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How Examining Our Own Motivation Can Help Us Provide Patient-Centered Care

Sometimes I think ‘we’ promote patients’ dependence on ‘us’ and this has an insidious and counterproductive effect on patient empowerment and patient-centered care! A very complicated and complex topic that is worth reflecting on and discussing and will be helpful in personal growth and shifting our systems in this direction.  So here’s the challenge:

When are we promoting dependence and when are we promoting independence?

Any time that healthcare professionals get secondary gains from helping others we may be contributing to patients being dependent on us.  This is a red flag that we should all be aware of!  I’m not talking about feeling good about being helpful to others, but I am talking about getting our needs met such as a sense of love and belonging in the course of providing care.  For instance, what about when a patient has a preference for a particular nurse or doctor?  Patients may have very good reasons for such a preference and I totally believe that therapeutic relationships and continuity of care are vitally important to outcomes, but if we ever catch ourselves going down a path where WE feel good about that preference, we need to be very careful!  Here’s an example that is oversimplified, but will help bring this point home.

The situation:  Mrs. Jones is an 84 year old widow who has been discharged from the hospital with a new diagnosis of insulin dependent type 2 Diabetes.  She is a retired teacher who has lived alone since her husband died 6 months earlier.  She has been assigned a home health RN, Nurse Smith to monitor her blood glucose and continue patient education regarding her dietary changes and insulin administration.  Nurse Smith is explaining that she is going on vacation the following week and the next home visit will be made by her colleague Nurse Brown when Mrs. Jones gets teary.  “You’re the only nurse that I want to come here.  You’ve been such a good teacher with all of this confusing information.”

The nurse who may be seeking some secondary gains:

This nurse listens to Mrs. Jones and provides a light touch to her arm with one hand and a tissue with the other.  She feels good that Mrs. Jones only wants to have her 60px-Crutch_symbol.svg-1come to her house and it affirms that she is a good nurse and person.  She wonders how she can address this patient’s concern and remembers that her vacation plans involve a late-in-the-day flight the following Monday and offers to make the next visit early in the morning before leaving.

The nurse with healthy professional boundaries:

This nurse also listens to Mrs. Jones and provides a light touch to her arm with one hand and a tissue with the other.  She feels good that her expertise is helping Mrs. Jones make progress in managing her diabetes and recognizes that the patient is vulnerable re: a new diagnosis as well as the recent loss of her spouse.  She also knows that Nurse Brown is very capable of providing effective care and they will need some time and opportunity to build their therapeutic relationship.  She wants to honor the patient’s feelings, facilitate a positive relationship with Nurse Brown, and preserve her vacation plans.  She shares that she is glad her interventions are helpful and that they have a nice rapport and offers that Nurse Brown has taken a recent workshop on the latest treatments for Diabetes and may have some additional insights to offer.

In the first scenario, the nurse may appear to be providing patient-centered care because she is doing what the patient wants.  In reality the nurse is encouraging the patient to be dependent on her for friendship or social support and lacks faith in both the patient and her colleague.  Care decisions become enmeshed with the nurse’s need for approval or belonging.

In the second scenario, the nurse subtly empowers the patient to engage in a successful therapeutic relationship with another nurse in order to promote her independence with her care.    Care decisions stay focused on the clinical needs of the patient and her therapeutic goals.

I think our ability to recognize our own needs and wants will help us to steer clear of expecting patients to meet them and seek other support, i.e. the needs and wants are totally fine, but inappropriate to seek them from our patients.  In order to do this we must be willing to reflect on our own behaviors and motivation.  As we do this, we’ll have a clearer path towards helping patients identify their own needs, being more receptive to patients challenging our expertise, and using our expertise to ensure optimal outcomes that are in sync with what patients want.  In other words, by getting our egos out of the picture of clinical decision-making we’ll have a cleaner field from which to meet patients where they are at in ways that will be helpful to them.

Ultimately there are many ways that our healthcare professionals and our systems promote dependency and I suspect we could have some interesting conversations about healthy versus unhealthy dependency affecting individuals and systems.  Consider how doctors are often referred to as “Gods” and nurses as “Angels”.  Do these labels fuel our secondary gains?  Do they keep us in ‘Us’ versus ‘Them’ mindsets?  And how about these common phrases:
  • If you are sick for more than three days you must have a doctor’s note to come back to work.
  • Make sure to talk with your healthcare professional if you are going to try this exercise program.
  • You must have a referral from your primary care physician if your insurance is going to cover your visit to the specialist.
Don’t they all have elements of dependency that may be misplaced?  What are your thoughts?

Guest post by Beth Boynton RN, MS

Beth Boynton, RN, MS, is a nurse consultant, author, and teacher specializing in communication and collaboration among healthcare professionals and within organizations. She offers interactive workshops, leadership coaching, a ‘whole systems’ approach for culture change efforts, and a new method for building ‘people skills’ called ‘Medical Improv’. She has recently completed her second book, a core text called: Successful Nurse Communication: Safe Care, Healthy Workplaces, and Rewarding Careers which is scheduled to be published by F.A. Davis Publishing Co. Spring 2015. She writes about related issues at, “Confident Voices in Healthcare” blog. Her video, “Interruption Awareness: A Nursing Minute for Patient Safety,” and blog have drawn audiences from all over the world. She is trained in the Professor Watson Curriculum for Medical Improv through Northwestern University Feinberg School of Medicine. She has one grown son who is works in India, loves improv, Zumba dancing, walking, and swimming, and lives in Portsmouth, NH.

You may view Beth's online contiuing education course - 4 Essential Stratefies that Promote Patient Safety. This is a 2 contact hour course that features Beth in 10 short video's designed to engage and teach the student.  This instructional continuing education course is designed for nurses who are in direct care or middle management positions in hospitals; long-term care facilities, and other frontline in- and out-patient practice settings.  Despite 15 years of national focus on improving patient safety outcomes, we continue to have staggering statistics involving preventable deaths, illnesses, and injuries that are due to medical errors. And because communication breakdowns and associated problems with inter-professional relationships have long been major contributors to these alarming problems it is imperative for nurses to develop skills and promote positive interpersonal dynamics. Respectful interactions and effective communication seem simple on paper, yet successful efforts to practice them in the field remain elusive.  In this course, students will examine patient safety statistics and root cause analysis data in order to understand the scope of the problem and how persistent issues with communication and human dynamics are interfering with providing safe care.  This foundation will provide the incentive to commit to exploring and practicing communication strategies that will help to solve them. A basic knowledge of assertiveness, listening, and emotional intelligence is required as students take a ‘deeper dive’ with Beth Boynton, RN, MS to develop their abilities to:  set limits, delegate tasks, and give and receive constructive feedback.

Posted: 5/20/2015 10:50:51 AM
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