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October 20, 2004
By Susan Bulfin, MN, ARNP
A pilot project is currently underway in the Emergency Department of the Boca Raton Community Hospital in partnership with the Christine E. Lynn College of Nursing at Florida Atlantic University. The project was initiated in response to Boca Raton Community Hospital's continued commitment to quality care, and to implement an innovative practice model that will humanize the workplace. The focus of the project is on creating a Caring-Based Health Care Delivery Model. . This project focuses on coming to understand the depth and meaning of living caring in everyday life. The second major focus of the project is designing, implementing and evaluating a model of care grounded in Nursing as Caring, A Model for Transforming Practice. Staff members in the Emergency Department are participating in the creation of new methods of incorporating caring strategies into their own unique practices.
Background
The pilot project is taking place in the emergency services department, which is often referred to as the front line of care for a large percentage of the persons being admitted to the hospital. A recent study (Keough, 2003) of emergency room nurses revealed a growing crisis evidenced by the nurses’ concerns regarding increased responsibilities, inexperienced staff, lack of rewards or incentives to stay, and low morale among staff. Keough (2003) suggests that the first step in addressing this crisis is to listen carefully to the voices of these experienced nurses.
This project attempts to provide the ears to hear the stories of not only the nurses, but of all the staff members who touch patients in the emergency department, as well as the stories of the patients and their loved ones. Through the use of story, the researchers began to discover what truly mattered to each of the persons in this setting.
Basic Assumptions of Nursing as Caring
According to Boykin and Schoenhofer (2001), the focus of nursing as a discipline and profession is grounded in the following assumptions:
- to be human is to be caring,
- persons are caring moment-to-moment; each moment provides opportunities to express one’s caring uniquely an to grow in caring,
- persons are whole and complete in the moment; this calls for the celebration of human wholeness valuing and respecting each person’s beauty, worth and uniqueness,
- the discipline and profession of nursing is about coming to know persons as caring and in that knowing, nurturing them as persons growing in caring.
These assumptions provided the framework for building a caring based model for health care delivery, while the stories provided the background for creating a model that was meaningful and relevant to those in this particular environment.
Coming to Know
During the first phase of this project, staff members, patients and the family members of patients were invited to share stories of caring with the nurse researcher. The stories are audio taped and transcribed, and a team of faculty members then analyzed the transcriptions to identify common themes. These themes reflected what seemed to truly matter to staff members, patients and family members in the emergency department. The data was shared with staff members for affirmation of the common themes. These themes included:
- Intimate knowing in order to respond to that which matters
- Being the best you can be
- Offering Self
- Going above and beyond (the extra mile)
The process of learning about self and other as caring is continually being emphasized with the staff. The project director relied upon Milton Mayeroff’s (1971) book, On Caring, to help staff understand basic caring ingredients. Staff members participated in the production of a videotape which served as a tool for enhancing the understanding of the living of caring. Each of Mayeroff’s eight caring ingredients was illustrated through examples of actual situations which took place in the emergency department. The film was shown to all staff members and served as a tool for facilitation of discussion about personal expressions of caring. The staff members were encouraged to reflect upon recognizing caring expressions within themselves as well as in others.
Creating the Model
After the staff members affirmed the themes and created the videotape, a “caring team” was created. The team consisted of representatives from each shift, as well as from each level of staffing. The staff, with the assistance of the Project Director, then began to design a model of care based on these themes. Strategies to support the living of each of these shared themes and values are currently being incorporated into every day care in the emergency department.
In the final phase, a thematic analysis will be done. Surveys of patient and staff satisfaction will be studied to determine the effect of the Caring-Based Model. Press-Ganey scores will be used to quantify results.
Transformation
It is hoped that the process of growing in caring will transform the workplace, will improve the morale of the health care personnel, and will change the environment from object-centered to person-centered. Preliminary findings from patient letters and surveys are suggesting that the patients presenting to the ER are truly feeling that they are being “listened to” and “cared for” by the personnel of the emergency department. Some of the quotes taken from patient letters include:
“extremely pleased….my overall experience was more than my expectations”
“I was treated with compassion, courtesy… the staff was prompt and excellent”
“best experience I’ve ever had at a hospital”
“never before in my life have I been handled with such care, expedience and good humor. . . . You guys rock!!! It’s refreshing to be around people who love their jobs because their jobs help others”
The staff have also described how incorporating their own personal caring strategies helped them overcome challenging situations and created a feeling of pride and accomplishment. They are encouraged to continue to share their stories, both positive and negative, and to dialogue with their colleagues regarding ways to meet these challenges in a manner which values and respects the beauty and uniqueness of each person.
Summary
The creation of a caring-based value system is a process which continues to evolve in this emergency services setting. The impact is truly being felt by the caregivers themselves, as well as by those being nurtured and cared for, and is positively transforming the environment.
Reference List:
Boykin, A. & Schoenhofer, S. (2001). Nursing as caring, a model for transforming practice. Boston: Jones and Bartlett.
Keough, V., Schlomer, R., & Bollenberg, B., (2003). Serendipitous Findings from an Illinois ED nursing educational survey reflect a crisis in emergency nursing. Journal of emergency nursing. 29(1):17-22.
Mayeroff, M. (1971). On Caring. New York: Harper and Row.
About the Author:
Susan Bulfin, MN, ARNP is the Project Director for the Caring Based Health Care Delivery Model, a joint partnership between the Christine E. Lynn College of Nursing and Boca Raton Community Hospital. She may be contacted via email at Sbulfin@fau.edu.
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