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

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

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? 3

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 4

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

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 7

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 8

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RBC Course of Events 10 Literature Search Model Selection Reflective Practice Cycle Discover Dream Dialogue Design Design Infrastructure and Develop Measures of Success Implement Education Design Measure

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 11

Reflective Practice Cycle Discover Appreciate and affirm “What Is” Dream Future vision “Desired Future” Dialogue “What will it take?” Design Intention “What will be” 12

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 13

Themes 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 14 Patient Care: Please share a story of patient care that was especially meaningful to you. How did you contribute to the successful outcome?

Themes 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 15 Professional Competencies: Share an example of professional competencies that had a significant impact on a patient outcome in your unit/department.

Themes Anticipation of coworker situation/needs Timing of response Taking initiative Competence/trust Knowing role Communication Patient first 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 16 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?

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” 17

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? 18

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 19

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 20

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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 22

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

2013 Formal Education 24

Informal Education 25

Thinking outside the box 26

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 27

Future plans 2014 Move to care of Peers 28

Final Thoughts Questions? 29

Thank you!