Relationship Based Care

Relationship Based Care
Stephenie Worrall
Concepts for Professional Nursing
NSG 311
Sue Nichols
Spring 2012

Relationship Based Care Relationship based care (RBC) is a concept model Memorial Hospital in Colorado Springs has adopted hospital wide. I chose this concept because it is new to the organization and I wanted to gain a better understanding of what exactly RBC is. This paper will provide information about what RBC is, how it works, who it involves and the perceptions of those involved in this health care delivery model. At the conclusion of this paper one should have a basic knowledge of what RBC is and how healthcare delivery can once again be rewarding for the nurse and her colleagues. You will also see how RBC promotes an enhanced healing environment for patients and their families.
Where did Relationship Based Care Come From, How is it being used RBC originates from primary nursing care. In primary nursing the primary nurse is the nurse that oversees a patients care throughout his/her hospital stay or course of treatment. She is responsible for implementing a plan of care individualized for that patient and their needs. The primary nurse is responsible for decision making, allocation of resources for that patient, communicating with other members of the hospital team, such as respiratory therapist or speech therapist, depending on the patient’s needs, and evaluating the patients response to his/her treatment. Primary nursing gives the nurse greater autonomy. Two main characteristics of primary nursing are the nurse’s acceptance of responsibility for the patient and the relationship the nurse builds with the patient, the patient’s family, the doctor and the team members involved in the patient’s treatment plan. RBC takes the building blocks from primary nursing and combines them with J. Watson’s Theory of Caring, to create a care delivery system that not only addresses the needs of the patient as a whole, mind body and spirit, it promotes healthy relationships among team members patients and their families. Promoting healthy relationships among team members decreases stress in the work place, and gives each team member a feeling of self-worth, they are part of a team, a well-oiled machine that can provide care for a patient and build relationships that promote an all-encompassing healing environment. More autonomy for the nurse gives her the ability to work with in her scope of practice and not feel like a task orientated organizational robot. Managers can act as part of the team rather than the dictator that sits in the office and hands down orders. RBC fosters relationships between the patient, family and all team members, not just the primary nurse and patient.
Characteristics of Relationship Based Care The basis of RBC is that care is centered on the priorities and needs of the patient and family. Care is delivered through relationships with patient, family and team members. This requires trust, respect and collaboration between all those involved. The principles for RBC are:
1. Caring and Healing Practice Environment: involves physical setting, supporting the patient culturally in a nurturing and supportive atmosphere, patient is involved their own care, care is centered on mind, body and spirit
2. Responsibility for Relationship and Decision-Making: the primary nurse accepts the patient and is responsible and accountable for the management of care, associate nurses provide care according to the plan of care
3. Work Allocation and Patient Assignments: the primary nurse has the authority to evaluate and determine the level of care needed, and who within the team is appropriate to deliver care
4. Communication between Members of the Health Care Team: communication between the team members, the patient and there family is facilitated by the primary nurse
5. Management/Leadership: manager promotes autonomy, mentors and inspires staff, leads an environment that will promote education, and professionalism
6. System Improvements: staff work together to provide care and assess clinical processes to be sure they are providing the desired results (Creative Health Care Management, 2010)
Upon admission to the hospital RBC is explained to the patient, the members of the team, if known, are introduced to the patient and their family. The patient and their family are told that they are also part of the team and that their concerns and input are of great value in the plan of care. The plan of care is overseen by the primary nurse and changes are made when appropriate as the patient’s condition changes.
Relationship Based Care Model Case A baby is born early at 29 weeks gestation, the baby is brought directly to the NICU, the father accompanies the baby. A team consisting of the nurse, charge nurse, nurse practitioner, respiratory therapist and doctor is as bedside. While the baby is being stabilized the father is being informed of what is going on at present, lines, meds, IV’s and monitors. The father is given a quick overview of the NICU and guidelines and then is escorted back down to the labor and delivery room to check on the mom. The father is also given the NICU number so that he or mom can call to check on the baby. A few hours later the mother and father of the baby are brought the unit to see their baby, time is allowed for them to see their baby, the nurse is close at hand to explain monitors and lines etc. and also explains to the family that their baby will have a healthcare team, consisting of two primary nurses, one for day shift and one for night shift, a primary neonatologist, and other support staff as needed. It is explained that these individuals will not always be on site, but they are responsible for overseeing the baby’s care. If the family has any questions or concerns they are free to speak to any staff caring for the baby, the primary healthcare team is designated to create continuity in care and to see that the plan of care is being carried out; the support staff is there to carry out the plan of care. Communication is set up and a relationship is being formed as the nurse explains the baby’s condition, and how the healthcare team is going to create an individual plan of care for their baby. They are also told that they are part of the team and their input into their baby’s care is important. The nurse also asks what the parents expect, and what would help them in their situation. It is noted on the plan of care if the parents have special requests, preferred names etc., things that individualize them and their baby. The family should feel that they are involved in the baby’s care and that there is a plan in place.
