- Email: [email protected]
Patient-centered care and patient safety: A model for nurse educators
Teaching and Learning in Nursing (2015) 10, 39–43
www.jtln.org
Patient-centered care and patient safety: A model for nurse educators Judith L. St. Onge PhD, RN⁎, Robin B. Parnell PhD, RN Associate Degree Nursing Program, Troy University, Montgomery, AL 36104, USA KEYWORDS: Patient safety; Patient-centered care; Teaching safety
Abstract Safe practice is a basic goal of nursing education. Despite recent highly visible efforts to include safety content within nursing curricula, there is evidence that safety education remains inconsistent. This article develops an evidence-based patient-centered care model with safety as a vital component. It provides a framework and examples for associate degree nursing programs in which safety education can be embedded into existing student experiences and focused on the patient in an efficient, realistic manner. © 2015 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
Preparation of students to provide safe, high-quality nursing care is a universal underpinning of nursing education. A survey conducted by the National Council of State Boards of Nursing (2012) found a high degree of concurrence among nurse educators, newly licensed registered nurses, and nursing supervisors in the identification of selected safety content as the most important knowledge for nurses. Likewise, the Quality and Safety Education for Nurses (QSEN) initiative pointed out the vital nature of a set of competencies (Table 1) to promote safe patient care (Cronenwett et al., 2007). Extensive outreach and training conducted within the QSEN initiative stimulated the inclusion of explicit quality and safety learning outcomes into many nursing curricula. Yet, despite this promising progress, recent evidence suggests that learning experiences to meet quality and safety outcomes are inconsistently incorporated into many of our nursing programs (Tella et al., 2014).
There is little in the literature to suggest reasons for the apparent omission of quality and safety learning experiences from many programs of nursing education. One obvious consideration is that safety education is in competition for time and space in the curriculum with other emerging, evidence-based content. However, perhaps, there are less obvious issues that may lead us to instinctively emphasize other educational content over quality and safety. One of these issues might be that safety interventions are often constructed according to an industrial safety model, complete with clipboards, checklists, and feedback loops (Jorm, Dunbar, Sudano, & Travaglia, 2009). As we search for ways to implement expert recommendations that we contextualize nursing education within actual experiences of the patient (Benner, Sutphen, Leonard, & Day, 2010), we are finding it difficult to add one more classification system, checklist, or hierarchy of concepts to our classroom and clinical experiences. How do the seemingly task-oriented, mechanistic approaches to safety management fit within the nurse–patient relationship that we seek to foster?
1. The patient safety paradigm refocused ⁎ Corresponding author. E-mail address: [email protected]
One answer to the question regarding safety's place in nursing's world view is to conceptualize safety as one aspect
http://dx.doi.org/10.1016/j.teln.2014.08.002 1557-3087/© 2015 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
40
J.L. St. Onge, R.B. Parnell
Table 1
Table 3
QSEN competencies
Components of patient-centered care
Patient-centered care Teamwork and collaboration Evidence-based practice Quality improvement Safety Informatics
Respect and dignity Information sharing Participation Collaboration Note. Summarized from Institute for Patient and Centered Care (2010).
Note. Summarized from Cronenwett et al. (2007).
of a larger culture or model. Rather than viewing safety as predominantly related to surveillance, reminder systems, checklists, and risk assessments, perhaps we might view safety as one ongoing component of a multifaceted approach to personalized patient care. Such a conceptualization was found in a systematic, comprehensive meta-analysis of the literature seeking to describe a culture of safety (Sammer, Lykens, Singh, Mains, & Lackan, 2010). This review identified seven properties of a culture of safety. These properties are listed in Table 2. These identified properties of cultures of safety are similar and complementary to the quality and safety core competencies for nurses identified in the QSEN project (Cronenwett et al., 2007). Both of these approaches also overlap with evolving definitions of patient-centered care, which has been described as the process of partnering with patients and their families, involving them in their own health care decisions (Warren, 2012). In the often-quoted words of visionaries promoting patient empowerment, patient-centered care is simply, “Nothing about me without me” (Delbanco et al., 2001). Table 3 lists the core components of patientcentered care (Institute for Patient & Centered Care, 2010). Although the competencies and identified components of safe, patient-centered care (Tables 1–3) offer important content for nurse educators, they seem to call for an organizing framework to guide inclusion into nursing educational programs. Without such a model, we are at risk for simply teaching the suggested characteristics or competencies as knowledge to be memorized or as add-on content within an already full curriculum. In keeping with Benner et al.'s (2010) recommendation that educators continue to find ways to focus students upon the experiences of patients, it is proposed that we use a model that places patient-centered care at the core, with safety being one aspect of a patient-centered approach. Such a model is Table 2 Properties of a culture of safety Leadership Teamwork Evidence-based Communication Learning Just Patient-centered Note. Summarized from Sammer et al. (2010).
