Developments in Nursing Care

Introduction to The Effective Workplace Culture Framework

In healthcare the workplace culture is focused on providing patient centred care, which is the basis of effective healthcare service delivery. It emphasized to increase positive patient satisfaction and treatment outcomes. It has been noted by many researches that practice of older methods has led to dissatisfaction in patients and unfavourable outcomes. Due to the direct relationship between the workplace culture of a healthcare setting and outcomes in the patients, there was a need to generate an effective workplace culture framework, highlighting the needs of the patients and deploying new methods for meeting those needs (Manley et al., 2011). In the words of the researchers Brownie & Nancarrow, (2013) the term Person-centred care is defined as, “multifactorial, comprising: elements of environmental enhancement; opportunities for social stimulation and interaction; leadership and management changes; staffing models focused on staff empowerment; and assigning residents to the same care staff and an individualized philosophy of care.”

According to this definition it can said that patient centred care enables the patients to make their own healthcare decisions and form their own healthcare goals, it gives the patient the right to practice autonomy. Although, additional analysis is mandatory to prove the effectiveness of person-centered care, as many health care professionals have argued that the principle of patient centered care hinders treatment planning due to high rate of ignorance of the patients, however, on the other hand (Frank, 2013), many researches and nursing professionals believe that it is imperative to clinical practice as it offers solutions to build therapeutic relationship amid the health care giver as well the receiver. It is further supported by the Quality Care Commission (n.d.) which stated that, “Providers must make sure that they take into account people's capacity and ability to consent, and that either they, or a person lawfully acting on their behalf, must be involved in the planning, management and review of their care and treatment. Providers must make sure that decisions are made by those with the legal authority or responsibility to do so, but they must work within the requirements of the Mental Capacity Act 2005, which includes the duty to consult others such as carers, families and/or advocates where appropriate.

” Many benefits of Patient centered care have been recorded in the clinical settings, Patient centred care model is effective for delivering quality healthcare services. It acknowledges the patient as a person and focuses on providing the holistic treatment instead of managing only the main condition of the patient. It encourages active participation of the person in making well-informed healthcare decisions. This has led to increase in awareness of the medical and health management for an individual, improving the quality of life. It has also resulted in positive personal experience to the patient as well as increased rate of success of treatment compliance and treatment outcome. Furthermore, the implementation of PCC has led to decreased healthcare burden resulting from the imbibition of ownership of self-care in the patients. Thereby, reducing the hospitalization period and also the expenditure of healthcare system.

Therefore, the work culture framework is based on the principle of PCC. PCC is also recognized by The Australian quality framework for healthcare (ACSQHC, 2011) as a prime factor for providing “safe” and “quality-competent healthcare system.” This approach lays emphasis on develop patient care plan with collaborative efforts (One view Healthcare, 2015; Newell & Jordan, 2015). An Australian research deduced that with the surge in active patient participation an improvement in patient safety was noted (Delaney, L.J., 2018). This fact was also underpinned by the National Safety and Quality Standards for Health Services (ACSQHC, 2012),standard 9.9, for empowering the patients and their families to engage in the process of the patient’s treatment.

Analysis of The Themes with Effective Workplace Culture Framework

The two main themes which play in the background of providing adequate care is are team work and effective communication.

Teamwork. An effective care plan is developed by the help of team work. In a patient treatment plan, various health care providers participate to obtain a desired result. It is called a multidisciplinary approach. The multidisciplinary team consists of Surgeon or a doctor, the nurse, a dietician, a psychologist, rehabilitation therapist, and more depending upon the needs of the patient. Without effect team work the desired result is not obtained. The NMBA, 2016 standard 2 states that, Sstandard 5.2: "together constructs nursing practice plans until contingencies, options, goals, procedures, outcomes and timeframes are agreed with the relevant persons." Many stakeholders are required to participate in the care plan of the treatment of the patient. However, the primary stakeholder in the person -centered program is the patient itself. The care plan development must consider the belief and value systems of the patient. It is important to increase the level of compliance to the goals of the treatment and the medication management. Team effort also motivates patients to do better for the improvement of their health. Most of the patients suffering from the disease may also be accompanied by or go through emotional and mental health hazards (Waweru et al., 2019). Team work offers solution for the patient, no to give into depression and stay motivated through out the period of care and be regular for follow ups.

