(RNAO, 2015)
Nipissing University BScN Learning Module
Best Practice Guideline:
Person-and Family-Centred Care
The Nipissing University BScN program is undergoing a pre-designation to become a Best Practice Spotlight Organization (BPSO). This project is funded by the RNAO in conjunction with the Ministry of Health and Long Term Care.
Disclosure: This presentation is based on the RNAO best practice guideline; Person-and Family-Centred Care.
First Year
Knowledge of BPG, and assessment using BPG’s (Introduce BPG order sets).
Second Year
Clinical exposure to application of BPG’s
Third Year
Knowledge and use of BPG’s in complex settings.
Fourth/Fifth Year
Application of BPG’s in complex scenarios (critical thinking).
How to Use BPG's based on your Academic Year- A General Guideline
This guideline outlines EB practice, that addresses recommendations for health care providers on the approach to client-and family-centred care. An overview of supports, and appropriate structures are discussed in order to provide the best possible evidence based (EB) care.
(RNAO, 2015)
What is person-and family-centred care?
Person-and family centred care is an approach that means the individual and their family work together with the health-care team to
make the bet decisions regarding the individuals health care. These decisions stem from the information received from these providers regarding treatment choices. The purpose of this model of care is to give the individual control of their health. When organizations follow this approach to care, the individual will be asked to assist with their plan of care so that care is delivered to meet their needs; this places the client in
the best position to explain to the health care team what they prefer.
(RNAO, 2015)
(RNAO, 2015)
Common Themes in Patient- and Family-Centred Care
(RNAO, 2015, p. 21-22)
Health Care Reform
Various counties including England, Australia, America, and Canada are reforming their primary-care supports to shift focus to the individual rather than the health care system and providers. The concept of this reform is to address the individual holistically, as a whole person, rather than be known for their disease alone. Health care providers must sustain a partnership with the individual and their family and allow them to be an active member in their plan of care. This must be done while maintaing a standard of care that continues to be comprehensive, integrated, recognized, coordinated, and accessible,
(RNAO, 2015)
Person- and Family-Centred Care Movement in Canada
Within the last decade, there have been various provincial initiatives, legislations, and organizations that have geared a focus towards the individual as a whole. These have improved the quality of care and have placed the person at the centre of their healthcare, allowing them to gain a sense of control, and to feel respected within the healthcare system.
The next three slides outline thirteen movements taking place in Canada to better person-and family-centred care.
(RNAO, 2015)
(RNAO, 2015)
(RNAO, 2015)
document used to outline the CMA’s action with a culture surrounding person-centred care with a Charter created specifically for this concept.
PATH and PANORAMA. The purpose of these projects are to promote the involvement of both person and family, sharing experiences and their advice for system reformed.
(RNAO, 2015)
Health-Care Partnerships
It is important to keep in mind that health care relationships should not be linear but are dynamic and continuously evolving. They are affected by many factors including internal and external, as well as the duration of the partnership.
It was stated by the authors of Partnerships in Healthcare: Transforming Relational Process (1998), that the most important competency to acquire by health care providers was the formation and sustainability of true partnerships.
The creation of partnerships is now the central focus of the health care reform (Suchman, Botelho, & Hinton- Walker).
By taking the time to build these relationships rather than to focus on treating the individual’s disease alone
assists the individual to achieve the health goals that they may find difficult to attain on their own. These partnerships are based on qualities of support, the value of diversity, and the recognition and input from the individual, family and health care provider.
(RNAO, 2015)
What is client centred learning?
Client-centred learning is a process used by healthcare providers that guides holistic, interactive, and social processes to:
Assess client learning by planning learning sessions Document client learning
Support individuals to become responsible in their health care decisions/choices
Identify the patients knowledge base, and link areas they lack to new learning opportunities
(RNAO, 2015)
How can client centred learning be facilitated?
