>> GOOD AFTERNOON, EVERYBODY. WELCOME TO CC GRAND ROUNDS. IT'S WONDERFUL TO HAVE GRAND ROUNDS CELEBRATING NATIONAL NURSES WEEK. AND THE THEME NURSING IS DELIVERING QUALITY AND IN LEGISLATION IS A IN PATIENT CARE AND OUR TWO SPEAKERS ARE GOING TO BE A WONDERFUL EXAMPLE OF THE THEME. WE ARE PLEASED THAT OUR CLINICAL CENTER PARTNERS ARE ACTIVE COLLEAGUES PARTICIPATING AND COLLABORATING IN ALMOST ALL ASPECTS OF THE NATIONAL CLINICAL RESEARCH ENTERPRISE. TODAY WE HAVE TWO PRESENTERS WHO ARE GOING TO DISCUSS THEIR TOPIC -- LENDING CLINICAL CARE IN RESEARCH, A CLINICAL RESEARCH NURSING MODEL OF CARE. AND OF COURSE, OUR FIRST SPEAKER'S GOING TO BE DR. CLAIRE HASTEINGS, THE CHIEF NURSING AS -- OFFICER FOR THE CLINICAL CENTER, AND THEN SHE'S GOING TO BE FOLLOWED BY DR. BARBARA JORDAN, WHO IS THE NURSING CHIEF FOR NURSING SCIENCES BEHAVIORAL HEALTH AND PEDIATRICS HERE AT THE CLINICAL CENTER. SO I AM GOING TO SAY A FEW COMMENTS ABOUT EACH AND THEN THEY HAVE A PLANNED MODE OF DELIVERY. DR. HASTEINGS IS THE CHIEF NURSING OFFICER, AND SHE STARTED HER CAREER AS THE STAFF NURSE HERE AT THE CLINICAL CENTER AND SUBSEQUENT HELD SENIOR MANAGEMENT ROLES AT THE HOSPITAL CENTER IN WASHINGTON AND THE UNIVERSITY OF MARYLAND MEDICAL SYSTEM IN BALTIMORE. AS THE CHIEF NURSING OFFICER, SHE DIRECTS NURSING PATIENT CARE SERVICES TO SUPPORT THE ENTIRE INTRAMURAL RESEARCH ACTIVITIES CONDUCT AT THE CLINICAL CENTER AT A 240-BED HOSPITAL FACILITY. DR. HASTEINGS HAS REPRESENTED THE CLINICAL CENTER IN HELPING TO DEFINE THE ROLE OF NURSES WITHIN THE NATIONAL CLINICAL RESEARCH RAIN?{}STRUCTURE AND IN SETTING STANDARDS FOR INTEGRATING PATIENT CARE AND MANAGEMENT OF THE CLINICAL RESEARCH PROCESS. SHE IS INTERNATIONALLY KNOWN FOR HER LEADERSHIP IN ESTABLISHING A CONCEPTUAL FRAMEWORK TO DESCRIBE AND EVALUATE THE ROLES OF NURSES IN CLINICAL RESEARCH AND TO ESTABLISH CLINICAL RESEARCH NURSING AS A SPECIALTY. SHE PROVIDES EXECUTIVE LEADERSHIP WITH THE NURSING RESEARCH PROGRAM HERE AT THE CLINICICAL CENTER WITH A PORTFOLIO OF STRENGTH AND HEALTH BEHAVIOR, CHRONIC DISEASE SELF-MANAGEMENT, SYMPTOM MANAGEMENT, OUTCOMES MANAGEMENT, AND RESEARCH CAREER DEVELOPMENT. SHE EARNED HER BACHELOR OF ARTS DEGREE IN ANTHROPOLOGY FROM REED COLLEGE IN PORTLAND, OREGON AND HER BACHELOR OF SCIENCE IN NURSING DEGREE AND HER PH. D DEGREE IN MURSING A -- NURSING AT THE UNIVERSITY OF MARYLAND. SHE'S ALSO COMPLETE AID MASTER'S DEGREE -- MASTER'S OF SCIENCE DEGREE IN NURSING ADMINISTRATION AT GEORGETOWN. JUST WANT TOMINATION FEW OF HER ACCOMPLISHMENTS BESIDES THE BROAD ONES I JUST MENTIONED. SHE