Enhancing Person-Centered Care

Kristin Thórarinsdóttir

For the next couple of weeks, the ANS featured article will be “Development of Hermes, a New Person-Centered Assessment Tool in Nursing Rehabilitation, Through Action Research” by Kristin Thórarinsdóttir, RN, BScN, MScN; Kristing Björnsdóttir,EdP, RN; Kristján Kristjánsson, PhD. In the article they describe the clinical application of a tool based on existentialist and hermeneutical phenomenology, a philosophy that they believe is meant to be a philosophy for real life.  I join the authors in inviting you to read their article (available at no cost while it is featured), and share your comments here!  Here is Kristin Thórarinsdóttir’s description of this work:

On behalf of my co-authors, Dr. Kristín Björnsdóttir and Dr. Kristján Kristjánsson, and myself, I would like to say that it is an honour to have our article featured in the “Editor’s Picks”. This article is a part of my PhD project at the Faculty of Nursing, University of Iceland.  My co-authors, who both are my supervisors, have guided me through the challenging but fruitful journey involved in my doctoral studies. To them I am deeply

grateful, as well as to the nurses who participated with genuine effort in developing Hermes. I am also thankful for the organizational leaders who supported the study.

The motivation for the development of the person-centered assessment tool Hermes, outlined in the article, arose in a

Kristing Björnsdóttir

project in which I was engaged, aimed at implementing standardized nursing systems at two rehabilitation wards. As the project progressed, it became apparent that the perspectives of the patients did not reveal themselves satisfactory in the existing nursing assessment at the wards. These practices raised concern for the nurses at the ward, as needing improvement, because they contradicted the person-centered approach that was independently emerging as a central aim at the wards. This recognition provided the platform for the action research through which Hermes was developed in collaboration with the nurses at the respective wards. The tool was meant to facilitate a person-centered approach to the participation of patients in nursing assessment and care planning. In this research project, I had the role of a consultant who provided for solutions in the form of the theoretical and phenomenological background of Hermes, its structure and potential use. In addition to reviewing the structure and use of Hermes, the nurses had the important role of testing out and evaluating Hermes in practice. Evaluations plans were designed through reflection in focus groups for revising and retesting the tool in practice. In spite of many challenges faced during the project, Hermes was adopted in practice at the respective wards where its use has been sustained.  The study showed that, as aimed for, person-centered assessment practices were enhanced through the use of Hermes. Moreover, several aspects of its phenomenological grounding were supported.

Since this study was conducted, an ethnographical study has been embarked upon in which the ways Hermes is used in

Kristján Kristjánsson

nursing assessment of patients with chronic pain are explored. Further studies are needed to explore the use of Hermes in practice for establishing an evidence base for its use.

The fact that Hermes has been implemented at two other rehabilitation settings, in addition to the wards where it was developed, is a positive indication of its practical applicability, but again its effectiveness stands in need of further research.