Caracterización de la gestión organizacional para atención centrada en adolescentes en un hospital infantil

Introducción: El cambio general en la concepción de los sistemas de salud de los hospitales como instituciones ha evolucionado a lo largo de los siglos, a tono con los grandes cambios de la humanidad. Objetivos: Evaluar el estado de la gestión organizacional en los servicios hospitalarios, para brindar atención centrada en los adolescentes según sus expectativas, determinar la preparación de médicos y enfermeros y describir la estructura hospitalaria. Métodos: Se realizó una investigación descriptiva y transversal en 1845 adolescentes ingresados en el Hospital Infantil Docente Sur Dr. Antonio María Béguez César, de Santiago de Cuba, del 1 de enero de 2019 al 30 de junio de 2020. Se aplicaron encuestas a los adolescentes hospitalizados, para conocer las preferencias y prioridades en relación con diversos aspectos que pudieran mejorar la satisfacción durante su estancia hospitalaria, y sobre la estructura de las salas. Se evaluaron las habilidades de médicos y enfermeros mediante guías de observación. Resultados: Entre los aspectos analizados, la amabilidad del personal sanitario (83,5 %), la comunicación dialógica (81,6 %) y la visita de amigos (53,7 %) resultaron muy importantes para los adolescentes, al igual que la importancia de la estructura hospitalaria. En relación con la atención a los adolescentes, la mayoría de los profesionales mostró completamente las habilidades. Conclusiones: La investigación mostró insuficiencias en la gestión hospitalaria para la atención centrada en la persona.

Introduction: The general change in the conception of health systems of hospitals as institutions has evolved over the centuries, in tune with the great changes of humanity. Objectives: To evaluate the state of organizational management in hospital services, to provide adolescent-centered care according to their expectations, determine the training of doctors and nurses, and describe the hospital structure. Methods: A descriptive and cross-sectional investigation was carried out on 1,845 adolescents admitted to the Southern Teaching Children's Hospital Dr. Antonio María Béguez César, in Santiago de Cuba, from January 1, 2019 to June 30, 2020. Surveys were applied to hospitalized adolescents to find out the preferences and priorities in relation to various aspects that could improve satisfaction during their hospital stay and with respect to the structure of the wards. The skills of doctors and nurses were evaluated using observation guides. Results: Among the aspect analyzed the friendliness of health personnel (83.5 %), dialogic communication (81.6 %) and the visit of friends (53.7 %) were very important for adolescents, as it was the importance of the hospital structure. In relation to adolescents care, most professionals fully showed the skills Conclusions: The research showed inadequacies in hospital management for person-centered care.

Phenomenology yesterday, today, and tomorrow: a proposed phenomenological response to the double challenges of contemporary recovery-oriented person-centered mental health care.

This paper argues that a dialectical synthesis of phenomenology's traditional twin roles in psychiatry (one science-centered, the other individual-centered) is needed to support the recovery-oriented practice that is at the heart of contemporary person-centered mental health care. The paper is in two main sections. Section I illustrates the different ways in which phenomenology's two roles have played out over three significant periods of the history of phenomenology in 20th century psychiatry: with the introduction of phenomenology in Karl Jaspers' General Psychopathology in 1913; with the development a few years later of structural phenomenological psychopathology; and in the period of post-War humanism. Section II is concerned with the role of phenomenology in contemporary mental health. There has been a turn to phenomenology in the current period, we argue, in response to what amounts to an uncoupling of academic psychiatry from front-line clinical care. Corresponding with the two roles of phenomenology, this uncoupling has both scientific aspects and clinical aspects. The latter, we suggest, is most fully expressed in a new model of "recovery," defined, not by the values of professionals as experts-by-training, but by the values of patients and carers as experts-by-experience, specifically, by what is important to the quality of life of the individual concerned in the situation in question. We illustrate the importance of recovery, so defined, and the challenges raised by it for both the evidence-base and the values-base of clinical decision-making, with brief clinical vignettes. It is to these challenges we argue, that phenomenology through a synthesis of its twin roles is uniquely equipped to respond. Noting, however, the many barriers to such a synthesis, we argue that in the current state of development of the field, it is by way of a dialectical synthesis of phenomenology's roles that we should proceed. From such a dialectic, a genuine synthesis of roles may ultimately emerge. We conclude with a note on the wider significance of these developments, arguing that contrary to 20th century stereotypes, they show psychiatry to be leading the way for healthcare as a whole, in developing the resources for 21st century person-centered clinical care.