HAS SERVED AS PRESIDENT OF THE AMERICAN ACADEMY OF AMBULATORY CARE NURSING FROM 1990 TO 19893. SHE'S BAIN MENTOR TO NUMEROUS PH. D STUDENTS. SHE'S CURRENTLY SERVES AS CO-CHAIR OF THE AMERICAN ACADEMY OF NURSING, HEALTH BEHAVIOR -- THE AMERICAN ACADEMY OF NURSING HEALTH BEHAVIOR EXPERT PANEL THAT IS DEVELOPING A TAXONOMY OF HEALTH BEHAVIORAL MODIFICATIONS INTERVENTIONS RELATEDED TO THE IMPACT OF HEALTH BEHAVIOR OF INDIVIDUAL NURSES. THE WORK FORCE HAS A WHOLE AND ON THE EFFECTIVENESS OF NURSES AS PATIENT COUNSELORS AND HEALTH COACHES. I THINK IT'S OBVIOUS TO ALL OF YOU BUT IT'S ESPECIALLY OBVIOUS TO ME THAT UNDER HER LEADERSHIP, OUR NURSING PROGRAM HAS BEEN BECOME RECOGNIZED NATIONALLY AS, I THINK, THE BEST IN THE COUNTRY. AND ALL YOU OF YOU MAKE THAT POSSIBLE SO WHAT A NICE THING TO BE ABLE TO SAY. NOW LET ME INTRODUCE OUR SECOND SPEAKER, DR. BARBRA JORDAN, WHO IS ALSO VERY DISTINGUISHED. SHE'S ONE OF THE NEWER MEMBERS OF OUR FAMILY AND THE -- PREVIOUSLY SHE SERVED AS VICE PRESIDENT OF PATIENT CARE SERVICES AND CHIEF NURSING OFFICER FOR THE UNIVERSITY OF PITTSBURGH MEDICAL CENTER NORTHWEST. SHE'S ALSO AN A PRAISER FOR THE AMERICAN NURSES CREDENTIALING CENTERS, PATHWAYS TO EXCELLENCE PROGRAM AND AN HISTORIC NURSING COURSES AT WAINZBURG UNIVERSITY. A LONG AND DISTINGUISHED CAREER IN NURSING ADMINISTRATION INCLUDES HER ROLES AS NURSE MANAGER OF VARIOUS ICU'S AT THE UNIVERSITY OF NORTH CAROLINA HOSPITALS IN CHAPEL HILL, CLINICAL OPERATIONS DIRECTOR OF THE ICU IN DURHAM REGIONAL HOSPITAL, AND CLINICAL DIRECTOR OF INFECTION CONTROL AND REGULATORY COMPLIANCE AT THE UNIVERSITY OF PITTSBURGH MEDICAL CENTER, SAINT MARGARET. SHE RECEIVED HER DOCTORATE OF NURSINGLE PRACTICE FROM WAINZBURG UNIVERSITY IN 2012 WAY FOCUS ON RELATIONSHIP-BASED CARE, PRECEDE BID A MASTER'S DEGREE FROM THE UNIVERSITY OF NORTH CAROLINA CHAPEL HILL AND A BACHELOR'S DEGREE IN NURSING. SO NOW PLEASE WELCOME DR. HASTEINGS, WHO IS GOING TO START THIS OFF. CLAIRE? [APPLAUSE] >> WELL, THANK YOU, WHAT A WONDERFUL WAY TO BE RECOGNIZED AND THEN TO LOOK OUT AND SEE ALL THE PEOPLE THAT MAKE THAT RECOGNITION IN ANY WAY POSSIBLE. I OWE IT TO ALL THE NURSES HERE AND TO ALL OF OUR COLLEAGUES WHO WORK WITH US TO HAVE A PLACE THAT YOU CAN REALLY DO SOME AMAZING THINGS IN TERMS OF THE BEST CARE THAT PATIENTS COULD RECEIVE AND THE BEST WAY THAT WE COULD SUPPORT RESEARCH. SO WE'RE GOING TO BE -- BARBARA AND I ARE GOING TO BE COMBINING OUR WORK IN LOOKING AT HOW NURSES AND PATIENTS GET TOGETHER IN DELIVERING PATIENT CARE. I AM GOING TO BE TALKING VERY QUICKLY FOR SOME OF THE WORK