·
Collaboration with your client to assess their learning needs and any preferences they may have
When providing information do so with health literacy in mind; speak slow and clear,
use plain language and simple illustrations Create a non-judgemental, and safe environment
Three main concepts per learning session; it is recommended to do the teach back method to assess individal learning
Health concepts should be specific towards the learning needs of the individual Use multiple strategies in order to distinguish a method for the client; printed, telephone, audio, visual, computer-based presentations
Keep open communication with the client and the health care team Continuously assess and document learning
(RNAO, 2015)
L.E.A.R.N.S. Model
Listen, Establish, Adopt, Reinforce, Name and Strengthen
(RNAO, 2015, p. 2)
This model is
based on an acronym that identifies the interactions of a client and nurse relationship. It addresses the importance of actively listening to the client to recognize their needs, so the health care provider is then able to truly have an understandingof the individual’s perspective. This creates an environment where the individual is viewed holistically, allowing a therapeutic relationship built on respect, autonomy, and self-reflection to be formed.
Developed by the Expert Panel for the Best Practice Guideline “Facilitating Client Centred Learning”.
Purpose of Guideline:
This BPG is to assist health care providers to become more confident, competent, and comfortable facilitating person-and family-centred care.
This guideline uses EB practice in order to assess, intervene, and manage persons care using a client-centred method.
(RNAO, 2017)
Scope
Best practice recommendations are provided in three areas:
As nursing students, the focus will be on practice recommendations.
It is benefical to be aware of the educational, and system, organization, and policy recommendations.
Gap Analysis
The difference between current knowledge/practices (what we are doing) and current Evidence Based Practices (what we should be doing).
Gaps can occur in knowledge, skills or practice.
Reflect on the following questions, and be specific:
Where is our current practice?
Where do we wish we were/where should we be? Why has this gap occurred?
How are we going to close the gap?
Performing a gap analysis on best practice guidelines is an essential part of reflecting on practice. When reviewing the recommendations identify where there are gaps in current practice or knowledge, and take the time to reflect.
(Anthony J. Jannetti, Inc. 2012)
Steps to Conduct a Gap Analysis
(Anthony J. Jannetti, Inc. 2012)
Recommendations
Person-and Family-Centred Care
1.0 Assessment
(RNA0, 2013)
1.1 Establish a therapeutic relationship with the person using verbal and non-verbal communication strategies to build a genuine, trusting, and respectful partnership.
1.2 Build empowering relationships with the person to promote the
person’s proactive and meaningful engagement as an active partner in their health care
1.3 Listen and seek insight into the whole person to gain an understanding of the meaning of health to the person and to learn their preferences for care.
1.4 Document information obtained on the meaning and experience
of health to the person using the person’s own words.
(RNA0, 2015)
(RNA0, 2015, p. 25-26)
(RNA0, 2015. p. 27)
(RNA0, 2015, p.. 29)
2.0 Planning
(RNA0, 2015)
2.1 Develop a plan of care in partnership with the person that is
meaningful to the person within the context of their life.
2.2 Engage with the person in a participatory model of decision making, respecting the person’s right to choose the preferred interventions for their health, by:
options for health care so the person can make an informed decision; and
their life.
(RNA0, 2015)
(RNA0, 2015, p. 32)
(RNA0, 2015, p. 33)
3.0 Implementation
(RNA0, 2015)
3.1 Personalize the delivery of care and services to ensure care is not driven from the perspective of the health-care provider and organization, by collaborating with the person on:
3.2 Partner with the person to tailor strategies for
self-management of care that are based on the person’s characteristics and preferences for learning.
(RNA0, 2015)
(RNA0, 2015, p. 37)
Behaviours that Improve Effectiveness of Care
4.0 Evaluation
(RNA0, 2015)
4.1 Obtain feedback from the person to determine the person’s satisfaction with care and whether the care delivered was person and family-centred
(RNA0, 2015)
Listed below are the education and system, organization and policy recommendations related to this BPG for your reference
5.0 Education Recommendations
(RNA0, 2015)
5.1 Educate health-care providers at a minimum on the following attributes of person- and family-centred care to improve the person’s clinical outcomes and satisfaction with care:
5.2 Educational institutions incorporate this Guideline into the curricula for nurses and, as appropriate, for other health-care providers.
(RNA0, 2015)
6.0 Organizational and Policy
Recommendations
(RNA0, 2013)
1) Demonstrating leadership and commitment to this approach to care;
6.1 Create an organizational culture that exemplifies its commitment to person- and family- centred care by:
6.2 Design an environment that demonstrably improves the person’s experience of health care by:
6.3 Collect continuous feedback from the person to determine whether their experience with health care and services was person- and family-centred, and utilize this feedback to make improvements at all levels of the health system.
