Transcript PATIENT- AND FAMILY-CENTERED CARE

PATIENT- AND FAMILY-CENTERED CARE:
Partnerships for Safety & Quality
New Employee Orientation
Module 2
PATIENT- AND FAMILY-CENTERED CARE:
Partnerships For Safety & Quality
New Employee Orientation Module 2
Our Time Together...
▼ What is Patient- and Family-Centered Care
(PFCC)?
▼ What does it mean to Veterans and their
families?
▼ What is different about working in a health care
facility dedicated to becoming patient- and
family-centered?
▼ How can you be successful in a patient- and
family-centered care environment?
You Should Be Able To...
▼ Define the core concepts of Patient- and Family-
Centered Care (PFCC).
▼ Describe how patient- and family-centered care
improves safety, quality, and positively impacts
other VHA priorities for the experience of care.
▼ Recognize practices that represent patient- and
family-centered care in your daily interactions.
▼ Make a commitment to applying the core concepts
of patient- and family-centered care to your
important work with our Veterans and their
families.
What Is Patient- and FamilyCentered 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.
VHA Experience of
Care Goals
Patient- and FamilyCentered Care Core Concepts
A.
A fully engaged
partnership of Veteran,
family, and health care
team.
B.
Established through
continuous healing
relationships.
C.
Provided in optimal
healing environments.
D.
In order to improve
health outcomes and
the Veteran’s experience
of care.
A. People are treated with respect
and dignity.
B. Health care providers communicate
and share complete and unbiased
information with patients and families
in ways that are affirming and useful.
C. Individuals and families build on
their strengths through participation
in experiences that enhance control
and independence.
D. Collaboration among patients,
families, and providers occurs in
policy and program development and
professional education, as well as in
the delivery of care.
How Can You Support
Moving Forward in
Patient- and
Family-Centered Care?
Recognize the
“Driving Forces”
Is it Patient- and
Family-Centered…or NOT?
 System-Centered (SC)
Because we’ve always done it that way; because it is more
convenient; because it is more efficient; it’s policy, procedure…
 Patient/Family Focused (PFF)
We know best, we’re doing it for you, we want to support you and
help you…
 Patient- and Family-Centered (PFC)
The choices, needs, and preferences of patients and their families
are fundamental…
1. Visiting policies specify that
spouses and children are
allowed to visit the intensive
care units at any time.
SC - PFF
3. In developing a new
ambulatory clinic, VA
leadership invite Veterans and
families to comment on the
final plans for the facility’s
upcoming renovation.
PFF – SC
5. Patients who have received
care at the VA, and their
families, participate as faculty
in the orientation program for
new staff and providers.
PFC
6. A social worker’s job
description states that “she/he is
to identify patient and family
needs for each discharged
ventilator dependent quadriplegic
patient.”
PFF
7. After reviewing SHEP patient
satisfaction survey data, the clinic
changes its hours of operation to
include some evening hours.
PFF - PFCC
8. Patients who have had a
stroke and their families develop
a peer support program.
PFC
10. The policy of the
housekeeping department is to
ask Veterans and families their
preferred time of day for their
hospital room to be cleaned.
PFCC
How Can You Support
Moving Forward in
Patient- and
Family-Centered Care?
Recognize The Expectations
Is it Patient- and
Family-Centered…or NOT?
Veterans and Families Expect
That You Will…
▼ Introduce yourself and describe your role on the
care team.
▼ Connect and engage with them in a welcoming way.
▼ Show respect and appreciation for the Veteran’s
military service.
▼ Show empathy for the Veteran and family.
▼ Respect their social, cultural, and spiritual diversity
and values.
Veterans and Families Expect
That You Will…
▼ Respect their perspectives and include their needs
and preferences in the plan of care.
▼ Identify the ways they prefer to learn and their
priorities for education and information about their
health, medications, and treatment choices.
▼ Actively promote their right to make choices about
their plan of care.
Veterans and Families Expect
That You Will…
▼ Work collaboratively with other staff and with Veterans
and families to move toward a more patient- and
family-centered environment of care.
▼ Continue learning about patient- and family-centered
practices and developing collaboration and
communication skills.
As Staff, How Do You Meet
These Expectations?
Patient- and Family-Centered Care
You are at the reception desk of the specialty clinic. At
11:00 am you realize that three patients are still waiting to
be seen in the clinic. You inquire and find out the doctor
has been called away, but no one told the Veterans and
their families in the waiting room. What should you do?
a) Announce to the people in the waiting room that Dr. D.
is gone and they will need to re-schedule through the
automated system.
b) Call each person up to the desk, apologize, and offer to
re-schedule them.
c) Tell the Clinic staff they have to tell the patients about
the SNAFU.
d) Apologize to the patients, offer them a choice to see
another physician or re-schedule, and facilitate
whichever option they choose.
A patient’s wife and two adult sons came with the
patient to his appointment. They have now been told
he has to be admitted immediately. However, they did
not bring either a change of clothing or money for food.
