My name is Michael, and I work in the ICU as a RN. The reason i am creating this post is to discuss a topic that was brought up during a staff meeting and to see where people stand on the idea. At the last staff meeting i attended the director focused on a topic central to nursing care, and how to improve it; that topic being caring. Her goal is to improve staff caring in the ICU. I mean, yes, this is a great idea. Improving caring improves patient satisfaction, i don't see a problem with this. The problem i guess lies in her approach. She wants to create a template and protocol for caring, and it all seems so scripted. The unit needs another protocol like i need a hole in the head. I can't get around to reading the three billion that exist already. A scaled template would rate caring on a scale of 1-5. 1 being below average, 5 being outstanding caring. The implementation of this scale would go something like this: "Susan, i can see you're having a tough time with that patient and their family, right now you're caring is at a 2, how can we improve that? what can we do to bring you up to a 4, i have some ideas." Great and all, but i've only been a nurse for a year, how do i go up to a nurse who's been working for 30+ years and tell them that their caring sucks. I probably wouldn't. Nor do i feel that it is my place to whip out a template and find their caring level based on set definitions for each number 1-5. This template exists by the way, and a lot of research went into creating it.
Ok, so i want to get back to the real reason i'm posting this. In the previous paragraph my tone sounded a bit negative, but i'm not opposed to the idea of improving caring. The other staff were a bit offended at the suggested ideas. Feeling that caring is learned, not taught, and everybody cares differently. Tomorrow i need to put together a presentation on caring for our staff meeting, and i feel like i am hitting a brick wall when it comes to ideas. I want to create a presentation that meets the needs of my director, but also a presentation that i wont get stoned for by the staff. The staff have been given a chance to present ideas with little ground gained during discussion.
Does anyone have any ideas of improving nursing caring, without offending staff in the process? Do you think a protocol or scale is appropriate? A caring committee has been created, which I'm not a part of, but i'm willing to bring ideas to the table. Like all change, there is a ton of resistance being met. I am not afraid to be a change agent, as long as it's done tactfully. Any ideas or suggestions on the situation or for my presentation would be greatly appreciated. I have a feeling i'm going to be presenting a neutral presentation on caring that involves nursing theories and what it caring means for nursing.
this was accomplished through the application of lean six sigma principles to analyze the delivery of nursing care, streamline processes and develop unit-based vision statements focused on strengthening relationships and improving outcomes. the time created by improved processes could be spent implementing six key elements of a caring model. adapted from sharon dingman’s caring model™.
six elements of the caring model:
asking the patient/family their preferred name •
introducing self and explaining their role in care •
sitting for five minutes with patient/ family to plan care •
use appropriate touch as defined by the patient •
connecting the organization’s mission to patients plan of care •
Thank you everyone for all the great feedback and ideas. Very much appreciated. The presentation is going to be during a staff meeting, so i've decided to go with an informal/discussion type presentation. Seeing that it's now three hours before the presentation and i'm still clueless as to what i want to say. Life wouldn't be interesting if it were easy, now would it?
I just want to point out that this presentation wasn't forced on me as a new grad. I've been in the ICU and working with the staff as an RN for almost a year and a half. Yes i feel like i still know nothing, but i volunteered to help my director because of huge negative reaction by the staff. I didn't want to see all of her efforts go completely to waste.
NRSKarenRN, awesome awesome awesome! This is going to help me so much.
Thanks again everyone! I am curious to see how this effort to improve caring turns out. Funny enough, that hospital has great caring scores. Especially by the ICU staff, i think that is part of the reason people were so offended. Always room for improvement on the surveys, right?
I'm too late but...I think caring gestures lose their impact when everyone does them. If I get the same things from every staff member, they are not personally caring for me, they are following company policy. Caring acts need to be individualized to retain their full impact.
Changing company policies result in more demands from consumers, and frustrated staff that used to have time to get the extra coffee for those that needed it, but now they're sucked dry by the entitlement brigade before they ever get to that exhausted family. And maybe that family actually needed 10 minutes to talk and not the mandated free coffee.
My sincere sympathy for the OP who has embarked on this task. It is fraught with 'gotchas'.
One of the problems with Nursing is that we do not incorporate research from other fields - so we are continually reinventing the wheel. This is particularly true in the area of Social Psychology. There is actually quite a bit of (non Jean Watson) work out there that is directly relevant to this issue.
I would suggest reviewing the literature on 'emotional labor' and the well-documented stressors that characterize it. This is the term for jobs that force people to adopt false emotional facades as part of the job. This includes jobs as diverse as bill collectors - forced to adopt mean, unforgiving attitudes and funeral directors - must show extreme sympathy and caring at all times. Basically, research has shown that this type of atmosphere is very stressful and destructive; producing burnout and unhappiness/sadness for workers. I am sure this is not the desired outcome.
There is another line of 'emotional labor' research that has to do with group dynamics... similar findings to work on development of moral reasoning (Kohlberg). If a happy, cheerful new person joins a glum and gloomy group, he/she may not necessarily adopt the same outlook, but will certainly become unhappy with the situation. On the other hand, if a gloomy person joins an upbeat group -- the gloomy person will gradually adopt the more positive outlook of the group. Fascinating stuff - as close as Google.
Thank you everyone for all the great feedback and ideas. Very much appreciated. The presentation is going to be during a staff meeting, so i've decided to go with an informal/discussion type presentation. Seeing that it's now three hours before the presentation and i'm still clueless as to what i want to say. Life wouldn't be interesting if it were easy, now would it?
I just want to point out that this presentation wasn't forced on me as a new grad. I've been in the ICU and working with the staff as an RN for almost a year and a half. Yes i feel like i still know nothing, but i volunteered to help my director because of huge negative reaction by the staff. I didn't want to see all of her efforts go completely to waste.
NRSKarenRN, awesome awesome awesome! This is going to help me so much.
Thanks again everyone! I am curious to see how this effort to improve caring turns out. Funny enough, that hospital has great caring scores. Especially by the ICU staff, i think that is part of the reason people were so offended. Always room for improvement on the surveys, right?
Michael
Since caring really is determined by each patient, maybe a goal of your project could be to individualize caring for each patient.
For your patients that can talk and comprehend, develop a simple tool that asks them to select what caring is to them. (Do they see caring as having their call bell answered within a certain time? A bed bath and clean sheets? etc). Allow them to either select from a list or write in three "care goals" for their stay.
Example
1. Good pain management
2. Explain procedures
3. Keep the room as quiet as possible
When the patient is discharged/transfered, ask them to evaluate how well the care goals were met and their satisfaction with the staff.
For patients who cannot talk/communicate, develop a pre-set list of goals and adapt them as the patient is able to provide input.
NRSKarenRN, BSN, RN
10 Articles; 19,192 Posts
poster presentation:
the caring model a practical application to improve patient satisfaction
book: quality caring in nursing : applying theory to clinical practice
joanne duffy phd, rn, faan