Thesis advisor: Dorothy A. Jones / Purpose: The purpose of this study was to define, develop, and psychometrically evaluate a scale designed to measure Nurse’s Perception of the Relationship Based Care Environment. Background: Relationship is a complex multidimensional concept. It is a critical component of professional practice and core to the interaction between nurse and patient. While there are a number of scales available to measure different dimensions of relationships between nurses and other groups there is no one scale that captures multiple dimensions. Methods: Based on a review of the literature and an earlier qualitative study, a theoretical representation was developed. This representation became the framework for development of elements and items for the NPRBCE scale. The content validity of the NPRBCE scale was determined by an expert panel of Registered Nurses. Four hundred and seventy three Registered Nurse participants completed the survey. Analysis: Data were subjected to Principal Components Analysis and Cronbach’s alpha was computed to determine reliability of the scale as a whole and each of the components of the scale. Results: The final solution was a five component 56-item scale. The five components include: nurse/ other discipline; nurse/organization; nurse/ nurse; nurse/ patient- knowing the patient; and nurse/patient-respecting the patient. The scale as a whole and each of the resulting components were found to be reliable. The components were parsimonious and interpretable. Keywords: relationship based care, relationship centered care, nurse practice environment / Thesis (PhD) — Boston College, 2016. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

The power to communicate effectively and respectfully in the health care setting promotes job satisfaction, retention, and healthy relationships. Ineffective communication is one of the major causes of sentinel events, incivility, nurse turnover, and workplace hostility in the health care environment. This project examined a communication competence educational program on a spinal cord injury (SCI) nursing department and its potential to improve communication competence. The project question explored whether an educational series on incivility and creating healthy relationships would increase communication competence in nurses on the SCI unit. The project used the high reliability solutions for health care model communications improvement and creative health care management tools. The oppressed group behavior theory was used to inform this project by providing an understanding of why nursing staff may experience hostility toward one another and lack effective communication skills to promote a healthy working environment. The dauntless survey questionnaire was used pre and posteducational intervention, and the results were analyzed to assess the effects of using descriptive statistics. The educational intervention reached 81 SCI nursing staff members. Results showed a 13% increase in the staff feelings of confidence when speaking up to their peers and physicians, a 3% increase in knowing what to say when difficult situations arose, and an 11% increase in feeling competent regarding their communication skills. The findings of this project may promote social change by improving communication by the team leader, charge nurse, assistance manager, and nursing staff during shift change, walking rounds, and huddles.

Thesis advisor: Dorothy Jones / A family's unique way of being, formulated through social, economic, environmental and political factors, becomes fractured during a loved one's critical illness. Family members experience burdensome physical and emotional symptoms as they transition through the marked uncertainty endemic to high acuity illness. For some, this burden results in long term psychiatric disturbances. Assessment tools and interventions have been proposed for family members experiencing a loved one's critical illness. However, ongoing suffering suggests inherent limitations within these reductionist approaches. The need for a more encompassing disciplinary perspective is suggested. Margaret Newman's (1986, 1994, 2008) theory of Health as Expanding Consciousness (HEC) and its praxis research method was employed to explore relationship based care among intensive care unit (ICU) family members and registered nurses. HEC retains person/environmental integrity through unfolding of unitary knowledge via exploration of meaning. Additionally, its holistic perspective aligns philosophically with the belief in nursing science as the study of caring in the human health experience, endorsing both the mutuality of the nurse/client relationship and pattern recognition's capacity to inspire transformational growth. The study was performed in an eighteen bed medical ICU in the northeast region of the United States. This unit's design includes an integrated critical/palliative care model. Exploration of the study's two research questions was accomplished using the practice and research components of HEC within a sample of eight family members and six registered nurses. Results demonstrated family members' capacity to achieve consciousness expansion within the context of a loved one's critical illness. Registered nurses revealed their ability to steadfastly partner with both patients and families. Repetitive elements distinguished as thematic commonalities were recognized among both family member and registered nurse participants. Additionally, thematic integration between family members and registered nurses was appreciated. HEC was found to offer unique insights into caring relationships between ICU family members and registered nurses. / Thesis (PhD) — Boston College, 2014. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

