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Transforming End-of-Life Care by Implementing a Patient-Centered Care Model

Findings From an Action Research Project

Dobrina, Raffaella, MES, RN; Tenze, Maja, MNS, RN; Palese, Alvisa, MNS, RN

Journal of Hospice & Palliative Nursing: December 2018 - Volume 20 - Issue 6 - p 531–541
doi: 10.1097/NJH.0000000000000468
Feature Articles

Patient-centered care is valued by health care professionals working in palliative care settings. However, studies have revealed the difficulty of adopting patient-centered care in daily practice and of sharing its meaning within the interdisciplinary team. The aim of this study was to report the process of transforming end-of-life care by implementing a patient-centered model of care in an Italian hospice. An action research process was conducted between June 2012 and June 2014. The following phases were performed: (a) “looking” phase: the diagnosis was established by collecting data through semistructured interviews in the field study and through the administration of the Frommelt Attitude Toward the Care of the Dying Scale Form B—Italian Version; (b) “thinking” phase: staff members, guided by a research team, redesigned practice by identifying priorities in improvements and actions through multiprofessional focus groups; (c) “acting” phase: actions identified in the previous phase were implemented; and (d) “relooking” phase: the same data collection processes used in the looking phase were applied to evaluate the outcomes achieved. Three areas of improvement have been established: (1) symptoms were intensively audited through patient self-reports by using validated tools; (2) patients' family needs were also regularly collected, documented in clinical records, and addressed; (3) patients' family members were involved in the plan of care through support and education. Inpatient hospice health carers in this study were aware of the concept of patient-centered care. However, its actual implementation was lacking. An action research approach helped them to implement expected changes.

Raffaella Dobrina, MES, RN, is clinical nurse, Nursing Home Brioni, Trieste, Italy.

Maja Tenze, MNS, RN, is nursing director, Casa di Cura Pineta del Carso, Trieste, Italy.

Alvisa Palese, MNS, RN, is associate professor in nursing science, Department of Medical Sciences, University of Udine, Italy.

Address correspondence to Alvisa Palese, MNS, RN, Department of Medical Sciences, School of Nursing, Udine university, Viale Ungheria 20, 33100 Udine UD, Italy (

The project was approved by the Region Friuli Venezia Giulia (Italy), and a grant was provided (Cod. Op: FP1123738001 SHARM).

The authors have no conflicts of interest to disclose.

© 2018 by The Hospice and Palliative Nurses Association.