Relationship Based Care: The Power of Vision, Values,

Voice, and Visibility

Dennis Ondrejka, Ph.D., RN, CNSAssociate Professor, Denver School of Nursing303-577-0387, ext 209d.ondrejka@denverschoolofnursing.org

Objectives and Subjectives

Objectives:1. Describe the 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.

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.

RBC Model for the Clinician

ColleaguesSelf-Clinician

Patient & FamilyAt the core

“The CORE of the healing environment is your Relationship to the patient and family”, p. 29

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.

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)

The Caring and Healing Environment

Preparation for RBC requires crossing the threshold into the pt’s environmentIt 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).

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 desiredMoving toward Magnet Hospital status. This impacts patient outcomes, nurse burnout, BBP injuries, patient satisfaction scores. Aiken, 1997

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!!!

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.

RBC Asks The Nurse to Advocate

For care, Presences,Patient, Family.

How does this become your Vision of 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 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 healing3.      Each person on the team plays a part4.      Relationship is at the heart of all of this5.      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 values8. We must understand and value of Relationship in patient care.9. A therapeutic relationship is essential for quality care10. Patient experiences improve measurably when staff own their own practice

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.

Disconnect to Connection

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

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

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 healingI know that how I partner with you is how I support your real healing, and my roleKnowledge is power, and RBC starts on the inside and then flows outward with a powerful voice—THIS MAKES ME VISIBLE!

Care Theories

Watson’s Caring-Healing FrameworkSwanson’s Five Caring ProcessesLeininger’s Caring TheoryDingman’s Caring Model

Dingman’s Caring Model

Introduce yourself and your roleFind 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 patientReinforce the mission, vision, and values of your facility and unit when planning care.