Discussion: formation of therapeutic relationships between professionals

Discussion: formation of therapeutic relationships between professionals ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: formation of therapeutic relationships between professionals What rationale can you provide which validates the selected model as a theoretical use APA formate and references from 5years old or newer.Discussion: formation of therapeutic relationships between professionals sp_week5.docx mccormackbrenda_2010_chapter7personcentred_personcentrednursingt.pdf mccormackbrenda_2010 Best Practices in Preparing the Project The following are best practices in preparing this project. 1. 2. 3. 4. Review directions thoroughly. Follow submission requirements. Make sure all elements on the grading rubric are included. Rules of grammar, spelling, word usage, and punctuation are followed and consistent with formal, scientific writing. 5. Title page, running head, body of paper, and reference page must follow APA guidelines as found in the 6th edition of the manual. This includes the use of headings for each section of the paper except for the introduction where no heading is used. 6. Ideas and information that come from scholarly literature must be cited and referenced correctly. 7. A minimum of four (4) scholarly literature references must be used. Copyright @ 2010. Wiley-Blackwell. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. Chapter 7 Person-Centred Nursing Outcomes and their Evaluation Introduction Outcomes are the results expected from effective PCN. The literature on PCN is weak in terms of methods for evaluating outcomes, with little clarity about outcome focus, methodologies or methods. We have identified three themes for outcome measurement. Outcomes in these themes can be demonstrated from the perspectives of both staff and patients/families. In this chapter, we will explore these three themes from the perspectives of challenges, approaches and tools (Figure 7.1). The chapter will begin with an overview of outcome evaluation in nursing with a particular focus on how caring outcomes are reflected in the literature. The challenges associated with determining outcomes from PCN will then be discussed. A framework for evaluating outcomes from PCN will be proposed that takes account of the evaluation of processes and outcomes arising. Finally, the chapter will propose a variety of methods that can be used to evaluate PCN outcomes. Outcome Evaluation in Nursing Measuring the effectiveness of nursing is problematic. There is a large and diverse literature that attempts to determine both the key indicators for outcome measurement and methodological approaches. The nursing literature also highlights the challenges associated with evaluating the effectiveness of nursing due to the Figure 7.1 Person-centred outcomes themes. • feeling involved in care, • having a feeling of wellbeing, • the existence of a therapeutic environment, described as one in which: • decision-making is shared, • staff relationships are collaborative, • leadership is transformational, • innovative practices are supported. Copyright @ 2010. Wiley-Blackwell. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. 112 Person-Centred Nursing diversity of perspectives and frameworks that underpin the practice of nursing.Discussion: formation of therapeutic relationships between professionals The challenges associated with what has been referred to as ‘the invisibility’ of nursing is also a significant issue in the evaluation of nursing outcomes. The invisibility argument refers to the nature of nursing practice itself. Unlike other health care professionals, many nursing practices cannot be delineated as specific interventions where there is a clear input matched to an outcome – for example, a physiotherapist can evaluate their input to a patient’s improvement following a fractured neck of femur repair in terms of the number and types of specific treatments (interventions) offered and the rate of improvement determined by the objective measurement of movement. Much of the work of other health care professionals (e.g. physiotherapists) is treatment or intervention specific and thus the outcome from these interventions has greater potential for outcome evaluation. Nursing on the other hand, whilst engaging in specific treatment interventions, often does so as a part of an ongoing and continuous engagement with patients/service users and so aspects of practice associated with providing a specific intervention (such as administration of intravenous therapies, treatment of a pressure sore or assisting with nutrition) are ‘hidden’ and not visible or open to objective measurement. In a discussion paper, McQueen (2000) highlights the incongruity that exists between models of care that emphasise the importance of therapeutic relationships between patients, families and care staff, whilst at the same time little emphasis is placed on these activities in the measurement of nursing outcomes. McQueen (2000) argues that if nurses are required in this way, then the interpersonal and emotional nature of the work needs to be recognised in clinical practice, education and research and be included in the way that nursing effectiveness is measured and evaluated. Staff nurse Orla Dempsey works in an acute medical ward where she is a primary nurse to six patients, each of whom have varied care needs. Orla is on duty with a care assistant (nurses aide). At the beginning of the shift, Orla undertakes an assessment of the care needs of the patients she is working with in order to determine how best to plan her work and that of the care assistant (nurses aide) for the shift. Some patients have very specific ‘technical’ care inputs that Orla is able to clearly identify and to which she can allocate a specific period of time. The rest of their care needs can largely be met by the care assistant (nurses aide) with Orla’s supervision. The remainder of the patients have more complex care needs that include technical interventions. Orla prioritises these patients as those she will dedicate most time to and in planning their care includes the technical interventions. She builds these into the overall plan of care. Discussion: formation of therapeutic relationships between professionals During the shift, the care assistant approaches Orla and lets her know that Shaun, one of the patients whom she has been allocated, Copyright @ 2010. Wiley-Blackwell. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. Person-Centred Nursing Outcomes and their Evaluation needs his intravenous nutrition replaced as the previous one is complete. Orla views this as a ‘straightforward’ and ‘uncomplicated’ task to do. However, whilst chatting with Shaun during the procedure she discovers that Shaun is deeply concerned about how he will resume his sexual relationship with his partner. Orla spends an hour talking this through with Shaun, discussing options with him and identifying sources of support, as well as attending to other aspects of his physical care needs. Later in the day, whilst completing the workload allocation record for a ‘nursing workload audit’, Orla documents her work with Shaun under two headings – ‘specific treatment’ and ‘patient support’. However, she feels deeply dissatisfied with this as she knows that during that time she also provided comfort, engagement, empathy and personal care but it is not possible to show these in the audit record. Some authors are critical of the ‘invisibility’ and ‘hidden’ arguments in health care practice and suggest that these arguments are more reflective of the need to understand ‘complexity’ in many health care practices (Plsek & Greenhalgh, 2001; Cutliffe & Wieck, 2008). The complexity of nursing is a key consideration and helps to make sense of why nursing effectiveness cannot be judged on ‘output’ alone, but that there need to be frameworks developed that evaluate outputs/outcomes in relation to inputs (Spilsbury & Meyer, 2000; Meyer & Sturdy, 2004). Internationally, much work has been undertaken on determining outcome indicators for nursing by organisations such as The International Council of Nursing (ICN) (development of nursingsensitive outcome indicators http://www.icn.ch/matters_indicators .htm) and the National Database of Nursing Quality Indicators in the United States (Montalvo, 2007). In addition, research into the ‘expertise of nursing’ has begun to identify the complexity of nursing work and the importance of evaluating the effectiveness of this work beyond simple input/output models (Hardy et al., 2009). A recent review of aspects of nursing linked to patient outcome from the UK ‘National Nursing Research Unit’ (Policy ? 2008) highlighted the complexity of measuring outcomes in patient care. The authors highlighted ‘failure to rescue’ and health care-associated infection as nurse-sensitive outcomes, but falls and pressure sores were less sensitive. They also highlight that positive contributions of nursing to outcomes such as well-being or recovery are less well addressed in nursing outcome frameworks. However, Maben and Griffiths (2008) highlight those aspects of care that patients most value, including: • • • • A holistic approach to physical, mental and emotional needs, patient-centred and continuous care. Efficiency and effectiveness combined with humanity and compassion. Professional, high-quality evidence-based practice. Safe, effective and prompt nursing interventions. 113 114 Person-Centred Nursing Copyright @ 2010. Wiley-Blackwell. