The nurse as advocate For care, Presences, Patient, Family.

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.

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 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 (I 2 E 2 ) 12.Transformational change happens one relationship at a time.

Disconnect Between What Drives a Health Care Organization and What Matters Most 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

Disconnect page 2 We understand human behavior as being non-rational most of the time, yet expect to solve these issues with rational interventions We realize there is a critical need for the care provider to have a positive relationship to self and we tend to ignore it anyway

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

Formula for Leading Change I 2 E 2 I 1 is inspiration: They will participate when they believe what they have to offer is valued and they are contributing to a compelling, valuable, life affirming vision I 2 is Infrastructure: The infrastructure must support the organizations overall vision (strategic, operational, tactical levels)

Formula for Leading Change I 2 E 2 E 1 is Education: Priorities are in self- awareness, patient-family experience of care, having healthy relationships, proactive positive com., creative & critical thinking, and leadership E 2 is Evidence: measure results of your actions and support inspiration.

Implementing I 2 E 2 Needs to have the 5 Cs in Place Clarity Why, benefits, how to, their part, scope or responsibility and authority frees actions Competency Know expectations, feel skills, educate Confidence Empowered to action, self-governance Collaboration RB work, respect others, know your part Commitment Ownership, headed for a shared goal

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 (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)

The Caring and Healing Environment Preparation to 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) 9Ulrich, 1984; Bilchik, 2002) At the core of the environment is the intentional caring relationship between health care provider and patient (family).

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

Watson’s Theory: Transpersonal Caring-Healing Framework The whole caring-healing consciousness is contained within a single moment The one caring and the one being cared for are interconnected Human caring and the healing processes are communicated to the one being cared for. (Opposite is also true) Caring-healing consciousness is spatially extended Caring-healing consciousness is temporally extended Caring-healing consciousness is dominated over physical illness and treatment

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.