Date post: | 25-Dec-2015 |
Category: |
Documents |
Upload: | alberta-shepherd |
View: | 217 times |
Download: | 0 times |
1
U N
C H E A L T H
C A R E S Y S T E M
TRANSLATING CARING THEORY INTO PRACTICE:
The Carolina Care™ Model
Mary Tonges PhD, RN, NEA-BC, FAAN Chief Nursing Officer, UNC Hospitals
October 17, 2014
Virginia Organization of Nurse Leaders
2
U N
C H E A L T H
C A R E S Y S T E M
Across the Continuum to Ambulatory Care
Carolina Care TM
Tonges Translational Model
Swanson Caring Theory
TRANSLATING CARING THEORY INTO PRACTICE
3
U N
C H E A L T H
C A R E S Y S T E M
Across the Continuum to Ambulatory Care
Carolina Care TM
Tonges Translational Model
Swanson Caring Theory
TRANSLATING CARING THEORY INTO PRACTICE
4
U N
C H E A L T H
C A R E S Y S T E M
“Caring is a nurturing way of relating to a valued other to
whom one feels a personal sense of commitment and
responsibility.” K. Swanson, 1993
Swanson Caring Theory
Swanson, KM 1991, Empirical development of a middle range-theory of nursing, Nursing Research, 40(3) 161-6.
• Knowing
• Being With
• Doing For
• Enabling
• Maintaining Belief
5
U N
C H E A L T H
C A R E S Y S T E M
• avoiding assumptions
• assessing thoroughly
• seeking cues
• centering on the other
• engaging the self of both
• Knowing:
• Being With
• Doing For
• Enabling• Maintaining
Belief
striving to understand an event as it has meaning in the life of the other
Swanson Caring Theory
6
U N
C H E A L T H
C A R E S Y S T E M
• being there
• conveying availability
• enduring with
• sharing feelings
• not burdening
being emotionally present to the other
• Knowing
• Being With:
• Doing For
• Enabling• Maintaining
Belief
Swanson Caring Theory
7
U N
C H E A L T H
C A R E S Y S T E M
• performing competently/skillfully
• comforting
• anticipating
• protecting
• preserving dignity
doing for the other as they would do for their self if it were at all possible
• Knowing
• Being with
• Doing For:
• Enabling• Maintaining
Belief
Swanson Caring Theory
8
U N
C H E A L T H
C A R E S Y S T E M
• informing/explaining • validating/giving feedback• supporting/allowing• focusing • generating alternatives/
thinking it through
facilitating the other’s passage through life events and transitions
• Knowing
• Being with
• Doing For
• Enabling:• Maintaining
Belief
Swanson Caring Theory
9
U N
C H E A L T H
C A R E S Y S T E M sustaining faith in the other’s
capacity to get through an event or transition and face a future with meaning
• Knowing
• Being with
• Doing For
• Enabling
• Maintaining Belief:
• believing in/holding in esteem• offering a hope-filled attitude• ‘going the distance’• offering realistic optimism• helping find meaning
Swanson Caring Theory
10
U N
C H E A L T H
C A R E S Y S T E M
Across the Continuum to Ambulatory Care
Carolina Care TM
Swanson Caring Theory
Tonges Translational Model
TRANSLATING CARING THEORY INTO PRACTICE
11
U N
C H E A L T H
C A R E S Y S T E M
1. Theory
2. Innovation
3. Application
4. Testing
5. Dissemination
6. Evaluation
7. Sustainment
Tonges Translational Model for Theory-Driven Practice
12
U N
C H E A L T H
C A R E S Y S T E M
Dr. Kristen Swanson
1. Theory: Swanson Caring Theory (SCT)
Tonges Translational Model for Theory-Driven Practice
13
U N
C H E A L T H
C A R E S Y S T E M
2. Innovation: creating value through new ideas
Tonges Translational Model for Theory-Driven Practice
14
U N
C H E A L T H
C A R E S Y S T E M
3. Application: putting ideas to a specific purpose/use
Tonges Translational Model for Theory-Driven Practice
• Moment of Caring
• Multi-level Rounding
• Hourly Patient Rounds
• No Passing Zone
• Words and Ways That Work
• Blameless Apology
• Proposed Links between
Carolina Care and SCT
• Framing the Culture of
Carolina Care
15
U N
C H E A L T H
C A R E S Y S T E M
Across the Continuum to Ambulatory Care
Carolina Care TM
Swanson Caring Theory
Tonges Translational Model
TRANSLATING CARING THEORY INTO PRACTICE
17
U N
C H E A L T H
C A R E S Y S T E M
• Each patient each shift
• Nurse sits with patient
• 3-5 minutes of touch and
therapeutic listening
Moment of
Caring:
Knowing
and
Being With
Carolina Care TM
18
U N
C H E A L T H
C A R E S Y S T E M
Multi-level Rounding
Hourly Patient Rounding
Health Unit Coordinator
(HUC)
Director
Interdisciplinary
NurseManager
Carolina Care TM
19
U N
C H E A L T H
C A R E S Y S T E M
Hourly Patient Rounds
Are you comfortable?
