Nurse and Nurse Manager Module

Welcome and Introductions

Today’s Session• Provide information and tools to continue the process of learning and

implementing patient- and family-centered care initiatives within VISN 7.

• Review the importance of patient- and family-centered nursing practice and how it complements the VA's strategic goals and priorities.

• Review a toolkit of interactive activities for nurse managers and nurse leaders to apply in nurse education, mentoring, and coaching front-line staff.

• Discuss how to partner with Veterans and families in developing unit-specific or hospital/clinic policies, programs, and processes with the ultimate goal of improving quality and safety.

Learning Objectives• Align patient- and family-centered care and VA priorities.

• Review: Nursing-specific best practices in patient- and family-centered

care that enhance quality and safety.Ways to partner with Veterans and their families.Ways to individualize care.

• Identify: Benefits to nurses and all team members.Resources within the hospital, clinic, and national VA Office of

Patient Centered Care.

Patient- and Family-Centered Care in the Department of Veterans Affairs

• A fully engaged partnership of Veteran, family, and health care team.

• Established through continuous healing relationships.

• Provided in optimal healing environments.

• In order to improve health outcomes and the Veteran’s experience of care.

The VA’s 12 Patient Centered Care Principles

• Honor the Veteran’s expectation of safe, high quality, and accessible care.

• Enhance the quality of human interactions and therapeutic alliances.

• Solicit and respect the Veteran’s values, preferences, and needs.

• Systematize the coordination, continuity, and integration of care.

• Empower Veterans through information and education.

The VA’s 12 Patient Centered Care Principles (cont.)

• Incorporate the nutritional, cultural, and nurturing aspects of food.

• Provide for physical comfort and management of pain.

• Ensure emotional and spiritual support.

• Encourage involvement of family and friends.

• Provide an architectural layout and design conducive to health and healing.

• Introduce creative arts into the healing environment.

• Support and sustain an engaged workforce as key to providing patient-centered care.

Patient- and Family-Centered Care Core Concepts

• People are treated with respect and dignity.

• Health care providers communicate and share complete and unbiased information with patients and families in ways that are affirming and useful.

• Individuals and families build on their strengths through participation in experiences that enhance control and independence.

• Collaboration among patients, families, and providers occurs in policy and program development and professional education, as well as in the delivery of care.

Supporting Positive Change

Your Role as Coach and Mentor

“To shoulder the responsibility to change health care…requires one final element of trust–trust in the workforce…Our premise is this: to achieve the health care we want, we will have to re-envision, and largely retrain, the health care workforce, so that they can become citizens in the improvement of their own work.”   

Don Berwick 2003  http://newhealthpartnerships.net/provider.aspx?id=1208New Health Partnerships: Improving Care By Engaging Patients  

Transformational Change

Despite common misperceptions, cultures are not static constructs. They do change, and often rapidly, when there are motivated change agents and a rationale or external pressure that resonates within the culture.

Levine and Murray, Cultures of Caregiving, 2004, p. 171

Nursing Leaders Are Key

Nursing leaders can take advantage of the forces driving change at the "macro" level to make small but important changes in their clinical "microsystems" (the small, interdependent groups of people who work together regularly to provide care for specific groups of patients and their families.)

Nursing Leader Roles in the Cultural Transformation

• Promote understanding of how every nurse contributes to creating effective partnerships with Veterans and family members.

• Serve as role models and coaches for front-line staff in partnering with Veterans and families.

• Act as change agents by fostering small pilots (rapid cycle change) that can serve as examples for others.

What are some of the changesyou have witnessed in

your health care careers?

A Day in the Life of a Nurse Manager

Nurse Manager’s “Passport to Success”

An Orientation Guide July 2009

NurseManager

ACNSPayroll

Residents

NPSB

Provider

Patient

Surgeon

Laundry

Supply

CommitteePeers

Affiliate

UNIONIRM

Education

Safety

Clerk

Family

Staff

CNE

ADPS UM/UR

DietaryEngineering

PharmacySocial Worker

Case Manager

Time Keeper

COS

Leadership Tips

• Never miss a chance to “connect the dots.”

• Channel attention through everything–calendars, meetings, project team reviews, rounding, performance feedback, hiring, promotion, recognition.

