To Know and Honor: (eBook)

Building a Culture of Person-Centered Decision-Making

Linda Briggs (Autor)

eBook Download: EPUB

2021 | 1. Auflage
478 Seiten
Bookbaby (Verlag)
978-1-6678-0173-5 (ISBN)

Infos

What does it mean to provide 'person-centered care?' There is no imperative more important than keeping promises to our patients; promises that pledge to provide care and treatment consistent with their goals, values, beliefs and decisions. But keeping promises to our patients and their families is no easy task and requires a commitment to building a culture of person-centered decision making that is focused on discovering 'what matters most' instead of 'what is the matter with you?' Through personal stories, implementation experiences, and consultations with healthcare and community leaders around the world, the co-creator of the Respecting Choices program illustrates the key elements in designing a person-centered decision-making system that has the power to transform the way healthcare is delivered.

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Over the past three decades, a plethora of programs, guidelines, tools, and techniques have emerged to improve person-centered care: "e;Care that is respectful of and responsive to individual patient preferences, needs, and values, ensuring that patient values guide all clinical decisions"e; (Institute of Medicine. Crossing the Quality Chasm). Yet, implementation remains largely an aspiration. Individual's goals and values are often unknown, which leads to uncertainty, over and under treatment, avoidable suffering, increased costs of care, and moral distress for healthcare providers. Fulfilling the promise of person-centered care mandates the creation of a culture that seamlessly integrates person-centered decision-making programs to assist individual in making current and future healthcare decisions and designs systems capable of knowing and honoring an individuals' goals and values. Creating this culture is no easy taskThe co-creator of the nationally recognized Respecting Choices program shares twenty years of implementation experience creating a national curriculum and consulting with over thirty organizations around the U.S. and in five countries to disseminate the principles of two person-centered decision-making programs, Advance Care Planning (ACP) and Shared Decision-Making in Serious Illness. The perspectives and lessons learned are not intended as a panacea to resolve the daunting challenge in creating cultural transformation, but to promote conversation and consensus on the work yet to be done. The Respecting Choices "e;Promises"e; framework is used to explore five elements in building a culture of person-centered decision-making: leadership, system redesign, education and competency, community engagement , and continuous quality improvement.

Textauszug

Chapter 1: Preparation for an Undefined Future

Why Nursing?

When my granddaughter was four years old, she announced, “Gamma, when I grow up, I want to be a nurse (or maybe a doctor), a schoolteacher, a piano and gymnastics teacher, and a firefighter.” I smiled, proud of her diverse aspirations, and responded with the feminist platitude, “Camryn, you can be anything you want to be.”

This was not the message that I received as a high school senior contemplating my future after graduation from a Catholic high school in a small Iowa town. I loved the sciences, especially biology, and was encouraged by the school counselor to be a nurse, or the only other alternative, a teacher. Although my career path exploration was not remotely close to Camryn’s world of possibilities, nursing seemed a good fit. Nursing offered a path to fulfill my altruistic nature, but I will avow that in 1970, my motivations were more egocentric. I wanted to move as far away as possible from the small Iowa town in which I grew up.

Needing tuition assistance, I enrolled in the only college that gave me a scholarship. I was the first sibling in the family who aspired to a four-year education, despite my father’s directive that I become a licensed practical nurse (LPN), because “a nurse is a nurse.” His insistence on my becoming an LPN was one more incentive for me to do the opposite, despite the ten years I would spend repaying four years of student loans. Subliminal at the time, or just the luck of the draw, the decision to pursue a Bachelor of Science degree in nursing was the perfect pathway. I had no idea how perfect.

I entered nursing education in the 1970s, a time when nurses still wore uniforms. During clinical rotations in the hospital, the female nurses wore white hats (with cool blue stripes), navy blue uniforms with huge white aprons (not so cool), white nylons, and spotless white shoes. Four years later, while leaving behind these nursing symbols at the graduation ceremony, I never left behind the pride and promise of being a nurse. This pride was energized by several remarkable mentors I encountered in my professional life that you will meet throughout this book.

The first was a unique female nun in the Catholic college I attended. Contrary to the stilted education I thought I would receive in this religious institution, I was “blessed” to encounter the smartest woman I had ever met. She guided my classmates and me to comprehend that being a caring nurse (although a quintessential quality) was insufficient to fulfill the ethos of nursing — the protection, promotion and optimization of health, prevention of illness, and alleviation of suffering through the diagnosis and treatment of human responses and advocacy in the care of individuals, families, communities, and populations (ANA definition).

She insisted that we understand what we were doing and embrace the science behind our nursing actions. She taught human anatomy, biology, and my personal favorite, physiology. She fueled my desire to grasp how the body worked: how an antibiotic could fight an infection, the gate control theory of pain, the precise muscle in the buttocks in which I would give my first intramuscular injection, the function of the mitochondria as the powerhouse of the cells, and how heart failure complications could lead to kidney disease. I was intrigued with how this knowledge could abet my promise to be a patient advocate, allow me to be an effective liaison between the patient, family, and healthcare team, and help me prevent complications and avoid suffering.