Other side? (Does patient need to turn?)
Use the bathroom (Does patient need assistance?)
Need anything
Door/curtain open or closed for privacy
Safety (Call bell will reach and no tripping hazards)
R
O
U
N
D
S
Associated Swanson Caring
Theory Component: Being With and
Doing For
Carolina Care TM
20
U N
C H E A L T H
C A R E S Y S T E M
• Answer call light regardless of assignment
• “Road Signs” posted in hallways
No Passing
Zone:
Being With
and
Doing For
Carolina Care TM
21
U N
C H E A L T H
C A R E S Y S T E M
• Alternative to “scripting”
• Key points to cover in interactions
Words
and
Ways
that Work:
Being With
and
Enabling
Carolina Care TM
22
U N
C H E A L T H
C A R E S Y S T E M
• Listen to patient
• Apologize without placing blame
• Take action to address problem
• Follow-up with patient
Blameless
Apology:
Being With
and
Enabling
Carolina Care TM
23
U N
C H E A L T H
C A R E S Y S T E M
Proposed Links Between Carolina Care and SCT
Carolina Care TM
25
U N
C H E A L T H
C A R E S Y S T E M
Tonges Translational Model for Theory-Driven Practice
making a preliminary evaluation before embarking on a course of action
Model Units
• Medicine Service
• Surgery Service
4. Testing:
26
U N
C H E A L T H
C A R E S Y S T E M
Model Units: Medicine
& Surgery Service
•Less than 20 beds
• Combination of
private/semi-private
rooms
CNO chaired Carolina
Care Steering
Committee to provide
high level direction,
integration and
support
Voice of the Patient
Rapid Cycle
Improvement:
Design & Implement
Nursing &
Interdepartmental
Unit-Based Teams
Data Driven Action
Plans/Performance
Tracking
4. Testing: Preliminary Evaluation
27
U N
C H E A L T H
C A R E S Y S T E M
BaselineN=34
Q1 2009N=49
4/3N=38
4/17N=47
5/1N=55
5/15N=59
5/29N=65
0102030405060708090
100
Courtesy of person served food
Courtesy of person cleaning room
Accommodations and comfort visitors
Staff include decisions re:trtmnt
Perc
entil
e
Data Driven Action Plan Areas
Discharge Week
Implementation of Carolina Care
TM
4. Testing: Model Unit Results
28
U N
C H E A L T H
C A R E S Y S T E M
BaselineN=34
Q1 2009N=49
4/3N=38
4/17N=47
5/1N=55
5/15N=59
5/29N=65
0
20
40
60
80
100
120
Promptness response to call
Staff addressed emotional needs
Response concerns/complaints
Discharge Week
Implementation of Carolina Care
TM
4. Testing: Model Unit Results
29
U N
C H E A L T H
C A R E S Y S T E M
Tonges Translational Model for Theory-Driven Practice
spreading information and/or practices
• Carolina Care Guidebook
• Pre-Work Unit Assessment
• Pre-Work Teams
• Roll Out
• Recognition for
Outstanding Performance
5. Dissemination:
30
U N
C H E A L T H
C A R E S Y S T E M
5. Dissemination: Carolina Care Guidebook
– CNO charge
– Lessons learned from Model Units
– Defined key staff roles and responsibilities
– Pre-Work
– Implementation sequence
– Defined Carolina CareTM
Interventions
• Moment of Caring
• Hourly Rounds
• No Passing Zone
• Words and Ways that Work
• Blameless Apology (Service Recovery)
‒ Discharge calls
31
U N
C H E A L T H
C A R E S Y S T E M
Patient satisfaction interviewPart I
Self assessmentPart II
Call bell activityPart IV
Environmental assessment Part V
Part III
5. Dissemination: Pre-Work Unit Assessment
Analyze one year of unit performance on Press Ganey data