• Get patients and family members onto your teams–from the executive suite on to the clinical micro system and improvement project teams.

Nurse Leader Rounding for Patient- and Family-Centered Care

• Did our staff explain their roles in your care?

• Did you get the information you needed and wanted?

• Was it provided to you in ways you found useful? In ways you prefer?

• Did we support your family's presence and participation in the ways you wished?

• Were your observations and concerns about your care respected by our staff?

Reward and Recognize

• Thank you notes.Patient comments.Thanks from the team.Let the Patient and Family Advisory Council know

so they can add their thanks.• Send stories to be published in the facility

newsletter.• Food!• Support career development–your patient-

and family-centered care champions will grow through continuing education, committee membership, mentoring roles, and special projects.

• SHARE BEST PRACTICES–and give the credit to the staff who are the best practitioners.

Deal With Resistance To Change

• Facilitate staff involvement in the change.

• Praise small successes.

• Do not waste large amounts of energy on those that simply won't or can't change.

• Explain how the change will benefit people.

• Teach new skills if new skills are needed.

• Use team solutions.

• Organize Brainstorming sessions.Encourage involvement! Assess and set priorities together.Encourage accountability.Encourage pride.

Nurse Executive—Dorn VAMC

A Framework for Change

Practice-Based Team Learning

Stages of Staff Involvement in Change Processes

Multiple Leadership

Single Leadership

Required Capacity for Direction Setting and Learning

Degree of Active InvolvementLow

High

TellingTools:• Mailings• Press releases,

press conferences• All other kinds of

formal and informal announcements

SellingTools:• Flyers and

brochures• Information centers• Exhibitions• Hotlines • Briefings• Intranet• Coaching• Training

TestingTools:• Pilot interventions• Simulations• Step-by-step

implementation with close monitoring

• Interviews• Testing in

communities of practice

• Coaching• Training

ConsultingTools:• Reply forms• Hearings and

workshops• Interviews• Opinion polls• Stakeholder

analyses• Intranet forums• Advisory boards• Focus groups• Interactive training

with consulation• Consulting

communities of practice

• Real time strategic change

Co-creatingTools:• “Whole system

change”:�̵Open space technology�̵Appreciative inquiry�̵Future search conferences

• World cafe • Planning for real• Joint scenario

analysis• Dialogue• Experimenting in

communities of practice

© Holger Nauheimer, 2006 – www.change-management-toolbook.com

Your Personal Mission

• Define your values and beliefs about patients and families and the experience of care.

• Commit personally to the vision, goals, and priorities.

• Communicate your personal commitment in a way that is sincere and heartfelt.

Nurse Manager and Leadership Toolkit

Your Menu of Options

The Toolkit Grid1. Fundamentals–foundation knowledge suitable for all staff in

health care.

2. Clinical practice–of particular value to those with direct clinical responsibilities.

3. Coach and mentor–clinicians, educators, charge nurses, and others who have responsibilities for coaching and guiding other staff, or who produce educational materials and resources for staff or patients and families.

4. Supporting positive change–team leaders, leaders and managers who are likely to be involved in process improvements, policy and procedure development, and new initiatives.

The Toolkit Grid

1. Staff Meeting2. In-Service3. Reflective Practice Session4. Task Force or Implementation Team5. Supplemental Materials

The Toolkit Grid, cont’d.

1. Staff Meeting2. In-service3. Reflective Practice Session4. Task Force or Implementation Team5. Supplemental Materials

Toolkit Activities

• Share best practices• Share what you discover works…and

doesn't work• Learn from each other• Learn from patients and families

Personal and Professional Stories

Patient–Family Story

Fundamentals

VA PrioritiesThe Basics of Patient- and Family-

Centered Care

VISN 7 Aligning With VA Priorities

• VHA Mission Statement• VHA Vision• VHA Office of Patient-Centered Care - 2010• VHA national patient-centered pilot of five

Field-based Implementation Teams (FIT): Birmingham VAMC

Honor America's Veterans by providing exceptional health care

that improves their health and well-being.