Borderline Relationship Based Care Case A 9 year old boy is admitted to the pediatric unit for shortness of breath and a low blood oxygen saturation rate. He accompanied by his mother and father. A nurse greets them and settles the boy into his room, while doing this she is getting information from the parents about the patient’s medical history. The nurse tells the parents that the plan for the night is to administer oxygen, draw labs and monitor the blood oxygen saturation. She will report the information to the charge nurse, the charge nurse will inform the doctor of pertinent information and the doctor will speak with them in the morning after he has assessed the boy. The family is given blankets and asked if they have any questions or concerns at this time. The nurse does address a plan of care, but is seems it is only for her shift. Team nursing involves caring for the patient based on a plan for that shift. Information is passed on to the charge nurse and is given to the oncoming shift and doctors, there is no continuity of care. Assignments are based on tasks required, acuity or location on the floor.
Contrary to Relationship Based Care Case An elderly female is brought to the ER by her son, after fainting at her home. The son is told to wait in the waiting room until his mother is examined. The patient is admitted and the son goes with his mother up to the medical floor. A charge nurse comes in and explains the admit process to the son and patient. Afterward, another staff member comes in and asks medical information etc. about the patient. Shortly after that, a staff member introduces herself as the nurse for the night, she assesses the patient and gets her in a gown and tells the son that they will just be monitoring his mother throughout the night and in the morning the doctor will be in. After the doctor sees the patient they will better be able to set up a plan of care for his mother. This appears to be more of a functional type of nursing; each staff member has certain tasks to complete. The staff may work as a team but only in performing their individual duties. Communication is short and vague, the son is in a wait and see situation.
Why is Relationship Based Care Important RBC is a model/concept that involves the patient and the patient’s family as well as medical staff and support staff. In today’s society patients are more informed and medical savvy, they want to be involved in their care and feel that they have a voice in the care they receive. For the nurse, he/she is able to work within her scope of practice and make informed decisions regarding the plan of care for that patient, each member of the team feels they are a valuable participant in the patient’s plan of care. The patient has a better relationship with the team knowing they are communicating with one another, and a sense that he/she is an individual patient, not a diagnosis or disease to be reckoned with. Nurses report feeling less stress, they are not just there to complete a list of tasks, they are part of a team that works together to provide the best care for the patient. Nurses are able to spend more time with the patient building a trusting relationship. Implementation of RBC by an organization is definitely a grand undertaking. Exploring ways to transition to this type of healthcare concept would help the healthcare organizations be more accepting. The major question and concern is whether this type of system would require more staff. In many instances more staff is not needed, utilizing the current staff differently is what would need to take place.
Conclusion
RBC is a concept that incorporates teamwork, professional nursing practice, and relationships. Sharon K Dingman, RN, MS of Presbyterian Hospital of Denton Texas stated that “RBC is comprised of three crucial relationships: (a) care provider relationship with patients and families, (b) care provider relationship with self, and (c) care provider relationship with colleagues. Caring is expressed and felt when one human being connects to another in the moment of care and service.” (Dingman, n.d., p. 136) In conclusion RBC is a concept that describes what nursing is about and why many individuals chose to pursue nursing as a profession. Nurses once again feel that they are part of the solution, not a task driven employee that is overworked and underappreciated. References
Blais, K. K., & Hayes, J. S. (2011). Professional Nursing Practice Concepts and Perspectives (6 ed.). Upper Saddle River, New Jersey: Pearson.
Creative Health Care Management. (2010). Implementation Guide for Relationship-Based Care. In . Minneapolis, MN: Creative Health Care Management.
Dingman, S. K. (n.d.). A Dialogue on Relationship-Based Care: Reflection on Practice. International Journal for Human Caring, 9(2)2, 136. Retrieved from
Koloroutis, M. (Ed.). (2004). Relationship-Based Care a Model for Transforming Practice. Minneapolis, MN: Creative Health Care Management.
Oxford English Dictionary. (2012). In . Retrieved from Colorado State University – Pueblo