6.4 Government agencies and regulatory bodies must monitor, measure, and utilize information from organizations regarding the person’s experience of health care to improve health-system performance.
(RNA0, 2015)
Research Gaps and Future Limitations
(RNA0, 2015)
References
Anthony J. Jannetti, Inc. (2012). A representation: Incorporating a needs assessment and gap analysis into the educational design. Pitman, NJ: Author.
British Columbia Ministry of Health. (2007). Primary health care charter—A collaborative approach. Retrieved from http://www.health.gov.bc.ca/library/publications/year/2007/phc_charter.pdf
Canadian Medical Association (CMA). (2010). Health care transformation in Canada. Retrieved from http://policybase.cma.ca/dbtw- wpd/PolicyPDF/PD10-05.PDF
Canadian Medical Association (CMA) & Canadian Nurses Association (CNA). (2011). Principles to guide health care transformation in Canada. Retrieved from https://cna-aiic.ca/~/media/cna/files/en/guiding_principles_hc_e.pdf
Canadian Patient Safety Institute. (2010) Patients for patient safety Canada. Retrieved from http://www.patientsforpatientsafety.ca/English/Pages/default.aspx
Dagnone, T. (2009). For patients’ sake—Patient First Review commissioner’s report to the Saskatchewan minister of health. Retrieved from http://www.health.gov.sk.ca/patient-first-commissioners-report
Excellent Care for All Act, 2010. (2010). S.O. 2010, c. 14, as amended. Retrieved from http://www.e-laws.gov.on.ca/ html/statutes/english/elaws_statutes_10e14_e.htm
Horne, F. (2010a). Putting people first: Part one—Recommendations for an Alberta Health Act. Retrieved from http://www.health.alberta.ca/documents/Alberta-Health-Act-Report-2010.pdf
Horne, F. (2010b). Putting people first: Part two —A summary of Albertans’ views. Retrieved from http://www.health.alberta.ca/documents/Alberta- Health-Act-Summary-2010.pdf
Local Health System Integration Act, 2006. (2006). S.O. 2006, c. 4, as amended. Retrieved from http://www.e-laws. gov.on.ca/html/statutes/english/elaws_statutes_06l04_e.htm
National Research Corporation Canada. (2014). Eight dimensions of patient-centred care. Retrieved from http://www.nationalresearch.com/products- and-solutions/patient-and-family-experience/eight-dimensions-of-patientcentered-care/
Province of New Brunswick. (2013). Rebuilding health care together: The provincial health plan, 2013-2018. Retrieved from http://www.gnb.ca/0212/values/pdf/9129%20english.pdf
Registered Nurses’ Association of Ontario. (2015). Person-and Family-Centred Care (Rev. ed.). Retrieved from http://rnao.ca/
Registered Nurses’ Association of Ontario (RNAO). (2014b). ECCO 2.0: Enhancing community care for Ontarians.Retrieved from http://rnao.ca/sites/rnao-ca/files/RNAO_ECCO_2_0.pdf
Registered Nurses’ Association of Ontario (RNAO). (2014c). Primary care: RNAO vision backgrounder. Retrieved from http://rnao.ca/sites/rnao-ca/files
/vision-docs/RNAO-Vision-Primary-Care.pdf
Registered Nurses’ Association of Ontario. (2013). Health Education Fact Sheet. Person-and Family Centred-Care (Rev. ed.) Retrieved from http://rnao.ca/
Registered Nurses’ Association of Ontario (RNAO). (2012a). ECCO 1.0: Enhancing community care for Ontarians. Retrieved from http://rnao.ca/sites/rnao-ca/files/RNAO_ECCO_WHITE_PAPER_FINAL_2.pdf
Saint Elizabeth. (2011). Client-centred care in the Canadian home and community sector: A review of key concepts. Retrieved from http://www.saint elizabeth.com/getmedia/4aba6e8e-0303-4b9c-9117-a8c22a43f8bd/Client-Centred-Care-in-the-Canadian-Home-and-Community-Sector.pdf.aspx
Starfield, B. (2011). Is patient-centred care the same as person-focused care? The Permanente Journal, 15(2), 63-69.
The Change Foundation. (2013). The change foundation’s journey into the world of patient experience: Lessons learned and projects underway. Toronto, ON: Author.