ABSTRACT
Aim
To explore medical nurses' perceptions of patient‐centred care (PCC) and their experiences of patient‐centredness in adult medical wards of three hospitals.
Design
We employed a descriptive qualitative design with focus group discussions (FGDs). This design suited the study's objectives of exploring medical nurses' perceptions of PCC in adult medical wards of three selected hospitals and is ideal for collecting data on a phenomenon or experiences of participants.
Methods
The method for data collection was FGDs, which enabled an interactive and dynamic exploration of medical nurses' perceptions of PCC. These data were collected from Northern Ghana in sub‐Saharan Africa and analysed using the Six‐phased Thematic Analysis proposed by Braun and Clarke.
Results
The study revealed that medical nurses conceptualise PCC as a holistic approach to nursing care involving respect for the patient's individuality, cultural considerations, and effective communication. Perceptions of patient‐centred practices highlight the importance of caring behaviours, collaboration, information dissemination, and holistic care. While PCC was perceived as positively affecting nursing care quality and nurse job satisfaction, it could increase workload. The predominant nursing models practised in the selected wards were task‐based and “cubicle nursing”. Successful PCC requires strong organisational support, adequate staffing, improved resources, and continuous patient‐centred training.
Reporting Method
Adherence to EQUATOR guidelines was achieved by adopting the Standards for Reporting Qualitative Research (SRQR).
Patient or Public Contribution
No patient or public contribution.
Keywords: adult medical wards, healthcare in Ghana, medical nurses, nurse job satisfaction, nursing models, patient‐centred care, quality nursing care
1. Introduction
Poor quality healthcare is a worldwide phenomenon. However, Haemmerli et al.'s (2021) study showed that poor quality healthcare accounts for a greater number of deaths in Low‐and‐Middle‐Income Countries (LMICs). Nurses are highly adaptable in the dynamic health delivery system, contributing significantly to high‐quality healthcare and improved patient outcomes (Jyothi et al. 2023). The characteristic adaptability of nurses and the 24‐h, 7‐days‐a‐week presence with inpatients places them at the forefront of leading the effort towards healthcare quality improvement. Therefore, nurses can lead the quest for quality healthcare by aligning nursing services with patients' needs in tandem with patient‐centred principles (International Council of Nurses 2015).
A core element of quality healthcare is patient‐centred care (PCC) or patient‐centredness (Okeny et al. 2024). PCC incorporates patients' beliefs, preferences, and values into healthcare standards, and is the gold standard for measuring the quality of healthcare, positively affecting nursing care quality and nurse job satisfaction (Abugre and Bhengu 2024; Dys et al. 2022). However, translating PCC from theory to practice is challenging due to the ambiguity surrounding its conceptualisation (Byrne et al. 2020).
PCC requires providing context‐specific strategies and identifying and incorporating patients' cultural nuances based on local values and preferences (World Health Organization 2015). PCC is an essential part of the daily work of all healthcare professionals. However, nurses are the majority in the healthcare industry, and their 24‐h‐a‐day presence at the patient's bedside plays the most significant role in PCC (Ben Natan and Hochman 2017).
In Sub‐Saharan Africa (SSA), including Ghana, scanty data exist on PCC practice (Molina‐Mula and Gallo‐Estrada 2020). Understanding nurses' perceptions of patient‐centredness is vital to bridging the PCC information gap and is crucial to patient‐centred practices and consequently improving quality healthcare. Nurses working in medical wards (medical nurses) were selected for this study. The study's objectives are to explore medical nurses' understanding of PCC, perceptions, and experiences of implementing PCC.
2. Background
Literature suggests nurses are essential in promoting quality healthcare (Jyothi et al. 2023). Quality nursing care (QNC) is crucial to the search for quality healthcare improvement. The pursuit of QNC has driven the evolution of various nursing models, with PCC as a contemporary model. PCC positively influences QNC (Dys et al. 2022) and staff job satisfaction (World Health Organization 2015).
Healthcare systems internationally are trying to enhance quality by implementing PCC models (Santana et al. 2018). PCC is recognised in well‐developed healthcare settings but Gallo et al. (2016) argued that patient‐centredness is not vigorously pursued. PCC is holistic healthcare that respects and incorporates the patient's needs, values, and preferences into the care process (Abugre and Bhengu 2024; Byrne et al. 2020; McCormack and McCance 2017). In advanced healthcare systems, health professionals rely on collaboration and communication to effectively implement PCC (Baek et al. 2023).
PCC is gaining momentum in LMICs including Ghana, but systematic barriers make its implementation inconsistent (Kuipers et al. 2021). A study in Nigeria identified limited health infrastructure and inadequate resources as challenges to patient‐centredness (Lateef and Mhlongo 2022). Similarly, a study by De Man et al. (2016) revealed structural and organisational barriers including the biomedical model of training health professionals and the broader socio‐economic challenges.
