Transcript Who is the Expert?

Patient Centered Care
Course - Part One
Ria Spée, RN, MSc. GNC(C),APN
Sunnybrook Veterans Centre
Leasa Knechtel, RN, MN CNCC(C), APN
Critical Care & Cardiovascular ICU
Participants’ Objectives
• Will distinguish between the concepts of
patient-centred care and provider-driven
care
• Will demonstrate effective therapeutic
communication with patients and identify
blocks to communication
• Will appreciate the harm of labeling and
controlling patients
• Will demonstrate patient-centred
documentation that give voice to the
patient in interdisciplinary discussions
To everything there is a
season and a time for…
• Reflecting on how we
have come to know
what we know
• Questioning our
assumptions, values,
and beliefs
• Imagining and
exploring alternatives
Brookfield (1987)
Principles of Sharing & Reflecting
• We acknowledge one another as equals
• We try to stay curious about each other
• We recognize that we need each other’s
help to become better listeners
• We show down so we have time to think
and reflect
• We expect it to be messy at times
• We need courage, faith, and time to
practice
Wheatley, 2002
Overview of the Day
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Settling in & Introductions
Discussion of expert followed by video
30 min. break at 1000
Share dialogues & work though video
45 min. lunch at 1200
Blocks to communication & video
15 min. break at 1415
Discussion of risk & choice
Wrap up
Who is the expert?
What is the health
What is the patient’s professional’s expertise?
expertise?
What patients really want:
• Really listen
• Ask me what I think
• Don’t dismiss my
concerns
• Don’t treat me like a
disease
• Talk to me, not at me
• Respect my privacy
• Don’t keep me waiting
• Don’t tell me what to do
without telling me how to
do it
• Keep me informed
• Remember who I used to
be
• Let me know you care
Messner, R .L. (1993)
A better way: 10 things Health
Professional can do…
1. Consider the
Uniqueness of
Individuals
2. Truly listen
3. Recognize
patients/families’
expertise of their
lives
4. Respect patient/ family’s
right to participate in
decisions
5. Support decisions people
make
6. Individuals judge their
own thoughts, feelings,
opinions, wishes
Parse et al (1999)
…to move to a more personal and
meaningful System
7. Provide information that is
relevant, meaningful to and
wanted by individual/family.
8. Encourage people to keep
their own health records
9. Invite people to give their
opinions about their care
10. Encourage advocacy of
their care for themselves
and others
Parse, et al.(1999)
Comparing Paradigms
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Provider-driven
Provider as expert
Teaching and telling
Rules and routines
Assessment and
compliance
Professionals define
quality
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Patient-centred
Patient as expert
Listening and exploring
Challenge status quo
Understanding human
experience
Quality is informed
through patient
feedback
Bournes et al. (1997)
Sharing First Dialogues
Initiating Dialogue…
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How are things going with you?
How was your night/day?
What are your concerns at this time?
What concerns do you have about…?
How would you like your day to go?
What would you like to see happen?
How do you like things done?
What is most important to you?
What is life like for you?
Seeking Depth & Clarity
• Tell me more about that.
• What is that like for you?
• What does that mean for you?
• What is it like for you to live with ...?
• What do you see yourself doing?
• What can you do to get help?
• Would you like to discuss options?
Seeking Depth & Clarity
• What one thing would help right now?
• What one thing can you do for yourself right
now?
• What would it be like if…
• What might help you go on?
• What would you like to see happen?
• How could it have been different?
• What are your plans in relation to ...?
• What do you hope happens?
• How was that helpful?
Who is leading?
Therapeutic Communication
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Acknowledge
Listen more, say less
Clarify
Ask open-ended
questions
• Use positive body
language
• Use silence wisely
Blocks to Communication
• Changing the
subject
• Giving Advise
• Incongruence
• Assumptions
• Invalidation
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Overloading
Under loading
Social response
Value judgments
Smith et al. (2004)
Blocks to Communication
1. Reassurance
2. Telling
3. Premature offering of services
4. Validating
5. Fixing
6. Giving answers
7. Acting on your need to “do” something
Beitel, J. (1998)
When Patients
lead:
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Listening
Exploring
Discovery
Openness
Bearing witness
When
Professional
leads:
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Telling
Explaining
Defending
Validating
Fixing
Whose Choice Is It?
Whose Choice Is It?
A dilemma called
Ellen
What risks have you
taken in your
practice?
• What price did you
pay for it?
• What made it worth
it?
The Dignity of Risk
& The Right to
Failure
• Did someone ever
tell you what to do?
• What was that like
for you?
Your Values are showing...
Provider Driven versus Patient Centre
Language
• Manipulative versus Self-determination
• Non-compliant versus Dignity of risk
• Uncooperative versus Respecting choices
• Unrealistic versus the Person’s perspective
• Dysfunctional versus Uniqueness/Wholeness
Jeopardy
Wrap - up!
• Topic highlights by table
• Hand-ins
– Evaluations
– Reflective question sheets
– First dialogue
• Handouts
- Day 2 Package
• 2 & #3 Dialogues due
Feb. 12th in KGE39 or
D404a
References
Beitel, J. (1999). Illuminations File Newsletter of International
Consortium of Parse Scholars, 7(3), 3-5.
Bournes, D. , Mitchell, G. J., Beitel, J., Das Gupta, T., Fleming, J.,
Hollett, J. Linscott, J. McGrath, P., & Spee, R. (1997). Sailing
beyond the boundaries, (p.5), Sunnybrook Health Sciences
Centre, Toronto.
Davies, C. (1991). A dilemma called Ellen, The Canadian Nurse,
23-24.
Messner, R .L. (1993). What patients really want from their nurses.
American Journal of Nursing, (8), 38-41.
Mitchell, G. J. (1994). The dignity of risk and the right to failure:
One profile of patient-focused care. Perspectives: The
Canadian Journal of Gerontological Nursing, 18(3), 10.
Parse, R.R., Bournes, D., Barrett, E., Malinski, V., & Philips, J. (1999).
A Better Way: 10 things health professionals can do to move to
a more personal and meaningful system. On Call, 2(8), 14-17.
Smith, S. F., Duell, D. J., & Martin, B. C. (2004). Cinical Nursing Skills:
Basic to Advanced Skills, 6th edition, (pg. 69-70), Pearson/
Prentice Hall: Upper Saddle River, N.J.