WE'VE DONE HERE AT THE CLINICAL CENTER TO FIND WHAT NURSES DO IN CLINICAL RESEARCH AND HOW THAT RELATES TO HOW WE WORK TOGETHER WITH OUR PATIENTS. AND SHE'S GOING TO TALK ABOUT A STUDY THAT WAS THE CORNERSTONE FOR HER DOCTORAL WORK THAT WAS FINISHED LAST YEAR. AND AFTER WE PRESENT A LITTLE BIT ABOUT HOW THAT APPLIES HERE, WE HOPE TO HAVE A DIALOGUE AND QUESTION AND ANSWER SESSION. NEITHER OF US HAVE ANYTHING TO DISCLOSE. AND OUR OBJECTIVES RELATE TO INTRODUCING REALLY TO THE CLINICAL CENTER FORMALLY, THE CONCEPT OF RELATIONSHIP-BASED CARE, WHICH IS THE CONSENT THAT BARBARA BASED HER DOCTORAL WORK ON. SO SHE'S GOING TO DEFINE THE CONCEPTS. WE'RE GOING TO TALK ABOUT THE RELEVANCE OF RELATIONSHIP-BASED CARE IN A CLINICAL RESEARCH SETTING, AND WE'RE GOING TO TALK ABOUT HOW IMPLEMENTING RELATIONSHIP-BASED CARE CAN HAVE AN IMPACT ON PATIENT OUTCOME. SO I AM GOING TO START US OFF BY JUST ASKING YOU TO CONSIDER NURSES AT THE CENTER OF THE HEALTHCARE DELIVERY SYSTEM AND WHAT IT TAKES TO MAKE NURSES PROVIDING CARE BE SUCCESSFUL. WHAT ARE THE INGREDIENTS THAT, WHEN PATIENTS TALK ABOUT NURSES, THEY CONSIDER THAT WHEN PHYSICIANS TALK ABOUT THE GOOD NURSES THAT THEY HOPE TAKES CARE OF HIS OR HER PATIENTS, WHAT QUALITIES GO INTO THAT NURSE'S PRACTICE AND WHAT WE AS COLLEAGUES VALUE IN EACH OTHER. AND I AM GOING TO TALK ABOUT IT FROM THE PERSPECTIVE OF OUR PRACTICE IN A CLINICAL RESEARCH SETTING, AND I AM GOING TO BEGIN TO TALK ABOUT THE IMPORTANCE THAT THE RELATIONSHIP THAT WE HAVE WITH OUR PATIENTS WITH EACH OTHER, AND REALLY ALSO WITH THE PERSON THAT IS OURSELVES, IN TERMS OF KEEPING OUR OWN SELVES HEALTHY, BECAUSE THAT'S AN INTEREST OF MINE, HOW NURSES CAN BECOME MORE HEALTHY BOTH IN THE WORK FORCE AND AS INDIVIDUALS. SO WE'RE GOING TO BE TALKING ABOUT THOSE THREE RELATIONSHIPS, WHICH ARE THE CORNERSTONES OF RELATIONSHIP AND CARE. AND ONE OF THE THINGS THAT WE'RE GOING TO BE DOING IS SHOWING HOW, WHEN NURSING LOOKS AT HOW IT DOES ITS WORK, AND WHEN IT MAKES A CHANGE AND SOMETHING AS BASIC AS THE NURSE NURSING CARE DELIVERY MODEL, WE REALLY OWE IT TO EVERYBODY TO DO A FORMAL ASSESSMENT OF OUTCOMES. THAT'S DEMANDED BY ACCOUNTABILITY, DATABASE EVALUATION, IF WE ARE GOING TO BE ACCOUNTABLE, WE HAVE TO BASE THAT FOR PROOF AND EVIDENCE ON EVIDENCE THAT'S DATABASED. OUR STAKEHOLDERS, THE PEOPLE WHO SUPPORT US, REQUIRE OUTCOMES DATA TO SUPPORT THE DECISIONS THAT THEY MAKE TO SUPPORT US IN OUR DECISIONS IN CHANGING OUR CARE OF DELIVERY. AND IF WE'RE GOING TO TRANSLATE OUR INNOVATIONS AND AS YOU KNOW THE CLINICAL CENTER IS REALLY KIND OF A HOTBED