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?
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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
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Nursing Strategic Plan
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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
Why RBC?
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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
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
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RBC Course of Events
Implement
Reflective
Practice Cycle
Model
Selection
Literature
Search
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• Discover
• Dream
• Dialogue
• Design
Design
Infrastructure
and Develop
Measures of
Success
• 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
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Reflective Practice Cycle
Discover
• Appreciate and affirm “What Is”
Dream
• Future vision “Desired Future”
Dialogue
• “What will it take?”
Design
• Intention “What will be”
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Discover
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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
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Themes
Patient Care: Please share a story of patient care that
was especially meaningful to you. How did you
contribute to the successful outcome?
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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
Themes
Professional Competencies: Share an example of professional
competencies that had a significant impact on a patient
outcome in your unit/department.
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Listening
Humility
Trust
Assessment
Experience
Assertiveness
Competence
Critical Thinking
Confidence
Advocating
Intuition
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Persistence
Relationships with different
disciplines
Education
Accountability
Experience/expertise
Advocacy
Respect/value
Being able to ask questions (inquiry)
Technical skills
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?
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Anticipation of coworker
situation/needs
Timing of response
Taking initiative
Competence/trust
Knowing role
Communication
Patient first
Teamwork between units
Coordinating Care
Being prepared
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Advocating
Problem solving/critical thinking
Respect for all team members
Communication
Assertiveness
Knowledgeable
Cooperation
Coordination
Focused on best patient outcome
Delegation
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”
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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?
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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
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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
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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
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2012
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One Chart hiatus
Focus shifted to RBC: Care of Self
UBC’s, share self stories
Video shown at forum and on nursing
homepage
2013 Formal Education
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Informal Education
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Thinking outside the box
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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
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Future plans
• 2014 Move to care of Peers
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Final Thoughts
Questions?
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Thank you!