system change to promote holistic care

  1. As we nurses know,patients must be treated holistically in order to truly heal.As a psychiatric rn working with cardiac pts.,I am trying tko develop more treatment programs for cardiac pts.Getting the system to buy in tothe mind/body connection is problematic.My first step has been is to become an active member of the cardiac care team in the hospital.
    I would love input from others reromoting system change to improve patient care.

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  2. 5 Comments

  3. by   MCoots
    I am glad to see that someone is thinking about the psychological needs of cardiac patients. Are you focusing patients with acute cardiac conditions or also considering chronic cardiac illness? Do you want to focus your efforts in the hospital or across the continuum of care?
  4. by   debra w
    being a psych nurse, i do tend to focus on psychological needs.currently,i am focusing on the acute pts -the pts who can get well.
    i want to teach them techniques to empower
    themselves so they will need to rely less on their doctors and on the system in general.
    this should help with some systems issues as the pts will not require so many medical visits-access will improve. it may also help with decreasing systems costs as the pts take better care of themselves -leading to fewer cabgs/surgeries,less need for expensive tests,etc. the medical system will benefit.
    in addition,the pt and his/her family will benefit from some holistic teaching.the pt and the family system can help to change the health care system by then giving feedback to the mds.
    i would like to deal with this issue across the continuum of care. this will help to keep the boundaries of the system loose and fluid.this would be beneficial to system change. the boundaries of various disciplines can be problematic so i like to work on decreasing the rigidity of these boundaries. i try to do this by education-
    telling the mds that some of my work would lessen their work. i remind them of the whole- in terms of the pt and in terms of
    health care.
    relationships are what i am trying to work on.after all, this is a significant part of our realities. with the expanded role of nurses ,doctors are feeling more threatened. i am very sensitive to this when i talk with the mds. i also work on reminding
    staff(and myself) of the vision of quality health care . by focusing on the vision,one is more able to be adaptable.
  5. by   MCoots
    One article you might be interested in is Chaos and the Limits of Modern Medicine by James S. Goodwin in the 11/5/97 issue of JAMA. The author discusses conceptual trends in biomedicine and the current trend of chaos theory in medicine. He points out that scientific medicine has studied only what it could measure. He thinks that the conceptual framework of chaos theory can be used to teach medical students ways of analyzing complex systems (like people) that do not promise total understanding or total predictability. There might be hope after all.
    Your ideas really fit into the collaborative management of disease model. Across the continuum you might want to consider how your efforts relate to the Multifit program.
    I think that it is interesting that you are focusing on relationships. I am working on a project that involves the coordination of care for renal patients. Improving the relationships and communication between the different departments providing care to renal patients would improve the quality of care provided to them and streamline our efforts.

  6. by   debra w
    thank you for your excellent input. chaos theory is definitely worth further exploration. and you are right about my need to connect with the multifit program as i work across the continuum. i do plan to do this as it is the best way to facililtate relationship development and to emphasize the interconnectedness of the system. relationships are very important to our reality. as relationships change so does our reality. i plan to educate the multifit team
    on the benefits of psychological interventions to cardiac pts. education is also critical as we work to change the system. i am hoping that our boundaries will loosen as we work together in overlapping areas. this will certainly benefit the relationships, the system, and pt care.
    i can relate to your work with coordination of care for the renal pts. relationships and communication are necessary in order to provide quality care. streamlining efforts would also benefit the system in the areas of cost, access, staff morale, pt satisfaction,etc.
    good luck with this work! have you tried developing a vision statement among the various depts? this could help people to be more open, flexible and also improve communication.remind staff that change can bring renewal and be energizing.
    what about a brainstorming session where people try to problem solve by throwing out ideas. this can be generative of new ideas,new autonomy, etc.
    back to your original idea involving chaos theory-from chaos, information is developed which can help the system to develop as a whole.
    good luck with your development.
  7. by   Elaine
    Are you familiar with the work of Barbara Dossey? She has done a lot of work in this area.

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