What should you do?
a) Tell them there is nothing you can do. They need to
go home, get money and clothing, and come back.
b) Tell them to go to the Social Worker’s office.
c) Express empathy and tell them where they can find
an ATM and a computer to check for hotels.
d) Take the family to the Social Work office, introduce
them and their situation to the Social Worker;
express confidence that the Social Worker can help
them. Make sure they know how to contact you so
you can follow up with the patient.
A patient’s wife waits for 6 hours outside the Intensive
Care Unit (ICU) in a cramped vending machine area. The
surgeon has told her the surgery was successful and the
patient is recovering in the ICU. The ICU nurse sees the
very anxious woman, who asks if she may come in to see
her husband. If you were that nurse, what should you do?
a) Explain that the ICU is not private and she will need
to wait until the patient is moved to a room.
b) Explain that visitors are an infection risk and she will
needs to go to the official waiting room until called.
c) Express empathy with her feelings and bring her in
for a few minutes to hold her husband’s hand.
d) Tell her you are sorry, but you really can’t break
the rules.
The nurse comes into the room to educate the patient
about chemotherapy medications. The patient’s husband,
who is present, wants to wait until later in the day so their
daughter can also be there. If you were the nurse, what
should you do?
a) Tell the husband that you will explain everything to him and
when the daughter comes she can call you with questions.
b) Find out when the daughter is coming; make a commitment
to return then; or, if your shift is ending, bring in the
oncoming nurse and explain the family’s request to her at
the bedside.
c) Leave the information in the room and tell the husband you
will come back later.
d) Review the basics of the information with the husband, give
him a notepad to write down questions.
The wife of a Veteran with heart disease asks the
clinic staff to print out her husband’s latest lab
results and send them to their home. What should
you do?
a) Tell the wife that only the physician can share
results and that the patient will have to call the
doctor.
b) Check the patient’s record for a consent/surrogate
form; then print the results and send them.
c) Tell the wife you will call the physician for the ok
and then send the results to their home.
d) Tell the wife you will call the physician for the ok but
you can only send the results to the referring
community clinic.
A Veteran with chronic obstructive pulmonary and heart
disease is told that he must have several more tests at
the VAMC. He lives in a community some hours away
from the clinic. He asks if the tests could be scheduled
at the same time so that he only has to make one trip.
What should you tell him?
a) Agree that it would be the best for him, but explain
that the tests are in different departments and they
schedule individually.
b) Tell him only his community-based outpatient clinic
physician can make those arrangements.
c) Offer to contact each department and make the
arrangements for tests over two days so he can come
and stay overnight.
d) Call the various departments and make the
arrangements before the patient returns home.
A Veteran is resting comfortably after a particularly difficult
outpatient procedure. His wife is in the hallway, and has
been told she cannot come into the small recovery room to
be with him. When the physician comes to tell him the
results, she follows the physician into the room. What
should you do?
a) Nothing.
b) Apologize to the physician and ask the wife to leave
the room.
c) Ask the physician’s permission to allow her to stay.
d) Introduce the wife to the physician and support her
desire to be with her husband while the results are
discussed.
The partner of a Veteran hospitalized for abdominal
surgery wants to spend the night in the patient’s
(private) room. Visiting hours are officially over at 8 pm.
What should you do?
a) Ask the patient if she wants her partner there, and if
so, make sure there is a sleeper chair in the room
and provide access.
b) Tell the charge nurse to make the decision.
c) Explain to the partner that visiting hours are over and
there is nothing you can do.
d) Check with the patient; if she wants her partner
there, explain to the partner that she can stay but has
to be out of the room before morning shift change.
A patient undergoing treatment for breast cancer
refuses to eat, saying that the smell of food makes her
sick. The physician’s orders are to make sure she gets
adequate nutrition. What should you do?
a) Ask the patient if there are some food options she
would find appealing to eat and contact the dietician
and/or physician to see if there are alternative
nutritional approaches for this patient.
b) Tell the patient that she may change her mind so you
will just leave the tray in the room for her.
c) Tell the patient she has to eat, and sit with her while
she does.
d) Call the physician and report that the patient is being
non-compliant.
A Veteran residing in a Community Living Center likes to sleep
until noon and then have his breakfast. He stays up late, then
asks for a “midnight” snack and walks around the building. He
gets very agitated when he is told he must eat at regular
mealtimes and observe lights-out time. What should you do to
handle this situation?
a) Hold a family conference and tell them they have to
make him understand he has to change his behavior.
b) Bring the nurse manager in to tell the Veteran resident
he has to follow the rules, period.
c) Task the Care Assistant with waking him up on time,
and putting him to bed on time.
d) Hold a team conference to individualize his care plan
and support his lifestyle.
Patient- and
Family-Centered Care
A Journey…Not a Destination
What Will YOU Do To Support Our
PFCC Journey???
Patient- and Family-Centered Care
Wearing new
glasses…
Seeing health
care with a
different set of
lenses
Personal Practice
After the call to serve,
many Veterans
continue to pay a
high price for the
sacrifices they made
at home and abroad.
Getting to know their
stories becomes part
of the healing.
“Let us not forget.”
Adapted from: Jillian Van Ens CNE,
“Our Veteran Population”,
Spokane VAMC, June 2010