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Patient Centered Care: Group 3

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Katy Haiflich

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Transcript of Patient Centered Care: Group 3

Patient-Centered Care Katy Haiflich
Becca Stark
Ashley Reed
Sara Marlow
Lexi Kleinmann
Austin Cass Leadership Assignment 3 Initiated to establish and standardize nursing education as it applies to quality and safety within the healthcare system

Six Competencies
Patient centered care
Teamwork and collaboration
Evidenced-based practice
Quality improvement
Safety
Informatics Quality and Safety Education for Nurses (QSEN) A nonprofit organization working to provide health care systems with uniformed and unbiased information and advice as it applies to the delivery of health related services

Six areas for improvement safety, effectiveness, patient-centered, timeliness, efficiency, and equitability Institute of Medicine (IOM) “Patient-centered care defined as care that informs and involves patients in medical decision-making and self-management; coordinates and integrates medical care; provides physical comfort and emotional support; understands the patients’ concept of illness and their cultural beliefs; and understands and applies principles of disease prevention and behavioral change appropriate to diverse populations” Patient-Centered Care Understanding of patient’s definition of the following:
Stressors – interpersonal, intrapersonal, and extrapersonal
Health and wellness
Prevention –primary, secondary, and tertiary
Environment – internal, external, and created Decision making
Self-management
Physical comfort
Emotional support
Concept of illness
Cultural beliefs
Disease prevention
Behavioral change Neuman Systems Model and Patient-Centered Care (Alligood & Tomey, 2010; Current Nursing, 2012) Wholistic approach to the patient who is comprised of parts

Assumptions
Nursing – see person as a whole and assist patient system to wellness using primary, secondary, and tertiary interventions to reduce reaction to stressors

Person – “whole” person comprised of five parts physiological, psychological, socio-cultural, spiritual, and developmental

Health – a state in which all parts of the person are in harmony

Environment – internal and external factors that affect the patient
Internal Environment – contained with in the patient and includes intrapersonal stressors
External Environment – factors outside of the patient that affect the patient these include interpersonal and extrapersonal stressors
Created Environment – an unconsciously created to allow the patient to cope Neuman Systems Model and Patient-Centered Care Institute of Medicine, 2001 Continuous healing relationships
Customized patient care
Patient is in control
Free flow of knowledge and information
Evidence-based
Safety
Transparency
Anticipation of needs
Proper use of resources
Cooperation among treatment team Institute of Medicine (IOM)
Rules for Redesign (QSEN Institute, n.d.a.) Knowledge Skills Attitudes Understand effective communication. Assess own level of communication and build a therapeutic relationship with patient. Continually improve communication and conflict resolution skills. Understand ethical and legal aspects of patient-centered care. Obtain informed consent for care. Recognize any tension between patient’s rights and professional responsibility and work to resolve any conflicts that may arise. Understand how patient involvement can improve the safety and quality of care and identify barriers to involvement. Remove barriers to involvement and engage patients. Value and respect active participation. Patient Centered Care & KSAs (QSEN Institute, n.d.a.) Elicit and communicate patient’s values, preferences, and needs to the health care team. Understand the concepts of pain, suffering, and comfort. Assess for the presence of and level of pain, suffering, and comfort. Recognize own values as it relates to pain and suffering and accept role in the management of pain, suffering, and comfort. Attitudes Skills Knowledge Value and respect the situation via “the patient’s eyes” and encourage them to express their needs. Integrate multiple dimensions
of patient-centered care such
as patient’s values, preferences, involvement, support, and comfort. Patient Centered Care & KSAs Key Points of PCC Correlation to Neuman (Maizes, Rakel, & Niemiec, 2009, p. 3) (National Academy of Sciences, 2012) (Institute of Medicine, 2001) (QSEN Institute, n.d.b.) (Forneris et al., 2012) Excellent Care Hourly Rounding

AIDET

Bedside reporting

(Parkview, 2009) Hourly Rounding Addresses each patient's needs

4 P's
Pain
Potty
Positioning
Possessions

(Parkview, 2009) AIDET Training tool

Enhances communication with patient interactions

AIDET
Acknowledge
Introduce
Duration
Explanation
Thank you
(Parkview, 2009) BEDSIDE REPORTING Already utilized at some of the hospitals in the area

