Transforming care practices: Re-imagining the nurse s role in long-term care

Transcription

1 Transforming care practices: Re-imagining the nurse s role in long-term care Kathryn L. Anderson Providence Mount St. Vincent

2 Providence Mount St. Vincent LTC, Medicare, AL, ADH, ILC Traditional design & construction LTC remodel in mid- 90s and adoption of resident-directed care philosophy Focus on relationships & knowing the person

3 Nursing & culture change What does professional nursing practice look like? How does professional nursing practice relate to culture change? Why can it be hard for nurses to embrace culture change? [How] can we get there from here? (Marilyn will answer.)

4 Acknowledgements Work of Charlotte Eliopoulous Pew Foundation and Hartford Institute/ Pioneer Network expert panel Other colleagues: Chris Mueller, Elena Siegel, Mary Ellen Dellefield Other presenters at today s workshop

5 Professional nursing practice: It s holistic Dorn, K. (2004.). Caring-healing inquiry for holistic nursing practice: Model for research and evidence-based practice. Topics in Advanced Practice Nursing ejournal, 4(4).

6 Culture change principles Person/resident-directed Values are autonomy, choice, dignity Balance of quality of life and length of life

7 Culture change & nursing: common goals & values Concerned with care of the whole person Importance of and interaction with the environment High value placed on resident selfdetermination Return to nursing origins: providing nursing care in the person s own home

8 How can home health nursing provide a guide for LTC? This is the resident s home, so resident is in charge chooses which interventions s/he wants chooses time and conditions for interventions can change her/his mind fully empowered to make decisions about own care

9 How can home health nursing provide a guide for LTC? Nurse is visitor (though stays longer than a home health nurse) respects privacy wears street clothes most important role is education for informed selfcare respectful of right to make bad choices

10 Goals of nursing care in culture change Success is measured in terms of whether resident goals for care and quality of life are met.

11 Why is this type of nursing so challenging for nurses in LTC? Confidence in and comfort of routines Industry and leadership emphasis on regulatory compliance Lack of preparation for noninstitutional roles at LPN and ADN education levels

12 Why is this type of nursing so challenging for nurses in LTC? Nursing education often emphasizes technical proficiency nursing process for clinical outcomes of interest to us importance of compliance or adherence to prescribed regimens

13 Why is this type of nursing so challenging for nurses in LTC? Leadership view of nursing View nursing as a set of tasks, rather than knowledge work; nurses aren t skilled at explaining their work unaware of content of nursing education programs without guidance from nurses, should not be expected to understand why nurses struggle with culture change

14 What can we do? How can we help nurses expand their view of what is possible? re-balance time and effort focusing on physical, psychosocial, spiritual health? work in partnership with residents to identify and meet goals?

15 Transforming care practices: Re-imagining the nurse s role Kathryn L. Anderson, Ph.D., R.N. Director of Clinical Services Providence Mount St. Vincent th Ave. S.W. Seattle, WA TEL: FAX: Kathryn.L.Anderson@providence.org

16 REFERENCES Transforming care practices: Re-imagining the nurse s role in long-term care Dorn, K. (2005). Caring-healing inquiry for holistic nursing practice: Model for research and evidence-based practice. Topics in Advanced Practice Nursing ejournal, 4(4). Edvardsson, D. (2008). Therapeutic environments for older adults: Constituents and meanings. Journal of Gerontological Nursing, 34(6), Eliopoulos, C. (2008). Culture change nurse coordinator manual. Cincinnati, OH: Health Education Network. Flesner, M.K., and Rantz, M.J. (2004). Mutual empowerment and respect. Journal of Nursing Care Quality, 19, Jeong, S.Y, and Keatinge, D. (2004). Innovative leadership and management in a nursing home. Journal of Nursing Management, 12, Kim, H., Kovner, C., Harrington, C., Greene, W., and Mezey, M. (2009). A panel data analysis of the relationships of nursing home staffing levels and standards to regulatory deficiencies. Journal of Gerontology: Social Sciences 64B(2), Lincoln, V., and Johnson, M. (2009). Staff nurse perceptions of a healing environment. Holistic Nursing Practice, 23, Murphy, K. (2007). Nurses perceptions of quality and the factors that affect quality care for older people living in long-term care settings in Ireland. Journal of Clinical Nursing, 16, Nightingale, F. (1859). Notes on Nursing: What it is and what it is not (Dover ed. 1969). New York: Dover Publications. Scalzi, C.C., Evans, L.K., Barstow, A., and Hostvedt, K. (2006). Barriers and enablers to changing organizational culture in nursing homes. Nursing Administration, 21, Schnelle, J.F., Simmons, S.F., Harrington, C, Cadogan, M., Garcia, E., and Bates-Jensen, B. (2004). Relationship of nursing home staffing to quality of care. Health Services Research, 39, Scott-Cawiezell, J., Pepper, G.A., Madsen, R.W., Petroski, G., Vogelsmeier, A., and Zellmer, D. (2007). Nursing home error and level of staff credentials. Clinical Nursing Research, 16, Spence, D., and Smythe, E. (2008). Feeling like a nurse: Re-calling the spirit of nursing. Journal of Holistic Nursing, 26,