Relationship Based Care: The Power of Vision , Values , Voice , and Visibility

1. Relationship Based Care: The Power of Vision, Values, Voice, and Visibility • Dennis Ondrejka, Ph.D., RN, CNS • Associate Professor, Denver School of Nursing • 303-577-0387, ext 209 • d.ondrejka@denverschoolofnursing.org

2. Objectives and Subjectives • Objectives: • 1. Describethe meaning of Relationship Based Care (RBC) • 2. Clarify the differences for nurses and patients when RBC is in use. • 3. Describe the research behind RBC stating the positive impact on patient outcomes, nursing satisfaction, Magnet status development, and nurse-physician communication. • Subjectives: • 1. Gain a sense of appreciation for the valuing of RBC in any practice. • 2. Explore tools that I can use that will bring RBC into my own practice.

3. Course Description:What Does RBC Mean? • Relationship based care encompasses a philosophy that is patient centered and then builds evidence based on professional nursing practice. It does this by changing the way clinicians connect to patients, families, colleagues, physicians, and administration.

4. RBC Model for the Clinician Colleagues Self-Clinician Patient & Family At the core “The CORE of the healing environment is your Relationship to the patient and family”, p. 29

5. Course Description:What Does RBC Mean? #2 • There is significant research that indicates how such a model will improve patient outcomes, patient satisfaction, nurse satisfaction, supports Magnet status development, empowers your front line staff, and creates a place where everything is possible, and toxic behaviors are encouraged to leave.

6. What Patients Want • Interpersonal skills of staff, be a person vs. a diagnosis (press & Ganey, 1997) • To be listened to, treated with respect, cared for gently (RBC Care conf. data) • Care providers responding and anticipating patient requests; ability to calm fears, good com., inform them about tests & procedures (Dingman, 1999) • RBC is key to quality care (Tresolini, 1994)

7. The Caring and Healing Environment • Preparation for RBC requires crossing the threshold into the pt’s environment • It has been called sacred space (Wright and Syre-Adams, 2000) • There is a physical element to this space that can be manipulated and promote better healing (room, building, view, sound, colors, traffic flow) Ulrich, 1984; Bilchik, 2002) • At the core of the environment is the intentional caring relationship between health care provider and patient (family).

8. RBC Depends On • Healthy Teams (not just work groups) • CHCM, 2003, Manthey, 2000, • Positive Communication between physicians and nurses • Rosenstein, 2002: improves nurse satis. • Shortell, et al. 1994: direct impact on mortality rates in ICUs • Stein, 1990: a collaborative model is required and desired • Moving toward Magnet Hospital status. This impacts patient outcomes, nurse burnout, BBP injuries, patient satisfaction scores. • Aiken, 1997

9. RBC is Evidence Based Practice • What is the number ONE predictor of overall patient satisfaction? • __________________________ Evans, Martin & Winslow, 1998; Varholak & Korwan, 1995; Vom Eigen, et al., 1999 They all find the same answer!!!

10. RBC is About Understanding the Differences Between these statements: • 1.Nursing Process with assessment, diagnosis, intervention and evaluation VERSUS • 2.Being in connection and knowing that healing or increased disease is an extension of the nurse (Clinician). YOU, set the stage for healing to begin through RBC. Or YOU set the stage for a less than desired outcome by ignoring RBC.

11. RBC Asks The Nurse to Advocate • For care, • Presences, • Patient, • Family. How does this become your Visionof who you are as a clinician (nurse) How does this become your Value statement of who you are as a clinician (nurse) How you do this is Visible to the everyone!

12. 12 Values Assumptions that guide the process of internal change are • 1.The meaning and essences of care is a connection in the moment • 2.Feeling connected creates harmony and healing • 3.Each person on the team plays a part • 4.Relationship is at the heart of all of this • 5.Care providers knowledge of self and self-care > quality of care, healthy relationships. • 6.Healthy relationships among health care member is essential to the quality of care provided to patients.

13. 12 Values Assumptions that guide the process of internal change are • 7. People are most satisfied when in alignment with their personal and professional values • 8. We must understand and value of Relationship in patient care. • 9. A therapeutic relationship is essential for quality care • 10. Patient experiences improve measurably when staff own their own practice

14. 12 Values Assumptions that guide the process of internal change are • 11. People willingly change when they are inspired to a shared common vision. When an infrastructure is implemented for it working, when relevant education is provided for personal professional development, and when they see evidence of success (I2E2) 12. Transformational change happens one relationship at a time.

15. Disconnect to Connection • We want to address patient quality and their perceptions---but we don’t do it very well • We cannot get out of this chaos unless we truly focus on the patient, but we are system driven • What if we answer every conflict and dilemma by putting the patient at the center

16. Disconnect-To Connect page 2 • Look at our filters • Look at how our personal behavior and biases and how we created them form our experience and background • What is your spiritual consciousness – you in the greater universe of possibilities • Assess your beliefs about individual rights, they need to express free will, and put the patient first

17. The Voice of Agency & becoming Visible • Do you know why you are here? Is it to serve your customers? (patients, families, colleagues) • I understand my role in relationship to supporting your healing • I know that how I partner with you is how I support your real healing, and my role • Knowledge is power, and RBC starts on the inside and then flows outward with a powerful voice—THIS MAKES ME VISIBLE!

18. Care Theories • Watson’s Caring-Healing Framework • Swanson’s Five Caring Processes • Leininger’s Caring Theory • Dingman’s Caring Model

19. Dingman’s Caring Model • Introduce yourself and your role • Find out what the patient wants to be called • Use touch appropriately • Sit a the bedside for 5 minutes each shift to partner with the patient around their goals for the day. Integrate your needs and set outcomes for your patient • Reinforce the mission, vision, and values of your facility and unit when planning care.