Parkview defined it as a type of standardized shift report for communicating the patient's perceptions of service and quality

Whiteboards- communicates the patient's expectations

(Parkview, 2009) Research Study Radke (2013) performed a study on a med-surge unit because of low patient satisfaction scores

Survey after discharge
Satisfaction scores were 76%
Overall goal: 90%patient satisfaction
Wanted to improve scores in the area "nurse communicate well"

(Radke, 2013) Implementing BSR Improving patient satisfaction scores between nurses, patient's, and their families.

Lewin's Change Theory

Needs assessment
Need for improvement of patient satisfaction
Alternative options
Unchanged HCAHPS scores for 2 years suggested a need to change reporting tools
(Radke, 2013) Results Increase in patient satisfaction related to communication to 87.6% in 3 months.

"Bedside shift report will require high-level mentoring skills and innovation in delivery of content, context building, knowledge building, and relationship building"

(Radke, 2013) Communication
Tools CUS Ask Me 3 Information Sharing Dignity & Respect Participation Collaboration Patient-and Family-Centered Care SBAR Situation
Background
Assessment
Recommendation (Kesten, 2011) SBAR Communication tool Increase patient satisfaction
Increase patient safety
Reduce medical and human error (Kesten, 2011) SBAR Increase interdisciplinary communication during: Shift report
Physician phone calls
Patient transfer
Patient discharge (Kesten, 2011) (Kesten, 2011) ISBARR Could not find any research on this form, but it has been presented at IPFW I = Introduction of self, patient, and unit Second R = Repeat back orders to ensure accurate
information is given and received More thorough version of SBAR, yet still gaining support and needing more research Nurse Leader Role Patient & Family Involvement Satisfaction Surveys How to Empower the Patient Leader Rounds: rounding on every patient to ensure they are receiving the best care possible. Scores are calculated for each unit and areas for improvement are established. The nurse manager provides education classes for audits and for skills labs (McSherry, Pearce, Grimwood, & McSherry, 2012). Collaborative Care Including the family and the patient in their care helps them to feel empowered.
Having a support system at the bedside has shown to improve care and aid in decision making about treatments (Warren, 2012) Surveys are taken by the patient after their stay to determine their perception of care during their stay. These scores are used to make improvements in the care provided (Warren, 2012). Example: A patient states "the nurse never smiled and had a very negative attitude"

Solution: The Nurse Leader would then send out an email or post on the huddle board the importance of a smile and positivity when providing care. Smile Explain Encourage Be positive Thank the patient Go above and beyond 8 Categories HCAHPS Usefulness HCAHPS Survey Hospital Consumer Assessment of Healthcare Providers and Systems Set of 27 questions concerning the patient
experience during previous hospital stay Scores are indication of patient satisfaction Questions developed by the Centers for Medicare and Medicaid Services DiGioia, Bozic, & Herzlinger, 2010) Communication with doctors
Communication with nurses
Staff responsiveness
Pain management
Medicine communication
Discharge information
Hospital cleanliness
Hospital quietness (DiGioia, Bozic, & Herzlinger, 2010) Indicate areas that need improvement

Provide feedback and results of QI initiatives being taken by the hospital

Influence the amount of reimbursement rewarded (or not rewarded) to hospital at end of fiscal year (DiGioia, Bozic, & Herzlinger, 2010) All of the previous factors support one of the most fundamental
focuses of healthcare—patient satisfaction. Conclusive Measure? -The Joint Commission on Accreditation of Healthcare (JCAHO)

-American Osteopathic Association (AOA)

-Centers for Medicaid Services (CMS) -If accreditation is achieved, the hospital receives reimbursement as well as the title. 3 Agencies legitimize accreditation: Ways to Achieve Accreditation (Employment Demand) Advantage #4 (Financial Support) Advantage #3 (Positive Recognition) Advantage #2 (Accountability) Advantage #1 Holds many advantages

Advantages include:

