Pull up a chair with the nurses at Oakwood Hospital in Dearborn, Mich., to discover how they have improved relationships with patients through a program called Relationship & Results Oriented Healthcare.
"It's all about bringing the basics back to nursing. As opposed to standing and towering over patients, we're pulling up a chair, talking to patients at eye level, holding their hands, and bringing that personal touch back to the bedside," says Diane Lopez, RN, clinical manager of Oakwood's intermediate care unit.
Communicating at eye level is only one facet of RROHC's adaptable, goal-oriented approach to improving patient safety, clinical outcomes, and staff and patient satisfaction.
"Healthcare professionals are often not functioning within a conceptual framework that allows them to most quickly learn and use expert practice, such as how to best connect with patients and families," says Ruth I. Hansten, RN, PhD, FACHE, principal consultant at Hansten Healthcare PLLC, the developer of RROHC. "RROHC teaches the skills to build relationships, maximize productivity, and help patients and staff focus on the result they are looking for."
"It's all about bringing the basics back to nursing. As opposed to standing and towering over patients, we're pulling up a chair, talking to patients at eye level, holding their hands, and bringing that personal touch back to the bedside," says Diane Lopez, RN, clinical manager of Oakwood's intermediate care unit.
Communicating at eye level is only one facet of RROHC's adaptable, goal-oriented approach to improving patient safety, clinical outcomes, and staff and patient satisfaction.
"Healthcare professionals are often not functioning within a conceptual framework that allows them to most quickly learn and use expert practice, such as how to best connect with patients and families," says Ruth I. Hansten, RN, PhD, FACHE, principal consultant at Hansten Healthcare PLLC, the developer of RROHC. "RROHC teaches the skills to build relationships, maximize productivity, and help patients and staff focus on the result they are looking for."
Communication Is Key
RROHC incorporates a bundle of best practices and skills, including therapeutic eye contact and focused listening, which focus on improving patient and family communication with staff.
The bundle also contains elements that foster a consistent team approach to goal setting and outcomes. These include
Consistent introductions to patients and families that include name and position.
A goal-planning session with each patient on each shift.
Regular meetings in which care teams share feedback and update goals and plans of care.
Interdisciplinary rounding and bedside handoffs that focus on goals and outcomes.
RROHC incorporates a bundle of best practices and skills, including therapeutic eye contact and focused listening, which focus on improving patient and family communication with staff.
The bundle also contains elements that foster a consistent team approach to goal setting and outcomes. These include
Consistent introductions to patients and families that include name and position.
A goal-planning session with each patient on each shift.
Regular meetings in which care teams share feedback and update goals and plans of care.
Interdisciplinary rounding and bedside handoffs that focus on goals and outcomes.
Bedside Shift Change
Oakwood Hospital has instituted bedside handoffs, which the staff dubbed Relationship Oriented Care, as another facet of its RROHC program.
"As opposed to being away in another room giving report for 15 minutes, we're doing it right at the bedside, which is more patient-focused," says Lopez, adding it also saves nurses time.
Handoff reports consistently focus on the four "Ps" purpose, picture, plan, and part.
Purpose: To stabilize Mr. Smith's blood sugar and help him to better manage it at home.
Picture: To discharge Mr. Smith home within two days.
Plan: Monitor glucose levels, adjust insulin regimen, assess learning needs for discharge, meet with diabetic educator and dietician.
Part: A nurse assesses Mr. Smith, monitors glucose levels and dietary intake, administers insulin, facilitates communication and coordinates care with other professionals, and reinforces teaching done by diabetic educator and dietician.
Oakwood Hospital has instituted bedside handoffs, which the staff dubbed Relationship Oriented Care, as another facet of its RROHC program.
"As opposed to being away in another room giving report for 15 minutes, we're doing it right at the bedside, which is more patient-focused," says Lopez, adding it also saves nurses time.
Handoff reports consistently focus on the four "Ps" purpose, picture, plan, and part.
Purpose: To stabilize Mr. Smith's blood sugar and help him to better manage it at home.
Picture: To discharge Mr. Smith home within two days.
Plan: Monitor glucose levels, adjust insulin regimen, assess learning needs for discharge, meet with diabetic educator and dietician.
Part: A nurse assesses Mr. Smith, monitors glucose levels and dietary intake, administers insulin, facilitates communication and coordinates care with other professionals, and reinforces teaching done by diabetic educator and dietician.
All Eyes on the Patient
The program focuses on having nurses at the bedside, at eye level to the patient, when helping determine short- and long-term goals.
"Too many times nurses multitask, taking vital signs, doing paperwork, checking medication sheets, and are not focusing on the patient. We recognize patients and families need more than that, and goal identification is the whole basis of this program," says Kari Szczechowski, RN, BSN, staff nurse on the intermediate ICU.
Daily goals, such as getting out of bed or getting a good night's sleep, are written on a patient care communication board located at each bedside.
"It reaffirms to everyone what the focus of the day is," says Lopez.
The program focuses on having nurses at the bedside, at eye level to the patient, when helping determine short- and long-term goals.
"Too many times nurses multitask, taking vital signs, doing paperwork, checking medication sheets, and are not focusing on the patient. We recognize patients and families need more than that, and goal identification is the whole basis of this program," says Kari Szczechowski, RN, BSN, staff nurse on the intermediate ICU.
Daily goals, such as getting out of bed or getting a good night's sleep, are written on a patient care communication board located at each bedside.
"It reaffirms to everyone what the focus of the day is," says Lopez.
Hourly Rounding
In addition, nurses are generally assigned to patients with whom they have established a rapport. Nurses complete an hourly rounding process in which they assess and address pain control, positioning, and elimination needs. The unit manager rounds daily with the charge nurse to meet all patients to ensure they feel as though they are getting what they need.
At St. Joseph Mercy Health System, Ann Arbor, Mich., the staff has dubbed their RROHC program Relationship Centered Care. A key element of the program on the general surgery unit is a unit council that is open to all staff, says Pat Merlo, RN, MSN, the organization's service delivery leader.
One of the projects conducted by the council is a monthly audit in which one of the council members interviews every patient on the unit about their care with questions such as, "Are you happy with your care?" and "Do the nurses treat you with respect?"
"I can intervene immediately from there, if needed," says Merlo. "It's so proactive, and the patients really appreciate it."
In addition, nurses are generally assigned to patients with whom they have established a rapport. Nurses complete an hourly rounding process in which they assess and address pain control, positioning, and elimination needs. The unit manager rounds daily with the charge nurse to meet all patients to ensure they feel as though they are getting what they need.
At St. Joseph Mercy Health System, Ann Arbor, Mich., the staff has dubbed their RROHC program Relationship Centered Care. A key element of the program on the general surgery unit is a unit council that is open to all staff, says Pat Merlo, RN, MSN, the organization's service delivery leader.
One of the projects conducted by the council is a monthly audit in which one of the council members interviews every patient on the unit about their care with questions such as, "Are you happy with your care?" and "Do the nurses treat you with respect?"
"I can intervene immediately from there, if needed," says Merlo. "It's so proactive, and the patients really appreciate it."
For complete information about RROHC, visit www.hansten.com/RROHC/home.htmlCatherine Spader, RN, is a contributing writer for Nursing Spectrum.To comment, e-mail editorMW@NursingSpectrum.com.
