive Nurse Fellow.
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