Whose Plan Is It? A Walker and Avant Concept Analysis of Patient-Centered Care, With a Working Definition for a Hospital Diabetes Center
Student Name
American College of Education
NUR5063: Patient-Centered Care
Module 1 Assignment
Instructor Name
January 12, 2027
Why Analyze a Familiar Term
Patient-centered care appears in the mission statement of the hospital whose outpatient diabetes center anchors this course's papers, in its job descriptions and on the survey its patients receive after each visit. The center is a composite, set in a Northeast Ohio city that resettled several thousand Bhutanese Nepali refugees after 2008, and about a third of its patients now come from that community. When staff at the center were asked what patient-centered care meant, the answers ranged from being friendly to letting patients choose their appointment times. A term that means everything to everyone cannot guide a design or be measured afterward.
The purpose of this analysis is to clarify the concept's meaning for nursing practice in an outpatient chronic disease setting and to produce a working definition precise enough to test. The method is the eight-step approach described by Walker and Avant (2019): after choosing the concept and stating the purpose of the analysis, the analyst surveys how the term is used, settles on its defining attributes, writes a model case and then contrasting cases, names what comes before and after the concept, and ends with the empirical referents that show it is present.
Uses of the Concept
The concept entered health care language through several doors. In medicine, Mead and Bower (2000) reviewed the conceptual and empirical literature on the doctor-patient relationship and described five dimensions: a biopsychosocial perspective, the patient as a person, the sharing of power and responsibility, the therapeutic alliance and the doctor as a person. The idea became health system policy when patient-centeredness was named one of six aims for quality, described as care that respects and responds to each patient's preferences, needs and values and lets those values guide clinical decisions (Institute of Medicine, 2001).
Nursing has used a closely related term. Morgan and Yoder (2012) analyzed person-centered care with the same Walker and Avant method and emphasized holistic, individualized, respectful and empowering care, a set that reflects nursing's long attention to the whole person. The broadest synthesis is by Scholl et al. (2014), who coded definitions in 417 articles and identified 15 dimensions, from the characteristics of the clinician to access, coordination and continuity of care, arranged across the levels of the individual encounter, the team and the system.
Outside health care, the term's origins in client-centered psychotherapy carry the idea that the person seeking help, not the helper, is the authority on that person's own experience. Across these uses one idea stays constant: the patient's view of what matters shapes the care, rather than decorating it.
Defining Attributes
From these uses, four attributes are proposed as the characteristics that must be present for care to be patient-centered. First, the patient is known as a person: the clinician learns about the patient's life, beliefs, family, language and circumstances and treats that knowledge as clinically relevant. Second, power is shared: the patient's preferences are sought, options are explained in a form the patient can use, and decisions are made with the patient rather than for the patient. Third, the family is involved to the degree the patient wishes, recognizing that for many patients the unit of decision is a household, not an individual. Fourth, care is coordinated around the patient's needs across settings and time, so that the patient does not carry the burden of the system's gaps.
These attributes deliberately leave out friendliness and convenience. Both matter, but either can be present while decisions are still made entirely by the clinician, and neither distinguishes this concept from good customer service.
Model, Borderline and Contrary Cases
Model case. Mrs. G., a 64-year-old Bhutanese Nepali woman with type 2 diabetes, comes to the diabetes center with her daughter-in-law after her A1C rises to 9.4%. The nurse arranges a trained Nepali interpreter rather than relying on the daughter-in-law, asks what Mrs. G. believes is causing her high sugar, and learns that she has been skipping her evening metformin on Hindu fasting days and eating most of her rice at a late family meal. The nurse asks who at home cooks and who decides about medicines, and invites the daughter-in-law and, by phone, Mrs. G.'s son into the discussion at Mrs. G.'s request. Together they agree on a plan that shifts some rice to earlier in the day, sets a rule for fasting days that the prescriber approves, and schedules a follow-up call in Nepali. The nurse sends the plan to the primary care office. All four attributes are present.
