Lebanese nursing students' perceptions of barriers to the implementation of person‐centered care in clinical settings: A qualitative study

Abstract

Aim

This study aims to investigate how Lebanese nursing students perceive the challenges of implementing person‐centered care in clinical settings.

Design

A qualitative descriptive design was adopted for this study.

Methods

At one of Lebanon's top universities, a qualitative descriptive study design was used with 18 nursing students from various academic levels. Content analysis was used to generate the results after three focus group discussions. The Consolidated Criteria for Reporting Qualitative Research were used to report this study.

Results

The content analysis gave rise to four main themes, namely, “overload”, “challenges with education”, “unawareness”, “establishing connection”, and “lack of initiatives related to policy”. The results showed a number of obstacles that Lebanese nursing students believed were in the path of providing person‐centered care. These obstacles included organisational issues like time restraints and an intense workload, as well as interaction difficulties with patients and healthcare teams, and educational issues like insufficient instruction in person‐centered care concepts during nursing programs.

1. BACKGROUND

Person‐centered care entails determining every individual's beliefs and inclinations, using those to direct all facets of medical care, and advocating for reasonable health and life objectives. At the moment, patient‐centered care and person‐centered care are frequently used indiscriminately. The goal of person‐centered care is for individuals to lead meaningful lives, while the goal of patient‐centered care is for individuals to live functional lives through the management of their diseases, despite the fact that the two share many similarities, including relationships, dignity decision‐making, communication, and compassion (Summer Meranius et al., 2020). According to the World Health Organization (WHO), people‐centered health care is crucial for achieving comprehensive health services, and their importance is growing as the number of chronic illnesses that are avoidable and require sophisticated therapies rises. Additionally, Kwame and Petrucka (2021) revealed that it is essential to provide patient‐centered care in order to provide high‐quality healthcare. Furthermore, by fostering a sense of respect, consultation, support, and self‐assurance in patients, person‐centered care is likely to have a statistically significant influence on enhancing patient care (Giusti et al., 2020).

Additionally, person‐centered care has been established globally, both in theory and in practice (Lewandowski et al., 2021; Stanhope et al., 2021). Nevertheless, contrary to focusing on nurses in hospitals, numerous research have instead concentrated on the nursing staff in elderly care facilities. Previous research on nursing students examined how well they understood the idea of person‐centered care (Ghane & Esmaeili, 2020), their encounters with providing person‐centered care to Alzheimer's patients (Skaalvik et al., 2010), and how they felt they learned about it in a single semester of study (van Leeuwen & Jukema, 2018) or through a simulation (Oddvang et al., 2021). Additionally, past research has mostly concentrated on the variables influencing nursing students' skills in providing person‐centered care. According to those studies, there are several benefits for patients, like decreased risk of falling, an increase in predicted life expectancy, an enhanced lifestyle, a decrease in the severity of chronic diseases, and an improvement in health‐related quality of life (Kuipers et al., 2019). Additionally, higher work satisfaction and care quality are among the benefits for nursing professionals. Thus, it is crucial to provide person‐centered care that acknowledges the nurse–patient connection as a kind of care that upholds the worth of each person. Because it benefits patients as well as nursing staff, person‐centered care in clinical practice should be continually improved (Kim & Kim, 2023).

Studies examining the difficulties in adopting person‐centered care in clinical settings are particularly few both domestically and abroad (Higgins et al., 2023). Additionally, there has not yet been a global report on studies investigating the obstacles to the adoption of person‐centered care in healthcare facilities based on the experiences of nursing students. The challenges of adopting person‐centered care in clinical settings have not yet been investigated, despite studies on personnel impressions of these challenges in nursing homes specifically.

Because nursing education is strongly tied to the real hospital setting, the portrayal of nursing students' perspectives might offer useful insight for recognising and solving difficulties in clinical situations (Zhang et al., 2022). Additionally, identifying obstacles to person‐centered care implementation can lead to improvements in the healthcare system, particularly in terms of patient satisfaction and quality of life (Kiwanuka et al., 2019; Schuttner et al., 2022). As a result, research on the encounters and perspectives of nursing students throughout clinical training as well as the obstacles to the adoption of person‐centered care can offer crucial insights into how to enhance and establish person‐centered care in a clinical context. High‐level, person‐centered care must be provided in clinical environments if nursing care to consumers is to be improved, as well as the quality of nursing care. For this, it is essential to determine what steps hospitals and academic institutions ought to undertake based on a thorough investigation of the obstacles to the application of person‐centered care in healthcare settings. Because enhancing person‐centered care is crucial for patients, nurses, and nursing students, it is critical to investigate the obstacles to its implementation in clinical settings via the observations of nursing students.