I begged to be one of the student nurses assigned to one of the limited intensive care unit clinical rotations that were available. The four days that I spent in the ICU sealed my career pathway for the next 25 years. Upon graduation, I was fortunate to be offered a position in a medical-surgical critical care unit. The environment was energizing. Exposure to state-of-the-art technology and science. Fast-paced. Intelligence required. New graduates were scheduled on the night shift, and while initially, I thought this was a penalty, it was an unforeseen advantage to be paired with a seasoned nurse.

Night after night, she challenged me to be a critical thinker, to anticipate problems, and to react quickly and competently to impending disaster. While sitting in front of the cardiac monitors one evening, I spotted ventricular tachycardia from one of my patients. Proud that I had recognized this lethal arrhythmia, I sat motionless. Recognizing the fear on my face, my mentor calmly said, “You know what to do. I will be right behind you.”

I will never forget the impact of that first defibrillation and my patient’s heart returning to sinus rhythm. He opened his fear-filled eyes, asking, “What happened to me?” He was totally unaware that my hands were still shaking, that I was amazed the defibrillation worked, and that I was more frightened than he was.

I was hooked. I immediately wanted to learn more and enrolled in a graduate-level histology course, a preclinical requirement for medical students. The plan was to begin post-graduate education while gaining clinical experience in critical care. It was a two-hour early morning course following the night shift, and the activity of looking under a microscope and identifying cells, tissues, and organs kept me wide awake.

I was intrigued with how the structure of epithelial cells, cilia, neutrophils, and plasma cells influenced their biologic function and clinical presentation. I now understood how the cilia (those tiny hairs that line the inside of bronchial tubes) of patients with chronic bronchitis had been destroyed and were unable to function normally to move mucous upward and out of the bronchi. It now made sense to me why we needed to treat the infection that caused the cilia inflammation, why we needed to ensure adequate hydration to liquefy the mucus, and why we had to assist with the removal of the copious amounts of mucous that were interfering with oxygen transport.

This interest sounds nerdy to me now, but my clinical experience enhanced my ability to immediately integrate this information in practical ways. I was surrounded by first-year medical students who, with little clinical experience, often probed me on my latest ICU adventures. During this semester-long course, I encountered a recurring question I would hear over the years, “Linda, you are so smart, why don’t you become a doctor?” I have known many nurse colleagues who have, like me, bristled at the mere implication that nurses do not need to be smart. But this unwitting question is likely what sparked my cravings to advance my knowledge and contribute to the credibility of the nursing profession. And I was fortunate to receive a federal grant to pursue a master’s degree in nursing.

The Power of Research

Over the next two years in graduate school, I constructed a variety of experiences that would assimilate my thirst for critical care expertise with organizational culture, research, and leadership. As is the case for many women, I confronted the challenge of integrating professional aspirations with the joys of motherhood. I always knew I wanted to be a mother but did not envisage becoming pregnant during my first year in graduate school. Joshua was not due to be born until the end of my first year, allowing me to orchestrate my class schedule so that I would complete the required exams and clinicals before he was born.

However, my son had different plans, deciding to make his entrance into the world one month premature — and one week prior to a midterm exam. Hoping that labor would be stalled, I brought study materials with me to the hospital. (They remained unopened in a pile on the bedside stand.) Despite my notice to the nursing instructor of my situation, she was not sympathetic and informed me that I would need to accept an incomplete if I could not be present for the exam. My stubborn attitude forced me to forge ahead, showing up at the exam just four days after Joshua was born and begrudgingly accepting the first “B” of my graduate education. This would not be the last time that my children would teach me the value of setting priorities.

During this graduate education, I was exposed to research, and the requirement to choose a topic for my master’s level thesis. There was a plethora of critical care topics I could have chosen, but I was intrigued with the nebulous issues surrounding informed consent. While my nursing career began in an age of paternalism, a person’s right to self-determination through the process of informed consent was being scrutinized in the courts.

The case of Canterbury v. Spence was one landmark case that changed the informed consent standards.1 Canterbury suffered permanent paralysis after a laminectomy performed by Dr. William Spence. Canterbury sued for malpractice based on negligence, claiming he had never been informed of the risk of paralysis. During his trial, the defense team could not provide an expert witness, likely the result of a “conspiracy of silence” that thwarted physicians from testifying against other physicians. Moreover, Dr. Spence admitted that he had only informed Canterbury of the risk of weakness (not paralysis) for fear he would not consent to the surgery. Although the jury ruled against Canterbury, the ramifications of this case left their mark on the clinical and legal landscape.

The disclosure standard for informed consent formally shifted from a “professional practice” standard (revealing information that a reasonable physician would provide) to...

Produkt-Details

• Erscheint lt. Verlag: 19.11.2021
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Allgemeines / Lexika
• ISBN-10: 1-6678-0173-2 / 1667801732
• ISBN-13: 978-1-6678-0173-5 / 9781667801735