Borderline case. A different nurse sees Mrs. G., uses an interpreter, explains the plan clearly and asks whether she has questions, but does not ask about fasting or who cooks. The care is respectful and well communicated, and some attributes are present, but the plan is the nurse's and it will fail on the next fast.
Contrary case. Mrs. G. is seen on a busy afternoon. Her grandson, aged 15, interprets. The nurse increases her insulin according to protocol, hands her an English pamphlet and books a visit in three months. None of the attributes is present, although every step was technically correct.
Antecedents, Consequences and Empirical Referents
Antecedents are what must exist before the concept can occur. They include clinician time, access to trained interpreters, a clinician attitude that treats the patient as the expert on the patient's own life, and an organization that rewards those things rather than throughput alone. Patients also need some capacity or support to participate, which is why health literacy and family involvement appear later in this course.
Consequences are what follow. Epstein and Street (2011) argue that patient-centered care has value both in itself, as care that respects the person, and for what it produces, including better understanding, trust and engagement in care. For the diabetes center, expected consequences include plans patients can follow at home, fewer missed visits and better patient-reported experience; changes in A1C are possible but depend on much more than the encounter.
Empirical referents are the observable signs that the concept is present. For this setting they include documented use of a trained interpreter, documentation of the patient's own goals and cultural practices that affect treatment, a plan recorded as agreed rather than instructed, and patient-reported measures of being involved in decisions, which Module 5 will select.
Working Definition
For the purposes of this course, patient-centered care in the outpatient diabetes center is defined as care in which the nurse comes to know the patient as a person, including language, beliefs and household, shares decisions with the patient and the family members the patient chooses, and coordinates the resulting plan across the settings the patient moves through, so that the plan reflects what matters to the patient and can be carried out at home. The definition is narrower than the broadest syntheses and wider than the idea of courtesy, and each of its parts can be observed and measured. The next module applies it to the cultural needs of the Bhutanese Nepali patients the center serves.
References
Epstein, R. M., & Street, R. L. (2011). The values and value of patient-centered care. Annals of Family Medicine, 9(2), 100-103. https://doi.org/10.1370/afm.1239
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. National Academy Press. https://doi.org/10.17226/10027
Mead, N., & Bower, P. (2000). Patient-centredness: A conceptual framework and review of the empirical literature. Social Science & Medicine, 51(7), 1087-1110. https://doi.org/10.1016/S0277-9536(00)00098-8
Morgan, S., & Yoder, L. H. (2012). A concept analysis of person-centered care. Journal of Holistic Nursing, 30(1), 6-15. https://doi.org/10.1177/0898010111412189
Scholl, I., Zill, J. M., Härter, M., & Dirmaier, J. (2014). An integrative model of patient-centeredness: A systematic review and concept analysis. PLOS ONE, 9(9), Article e107828. https://doi.org/10.1371/journal.pone.0107828
Walker, L. O., & Avant, K. C. (2019). Strategies for theory construction in nursing (6th ed.). Pearson.
How this NUR 5063 Module 1 example is structured
NUR 5063 Module 1 typically asks for a concept analysis of patient-centered care that ends in a working definition; your classroom's instructions decide the method and whether cases are required. This example names its method, reviews the concept's uses, sets out four defining attributes, builds a model case with contrasting cases, identifies antecedents, consequences and empirical referents, and closes with a definition the rest of the course can measure.
NUR5063 Module 1 questions, answered
What does NUR5063 Module 1 usually ask for?
NUR5063 Module 1 typically asks for a concept analysis of patient-centered care that ends in a working definition. Many sections expect a named method such as Walker and Avant, with attributes, cases, antecedents, consequences and empirical referents. Your classroom's instructions decide the method and length.
Do I need a model case, a borderline case and a contrary case?
If you use the Walker and Avant method, yes. The model case shows every attribute, the borderline case shows most but not all, and the contrary case shows none. Build them in the same setting so the contrast is clear.
Can I analyze person-centered care instead?
Only if your instructions allow it. The two terms overlap, and you can cite analyses of either, but NUR5063 is built around patient-centered care, so explain how you treat the difference.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official American College of Education document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.