2. CONCEPTUAL FRAMEWORK

Person‐centered care's conceptual framework offers a thorough grasp of the concepts and processes that put the needs, values, preferences, and experiences of the patient first in healthcare. This paradigm directs medical personnel in providing treatment that acknowledges the distinct identity and conditions of every individual. According to this concept, person‐centered care places a strong emphasis on comprehending and meeting the holistic requirements of each patient. It acknowledges that every individual's health and well‐being are influenced by their distinct life narrative, goals, and social environment. Person‐centered care takes into account a patient's physical, emotional, social, and spiritual needs in addition to medical ones. The concept of “person‐centered care” refers to a more encompassing and expansive viewpoint that views people as distinct individuals with a variety of identities, encounters, and necessities in addition to patients with particular medical illnesses. It includes appreciating the full individual and accounting for their social, psychological, physical, and cultural aspects. We want to highlight the significance of tackling the person's holistic well‐being and supporting treatment that is in line with their beliefs, preferences, and aspirations outside of the current healthcare environment by focusing on the person rather than simply the patient. The phrase “person‐centered care” recognizes that an individual's health and well‐being are influenced by a wider range of environmental and social factors. It acknowledges the importance of cultural norms, personal conditions, and social determinants of health in healthcare encounters and results. Our goal is to advance equitable and culturally competent healthcare by embracing a person‐centered methodology that is cognizant of these contextual elements.

3. METHODS

3.1. Research design

The present research uses a qualitative descriptive approach that restricts the interpretation of the investigator and produces an analysis that is closely related to the information at hand (Sandelowski, 2000). To further analyse the data, we employed qualitative content analysis (Elo & Kyngäs, 2008). This methodology is appropriate for investigating how nursing students encounter and evaluate barriers to adopting person‐centered care in clinical settings in order to comprehend their nature and significance. With this approach, we want to record both a detailed account of the occurrences and the interpretations individuals had of them. It aspires to produce information that details the context of encounters or incidents (Paley, 1997). So, rather than overly evaluating the motivations behind the students' replies, this research technique is best suited for studies that ask to document the participants' real impressions as they are (Yilmaz, 2013). This design is well‐suited for obtaining a comprehensive and detailed understanding of participants' experiences and perspectives in their own words. It allows for rich, contextual insights and emphasizes the importance of capturing the voices of stakeholders involved in the implementation of person‐centered care. The qualitative descriptive design provides flexibility and adaptability in data exploration, ensuring that the findings are grounded in the participants' experiences.

3.2. Setting and sample

From an accredited national institution in Beirut, Lebanon, 18 nursing students were purposively selected for the study project (Shorten & Moorley, 2014). The ages of the students ranged between 19 and 22 years, where 8 (44.4%) were male and (55.6%) were female. The university provides studies in a range of subjects and has more than 16,000 students' enrolled in total. The institution has a three‐year nursing program that is accredited and provides students with a range of in‐person, online, instructive, dynamic, and clinical courses that cover the full spectrum of nursing care. The following criteria were necessary for inclusion: participation in a voluntary qualitative interview; as well as being a second‐ to third‐year student who has benefited from clinical training at some point throughout their academic journey. The students included in the study were those who engaged in hospital‐based clinical training. Students in their first academic year and those registered previously in academic programs that required clinical training, as well as students engaging in community‐based training were excluded from the research. In order to recruit both an externally homogenous and an internally heterogeneous group, a purposive sampling strategy with maximum variation sampling was adopted. In this study, a purposeful sample of 18 students from a top Lebanese institution was employed. Out of the 22 contacted students, 81.8% answered; that the main barrier to participation was the program's workload of studying and preparing assignments. In order to get comprehensive data, students of a variety of ages, genders, and academic levels were selected. Krueger and Casey's (2015) suggestions were used for determining the sample size for the study's focus group discussions, and they found that five to eight participants each time were a suitable number. The focus group's objectives and methods were clearly described to the student nurses before they participated. Three focus groups in all were scheduled.