depicted in the Patient-Centered Safety Model (Fig. 1), which combines the components of patient-centered care, the QSEN competencies, and the properties of cultures of safety. The model is arranged to suggest interactive, multidirectional relationships among the various components. It is apparent in the model that some of its components extend beyond the model's core. That is because it is recognized that there are times that in-depth study may be required to increase understanding of a particular concept or activity. However, these avenues of study and inquiry are outside of the direct nurse–patient interaction and are not part of the primary focus upon the experience of the patient. In an associate degree nursing program, such study might be reserved for special projects or elective courses. Further examination of this model may offer one additional answer to our original question regarding why some schools of nursing do not appear to consistently teach safety content. Perhaps many educators have, as depicted in our model, embedded safety content so seamlessly within their student–patient experiences that descriptions of individual learning experiences do not reflect the culture of safety to which students are actually exposed. If this is the case, educators who apply these strategies are encouraged to more fully document and share them. For those of us who have not yet imbedded a patient-centered culture of safety into our students' educational experiences, or for those who seek additional strategies, the model and exemplars in this article may be of assistance. It is to be noted that all components depicted in the model have been identified as working synergistically among other components to drive high-quality, satisfying patient experiences. This article focuses on two of the components: patient-centered care and patient safety.
2. Patient-centered care and safety Patient-centered models of care have often been found to increase patient satisfaction, nurture trust in clinicians, and enhance perceived adequacy of communication (Walton & Barnsteiner, 2012). In addition, evidence has been emerging for over a decade linking patient-centered care to positive safety outcomes, including fewer adverse events and lower rates of complications (Ponte, Connor, DeMarco, & Price, 2004; Warren, 2012). In fact, the Institute for Healthcare Improvement identifies patient safety as one driver of
Patient-centered care and patient safety
41
Fig. 1
Patient-centered safety model.
exceptional, patient-centered care (Balik, Conway, Zipperer, & Watson, 2011). The National Patient Safety Foundation (2014) report on consumer engagement in patient safety points out that the level of safety in clinical care is an extremely personal experience for both patients and caregivers. The report states that the experiences of those patients and clinicians who participate in care at its best, as well as those who undergo adverse events, provide vital information needed to create safer patient encounters. Further, the report maintains that insights from these personal patient care experiences can only be gained within partnerships between the patients, their families, and caregivers. These deeply personal insights drive improvements in patient safety.
3. Implications for nurse educators Recognizing the mutually synergistic relationship between true patient-centered care and patient safety provides an opportunity for educators to integrate patient-centered safety activities throughout the curriculum. Although student projects, unexpected clinical events, and even elective courses may address specialized safety tools and analyses, development of a nursing school culture of safety must be a process of integrating a broad concept of safety as a necessary component of patient-centered care. This approach
is more encompassing than simply providing lectures on selected patient safety skills and concepts; nevertheless, it does not require a great deal of dedicated classroom or clinical time. It is simply part of assessing patients, planning and delivering care, and evaluating outcomes. Several examples are illustrative. Girdley, Johnsen, and Kwekkeboom (2009) developed a short set of patient-centered questions to include in students' nursing assessments. The questions were open ended, eliciting information from patients regarding their expectations of care, along with suggestions to improve their hospital stay. These questions were accompanied by a brief environmental safety scan where students and patients are able to mutually identify areas of concern. It is easy to envision how opening the health assessment to patient participation might uncover safety concerns held by the patient or family, even identifying issues not necessarily obvious to a caregiver. For example, a patient might recognize that the period between insulin administration and meal times in the hospital is longer than his or her own experience has found to be personally safe. Providing an opportunity for the patient to voice this concern might help avoid a possible dangerous episode of hypoglycemia. Several practice settings have found inclusion of patients in daily rounds, reports, and/or patient handoffs to be effective. Maxson, Derby, Wrobleski, and Foss (2012) found that inclusion of patients in bedside shift reports increased