In Ghana, PCC is an emerging model within the ongoing healthcare reforms. A study in Ghana identified barriers to PCC including inadequate PCC training for health staff, resource constraints, and institutional policies (Nkrumah and Abekah‐Nkrumah 2019). Adopting PCC practices could help mitigate some of the quality healthcare challenges in LMICs and ultimately improve health outcomes and patient satisfaction (De Man et al. 2016; Nkrumah and Abekah‐Nkrumah 2019). Hence, this study aims to explore medical nurses' perceptions of PCC and their experiences of patient‐centredness in adult medical wards of three hospitals. The findings of this study may contribute significantly to addressing the quality healthcare challenges in LMICs and enhance the implementation of PCC in medical wards in Ghana.
3. Methods
3.1. Setting of the Study
This study was conducted in the northern part of Ghana, a sub‐Saharan African country. Northern Ghana comprises five of the 16 administrative regions of Ghana accounting for approximately 45% of Ghana's land mass and 18.9% of the country's population (Ghana Statistical Service [GSS] 2021). The study was conducted in six adult medical wards of three hospitals from Northern Ghana including Tamale Teaching Hospital (TTH), Upper West Regional Hospital (UWRH), and Upper East Regional Hospital (UERH).
3.2. Study Design
We employed a descriptive qualitative design which suited the study's objectives to explore medical nurses' perceptions of PCC in adult medical wards of three selected hospitals. This design is ideal for collecting data on a phenomenon or experiences of participants (Bradshaw et al. 2017). Qualitative descriptive design enables detailed exploration of phenomena. The design provides data that represents the true account of the participants, improving the transparency of analysis and is compatible with the thematic analysis method chosen for this study (Bradshaw et al. 2017).
3.3. The Study Population, Sampling, and Sample Size
The primary cohort under consideration consists of 130 medical nurses in the six selected adult medical wards of TTH, UERH, and UWRH. Multiple sampling techniques were employed because the study involved sampling of Northern Ghana (purposive sampling), sampling of the regional and teaching hospitals (cluster sampling), and sampling of nurses (random sampling). The sample included medical nurses with varying experience levels, working in different shifts, and representing diverse perspectives. Nurses working in six adult medical wards (medical nurses) participated in six focus group discussions (FGDs) of 10 participants each. Consequently, the final sample of 60 medical nurses participated in six focus groups coded FG1 to FG6 of 10 participants coded P1–P10 for each focus group. For instance, FG1P1 stands for focus group 1, participant 1.
3.4. Data Collection Method and Procedure
We used the FGDs method to collect data on medical nurses' perceptions of PCC in adult medical wards of three hospitals. Sample questions included: What does ‘Patient‐centred care’ mean to you? and what nursing care activities do you perceive as ‘patient‐centred’? The FGDs promoted an interactive and dynamic exploration of nurses' perceptions of patient‐centredness. The FGDs also encouraged participants to share and build upon each other's views. Multiple focus groups (6) were conducted to ensure data saturation, which is the ‘gold standard of qualitative research’ (Moura et al. 2021). The principal investigator (PI) introduced the purpose and the structure of the FGD, emphasising the significance of participants' providing honest and open contributions. The participants' confidentiality was assured through anonymity, and informed consent was obtained. The PI conducted the discussions guided by the semi‐structured FGDs guide, allowing the participants to share their thoughts and experiences. Two research assistants took detailed notes and audio recordings, with permission, capturing the nuances of the conversation. The PI debriefed the participants, addressed their concerns, and thanked them for their contributions. Each session lasted between 90 and 120 min. The discussions were transcribed verbatim, capturing both spoken words and non‐verbal cues. Transcription and analysis were done after each FGD. Signs of data saturation occurred during the 5th FGD and were confirmed with the 6th FGD. Data were collected in January and February 2020.
3.5. Trustworthiness
Methodological trustworthiness in the study was ensured through credibility, transferability, dependability, and confirmability measures (Polit and Beck 2010). Prolonged engagement with each group (90 and 120 min) and rigorous transcription, coding, and analysis processes were employed to ensure credibility. Detailed descriptions of the participants, the research setting, and the research process have been provided to enhance transferability in other research settings. Dependability was reinforced by the consistent use of the same tools, methods, and data sources (6 focus groups from three hospitals). The PI and two trained research assistants facilitated each FGD to ensure consistency and reliability. Member checking was employed to enhance confirmability by clarifying any ambiguous points and summarising key discussion points. This study complied with O'Brien et al.'s (2014) recommendations on the Standards for Reporting Qualitative Research (SRQR).