4. PROCEDURE

Through WhatsApp groups, participants were electronically asked to participate in the study project, and those who were interested were encouraged to contact the researchers of their own will. Those who expressed interest in participating went through screening to ensure that only individuals who had undergone clinical training participated in the study. Three focus groups with participants were held throughout May and July 2023. Two investigators (Initials: K. I. and M. N.) performed the in‐person interviews in a calm, well‐lit, spacious classroom on campus conducive to interviewing. These authors have prior experience in conducting focus groups, which was gained through relevant training, research experience, and professional development activities. Their skills in facilitating focus groups were further refined through ongoing engagement in qualitative research and participation in related workshops or courses. One of the researchers who conducted the interviews was known to the students in their capacity as a faculty member at the university where the study was conducted. However, the mentioned researcher was not actively involved in delivering any courses to the students who took part in the study. This has helped in bypassing any power differential that might have influenced the students' expression of their perceptions. Efforts were made to establish a comfortable and non‐threatening environment during the focus groups to encourage open and honest participation from the students. The researchers' interest in the topic of person‐centered care stemmed from their commitment to enhancing nursing education and practice. They recognised the importance of understanding the barriers faced by nursing students in implementing person‐centered care and sought to contribute to the existing body of knowledge in this area. Each discussion lasted 35–45 min, and all participants gave their approval for the meetings to be recorded on audio. In order to ensure anonymity for participants, pseudonyms were used to distinguish among participants during the participant recruitment process and the succeeding interviews. Questions about the students' understanding of person‐centered care, their way of delivering it, and the barriers to delivery were tackled during the interviews. Inquisitive questions that pushed participants to elaborate on and justify their thoughts were asked in return. The handbook for interviews utilised in this study was created by the researchers using person‐centered care research (Table 1). The inclusion of expert opinion increased the reliability of the interview guide. The experts consulted were clinical nurse educators who had previous experience in qualitative research, as well as nurses and nurse managers. The first interview acted as a pilot test as well, but the findings were used in the study since they were believed to be acceptable. The audio recordings were reviewed and transcribed, and the transcriptions of the data were all stored on the investigator's laptop with a username and password. The results from the original pilot interview were taken into account in the examination of all data since no substantial changes were made.

TABLE 1.

Interview questions.

Introduction question	Can you introduce yourself to us and the group? What are your thoughts on the phrase “person‐centered care”?
Transition question	What were your impressions of your clinical training so far?
Key questions	How do you feel about your delivery of person‐centered care?
	How do you feel about the nurses' delivery of person‐centered care?
	Describe the barriers that you or nurses face while delivering person‐centered care
	What kind of action is needed to promote person‐centered care?
Final prompt	Do you have anything further to say?
Probing questions	Could you give us a better description?
	Could you provide us with a better description?

4.1. Data analysis

Data collection and analysis were done at the same time. Open coding, organisation, classification, and abstraction were used in an inductive content analysis technique to analyse the data (Elo & Kyngäs, 2008). NVivo was used to code the data, and both the quantity and structure of coding were determined. The analysis was conducted by the same two researchers who carried out the interviews. This helped as they were immersed in the data during the interviews. A third investigator was given the transcripts and she conducted the analysis separately. This helped in triangulating the perspectives of investigators to increase the rigour of the data analysis. The researchers analysed the data independently and then they convened to compare and discuss the findings. By going over the data repeatedly and making code spreadsheets, the authors were able to identify codes. Together, the researchers transformed the codes and subcategories after discussing them. Subsequently, the writers divided the categories into subcategories based on similarity. For thorough and rich analysis, we discussed the original data and went over it multiple times through an iterative approach. The researchers also established categories and sub‐categories by continuing the abstraction procedure.

4.2. Trustworthiness and credibility

The present research looked into the four characteristics of trustworthiness proposed by Lincoln and Guba (1986) in order to increase the rigour of the data analysis which is determined by its credibility, transferability, dependability, and confirmability (Moorley & Cathala, 2019). Participants were initially requested to review the data transcripts for comments and corrections to make sure that they reflect their perceptions thoroughly. Then, three researchers separately examined all the data many times. The authors had conversations until an agreement was achieved if there were any differences. Additionally, all researchers fixed any English translation errors by having multilingual experts back‐translate Arabic into English and vice versa for statements from participants. In addition, the investigators offered a thorough explanation of data gathering and analysis to improve transferability. Third, two investigators employed NVivo to increase dependability. The writers continuously analysed information until the same classifications were retrieved, and a professional in qualitative research performed peer checking. Additionally, from the start of the investigation to data collecting and analysis, an audit trail was carried out. Finally, the gathering and processing of data were peer‐reviewed by a qualitative research specialist to increase confirmability. The Consolidated Criteria for Reporting Qualitative Research (COREQ) standards were utilised as well in this study (Tong et al., 2007).