Accountability
Positive Recognition
Financial Support
Employment Demand Importance of Accreditation 2004
JCAHO
launches
“Shared
Visions - New
Pathways” 1997
New CoP
creates Quality
Assurance and
Performance
Improvement
Program 1986
CoPs expanded 1972
Congress requires
DHHS Secretary
to validate
JCAHO findings 1966
AOA granted
deeming
authority 1965
Medicare
legislation
enacted 1951
Joint
Commission
forms 1945
AOA
introduces
survey
program 1935
Federal
goverment sets
standards of
maternity and
child care 1918
ACS sets
minimum
standards Tool Used to Deem Accreditation NCLEX Review Questions (Lambert-Lagerquist et al., 2012, p. 95) 5. A client dies in the hospital. The driver’s license indicates that the client wanted to be an organ donor. The family is refusing organ donation. What is the correct action by an RN?

A. Discuss with the family the legality of the driver’s license indicating organ donation.
B. Respect the family’s wishes.
C. Seek legal advice to carry out the client’s wishes.
D. Activate the donor team to go forward with the organ donation process. Question (Lambert-Lagerquist et al., 2012, p. 102) 4. A client is admitted with an existing advance directive that sates “Do Not Resuscitate” (DNR). The client goes into cardiac arrest. How should the nurse respond?

A. Do not resuscitate the client as detailed in the advance directive.

The advance directive is an expression of the client’s wishes. Answer and Rationale (Irwin & Burckhardt, 2013, p. 199) 3. A client requires a lifesaving blood transfusion per hospital guidelines. The client refuses based on religious beliefs. It would be MOST appropriate for the nurse to take which of the following actions?

A. Confirm with the client that the client understands the potential risks of not having the blood transfusion.

The nurse must be sure the client understands the potential risks of not receiving the transfusion. Answer and Rationale (Irwin & Burckhardt, 2013, p. 197) 2. The client is a non-English-speaking elderly woman who is being admitted to the hospital for worrisome symptoms. She is accompanied by family members who speak English. The nurse admitting the client needs to ask some general admission questions. It would be MOST appropriate for the nurse to take which of the following actions?

A. Call the hospital’s interpreter services to assist with asking the client questions in her native language.

The only way to avoid bias and interjection by family members is by utilizing interpreter services at your hospital. Answer and Rationale (Irwin & Burckhardt, 2013, p. 187) 1. On the evening shift, the nurse is caring for a client who will be undergoing a mastectomy in the morning. A call from the front desk alerts the nurse that the client’s family has arrived. It would be MOST appropriate for the nurse to take which of the following actions?

A. Tell the family that they cannot come in because visiting hours are over.
B. Tell the client you want to make sure she has some alone time to relax.
C. Invite the family in to offer support after confirming with the client.
D. Tell the nursing assistant to sit with the client who needs company. Question (Lambert-Lagerquist et al., 2012, p. 102 5. A client dies in the hospital. The driver’s license indicates that the client wanted to be an organ donor. The family is refusing organ donation. What is the correct action by an RN?

B. Respect the family’s wishes.

The family’s wishes must be followed. If the client had an advance directive, this may not have been an issue. Answer and Rationale (Lambert-Lagerquist et al., 2012, p. 95) 4. A client is admitted with an existing advance directive that sates “Do Not Resuscitate” (DNR). The client goes into cardiac arrest. How should the nurse respond?

A. Do not resuscitate the client as detailed in the advance directive.
B. If the client is admitted to the hospital, a new advance directive is needed; therefore, resuscitate the client.
C. Start chest compressions, but do not intubate.
D. Intubate only to secure an airway. Question (Irwin & Burckhardt, 2013, p. 191-192) 3. A client requires a lifesaving blood transfusion per hospital guidelines. The client refuses based on religious beliefs. It would be MOST appropriate for the nurse to take which of the following actions?

A. Confirm with the client that the client understands the potential risks of not having the blood transfusion.
B. Tell the client that, regardless of personal beliefs, the client has to have the lifesaving transfusion.
C. Call the Legal Department of the hospital immediately.
D. Try to gently encourage the client to change his or her mind. Question (Irwin & Burckhardt, 2013, p. 190) 2. The client is a non-English-speaking elderly woman who is being admitted to the hospital for worrisome symptoms. She is accompanied by family members who speak English. The nurse admitting the client needs to ask some general admission questions. It would be MOST appropriate for the nurse to take which of the following actions?

