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A Dimensional Analysis of Patient-Centered Care

Hobbs, Jennifer Lynn

doi: 10.1097/NNR.0b013e31818c3e79

Background: Patient-centered care (PCC) is a poorly conceptualized phenomenon and can indicate anything from soothing room design, emotional support of patients, customization of meals, to support of patient decision making. This inconsistency across the clinical and research literature makes the application of PCC difficult.

Objectives: The objective of this study was to identify dimensions of PCC as found in the literature.

Methods: A dimensional analysis of PCC was conducted from 69 clinical and research articles published from 2000 to 2006. Coding of the literature for the perspective, context, conditions, process, and consequences of PCC was completed. These codes were used to determine literature selected for inclusion, organize article content, and frame the delineation of PCC.

Results: Alleviating vulnerabilities, consisting of both compromised physiological states and threats to individual identity, was constant throughout the literature. Therapeutic engagement was the process sustaining the patient during an illness episode that necessitated service use and involved allocating time, carrying out information practices, knowing the patient, and developing a relationship. This process occurs during nurse-patient interaction, sustained during successive interactions, and reinforced by the information practices of a particular setting.

Discussion: The interaction between nurse and patient is central to the effective study and application of PCC. Appropriate use of PCC can improve study outcomes and measurements by clarifying the variables involved, and PCC holds great promise to frame patient outcome and satisfaction research by analyzing how and with what effect nurses alleviate patient vulnerability. Moreover, consideration of information practices as a critical supporting structure of nurse-patient interaction can be explored.

Jennifer Lynn Hobbs, MSN, RN, is Doctoral Candidate, School of Nursing, University of Pennsylvania, Philadelphia; and VA Predoctoral Nurse Fellow, VA San Diego Healthcare System, California.

Editor's Note: Additional information provided by the author expanding this article is on the Editor's Web site at

Accepted for publication June 23, 2008.

This study was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Academic Affiliations, Predoctoral Nurse Fellowship Program.

The author thanks Anna Beeber, PhD, RN, assistant professor, University of North Carolina-Chapel Hill; Marty Shively, PhD, RN, associate chief for nursing research, VA San Diego Healthcare System; Keynan Hobbs, MSN, APRN, BC, clinical nurse specialist, Scripps Mercy Hospital; Daniel Pesut, PhD, APRN, FAAN, professor and associate dean for graduate programs, Indiana University; Gwen Sherwood, PhD, RN, FAAN, professor and associate dean for academic affairs, University of North Carolina-Chapel Hill; and the anonymous reviewers for their thoughtful comments and suggestions on this manuscript. Special thanks is given to Sarah Kagan, PhD, RN, FAAN, professor, University of Pennsylvania, for suggesting the methodological approach and providing critical feedback on the earliest versions of the manuscript.

Corresponding author: Jennifer Hobbs, MSN, RN, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92109 (e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.