Atención Obstétrica Centrada en la Persona

El Código de Ética del Colegio Médico del Perú establece que la medicina es una profesión científica y humanística. La Atención Centrada en la Persona ahora es reconocida como un componente fundamental de la atención médica de calidad porque se han observado numerosos resultados beneficiosos para los pacientes, incluidos familiares y proveedores. Objetivo. Explorar los argumentos de la medicina centrada en la persona para incorporarlos a nuestra especialidad y contribuir a mejorar la atención obstétrica. Metodología. Revisión no sistemática de la literatura, con selección de 72 referencias para construir este ensayo. Resultados. A lo largo del tiempo, las mujeres han sido atendidas por otras mujeres durante el parto. Sin embargo, en los hospitales de todo el mundo, el apoyo continuo durante el trabajo de parto a menudo se ha convertido excepcional. En la actualidad, las mujeres tienen su parto en un ambiente privado sin nadie que las acompañe, situación a ser cambiada, de acuerdo con las evidencias. La OMS recomienda la atención materna respetuosa y se refiere que la atención que mantiene la dignidad, la privacidad y el secreto profesional garantiza que no se haga daño ni maltrato, y permite la elección informada y el apoyo continuo durante el trabajo de parto y el parto. Conclusión. La revisión de la bibliografía muestra que la atención obstétrica centrada en la persona mejora la salud materna y perinatal.

The Code of Ethics of the Peruvian Medical Association states that medicine is a scientific and humanistic profession. Person-Centered Care is now recognized as a fundamental component of quality medical care because numerous beneficial outcomes have been observeds for patients, family members and providers. Objective: To explore the arguments for person-centered medicine in order to incorporate it into our specialty and contribute to improving obstetric care. Methodology: Non-systematic review of the literature with selection of 72 references to construct this trial. Results: Over time, women have been attended by other women during childbirth. However, in hospitals around the world continuous support during labor has often become the exception. Currently, women deliver in a private setting with no one to accompany them, a situation to be changed, according to the evidence. The WHO recommends respectful maternity care and refers to care that maintains dignity, privacy and professional secrecy ensures freedom that no harm or abuse is done and allows informed choice and ongoing support during labor and delivery. Conclusion: The literature review shows that person-centered obstetric care improves maternal and perinatal health.

Implementation of an integrated care strategy for child contacts of tuberculosis patients: a quasi-experimental study protocol.

BACKGROUND: Childhood tuberculosis continues to be a major public health problem. Although the visibility of the epidemic in this population group has increased, further research is needed. OBJECTIVE: To design, implement and evaluate an integrated care strategy for children under five years old who are household contacts of bacteriologically confirmed pulmonary tuberculosis patients in Medellín and the Metropolitan Area. METHODS: A quasi-experimental study in which approximately 300 children who are household contacts of bacteriologically confirmed pulmonary tuberculosis patients from Medellín and the Metropolitan Area will be evaluated and recruited over one year. A subgroup of these children, estimated at 85, who require treatment for latent tuberculosis, will receive an integrated care strategy that includes: some modifications of the current standardized scheme in Colombia, with rifampicin treatment daily for four months, follow-up under the project scheme with nursing personnel, general practitioners, specialists, professionals from other disciplines such as social work, psychology, and nutritionist. Additionally, transportation and food assistance will be provided to encourage treatment compliance. This strategy will be compared with isoniazid treatment received by a cohort of children between 2015 and 2018 following the standardized scheme in the country. The study was approved by the CIB Research Ethics Committee and UPB. CLINICALTRIALS: gov identifier NCT04331262. DISCUSSION: This study is expected to contribute to the development of integrated care strategies for the treatment of latent tuberculosis in children. The results will have a direct impact on the management of childhood tuberculosis contributing to achieving the goals proposed by the World Health Organization's End TB Strategy. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT04331262 . Implementation of an Integrated Care Strategy for Children Contacts of Patients with Tuberculosis. Registered 2 April 2020.