A. Call the hospital’s interpreter services to assist with asking the client questions in her native language.
B. Ask family members the questions and document their responses.
C. Ask family members to translate and ask the questions for the nurse.
D. Document “Unable to obtain answers, patient does no speak English.” Question (Irwin & Burckhardt, 2013, 193) 1. On the evening shift, the nurse is caring for a client who will be undergoing a mastectomy in the morning. A call from the front desk alerts the nurse that the client’s family has arrived. It would be MOST appropriate for the nurse to take which of the following actions?

C. Invite the family in to offer support after confirming with the client.

During times of stress and anxiety, such as undergoing surgery, nurses should promote family support. The answer choice also states that the nurse would ask the client first. This supports including clients in their care. Answer and Rationale Parkview Health. (2009). Two thousand and nine the parkview nurse: A publication for nurses. Retrieved February 13, 2013 from http://www.parkview.com/employment/workatparkview/documents/nursing09ar.pdf

QSEN Institute (n.d.a.). Pre-licensure KSAS. Retrieved February 16, 2013 from http://qsen.org/competencies/pre-licensure-ksas/

QSEN Institute (n.d.b.). Project Overview. Retrieved February 16, 2013 from http://qsen.org/about-qsen/project-overview/

Radtke, K. (2013). Improving patient satisfaction with nursing communication using bedside shift report. Clinical Nurse Specialist: The Journal For Advanced Nursing Practice, 27(1), 19-25. doi:http://dx.doi.org.ezproxy.library.ipfw.edu/10.1097/ NUR.0b013e3182777011

Sprague, L. (2005). Hospital oversight in Medicare: Accreditation and deeming authority. Retrieved February 27, 2013 from http://www.nhpf.org/library/issue-briefs/IB802_Accreditation_05-06-05.pdf

Warren, N. (2012). Involving patient and family advisors in the patient and family-centered care model. MEDSURG Nursing, 21(4), 233-239. Institute of Medicine (2001). Crossing the quality chasm: A new health system for the 21st century. Retrieved February 16, 2013 from www.nap.edu/html/quality_chasm/reportbrief.pdf

Irwin, B.J., & Burckhardt, J.A. (2013). NCLEX-RN strategies, practice, and review. New York, NY: Kaplan
Lambert-Lagerquist, S., McMillin, J.L., Nelson, R.M., Parilo, D.W., Snider, K.E., & Wisherop, J.R. (2012). Davis’s NCLEX-RN success (3rd ed.). Philadelphia, PA: F.A. Davis Company.

Kesten, K. S. (2011). Role-play using SBAR technique to improve observed communication skills in senior nursing students. Journal Of Nursing Education, 50(2), 79-87. doi:http://dx.doi.org.ezproxy.library.ipfw.edu/10.3928/01484834-20101230-02

Maizes, V., Rakel, D., & Niemiec, C. (2009). Integrative medicine and patient-centered care. Retrieved February 11, 2013 from Institute of Medicine website: http://www.iom.edu/~/media/Files/Activity%20Files/Quality/IntegrativeMed/Integrative%20Medicine%20and%20Patient%20Centered%20Care.pdf

McSherry, R., Pearce, P., Grimwood, K., & McSherry, W. (2012). The pivotal role of nurse managers, leaders and educators in enabling excellence in nursing care. Journal of Nursing Management, 20(1), 7-19. doi:10.1111/j.1365-2834.2011.01349.x

National Academy of Sciences (2012). About the IOM. Retrieved February 16, 2013 from http://www.iom.edu/About-IOM.aspx Abraham, M., & Moretz, J. (2012). Implementing patient- and family-centered care: Part I - understanding the challenges. Pediatric Nursing, 38(1), 44-47.

Ahmann, E., & Dokken, D. (2012). Strategies for encouraging patient/family member partnerships with the health care team. Pediatric Nursing, 38(4), 232-235.

Alligood, M.R., & Tomey, A.M. (2010). Nursing theorists and their work (7th ed.). Maryland Heights, MO: Mosby Elsevier.

