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.

<p>Today patients are more aware of their rights regarding their own care. They are more informed, more engaged and have more and individual requirements, which leads to increased demands for information and participation increases. The Health Act sets out the patients´ right to participation. Participation increases patient satisfaction with care, promotes healing and increases adherence to health care advise. The patient doesn´t always experience participation in their own care to the extent they wish, which suggests that nurse’s does not always succeed in getting the patient involved. The purpose of this study is to describe factors that are important for patient participation in nursing care in a nurse- and patient perspective. Nine research articles were analyzed with qualitative content analysis. The analysis resulted in two themes: health care relationships and communication. Through various acts of nursing care, patients experienced themselves as being seen and confirmed. Patients experienced a sense of security and trust, which is the essence of a trusting relationship, which in turn is the basis for caring and patient participation in their own care. Patient participation requires a sophisticated interaction between nurse and patient, a quest of a safe relationship that can lead the patient to see themselves seen and confirmed.</p><p> </p><p> </p><p> </p><p>Keywords: patient participation, nurse-patient relationship, nurse, care</p>

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.

Today patients are more aware of their rights regarding their own care. They are more informed, more engaged and have more and individual requirements, which leads to increased demands for information and participation increases. The Health Act sets out the patients´ right to participation. Participation increases patient satisfaction with care, promotes healing and increases adherence to health care advise. The patient doesn´t always experience participation in their own care to the extent they wish, which suggests that nurse’s does not always succeed in getting the patient involved. The purpose of this study is to describe factors that are important for patient participation in nursing care in a nurse- and patient perspective. Nine research articles were analyzed with qualitative content analysis. The analysis resulted in two themes: health care relationships and communication. Through various acts of nursing care, patients experienced themselves as being seen and confirmed. Patients experienced a sense of security and trust, which is the essence of a trusting relationship, which in turn is the basis for caring and patient participation in their own care. Patient participation requires a sophisticated interaction between nurse and patient, a quest of a safe relationship that can lead the patient to see themselves seen and confirmed.       Keywords: patient participation, nurse-patient relationship, nurse, care

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.

Abstract This study deals with the phenomenon of a doctor-patient relationship from a relationship-centered care point of view. Relationship-centered care is viewed as an opportunity for the doctor to enhance comprehensive care of the patient and to improve the quality of primary health care. The research was conducted in the context of General Practice-education aimed at physicians specializing in general medicine. The training was organized by the General Practice Unit of Northern Ostrobothnia Hospital district (PPSHP) and the Department of Medicine and Health Sciences at the University of Oulu. The aim of the research is to increase understanding of the phenomenon of a patient-doctor relationship. The phenomenon is examined by looking at the possibilities for a doctor specializing in general medicine to have a personal doctor-patient relationship with dialogical orientation. With the help of personal reflection the doctor specializing in general medicine can develop ways to prepare for the relationship and be in it. The possibility for a patient to encounter valuable care is constructed through reflection and introduction of dialogue. A doctor working in relationship-centered care strategically receives information about the patient's personal experiences. Combining this information with the latest biomedical knowledge assists in the general recommendations of the Current Care Guidelines, when applying them individually. The research is qualitative. The data comprises 16 doctors who participated in the General Practice-education, their semi-structured thematic interviews with transcribed texts, as well as the findings from questionnaires completed at the end of the education. The data is analyzed using qualitative methods. The results showed that subjects felt that the core of general medicine is a personal doctor-patient relationship, in which it is essential to listen to the patient's concerns, experiences, thoughts and expectations when making treatment decisions and deciding on the correct diagnosis. Personal readiness is increased by the doctor-patient relationship when outlining the theoretical content, practicing situations of interaction, handling challenges that have emerged from work in a peer group, as well as the doctor's awareness based on previous work experience in medicine. There can be barriers, attitudes, beliefs and non-processed emotions that emerge from one's personal history of experiences; processing these strengthens the belief in one’s own abilities to work according to internal information and to be more personally present in relationships. The results could be utilized during basic medical education and post-graduate training, as well as in supervision. / Tiivistelmä Tutkimus käsittelee potilas-lääkärisuhteessa olemisen ilmiötä suhdekeskeisyyden näkökulmasta. Suhdekeskeisyyttä tarkastellaan lääkärin mahdollisuutena tehostaa potilaan kokonaisvaltaista hoitamista ja hoidon laatua. Tutkimus toteutettiin prosessiluontoisessa General Practice -koulutuksessa, joka oli suunnattu yleislääketieteeseen erikoistuville lääkäreille. Koulutuksen järjestivät Pohjois-Pohjanmaan sairaanhoitopiirin kuntayhtymän (PPSHP) yleislääketieteen yksikkö ja Oulun yliopiston lääketieteellisen tiedekunnan terveystieteiden laitos. Tutkimuksen tavoitteena on lisätä ymmärrystä potilas-lääkärisuhteessa olemisen ilmiöstä. Ilmiötä lähestytään tarkastelemalla yleislääketieteeseen erikoistuvan lääkärin mahdollisuuksia olla potilas-lääkärisuhteessa persoonallisesti ja dialogisuutta tavoitellen. Persoonallisen reflektion avulla yleislääketieteeseen erikoistuva lääkäri voi kehittää valmiuksiaan asettua suhteeseen ja olla siinä. Reflektiivisyyden käynnistyminen ja dialogisuuden omaksuminen mahdollistavat potilasta arvostavien hoitokohtaamisten rakentumisen. Suhdekeskeisesti työskentelevä lääkäri saa henkilökohtaista tietoa potilaan kokemusmaailmasta. Tämän tiedon yhdistäminen uusimpaan biolääketieteelliseen tietoon auttaa yleisten Käypä hoito -suositusten soveltamisessa yksilöllisesti. Tutkimus on laadullinen tutkimus, jonka aineisto koostuu 16:n General Practice -koulutukseen osallistuneen lääkärin puoli-strukturoiduista teemahaastatteluista litteroiduista teksteistä, heidän reflektiopäiväkirjoistaan sekä koulutuksen lopussa suoritetusta palautekyselystä. Aineisto analysoidaan laadullisin menetelmin. Tulosten mukaan tutkittavat pitävät yleislääketieteen ytimenä persoonallista potilas-lääkärisuhdetta, jossa oikean diagnoosin ja potilasta hyödyttävien hoitopäätösten tekemisen kannalta on oleellista kuunnella potilaan huolia, kokemuksia, ajatuksia ja odotuksia. Persoonallisia valmiuksia lisäävät potilas-lääkärisuhteen sisältöjen teoreettinen jäsentely, vuorovaikutustilanteiden harjoittelu, työstä nousevien haasteellisten tapausten käsittely vertaisryhmässä sekä lääkärin kokemushistoriasta kumpuavien asioiden tiedostaminen ja käsittely. Omasta kokemushistoriasta kumpuavien esteiden, asenteiden, uskomusten ja tunteiden käsittelemättömyyden työstäminen vahvistaa uskoa omiin kykyihin toimia sisäisen informaation mukaan ja olla persoonallisemmin läsnä suhteissa. Tutkimuksen tuloksia voidaan hyödyntää lääkäreiden perus- ja jatkokoulutuksessa sekä lääkäreiden työnohjauksessa.