4.3. Ethical considerations

The university's institutional review board (ECO‐R‐191) gave its approval to this project. Verbal and printed material was given to participants on the research's goals and methods, advantages and hazards, privacy of information, disengagement from the study, and confidentiality. Participants gave their verbal and written agreement before participating willingly. One of the authors gave each participant a number in order to maintain their anonymity, and they were all identified by that number when the findings were reported. To maintain privacy, all information was kept in a password‐protected computer file, and the written transcripts were kept in a locked cabinet. The study was carried out in accordance with ethical standards and all authors took into account any potential ethical concerns that can arise in qualitative research (Houghton et al., 2010). For example, the authors were vigilant in preserving the anonymity of the students and were keen during the interviews on spotting any instances of confidentiality breach. The authors were also mindful of the potential emotional distress that might be expressed by the students. They created a safe and supportive environment, allowing participants to freely express their views while considering their emotional well‐being. Adequate debriefing and support mechanisms were in place to address any potential distress that participants may have experienced. The authors were further committed to maintaining transparency and honesty throughout the research process. They clearly communicated the purpose of the study, the use of the data, and the potential benefits and limitations to the participants. Additionally, any conflicts of interest or affiliations were disclosed to ensure transparency.

5. RESULTS

Upon conducting content analysis the results gave rise to four main themes, namely, “overload”, “challenges with education”, “unawareness”, “establishing connection”, and “lack of initiatives related to policy” (Table 2).

TABLE 2.

Thematic tree.

Themes	Subthemes	Quotes
Overload	Nursing shortage	“…The nursing shortage is having an adverse effect on patient care…”
	Intense workload	“…There never seems to be enough time to offer our patients the care they require because of the mounting workload…”
Challenges with education	Gap in nursing curriculum	“…I wish our nursing curriculum taught about it more…”
	Continual nursing education	“…We must always be learning if we want to advance as nurses…”
Unawareness	Unawareness of nurses	“…we've found that some don't completely appreciate how important it is for enhancing patient outcomes…”
	Unawareness of patients	“…patients are unaware of our role as nurses in providing person‐centered care…”
Establishing connection	Miscommunication	“…Patients may not feel seen or appreciated when communication is poor…”
	Disrespect	“…Every patient should to be dealt with respect and decency…”
Lack of initiatives related to policy		“…We are dedicated to working with management to create person‐centered policies…”

5.1. Overload

5.1.1. Nursing shortage

Concern regarding the shortage of skilled nurses to satisfy the rising demand for healthcare services was voiced by nursing students. Nurses frequently struggled to manage numerous patients at once, which was seen to have an adverse effect on patient care and increase duties. The high incidence of turnover among experienced nurses was also acknowledged by nursing students as a major problem. Burnout‐related work dissatisfaction, poor pay, and a lack of professional growth prospects were among the factors causing turnover. For example, one student proclaimed, “…everyone is leaving…every couple of weeks we say goodbye to another colleague…another nurse we looked up to…they get higher salaries and better lives abroad, but our patients are suffering because of this” (S14). The scarcity of nurses was made worse by this ongoing churn, which also had an impact on the general stability of healthcare organisations. Higher nurse–patient ratios are frequently the consequence of a lack of nursing staff, forcing nurses to provide treatment for a greater number of patients than they are capable of managing. The provision of person‐centered care may be jeopardised as a result of this increased burden since less time and attention may be given to each patient. For instance, one of the students said, “…The nursing shortage is having an adverse effect on patient care. We want to offer each patient the individualized attention they require, but it is difficult to do so due to the high nurse‐to‐patient ratios…It's upsetting to watch seasoned nurses quit their jobs because they're burned out and unhappy with their work. We require a welcoming workplace that nurtures our enthusiasm for person‐centered treatment…” (S2). Another student also shared, “…In a person‐centered practice, consistency of care is essential, but it can be challenging to develop that trust and connection with patients when staff turnover is common. As nursing students, we want to improve the lives of patients, but we are concerned about how a lack of nurses may affect our capacity to provide high‐quality care…” (S13).