3.6. Ethical Clearance
The study was approved by the Biomedical Research Ethics Committee of the University of KwaZulu‐Natal (Ref. no. BFC 364/18) and the Ethics Review Committee of Tamale Teaching Hospital (TTHRC/19/06/18/04) for compliance with standards. Permission letters were obtained from the hospitals' administrators before data collection. We explained the study's purpose and informed participants of their rights, including the option to refuse, skip questions, or withdraw from the study at any time they so wished. The participants were encouraged to seek clarification. The participants voluntarily signed consent forms before the FGDs. We ensured confidentiality through anonymity and non‐disclosure of any personal information. The PI kept all data including transcripts, notes, and recordings under lock and key. The questions were framed to avoid distress to the participants. The study findings were disseminated to the management of the hospitals, including the ward managers. We intend to publish the findings in a peer‐reviewed journal to contribute to the scientific knowledge of PCC practice. The study was conducted in compliance with the Declaration of Helsinki (World Medical Association 2014).
3.7. Data Analysis
We employed the six‐phased thematic analysis framework proposed by Braun and Clarke (2006) as the method for data analysis. These thematic phases include (a) Familiarising ourselves with the data and identifying items of potential interest (b) Generating codes (c) Generating initial themes (d) Reviewing potential themes (e) Defining and naming themes, and (f) Producing the report (Braun and Clarke 2006, 87). We transcribed the data verbatim and colour‐coded it for efficient analysis. Familiarisation with the data involved repeated reading of the transcripts and noting recurring ideas. We generated codes using colour coding, where similar ideas, such as nurses' conceptualisation of PCC, were coded green. The colour‐coded segments were reviewed for similar patterns and grouped into initial themes. Themes were reviewed and refined by evaluating their cohesiveness and validity relative to the entire dataset. Overlapping themes were merged or divided. The final report contains four themes and 11 subthemes supported by relevant extracts from the FGDs.
4. Findings of the Study
4.1. Participants' Background Characteristics
The study involved 60 nurses, with 41 females and 19 males. The sample was a youthful one, with the majority (32) between 21 and 29 years old, 27 aged between 31 and 39, and one being 40 years old. However, these young nurses had considerable nursing experience, as the majority (32) had nursing experiences ranging from 5 to 12 years, 24 with experiences between 1 and 4 years, and only four with less than a year's experience. The participants had been working in their respective wards over various periods, including one nurse for 8 years, 33 for 1–5 years, and 26 for less than 1 year. Most (54) were employed for the first time in their current hospitals. Two nurses had Master of Nursing degrees, the majority had BSc nursing degrees (32), 20 had diplomas in nursing, and 8 were certificate holders.
4.2. Themes and Subthemes From the Study
Four themes were generated including nurses' conceptualisation of PCC, their perceptions of PCC practices, perceived effects of PCC, and organisational and resource challenges to PCC implementation, and nursing models practised in the hospitals with 11 subthemes. These themes and sub‐themes are presented in Table 1.
TABLE 1.
Themes and subthemes of nurses' perceptions of patient‐centred care.
| Themes | Subthemes |
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4.3. Theme 1. Nurses' Conceptualisation of PCC
The nurses across the focus groups conceptualised PCC as evolving around two subthemes including considering the uniqueness, respecting the patient's individuality and culture and effective communication and good interpersonal relationships.
4.3.1. Subtheme 1: Considering the Uniqueness
The nurses conceptualised PCC as respecting the patient's individuality and his uniqueness as a person. The following statements capture their views:
PCC and Individualized care are similar because the patient's unique needs determine the nursing care given. FG3P4
…Yes, I agree PCC refers to respecting each patient as an individual and providing care specific to the patient's needs, culture and religious beliefs, and perceptions. FG3P1
We believe that each patient must be treated as a unique human being, a person seeking care and not a disease entity FG5P9
Additionally, the nurses also conceptualised PCC as nursing services built on the patient's culture, capabilities, needs, values, and preferences as illustrated below:
The process of delivering PCC involves nurses identifying each patient's cultural background, values, needs, and preferences and then planning the appropriate care, implementing, and evaluating the care. FG2P8
PCC depends on identifying the needs of the individual patient first. Patients with the same medical diagnosis may have different care needs depending on the patient's personality, cultural background, religion, or even financial status. FG5P5
True, an example based on religious affiliation is that one patient may need the priest or Imam to pray for him while others may not require such care. FG5P6
4.3.2. Subtheme 2: Effective Communication and Good Interpersonal Relationships
Effective communication, good interpersonal relationships, and culturally sensitive nursing also emerged as the conceptual meaning of PCC as per the following statements:
PCC involves effective communication and good interpersonal relationships with patients, patient's relatives, and other health personnel. FG4P9
In patient‐centred communication, you seek the patient's consent and explore the cultural background to identify the appropriate approach to care. FG5P4
The nurses' conceptualisation of PCC is multifaceted, encompassing the patient as a unique person with needs, values preferences, and capabilities, and providing culturally sensitive communication and interpersonal relationships.
