RelationshipBased Care Nursing 511 Nicholas Betz Ferris State

Relationship-Based Care Nursing 511 Nicholas Betz Ferris State University

Relationship-Based Care (RBC) History • Developed by consultants of Creative Health Care Management (CHCM) for over 25 years • Based upon existing caring theories & nursing models • 3 ideas for transformative change to implement model – Leaders committed to change • Nurse leaders can work in quality initiatives (Marshall, 2011) – Adoption of methodology for change it desires – Goals are clearly communicated (Koloroutis, 2004)

Relationship-Based Care • 3 Main relationships 1. Care provider and patient relationship 2. Care provider’s relationship with self 3. Care provider’s relationship with other care providers • Heart of Relationship-Based Care – Developing a healing relationship • • • Touch Kind Acts Clinical Interventions Listening Seeking to understand

Relationship-Based Care Elements • 6 Elements of RBC to create a Healing Environment 1. 2. 3. 4. 5. 6. Leadership Teamwork Professional Nursing Practice Patient Care Delivery Resource Driven Practice Outcomes Measurement

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Model of Care perspectives • Creates consumer loyalty and relationships • Decreases costs and increases staff efficiency • “Creates data from the bedside to the boardroom” (Koloroutis, 2004, p. 19) allowing for measurable changes of the organization. • Maximizes all available resources – Staff – Time – Equipment – Systems – Budget • Safeguards patient care (Koloroutis, 2004)

About Spectrum Health • Mission - “Spectrum Health's employees and physicians share a common mission: to improve the health of the communities we serve. ” • Vision - “By 2020, Spectrum Health will be the national leader for health. ” • Values – Excellence – Accountability – Integrity – Compassion – Teamwork – Respect (Spectrum Health, 2014)

Modified RBC by Spectrum Health • Assignments - RN is coordinator of care: “delegation, communication, accountability, relationships and efficiency. ” • Breaks - Allows the nurse time to rest, eat and return to the task of patient care “with renewed focus, energy and safety. ” • Caring Conversations - To establish a “caring, trusting, and therapeutic relationship with patients and families while connecting about what is truly important to them. ” It is important “to talk about the bad as well as the good because it is important for changing, improving, and developing best care practices and policies” (St. Jude Children’s Research Hospital, 2014, p. 1). • Checkpoints - A checkpoint allows information to be given to the staff that “supports the organization, department, unit and employee's ability to provide exceptional patient care and safety. ” (Spectrum Health, 2014)

Modified RBC for Spectrum Health • Feedback and Self Awareness - Important to help with positive outcomes and is “to provide and invite positive as well as constructive comments related to behavior observed that supports the RBC Principles, exceptional patient and family-centered care, Spectrum Health Values and Vital Behaviors. ” Should have a readiness to learn (Keating, 2011) • Healing Environment - To create and maintain an atmosphere that promotes “physical, emotional, and spiritual health that is culturally specific and individualized for our patients, families and team. ” • Hourly Rounds - This allows staff to be proactive instead of reactive in addressing care needs and helps to maintain safety. • Huddle (Report) - The next behavior of the huddle is used to “provide a structure for team members to meet frequently to create, communicate, modify and celebrate the teams’ plan for exceptional patient and family-centered care. ” (Spectrum Health, 2014)

Modified RBC for Spectrum Health • Report - The element of report is done at the bedside and “efficiently communicates standard patient information” to provide a safe patient experience. • Scheduling - Patient-centered scheduling practices help with continuity of care. • Self-Care - The purpose is “to inspire and motivate the nurturing of ourselves personally, emotionally, physically and spiritually. ” • Vision - Connects the staff's vision with the vision of Spectrum Health. The vision is an expression of what the institution wants to be (Billings & Halstead, 2012) • Whiteboards – Important because “providing efficient communication that supports patient and family-centered care, we increase safety as well as patient, family and staff satisfaction” (Spectrum Health, 2014)

Addressing Interdisciplinary Concerns • Assignments allow the RN to direct care and “are responsible for delegating the right task to the right person in the right set of conditions, the education, knowledge, experience, competency, and supervision of the unlicensed person is at the forefront” (Nurse on guard, 2011, p. 5) • Rounds allows the interdisciplinary team to share expertise (Atkins. Burnett & Allen-Mears, 2000) and discuss care of the patient providing more comprehensive care with input from the patient or family • Report allows for team members to hand-off care to the next provider “to ensure continuity of care and to safely transition the patient to the new care setting or new care provider” (Center, 2011, p. 9) – Accurate hand-off is essential to the safety of the patient (Doyle & Cruickshank, 2012) • Scheduling allows for interdisciplinary teams to determine a flow of care and allows different care providers time to meet with the patient or perform tests without coinciding with other team members