Effective Communication.

Communication is the vital component of any relationship. It forms the basis of understanding between the two people, the most important part of communication is active listening. In a clinical set up, it is necessary for a health care provider to develop the skill of active listening in order to understand the needs of the patient. “Patient Centered Care ensures there is no communication gap between the patient and the nurse or any other healthcare professional which causes shared collaboration in the decision-making processes while delivering health care services (Fix et al, 2018; NEJM Catalyst 2016).” It plays a major role in building the therapeutic relationship with the patient. The main part of effective communication is active listening. The skill active listening is impertinent in clinical nursing practice. According to the research done by Hertog & Niessen, (2019), “It is a challenge faced personally by all nursing staff. But the importance of active listening in the process of healthcare delivery cannot be ignored. It is important for the healthcare professional in order to work with the patient in partnership to understand and comprehend their health issues and feelings.

Active listening helps in remembering important information. It also helps in having a detailed knowledge of the patient which is essential in providing effective care to the patient. It avoids malpractice by focusing on the details and avoids medical errors. Listening is an important component of communication. It forms the basis of an effective communication practice and most of the nurses argue that it is not actually time consuming but in fact time-saving. It was also reinforced by Yoost & Crawford (2019), who noted that active listening is efficient in building rapport with the patient and helps in providing tailored care or personalized care. Furthermore, paying attention to the patient helps in the identification of patient preferences and enhances the quality of life of the patients. Active listening skills can be developed by, removing all the patient related prejudices from one’s mind. It is important that the nurse sees every patient differently.” 

Recommendations for Improvements to The Caring Culture

As per Yoder’s research, (2010), “Health workers are more likely to fall into traditional hierarchical practice behavior when there is lack of effective supportive supervision and mentorship” and Epstein, (2014), the increased work-load on the health care staff acts as a hurdle as it causes difficulty for the nurses to effectively manage their time to be spent with each patient. It also creates mental pressure on the nurse due to which the nurse in unable to devote time in establishing effective communication with the patient. The challenge must be addressed by the clinical governance staff and senior nursing professionals. The senior nurses should also supervise and train the fresh nursing staff or students during their time with the patient to establish therapeutic communication. During their academic years, nurses are not provided with a discrete or exclusive training on the principles of developing person-centered approach. Consequently, it is vital to reform the curriculum and help the nurses to practice the learning of PCC in clinical setting (Entwistle & Watt, 2013).

The healthcare worker should focus on leaving no communication gap between them and the patient (Sedig, 2016). Effective communication is the most vital skill of a leader. Sufficient classroom as well as practical trainings must be provided to the nurses to develop clinical leadership skills. Most often the healthcare workers showed significant sign of worry regarding the lack of understanding of the instruction given to the patients. This occurs mostly because of the inability of the patients to read. It caused difficulty for the patients in comprehending the consultation notes from their provider visit as well as difficulty in understanding the diagnostic procedures, such as laboratory findings or radio diagnostic results. In these cases, education can be provided to the patients or their carers those who lack access to any visual aids. Also, the level of education which the patient has regarding his health is very important, check for readiness, environment barriers and communication skills before beginning the education. Use of modern technology can be helpful in increasing the awareness of health and literacy and bridging the communication gap between healthcare provider and the patients.

For instance, use of VHTs, enhancing communication through email, presenting the informative hand-outs, and videos related to the disease they are suffering from. Another good example of utilizing technology for improvement patient interaction and communication, is by deploying “Centura- a patient engagement technology”, which enables the patient to ask questions and obtain answers through a web page or portal, in order to obtain guidance regarding their next step in the treatment process, or for booking a consultation by themselves. For increasing competency, the web portal must include a feature of selecting few major languages which are spoken in the native land. As nurses form the front face of the hospital workforce, they must develop skill of cultural competency as well as effective clinical leadership to make the patients feel comfortable and develop rapport with them.