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. • • Patient empowerment, support and advocacy. Seamless care through effective teamwork with other professions. Discussion: formation of therapeutic relationships between professionals These aspects of patient care feature less strongly in nursing outcomes frameworks but yet are consistent with the principles and values underpinning PCN. Outcome Evaluation in Person-Centred Nursing The evaluation of nursing specific outcomes arising from the adoption of a person-centred approach to practice is underdeveloped and there are few reports of published person-centred outcome evaluation in the literature. Whilst the principles and values of personcentred care/nursing are enshrined in much contemporary nursing and health care policy and strategy, the empirical evidence available to support it as an operational framework for nursing and health care delivery is as yet unconvincing. Descriptive accounts of PCN leave little doubt that it does impact on patient’s experience of care services and nurses experiences of caring. However, there is a need to develop creative strategies for evaluating the complex processes that underpin person-centredness in practice. Research in areas of vulnerable people such as older people and people with intellectual disabilities has shown it to be effective in promoting patient choice, improving the experience of being cared for and patient involvement in care (Parley, 2001; Dewing, 2002; Clarke et al., 2003). Despite this, the evidence to support its impact on nursing is sparse. Attempts have been made to evaluate the impact of PCN in specific aspects of care, for example, the impact of person-centred showering (bathing) on bathing-associated aggression, agitation and discomfort in nursing home residents with dementia (Sloane et al., 2004; Hoeffer et al., 2006), the impact of multisensory environments on older people with dementia (Hope & Waterman, 2004), the evaluation of the development of ‘relationship skills’ between nurses aides and patients (Medvene et al., 2006) and exploration of how preceptors interpret, operationalise, document and teach personcentred care with students in a surgical setting (McCarthy, 2006). Other studies have evaluated person-centred planning with people with intellectual disabilities (Robertson et al., 2007), the experience of woman-centred care (Pope et al., 2001) and a number of studies that have evaluated the impact of person-centred care on people with dementia from a variety of perspectives (Dewing, 2008c). Person-centred nursing, as a model, reports the advancement of traits such as adequate staffing levels, decentralised structures, professional practice models of delivery and professional development issues (Binnie & Titchen, 1999) as a result of systems changes adopted to facilitate its implementation. The work of Binnie and Titchen (1999) remains one of the few studies that systematically analysed development of a person-centred culture in an acute care setting1. Evidence from Binnie and Titchen’s Copyright @ 2010. Wiley-Blackwell. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. Discussion: formation of therapeutic relationships between professionals Person-Centred Nursing Outcomes and their Evaluation research suggested that adopting this approach to nursing provides more holistic care. In addition, it may increase patient satisfaction with the level of care, reduce anxiety levels among nurses in the long term and promote team working among staff. Binnie and Titchen, however, did not test these assertions and were therefore unable to provide evidence of the suggested relationships. Existing evidence is consistent with the view that being personcentred requires the formation of therapeutic relationships between professionals, patients and others significant to them in their lives and that these relationships are built on mutual trust, understanding and a sharing of collective knowledge (Binnie & Titchen, 1999; Dewing, 2004; McCormack, 2004; Nolan et al., 2004). Binnie and Titchen (1999) tried to make explicit what is a nurse–patient therapeutic relationship. They highlighted the importance of the nurse avoiding the making of assumptions about patients, being ready to listen and to watch with an open mind. The emphasis on skills is essential, both in terms of practical skill and trained presence. This approach requires intelligence, creativity and attention to detail, and transforms the focus of bedside care: in skilled hands, the opportunities presented by everyday bedside caring become the medium through which a patient’s experience of illness can be transformed. (Binnie & Titchen, 1999: 18) We have already suggested that life plans of the individual and enabling and disabling aspects of the context of the care environment are important considerations in PCN. The context of care was seen as having the greatest potential to help or hinder the facilitation of PCN. In modern health care, the fundamental moral situation of nurses is that whilst they are expected to engage in autonomous decisionmaking, they are often deprived of the freedom to exercise moral authority. To exercise their freedom requires nurses to ask questions of their traditional methods of nursing, and having the belief that they can and should change the context of care. The context of care extends beyond autonomy to practice, and can be found, with equal significance, in other organisational factors such as systems