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See the Person, Not the Patient

 |  By Alexandra Wilson Pecci  
   June 17, 2014

A book written by two RNs details strategies for understanding and interacting with patients as individuals, and suggests nurse leaders can help by "giving nurses space" to do so.

It's early evening, and it's time to take Mrs. Smith's vitals. The nurse knocks on the door, just as a formality, and doesn't pause before entering the room. The patient is talking with her daughter, but the nurse goes about his business anyway, interrupting the conversation, quickly taking the vitals, and leaving. He's got a job to do, and other patients to see.

But Mary K. Walton, MSN, MBE, RN, director for Patient and Family Centered Care at the Hospital of the University of Pennsylvania, as well as a nurse ethicist, says a nurse's job isn't only about tending to a patient's physical needs, nor is it only about clinical responsibilities.

"It's not about the tasks," she says. "The tasks are important, the clinical skills are important, but it's [about] understanding the patient's needs."

Walton, along with Jane Barnsteiner, PhD, RN, FAAN, and Joanne Disch, PhD, RN, FAAN, is the co-author of a new book, Person- and Family-Centered Care, published by the Honor Society of Nursing, Sigma Theta Tau International. The book aims to help nurses move away from the idea of caring for a "patient" and instead toward caring for a person.

Understanding the patient as a person means making a conscious effort to discover the individual who's being cared for, his or her unique needs, fears, vulnerabilities, values, and families.

"There's a different kind of vulnerability when you're admitted to the hospital," Walton says. "When you take your underwear off and put on a gown and a nametag it really changes who you are."

With that in mind, a patient's values should help to guide healthcare decision making, and it's up to clinicians to forge a partnership with patients and families to understand what those values are. Although good nurses certainly know the ropes of clinical care, patients are the experts on themselves, Walton says. And family members can be experts on their loved ones, too.

"On the clinician's side, it's important to learn how to elicit an individual's values and preferences," she says. "If you're going to honor them, you have to know what they are."

Toward Better Outcomes
Sometimes nurses and other clinicians think family members are the way, but having family members present and engaged in care just might improve outcomes.

For instance, when a nurse is explaining to a sick person how to change a wound dressing or take their medications, he or she might also ask who could sit with them to hear the instructions, too, just to make sure that they understand.

Or maybe talking with a patient about what makes them feel nervous or unsure would reveal that they "feel really scared lying in this bed at night and I feel good to have my brother with me," Walton says.

Nurses might make little tweaks to their rounding by knocking on a patient's door and waiting for the patient to tell them to come in. Or they could ask the patient whether it's a good time for them to come in, and let them know that it's OK for them to ask the nurse to come back in ten minutes. If the nurse doesn't come back in ten minutes he or she should offer an apology.

A nurse should also consider whether a patient with a bad attitude might be acting out of fear, rather than anger. Instead of backing away from the situation, a nurse might say, "I can tell you're concerned about something. I want to understand," Walton says.

"That skill is not something that people know intuitively for the most part… sometimes listening is a very effective therapeutic strategy."

How Nurse Leaders Can Help
Walton says nurse leaders can help with the culture shift toward patient- and family-centered care by modeling these behaviors and letting nurses know they're not alone. Leaders might do things such as rounding with the nurses and showing them how to ask questions that elicit a patient's values.

For instance, if a patient says that everything is fine, a nurse leader might ask, "Tell me what fine looks like," Walton says.

And nurse leaders should honor how their staff feels, too, by "giving space for nurses to say, 'I'm having a really hard time with this," Walton says. Debriefings between nurses and leaders after dealing with challenging situations are helpful, too.

All of these strategies can be implemented with an eye toward providing better patient care and ultimately, achieving better outcomes.

"It's not about the patient is always right," Walton says. "It's about helping people improve their communication skills."

Alexandra Wilson Pecci is an editor for HealthLeaders.

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