32
U N
C H E A L T H
C A R E S Y S T E M
5. Dissemination: Pre-Work Teams
Carolina CareTM Implementation Oversight Committee
• CNO
• Nursing Directors
• Nurse Managers
• Director, Environmental
Services
• Director, Food and Nutrition
• Data Analyst
Nursing Teams
• Nurses• Nursing
Assistants• Health Unit
Coordinators
Interdepart-mental Teams
• Nurses• Housekeeping
• Nutrition & Food Service• Plant Engineering
• Other Support Services
Action Plans
• Assign process owners
accountability for specific
items• Team approves
action plan
Unit Implementation Led by Nurse
Mangers
• Nurse Manager held
accountable for improving
inpatient satisfaction at the unit level
33
U N
C H E A L T H
C A R E S Y S T E M
5. Dissemination: Roll Out
Simultaneousroll out on all
acute care units
8 Week Implementation Sequence
• Monday morning Nurse Managers’ meeting
• Weekly focus areas• Rounding• Words & Ways that Work
• Bi-weekly nursing & Interdepartmental team meetings• Building Action Plans• Tracking performance measures• Discharge calls
• Daily huddles• Bright ideas• Implementation Oversight Committee
34
U N
C H E A L T H
C A R E S Y S T E M
5. Dissemination:Recognizing Outstanding Performance
“Carolina CareTM Dollars”
Unit recognition for Press Ganey goals achievement
Unit Celebrations
35
U N
C H E A L T H
C A R E S Y S T E M
Tonges Translational Model for Theory-Driven Practice
6. Evaluation: ascertaining value or worth
• Press Ganey Scores
• HCAHPS Scores
• Effect on Pressure Ulcer Prevalence
36
U N
C H E A L T H
C A R E S Y S T E M
6. Evaluation: Results - Annual Mean PG ScoresOverall Inpatient Satisfaction and Satisfaction with Nursing
2004 2005 2006 2007 2008 2009 2010 2011 2012 201378
80
82
84
86
88
90
92
94
Overall Nursing
Carolina CareTM implemented in July
37
U N
C H E A L T H
C A R E S Y S T E M
6. Evaluation: Results - Mean PG ScoresConcern with Privacy, Meeting Emotional Needs and Attention to
Special/Personal Needs
2004 2005 2006 2007 2008 2009 2010 2011 2012 201374
76
78
80
82
84
86
88
90
92
Concern for privacy Meeting emotional needsAttention to special/ personal needs
Carolina CareTM implemented in July
38
U N
C H E A L T H
C A R E S Y S T E M
6. Evaluation: Results - Annual Mean PG ScoresSatisfaction with Pain Control and Prompt Response to Call
2004 2005 2006 2007 2008 2009 2010 2011 2012 201381
82
83
84
85
86
87
88
89
90
91
Pain controlled Promptness response to call
Carolina CareTM implemented in July
39
U N
C H E A L T H
C A R E S Y S T E M
6. Evaluation:Results - HCAHPS Scores
March, 2011 – March, 2012#1 Communication about Medications
#2 Discharge Information
40
U N
C H E A L T H
C A R E S Y S T E M
5/2/20
13
12/11/2
012
5/29/2
012
11/15/2
011
5/24/2
011
12/7/201
0
5/25/2
010
12/10
/2009
5/19/20
09
12/2/
2008
6/26/20
08
11/13
/2007
0.09
0.08
0.07
0.06
0.05
0.04
0.03
0.02
0.01
0.00
Rat
e
_U=0.0306
UCL=0.0530
LCL=0.0081
Carolina CareDecubiti Prevention Initiative
Tests performed with unequal sample sizes
Prevelance Survey: Presseure Ulcers/100 Patients (All Stages)
Project: CONTROL CHARTS.MPJ; Worksheet: Skin8_May2013
6. Evaluation:Effect on Pressure Ulcer Prevalence
41
U N
C H E A L T H
C A R E S Y S T E M
7. Sustainment:
Tonges Translational Model for Theory-Driven Practice
