Category Archives: Patient-Centered Care
This is part of the November 2014 issue of Sharing Nursing’s Knowledge.
“As a nurse, I understand the risk that I take every day to go to work, and he’s no different than any other patient that I’ve provided care for. So I wasn’t going to say, ‘No, I’m not going to provide care for him. I didn’t allow fear to paralyze me. I got myself together. I’d done what I needed to get myself prepared mentally, emotionally, physically, and went in there.”
--Sidia Rose, a nurse at Texas Health Presbyterian Hospital, Treating Ebola: Inside the First U.S. Diagnosis, 60 Minutes, CBS News, Oct. 26, 2014
“...I grabbed a tissue and I wiped his eyes and I said, ‘You’re going to be okay. You just get the rest that you need. Let us do the rest for you.’ And it wasn’t 15 minutes later I couldn’t find a pulse. And I lost him. And it was the worst day of my life. This man that we cared for, that fought just as hard with us, lost his fight. And his family couldn’t be there. And we were the last three people to see him alive. And I was the last to leave the room. And I held him in my arms. He was alone.”
--John Mulligan, a nurse at Texas Health Presbyterian Hospital, Treating Ebola: Inside the First U.S. Diagnosis, 60 Minutes, CBS News, Oct. 26, 2014
“Someone asked a nurse, what do you make? I make sure your seriously ill father is cared for. I make sure that when you’re incontinent you’re cared for. It’s this everyday, profound yet intimate work that people do. People don’t understand it. It requires incredible cognitive and emotional intellect to do it. You are with someone at the most difficult and challenging and joyous moments of their lives.”
--Diana Mason, PhD, RN, FAAN, professor, Hunter-Bellevue School of Nursing and president, American Academy of Nursing, Nurses Want to Know How Safe is Safe Enough With Ebola, NPR.org, Oct. 14, 2014
Michael Hochman, MD, MPH, is medical director for innovation at AltaMed Health Services, the largest independent federally qualified health center in the United States. AltaMed has enrolled more than 30,000 Southern Californians in Medi-Cal and Covered California, the state health care exchange. Hochman is an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program at the University of California, Los Angeles, and the U.S. Department of Veterans Affairs. Martin Serota, MD, is AltaMed’s chief medical officer.
Although the dust is still settling, most indicators suggest that the first wave of national health care reform was a success, particularly in California. More than 8 million Americans enrolled in commercial health plans under the Affordable Care Act, surpassing targets set by the Obama administration. Many more will qualify for plans under Medicaid expansion. As leaders at a community health center that serves a large population of low-income patients—many of whom currently lack coverage—we could not be happier about the new opportunities for our patients.
But we also know that the work is far from complete. Health care reform will only be a success if coverage expansion results in improvements in quality and efficiency, and better health for the population. As we know from the Massachusetts experience, it took time and a lot of effort for these benefits to ensue. Only now, several years after health care reform began in Massachusetts, are residents of the state starting to reap the benefits.
Physician assistants (PAs) received high marks from patients in a recent survey conducted by Harris Poll for the American Academy of Physician Assistants (AAPA). Among 680 Americans (out of more than 1,500 surveyed) who have interacted with a PA in the past year, 93 percent see PAs as part of the solution to the nation’s shortage of health care providers; 93 percent regard PAs as trusted health care providers; and 91 percent agree that PAs improve health outcomes for patients.
“The survey results prove what we have known to be true for years: PAs are an essential element in the health care equation and America needs PAs now more than ever,” AAPA President John McGinnity, MS, PA-C, DFAAPA, said in a news release. “When PAs are on the health care team, patients know they can count on receiving high-quality care, which is particularly important as the system moves toward a fee-for-value structure.”
The AAPA points out that more than 100,000 PAs practice medicine in the United States and on U.S. military bases worldwide. A typical PA will treat 3,500 patients in a year, the association says, conducting physical exams, diagnosing and treating illnesses, ordering and interpreting tests, prescribing medication, and assisting in surgery.
How Can Health Systems Effectively Serve Minority Communities? Improve Medical Literacy, Take a Holistic Approach.
To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Cheryl C. Onwu, BS, a public health graduate student at Meharry Medical College, responds to the question, “What are the challenges, needs, or opportunities for health systems to effectively serve minority communities?” Onwu is a Health Policy Scholar at the RWJF Center for Health Policy at Meharry Medical College.
A doctor informed an African American male that he has diabetes mellitus, and medication was prescribed. However, the doctor did not mention the extent of the dangers involved in having diabetes, or “the sugars.” Additionally, the doctor did not explain the detrimental effects if the patient failed to follow the prescription regimens and other recommendations.
Some of the challenges faced by minorities include lack of medical literacy, which can affect their overall health. Clear communication between a health care provider and his or her patients is important, so patients are cognizant of their health status, the importance of maintaining a healthy lifestyle, potential threats to well-being, and how to control health problems.
As the patient-centered medical home (PCMH) has emerged as a model for providing effective team-based care that can help offset the impending primary care provider shortage, so, too, is there a growing need for educational strategies that promote interprofessional collaboration. A short report published online by the Journal of Interprofessional Care describes the strategies in place at the VA Connecticut Healthcare System Center of Excellence in Primary Care Education (CoEPCE) and indicates promising results in just one year: doubled productivity in patient care delivered by faculty providers, and a marked increase in same-day clinic access for patients receiving care from an interprofessional team.