RBC Implementation • Determine Hospital Needs and Organizational Framework – Determine what needs to be changed in the framework • Hospital-wide RBC implementation – Discuss hospital wide initiatives • Unit-Specific Implementation – RBC team with respected staff members – Write a unit RBC constitution – Discuss unit specific initiatives

RBC effectiveness Evaluation • Decreased RN turnover • Improved Caring Behaviors • Stronger Communication and Documentation (Carabetta, Lombardo, & Kline, 2013) • Patient Engagement and Satisfaction • Increased patient wellness (Guglielmi, Stratton, Healy, Shapiro, & Duffy, 2014)

RBC Conclusion • Implementation is achievable • Implementation of RBC is beneficial for creating consumer loyalty and relationships, improving care, decreasing costs, increasing staff efficiency, the budget, system use, decreasing staff turnover and increasing staff satisfaction • The RBC model can be evaluated objectively

References • • Atkins-Burnett, S. , & Allen-Mears, P. (2000). Practice update. Infants and toddlers with disabilities: relationship-based approaches. Social Work, 45, 371 -379. http: //dx. doi. org/10. 1093/sw/45. 4. 371. Billings, D. M. , & Halstead, J. (2012). Teaching in nursing (4 th ed. ). St. Louis, MO: Elsevier. Carabetta, R. , Lombardo, K. , & Kline, N. (2013). Implementing primary care in the perianesthesia setting using a relationship-based care model. Journal of Peri. Anesthesia Nursing, 16 -20. http: //dx. doi. org/10. 1016/j. jopan. 2012. 10. 004 Center, D. (2011). Safe handoffs improve transitions of care to home care. Colorado Nurse, 111(3), 9 -11. Retrieved from http: //0 web. b. ebscohost. com. libcat. ferris. edu/ehost/pdfviewer? sid=22694752 b 209 -4 e 5 b-ba 24 -5 d 411 f 23 cd 45%40 sessionmgr 111&vid=26&hid=110 Doyle, K. , & Cruickshank, M. (2012). Stereotyping stigma: undergraduate health students’ perceptions at handover. Journal Of Nursing Education, 51, 255 -261. http: //dx. doi. org/10. 3928/01484834 -20120309 -03 Guglielmi, C. , Stratton, M. , Healy, G. , Shapiro, D. , & Duffy, W. (2014). The growing role of patient engagement: relationship-based care in a changing health care system. AORN Journal, 99, 517 -528. http: //dx. doi. org/10. 1016/j. aorn. 2014. 02. 007 Keating, S. (2011). Curriculum development and evaluation in nursing (2 nd ed. ). New York, NY: Springer Publishing Company.

References • • • Koloroutis, M. (Ed. ). (2004). Relationship-based care: a model for transforming practice (2 nd ed. ). Retrieved from http: //books. google. com/books? hl=en&lr=&id=a. C 1 SJCa. H 5 k. C&oi=fnd&pg=PR 5&dq=relationship+based+care+theory&ots=8 FWo. Oprt. MO&sig=Mnu. M 4 o. Yb. F 8 THDvye. Zd 3 Cl. VJP-Iw#v=onepage&q=relationship%20 based%20 care%20 theory&f=false Marshall, E. S. (2011). Transformational leadership in nursing. New York, NY: Springer. Nurse on guard -- best practice in patient safety. Delegation versus assignment. (2011). Texas Board of Nursing Bulletin, 43(3), 5. Retrieved from http: //0 web. b. ebscohost. com. libcat. ferris. edu/ehost/pdfviewer? sid=22694752 -b 209 -4 e 5 b-ba 24 -5 d 411 f 23 cd 45%40 sessionmgr 111&vid=30&hid=110 Spectrum Health. (2014). History, Mission, Vision & Values. Retrieved November 9, 2014, from http: //www. helendevoschildrens. org/Our. History. Mission. Visionand. Values Spectrum Health. (2014). Relationship-Based Care. Retrieved from https: //insite. spectrumhealth. org/departments/nursing/Relationshipbased%20 Care/RBC%20 Elements%20 of%20 Care%20 Delivery%20 Review/1. %20 RBC%20 Overview%20 of%20 the%20 Care%20 Delivery%20 System. pdf St. Jude Children’s Research Hospital. (2014). What is patient family centered care? . Retrieved from http: //www. stjude. org/stjude/v/index. jsp? vgnextoid=0342 a 1673 c 82 f 110 Vgn. VCM 1000001 e 0215 ac RCRD