The Design and Implementation of a Relationship-Based Care Delivery Model on a Medical- Surgical Unit by Paula A. Rodney MSN, California University of Pennsylvania, 2011 BSN, University of Virginia, 1979 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University April 2015   Patient satisfaction and clinical outcomes have become important issues in healthcare since the introduction of the Value Based Purchasing Program. Patient satisfaction, as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, was declining and hospital-acquired pressure ulcers (HAPU), falls, and catheter-associated urinary tract infections (CAUTI) were rising on the pilot unit. The purpose of this non-experimental correlational design quality improvement project was to combine information from focus groups, a content analysis of the literature on Kristen Swanson's theory of caring, and relationship-based care, to develop and implement a relationship-based care delivery model. An additional aim was to determine its impact on patient satisfaction and the reduction of HAPU, falls, and CAUTI. The model was designed and implemented by a team consisting of bedside care providers, leaders, an educator, and a student facilitator. The components of the model included scheduling for continuity of care, whiteboards, seated bedside report, hourly rounding, a nurse advocate, and 5 focused minutes of attention per shift. Descriptive statistics were used to determine the mean change in HCAHPS scores before and after implementation of the model, and revealed improvements in dimensions of communication with nursing by 13.2%, responsiveness by 12.5%, overall rating of care by 14.5%, and willingness to recommend by 8.7%. The result of audits of the pilot unit's medical records indicated a reduction in falls by 3, HAPU by 2, and CAUTI by 2 from August, the baseline month. As a result of these findings the model will be implemented on all inpatient nursing units. The target audience for this project includes nursing leaders, educators, and bedside providers with interest in patient-centered care and staff empowerment.

Leaders of a rural Southwest Oklahoma hospital requested the development of an evidence-based program that could transform unit charge nurses into effective leaders in order to improve the leadership of direct care nurses. Nursing executive leadership discovered staff members were demonstrating high levels of stress, dissatisfaction, and burnout. Press-Ganey survey results revealed that staff felt they were not supported and did not believe nurses cared for patients' or other co-workers' well-being or safety. The Hospital Consumer Assessment of Healthcare Providers and Systems outcome scores, which were below hospital and national desired benchmarks, revealed that patients were not satisfied with the care they received. Thus, the goal of this project was to use evidence to craft a program and evaluation plan that could be used by the hospital to develop stronger charge nurse leaders. A detailed examination of evidence supported the development of a program based on the relationship-based care (RBC) model. The RBC model is a transformational leadership development program that increases leadership skills and positive interaction between people. A full program was adapted from the RBC model and designed for the rural hospital. An evaluation plan to measure the short-and long-term objectives was developed. Implementation is expected to create social change by imparting charge nurses with leadership and relationship skills, thus empowering them with greater abilities to provide care. Benner's novice to expert and Watson's theory of caring models served as the foundation of the RBC model. The goal is to present the results at the hospital level and to disseminate the findings locally at professional nursing leadership conferences.

The purpose of this project was to evaluate the effects of relationship-based care (RBC) on patient satisfaction. RBC is a caring model that promotes a caring and healing environment by establishing and maintaining therapeutic relationships between patient, self, and coworker. The Centers for Medicare & Medicaid Services links Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores with reimbursement to hospitals. It is essential to not only achieve high patient satisfaction scores in order to ensure full financial reimbursement, but also to ensure high quality, patient-centered care. The current project assessed samples from 2 medical surgical groups, one system-wide and the other only patients from a single inpatient unit with sample sizes approximately 2,900 and 250 respectively. Data were collected retrospectively 3 times using the Press Ganey webpage at pre implementation, 6 months, and 12 months post RBC training. Results from an ANOVA indicated only a slight increase in post intervention HCAHPS scores with no statistical significant improvement. However, this increase indicates a positive trend, suggesting that the implementation of RBC may have assisted in improving patient responses. This evaluation has implications for the continued implementation for the enhancement of patient-centered care. These findings suggest that a nursing care model provides a collective belief to define a specific attitude to deliver care, facilitate professional development, and improve outcomes. By following RBC, nurses share a similar philosophy toward a caring environment.

When patients and families come to the emergency department seeking medical attention, they come in with many mixed emotions and thoughts. The fast paced, rapid turnover of patients and the chaotic atmosphere may leave patients who visit the emergency department with the perception that staff is uncaring. The purpose of this project was to implement a patient care delivery model, relationship-based care, in the emergency department. The model is comprised of several caring theories including Jean Watson's model of human care and Kristen Swanson's middle range theory of caring. The main goals of the project were to help staff enhance the patient and caregiver interaction, strengthen co-worker relationships, and gain appreciation of the importance of self-care. The intervention was an educational workshop about the relationship-based care model. Eight participants were consented, given a preassessment survey, educated about the model, and then given a postassessment survey. Prior to education, 83% of participants believed strongly that patients and families need to feel cared for during an emergency department visit; this increased to 100% posteducation. Perception about the importance of coworkers' relationships being trusting went from 38% to 50% and the importance of caring for one's self increased from 63% to 100%. It was recommended that the model be implemented in all emergency departments and all staff educated in its use as a way to promote social change through intentional focus on caring in every patient interaction.