The Connecticut CoEPCE, like four other program sites funded through the U.S. Department of Veterans Affairs Office of Academic Affiliations, builds on the VA’s system-wide PCMH model, known as Patient Aligned Care Teams (PACT). It seeks to develop exportable models of interprofessional education and patient care, according to the report, “Moving From Silos to Teamwork: Integration of Interprofessional Trainees Into a Medical Home Model.” The CoEPCE sites share four core curricular domains—shared decision-making, sustained relationships, interprofessional collaboration, and performance improvement—and the Connecticut center groups together physician, nurse practitioner (NP), pharmacy, and health psychology trainees.
The trainees divide their time evenly between interactive educational sessions and caring for patients, guided by faculty who provide supervision, mentorship, and collaborative shared care. Additionally, the Connecticut center incorporates a one-year post-master’s adult NP interprofessional clinical fellowship, to further enhance clinical proficiency and teamwork experience for NPs.
Gretchen Hammer, MPH, is executive director of the Colorado Coalition for the Medically Underserved. She works with local and state health care leaders and policy-makers to improve Colorado’s health care system.
Healing is both an art and a science. On one hand, clinicians are intensely driven by the quantifiable, the measurable, and the evidence-based algorithms that lead to accurate diagnosis and treatment as well as allow us to develop new innovations in medicine. However, healing is also an art. Patients are not just a collection of systems that can be separated out and managed in isolation of the whole patient. Each patient and their family has a unique set of values, life experiences, and resources that influence their health and ability to heal. Recognizing the wholeness and uniqueness of each patient is where the art of healing begins.
Empathy is defined as “the ability to understand and share the feelings of another.” It takes presence of mind and time to be empathetic. For clinicians, finding the balance between the necessary detachment to allow for good clinical decision making and empathy can challenging. This balance can be particularly difficult for students and new clinicians.
Lisa Ross DeCamp, MD, MSPH, is an alumna of the Robert Wood Johnson Foundation Clinical Scholars program. She is an assistant professor of pediatrics at Johns Hopkins University School of Medicine and a researcher with the Center for Child and Community Health Research.
Good communication is critical for development of an effective partnership between patient and provider. However, for the more than 25 million people in the United States who report speaking English less than very well and are classified as having limited English proficiency (LEP), access to the most basic aspect of communication—a common language with the provider—may be limited.
It is easy to imagine how language barriers may compromise the quality and safety of health care. Research consistently demonstrates that physicians falter in many aspects of communication, compromising health care quality and lowering patient satisfaction even when they speak the same language. Quality and satisfaction gaps stemming from poor communication are only magnified when a language barrier is present. Health care safety requires understanding instructions, again an impossible task if the patient and provider do not share a common language.
“Prescribe the right drug to the right patient at the right time” is not a new medical practice, but when a biomarker—that is, a measure of disease pathophysiology—or a gene makes this decision, that is a radically new medical practice. The promise of personalized medicine is that biomarker and gene driven algorithms will do much of the work of medicine. By predicting patients’ future health and the outcomes of an intervention, they will guide what doctors recommend to their patients. Like the theory of evidence-based medicine, personalized medicine promises a more objective, efficient and precise medical practice.
To date, personalized medicine has largely flourished “below the neck,” that is, in the care of patients with common medical diseases, particularly cancer and cardiovascular disease. In the last two decades though, the National Institutes of Health, the pharmaceutical industry, and researchers have invested substantial time and money in research such as the Alzheimer’s Disease Neuroimaging Initiative (called “ADNI”) dedicated to discovering and validating the biomarkers and genes that predict whether a brain will fail. This research is beginning to reshape how we talk about the diagnosis and treatment of the aging brain, an organ that is more and more, like hearts and bones, regarded as an organ “at risk.” As a result, clinicians, ethicists, and health care policy-makers are beginning to ask how we should practice personalized medicine for the seemingly healthy brain that is at risk for neurodegenerative dementias such as Alzheimer’s, Parkinson’s, Lewy Body Disease and frontotemporal lobar degeneration.
Kathleen Hickey, EdD, FNP-BC, ANP-BC, FAAN, is a nurse practitioner in cardiac electrophysiology, an assistant professor at the Columbia University School of Nursing, and an alumna of the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars program. Hickey is president of the International Society of Nurses in Genetics.
As a cardiovascular nurse practitioner, there have been many instances when a patient has reported an intermittent and sporadic racing of the heart, chest pressure or other vague symptom. If I had only an ECG (electrocardiogram) when that was happening, I thought to myself on many occasions.
But as most practitioners know, in the real world such episodes rarely occur while the patient is right in front of them. Rather, symptoms occur when the patient is at home, at work, has just left the provider’s office, or is on vacation!
The widespread use of smart phones has resulted in a plethora of gadgets, gizmos, and associated health care applications—but one I can’t live without is the AliveCor heart recorder and application that is now compatible with the iPhone.
Join U.S. News & World Report this afternoon for a Twitter chat about how patients in hospitals can take ownership of their care and become actively engaged and informed about their treatment.
Among the experts participating in the chat is Marianne Weiss, DNSc, RN, a grantee of the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative. Weiss is a researcher focusing on improving patients’ experience with hospital discharge and the role nurses play in discharge preparation and the discharge transition. Her research on patient perceptions of discharge teaching, readiness for discharge, and coping difficulty at home following hospital discharge have highlighted the importance of inclusion of patient voice to improve discharge experiences.
She will join representatives from the National Patient Safety Foundation, the Patient Advocate Foundation, and CNN’s Elizabeth Cohen, among others, for the chat.
Date: Thursday, July 25
Time: 2 p.m. to 3 p.m. ET
Experts: @INQRIprogram, @RWJF_HumanCap, @theNPSF, @NPAF_tweets, @TrishaTorrey, @tedeytan, @elizcohencnn