Patient-centered care - evidence in the context of professional health practice / Evidências do cuidado centrado no paciente no contexto da prática profissional de saúde brasileira / Evidencias del cuidado centrado en el paciente en el contexto de la práctica profesional de la salud brasileña

ABSTRACT Objectives: to analyze patient-centered attitudes in care and sharing practices of nursing, speech therapy, dentistry and medicine professionals. Methods: cross-sectional research was used with 411 professionals, and the Patient-Practitioner Orientation Scale instrument was applied as a measure of outcome. Results: physicians presented higher mean scores, reflecting a patient-centered orientation, shared control, and focus on the person, with statistical difference for all domains (p<0.02). Dentists were the professionals who presented lower scores, especially in the sharing domain, with statistical difference in relation to nurses, speech therapists, and physicians (p<0.05). Conclusions: finally, the attitudes of professionals in the health areas studied indicated self-reported preference for centrality in patients. In this context, patient-centered care can be an important resource in health care when committed to overcoming the object man.

RESUMO Objetivos: analisar as atitudes centradas no paciente nas práticas de cuidado e compartilhamento dos profissionais de enfermagem, fonoaudiologia, odontologia e medicina. Métodos: um estudo pesquisa transversal foi usado com 411 profissionais, e o instrumento Patient-Practitioner Orientation Scale foi aplicado como uma medida de resultado. Resultados: os médicos apresentaram escores médios mais elevados, refletindo orientação centrada no paciente, controle compartilhado e foco na pessoa, com diferença estatística para todos os domínios (p<0,02). Os dentistas foram os profissionais que apresentaram menores escores, principalmente no domínio compartilhamento, com diferença estatística em relação aos enfermeiros, fonoaudiólogos e médicos (p<0,05). Conclusões: por fim, as atitudes dos profissionais das áreas de saúde estudadas indicaram preferência autorreferida pela centralidade nos pacientes. Nesse contexto, o cuidado centrado no paciente pode ser um recurso importante na assistência à saúde quando comprometido com a superação do objeto homem.

RESUMEN Objetivos: analizar las actitudes centradas en el paciente en el cuidado y compartir prácticas de profesionales de enfermería, logopedia, odontología y medicina. Métodos: se utilizó una investigación transversal con 411 profesionales, y como medida de resultado se aplicó el instrumento Patient-Practitioner Orientation Scale. Resultados: los médicos presentaron puntuaciones medias más altas, lo que refleja una orientación centrada en el paciente, control compartido y enfoque en la persona, con diferencia estadística para todos los dominios (p<0,02). Los odontólogos fueron los profesionales que presentaron puntajes más bajos, especialmente en el dominio compartir, con diferencia estadística en relación a los enfermeros, logopedas y médicos (p<0,05). Conclusiones: finalmente, las actitudes de los profesionales de las áreas de salud estudiadas indicaron preferencia autorreferida por la centralidad en los pacientes. En este contexto, el cuidado centrado en el paciente puede ser un recurso importante en el cuidado de la salud cuando se apuesta por la superación del objeto hombre.

Intersections of the arts and art therapies in the humanization of care in hospitals: Experiences from the music therapy service of the University Hospital Fundación Santa Fe de Bogotá, Colombia.