42 patient satisfaction and improved nurse safety practices such as medication reconciliation and communication with the physician. An interdisciplinary team in a pediatric intensive care unit found that bedside rounds that included medical staff, nurses, patients, and families improved communication among all participants and increased the identification of discrepancies in medical orders by 26% (Licata et al., 2013). A patient-centered bedside transfer process was implemented in an emergency department with similar findings, including an increase in patient satisfaction scores and a significant decrease in errors related to the transfer process (CroninWaelde & Sbardella, 2013). Such approaches seem easily applied by students in a clinical practicum experience. Patients and students might be invited to update the nursing instructor together on patient progress throughout a clinical day. Students might include patients in a bedside handoff reports to the staff nurse at the end of the students' shift. The key point is for students to be comfortable planning, delivering, and evaluating care in full collaboration with the patient, rather than in an area away from the patient, accompanied only by handwritten notes or a stack of textbooks. The authors of this article, two instructors in adult health in an associate degree nursing program, have utilized an emotional intelligence model (Salovey & Mayer, 1990) to increase student understanding of patient-centered care and patient safety. In this experience, students are invited to role-play and reflect upon the experience of being a patient. In addition, students vicariously experience the feelings a patient and family member might undergo if they are involved in a patient care error. Since implementing these activities as part of clinical post-conferences and during the leadership seminar, we have noticed a marked increase in verbalizations of empathy and “connectedness” with the feelings of the patients, in particular to the need to be heard and appreciated. One student verbalized that she was better able to formulate a safe, patient-centered care plan by obtaining as much information as possible directly from the patient first, rather than searching clinical records. In addition, our students' objective scores on diagnostic NCLEX-style questions have increased in the area of patient safety. We hypothesize that emotionally connecting to the feelings of being a patient has sparked in our students an increased interest in finding ways to be more safe and patient centered. Opportunities to enmesh practical experiences of patientcentered care and patient safety in the educational arena are limited only by our imagination and the creativity of our students and our patients. Several of our clinical instructor colleagues have begun implementing the requirement that students' plans of nursing care be co-produced with patients and/or families as appropriate. Others are encouraging students to provide and discuss with patients literature available at the clinical facility, encouraging patients and families to use their voices when they have concerns about issues like staff handwashing or ordered medications.
J.L. St. Onge, R.B. Parnell Using a patient-centered approach does not have to end at the level of a course or a clinical rotation. Many hospitals using a patient-centered care model have recruited patient and family advisors for their patient care units and their committees, task groups, and design teams (Warren, 2012). Facilities that utilize such advisors report positive results, including increased reimbursement, higher patient satisfaction scores, and reduced lengths of stay. Imagine the possibilities of having patient and family advisors partner with educators within our school of nursing committees and work groups as we continuously seek better ways to serve our communities through the nurses we educate.
4. Summary Broadening the concept of patient care to include partnerships with patients can be integrated throughout a nursing curriculum. In addition, recognizing and applying the synergistic relationships among the various competencies needed to positively enhance the patient's experience, such as patient-centered care and patient safety, offer ways to apply more than one concept at a time in an efficient, yet contextually meaningful way. In doing so, we have the opportunity to continuously improve patient safety while heeding those nurse leaders who challenge us to transform nursing education by keeping patient experiences as the central focus of all that we do (Benner et al., 2010).
References Balik, B., Conway, J., Zipperer, L., & Watson, J. (2011). Achieving an exceptional patient and family experience of inpatient hospital care. IHI Innovation Series white paper Cambridge, Massachusetts: Institute for Healthcare Improvement. Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. Stanford, CA: Jossey-Bass. Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., et al. (2007). Quality and Safety Education for Nurses. Nursing Outlook, 55(3), 122−131. Cronin-Waelde, D., & Sbardella, S. (2013). Patient-centered transfer process for patients admitted through the ED boosts satisfaction, improves safety. ED Management, 24(2), 17−20. Delbanco, T., Berwick, D., Boufford, J., Edgman-Levitan, S., Ollenschläger, G., Plamping, D., et al. (2001). Healthcare in a land called PeoplePower: Nothing about me without me. Health Expectations, 4(3), 144−150. Girdley, D., Johnsen, C., & Kwekkeboom, K. (2009). Facilitating a culture of safety and patient-centered care through use of a clinical assessment tool in undergraduate nursing education. Journal of Nursing Education, 48(12), 702−705. Institute for Patient and Centered Care (2010). What are the core concepts of patient and family centered care? Retrieved 5/10/2014 from, http:// www.ipfcc.org/faq.html. Jorm, C., Dunbar, N., Sudano, L., & Travaglia, J. (2009). Should patient safety be more patient centred? Australian Health Review, 33(3), 390−399. Licata, J., Aneja, R., Kyper, C., Spencer, T., Tharp, M., Scott, M., et al. (2013). A foundation for patient safety: Phase I implementation of interdisciplinary bedside rounds in the pediatric intensive care unit. Critical Care Nurse, 33(3), 89−92.
