Disclosure. Personal Disclosure. APNA 28th Annual Conference Session 3027: October 24, Davis 1

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1 Lisa Davis BSN, MEd, RN-BC Nurse Manager, General Psychiatry Virginia Commonwealth University Health System Disclosure This presenter has no conflicts of interest, commercial support, or off-label use to disclose. Personal Disclosure Today is my 16 th wedding anniversary which I will celebrate when I get home. I am probably more nervous now than I was 16 years ago! Davis 1

2 A wakeup call and sign I needed help in my new role as a manager: 6:30pm: Honey, we have no water Objectives Identify key components and theoretical origins of Relationship Based Care (RBC) Identify how the use of RBC supports positive patient outcomes Identify how the use of RBC can help a leadership team keep focused during turbulent times while also meeting key performance indicator goals What is Relationship Based Care Evidence Based Care Delivery System Primary Nursing Matured Blended Theoretical Approach Watson s Human Caring Theory Kristen Swanson s Caring Theory Madeline Leininger s Cultural Care Diversity and Universality Relationship-Based Care: A model for transforming practices. M.Koloroutis Editor; Creative Health Care Management (2004) Davis 2

3 Adaptation of RBC at the VCUHS Watson s Human Caring Theory: o Help those who follow in our footsteps o Lend Knowledge o Teach skills and values through role modeling and mentorship o Form caring, healing relationships with patients, their community, each other and ourselves Adaptation of RBC at the VCUHS Leininger s theory of Cultural Care Diversity and Universality o Care is culturally sensitive and competent Adaptation of RBC at the VCUHS Swanson s Theory of Care focusing on the 5 dimensions of: o Knowing: striving to understand o Being emotionally present to others o Doing for the other what he/she can not do o Enabling is explaining, supporting, thinking, giving o Believing in people, positive attitude, realistic optimism Davis 3

4 Three Key Relationships at the VCUHS Relationship with the patient and family Relationship with the team Relationship with self Description of N4, General Psychiatry 20 beds, male hall and female hall. 4 male and 4 female private rooms, rest are semiprivate Acute Care One of 2 adult psychiatric inpatient units Academic urban teaching hospital with over 700 beds Not for profit Magnet Hospital Majority of our patients are indigent ALOS 5-6 days North 4 Staff Combination of RN s, care partners, patient safety assistants and behavioral specialists Very experienced; majority have at least 10 years of working with the mentally ill Passionate and extremely committed to our patient population serving as advocates within the VCUHS and the community Sandwich generation: Launching children or becoming grandparents while caring for their own parents Davis 4

5 Overarching Care Principles Trauma Informed Care Moving into Recovery Oriented Care Motto: What s best for this patient, in this moment, in this milieu! Using RBC to Manage a difficult situation Completed suicide of two young adult male patients following discharge o Patient/Family Calls to family Attended Funeral Sent a handmade quilt at the holidays with a note o Team Offered support in the moment and support groups afterwards M&M EAP Open door, invited dialog o Self Sought outside support of clergy Prayed on beach and got in the moment celebrating my son and family Note to family Second Situation Unexpected death and near death of staff members children Patient/Family o Assured appropriate staffing o Monitored for countertransference Team o Supported the primary team member with time off, attended services or went to hospital o EAP o Provided access to care o Monitored and intervened when other staff members were affected through support and inviting dialog Self o Provided care for the staff member o Practiced own self care o Stayed in moment with own family (children demand this, thank goodness!) Davis 5

6 Third situation (No one dies!) Launching the care of mentally ill patients in our ED by psychiatric nurses Patient/Family o Environment of Care o Care model o Patient flow o Assure medical clearance Team o Frequent communication inviting dialog o Competencies o Relationship building with ED staff o Hiring and team building Self Primary focus: cleaned office, completed staff evaluations and other management tasks Seeking expertise and support from those that have come before me Mr. Toad s Wild Ride: Enjoy the Adventure Planned vacations, Jimmy Buffet music Patient Outcome Restraint Data: 2012: : : Jan to June - 10 Team Outcomes Low RN Turnover for the last 2 years o Three retirements: 2 stayed at reduced hours o Two transferred within VCUHS to APN roles o One outside of the system but stayed prn o One termination secondary to educational requirements NDNQI RN Satisfaction Survey - Job Enjoyment Rating o Above the AMC comparison mean 2011, 2012 and 2013 climbing each year NDNQI RN Satisfaction Survey Opportunities o Foundations of quality care o Nurse Manager o RN/MD Relationships On Budget Davis 6

7 Personal Outcomes Still happily married Water has not been cut off Opportunities: o Weight o Exercise o Knowledge and Experience Questions and Discussion Final Thoughts: RBC is a way for leaders to. Conceptualize Care Prioritize Actions Self Reflect Find meaning and direction in turbulent/chaotic times Davis 7

8 Contact Information Lisa S. Davis Many Thanks! Davis 8