4.4. Theme 2. Nurses' Perception of PCC Practices in the Wards
The nurses' perceptions of PCC practices in the selected adult medical wards were varied. The nurses unanimously described several perceived PCC practices as having “caring behaviours” as succinctly captured in the following subthemes.
4.4.1. Subtheme 3: PCC Is Kind and Respectful Nursing
The nurses in the adult medical wards conceptualised PCC as nursing care that reflects kindness and respect as illustrated in the following quotations:
PCC include welcoming patients warmly, explaining and seeking permission before performing procedures, and providing comfortable beds. FG4P7
PCC involves allocating time for visitors, and being polite to patients all the time. FG3P3
4.4.2. Subtheme 4: Communication, and Health Education
A critical activity of PCC practice emerging from the adult medical ward nurses was providing information, communication, and health education captured by the under‐listed quotes from the nurses:
One of the ways to enact patient‐centredness is through providing appropriate information. We [nurses] need to keep open communication with the patients. For effective PCC, nurses need respectful communication. FG3P1
We need to educate each patient on the rationale for his treatment, his condition, what foods they can or can't eat, and explain all nursing procedures to the patient. FG3P10
4.4.3. Subtheme 5: Collaboration and Coordination of Nursing Care
The nurses viewed providing PCC as collaborative nursing care, with nurses coordinating the care process. The following statement aptly captures this notion of patient‐centredness.
PCC is a collaborative nursing model whereby the patient is part in his care or ensures that the patient and relatives are involved in nursing care. FG1P7
For effective PCC, nurses should collaborate and coordinate care with other health professionals including medical officers. FG1P5
4.4.4. Subtheme 6: Holistic Nursing or Whole‐Person Care
Holistic care emerged as another conceptual dimension of PCC as shown in the statements:
PCC refers to giving holistic nursing care to the patient including the patient's physical care, emotional needs, religious needs, cultural taboos, perceptions of his illness, and general economic and cultural background. FG4P2
Providing patient‐centred care is nursing all aspects of each patient. Nurses take care of the patient's physical needs including feeding, bathing, and grooming. PCC also involves caring for the patient's psychological or emotional needs, through reassurance and caring interactions. FG3P1
Let us not forget the spiritual and social needs of our patients. The patients always seek opportunities to meet their pastors or imams. Effective PCC in this ward includes caring for the whole person. FG3P3
4.5. Theme 3: Effects of PCC on Nursing Care
Two main effects of PCC on nursing care emerged, including PCC improving QNC and increasing nurse job satisfaction (NS).
4.5.1. Subtheme 7: PCC Improves QNC
According to the nurses, PCC is perceived to improve QNC through good interpersonal relationships, improved nurse assessment skills, and faster patient recovery. These perceptions are captured as follows:
PCC promotes quality nursing care as it fosters good working relationships between nurses and patients and promotes collaboration with colleague health workers. For example, collaborating with other health workers such as the hospital dietician could help improve the poor dietary habits of a diabetic through education on nutrition and this helps stabilise the patient's glucose level. FG4P4
PCC will improve the nurse's skills in assessment because the nurse will constantly assess and reassess the patient to identify his needs for better planning and effective nursing interventions. Therefore, both the patient and the nurse will feel that quality nursing is being delivered. FG5P1
PCC enables the nurse to help the patient recover faster and not just follow orders from the prescriber but do other things you think are necessary professionally to help the patient recover. FG3P7
4.5.2. Subtheme 8: PCC Increases Nurse Job Satisfaction (NS)
The nurses' perceived effects of PCC on NS were positive. Contributors of PCC to increased NS were improvement in the patient's health status and development of good interpersonal relationships. These perceived effects of PCC on NS are captured below:
PCC increases nurse job satisfaction (NS) due to the improvement of patient's health status making both nurses and patients happy and satisfied. The patients are happy because of faster recovery while the nurses feel a sense of accomplishment. FG3P7
PCC strengthens the nurse‐patient relationship as well as inter‐professional collaboration and coordination. There is the feeling of working together which makes the working environment conducive and increases job satisfaction levels. FG5P10
The impact of PCC from the perspective of the nurses was positive. The nurses associated PCC with improved QNC and increased job satisfaction.
4.6. Theme 4: Organisational and Resource Challenges to PCC Implementation
The nurses indicated that PCC activities were essential to patient care, but some organisational and resource challenges were impeding PCC implementation in their wards. These perceived challenges are captured in this section.