Veterans Health Administration (VHA)

Mission Statement

Veterans Health Administration (VHA) Mission Statement

Veterans Health Administration (VHA)

Vision Statement

VHA will continue to be the benchmark of excellence and value in health care and benefits by

providing exemplary services that are both patient centered and evidence based.

Office of Patient-Centered Care and Cultural Transformation

FY11 VHA Patient-Centered Care Implementation Plan

▼ Establish Regional Centers of Innovations (COI)Four regional host sites for Field-based

implementation teams• Region 1 – West: Greater Los Angeles HCS (VISN 22)• Region 2 – Central: North Texas HCS (VISN 17)• Region 3 – South: Birmingham VAMC (VISN 7)• Region 4 – Northeast: New Jersey HCS (VISN 3)

Washington DC VAMC selected as 5th COI▼ COI's selected based on their advanced PCC

practices and culture

FY 11 ECF Performance Plan

Client Satisfaction: PC1 Promoting Excellence in Patient-Centered Care

Organizational Performance Goals PC2 Promoting Organizational Health

▼Networks will continually monitor facility performance based upon validated inpatient and outpatient satisfaction metrics.

▼Working in Teams, continuous improvement, and being data driven will support VHA goals of being patient- and family-centered.

PROMISE ONE: To provide care, second to none– the best care anywhere!

PROMISE TWO: To maintain and expand health services wherever possible.

PROMISE THREE: To ensure that every Veteran will be personally satisfied with the care that they receive based on the highest quality of outcomes.

VISN 7Three Promises to Veterans

The VA’s 12 Patient-Centered Care Principles

• Honor the Veteran’s expectation of safe, high quality, and accessible care.

• Enhance the quality of human interactions and therapeutic alliances.

• Solicit and respect the Veteran’s values, preferences, and needs.

• Systematize the coordination, continuity, and integration of care.

• Empower Veterans through information and education.

The VA’S 12 Principles (cont.)

• Incorporate the nutritional, cultural, and nurturing aspects of food.

• Provide for physical comfort and management of pain.

• Ensure emotional and spiritual support.

• Encourage involvement of family and friends.

• Provide an architectural layout and design conducive to health and healing.

• Introduce creative arts into the healing environment.

• Support and sustain an engaged workforce as key to providing patient-centered care.

Patient- and Family-Centered Care Core Concepts

▼ People are treated with respect and dignity.

▼ Health care providers communicate and share complete and unbiased information with patients and families in ways that are affirming and useful.

▼ Individuals and families build on their strengths through participation in experiences that enhance control and independence.

▼ Collaboration among patients, families, and providers occurs in policy and program development and professional education, as well as in the delivery of care.

Veteran Advisor—Atlanta

Fundamentals Toolkit Items:

• What’s In It For Us? Mutual Benefits

• As Staff We Can…!

• Power of Words

• C.A.R.E. Connection

The Power of Words

Family Advisor—Birmingham

Doctor—Birmingham

Awareness of the impact of the words we use unconsciously is a key skill for patient- and family-centered practice.

Allow….…….Encourage

Permit…….…Support

Informed Consent….…….Informed Choice

Watch your Words

Medical talk

“Dialysis is the process of

osmosis, diffusion, and ultrafiltration used to restore electrolyte and fluid balance and remove waste products from the blood.”

Plain talk

“Dialysis is a way to clean the blood now that my kidneys have failed.”

Words That May Frighten or Confuse

• Chief Complaint• Inform• Allowed• Informed Consent• Demanding and

Difficult

• Analgesic• Anti-inflammatory• Ambulatory Clinic• Discharge• NPO

Words That Make It Clearer

AVOID• Chief complaint

• Problem Conference

• Analgesic

• Anti-inflammatory

• Ambulatory Clinic

USE• Patient/family observations or

concerns

• Conference for challenging situations

• Medicine for pain

• Reduces swelling

• Walk-in Clinic

Empowering Words

AVOID

• Allow• Permit• Require• Prohibited• Should• We can't• We don't• I'll try

USE

• Offer• Choose • Support• Encourage• What do you think?• I'm able• Your opinion?• I'll take you there• Part of the team

The Power of Words: Labeling

Words to Avoid

▼ Dysfunctional▼ Non-Compliant▼ Uninvolved

The Words We Use

A Brainstorming Exercise