5.1.2. Intense workload

Nursing students observed that the patients they care for in hospital settings frequently had severe illnesses and complicated medical issues. Nursing staff were under more workload pressure because caring for patients with acute needs necessitated constant oversight, assistance, and management of care. Participants described being overburdened with significant administrative duties and paperwork requirements in addition to providing direct patient care. It frequently took a lot of time to finish paperwork, update patient records, and comply with regulatory documents, taking focus away from patient encounters. For example, one of the students said, “…There never seems to be enough time to offer our patients the care they require because of the mounting workload…paper work…paper work…Due to the increasing burden and continual juggling of tasks, it is difficult to concentrate on providing person‐centered care. The tremendous workload makes me occasionally feel like I'm just going through the motions, which is frustrating because I went into nursing to make a difference…” (S9). Another nurse also said, “I struggle to balance getting things done and spending time with each patient. I sometimes feel pulled in several ways by my workload and I am still just a student…. I look at the nurses and it is even worse… Although I think it's crucial to provide person‐centered care, it might be difficult to maintain this focus amidst all the expectations due to the workload. It's challenging to give our patients our best selves since the additional burden has a negative impact on our general wellbeing…” (S5).

5.2. Challenges with education

5.2.1. Gap in nursing curriculum

Participants said that during their schooling, person‐centered care principles received little attention in their nursing classrooms. They noted a need for more thorough and organised training that emphasised the value of tailored treatment, efficient interaction, and empowerment of patients. Although there were occasionally theoretical lectures on person‐centered care, nursing students observed that there were little chances for practical implementation during their clinical rotations. They believed that in order to build practical skills, real‐world experience and simulations of person‐centered encounters were required. For instance, one of the students said, “…It's such an important part of nursing practice, and I wish our nursing curriculum taught about it more. Acknowledging the person behind the sickness is key to provide person‐centered care, but our education placed more of an emphasis on the medical side of nursing than the human side…” (S15). Another student also shared a detailed account, “…As nursing students, we yearn for hands‐on experience in person‐centered communication since it is essential to developing rapport and trust with our patients… We need to place a greater focus on the human element of caregiving and the value of empathy; our school placed too much emphasis on the technical components of nursing… The core of nursing should be person‐centered care, yet our training occasionally felt distant from actual patient encounters… Although I support person‐centered care, it frustrates me when our education doesn't adequately educate us to provide it in real‐world settings…” (S12).

5.2.2. Continual nursing education

Participants reported that availability of person‐centered care specific training sessions and ongoing training programs was restricted at the clinical setting for nurses. They stated that in order to update and strengthen their knowledge and abilities in providing person‐centered care, frequent educational sessions were crucial. Participants agreed that patient requirements and healthcare procedures change throughout time. Without sufficient and ongoing education, they voiced worry about remaining current with the most recent developments in person‐centered care. For instance, one of the anecdotes was, “…We must always be learning if we want to advance as nurses. We don't feel well‐equipped to deliver the finest treatment if we don't receive regular training in person‐centered care. The foundation of nursing is person‐centered care, therefore it is disappointing to learn that there are few options for continuing education in this crucial area of our work…” (S4). Another student also shared, “…We want to keep up to date with the most recent best practices to better serve our patients, and person‐centered care is a notion that is always changing. We are aware that the healthcare industry is dynamic, and we believe that ongoing education is crucial to our ability to successfully adapt and provide person‐centered care… Continuous learning about person‐centered care is essential for our professional success as we advance from being nursing students to practicing professionals…” (S1).

5.3. Unawareness

5.3.1. Unawareness of nurses

Many students claimed that registered nurses did not fully understand the idea of person‐centered care or its guiding principles. They demonstrated a lack of knowledge of the advantages person‐centered care may provide as compared to more conventional care approaches. Some admitted that the task‐oriented treatment that is frequently prioritised above concentrating on the unique needs and preferences of patients has been reinforced in their training and working culture. For example, one of the narratives was, “…When we join the field, we aim to shift some of the seasoned nurses' startling disregard for the value of person‐centered care…Although some nurses emphasize chores over knowing patients' preferences and wants, it is discouraging to see… as students as we learn about person‐centeredness…” (S14). Another student also shared, “…Given an absence of person‐centered care among some seasoned nurses, we look forward to being champions for it. Every nurse should prioritize person‐centered care, but we've found that some don't completely appreciate how important it is for enhancing patient outcomes. Since some of our nursing mentors appear to ignore person‐centered care, we nursing students intend to close the knowledge gap by campaigning for greater education in this area….” (S8).