Patient-centered care and patient safety Maxson, P., Derby, K., Wrobleski, D., & Foss, D. (2012). Bedside nurse-tonurse handoff promotes patient safety. Medsurg Nursing, 21(3), 140−144. National Council of State Boards of Nursing (2012). Report of Findings from the 2011 RN Nursing Knowledge Survey. Chicago: Author. National Patient Safety Foundation (2014). Safety is personal: Partnering with patients and families for the safest care. Boston: National Patient Safety Foundation's Lucian Leape Institute. Ponte, P., Connor, M., DeMarco, R., & Price, J. (2004). Linking patient and family-centered care and patient safety: The next leap. Nursing Economics, 22(4), 211−215. Salovey, P., & Mayer, J. (1990). Emotional intelligence. Imagination, Cognition, and Personality, 9(3), 185−211.
43 Sammer, C., Lykens, K., Singh, K., Mains, D., & Lackan, H. (2010). What is patient safety culture? A review of the literature. Journal of Nursing Scholarship, 44(2), 156−165. Tella, S., Liukka, M., Jamookeeah, D., Smith, N., Partanen, P., & Turunen, H. (2014). What do nursing students learn about patient safety? An integrative literature review. Journal of Nursing Education, 53(1), 7−13. Walton, M., & Barnsteiner, J. (2012). Patient-centered care. In G. Sherwood, & J. Barnsteiner (Eds.), Quality and safety in nursing: A competency approach to improving outcomes (pp. 67−89). Ames, IA: John Wiley & Sons, Inc. Warren, N. (2012). Involving patient and family advisors in the patient and family-centered care model. Medsurg Nursing, 21(4), 233−239.
www.jtln.org
Patient-centered care and patient safety: A model for nurse educators Judith L. St. Onge PhD, RN⁎, Robin B. Parnell PhD, RN Associate Degree Nursing Program, Troy University, Montgomery, AL 36104, USA KEYWORDS: Patient safety; Patient-centered care; Teaching safety
Abstract Safe practice is a basic goal of nursing education. Despite recent highly visible efforts to include safety content within nursing curricula, there is evidence that safety education remains inconsistent. This article develops an evidence-based patient-centered care model with safety as a vital component. It provides a framework and examples for associate degree nursing programs in which safety education can be embedded into existing student experiences and focused on the patient in an efficient, realistic manner. © 2015 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
Preparation of students to provide safe, high-quality nursing care is a universal underpinning of nursing education. A survey conducted by the National Council of State Boards of Nursing (2012) found a high degree of concurrence among nurse educators, newly licensed registered nurses, and nursing supervisors in the identification of selected safety content as the most important knowledge for nurses. Likewise, the Quality and Safety Education for Nurses (QSEN) initiative pointed out the vital nature of a set of competencies (Table 1) to promote safe patient care (Cronenwett et al., 2007). Extensive outreach and training conducted within the QSEN initiative stimulated the inclusion of explicit quality and safety learning outcomes into many nursing curricula. Yet, despite this promising progress, recent evidence suggests that learning experiences to meet quality and safety outcomes are inconsistently incorporated into many of our nursing programs (Tella et al., 2014).
There is little in the literature to suggest reasons for the apparent omission of quality and safety learning experiences from many programs of nursing education. One obvious consideration is that safety education is in competition for time and space in the curriculum with other emerging, evidence-based content. However, perhaps, there are less obvious issues that may lead us to instinctively emphasize other educational content over quality and safety. One of these issues might be that safety interventions are often constructed according to an industrial safety model, complete with clipboards, checklists, and feedback loops (Jorm, Dunbar, Sudano, & Travaglia, 2009). As we search for ways to implement expert recommendations that we contextualize nursing education within actual experiences of the patient (Benner, Sutphen, Leonard, & Day, 2010), we are finding it difficult to add one more classification system, checklist, or hierarchy of concepts to our classroom and clinical experiences. How do the seemingly task-oriented, mechanistic approaches to safety management fit within the nurse–patient relationship that we seek to foster?
