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The Beryl Institute invites members to submit posts on patient experience related topics. For guidelines and information on submitting a post for consideration, please contact us at info@theberylinstitute.org.

 

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Patient Experience Sits at the Center of Nursing

Posted By Susan E. Mazer, Friday, October 21, 2016
Updated: Friday, October 21, 2016

The patient experience is neither new nor revolutionary in healthcare. 

Florence Nightingale, 1820-1910

In fact, it goes all the way back to the work of Florence Nightingale who, in response to what she saw in the Crimean War, realized so much suffering could be relieved with the standardization of nursing practices. 

In her first and most famous monograph, Notes on Nursing, Nightingale claimed that suffering should not be presumed as part of the disease. Rather she wrote that “the symptoms or the sufferings generally considered to be inevitable and incident to the disease are very often not symptoms of the disease at all, but of something quite different -- of the want of fresh air, or of light, or of warmth, or of quiet, or of cleanliness, or of punctuality and care in the administration of diet, of each or of all of these.” 

From experience and observation, Nightingale knew how rudeness and inconsideration on the part of physicians and nurses could cause patient suffering. The task of the nurse was to protect the patient.

She warned that the vital energy needed by the patient to go through the reparative process should not be wasted nor distracted. Nightingale considered all disease to be reparative, coming on over many years and finally showing itself in a serious of symptoms observable and obvious to both patient and nurse.

There’s no doubt that nursing is where the patient experience initiative began and is what should guide it today.

Our healthcare system has thrown out the idea that nursing might be where we could best learn about the patient experience. And yet nurses have always been the strongest clinical advocates for patients. They understand the source of pain and suffering first because of their intimate relationship with patients.

In truth, the patient experience began to deteriorate when our healthcare system became consumed with medications and technologies. Patients then became the last people to be consulted about their condition and their needs. And, nurses became medicalized as the whole system sought to make all symptoms ripe for medical diagnosis and treatment.

However, Nightingale defined nursing as managing symptoms of suffering that were neither medical nor complex -- symptoms that could be solved by manipulating the environment or paying attention to the patient’s spoken needs. Or, symptoms that reveal other issues that would undermine that patient’s own capacity to heal.

My relationship and work with nurses, which began in 1980 when I designed educational programs on the use of music as therapy, has given me perspective on the considerations prioritized by Nightingale. Dallas Smith and I wrote and presented a docudrama (now a podcast), “Florence Nightingale: In her Own Words,” that brought to life her frustrations with the system that inspired her work. Nightingale’s writings were and are consistent with her absolute commitment to the humanity of the patient, to the uniqueness of each individual and the specificity of their situation.

Additional study of nursing theory has also helped me understand and respect the transpersonal relationship that nurses have with their patients and the way that nursing holds the tradition and expertise of the patient experience.

Dr. Jean Watson, Professor Emeritus and Nurse Theorist, moved Nightingale’s work further in identifying the unique role of nurses in her Theory of Human Caring (or Caring Science). Her Caritas principles, which are the guide to her Nursing Practice Model, call upon nurses to be authentic in their caring for their patients, to treat themselves and others with loving-kindness and equanimity, and allow for the depth of physical and spiritual wholeness in themselves and their patients.

Our relationship with Dr. Watson has taken Dallas and I to Qatar and Jordan, working with nurses in the Middle East who are committed to human caring across borders and political conflict. There, where some Palestinian nurses are not paid for nine months, and where Israeli nurses take in Syrian children and love them as they heal their physical and emotional wounds, human caring has taken on profound meaning.

The bottom line for nurses is to respect patients and their autonomy regardless of their acuity, capacity, or personality. Then allow patients to do as much as they can for themselves and to not get lost in a system where patients are often just medical records.

May Solveig Fagermoen, Ph.D., R.N., associate professor at the Institute of Nursing Science at the University of Oslo, Norway writes, “In nursing, respect must be, or rather is, grounded in the inherent worth of individuals as human beings regardless of their capacities and characteristics (a nonsecular position). … a person is respected not because of his individuality, we do respect him in his individuality. We take his interests, purposes, and degree of autonomy itself into account in the particular way we treat him.”