Humanization of care is becoming an increasingly important aspect in providing high-quality health services and the arts are more and more implemented to support and foster humanization and person-centered care efforts. Musical experiences are one of the most frequently encountered art forms in medical settings. Music therapy as a healthcare profession has a decades-long tradition in hospitals, both in inpatient and outpatient areas. However, while studies regarding the effectiveness of music therapy are on the forefront of clinical research, little attention has been paid to the profession's inherent opportunities to assist the hospitals' strategies in terms of humanization of care. Yet, the musical experiences in music therapy are especially versatile in supporting healthcare users from a holistic perspective, contributing to a more compassionate, personalized, and humanized environment. In this article, the basic pillars of humanized and person-centered care will be outlined, followed by examples of seven intersections in which the music therapy service of the University Hospital Fundación Santa Fe de Bogotá aligns with its Humanized and Compassionate Care Model. The aim of this article is to stimulate the discussion on music therapy not only as a profession that provides safe and effective treatment, but also as a therapeutic art experience that can add value for hospitals on their path toward a more humanized care culture.

The influence of feminist abortion accompaniment on emotions related to abortion: A longitudinal observational study in Mexico.

Emotions can reflect how individuals internalize identities, social roles, and broader power structures, including abortion stigma. Abortion accompaniment, in the form of logistical, informational, and emotional support offered by individuals and organizations, takes a person-centered, feminist, and rights-based approach. We tested the extent to which abortion accompaniment may decrease negative and increase positive feelings an individual holds related to their abortion. Using observational longitudinal data collected between January 2017 and mid-2018, we compared negative and positive emotional responses to a personal abortion experience one month and six months following the abortion to emotions immediately prior to the abortion ("baseline"), among women travelling from outside of Mexico City to abortion clinics in Mexico City with and without support of the accompaniment organization, Fondo MARIA. We used doubly robust longitudinal mixed effects models with inverse probability weighting methods. At baseline, accompanied and unaccompanied participants experienced an average of 4.9 and 4.4 negative emotions out of eight respectively (i.e., anguish, nervousness, scared, anxious, sadness, guilt, anger, shame) and 1.7 and 1.9 positive emotions of out 4 respectively (happiness, calmness, decidedness, and relief). From our model results, women accompanied (n = 77) had larger decreases in negative feelings (p < .05) and larger increases in positive feelings (p < .01) toward their abortion compared to those who were not accompanied (n = 119) at six months. These changes led the majority of accompanied respondents to have primarily positive feelings about their abortion by endline. Abortion accompaniment through Fondo MARIA in Mexico City was associated with a larger decrease in negative feelings, particularly those related to stigma, and a larger increase in positive feelings six months after abortion. Accompaniment's focus on person-centered support, self-determination, and autonomy may enable people seeking abortion to view their decision as one that is valid and legitimate, and resist the predominant stigmatizing narratives framing abortion as something that is transgressive.

Rediseño en el abordaje de personas con multimorbilidad crónica: desde la fragmentación al cuidado integral centrado en las personas / Redesign in the approach of people with multimorbidity chronic: from fragmentation to comprehensive care people-centered

En Chile, el 70% de la población de 15 años y más vive con multimorbilidad, es decir, con la presencia de dos o más condiciones crónicas de forma simultánea. El abordaje clásico de la cronicidad por programas en atención primaria de salud, con foco en la enfermedad, se expresa en cuidados fragmentados, ineficaces y muy alejados de los principios de centralidad en la persona, integralidad y continuidad del cuidado impulsados desde el modelo de atención integral de salud familiar y comunitario (MAIS). La estrategia de cuidado integral centrado en las personas para la promoción, prevención y manejo de la cronicidad en contexto de multimorbilidad (ECICEP), se constituye en una respuesta a esta problemática.La multimorbilidad representa un desafío de gran envergadura en el rediseño desde una atención fragmentada hacia el cuidado integral centrado en la persona. Implica un proceso de gestión del cambio, en donde es necesario sensibilizar en la urgencia y sentido del cambio, estratificar a la población según riesgo, capacitar a los equipos de salud, reorganizar los procesos administrativos (agendamiento, registro clínico) y clínicos (ingreso y control integral, planes de cuidado consensuados, gestión del cuidado, seguimiento a distancia, automanejo), así como favorecer el liderazgo y acompañamiento del cambio y el trabajo colaborativo en red.Este proceso requiere voluntad política, con sentido de urgencia del cambio y gradualidad, para que su instalación sea eficiente y respetuosa. Por ello, se inicia el proceso con las personas de alta complejidad, que son quienes tienen más riesgo de hospitalizaciones evitables y otras complicaciones