Nurse engagement is essential for organizational success. If organizations can engage nurses, they may be able to improve organization and patient outcomes. The purpose of the evidence-based practice project was to use current evidence of direct supervisor influence on nurse engagement to create an educational program for clinical leads to use in their interactions with direct reports. The relationship-based care model was used as a framework for the project, and concepts included work engagement, nurse engagement, recognition versus meaningful recognition, professional development, communication, transformational leadership, and authentic leadership. Before and after attending the education program, clinical leads were given a self-assessment on a 5-point Likert scale to assess their perception of their leadership skills. The data were analyzed using SPSS descriptive statistics to describe differences in pre and post education self-assessments. All of the questions had increased means following the education program. The most improvement was in the following areas: coordinating relationships among staff improved by50% and accepting and using constructive criticism improved by 50%. Clinical leads recognized that having the knowledge and tools would give them the ability to impact nurse engagement. Researchers should continue to study the leader's influence on nurse engagement in relationship to other environmental factors that influence nurse engagement; as well as, how to better prepare leaders to engage nurses in his/her professional roles.

Sammanfattning: Syfte: Att belysa barnsjuksköterskors erfarenheter av att bedriva relationsbaserad vård för det förtidigt födda barnet och dess föräldrar. Bakgrund: Aktuell kunskapsgrund redovisar vikten av en familjecentrerad, relationsbaserad, neonatalvård i strävan efter tidig anknytning och självständigt föräldraskap. Bakgrunden redovisar även barnsjuksköterkans erfarenheter av den relationsbaserade vården. Design: En intervjustudie utifrån en kvalitativ ansats, med ett vårdarperspektiv som studiens teoretiska referensram. Metod: Data samlas in under 2015 genom öppna och semistrukturerade intervjuer med 10 barnsjuksköterskor verksamma vid neonatalavdelningar. Som stöd för intervjuerna används en intervjuguide, som testas i en pilotintervju. Materialet bearbetas i en kvalitativ innehållsanalys, och resulterar i tre kategorier, 10 subkategorier och ett tema. Resultat: Resultatet redovisas utifrån följande kategorier: att utveckla en vårdande relation, att använda relationsfrämjande arbetssätt på neonatal, att erfara svårigheter att bedriva relationsbaserad vård. Temat för resultatet är; en varsam och utmanande vägledning. Konklusion: Barnsjuksköterskornas erfarenheter av att bedriva relationsbaserad vård på en neonatalavdelning kan förstås som en varsam och samtidigt utmanande vägledning mot föräldraskap. Att bedriva relationsbaserad vård är en viktig del i att skapa föräldrar på neonatalavdelning och det finns all anledning att fortsätta att utveckla ett relationsbaserat vårdande på landets neonatalavdelningar. / Abstract: Aim: To explore pediatric nurses' experiences of practicing relationship-based care for premature infant and their parents. Background: A family centered, relationship-based, care is significant for pursuing early ties and independently parenting in the neonatal care unit. The backround also reports pediatric nurses’ experiences of relationship-based care. Design: An interview study with a qualitative approach, using caring perspective as a theoretical framework. Methods: The data is collected in 2015 through open and semi-structured interviews with 10 children nurses’ working in neonatal units. An interview guide, tested and validated in a pilot interview, is used as guidance for the interviews. The transcribed data is analysed using qualitative content analysis, and resulted in an overarching theme illustrating the latent content including three categories and 10 subcategories. Results: The findings portrayes in the following categories: development of a caring relationship, relationship promotion practices in the neonatal unit, the difficulties with practicing relationship-based care. The theme is a gentle and challenging guidence. Conclusion: Pediatric nurses' experiences in conducting relationship-based care in neonatal units can be understood as a gentle and challenging guidance on parenting. To engage in relationship-based care is an important part of creating parents in the neonatal care unit and there is every reason to continue to develop a relationship based care.

No description available.