1. The patient safety paradigm refocused ⁎ Corresponding author. E-mail address: [email protected]
One answer to the question regarding safety's place in nursing's world view is to conceptualize safety as one aspect
http://dx.doi.org/10.1016/j.teln.2014.08.002 1557-3087/© 2015 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
40
J.L. St. Onge, R.B. Parnell
Table 1
Table 3
QSEN competencies
Components of patient-centered care
Patient-centered care Teamwork and collaboration Evidence-based practice Quality improvement Safety Informatics
Respect and dignity Information sharing Participation Collaboration Note. Summarized from Institute for Patient and Centered Care (2010).
Note. Summarized from Cronenwett et al. (2007).
of a larger culture or model. Rather than viewing safety as predominantly related to surveillance, reminder systems, checklists, and risk assessments, perhaps we might view safety as one ongoing component of a multifaceted approach to personalized patient care. Such a conceptualization was found in a systematic, comprehensive meta-analysis of the literature seeking to describe a culture of safety (Sammer, Lykens, Singh, Mains, & Lackan, 2010). This review identified seven properties of a culture of safety. These properties are listed in Table 2. These identified properties of cultures of safety are similar and complementary to the quality and safety core competencies for nurses identified in the QSEN project (Cronenwett et al., 2007). Both of these approaches also overlap with evolving definitions of patient-centered care, which has been described as the process of partnering with patients and their families, involving them in their own health care decisions (Warren, 2012). In the often-quoted words of visionaries promoting patient empowerment, patient-centered care is simply, “Nothing about me without me” (Delbanco et al., 2001). Table 3 lists the core components of patientcentered care (Institute for Patient & Centered Care, 2010). Although the competencies and identified components of safe, patient-centered care (Tables 1–3) offer important content for nurse educators, they seem to call for an organizing framework to guide inclusion into nursing educational programs. Without such a model, we are at risk for simply teaching the suggested characteristics or competencies as knowledge to be memorized or as add-on content within an already full curriculum. In keeping with Benner et al.'s (2010) recommendation that educators continue to find ways to focus students upon the experiences of patients, it is proposed that we use a model that places patient-centered care at the core, with safety being one aspect of a patient-centered approach. Such a model is Table 2 Properties of a culture of safety Leadership Teamwork Evidence-based Communication Learning Just Patient-centered Note. Summarized from Sammer et al. (2010).
depicted in the Patient-Centered Safety Model (Fig. 1), which combines the components of patient-centered care, the QSEN competencies, and the properties of cultures of safety. The model is arranged to suggest interactive, multidirectional relationships among the various components. It is apparent in the model that some of its components extend beyond the model's core. That is because it is recognized that there are times that in-depth study may be required to increase understanding of a particular concept or activity. However, these avenues of study and inquiry are outside of the direct nurse–patient interaction and are not part of the primary focus upon the experience of the patient. In an associate degree nursing program, such study might be reserved for special projects or elective courses. Further examination of this model may offer one additional answer to our original question regarding why some schools of nursing do not appear to consistently teach safety content. Perhaps many educators have, as depicted in our model, embedded safety content so seamlessly within their student–patient experiences that descriptions of individual learning experiences do not reflect the culture of safety to which students are actually exposed. If this is the case, educators who apply these strategies are encouraged to more fully document and share them. For those of us who have not yet imbedded a patient-centered culture of safety into our students' educational experiences, or for those who seek additional strategies, the model and exemplars in this article may be of assistance. It is to be noted that all components depicted in the model have been identified as working synergistically among other components to drive high-quality, satisfying patient experiences. This article focuses on two of the components: patient-centered care and patient safety.