5.3.2. Unawareness of patients

Patients may not completely understand the advocacy role that nurses play in advancing person‐centered care, according to nursing students. They argued that rather than serving as crucial advocates in the coordination and personalisation of care, patients frequently saw nurses as being completely in charge of giving treatments. Students of nursing were also conscious that patients may not be aware of the thorough evaluations nurses do to determine not just their physical illnesses but also their emotional, social, and psychological requirements. They believed that patients might not completely comprehend the role that this holistic approach plays in providing individualised care. Therefore, this can make it more difficult for patients to evaluate and enhance nursing care. For example, one of the anecdotes was, “…Reduced person‐centered care may result unintentionally if patients are unaware of our role as nurses in providing person‐centered care. Patients may be reluctant to actively participate in shared decision‐making or communicate their particular concerns if they don't completely comprehend how deeply we are committed to their needs and preferences….” (S17). Another student also said, “…Patients may be reluctant to disclose information that is necessary for providing really tailored care when they are unaware of the full scope of our engagement in person‐centered care. As nursing students, it is our responsibility to foster an atmosphere of confidence and compassion where clients are aware of our dedication to their welfare. This will allow for deeper communications and, as a result, a higher standard of person‐centered care…” (S6).

5.4. Establishing connection

5.4.1. Miscommunication

Nursing students expressed worry about scenarios where there was insufficient patient–nurse interaction, resulting in miscommunication and unmet patient needs. They noticed that poor communication could make it more difficult for them to completely comprehend the preferences, beliefs, and concerns of patients—essential elements of person‐centered care. The need for thorough communication instruction and opportunity for continued professional growth was underlined by the participants. They thought that improving communication would help them and nurses deliver care that was more person‐centered and promote healthier nurse–patient interactions. For instance, one of the students shared, “….We know as nursing students that strong communication is very important. Patients may not feel seen or appreciated when communication is poor, which makes it harder to give them the best treatment possible. In hospitals, time restrictions may be a major barrier to genuine interaction. In our view, providing person‐centered care requires spending time actively listening and developing relationships…” (S18). Another student had a similar perspective, “…In order to become capable and caring nurses, we must complete communication training. We think that maintaining our professional growth in communication abilities will improve the efficiency with which we provide person‐centered treatment….” (S5).

5.4.2. Disrespect

Concern over the damaging effects of disrespectful behaviour on the nurse–patient relationship was stated by nursing students. They understood that patients who feel disrespected by their caregivers have a harder time opening up and participating in their treatment. Participants said that disrespectful interactions might cause nurse–patient relationships to suffer. This breach in confidence makes it difficult to build the solid therapeutic alliance required for person‐centered treatment. For example, one student said, “…Every patient should to be dealt with respect and decency, in our opinion as nursing students. Nursing misconduct can obstruct good communication and trust, which makes it harder to provide person‐centered care. Relationships between nurses and patients are based on mutual respect and trust. We are aware that disrespectful encounters can weaken this basis, making it difficult to give patients the compassionate care they require…” (S11).

5.5. Lack of initiatives related to policy

Insufficient person‐centered policies and procedures have the potential to negatively affect patient outcomes, according to nursing students. They understood that the delivery of treatment may vary if there were no defined criteria, resulting in poor patient results and perceptions. Students understood that person‐centered policies needed to be reviewed and improved frequently to be in line with patients' changing requirements and preferences. For instance, some of the quotes were, “…Compassionate healthcare is built on the foundation of person‐centered policies and practices. As nursing students, we push for regulations that emphasize customized care and provide patients the freedom to take an active role in their own care. It is impossible to exaggerate the effect of person‐centered policy on patient outcomes. The patients we serve eventually benefit from clear standards because they improve care coordination and smooth communication between healthcare professionals.” (S2) Another quote was, “…As aspiring nurses, one of our roles is to advocate for policies. We are dedicated to working with management to create person‐centered policies that take our target audience's requirements and preferences into account. It is critical to close the gap between policy and practice. We understand that in order to have the desired beneficial influence on patient care experiences, person‐centered policies must be properly executed….” (S15).

6. DISCUSSION

This study aims to investigate how Lebanese nursing students perceive the challenges of implementing person‐centered care in clinical settings. It's crucial to practice person‐centered care in clinical settings for the benefits of patients as well as for nurses and nursing students alike. In order to improve person‐centered care, it is vital to investigate the obstacles to its implementation in healthcare settings. The challenges that nurses face when providing person‐centered care are examined in this study for the first time qualitatively using the perspectives of nursing students who participated in practical training. This research's significance also stems from the fact that it demonstrated how to go through obstacles in the collaboration between nurses and patients, which is a crucial component of person‐centered care. Five major categories emerged from the findings: overload, challenges with education, unawareness, establishing connections, and lack of initiatives related to policy.

