Portugal follows the European agenda in the shift towards a more person-centred healthcare practice, wherein the
SNS Proximity might be considered the ground effort towards accomplishing a healthcare system that
acknowledges the central role of the person in any healthcare process in the context of health transitions. The
Structuring Project ‘Person-centred complex interventions to support health transitions’ is aligned with the
Portuguese plan described in the SNS proximity as “a change centred in the persons” and thereby envisions the
following specific objectives:
a) to support the person with complex needs in the positioning at the centre of the care process
continuum,
b) to support the healthcare team a) in acknowledging the person’s role with their inherent complex
needs, preferences and personal goals, and b) in meeting the person in a reciprocal care partnership, and
c) to develop structuring elements for a systematic and sustainable shift towards person-centred care in
relation to complex health transitions.
The structuring project endorses the principles for person-centred practice (Ekman et al., 2011; McCormack &
McCance, 2006) and its philosophical foundations in the concepts of person and person-centredness, whereas a
person is someone with inherent capabilities and vulnerabilities, strengths and fragilities that emerge to more or
less an extent along a continuum of wellbeing. This person is a resourceful agent, responsible for the actions they
undertake, in spite of the potential weaknesses (Eneau, 2008; Ricoeur, 1994; Smith, 2010).
The more an intervention is tailored to the specific situation of a person, the greater is its potential to actually
assist in meeting the person’s unique needs (Lauver et al., 2002). Nursing interventions delivered at the care
setting following a person-centred care philosophy, have this element naturally embedded (McCormack &
McCance, 2006). In the context of this Structuring Project, an intervention is defined as an activity or action framed
within the goals and values of nursing and undertaken by healthcare providers with the purpose of enhancing the
wellbeing and quality of care of people with health-related needs. Such actions might even be undertaken by
patients themselves as in self-care activities (Naylor, 2003; Richards & Rahm Hallberg, 2015). Within the wider
sphere of intervention research, the complexity of health interventions has gained special attention during recent
years. Scholars argue that simplicity might be a chimera when interventions relate to the promotion, support or
change of health behaviours (Richards & Rahm Hallberg, 2015). If defining ‘intervention’ is quite consensual and
straightforward, identifying the complexity elements of an intervention is in itself a challenge.
Recent studies in intervention research have uncovered components of intervention complexity. Scholars have
passed the initial analysis of behaviours, outcomes and intervention delivery (Medical Research Council, 2008) to
include dimensions along the intervention lifecycle, that is, from early development to implementation. Within
areas of complexity (e.g. intervention, design, evaluation, implementation, context, participant response), several
sub-themes have been identified that correspond to the specific challenges (Anderson et al., 2013; Datta &
Petticrew, 2013). The variability in potential complexity issues makes the process of defining ‘complex’ difficult and only reinforces the need to have a comprehensive methodological guidance from early development to long- term
implementation. Such guidance is crucial to address key uncertainties, thereby ensuring that sufficient effort has
been made to develop and pilot the intervention before departing to a full trial, and to ease the process of
implementation into clinical daily practice (Richards & Rahm Hallberg, 2015).
The enhancement of complex care delivery with a focus on person-centred principles will naturally entail the
provision of integrated care, the support of patients’ self-agency and the support of the healthcare team in
meeting the patient in a symmetrical care partnership.
Anderson, L. M., Petticrew, M., Chandler, J., Grimshaw, J., Tugwell, P., O'Neill, J., . . . Shemilt, I. (2013). Introducing a series of
methodological articles on considering complexity in systematic reviews of interventions. Journal of Clinical
Epidemiology, 66(11), 1205-1208. doi:10.1016/j.jclinepi.2013.07.005
Datta, J., & Petticrew, M. (2013). Challenges to evaluating complex interventions: a content analysis of published papers. BMC
Public Health, 13(568), 1-18.
de Silva, D. (2014). Healping measure person-centred care. Long Acre, London WC2E 9RA: the Health Foundation, 90.
