OJIN is a peer-reviewed, online publication that addresses current topics affecting nursing practice, research, education, and the wider health care sector. Engaging the Hearts and Minds of Nurses community as partner theory and practice in nursing pdf a Patient-Centered Practice Model” OJIN: The Online Journal of Issues in Nursing Vol. Care at the Cleveland Clinic has been always centered on patients.
Cleveland Clinic, has a long heritage of being patient focused, it faces the same challenges that other health systems do in implementing PFCC. The Cleveland Clinic, like every healthcare system today, is a complex combination of medical hospitals, institutes, and services where existing technologies and conflicting priorities can create significant barriers to standardizing care quality. Delivering on the promise of World Class Care’ in recognition of its mandate. The leadership of the Nursing Institute recognized the need for a systemwide nursing practice model to guide nurses in achieving the Cleveland Clinic vision and demonstrated the commitment of nursing leadership to PFCC. Identifying the Essence of Patient- and Family-Centered Care a single, simple description of patient- and family-centered care may not suit the needs of a complex health system. There is no universal definition of PFCC because the definition changes with the context in which it’s being used.
For example, family practice, cancer care, and acute care all have multiple articles with slightly different definitions relevant to their particular research issues. However, a single, simple description of patient- and family-centered care may not suit the needs of a complex health system. Even the smallest modern health system is a collection of diverse services that can include acute care in urban and rural settings, inpatient care, urgent care, trauma care, home health care, and hospice care. Nurses play one of the most important roles in influencing patient perceptions. Barriers to Successful Implementation of Nursing PFCC A health system like the Cleveland Clinic faces at least three major barriers when trying to implement uniform PFCC practices. Although it may be unnecessary to agree on a detailed definition of patient- and family-centered care, health systems do need to implement uniform best practices as quickly as possible if they’re going to deliver consistent PFCC.
Waiting for existing technologies at the different units of a health system to be standardized can significantly slow down the implementation of consistent PFCC policies. The Cleveland Clinic is a merged system, consisting of 11 hospitals in northeast Ohio, of which 10 were existing hospitals that joined the original Cleveland Clinic hospital through acquisition or joint operating agreements. In addition, there are many offsite care delivery facilities and support operations in northeast Ohio, such as home health and ambulatory surgery centers. Cleveland Clinic currently has numerous technologies and policies that are unique to specific areas, most of which are in the process of being standardized. Faster standardization of PFCC requires independence from other standardization projects.
Implementation must be done via paper and the Internet, supported by onsite training, ongoing education, and role modeling. A nursing practice model needs to give guidance that will help nurses perform in a variety of roles, from direct caregiver to central coordinator of care to supporting team member in any of the multiple facilities. Nursing engagement has been linked to better patient outcomes. Development of the Nursing Practice Model Nurses across the system wanted to have their roles better defined and to be more empowered so as to deliver better care. This review included a gap analysis, benchmarking of nursing metrics, and interviews with nurses and nurse leaders. Nurses across the system wanted to have their roles better defined and to be more empowered so as to deliver better care. The first step in development of the model was the establishment of a steering committee that consisted of key stakeholders representing each hospital and service.
Inquiries were made of other hospitals and systems regarding their nursing practice models so as to enhance our knowledge base and establish a common understanding for further development of our model. Physician input was received from the Chair of Patient Safety, the Chair of Regional Quality, and the Chair of the Office of Patient Experience, among others. Staff participation included ten focus groups of nurses from across the system. Next the current nursing care delivery process was mapped out, including accepted definitions, expected competencies, practice environments, and levels of care. Figure 2 presents an example of a chart used to flowchart the care delivery process. The nursing and management literature was reviewed to determine the best theoretical framework for the nursing practice model. It was determined that existing nursing care models, even patient-centered ones, were too specific and task-oriented to adequately encompass the issues facing a complex health system.
Rather the model needed to reflect the concerns and needs of the nurse and the Institute as well as the patient. Practice of the Learning Organization, provided an understanding of the purpose of the model from a management viewpoint and explained how the model could be used to build a shared vision with staff nurses. The primary objective of a nursing practice model needs to be communicating a shared vision that helps nurses manage changes in their practice and maintain their patient focus. Senge: systems thinking, personal mastery, mental models, team learning, and building shared vision. The shared vision of the Cleveland Clinic nursing practice model was based on three concepts, namely serving leader, relationship-based care, and thinking in action.
Framework of Care’ for the model. This descriptor was used because these three attributes together support a patient- and family-centered care model. The three concepts are detailed below. Understanding the serving leader concept helps nurses guide patients in directing their own care.
Although almost every nurse acts as a leader in some manner, this role is often hard to understand in a patient-centered environment. The most important aspect of developing a practice model for nurses was clarifying and simplifying the role of individual caregivers. This required not only defining the relationship between patients, families, and other team members, but also identifying how the nurse should attempt to deliver care and support. Providing expert guidance in ongoing care delivery was another important requirement. The diverse care needs of the patient population at the Cleveland Clinic meant that the nursing practice model could act as no more than a general guide to care delivery.
The Framework of Care was a sound foundation for nursing practice but it did not cover all the things that nurses must know and do to be useful and grow in a rapidly changing environment. The first domain, Quality and Patient Safety, is at the forefront of the Cleveland Clinic’s care delivery. Nurses are the first line of defense in assuring patient safety. Clinic’s ongoing commitment to excellent outcomes, data transparency, and public reporting. Today we see a growing body of research that clearly demonstrates the benefits of a healing environment.
Research and evidence-based practice were combined into one domain as they are integrated and intertwined at the Cleveland Clinic. Additionally there are many opportunities for advanced education that will lead to improved patient care, career advancement, and personal satisfaction. Delivering on the promise of World Class Care’ to symbolize the goals of nursing at the Cleveland Clinic. Centering the Patients First guiding principle in the hand holding globe image was unanimously accepted as a starting point for the practice model imagery.