The concept of “insufficient time” was highlighted in a qualitative investigation on barriers to person‐centered care for eldercare providers (Richter et al., 2022), despite the fact that prior research has not documented the challenges nursing students face when providing person‐centered care during their clinical experiences. This topic may be seen in relation to the primary category of “Overload” in the present research. It is a significant aspect since previous research (Dellenborg et al., 2019; Kwame & Petrucka, 2021) has identified workload as an impediment to person‐centered care in nursing homes. In order to communicate with patients and effectively grasp their motives, choices, and goals, nurses must have strong interpersonal abilities (Kwame & Petrucka, 2021). In, person‐centered care, adequate time is needed for such dialogue, yet being overly busy, particularly in clinical settings, is a significant roadblock. In this research, it was discovered that nurses' workload was one of the contributors to their failure to provide person‐centered care in the clinical setting. Overload is defined as having numerous patients to care for per caregiver and having a high workload due to repetitious and mundane tasks. As a result, hospitals must discover strategies to assist nurses, modify the number of patients receiving care by one nurse, and lessen the burdensome tasks. In addition, hospitals must examine the reasons behind the elevated levels of employee turnover, pay consideration to the challenges faced by nurses, and be committed to enhancing person‐centered care.

The findings on educational barriers are in line with the “challenges with education” theme that was recognised as a hindrance to person‐centered care in an earlier investigation (Carvajal et al., 2019). The findings of the present research demonstrate the necessity for facilities to routinely offer nursing education and create case‐specific, practice‐relevant curricula. In order to perform organised nursing education, institutions must also improve their collaboration with academic organisations. It would be preferable to enhance role modelling as it was previously mentioned as a key tactic used by instructors to teach clinicians about person‐centered care (Bejarano et al., 2022). In addition, nursing students must follow a systematic strategy for learning about person‐centered care in the program of study (Moore et al., 2021). Additionally, the nursing curriculum in Lebanon emphasizes treating serious illnesses, and clinical care primarily aims to address disease‐centered medical issues, so person‐centered care that offers tailored attention to patients has unavoidably been overlooked (Alkhaibari et al., 2023). There is a requirement for tangible changes in the nursing program especially since the research findings indicate that courses for nursing students should include more material on person‐centered care and should help students understand it via clinical experience (Wallengren et al., 2022). In order to enhance conceptual and practical learning, the university should create an established program around person‐centered care. The healthcare facility should also establish a system of nursing student mentorship so that they may practice person‐centered care in clinical settings.

Regarding the “unawareness” theme, in addition to the nurses' potential confusion with person‐centered care, patients' ignorance of nurses' responsibilities may also impede the delivery of person‐centered care. Some nursing students have noted that nurses may not be mindful of person‐centered care since they have had adverse encounters with it; as a result, it may be beneficial to get positive experience using real‐world scenarios. In addition, institutions should promote person‐centered care and run ongoing initiatives to alter public perceptions of nurses. Given that reverence for others and mutual respect are the guiding principles of person‐centered care, it is imperative to raise both patient and nurse knowledge of this concept. According to a recently published study, patients' opinions of nursing were impacted by nurses' behaviours (Fiorini et al., 2022); as a result, nurses must work to alter this image. Additionally, an earlier study found that portrayals of nursing in the press and on the internet were lacking in competence and affected how nurses were seen (Grinberg & Sela, 2022). The integrity of nurses must thus be improved, as must how the field of nursing is depicted. A lack of regard for patients and inadequate interpersonal abilities were the results of a lack of relationship‐building. As nurses respect patients and offer tailored care via therapeutic interactions, respect and communication are the two fundamental components of person‐centered care (Ryan, 2022). Respect for the patient entails treating them with dignity and honouring their decision‐making (Bridges et al., 2021).

Our research demonstrated that an impediment to the delivery of person‐centered care might be a deficiency of respect for clients, which could appear to deprive them of their right to make decisions or provide them with instructions without justification. In order for nurses to have expertise in building positive connections with clients, schools must teach students of nursing about developing relationships with patients as part of the program of study, and healthcare facilities must expand education programs. In order to build a therapeutic bond with clients, nurses' interpersonal abilities are a key component. Interaction is defined as the contact between nurses and patients (Wang et al., 2022). The findings of this study also suggest that developing connections with patients is crucial for advancing person‐centered care. However, in this investigation, we discovered that nurses and nursing students struggled to interact with patients in a clinical context. Since nursing students do not receive frequent instruction and only have a brief introduction to interpersonal skills in the first grade, ongoing communication training is necessary. Hospitals ought to create and implement communication training programs that would provide nurses with the skills they need to handle various circumstances.