Ekman, I., Swedberg, K., Taft, C., Lindseth, A., Norberg, A., Brink, E., . . . Sunnerhagen, K. S. (2011). Person-centered care - Ready
for prime time. Eur J Cardiovasc Nurs, 10(4), 248-251. doi:10.1016/j.ejcnurse.2011.06.008
Eneau, J. (2008). From Autonomy to Reciprocity, or Vice Versa? French Personalism's Contribution to a New Perspective on Self-
Directed Learning. Adult Education Quarterly, 58(3), 229-248. doi:10.1177/0741713608314135
Lauver, D. R., Ward, S. E., Heidrich, S. M., Keller, M. L., Bowers, B. J., Brennan, P. F., . . . Wells, T. J. (2002). Patient-centered
interventions. Research in Nursing and Health, 25(4), 246-255. doi:10.1002/nur.10044
McCormack, B., & McCance, T. V. (2006). Development of a framework for person-centred nursing. Journal of Advanced
Nursing, 56(5), 472-479. doi:10.1111/j.1365-2648.2006.04042.x
Naylor, M. D. (2003). Nursing Intervention Research and Quality of Care: Influencing the future of healthcare. Nurisng Research,
52(6), 380-385.
Richards, D. A., & Rahm Hallberg, I. (2015). Complex interventions in health: an overview of methods. Abingdon, Oxon:
Routledge.
Ricoeur, P. (1994). Oneself as another (New ed. ed.). Chigago: University of Chicago Press.
Smith, C. (2010). What is a person? rethinking humanity, social life, and the moral good from the person up. Chicago: University
of Chicago.
Ventura, F., Koinberg, I., Sawatzky, R., Karlsson, P., & Öhlén, J. (2016). Exploring the Person-Centeredness of an Innovative ESupportive
System Aimed at Person-Centered Care Prototype Evaluation of the Care Expert. Computers, Informatics,
Nursing, May; 34(5), 231-239. doi:10.1097/CIN.0000000000000225.
The current SP is expected to bring improvements at three levels: a) for the person in complex health transitions, b) for the healthcare professionals caring for the person in complex health transitions, and c) for Nursing Science and Research.
Overall in the clinical domain, preliminary evidence from evaluation studies of person-centred care portray costeffectiveness,
reduced in-patient time and better work satisfaction, among other person-centred outcomes. A more person-centred practice is expected to enhance the role of the patient in the care process, to the wished extent and according to the personal goals and preferences. Such person-centred processes have been associated with patient empowerment and increased health literacy, health self-efficacy and self-management activities in relation to symptoms and treatment side effects (de Silva, 2014; Lauver et al., 2002). Moreover, given the focus on supporting the person experiencing chronic illness or long-term care processes, the structuring project is expected to contribute to the care integration along the care pathway continuum assisting the patient at distance, which in turn leads to experiences of enhanced accessibility to healthcare (Ventura, Koinberg, Sawatzky, Karlsson, & Öhlén, 2016).
While acknowledging the central positioning of the person within the care continuum, transdisciplinarity between healthcare professionals is likely to be enhanced towards a more collaborative partnership, with the nursing profession naturally assuming a leading role.
Overall, a more person-centred practice as also been associated with decreased burden of healthcare professionals. Moreover, the development of person-centred interventions for the management of complex health issues is expected to support healthcare professionals in dealing with such issues, with the consequent benefits resulting from a more evidence-based practice. Finally, the Structuring Project is expected to contribute to the inclusion of information and communication technology into the clinical care context, in line with priorities related to the European Agenda for Digital Transformation.
Specifically concerning Nursing Science, the Structuring Project is expected to contribute to the enhancement of the person-centred care philosophy and practices, to a sound methodological development of Nursing, and engagement of students (from initiation to research to post-graduate) in complex interventions research.
01/01/2020
Em desenvolvimento
Care Systems, Organization, Models, and Technology