4.6.1. Subtheme 9: Management's Delay in Approving PCC
Implementing PCC in the wards was subject to the approval by the management of the hospitals, which was perceived to have been delayed and succinctly captured in the following:
For us nurses in the wards to implement PCC, nursing and hospital management need to accept and approve PCC as a guiding model of patient care. FG4P8
The nursing management will need to give directives and protocols for us to implement PCC in our ward but there is a delay in management's approval. Clear directives are not available and protocols have not been developed yet. FG1P5
4.6.2. Subtheme 10: Inadequate Resources and Insufficient Nursing Staff
The nurses across groups indicated that material and human resources essential for PCC implementation were inadequate. The perceived inadequate resources include inadequate equipment, medical consumables, stationery, and insufficient nursing staff. These sentiments were best captured as follows:
We do not have adequate medical consumables and stationery. FG5P8
We need more bedside monitors, beds, and bed accessories to work comfortably. FG3P5
The space is limited we can admit only a few patients at a time and our washrooms need improvement. We wish management could help improve the wards before considering PCC adaption. FG4P7
The nurses felt the nursing staff was insufficient and better staff levels were needed to implement PCC and that PCC would increase workload as stated below:
There are only a few nurses in this ward and already the workload is too much. With PCC implementation the workload will even be higher because we will spend more time on the patient's needs. FG3P6
We prefer PCC because it helps our patients recover faster, but management will need to increase the number of staff in the wards for effective implementation. FG4P2
4.6.3. Subtheme 11: Insufficient Communication and Patient Assessment Skills
Even though the nurses were in support of PCC implementation, they expressed the desire to upgrade their skills through further training in interpersonal communication and assessment skills as shown in the following statements:
PCC is a fantastic model but more PCC training is needed for its implementation. FG2P1
Our skills in communication and patient‐centred assessment are not adequate. We need refresher training in interpersonal communication and patient assessment because the nurse must first build good interpersonal relationships with the individual patient. A trusting relationship makes the patient trust the nurses and freely discuss his perspectives on the care process, therefore, facilitating PCC.FG1P3
PCC cannot be effective without a complete assessment of the individual patient's needs. We need [nurses] adequate assessment skills to initiate PCC. The Nursing Process approach to patient assessment must be applied conscientiously to promote PCC. Even though we were taught how to employ the Nursing Process during our training as nurses, we haven't implemented it due to resource constraints. Many of us will require some form of refresher training on PCC.FG2P6
The importance of leadership support and approval, adequate staffing, well‐equipped facilities, and continuous training in communication and assessment skills emerged as critical challenges for integrating patient‐centredness in the participating hospitals.
5. Discussion
5.1. The Young Sample
A notable characteristic of this study's sample (60) is its youthful nature, with the majority (32) of the nurses between 21 and 29 years and only one nurse aged 40 years. This youthful sample reflects the nursing workforce in Northern Ghana due to the relatively younger graduates from nursing institutions recruited to fill the acute nursing shortage in the area. We achieved data saturation by the fifth focus group, despite the youthfulness of the sample. The age homogeneity likely influenced the group dynamics by providing a more favourable environment for discussions (Hancock et al. 2016), enhancing the depth and frankness of the FGDs. The youthful sample shapes the study's findings and implications.
5.2. Themes and Subthemes
The study contributes to understanding nurses' perceptions and practices of PCC in the medical wards of the selected hospitals. Four themes and 11 subthemes emerged from the research. These are discussed under the appropriate sections.
5.3. Theme 1: Nurses' Conceptualisation of PCC
Nurses' conceptualisation of PCC is fundamental to effective patient‐centredness in healthcare settings. The nurses conceptualised PCC as recognising the patient as a unique individual and considering the patient's cultural background in tandem with the findings of Byrne et al. (2020).
Respecting the patient's individuality emerged as a key concept of patient‐centredness aligning with the integrative review by Byrne et al. (2020) which emphasises that patients are unique individuals rather than mere recipients of care. The nurses' emphasis on respecting the patient's individuality and treating patients as unique individuals aligns with the assertion that healthcare involves viewing the patient as a person (Blain‐Moraes et al. 2018). The significance of respecting the patient's uniqueness and individuality underscores the need for tailor‐made nursing care to patients' unique needs and preferences in line with the findings of Santana et al. (2018).
Our findings of considering the patient's cultural background, needs, and values are consistent with Sheeran et al. (2023) views that cultural factors significantly influence patients' perceptions and preferences. Similarly, our findings confirm existing literature emphasising cultural sensitivity as a key activity of PCC (Chow et al. 2022; McCormack and McCance 2021). The need to explore cultural aspects in patient‐centred communication reflects an awareness of the diverse patients' backgrounds and preferences. These findings confirm that PCC requires tailoring care to the patient's needs and culture (Sheeran et al. 2023).