The absence of a policy strategy in Lebanon, demonstrated the need for basic and practical adjustments for nurses to enhance the delivery of person‐centered care in healthcare settings. Because it takes ongoing work to foster transformation in culture across units and institutions, person‐centered care cannot be enhanced by a single practitioner's motivation alone (Nkrumah & Abekah‐Nkrumah, 2019). In this research, we discovered that even while nurses are aware of the value of person‐centered care, they would find it challenging to put it into practice without legislation that restricts the number of patients they may see at once and modifies how hospitals operate in a clinical context.

In this research, nursing students were asked to share their experiences with any obstacles to providing person‐centered care in hospitals. The present investigation used the perspectives of nursing students to identify the needs and challenges for the delivery of person‐centered care, with the goal of improving person‐centered care in the clinical context. In the coming years, attempts should be undertaken to more effectively distribute the burden of nurses, expand person‐centered care education and awareness, strengthen the bonds between patients and nurses, and create policy frameworks to fundamentally address the stated issues.

6.1. Limitations

This research has several drawbacks. First, since the study was limited to nursing learners from a single institution in Lebanon, careful transfer of the findings is advised. Additionally, only the observations of nursing learners who served at university hospitals were used to draw conclusions. Last but not least, given that the investigators were academics who teach nursing students, it is likely that some nursing students compromised their answers during the interviews. Based on the findings, we recommend that a qualitative research be conducted by enlisting nursing learners from different universities who have completed clinical training at minor and tertiary healthcare facilities in order to determine the obstacles to person‐centered care. When determining the obstacles that must be addressed in order to adopt person‐centered care in the clinical context, it is important to take into account the viewpoints of nurses as well as nursing students.

7. CONCLUSION

Because person‐centered care is advantageous to both patients and nurses, it must be continually improved in healthcare facilities. To create an approach that offers person‐centered care in medical environments, it is also crucial to recognize implementation challenges for person‐centered care. Since nursing education is intimately tied to the practical setting, nursing students' perspectives can offer significant knowledge to comprehend the clinical condition. Therefore, using the observations of nursing students throughout practicums, this study investigated the challenges that nurses have when providing person‐centered care. This study demonstrated that work overload, educational difficulties, a lack of knowledge, deficiency in building relationships, and a dearth of organisational strategies were hurdles to implementing person‐centered care in healthcare settings. These obstacles can be removed by hiring more nurses, decreasing their load of work, offering specialised training for them, creating a rich learning framework for nursing students, stepping up guidance to promote nursing students' person‐centered care philosophy during practicums, bolstering interpersonal interaction and development programs, as well as enhancing policies.

AUTHOR CONTRIBUTIONS

The manuscript has been conceptualised and designed by MF and HN, NT, EK wrote the proposal and MF reviewed it and developed the manuscript. All authors equally worked on validation, data curation, analysis, writing and finalising the manuscript. MF, HN, NT, and EK equally helped in data validation and analysis as well as reviewing the final draft and rewriting sections in the manuscript.

FUNDING INFORMATION

This research did not receive any specific grant from funding agencies in the public, commercial, or not‐for‐profit sectors.

CONFLICT OF INTEREST STATEMENT

The authors declare that they have no competing interests.

ETHICAL APPROVAL AND CONSENT TO PARTICIPATE

The researcher was granted the approval from the university's Research and Ethics Committee (Name and Number: ECo‐R‐191). All ethical considerations were applied according to the international Declaration of Helsinki's principles and guidelines, where the students were informed about all details of the study before recruitment and were not forced to be inducted. No disadvantages were reported to students who did not participate, and written informed consent was obtained.

PATIENT CONSENT STATEMENT

No patient consent was needed as this study did not involve patients.

Kavuran, E. , Türkoğlu, N. , Al‐Nuqaidan, H. , & Fawaz, M. (2024). Lebanese nursing students' perceptions of barriers to the implementation of person‐centered care in clinical settings: A qualitative study. Nursing Open, 11, e2116. 10.1002/nop2.2116

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.