Mike Nolan: how relationship-centred care can improve patient outcomes
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This document discusses relationship-centered care and creating an environment where all people, including older adults, family, staff, and students, feel a sense of security, belonging, continuity, purpose, achievement, and significance. It argues that relational practice must be a core goal and benchmark for success in order to improve outcomes for patients, staff, and family carers. Leading by example and creating a shared philosophy that values holistic, relational care can help establish an "enriched environment" where all parties feel their relationships and contributions are meaningful.
Mike Nolan: how relationship-centred care can improve patient outcomes
- 1. Relationship-centred care: Improving outcomes for patients, staff and family carers by Mike Nolan Professor of Gerontological Nursing The King’s Fund, November 2012
- 2. You can’t discuss something with someone whose arguments are too narrow
- 3. Caring in crisis? • Commission on Dignity in Care (2012) • Losing sight of the value of ‘fundamental’ care (Davies et al 1999) • Quick fix, target driven NHS (RCN 2008, NMC 2009) • Technocratic solutions- incentives, penalties, regulations- ‘fundamentally miss the point’ (Goodrich and Cornwell 2008) • Impressive technical advances but failing at a ‘fundamental level’ (Youngson 2007, 2008)
- 4. What is the solution? • Culture change • Buzzwords of the 21st century (Stone 2003) • Social Movement (Meyer and Owen 2008) • New core values – compassion (Darzi Report) • Highly complex • Attend to ‘complex social interactions’ (Powell et al 2009) • Fundamentally ‘relational concepts’, requires ‘relational practice’ (Patterson et al 2011)
- 5. Time to question the values • Independence, well-being and choice • ‘Cultural glue’ • Consistent with other concepts in academic and policy literatures • Autonomy and independence • What of interdependence? • Is person-centred care appropriate?
- 6. The roots of ‘person-centred’ care • Pioneering work of Tom Kitwood, Bradford Dementia Group – Dawn Brooker • See the person not the disease • Creating a positive environment of care • Original vision not consistent with current usage • Little more than a political slogan (Burstow 2006)
- 7. The Senses Framework and relationship-centred care • Developed over a 25 year period • Intellectual itch - What provides a sense of therapeutic direction for staff in LTC environments? • Cure • Rehabilitation • ‘Good geriatric care’ (Reed and Bond 1991) or ‘Endless residual care’ (Evers 1981)
- 8. Creating an ‘enriched environment’ • Security – to feel safe physically, psychologically, existentially • Belonging – to feel part of a valued group, to maintain or form important relationships • Continuity – to be able to make links between the past, present and future • Purpose – to enjoy meaningful activity, to have valued goals • Achievement – to reach valued goals to satisfaction of self and/or others • Significance – to feel that you ‘matter’ and are accorded value and status
- 9. “ Traditional treatment models lead to fractionalisation of the patient” “As synthesisers of care we are in the business of creating the right environment for others to grow”
- 10. Creating the right environment for others to grow? • Not just ‘others’ but everyone ‘If employees are abandoned and abused, probably clients will be too. If employees are supported and encouraged they will take their sense of well-being into their day-to-day work’. (Kitwood 1997)
- 11. Filling in the gaps Older Family Staff Students people carers Security Belonging Continuity Purpose Achievement Significance
- 12. Towards relationship-centred care Tresolini and the Pew-Fetzer Task Force 1994 • Major review of the bases for health care systems and the way that practitioners operate and are trained • Relationship-centred care • Relational Practice
- 13. Modelling change Leadership Unit Outcome • Lead by Philosophy Staff-morale/ motivation Example → Resources → Patient Involvement Family • Support from Team working Matron The Top Workload Support
- 14. ‘The leadership role of the ward sister nurse/charge nurse is crucial’ (Commission on Dignity in Care) Ward leaders need to: • Instil pride/focus on what we do well • Improve confidence/Positive feedback • Considers teams’ interests in decisions • Consult widely • Clear and explicit standards
- 15. • Caring and supportive • Promote excellence • Clear goals and objectives • Readily available to staff • Coach individual performance • Directly involved in care delivery
- 16. Creates an environment in which: • Staff share a philosophy • Value holistic care • Communicate goals to new members • Involve users/family • Focus on people not tasks
- 17. The ‘Senses’, relational practice and improved outcomes • Does policy promote an enriched environment? • Significance – does relational practice matter? • Purpose – is relational practice seen as a core goal? • Achievement – is relational practice a key benchmark for success?
- 18. • Continuity – is relational practice embedded in care? • Belonging – is relational practice shared with and between disciplines? • Security – are the potential vulnerabilities of relational practice acknowledged and addressed?
- 19. Reconfiguring the direction of care Significance Security Purpose Belonging Achievement Continuity Define our direction of Define the conditions travel needed to arrive Culture of care Climate of care