This study's findings underscore the significant role culture plays in shaping nurses' perceptions of PCC. In the Ghanaian context, respect for elders, family involvement, and spiritual beliefs are deeply embedded in everyday life, making culturally informed care essential (Nkrumah and Abekah‐Nkrumah 2019). Cultural alignment enhances the effectiveness of PCC and affirms that patient‐centredness must be contextually adapted rather than universally applied (Chow et al. 2022). Nurses in Ghana should be encouraged to adopt PCC and integrate appropriate cultural practices in its practice, supported by training in cultural competence and communication as proposed by Wasim et al. (2023). However, there is a need to balance cultural sensitivity with professional ethics and evidence‐based practice so as not to compromise patient safety (Santana et al. 2018). Therefore, effective PCC is context‐driven and requires understanding and respecting the patient's cultural norms and nuances that promote patient satisfaction and outcomes.
Communicating effectively and establishing good interpersonal relationships with the patient emerged as a conceptual meaning of PCC in this study, which is in tandem with the view that communication is central to patient‐centredness (McCormack and McCance 2021), and also that patient‐centred communication is culturally sensitive (Wasim et al. 2023).
The multiple conceptualisations of PCC emerging from this study confirm the multidimensional nature of PCC as a ‘container concept’ (Araki 2019; Bensing 2000). This study provides insight into the perceptions and behaviours that shape nurses' approaches to patient‐centredness.
5.4. Theme 2: Nurses' Perception of PCC Practices in the Wards
Understanding how nurses perceive PCC in ward settings is crucial for evaluating the effectiveness of care delivery. The nurses perceived PCC practices as caring attitudes and behaviours including kind and respectful nursing care, communication and health education, collaboration and coordination of care, and holistic nursing. The findings of PCC as kind and respectful nursing care encompassing warmth, politeness, and patient comfort are consistent with the assertion that caring behaviours are fundamental to PCC (Rathert et al. 2016). True patient‐centredness is achieved through nurses' caring and therapeutic relationships that engender trust and rapport with patients and their relatives (McCormack and McCance 2017).
The provision of appropriate information and health education emerging from this study confirms the importance of communication as a process domain of PCC (Santana et al. 2018). Effective communication involves transferring information and engaging patients in their care process (Kuipers et al. 2021). This engagement can improve patient outcomes by ensuring they are well informed and actively participating in their treatment plans. Additionally, the study's finding of health education as essential for PCC is consistent with health education as a key patient‐centred practice (Chow et al. 2022).
Nurses coordinating healthcare processes emerged as a subtheme under ‘coordination of care processes’ and confirm an earlier study (Araki 2019) that identified nurse coordination of healthcare as an essential PCC dimension. Similarly, the essence of nurses coordinating healthcare aligns with Baek et al. (2023), who found that teamwork, inter‐professional collaboration, and coordination are vital for promoting PCC. This implies that nurses can impact PCC positively if they coordinate healthcare, especially in the ward setting. The emphasis on collaboration highlights the need for integrated care models that foster cooperation among healthcare providers. Holistic nursing care involving physical, emotional, spiritual, and social needs identified as a core PCC practice in this study is in tandem with the proposal that PCC is holistic care (Ben Natan and Hochman 2017) and promotes comprehensive care to meet the patient's needs (Evén et al. 2019). This study found that nurses in Northern Ghana predominantly conceptualise PCC as individualised and culturally sensitive care that emphasises respect, communication, holistic, and collaborative care. While PCC literature recognises these elements, global comparisons reveal both alignments and divergences shaped by cultural, systematic, and resource differences.
The perception of PCC in this study aligns with findings in the African setting, especially sub‐Saharan Africa. This study's findings confirm those of Lateef and Mhlongo (2022) in Nigeria, which found that inadequate staffing and limited infrastructure constrained the ability of nurses to provide PCC. In Asia, perceptions of PCC practice must accommodate the collectivist perspective (Giusti et al. 2022), similar to culturally sensitive approaches that emerged from this current study. Additionally, the study of Wasim et al. (2023) in Pakistan emphasises culturally sensitive communication in PCC delivery, supporting our finding of adopting communication strategies to meet cultural expectations.
In high‐income systems in regions like Europe and North America, PCC is often institutionalised with formal frameworks which support its implementation (McCormack and McCance 2021). The study of McCormack and McCance (2021) in the European context highlighted the development and implementation of the Person‐Centred Framework. The Person‐Centred Framework (McCormack and McCance 2021) emphasises patient involvement, empathy, shared decision‐making, and individualised care in tandem with nurses' perceptions of PCC in our study. In the USA, Rathert et al. (2016) described PCC as an organisational value linked to quality metrics, patient satisfaction, and operationalised by nurses through evidence‐based guidelines and interdisciplinary teamwork. This conceptualisation and practice of PCC in the USA differ from the nurses' perceptions in this study mainly due to systemic enablers including adequate staffing, policy support, and training which facilitate PCC as an expected standard care practice. The differences in perceptions lend credence to the need for context‐driven implementation of PCC based on localised content, resources, and culture.