2. Patient-centered care and safety Patient-centered models of care have often been found to increase patient satisfaction, nurture trust in clinicians, and enhance perceived adequacy of communication (Walton & Barnsteiner, 2012). In addition, evidence has been emerging for over a decade linking patient-centered care to positive safety outcomes, including fewer adverse events and lower rates of complications (Ponte, Connor, DeMarco, & Price, 2004; Warren, 2012). In fact, the Institute for Healthcare Improvement identifies patient safety as one driver of
Patient-centered care and patient safety
41
Fig. 1
Patient-centered safety model.
exceptional, patient-centered care (Balik, Conway, Zipperer, & Watson, 2011). The National Patient Safety Foundation (2014) report on consumer engagement in patient safety points out that the level of safety in clinical care is an extremely personal experience for both patients and caregivers. The report states that the experiences of those patients and clinicians who participate in care at its best, as well as those who undergo adverse events, provide vital information needed to create safer patient encounters. Further, the report maintains that insights from these personal patient care experiences can only be gained within partnerships between the patients, their families, and caregivers. These deeply personal insights drive improvements in patient safety.
3. Implications for nurse educators Recognizing the mutually synergistic relationship between true patient-centered care and patient safety provides an opportunity for educators to integrate patient-centered safety activities throughout the curriculum. Although student projects, unexpected clinical events, and even elective courses may address specialized safety tools and analyses, development of a nursing school culture of safety must be a process of integrating a broad concept of safety as a necessary component of patient-centered care. This approach
is more encompassing than simply providing lectures on selected patient safety skills and concepts; nevertheless, it does not require a great deal of dedicated classroom or clinical time. It is simply part of assessing patients, planning and delivering care, and evaluating outcomes. Several examples are illustrative. Girdley, Johnsen, and Kwekkeboom (2009) developed a short set of patient-centered questions to include in students' nursing assessments. The questions were open ended, eliciting information from patients regarding their expectations of care, along with suggestions to improve their hospital stay. These questions were accompanied by a brief environmental safety scan where students and patients are able to mutually identify areas of concern. It is easy to envision how opening the health assessment to patient participation might uncover safety concerns held by the patient or family, even identifying issues not necessarily obvious to a caregiver. For example, a patient might recognize that the period between insulin administration and meal times in the hospital is longer than his or her own experience has found to be personally safe. Providing an opportunity for the patient to voice this concern might help avoid a possible dangerous episode of hypoglycemia. Several practice settings have found inclusion of patients in daily rounds, reports, and/or patient handoffs to be effective. Maxson, Derby, Wrobleski, and Foss (2012) found that inclusion of patients in bedside shift reports increased
42 patient satisfaction and improved nurse safety practices such as medication reconciliation and communication with the physician. An interdisciplinary team in a pediatric intensive care unit found that bedside rounds that included medical staff, nurses, patients, and families improved communication among all participants and increased the identification of discrepancies in medical orders by 26% (Licata et al., 2013). A patient-centered bedside transfer process was implemented in an emergency department with similar findings, including an increase in patient satisfaction scores and a significant decrease in errors related to the transfer process (CroninWaelde & Sbardella, 2013). Such approaches seem easily applied by students in a clinical practicum experience. Patients and students might be invited to update the nursing instructor together on patient progress throughout a clinical day. Students might include patients in a bedside handoff reports to the staff nurse at the end of the students' shift. The key point is for students to be comfortable planning, delivering, and evaluating care in full collaboration with the patient, rather than in an area away from the patient, accompanied only by handwritten notes or a stack of textbooks. The authors of this article, two instructors in adult health in an associate degree nursing program, have utilized an emotional intelligence model (Salovey & Mayer, 1990) to increase student understanding of patient-centered care and patient safety. In this experience, students are invited to role-play and reflect upon the experience of being a patient. In addition, students vicariously experience the feelings a patient and family member might undergo if they are involved in a patient care error. Since implementing these activities as part of clinical post-conferences and during the leadership seminar, we have noticed a marked increase in verbalizations of empathy and “connectedness” with the feelings of the patients, in particular to the need to be heard and appreciated. One student verbalized that she was better able to formulate a safe, patient-centered care plan by obtaining as much information as possible directly from the patient first, rather than searching clinical records. In addition, our students' objective scores on diagnostic NCLEX-style questions have increased in the area of patient safety. We hypothesize that emotionally connecting to the feelings of being a patient has sparked in our students an increased interest in finding ways to be more safe and patient centered. Opportunities to enmesh practical experiences of patientcentered care and patient safety in the educational arena are limited only by our imagination and the creativity of our students and our patients. Several of our clinical instructor colleagues have begun implementing the requirement that students' plans of nursing care be co-produced with patients and/or families as appropriate. Others are encouraging students to provide and discuss with patients literature available at the clinical facility, encouraging patients and families to use their voices when they have concerns about issues like staff handwashing or ordered medications.