of decision-making, staff relationships, organisational systems, power differentials and the potential of the organisation to tolerate innovate practices and risk-taking (McCormack et al., 2002). Hale (1986), using a simple version of PCN, found increased levels of job satisfaction and morale among the staff; nursing stress levels also decreased. Johns (1994) and Ellis (1999) reported similar results. Ellis added that PCN ‘enhanced oneself, ones practice, professional education and the organisation as a whole’ (p. 300), thus highlighting the importance of the evaluation of PCN extending beyond direct patient outcomes, and including staff and organisational outcomes. Complementary evidence from research such as magnet hospitals and models of nursing practice shows that changing an organisations’ culture has an impact on the issues concerning nurses working life 115 Copyright @ 2010. Wiley-Blackwell. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. 116 Person-Centred Nursing (Hayes et al., 2006; Manojlovich & Laschinger, 2007; Gunnarsdóttir et al., 2009).Discussion: formation of therapeutic relationships between professionals The bulk of this evidence draws a causal link between organisational culture change and working environment factors such as retention of staff, job satisfaction and job stress. Yet, Newman et al. (2001) found that, in the United Kingdom, there has been no unified or cohesive approach to workplace planning. The researchers state that there is a governmental acknowledgement of and commitment to the importance of the organisational culture in promoting nurse retention, job satisfaction and reduced stress, yet this commitment has not manifested itself into a single method of implementation (Newman et al., 2001). The Institute of Medicine in the United States reiterated the importance of organisational culture as an aspect of improving nurses’ working environment and proposed guidelines for hospitals based on research conducted into ‘magnet hospitals’ where it identified a number of traits such as professional autonomy and practice control as key in keeping nurses working. The report authors concluded that: Quality problems (nurse retention and patient satisfaction levels) occur typically not because of a failure of goodwill, knowledge, effort, or resources devoted to health care, but because of fundamental shortcomings in the way care is organised. (2001: 25). Person-centred nursing involves the reorganisation of the context of care to promote continuity of care, amongst other things (McCormack, 2003, 2004). The context of care offers the greatest source of facilitation (or hindrance) to the development of a person-centred ethos in the nurse’s workplace (Manley, 2001; McCormack, 2004). Whilst overall, there is a lack of outcome evaluation in PCN, the potential benefits of PCN to patients is more often documented (Parley, 2001; Dewing, 2002; Clarke et al., 2003), with the benefits to nurses not so clearly articulated. The research that exists reports the advancement of traits such as adequate staffing levels, decentralised structures, professional practice models of delivery and professional development issues (Binnie & Titchen, 1999) and with these changes reduced stress levels, increased job satisfaction and nurse retention. Research into organisational culture supports the link between decentralised structures, autonomy and nurse satisfaction and retention (Hayes et al., 2006; O’Brien-Pallas, 2008). In summary, whilst the values and principles of PCN are increasingly espoused in policy and strategy, its evaluation and particularly outcome evaluation is poorly developed. Whilst debates persist about the meaning of underpinning concepts, the appropriateness of models and their implementation, approaches to outcome evaluation receive less attention. Some of this lack of attention is due to the limitations of existing methodologies to capture the complexity of PCN in its entirety and thus it is easier to evaluate sub-elements. In addition, few instruments measure constructs such as ‘patient involvement in care’ and there are few conceptual frameworks of patient satisfaction that explicitly include patient involvement. Previous research and development work focusing on caring in nursing highlights that Copyright @ 2010. Wiley-Blackwell. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. Person-Centred Nursing Outcomes and their Evaluation perceptions differed between patients and nurses, which is discussed in Chapters 3 and 4. Such challenges highlight the need for evaluation frameworks that capture the complexity of the interrelationships of the elements of PCN if it is to be embedded in practice. It is this challenge that we will next address. A Framework for Outcome Evaluation In the PCN Framework presented in this book, we have identified four outcomes that would be achieved from the development of a PCN cu … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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