Balbale Salva Najib, Morris Megan A, LaVela Sherri L
Department of Veterans Affairs, Center for Evaluation of Practices and Experiences of Patient-Centered Care, Hines, IL, USA,
Patient. 2014;7(2):187-95. doi: 10.1007/s40271-014-0044-5.
Accounting for patient views and context is essential in evaluating and improving patient-centered care initiatives, yet few studies have examined the patient perspective. In the Veterans Affairs (VA) Health Care System, several VA facilities have transitioned from traditionally disease- or problem-based care to patient-centered care. We used photovoice to explore perceptions and experiences related to patient-centered care among Veterans receiving care in VA facilities that have implemented patient-centered care initiatives.
Participants were provided prompts to facilitate their photography, and were asked to capture salient features in their environment that may describe their experiences and perceptions related to patient-centered care. Follow-up interviews were conducted with each participant to learn more about their photographs and intended meanings. Participant demographic data were also collected.
Twenty-two Veteran patients (n = 22) across two VA sites participated in the photovoice protocol. Participants defined patient-centered care broadly as caring for a person as a whole while accommodating for individual needs and concerns. Participant-generated photography and interview data revealed various contextual factors influencing patient-centered care perceptions, including patient-provider communication and relationships, physical and social environments of care, and accessibility of care.
This study contributes to the growing knowledge base around patient views and preferences regarding their care, care quality, and environments of care. Factors that shaped patient-centered care perceptions and the patient experience included communication with providers and staff, décor and signage, accessibility and transportation, programs and services offered, and informational resources. Our findings may be integrated into system redesign innovations and care design strategies that embody what is most meaningful to patients.
在评估和改进以患者为中心的护理举措时，考虑患者的观点和背景至关重要，但很少有研究考察患者的视角。在退伍军人事务部（VA）医疗保健系统中，一些VA机构已从传统的基于疾病或问题的护理模式转变为以患者为中心的护理模式。我们运用照片声音法，探索在已实施以患者为中心护理举措的VA机构接受护理的退伍军人对以患者为中心护理的认知和体验。
为参与者提供提示以促进他们拍照，并要求他们捕捉环境中的显著特征，这些特征可能描述他们与以患者为中心护理相关的经历和认知。对每位参与者进行后续访谈，以进一步了解他们的照片及其 intended meanings（此处原文有误，推测应为intended meanings，意为“意图含义”）。还收集了参与者的人口统计学数据。
来自两个VA地点的22名退伍军人患者（n = 22）参与了照片声音法方案。参与者将以患者为中心的护理广义地定义为在满足个人需求和关切的同时照顾整个人。参与者拍摄的照片和访谈数据揭示了影响以患者为中心护理认知的各种背景因素，包括患者与提供者的沟通及关系、护理的物理和社会环境以及护理的可及性。
本研究有助于围绕患者对其护理、护理质量和护理环境的观点及偏好的知识基础不断扩大。塑造以患者为中心护理认知和患者体验的因素包括与提供者和工作人员的沟通、装饰和标识、可及性和交通、提供的项目和服务以及信息资源。我们的研究结果可整合到系统重新设计创新和护理设计策略中，体现对患者最有意义的内容。