In Chile, 70% of the population aged 15 years and over lives with multimorbidity, that is, with the presence of two or more chronic conditions simultaneously. The classic approach to chronicity by programs in primary health care, with a focus on the disease, is expressed in fragmented care, ineffective and far removed from the principles of person-centeredness, comprehensiveness and continuity of care promoted by the Comprehensive Family and Community Health Care Model (MAIS). The People-Centered Integrated Care Strategy for the Promotion, Prevention and Management of Chronicity in the Context of Multimorbidity (ECICEP) is a response to this problem. Chronic multimorbidity represents a major challenge in the redesign from fragmented care to comprehensive person-centered care. It implies a process of change management, in which it is necessary to raise awareness of the urgency and sense of change, stratify the population according to risk, train health teams, reorganize administrative (scheduling, clinical records) and clinical processes (admission and comprehensive control, consensual care plans, care management, remote follow-up, self-management), as well as promoting leadership and accompaniment of change, networking and intersectoral coordination. This process requires political will, with a sense of urgency of change and gradualness, so that its installation is efficient and respectful. For this reason, the process begins with highly complex patients, who are at the greatest risk of avoidable hospitalizations and other complications.

KDOQI US Commentary on the 2020 ISPD Practice Recommendations for Prescribing High-Quality Goal-Directed Peritoneal Dialysis.

The recently published 2020 International Society for Peritoneal Dialysis (ISPD) practice recommendations regarding prescription of high-quality goal-directed peritoneal dialysis differ fundamentally from previous guidelines that focused on "adequacy" of dialysis. The new ISPD publication emphasizes the need for a person-centered approach with shared decision making between the individual performing peritoneal dialysis and the clinical care team while taking a broader view of the various issues faced by that individual. Cognizant of the lack of strong evidence for the recommendations made, they are labeled as "practice points" rather than being graded numerically. This commentary presents the views of a work group convened by the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) to assess these recommendations and assist clinical providers in the United States in interpreting and implementing them. This will require changes to the current clinical paradigm, including greater resource allocation to allow for enhanced services that provide a more holistic and person-centered assessment of the quality of dialysis delivered.

Brazilian nurses' concept of religion, religiosity, and spirituality: A qualitative descriptive study.

Evidence points toward the impact of nurses' personal views and knowledge about religion, religiosity, and spirituality on health care. This qualitative research investigates nurses' concepts of religion, religiosity, and spirituality and how they use these concepts in practice. Thirty-four nurses were interviewed at a hospital in the state of São Paulo, Brazil. Content analysis was used to organize and code the results. Three main themes generated from the interviews were (i) religiosity/spirituality as an important dimension in life; (ii) notions of religiosity and spirituality; (iii) formal knowledge of the concept of religion, religiosity, and spirituality. The results indicate that religion, religiosity and spirituality should be incorporated into nurse training to improve the comprehension and competence of nurses in these areas of practice. It is recommended that to ensure holistic and person-centered care, there must be constant reflection on these concepts.

National Health Policy Reform for Primary Care in Chile: A Qualitative Analysis of the Health Program Documents.

Introduction: Chilean policy makers reformed the national health policy for primary health care (PHC), shifting from the traditional biomedical model to the integral family and community health model with a biopsychosocial approach, to guide the delivery of PHC throughout the country. Purpose: To evaluate the implementation of the national health policy for PHC through an analysis of the program documents for PHC; and to identify to what extent the national health policy is expressed in each program document, and across all the documents. Methods: A qualitative document analysis with a purposive sample of program documents for PHC. The Chilean Ministry of Health website was systematically searched between October and December 2018 to identify relevant program documents. Thematic and content analysis were performed to identify evidence of the biopsychosocial approach to care delivery with each program document, including the types of interactions between professionals that contribute to person-centered or fragmented care. Results: The study included 13 PHC program documents. Three themes and 10 categories emerged from the data. Most program justifications focused on the biopsychosocial approach to care while including biomedical interventions and supporting independent professional work. Only 4 of the 13 programs were consistent in the justification, interventions, and types of stated professional interactions: 2 from the biopsychosocial and 2 from the biomedical perspectives. Conclusion: In terms of the national health policy for PHC in Chile, interprofessional collaboration and person-centered care processes and practices were partially aligned with the written content of the health program documents. As such, policy makers and health sector leaders are advised to analyze draft health program documents for consistency in translating national health policies into the written communications that define the actualization of the care model in PHC and direct professionals how to provide PHC to individuals and families.

