Implementing Relationship Based Care: One Step at a Time

1. Implementing Relationship Based Care: One Step at a Time State of the Art April 28, 2014 The Nebraska Medical Center Dawn Straub, MSN, RN, NEA-BC Kaylie Guinan BSN, RN-BC

2. Objectives • Participants will learn how a care delivery model can be implemented and become central to the practice of caring for patients and family, caring for colleagues and caring for self • Participants will discuss methods to hardwire aspects of a care delivery model into daily practice • Participants will take away ideas for how to care for themselves

3. The Heart of the Matter Break into groups and each tell a story Please share a story of patient care that was especially meaningful to you. How did you contribute to the successful outcome?

4. History • Blended Primary Nursing and Patient-Focused Care • Magnet Site Visit in 2007 • Primary Nursing was the Care Delivery Model • Staff could state “Primary Nursing” but could not articulate what it meant

5. Nursing Strategic Plan • Fall of 2009 • Adopted mission and values for nursing • Created new vision for nursing • Adopted Jean Watson’s Caring Theory • Adopted Relationship Based Care Model • Developed tactical plans for 2010-2013

7. Why RBC? • Endorsed by Jean Watson • Aligned with Pillars of Excellence • Aligned with current practice • Aligned with “Patient First” • Aligned with Magnet Program concepts • Ease of implementation & ability to “speak to it” • Resources available to help guide implementation

8. What is RBC? Foundation: • Relationship between nurses and patients/families is a sacred, privileged trust • Values of caring, advocacy, collaboration, safety, and seeking what is in the best interest of those we serve • 3 Crucial Care Provider Relationships: • Patients/families • Self • Colleagues

10. RBC Course of Events

11. Related Evidence • Patient involvement and confidence in care increases with positive relationships with care providers • Patient safety is most effectively safeguarded when an advocate in the health care system knows them and what matters to them • Organizations with caring and healing environments and a focus on relationships have higher patient, staff, and physician satisfaction and higher productivity

12. Reflective Practice Cycle

13. Discover • Spring 2010 • Focus on care of Patients/Families • Representatives from all UBCs • Appreciative assessment • Split into groups • Storytelling based on questions • Each member of the group tells a story • Document themes and report out

14. Themes Patient Care: Please share a story of patient care that was especially meaningful to you. How did you contribute to the successful outcome? • Communication • Education • Teamwork • Trust • Bonding • Caring – extraordinary • Continuity of Care • Communication • Ability to listen • Family involvement • Follow-up • Personalizing care • Intuition • Caring as a priority of your day • Teamwork • Connecting with patient and family

15. Themes Professional Competencies: Share an example of professional competencies that had a significant impact on a patient outcome in your unit/department. • Listening • Humility • Trust • Assessment • Experience • Assertiveness • Competence • Critical Thinking • Confidence • Advocating • Intuition • Persistence • Relationships with different disciplines • Education • Accountability • Experience/expertise • Advocacy • Respect/value • Being able to ask questions (inquiry) • Technical skills

16. Themes Teamwork: Describe a time when you were part of or observed an extraordinary display of cooperation or teamwork. What were the behaviors that made it possible? • Anticipation of coworker situation/needs • Timing of response • Taking initiative • Competence/trust • Knowing role • Communication • Patientfirst • Teamwork between units • Coordinating Care • Being prepared • Advocating • Problem solving/critical thinking • Respect for all team members • Communication • Assertiveness • Knowledgeable • Cooperation • Coordination • Focused on best patient outcome • Delegation

17. Dream • Reviewed themes from Discover session • Best patient care • Professional competencies present • Teamwork Visioning • Treat patient and family like our own • All providers sending same message of “we are here for the patients”

18. Dialogue • What will it take? • How much of the theory that we shared with you is needed for all staff—in order for them to understand & speak to it? • What process of education of all staff would be most effective & drive home the point of relationships? • How do we sustain RBC? How do we keep it in the forefront of all that we do?

19. Design • Unit specific roll out • Attended UBC and Staff meetings • Discussed care delivery model dimensions and focus • Linked all initiatives • Caring Connection • Patient First • NDNQI Nurse Sensitive Indicators and RN Satisfaction

20. Hardwire for Sustainability • Leadership Development • Report out of work to date • Discussion of leadership expectations • Storytelling • Agenda templates • Stories at Employee Forums • Patient Focused Goals • Documented every shift on white board • Moved into electronic care plan

22. Next Phase • A tenured nurse openly discussed her issues with post-traumatic stress syndrome • Other staff started discussing concerns related to stress • Decided to use “care of self” dimension of RBC to address • Began development of this dimension

23. 2012 • One Chart hiatus • Focus shifted to RBC: Care of Self • UBC’s, share self stories • Video shown at forum and on nursing homepage

24. 2013 Formal Education

25. Informal Education

26. Thinking outside the box

27. Outcomes • 60 attend Healing the Healer: Care of Self (with follow up reminder) • 145 attend Self Care Express in-service • 45 Care of Self for floors education • 150 x 2 Nurse Residents a year • 68 attended Nursing Grand Rounds • 60 Self Study Modules • 180 Self Care Bingo participants (with follow up reminder) • 108 Care of Peer Bingo participants (with follow up reminder) • 300 self-care kits

28. Future plans • 2014 Move to care of Peers

29. Final Thoughts Questions?

30. Thank you!