The case for concordance: value and application in nursing practice

This is the first of two articles exploring the concept of concordance in practice. This first paper draws on psychology, research in clinical practice and social participation theory to argue for a concordant approach to nursing care. Where most writers have confined discussions on concordance to medicines management, the author seeks to widen the debate to explore the value of the principle across the whole spectrum of nursing practice. Studies describing patient involvement are mapped against Arnstein's model of citizen participation to determine true levels of patient-practitioner working. The outcomes of care delivered in a paternalistic way are compared with those arising from patient-practitioner partnership working across a range of healthcare settings. The values underpinning concordance and the relationships and skills necessary to achieve and sustain it are considered. A recommendation for practice is that concordance needs to be taught as a central part of the healthcare process rather than merely an ethical principle in healthcare education. The power of the nurse-patient relationship on which concordance is built needs to be recognised and valued. The principle of concordance will be more feasible in practice when accompanied by other initiatives that promote public participation in education review commissioning and standard setting.