keeping in existence, maintaining
• Sustainment Efforts
• HCAHPS Scores
42
U N
C H E A L T H
C A R E S Y S T E M
7. Sustainment: Efforts
Expansion
• Outpati
ent
• Carolin
a Care
at
Home
Infrastructure• Commi
tment
to
Caring
Steerin
g
Commi
ttee
• Big 5 &
Big 6
• Service
Frame
work
New Interventions
• Semi-Private Rooms
• Family Meals
• VP Partners
• Happy Healing Days
• Heart of Carolina Care
44
U N
C H E A L T H
C A R E S Y S T E M
Inpatient
7. Sustainment: Infrastructure
Change Management ResourcesD. Kaye, S. Herman,
L. Mandelkher, G. Spivak
Patient ExperienceSteering Committee
Co-ChairsK. McCallW. Rotella
FocusTeam
InpatientExperience Team
Employee Outpatient
Engagement Communication
Co-ChairsD. OlmosT. Garner
ExecutiveSponsors
C. DonohueW. Rotella
Co-ChairsD. BassW. Arey
ExecutiveSponsor
J. Hirneisen
Admitting
Room
Meals
Nursing
Tests – Txs
Visitors&Families
Discharge
PersonalIssues
Co-ChairsL. DanielsL. Kapps
ExecutiveSponsor
M. Tonges
JJ. CampbellJ Strickler
L. Osborne
A. Mojica
J. Ray
C. RegeT. Smiley
M. McCannL. Muss
M. BossertR. Daniels
S. RogersS. Crenshaw
K. Mc Call
J Pomerantz
J. Hadar
D. Lehman
D. Lehman
M. Tonges
M. Rifkin
K. McCall
Co-ChairD. Bauer
ExecutiveSponsors
D. SpencerR. Lafrenaye
48
U N
C H E A L T H
C A R E S Y S T E M
Jul-1
3
Aug-1
3
Sep-1
3
Oct-
13
Nov-1
3
Dec-1
3
Jan-
14
Feb-1
4
Mar
-14
Apr-1
4
May
-14
Jun-
14
FYTD0
10
20
30
40
50
60
70
80
90
100
78.5 80.4 79.2 72.7 83.6 74.3 76.6 77.9 78.0 74.4 76.3 82.1 77.6
8793
89
60
98
69
8185 86
70
80
96
Percentage FYTD Percentage Percentile
7. Sustainment:HCAHPS – Rate The Hospital Highly
FYTD Percentage – 77.6 (84th Percentile)
49
U N
C H E A L T H
C A R E S Y S T E M
Jul-1
3
Aug-1
3
Sep-1
3
Oct-
13
Nov-1
3
Dec-1
3
Jan-
14
Feb-1
4
Mar
-14
Apr-1
4
May
-14
Jun-
14
FYTD0
10
20
30
40
50
60
70
80
90
100
81.8 84.5 86.7 81.4 91.2 78.8 84.2 80.8 80.3 82.0 80.3 87.1 83.0
8593 97
84
99
75
92
82 8186
81
97
Percentage FYTD Percentage Percentile
7. Sustainment: HCAHPS – Recommend Hospital
FYTD Percentage – 83.0 (89th Percentile)
50
U N
C H E A L T H
C A R E S Y S T E M
Jul-1
3
Aug-1
3
Sep-1
3
Oct-
13
Nov-1
3
Dec-1
3
Jan-
14
Feb-1
4
Mar
-14
Apr-1
4
May
-14
Jun-
14
FYTD0
10
20
30
40
50
60
70
80
90
100
81.6 82.0 81.2 74.4 83.0 81.1 81.5 78.9 79.5 81.2 80.3 84.8 80.8
75 7972
17
8671 74
4955
7263
95
Percentage FYTD Percentage Percentile
7. Sustainment: HCAHPS – Communication w/ Nurses
FYTD Percentage – 80.8 (69th Percentile)
51
U N
C H E A L T H
C A R E S Y S T E M
7. Sustainment:Press Ganey – Inpatient Overall
FYTD Mean Score – 87.7 (79th Percentile)
Jul-1
3
Aug-1
3
Sep-1
3
Oct-
13
Nov-1
3
Dec-1
3
Jan-
14
Feb-1
4
Mar
-14
Apr-1
4
May
-14
Jun-
14
FYTD0
10
20
30
40
50
60
70
80
90
100
87.7 87.8 88.3 87.0 87.9 87.5 88.3 87.9 87.8 86.1 87.9 87.8 87.7
77 79 84
60
7973
8480 79
45
82 78
Mean FYTD MeanPercentile Goal Mean Target (88.0)
88.0
52
U N
C H E A L T H
C A R E S Y S T E M
Jul-1
3
Aug-1
3
Sep-1
3
Oct-
13
Nov-1
3
Dec-1
3
Jan-
14
Feb-1
4
Mar
-14
Apr-1
4
May
-14
Jun-
14
FYTD0
10
20
30
40
50
60
70
80
90
100
85.2 84.7 85.7 84.1 84.2 83.1 84.4 85.3 84.4 85.0 85.2 85.3 84.8
98 96 9995 95
84
95 98 95 97 98 98
Mean FYTD MeanPercentile Goal Mean Target (84.5)
84.5
7. Sustainment: Press Ganey – Meals
FYTD Mean Score – 84.8 (96th Percentile)