J.L. St. Onge, R.B. Parnell Using a patient-centered approach does not have to end at the level of a course or a clinical rotation. Many hospitals using a patient-centered care model have recruited patient and family advisors for their patient care units and their committees, task groups, and design teams (Warren, 2012). Facilities that utilize such advisors report positive results, including increased reimbursement, higher patient satisfaction scores, and reduced lengths of stay. Imagine the possibilities of having patient and family advisors partner with educators within our school of nursing committees and work groups as we continuously seek better ways to serve our communities through the nurses we educate.
4. Summary Broadening the concept of patient care to include partnerships with patients can be integrated throughout a nursing curriculum. In addition, recognizing and applying the synergistic relationships among the various competencies needed to positively enhance the patient's experience, such as patient-centered care and patient safety, offer ways to apply more than one concept at a time in an efficient, yet contextually meaningful way. In doing so, we have the opportunity to continuously improve patient safety while heeding those nurse leaders who challenge us to transform nursing education by keeping patient experiences as the central focus of all that we do (Benner et al., 2010).
References Balik, B., Conway, J., Zipperer, L., & Watson, J. (2011). Achieving an exceptional patient and family experience of inpatient hospital care. IHI Innovation Series white paper Cambridge, Massachusetts: Institute for Healthcare Improvement. Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. Stanford, CA: Jossey-Bass. Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., et al. (2007). Quality and Safety Education for Nurses. Nursing Outlook, 55(3), 122−131. Cronin-Waelde, D., & Sbardella, S. (2013). Patient-centered transfer process for patients admitted through the ED boosts satisfaction, improves safety. ED Management, 24(2), 17−20. Delbanco, T., Berwick, D., Boufford, J., Edgman-Levitan, S., Ollenschläger, G., Plamping, D., et al. (2001). Healthcare in a land called PeoplePower: Nothing about me without me. Health Expectations, 4(3), 144−150. Girdley, D., Johnsen, C., & Kwekkeboom, K. (2009). Facilitating a culture of safety and patient-centered care through use of a clinical assessment tool in undergraduate nursing education. Journal of Nursing Education, 48(12), 702−705. Institute for Patient and Centered Care (2010). What are the core concepts of patient and family centered care? Retrieved 5/10/2014 from, http:// www.ipfcc.org/faq.html. Jorm, C., Dunbar, N., Sudano, L., & Travaglia, J. (2009). Should patient safety be more patient centred? Australian Health Review, 33(3), 390−399. Licata, J., Aneja, R., Kyper, C., Spencer, T., Tharp, M., Scott, M., et al. (2013). A foundation for patient safety: Phase I implementation of interdisciplinary bedside rounds in the pediatric intensive care unit. Critical Care Nurse, 33(3), 89−92.
Patient-centered care and patient safety Maxson, P., Derby, K., Wrobleski, D., & Foss, D. (2012). Bedside nurse-tonurse handoff promotes patient safety. Medsurg Nursing, 21(3), 140−144. National Council of State Boards of Nursing (2012). Report of Findings from the 2011 RN Nursing Knowledge Survey. Chicago: Author. National Patient Safety Foundation (2014). Safety is personal: Partnering with patients and families for the safest care. Boston: National Patient Safety Foundation's Lucian Leape Institute. Ponte, P., Connor, M., DeMarco, R., & Price, J. (2004). Linking patient and family-centered care and patient safety: The next leap. Nursing Economics, 22(4), 211−215. Salovey, P., & Mayer, J. (1990). Emotional intelligence. Imagination, Cognition, and Personality, 9(3), 185−211.
43 Sammer, C., Lykens, K., Singh, K., Mains, D., & Lackan, H. (2010). What is patient safety culture? A review of the literature. Journal of Nursing Scholarship, 44(2), 156−165. Tella, S., Liukka, M., Jamookeeah, D., Smith, N., Partanen, P., & Turunen, H. (2014). What do nursing students learn about patient safety? An integrative literature review. Journal of Nursing Education, 53(1), 7−13. Walton, M., & Barnsteiner, J. (2012). Patient-centered care. In G. Sherwood, & J. Barnsteiner (Eds.), Quality and safety in nursing: A competency approach to improving outcomes (pp. 67−89). Ames, IA: John Wiley & Sons, Inc. Warren, N. (2012). Involving patient and family advisors in the patient and family-centered care model. Medsurg Nursing, 21(4), 233−239.