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.

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.

Bakgrund: Övervikt är ett ökande problem världen över och är den främsta orsaken till ohälsa bland barn samtidigt som risken att bibehålla övervikten som vuxen är stor. Detta kan leda till flera olika folksjukdomar och påverka folkhälsan globalt. Skolsköterskor har en betydelsefull roll i att tidigt uppmärksamma övervikt hos barn och arbeta hälsofrämjande och förebyggande. Syfte: Syftet med studien var att beskriva skolsköterskors erfarenheter av det hälsofrämjande och förebyggande arbetet i grundskolan med barn som har en övervikt. Metodbeskrivning: Kvalitativ metod med induktiv ansats tillämpades vid studiens genomförande. Semistrukturerade intervjuer med 11 skolsköterskor från södra till norra Sverige utgjorde datainsamlingen. Dataanalysen genomfördes med manifest innehållsanalys enligt Graneheim och Lundman. Resultat: I det bearbetade intervjumaterialet framkom fyra kategorier: Betydelsen av att bedöma barnets övervikt, Skolsköterskans förhållningssätt i hälsosamtalet, Vikten av samverkan med föräldrar vid bedömd övervikt och Vikten av att se möjligheter och utmaningar i arbetet mot övervikt. Slutsatser: Det är betydelsefullt att skolsköterskan tar hänsyn till barnet som helhet där stöd utifrån Swansons omvårdnadsteori kan stödja barnet att uppnå välbefinnande. För att möjliggöra detta behöver riktlinjer utvecklas för att vägleda skolsköterskor i arbetet då de är en nyckelperson i det hälsofrämjande och förebyggande arbetet mot barnets övervikt. / Background: Overweight is an increasing problem worldwide and the main reason for morbidity among children. At the same time, there is a great risk of maintaining excess weight in adulthood, which can cause chronic diseases and affect the public health globally. School nurses have an important role to inform parents about overweight and unhealthy habits for children, as well as contributing knowledge of healthy lifestyles. School nurses have an important role to identify overweight in an early stage and work with health promotion and prevention. Aim: The aim of the study was to describe school nurses' experiences of the health promotion and prevention in primary school among children who are overweight. Method: The study was made using qualitative content analysis with inductive approach. Semi-structured interviews with 11 school nurses´ from southern to north of Sweden constituted the data collection.  The data analysis was carried out with qualitative content analysis. Result: Four categories emerged in processed study material: The importance of identifying the child's overweight, School nurse's approach in the health dialog, The importance of cooperation with parents in the case of assessed overweight, The importance of seeing opportunities and challenges in the work against overweight. Conclusion: It is important that the school nurse takes the whole child into account, where support based on Swanson's nursing theory can support the child to achieve well-being. To enable this, guidelines need to be developed to guide school nurses in their work as they are a key person in the health promotion and prevention work against child overweight.

Bakgrund: En graviditet ses hos många kvinnor som något positivt och för med sig mycket glädje, men en graviditet innebär också en risk för missfall. Omkring 20–30 procent av alla gravida kvinnor kan komma att drabbas. Ett missfall kan göra kvinnor extra sårbara och utsatta. Det är betydelsefullt att undersöka kvinnors upplevelser vid missfall för att få ökad förståelse och kunskap om hur missfall kan upplevas.  Syfte: Syftet var att beskriva kvinnors upplevelser vid missfall.  Metod: En litteraturöversikt har använts som metod för arbetet. Tio vetenskapliga originalartiklar med kvalitativ metod har analyserats utifrån Fribergs analysmodell. Litteraturöversikten utgick från kvinnor som haft missfall innan graviditetsvecka 22. Resultat: Resultatet innehåller tre huvudteman: Kvinnors emotionella smärta, Stöd från familj och vänner, Omvårdnad vid missfall samt två underteman: Missfall - ett stigma, och Känslig omvårdnad. Slutsats: Slutsatsen i denna litteraturöversikt var att kvinnor upplever en emotionell smärta med känslor av sorg, tomhet och hjälplöshet, och ett stöd från familj, vänner och andra kvinnor som genomgått missfall är viktigt för att de ska kunna bearbeta sitt missfall. Kvinnor beskrev att omvårdnaden var avgörande i hur de upplevde sitt missfall, och en känslig omvårdnad där vårdpersonalen visar empati och förståelse för kvinnan är väsentligt för hennes välmående vid ett missfall. / Background: A pregnancy is seen by many women as something positive and brings a lot of joy, but a pregnancy also entails a risk of miscarriage. Around 20-30 percent of all pregnant women may be affected. A miscarriage can make women extra vulnerable and exposed. It is important to investigate women's experiences of miscarriage in order to gain increased understanding and knowledge of how miscarriage can be experienced.  Aim: The aim was to describe women’s experiences of miscarriage. Method: A literature review has been used as a method for this work. Ten original scientific articles using a qualitative method have been analyzed based on Friberg’s model of analysis. The literature study was based on women who had miscarried before 22 weeks of pregnancy.  Results: The result contains three main themes: Women's emotional pain, Support from family and friends, Nursing care in case of miscarriage, and two sub-themes: Miscarriage - a stigma, and Sensitive care.  Summary: The conclusion of this literature review was that women experience an emotional pain with feelings of sadness, emptiness and helplessness, and support from family, friends and other women who have experienced a miscarriage is important for them to be able to process their miscarriage. Women described that the care was decisive in how they experienced their miscarriage, and sensitive care where the care staff shows empathy and understanding for the woman is essential for her well-being in the event of a miscarriage.

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