OUR MODEL OF PROFESSIONAL NURSING CARE DELIVERY – HOW WE GOT THERE

In early 1992, a group of nursing leaders met and discussed adopting Jean Watson’s Theory of Caring as the Winter Haven Hospital’s model for nursing care. Over the next twelve years, Jean was the keynote speaker at our annual nursing research seminars. Her addresses energized the seminar participants, but we had not identified the strategies for communicating her vision for caring and healing.

In 2005, Mary Jo Schreiber, the Chief Nursing Officer (CNO) , decided we needed to utilize ANCC Magnet Standards to assist in formulating our nursing strategic plan. One of the first goals was to develop a tool that described our values for nursing care delivery using Jean Watson’s Theory of Caring. The first Shared Governance group was assigned this task and the Professional Model of Care was born in the fall of 2006.

DEVELOPMENT

Development of the first Professional Model of Care was entrusted to our Nursing Shared Governance Team. At their first meeting in August 2006, a presentation on “Professional Model of Care – Formula for Success” was presented. After the presentation, the Nursing Shared Governance team elected a smaller group to work with an appointed administrative liaison to begin drafting schematics and content of a nursing Professional Model of Care.

The group drew upon information from the Winter Haven Hospital strategic plan and vision, regulatory agency standards, ANA Standards of Practice (2004), and Jean Watson’s Theory of Caring as Kristen Swanson described in her work Middle Range Theory of Caring. The group met to develop a model. Suggestions for the schematic and content were brought monthly to the Shared Governance Team, who reviewed, revised or accepted suggestions.

In January 2007, the Shared Governance Team completed their work and presented it to the Patient Services Executive Board (shown below). The Board endorsed the final outcome of the project and booklets explaining the model were printed for each registered nurse.

APPLY

Jean Watson’s caring behaviors were applied to the hospital-wide implementation of a computerized job description. A small group was convened by Human Resources (2009) and was tasked with revising job descriptions. The group was challenged to include language that embraced Jean Watson’s caring theory and our new hospital branding concepts.

The following statement was included in all job descriptions:
“All Winter Haven Hospital employees practice the Art and Science of Caring as described by Jean Watson’s Caring Behaviors, including but not limited to: treating everyone with loving kindness, honoring faith and hope, developing caring trusting relationships, promoting teaching and learning, and creating healing environments.”

Under Standards of Excellence, our headings reflect our core values of safety, customer service, competence, accountability etc. which are reflected in nursing’s model of care.

The Professional Model of Care behaviors were also incorporated in the electronic documentation system. McKesson’s Horizon Electronic Documentation (HED™) system is the platform in which nursing applied the caritas language to patient care documentation . Nursing staff has the ability to describe their caring behaviors as they deliver nursing care.

EVALUATE

Caring behaviors identified in our Model of Care are included in nursing job descriptions. These behaviors are included as measures of performance in annual performance appraisals, with potential merit increases tied to this performance.

The first Nursing Shared Governance team created the RN Clinical REWARDS (Recognizing Excellence, Worth, Ambition, Resourcefulness, and Dedicated Service) clinical ladder. The application process requires the nurse to write about how they have used five Caritas processes while caring for a patient or patients. The Nursing Shared Governance membership evaluates each applicant’s documentation of how they have effectively used Jean Watson’s Caring Theory to provide care for their patients.

The Daisy Award recognizes extraordinary nurses and their ability to render excellent, compassionate nursing care. These staff members are recognized by their peers and managers as the kind of nurse our “patients and their families recognize as an outstanding role model”. Nominations address specific criteria that mirror our caring language and commitments to our patients: extraordinary compassion and caring, commitment to excellence and innovation, commitment to patient-centered care, instills faith, hope and trust, and sensitivity to self and others. The Nursing Shared Governance team evaluates nominations several times a year and recipients are announced and celebrated on the units where they work.

ADAPT

Enculturation has been our approach to adapting our Model of Care. Enculturation activities are diverse and numerous. Every meeting in the hospital, from direct care staff meetings to Board of Trustee meetings, begins with a “Caring Story.” Caring Stories reflect the foundation of our Model of Care.

The Professional Practice Model has been adapted for use by our Watson Caring Science Institute Caritas Coaches. We have seven Caritas Coaches working in various clinical areas and hospital administration. These coaches individually observe, recognize and validate the Caritas processes in our Model of Care when enacted by direct care nurses.

Watson Caring Science Institute’s working definition of a Caritas Coach is:
“a knowledgeable, experienced, reflective health care professional/caregiver, who is prepared and committed to personally and professionally practice and model intelligent heart-centered approaches and coach others by translating and sustaining the ethic, philosophy, theory and practice of the Science of Human Caring into our systems and society”.

The hospital committed to have staff members participate in the Caring Coach program since its inception, supporting the development and growth our of caring philosophy as well as our Model of Care. For example, one coach from the CVICU took the caring behaviors from the model and worked with her ICU peers to create common language that consistently describes the behaviors in the electronic documentation tool. This language is summarized in a document that now supports the nurses when they chart.

Another WHH caritas coach worked to create a healing environment for oncology patients. She worked with Engineering to get each room painted a different color and worked with local artists who donated artwork for each room creating more of a “bedroom” feel, instead of the typical, stark hospital room. She also had the staff’s break room painted and worked to create a more serene space where staff could go and get away from work demands. This demonstrates Caritas process number 3, ”Sensitivity and caring for self and others”.

MODIFY

The first iteration of the model was utilized until the fall of 2009. Our original Professional Practice Model used Kristen Swanson’s five descriptions of caring, but after discussions with Jean Watson we determined her preference to modify the model to reflect the Caritas Language. The model also included what Jean referred to as “industrial terms.” Customer Satisfaction was changed to Satisfaction, and Patient Safety was changed to Safety, which better describes all participants involved in the delivering and receiving of care. Flow and Efficiency was modified to Efficiency. The schematic colors were changed to bright red. The central focus of the model was modified from a circle to a heart to denote the “heart-centered approach” for providing care.

Since the development of the first Nursing Professional Model of Care in 2006, it has been our guide for providing quality compassionate care. Over time, we have modified the model, used it to evaluate our clinical practice, applied meaningful caring language to our nursing electronic charting system, and had our caring coaches adapt the content to be used in their Caring Coach Projects which were implemented in their clinical areas.

The modification of the model was sent to Dr. Jean Watson for review and she sent the following kind words to our Chief Nursing Officer:

“Mary Jo, you all are dear and authentic to the bones with all this beautiful work and labor of love. I am so honored and proud to know and work and be inspired by your devotion, dedication, and remarkable successes. I am so happy to see this shift and am excited to share with others in my presentations as another Winter Haven Hospital exemplar of an authentic Caring Science Institution.

My heart is smiling. My love to all.”

Jean