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T RANSLATING C ARING T HEORY I NTO P RACTICE:

T RANSLATING C ARING T HEORY I NTO P RACTICE: The Carolina Care™ Model Mary Tonges PhD, RN, NEA-BC, FAAN Chief Nursing Officer, UNC Hospitals October 17, 2014. Virginia Organization of Nurse Leaders. T RANSLATING C ARING T HEORY I NTO P RACTICE. Swanson Caring Theory.

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T RANSLATING C ARING T HEORY I NTO P RACTICE:

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  1. TRANSLATINGCARINGTHEORYINTOPRACTICE: The Carolina Care™ ModelMary Tonges PhD, RN, NEA-BC, FAAN Chief Nursing Officer, UNC Hospitals October 17, 2014 Virginia Organization of Nurse Leaders

  2. TRANSLATING CARING THEORY INTO PRACTICE Swanson Caring Theory Tonges Translational Model Carolina Care TM Across the Continuum to Ambulatory Care

  3. TRANSLATING CARING THEORY INTO PRACTICE Swanson Caring Theory Tonges Translational Model Carolina Care TM Across the Continuum to Ambulatory Care

  4. Swanson Caring Theory “Caring is a nurturing way of relating to a valued other to whom one feels a personal sense of commitment and responsibility.”K. Swanson, 1993 • Knowing • Being With • Doing For • Enabling • Maintaining Belief Swanson, KM 1991, Empirical development of a middle range-theory of nursing, Nursing Research, 40(3) 161-6.

  5. Swanson Caring Theory • Knowing: • Being With • Doing For • Enabling • Maintaining Belief striving to understand an event as it has meaning in the life of the other • avoiding assumptions • assessing thoroughly • seeking cues • centering on the other • engaging the self of both

  6. Swanson Caring Theory • Knowing • Being With: • Doing For • Enabling • Maintaining Belief being emotionally present to the other • being there • conveying availability • enduring with • sharing feelings • not burdening

  7. Swanson Caring Theory • Knowing • Being with • Doing For: • Enabling • Maintaining Belief doing for the other as they would do for their self if it were at all possible • performing competently/skillfully • comforting • anticipating • protecting • preserving dignity

  8. Swanson Caring Theory • Knowing • Being with • Doing For • Enabling: • Maintaining Belief facilitating the other’s passage through life events and transitions • informing/explaining • validating/giving feedback • supporting/allowing • focusing • generating alternatives/ thinking it through

  9. Swanson Caring Theory • Knowing • Being with • Doing For • Enabling • Maintaining Belief: sustaining faith in the other’s capacity to get through an event or transition and face a future with meaning • believing in/holding in esteem • offering a hope-filled attitude • ‘going the distance’ • offering realistic optimism • helping find meaning

  10. TRANSLATING CARING THEORY INTO PRACTICE Swanson Caring Theory Tonges Translational Model Carolina Care TM Across the Continuum to Ambulatory Care

  11. Tonges Translational Model for Theory-Driven Practice Theory Innovation Application Testing Dissemination Evaluation Sustainment

  12. Tonges Translational Model for Theory-Driven Practice Theory: Swanson Caring Theory (SCT) Dr. Kristen Swanson

  13. Tonges Translational Model for Theory-Driven Practice Innovation: creating value through new ideas

  14. Tonges Translational Model for Theory-Driven Practice Application: putting ideas to a specific purpose/use • Moment of Caring • Multi-level Rounding • Hourly Patient Rounds • No Passing Zone • Words and Ways That Work • Blameless Apology • Proposed Links between Carolina Care and SCT • Framing the Culture of Carolina Care

  15. TRANSLATING CARING THEORY INTO PRACTICE Swanson Caring Theory Tonges Translational Model Carolina Care TM Across the Continuum to Ambulatory Care

  16. Carolina Care TM

  17. Carolina Care TM • Each patient each shift • Nurse sits with patient • 3-5 minutes of touch and therapeutic listening Moment of Caring: Knowing and Being With

  18. Carolina Care TM Multi-level Rounding Nurse Manager Interdisciplinary Health Unit Coordinator (HUC) Director Hourly Patient Rounding

  19. Carolina Care TM Hourly Patient Rounds R Are you comfortable? O Other side? (Does patient need to turn?) Associated Swanson Caring Theory Component: Being With and Doing For U Use the bathroom (Does patient need assistance?) N Need anything D Door/curtain open or closed for privacy S Safety (Call bell will reach and no tripping hazards)

  20. Carolina Care TM • Answer call light regardless of assignment • “Road Signs” posted in hallways No Passing Zone: Being With and Doing For

  21. Carolina Care TM • Alternative to “scripting” • Key points to cover in interactions Words and Ways that Work: Being With and Enabling

  22. Carolina Care TM • Listen to patient • Apologize without placing blame • Take action to address problem • Follow-up with patient Blameless Apology: Being With and Enabling