From the study, it can be concluded that development of Workplace Culture Framework is mandated for providing a holistic care to the patient. It is aligned with the NMBA and the ACSHQ standards and promotes positive treatment outcomes, cultural competency, increased patient compliance and increase patient satisfaction, thus meeting all the goals of a health care system.

References for Effective Workplace Culture Framework

ACSQHC, (2011). Patient Centered Care: Improving Quality and Safety through Partnerships with patients and consumers. Retrieved from https://www.safetyandquality.gov.au/wp-content/uploads/2012/03/PCC_Paper_August

Brownie, S., & Nancarrow, S. (2013). Effects of person-centered care on residents and staff in aged-care facilities: a systematic review. Clinical interventions in Aging8, 1.

Care Quality Commission, (n.d.). The Independent Regulator of Health and Social Care in England. Retrieved from https://www.cqc.org.uk/guidance-providers/regulations-enforcement/regulation-9-person-centred-care

Delaney, L. J. (2018). Patient-centered care as an approach to improving health care in Australia. Collegian25(1), 119-123.

Department of Health, (2012). Comparison in Practice: Nursing, Midwifery and care Staff: Our Vision and Strategy. Retrieved from https://www.bl.uk/collection-items/compassion-in-practice-nursing-midwifery-and-care-staff-our-vision-and-strategy

Entwistle, V. A., & Watt, I. S. (2013). Treating patients as persons: a capabilities approach to support delivery of person-centered care. The American Journal of Bioethics13(8), 29-39.

Epstein, R. M. (2014). Realizing Engel's biopsychosocial vision: resilience, compassion, and quality of care. The International Journal of Psychiatry in Medicine47(4), 275-287.

Fix, G. M., VanDeusen Lukas, C., Bolton, R. E., Hill, J. N., Mueller, N., LaVela, S. L., & Bokhour, B. G. (2018). Patient‐centered care is a way of doing things: How healthcare employees conceptualize patient‐centered care. Health Expectations21(1), 300-307.

Frank, L. (2013). Person-centered care, autonomy, and the definition of health. The American Journal of Bioethics13(8), 59-61.

Friberg, F., Wallengren, C., Håkanson, C., Carlsson, E., Smith, F., Pettersson, M., ... & Öhlén, J. (2018). Exploration of dynamics in a complex person-centred intervention process based on health professionals’ perspectives. BMC health services research18(1), 441.

Gerteis M, Edgman-Levitan S, Daley J & Delbanco T, (1993), Through the Patient's Eyes: Understanding and Promoting Patient-Centred Care. Jossey-Bass, San Francisco

Manley, K., Sanders, K., Cardiff, S., & Webster, J. (2011). Effective workplace culture: the attributes, enabling factors and consequences of a new concept. International Practice Development Journal1(2), 1-29.

Mitchell, M. (2010). A patient-centered approach to day surgery nursing. Nursing Standard24(44).

NEJM Catalyst, (2016). What is Patient-Centered Care? Retrieved from https://catalyst.nejm.org/what-is-patient-centered-care/

NMC, (2018). Standards for competence for registered nurses. Retrieved from https://www.nmc.org.uk/globalassets/sitedocuments/standards/nmc-standards-for-competence-for-registered-nurses.pdf

Sedig, L. (2016). What’s the role of autonomy in patient-and family-centered care when patients and family members Don’t agree?. AMA journal of ethics18(1), 12-17.

Social Care Institute for Excellence, (n.d.). Care planning, involvement and person-centered care. Retrieved from https://www.scie.org.uk/mca/practice/care-planning/person-centred-care

Stewart, M. (2001). Towards a global definition of patient centered care: the patient should be the judge of patient centered care.

Waweru, E., Sarkar, N. D., Ssengooba, F., Gruénais, M. E., Broerse, J., & Criel, B. (2019). Stakeholder perceptions on patient-centered care at primary health care level in rural eastern Uganda: A qualitative inquiry. PLOS ONE14(8), e0221649.

Yoder, E. A. (2010). Compassion fatigue in nurses. Applied nursing research23(4), 191-197.

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