College of Science, Health & Engineering

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1 How to Title include of presentation the patient ideas but still deliver best practice Name of with presenter wound care? Assoc Prof Title Bill of McGuiness presenter PhD, RN, FAWMA Head of School School / Faculty / Division School of xx Nursing Month & 201x Midwifery College of Science, Health & Engineering w.mcguiness@latrobe.edu.au latrobe.edu.au CRICOS Provider 00115M

2 Outline Patient centered care Evidenced based practice Interfacing both models of care La Trobe University 2

3 Evidenced based practice (EBP) the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research. (Sackett D, 1996) La Trobe University 3

4 EBP elements Population based Normal distribution Science of practice Plan health care resources Quality & resources Ranking of rigor Levels of evidence Strength of evidence La Trobe University 4

5 The rise of the clinical guideline La Trobe University 5

6 An attempt to implement EBP La Trobe University 6

7 Criticism of EBP Stereotyping Cook book care Promotes a hierarchy of care La Trobe University 7

8 Patient centered care (PCC) Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions (Institute on Medicine. "Crossing the Quality Chasm: A New Health System for the 21st Century 2011) Cultural competence is the delivery of health services that acknowledges and understands cultural diversity in the clinical setting and respects individuals' health beliefs, values, and behaviors. (HasnainWynia Romana 2006) La Trobe University 8

9 Aspects of PCC Art of practice Caring Individual based Collaboration & respect Clinician experience, attitude and creativity La Trobe University 9

10 Criticism of PCC Tokenism Hospital hotel Focus on e health Can t be resourced La Trobe University 10

11 How do we combine the principles of evidence based care with patient centered care

12 Start with yourself Who owns the health concern How do I respond when the patient rejects my advice What are my personal biases or prejudices How creative am I

13 Establish a collaborative relationship with the patient What does the patient want What is the patients motivation How is the patient getting their information & support What resources does the patient have available

14 Where is the best location for the care?

15 An example Centre of care Referral time: 6 wks Travel time: 90 mins Wait time: 35 mins Consult time: 10 mins Referral time: 4 weeks Travel time: 30 mins Wait time: 30 mins Consult time: 20 mins Referral time: 2 wks Travel time: 30 mins Wait time: 20 mins Consult time: 20 mins Travel time: 20 mins Wait time: 15 mins Consult time: 10 mins

16 E technology options Response time: 3 hours Travel time: 0 mins Wait time: 0 mins Consult time: 10 mins 3D printing time: 3 hrs Travel time: 0 mins Wait time: 2 days Consult time: 0 mins Referral time: 0 wks Travel time: 0 mins Wait time: 0 mins Consult time: 0 mins Response time: 2 hrs E Consult time: 30 mins EWMA/AWMA position paper Dear Dr I have a saw leg

17 Alternative care locations La Trobe University 17

18 Culture of the care setting

19 Clinician attitude Waste of my time seeing another obvious venous ulcer You did what with the bandage Please sit still Ethel so I get the best image I can t get rid of her. She just wants to talk

20 Maggie 81 year old Uncontrolled Type 11 diabetic Rheumatoid arthritis Lost 20 kg in the last 12 mths Confused sometimes Attitude La Trobe University 20

21 Pharmacist Not sure why involved Rheumatologist Increase steroids Community nursing Needs a carer not a nurse Endocrinologist Decrease steroids Podiatrist Feet good nothing further Wish they would all bugger off and let me go to the pub! Diabetes educator Don t know how often she needs to be told Social services Admit to supportive care Dietician Increase protein & Calories Wound Specialist Determine aetiology Decrease steroids Treat the wound infection La Trobe University 21

22 Managing Wounds as a Team 2014 La Trobe University 22

23 The team La Trobe University 23

24 Decision making (Modified from Dorahy & Hamilton 2009) La Trobe University 24

25 Setting the expectations

26 Consider informal care contracts What the health care agency will provide What the patient will provide Expected outcomes Time lines

27 My clinic Ethel contract Outcome The stinking leg ulcer will heal and be out of my life, Dear Me The Patient I will make every effort to replicate Jenifer Hawking's legs by: Reduce the fluid in your leg Prevent infection of your leg ulcer Minimize the pain Help stop the leak and the stink Care location Timeframe No longer than 12 weeks to heal Review Monthly I will make every effort to Keep my leg dry Wear the support bandages Let Bill know if I am concerned Be cheerful and humorous Home weekly and clinic monthly, unless I need to see Bill for entertainment Penalty for non performance One Fredo frog (flavor determined by the complainant if complaint upheld)

28 Achieving the outcomes collaboratively

29 Involve the patients in monitoring Phone photos Compare with other patients Leg club Social media Diaries Pain Food Teach other patients

30 Provide feedback as motivation Healer

31 Be flexible Open to new ideas Learn from other clinicians Alternative service options Let peer support resolve some problems Coach more than a clinician

32 Some warnings You are a registered health professional Bound by code of ethics Governed by criminal, common and statute law Patient center approach should only involved Approved devices or products Systems that maintains the personal safety of the clinician Are legal Comply with your personal and professional ethics La Trobe University 32

33 So how do we involve the patient in and EBP environment? Your knowledge of the evidence and experience Patient expectations & motivation Legal Professional and Ethical Framework Creative re-engineering of care

34 Passionate & Persistent & Creative World peace & global warming

35 Thank you latrobe.edu.au CRICOS Provider 00115M