Code of ethics for nurses with interpretive statements. (2001). Retrieved February 14, 2013 from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf

Current Nursing (2012). Betty Neuman’s System Model. Retrieved March 9, 2013 from http://currentnursing.com/nursing_theory/Neuman.html

DiGioia, A., Bozic, K., & Herzlinger, R. (2010). HCAHPS and you: using experience-based methodology to deliver exceptional care experiences and outcomes. Orthopedics Today, 30(12), 28.

Forneris, S.G., Crownover, J.G., Dorsey, L., Leahy, N., Mass, N.A., Wong, L., Zabriskie, A., & Zavertnik, J.E. (2012). Integrating QSEN and ACES: An NLN simulation leader project. Nursing Education Perspectives, 33(3), 184-187.

Hardin, S. R. (2012). Geriatrics. Engaging families to participate in care of older critical care patients. Critical Care Nurse, 32(3), 35-40. Family Roles Active Presence Protector Facilitator Historian Coaching Voluntary Caregiver The family or significant other remains constantly at the patient's side. Patients may feel safer and remain more oriented through a familiar voice.

(Hardin, 2012) The role that family members take on by ensuring that the needs of the patient are met and that the best possible care is given. Protection can be interpreting the patient's needs or by consistently assessing the patient.

(Hardin, 2012) The family interprets patient's needs to nurses and other HCPs. The facilitator role can be very useful to nurses to explain what certain signs mean. These signs can be interpreting pain, nausea, constipation, etc.

(Hardin, 2012) The family provides the patient's history. Being a historian can help protect the patient's safety by clarifying symptoms, current medications, response to medications, events leading up to the admission, and typical preferences of the patient. Helping nurses to know the patient as a person promotes individualized care.

(Hardin, 2012) The family encourages and supports the patient. Coaching is providing hope and strength when the odds appear to be against survival. It is often the key to patients finding the inner strength to persevere.

(Hardin, 2012) The family performs activities of daily living for the patient. These include feeding, turning, bathing, and even more advanced care such as suctioning, changing dressings, or administering medications.

(Hardin, 2012) Program developed by the Partnership for Clear Health Communication at the National Patient Safety Foundation.
Its purpose is to encourage patients and family members to be active participants in their care.
What is my (or my child's) main problem?
What do I (we) need to do?
Why is it important for me (us) to do this?

(Ahmann & Dokken, 2012) Part of TeamSTEPPS, which is an approach to communication and teamwork to ensure patient safety that was developed by the Patient Safety Program of the Department of Defense.
TeamSTEPPS also designed SBAR.
The CUS communication tool, also called the "Two Challenge Rule" is designed to slow down or stop a procedure or other situation when any member of a health care team, including a family member has a safety concern.
C- "I'm concerned"
U- "I'm uncomfortable" or "I need clarity."
S- "Stop!/Safety at risk!"

(Ahmann & Dokken, 2012) Patient and family knowledge, values, beliefs, and cultural backgrounds are incorporated into the planning and delivery of care.

(Abraham & Moretz, 2012) Patients receive timely, complete, and accurate information to effectively participate in care and decision-making.

(Abraham & Moretz, 2012) Patients and families are encouraged and supported in participating in care and decision-making at the level they choose.

(Abraham & Moretz, 2012) Patients, families, and HCPs collaborate in policy and program development, implementation, and evaluation.

(Abraham & Moretz, 2012) ANA Code of Ethics "The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems" ("Code of ethics," 2001, p. 3). Provision 2 Provision 3 Provisions specific to Patient-Centered care Provision 1 "The nurse's primary commitment is to the patient, whether an individual, family, group, or community" ("Code of ethics," 2001, p. 5). "The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient" ("Code of ethics," 2001, p. 6). 4 Core Concepts (Sprague, 2005) (Sprague, 2005) (Sprague, 2005) (Sprague, 2005) (Sprague, 2005) (Sprague, 2005) (Sprague, 2005) (Sprague, 2005) References (Alligood & Tomey, 2010; Current Nursing, 2012; Maizes, Rakel, & Niemiec, 2009)
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