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 Family- Centered 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.

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. Patient- and Family- Centered Care Core Concepts 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. VHA Experience of Care Goals

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