If the patient experience demands respect from physicians and nurses, identifies the patient’s right to expect and need for quiet and cleanliness, and if it presses to not have patients wait for any reason, then the practical map of how to do this lies in Nightingale’s work and ultimately in nurses.

And, if there is absolute respect for the suffering that you could not know, the anxiety you do not want to cause, and a sense of professional accountability for each patient, then the patient experience sits at the center of nursing, in each nurse, in every hospital.

 

Susan E. Mazer, Ph.D. is the President and CEO of Healing HealthCare Systems®, Inc., which produces The C.A.R.E. Channel. In her work in healthcare, she has authored and facilitated educational training for nurses and physicians. Dr. Mazer has published articles in numerous national publications and is a frequent speaker at healthcare industry conferences.

Tags:  accountability  healing  nurse  Nurse Leadership  relational healthcare  relationship 

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Patient Experience: A Relational Achievement

Posted By Kenneth J. Gergen, Friday, June 24, 2016

We often think of experience as a private mirror. That is, there are events in the world, and they are reflected in our private experience. A patient may thus experience individuals in a healthcare system as nurturing and helpful as opposed to cold and indifferent. This view is shortsighted in two related ways. First, we are not passive recipients of others actions toward us; we are active agents in the world – even as patients – and these activities affect how we experience others. The quality of experience depends on what we are seeking, and what role we are playing. For example, the experience of pain you might experience at a sharp blow to your head is not the same as that of a boxer in the ring. Likewise, the pain of a needle being stuck in your arm is quite different for a patient who fears pain and is trying to avoid it, than one who eagerly seeks a blood test. The way we participate in health systems will vitally color what and how we experience.

AS WE PARTICIPATE, SO DO WE EXPERIENCE

This brings us to the second flaw in the common assumption that experience is like a mirror. It is not simply that the way we participate colors our experience. But this participation does not take place in a vacuum. The quality of experience depends on the relationships in which we are participating. Consider again the pain of the boxer. He is not boxing alone, but participating in a traditional form of relationship. In the same way, when we approach health systems with fear and defensiveness, we are also participating in a particular social tradition. Similarly, the way one experiences the probing hands of a doctor – a formalized relationship - is far different than the same touches occurring in the hands of a partner’s embrace. In effect, we may say that experience vitally depends on our participation in relationships.

TOWARD RELATIONAL HEALTHCARE

In this light, the concern with patient experience shifts focus from the individual to the relationships of which the individual is a part. In effect, our sites turn to relational practices, and especially those practices that enhance the patient’s experience. Some of these practices are clear enough. We all know the positive impact of family relations that can lift the spirits and give meaning to the future. New innovations are also emerging on the scene. Programs in which patients are drawn into the treatment team – collaborating with physicians and nurses in their own care – are blossoming. Programs that increase the empathy of doctors for their patients, and patients for their doctors, are growing in numbers. Practices in which patients contribute to the education of physicians are inspiring. In all cases, there is an increasing sense that the best in healthcare grows from an awareness that "we are all in this together.”

A CONFERENCE ON RELATIONAL PRACTICES IN HEALTHCARE

For anyone wishing to know more, to explore the many potentials of a relational approach to healthcare, I would also like to recommend an upcoming conference Relational Practices in Health and Healthcare: Healing through Collaboration. It promises to be a lively, informative, and significant event.

This international conference will be held in Cleveland, Ohio at the new Global Center for Health Innovation, November 10-12, 2016. The conference is offered by the Taos Institute in collaboration with the International Institute for Qualitative Methodology, Alberta, Canada. The significance of relational practices will be underscored by a plenary offering from Jason Wolf, President of The Beryl Institute, and passionate champion of positive patient experience.

Kenneth Gergen is a Senior Research Professor at Swarthmore College and the President of the Taos Institute. He is internationally known for his writings on social construction and relational process, and their many applications to professional practice.

Tags:  collaboration  participation  partnership  patient  quality of care  relational healthcare  relationship 

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