The elderly patient was in a quandary, and he turned to his nurse for help.
"His family strongly desired to help care for him while he was in the hospital, to take over some of his basic care like his bed bath," says Maria Brennan, MSN, RN, CPHQ, Chief Nursing Officer, St. Joseph's Healthcare System (SJHS) and Vice President, Patient Care Services, St. Joseph's Regional Medical Center (SJRMC). But the patient wanted the nursing staff to do it instead.
"It was a matter of his dignity," Brennan says. "He was embarrassed in front of his family. He also wanted to be fresh when they arrived, rather than have them help him get ready."
The nurse explained the situation to the family, and, with discussion, they understood. It was a family issue averted and another success for relationship-based care, an innovative care delivery model at St. Joseph's that enhances the current high standard of care by emphasizing the importance of caring and collaboration to address the unique needs of each patient.
Redefining Nursing Care
Founded nearly 150 years ago, St. Joseph's has a long tradition of nursing excellence, with three consecutive Magnet® awards for outstanding nursing care.
Still, Brennan, who joined the organization eight years ago, decided she wanted to take the nursing department in a new direction. "I'm a true believer in Total Quality Management," she says. "I believe you can always get better, no matter how good you are."
After extensive research, she and other members of the system's nursing team have redefined nursing at St. Joseph's by basing its nursing practice on Jean Watson's Theory of Human Caring, incorporating relationship-based care, and using evidence-based models such as Transforming Care at the Bedside (TCAB), the IOWA model for Performance Improvement and Research design.
Jean Watson's Theory of Human Caring, focuses on the nurse's interactions with the patient and the family and on how he or she prepares to work. The Relationship-based Care model, developed by Marie Manthey, allows for and encourages a team approach that is based on active collaboration among nursing staff and all healthcare providers, such as housekeeping employees and food service employees to promote the caring and healing environment described by Watson.
While Watson defines the relationship between nurse and patient, Manthey defines the relationship among the healthcare team members. Both theories emphasize care for self, care for each other and care for patients and families – that is, Brennan explains, "the ability to do one's best and give one's best to the patient and family, without allowing personal problems or issues to intrude." Both are strongly embraced by employees within St. Joseph's Healthcare System.
"We feel that Jean Watson's Theory of Human Caring and relationship-based care are a perfect fit for St. Joseph's because they support our mission, vision and values," Brennan says. Sponsored by the Sisters of Charity of Saint Elizabeth, St. Joseph's mission is to provide "quality healthcare in northern New Jersey, with a special concern for the poor and underserved." There is a strong commitment to a "patients first" approach to caring for the whole person, body, mind and spirit.
The models have been integrated as the care delivery system on all units at St. Joseph's Regional Medical Center and St. Joseph's Wayne Hospital as well as in peri-operative services. Each unit rollout involved extensive staff education on how to apply the principles at the bedside and benefits from lessons learned on other units. The model is modified from unit to unit to take into account different patient populations with different needs. The initiative extends beyond nursing; relationship-based care has also been introduced in the respiratory therapy, pharmacy and radiology departments.
"We soon saw closer relationships and improved communication among staff and, in turn, with patients and their families," Brennan says. These changes have led to a better understanding of patients' needs and better care. "Our nurses take pride, not only in their relationships with each other, but also in the collaborative relationships amongst all other disciplines within the Healthcare System family," adds Brennan.
Theory in Action
Nurses and other staff members now make a concerted effort to really understand their patients and what was important to them prior to their hospitalization, as opposed to just meeting them on admission and focusing solely on their current issues.
As a case in point, Brennan recalls an elderly patient on the infectious disease unit. "He was confused," she says, "and his daughter, who was a nurse, attributed it to the pain medication her father was taking. But he had only two doses, and his primary nurse felt that was not enough to cause so much confusion."
The primary nurse sought out her nurse manager, and together they spoke with the patient. What they learned changed the course of his hospital stay. He was a pack-a-day smoker, and it was the nicotine withdrawal that was causing his confusion. The remedy: a nicotine patch. The patient's confusion lifted, and he was able to progress in his recovery, participate in physical therapy and eventually go home.
"This is nursing care at its greatest," adds Brennan.