5.5. Theme 3: The Effects of PCC
The study found positive perceptions of PCC's effects on QNC and nurse job satisfaction (NS). The nurses perceived that PCC improves QNC through good working relationships between nurses and patients, collaboration with colleagues, enhanced nurses' assessment skills, and faster patient recovery. These findings align with the suggestion that patient‐centredness promotes the quality of nursing care (Dys et al. 2022). The nurses perceived that PCC positively affects nurse job satisfaction through improved patient health status, good relationships between nurses and patients, and nurses feeling accomplished with the nursing care provided. These findings are consistent with the World Health Organization's (2015) study that intimated that PCC increases professional work satisfaction.
Exploration of the perceptions of nurses of PCC's effect on nursing provided insights into the complex dynamics of patient‐centred practices and shed light on the benefits of patient‐centredness. The nurses generally perceived PCC positively affects QNC and nurse job satisfaction. However, some challenges to the adoption and implementation of PCC in the study area were raised.
5.6. Theme 4: Organisational and Resource Challenges to PCC Implementation
Challenges to PCC implementation emerging from this study include management delay in approving PCC as the official care model, insufficient nursing staff, inadequate resources, and insufficient communication and assessment skills. These findings confirm global difficulties influencing the entire PCC implementation process including insufficient time, resources, lack of support, lack of involvement of the multi‐professional team, and difficulties regarding communication (Richter et al. 2022). This study's findings are consistent with those of (Chow et al. 2022) in a systematic review that revealed organisational support, resources, and training are essential for PCC implementation. Similarly, in China, nurses perceived barriers to PCC as including resource constraints, social influences, and deficits in knowledge and skills (Younas et al. 2023) aligning with this study's findings.
The finding that management reluctance to approve PCC as a challenge to patient‐centredness confirms an earlier study in Ghana (Nkrumah and Abekah‐Nkrumah 2019) which indicated leadership support as essential for patient‐centredness. Therefore, successful implementation of PCC will require management approval.
This current study also found insufficient nursing staff and resource constraints as barriers to PCC, supporting the findings of Lateef and Mhlongo (2022) that inadequate staffing and resource constraints impact PCC negatively in primary healthcare in Nigeria. The assertion that high patient‐to‐nurse ratios and the prevailing task‐oriented models practiced in Ghana are constraints to PCC practice (Nkrumah and Abekah‐Nkrumah 2019) supports our finding of insufficient nursing staff as a challenge to PCC. This study's finding is also consistent with the assertion that insufficient human resources serve as barriers to effective PCC implementation in German nursing homes (Richter et al. 2022). Promoting patient‐centredness, therefore, requires sufficient staffing to mitigate work overload.
Inadequate communication and patient assessment skills emerged in this study as challenges to PCC, supporting the assertion that communication and interpersonal skills are prerequisites for patient‐centredness (McCormack and McCance 2021). Communication‐related challenges also validate an earlier study in Ghana by Nkrumah and Abekah‐Nkrumah's (2019) which stressed the importance of continuous training and development for nursing personnel to improve essential PCC skills, including effective communication.
Even though PCC is globally promoted in nursing practice, its implementation is fraught with challenges. High patient‐to‐nurse ratios and the prevailing task‐oriented models practiced in Ghana and similar contexts are constraints to PCC practice (Nkrumah and Abekah‐Nkrumah 2019). There have been reported conflicts between nursing staff and patients or patient relatives when expectations differ, particularly around cultural perceptions of health and illness or cultural values (Taylan and Weber 2023). These conflicts have been resolved through family meetings, culturally competent mediation, or therapeutic communication training (Chow et al. 2022; Santana et al. 2018). These challenges highlight the need for systematic support and policy alignment to enable meaningful PCC delivery.
In conclusion, this study provides a comprehensive understanding of how nurses conceptualise PCC, perceive PCC practices, and the perceptions of the effect of PCC on QNC and nurse job satisfaction, shedding light on the dynamics of PCC implementation. The study illuminated nurses' perceptions of PCC, highlighting critical areas for improvement and underscoring the need for context‐specific strategies for patient‐centred practice and continuous training on patient‐centred skills. Even though the effect of PCC on nursing care was generally perceived positively, addressing institutional challenges is crucial to its effective implementation of PCC.