Bakgrund Utformningen av miljön i akutsjukvården leder till svårigheter att tillvarata patientens integritet. Lyhördhet krävs från sjuksköterskans sida gällande att ge en individanpassad omvårdnad utifrån patientens egna preferenser och kultur. Integritet har flera dimensioner och innefattar personlig, psykisk och fysisk integritet. Integritet är kopplat till människans upplevelse av värdighet och egenvärde. Individens etiska hållning kan skapa en medvetenhet om andra människors värdighet. En grundläggande aspekt inom omvårdnad är att tillvarata patientens värdighet och därmed autonomi. Syfte Syftet med litteraturöversikten var att belysa patientens upplevelse av integritet inom akutsjukvård. Metod Designen till denna studie var en litteraturöversikt som omfattar vetenskapliga artiklar. Dessa har tagits fram genom databassökning. Sökningar avgränsades till CINAHL och PubMed. Resultatet baseras på 17 artiklar för granskning och analys. Av de 17 artiklarna var sju av kvalitativ design, sju av kvantitativ design medan tre var mixstudier. Artiklarna kvalitetsgranskades sedan enligt Sophiahemmet Högskolas bedömningsunderlag. Dataanalysen genomfördes med hjälp av en integrerad analysmetod. Resultat Resultatet visade på att patientens upplevelse av integritet var beroende av miljöfaktorer, sjuksköterskans förhållningssätt i vårdrelationen samt sjuksköterskans förmåga att tillämpa integritetsskyddande beteenden. Miljöfaktorer och sjuksköterskans förhållningssätt var avgörande för att upprätthålla patientens värdighet. Slutsats Slutsatsen blev att integritet är ett kontextberoende fenomen. Integritet anses vara personbunden samt att den kan avgöras av människans kultur. Kunskap och reflektion hos sjuksköterskan gällande integritetsskyddande beteenden hade en central roll för att patientens integritet skulle bibehållas. Värdighet och därmed autonomi kunde upplevas av patienterna när integriteten tillvaratagits. / Background The design of the environment in emergency care leads to difficulties in safeguarding the patient's privacy. Responsiveness is required from the nurse's side to provide individualized care based on the patient's own preferences and culture. Privacy has several dimensions and includes personal, psychological and physical privacy. Privacy is linked to the human experience of dignity and intrinsic value. The individual's ethical stance can create an awareness of other people's dignity, something that is changeable throughout life. A fundamental aspect of nursing care is to protect the patient's dignity and thus autonomy. Aim The purpose of this literature review was to illustrate the patient experience of privacy in emergency care. Method The design for this study was a literature review covering scientific articles. These have been developed through database search. Searches were separated into CINAHL and PubMed. The result is based on 17 articles for review and analysis. Of the 17 articles, seven were of qualitative design, seven of quantitative designs while three were of both qualitative and quantitative design. The articles were then quality-reviewed according to Sophiahemmet University's assessment dossier. The data analysis was carried out using an integrated analytical method. Results The results consisted of that the patient ́s experience of privacy depended on environmental factors, the nurse ́s approach in the care relationship and the nurse ́s ability to apply privacy-protection behaviors. Environmental factors and the nurse's approach were crucial to maintaining the patient's dignity. Conclusions The literature review highlights privacy as a context-dependent phenomenon. Privacy is considered to be person bound and can be determined by human culture. The knowledge and reflection of the nurse regarding privacy behaviors had a central role in maintaining the patient's privacy. Dignity and thereby autonomy could be experienced by the patients when the privacy was exploited.

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