Integrated continuous care: implementation in Mato Grosso do Sul, Brazil / Cuidado contínuo integrado: implantação em Mato Grosso do Sul, Brasil

The demographic transition that occurred in Brazil brought changes in its health indicators. Integrated Continuous Care (ICC) was organized as a health care model aimed at increasing the independence and well-being of people with acute or recent functional dependence. This study aimed to describe the development and implementation of the Integrated Continuous Care in the state of Mato Grosso do Sul, Brazil. This care model utilized the principles of the National Humanization Policy, such as the extended and shared clinic, embracement, educational practices and meetings with caregivers, families, and patients, open visits, participation and autonomy of the patient and family in the construction of the Singular Therapeutic Project, and shared discharge from hospital. Assistance and support to patients who were already released from ICC must be increased in the primary health care setting to ensure continuity of recovery, better readaptation, and successful family and social reintegration. As a positive result, we set up an outpatient clinic for ICC patients who needed continuous clinical follow-up after rehabilitation. This allows patient re-evaluation, reduces re-admission rates, and maintains the domiciliary care management educational process. As an innovative approach to improving health care outcomes, ICC allows the patients to leave the hospital environment and go home on some weekends. The ICC project has enabled many advances, especially in patient-centered care and shared decision-making. The support of the São Julião Hospital administration has been vital to the success of ICC Unit treatments.

A transição demográfica identificada no Brasil trouxe mudança de indicadores de saúde. Os Cuidados Continuados Integrados (CCI) se formatam como um modelo de assistência que busca aumentar a independência e bem estar das pessoas com dependência funcional aguda ou recente. O estudo tem como objetivo de descrever a construção e implantação dos Cuidados Continuados Integrados no estado de MatoGrosso do Sul, Brasil. Este modelo de assistência utiliza ferramentas da Política Nacional de Humanização, como clínica ampliada e compartilhada, acolhimento, práticas educativas e reuniões com cuidadores, familiares e pacientes, visitas abertas, participação e autonomia do paciente e familiares no projeto terapêutico singular e alta compartilhada. A assistência e o apoio aos pacientes pós-alta CCI precisam ser fortalecidos na rede básica de saúde, a fim de garantir a continuidade da recuperação, readaptação e perfeita reinserção familiar e social. Como resultado positivo, iniciou-se o ambulatório para pacientes egressos do CCI que precisavam de acompanhamento clínico contínuo após a reabilitação. Esse ambulatório permite a reavaliação do paciente, contribui para reduzir a reinternação e mantém o processo educacional de gerenciamento do cuidado domiciliar. Enquanto inovação em saúde para melhorar os resultados dos cuidados de saúde, o CCI permite a saída dos pacientes do ambiente hospitalar para o domicilio em alguns finais de semana. O projeto CCI trouxe muitos avanços, especialmente o cuidado centrado no paciente e a decisão compartilhada. O apoio da administração do Hospital São Julião tem sido vital para o sucesso dos tratamentos realizados na unidade CCI.