6. Conclusions
The nurses in the medical wards perceive PCC as individualised and holistic nursing that considers patients' unique needs, values, and cultural beliefs.
The medical nurses perceived that for effective PCC delivery, management approval, strengthening communication and assessment skills are prerequisites.
The study found that PCC is conceptualised based on cultural nuances. Cultural differences can affect nurses' perceptions and practice of PCC.
This study found that the nurses need further skills training in communication and assessment. Variations in nursing education and training standards internationally can influence nurses' perceptions and practice of PCC.
Resource availability, including staffing levels, equipment, and access to training affect the adoption of PCC.
Workplace culture and management practices can impact the implementation and perception of PCC. For instance, management in our study hospitals did not approve PCC, as the predominant practice model.
7. Strengths and Limitations
Strengths
The study adequately explored PCC from the nurses' perspective and established the context for the PCC implementation or piloting in Ghana and possibly applicable to other LMICs struggling with both quality and PCC adoption.
The findings can serve as baseline data to help develop a Ghanaian context‐driven and evidence‐based PCC model.
The study recognises the importance of cultural dimensions in the conceptualisation of PCC. Understanding cultural nuances adds depth to the analysis and contributes to the cultural sensitivity of the findings.
Limitations
The study was conducted in a specific environment; the findings, therefore, may not apply to nurses in other health settings or regions.
8. The Study's Practical Implications
Policymakers
Healthcare policy developers can use the findings to help shape healthcare policies that emphasise the need for patient‐centredness.
The findings serve as a guide for promoting leadership support, allocation of adequate resources, and incentives for training to enhance PCC.
Health Institutions
Health managers can improve patient‐centred culture and support PCC initiatives by promoting management approval and facilitating smoother PCC implementation.
The health institutions should prioritise resources for staffing, training in communication and assessment skills, and improving logistical support to facilitate effective PCC.
Nursing Education
Nursing education programs can incorporate the study's findings into their curricula, emphasising training in communication and assessment skills to guide in refining PCC.
Nurse educators should emphasise the importance of PCC in nursing education, ensuring that future nurses are well‐prepared to deliver PCC in diverse healthcare settings.
Nursing Practice
The study findings offer a practical roadmap for healthcare managers desirous of quality improvement through a patient‐centred approach.
Nurses can use the study's findings at the individual practice level to reflect on and refine their approaches to patient care.
9. Future Research
Future research could delve deeper into the contextual considerations influencing PCC implementation in Ghanaian healthcare settings.
Future research may assess the effectiveness of PCC interventions and investigate patients' perspectives on the care they receive.
Future longitudinal studies would provide a more robust understanding of how nurses' perceptions evolve with experience or changes in healthcare practices.
Author Contributions
Both writers collaborated on the research project from its inception to its completion. D.A. originated the concept, formulated the proposal, and collected data. Both authors contributed to significant revisions, and B.R.B. provided supervision.
Ethics Statement
The study was approved by the Biomedical Research Ethics Committee of the University of KwaZulu‐Natal (BREC Ref. no. BFC 364/18) and the Ethics Review Committee of Tamale Teaching Hospital (TTHERC/19/06/18/04) for compliance with standards. Permission letters were obtained from the hospitals' administrators before data collection. We explained the study's purpose and informed participants of their rights, including the option to refuse, skip questions, or withdraw from the study at any time they so wished. The participants were encouraged to seek clarification. The participants voluntarily consented before the FGDs. We ensured confidentiality through anonymity and non‐disclosure of any personal information. The PI kept all data including transcripts, notes, and recordings under lock and key. The questions were framed to avoid distress to the participants. The study findings were disseminated to the management of the hospitals including the ward managers. We intend to publish the findings in a peer‐reviewed journal to contribute to scientific knowledge of PCC practice. The study was conducted in compliance with the Declaration of Helsinki (World Medical Association 2014).
Conflicts of Interest
The authors declare no conflicts of interest.
Acknowledgements
The University for Development Studies and the University of KwaZulu‐Natal supported this research financially. Special appreciation goes to the administration of Tamale Teaching Hospital, Upper West Regional Hospital, and Upper East Regional Hospital. Our gratitude extends to the participating medical nurses. I acknowledge Wolters Kluwer Health Inc. and Copyright Clearance for granting a licence to use the table of the Standards for Reporting Qualitative Research by Bridget O'Brien, Ilene Harris, Darcy Reed, and David Cook.
Abugre, D. , and Bhengu B. R.. 2025. “Qualitative Exploration of Medical Nurses' Perceptions of Patient‐Centred Care: A Study in Medical Wards of Three Hospitals.” Nursing Open 12, no. 10: e70329. 10.1002/nop2.70329.
Funding: The authors received no specific funding for this work.
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.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
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.