  23. Carolina Care TM Proposed Links Between Carolina Care and SCT

  24. Carolina Care TM SCT: Framing the Culture of Carolina Care

  25. Tonges Translational Model for Theory-Driven Practice Testing: making a preliminary evaluation before embarking on a course of action • Model Units • Medicine Service • Surgery Service

  26. 4. Testing: Preliminary Evaluation • Model Units: Medicine & Surgery Service • Less than 20 beds • Combination of private/semi-private rooms • CNO chaired Carolina CareSteering Committee to provide high level direction, integration and support • Voice of the Patient • Rapid Cycle Improvement: Design & Implement • Nursing & Interdepartmental Unit-Based Teams • Data Driven Action Plans/Performance Tracking

  27. 4. Testing: Model UnitResults

  28. 4. Testing: Model UnitResults

  29. Tonges Translational Model for Theory-Driven Practice Dissemination: spreading information and/or practices • Carolina Care Guidebook • Pre-Work Unit Assessment • Pre-Work Teams • Roll Out • Recognition for Outstanding Performance

  30. 5. Dissemination: Carolina Care Guidebook • CNO charge • Lessons learned from Model Units • Defined key staff roles and responsibilities • Pre-Work • Implementation sequence • Defined Carolina CareTMInterventions • Moment of Caring • Hourly Rounds • No Passing Zone • Words and Ways that Work • Blameless Apology (Service Recovery) • Discharge calls

  31. 5. Dissemination: Pre-Work Unit Assessment Patient satisfaction interview Part I Self assessment Part II Analyze one year of unit performance on Press Ganey data Part III Call bell activity Part IV Environmental assessment Part V

  32. 5. Dissemination: Pre-Work Teams • Carolina CareTM Implementation Oversight Committee • CNO • Nursing Directors • Nurse Managers • Director, Environmental Services • Director, Food and Nutrition • Data Analyst

  33. 5. Dissemination: Roll Out • 8 Week Implementation Sequence • Monday morning Nurse Managers’ meeting • Weekly focus areas • Rounding • Words & Ways that Work • Bi-weekly nursing & Interdepartmental team meetings • Building Action Plans • Tracking performance measures • Discharge calls • Daily huddles • Bright ideas • Implementation Oversight Committee Simultaneous roll out on all acute care units

  34. 5. Dissemination: Recognizing Outstanding Performance

  35. Tonges Translational Model for Theory-Driven Practice Evaluation: ascertaining value or worth • Press Ganey Scores • HCAHPS Scores • Effect on Pressure Ulcer Prevalence

  36. 6. Evaluation: Results- Annual Mean PG Scores Overall Inpatient Satisfaction and Satisfaction with Nursing Carolina CareTM implemented in July

  37. 6. Evaluation: Results- Mean PG Scores Concern with Privacy, Meeting Emotional Needs and Attention to Special/Personal Needs Carolina CareTM implemented in July

  38. 6. Evaluation: Results - Annual Mean PG Scores Satisfaction with Pain Control and Prompt Response to Call Carolina CareTM implemented in July

  39. 6. Evaluation: Results - HCAHPS Scores March, 2011 – March, 2012 #1 Communication about Medications #2 Discharge Information

  40. 6. Evaluation: Effect on Pressure Ulcer Prevalence

  41. Tonges Translational Model for Theory-Driven Practice Sustainment: keeping in existence, maintaining • Sustainment Efforts • HCAHPS Scores

  42. 7. Sustainment: Efforts

  43. 7. Sustainment: Expansion

  44. 7. Sustainment: Infrastructure Patient Experience Steering Committee Change Management Resources D. Kaye, S. Herman, L. Mandelkher, G. Spivak Co-Chairs K. McCall W. Rotella Employee Inpatient Outpatient Co-Chair D. Bauer Engagement Communication Focus Team Inpatient Experience Team Co-Chairs D. Bass W. Arey JJ. Campbell J Strickler Co-Chairs D. Olmos T. Garner Co-Chairs L. Daniels L. Kapps Executive Sponsors D. Spencer R. Lafrenaye Admitting J. Hadar L. Osborne Room Executive Sponsor J. Hirneisen Executive Sponsors C. Donohue W. Rotella D. Lehman Executive Sponsor M. Tonges Meals A. Mojica D. Lehman Nursing J. Ray M. Tonges C. Rege T. Smiley Tests – Txs K. McCall Visitors& Families M. McCann L. Muss M. Rifkin Discharge M. Bossert R. Daniels J Pomerantz Personal Issues S. Rogers S. Crenshaw K. Mc Call

  45. 7. Sustainment: Infrastructure

  46. 7. Sustainment: New Interventions

  47. 7. Sustainment: New Interventions

  48. 7. Sustainment: HCAHPS – Rate The Hospital Highly FYTD Percentage – 77.6 (84th Percentile)

  49. 7. Sustainment: HCAHPS – Recommend Hospital FYTD Percentage – 83.0 (89th Percentile)

  50. 7. Sustainment: HCAHPS – Communication w/ Nurses FYTD Percentage – 80.8 (69th Percentile)

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