Agenda para a pesquisa sobre o cuidado centrado no paciente no Brasil / Agenda for patient-centered care research in Brazil

Resumo O cuidado centrado no paciente se constitui em um movimento incipiente e sua prática ainda encontra obstáculos no sistema de saúde brasileiro, onde é pouco identificado como uma dimensão da qualidade dos cuidados de saúde. Baseado nisso, este artigo se propõe a estabelecer uma agenda de pesquisa sobre o cuidado centrado no paciente/pessoa, com vistas a subsidiar a sua implementação em serviços de saúde do país. Foi realizado um painel com nove especialistas, a fim de apreender diferentes olhares sobre o tema. A discussão presencial foi subsidiada por um documento sistematizando uma proposta inicial de agenda e uma breve apresentação sobre o conceito de cuidado centrado no paciente e elementos teóricos que conformam sua prática. Os participantes do painel definiram um conjunto de itens a serem explorados em estudos no sentido da identificação de estratégias de implementação, fortalecimento e medição do cuidado centrado no paciente no contexto brasileiro.

Abstract Patient-centered care is an incipient movement and its practice still faces obstacles in the Brazilian health system, where it is not extensively identified as healthcare quality realm. Thus, this paper aims to establish a patient/person-centered care research agenda to support its implementation in the country's healthcare services. A panel was held with nine experts to grasp different views on the subject. The face-to-face discussion was supported by a document systematizing an initial agenda proposal and a brief presentation of the patient-centered care concept and theoretical elements that underpin its practice. Panel participants defined a set of items to be explored in studies to identify implementation and to strengthen and to measure strategies for patient-centered care in the Brazilian context.

A bioethical framework to guide the decision-making process in the care of seriously ill patients.

BACKGROUND: One of the biggest challenges of practicing medicine in the age of informational technology is how to conciliate the overwhelming amount of medical-scientific information with the multiple patients' values of modern pluralistic societies. To organize and optimize the the Decision-Making Process (DMP) of seriously ill patient care, we present a framework to be used by Healthcare Providers. The objective is to align Bioethics, Evidence-based Practice and Person-centered Care. MAIN BODY: The framework divides the DMP into four steps, each with a different but complementary focus, goal and ethical principle. Step 1 focuses exclusively on the disease, having accuracy is its ethical principle. It aims at an accurate and probabilistic estimation of prognosis, absolute risk reduction, relative risk reduction and treatments' burdens. Step 2 focuses on the person, using empathic communication to learn about patient values and what suffering means for the patient. Emphasis is given to learning and active listening, not taking action. Thus, instead beneficence, we trust comprehension and understanding with the suffering of others and respect for others as autonomous moral agents as the ethical principles of Step 2. Step 3 focuses on the healthcare team, having the ethics of situational awareness guiding this step. The goal is, through effective teamwork, to contextualize and link rates and probabilities related to the disease to the learned patient's values, presenting a summary of which treatments the team considers as acceptable, recommended, potentially inappropriate and futile. Finally, Step 4 focuses on provider-patient relationship, seeking shared Goals of Care (GOC), for the best and worst scenario. Through an ethics of deliberation, it aims for a consensus that could ensure that the patient's values will be respected as well as a scientifically acceptable medical practice will be provided. In summary: accuracy, comprehension, understanding, situational awareness and deliberation would be the ethical principles guiding each step. CONCLUSION: Hopefully, by highlighting and naming the different perspectives of knowledge needed in clinical practice, this framework will be valuable as a practical and educational tool, guiding modern medical professionals through the many challenges of providing high quality person-centered care that is both ethical and evidence based.

Understanding and execution of discharge instructions.

Discharge from the acute care hospital is increasingly recognized as a time of heightened vulnerability for lapses in safety and quality. The capacity of patients to understand and execute discharge instructions is critical to promote effective self-care. This study explores factors that predict understanding and execution of discharge instructions in a sample of 237 recently discharged older adults. A study nurse conducted a postdischarge home visit to ascertain patient understanding and assess execution of instructions. Health literacy, cognition, and self-efficacy were important predictors of successful understanding and execution of instructions. Neither discharge diagnosis nor complexity of discharge instructions was found to be a significant predictor of these outcomes. Results indicate a need to implement reliable protocols that identify patients at risk for poor understanding and execution of hospital discharge instructions and provide customized approaches to meet them at their respective levels.