CONCEPT ANALYSIS PAPER
Introduction –5 points What is the concept you are analyzing? What interested you about this concept? Write an introduction for this paper, including the relevance of this topic to you. Include elements that will be in the paper, as well as the purpose of the paper.
History/Nursing Literature – 15 points What is the origin of the concept? Use the Oxford Dictionary (in the library) to discover the etymology of your concept. How has your concept been used in Psychology and Sociology, two areas nursing has borrowed theory from until now. How is the concept being used today in the nursing literature (nursing journals)? Really get into the literature and make this part of your paper meaningful. How your concept is “like and not like” closely related concepts.
Defining Attributes – 15 points As you read the literature, notice the attributes that are most commonly mentioned. Write these down. They are your critical attributes. Keep a list of attributes that are not descriptive of your concept. These will be useful later when creating your borderline and contrary case. Describe these attributes in your paper in some form of a summary. Keep in mind that these attributes could be used for making a tool to measure your concept. Tell a classmate the attributes without telling what the concept is.
Model Case - -15 points Construct a model case. The model case should be drawn from real life and contain all of the attributes you have identified. At the end of your model case, summarize by telling your reader how the critical attributes are depicted. The model case should be a clear example of the concept you are analyzing.
Borderline Case – 10 points Give an example of a case that includes some of the essential attributes, but not all of them so it is not a clear case of your concept. Summarize by explaining how some attributes are present and which ones are missing.
Contrary Case – 10 points Give an example that may be sometimes mistaken for your concept but clearly does not have the needed attributes. Summarize by explaining how this is not a description of your concept.
Implications for Nursing – 10 points What implications does your concept have for nursing practice? Why is your concept important? How does it need to be explored further? Should research be done on your concept?
Conclusion – 5 points Write a conclusion for your paper. The conclusion should be a reflection of the introductory paragraph and should include a brief summary of the main points.

APA/Grammar – 15 points Use APA format to write your paper. Follow your APA guidelines carefully. Use third person, not first person, to write your paper. (Remember, this is a scientific, scholarly paper! A well-written paper could be published in a nursing journal). Be sure you use level headings appropriately and according to APA format. Proofread your paper for grammar and spelling. If you have trouble writing, have a peer read your paper and give you feedback. Utilize the writing center and have them give you feedback. The paper should be a maximum of 6 pages, not including title or reference page, and double spaced. APA format is required.

References: Blais, K. K., & Hayes, J. S. (2011). Professional Nursing Practice Concepts and Perspectives (6 ed.). Upper Saddle River, New Jersey: Pearson. Creative Health Care Management. (2010). Implementation Guide for Relationship-Based Care. In . Minneapolis, MN: Creative Health Care Management. Oxford English Dictionary. (2012). In . Retrieved from Colorado State University – Pueblo CONCEPT ANALYSIS PAPER