FOR INNOVATIONS IN HEALTHCARE DELIVERY AND HOW TO DO CLINICAL RESEARCH AND HOW TO TAKE CARE OF PEOPLE, PARTICIPATING RESEARCH -- IF WE'RE GOING TO TRANSLATE THOSE INNOVATIONS, WE NEED TO BE ABLE TO SPECIFY THE INNOVATIONS, IN OTHER WORDS DESCRIBE IT VERY SPECIFICALLY, AND WE THEN NEED TO QUANTIFY THE IMPACT OF THAT INNOVATION. AND THESE AREAS HAVE BEEN A MAJOR FOCUS FOR NURSING OVER THE LAST SEVERAL YEARS, BUT ESPECIALLY OVER THE LAST FIVE YEARS, AS WE'VE BEGUN TO SAY WE NEED TO FORMALLY DOCUMENT AND MEASURE AND DEMONSTRATE THE EFFECTIVENESS OF OUR OUTCOMES. AND WHAT WE'RE SEEING IN NURSING IS A SHIFT IN SOME OF THE EDUCATIONAL APPROACHES THAT ARE BEING PROVIDED FOR STAFF WHO ARE INTERESTED IN WORKING IN HEALTHCARE DELIVERY SETTINGS AND DEMONSTRATING THE OUTCOMES AS THEY ARE PRODUCING. I THINK PEOPLE HERE ARE FAMILIAR WITH THE PROFESSIONAL DOCTORATE THAT IS AVAILABLE TO PEOPLE WORKING IN PHARMACOLOGY AND PHARMACEUTICALS WORK IN PHARMACY. WELL, THE NURSING DEGREE OF DOCTORATE OF NURSING PRACTICE IS A PRACTICE DEGREE THAT IS DEVELOPED FOR PEOPLE WHO ARE IN CLINICAL PRACTICE WHO WANT TO BE ABLE TO APPLY ADVANCED ANALYTIC TECHNIQUES TO DEMONSTRATE THE OUTCOMES.^ WHAT THEY DO. AND WE ARE SEEING IN OUR STAFF AND A NUMBER OF PEOPLE WHO ARE GOING FOR THAT DOCTORAL DEGREE AND WHO ARE BEING SUCCESSFUL IN OBTAINING IT. AND DR. JORDAN IS ONE OF THOSE PEOPLE AND AS WELL AS SEVERAL OTHERS WHO I AM GOING TO TALK ABOUT IN A MINUTE. SO THIS YEAR, WE HAVE A LIST OF SIX PEOPLE, AND I AM -- WOHAVE ACTUALLY EARNED A RIGHT, IF YOU WILL, TO PUT A DOCTORATE AFTER THEIR NAME. SO WE HAVE A FEW PEOPLE WHO WILL GET THEIR RECOGNITION NEXT YEAR. BUT I THINK IT'S VERY COMPELLING TO NOTE THAT THE THREE PEOPLE THAT WE SELECTED FOR SERVICE CHIEFS AS THEY CAME INTO OUR ORGANIZATIONAL STRUCTURE ARE ALL PREPARED AT THE DOCTORAL LEVEL AND ALL AS DOCTORS OF NURSING PRACTICE AND THERE IS A TERM FOR THIS IN NURSING EDUCATIONAL ARENA, WHICH IS EXECUTIVE PRACTICE. SO PEOPLE WHO ARE APPLYING THEIR UNDERSTANDING OF NURSING TO THE ROLE OF AN EXECUTIVE LEADER. AND THOSE PEOPLE HAVE A MANDATE TO REQUIRE THAT PEOPLE WHO ARE WORKING FOR THEM AND WITH THEM DEMONSTRATE THE OUTCOMES OF THE WORK THAT THEY DO THROUGH QUANTITY FATEIVELY AND QUANTITATIVELY AS BEST WITH THE RESULTS. AND IN OUR CLINICAL LEADERSHIP AGAIN, PEOPLE FOCUSING PRIMARILY MORE ON A CLINICAL OR RESEARCH AREA, WE HAVE THREE NEW PHD'S -- WHO WORKS IN THE RESEARCH OFFICE AND ANN PETERSON, WHO ACTUALLY FINISHED A YEAR AGO BUT WE DIDN'T SCLANS TO RECOGNIZE HER AND MIRA WHO FINISHED THIS YEAR. SO BOTH ANN AND MIRA ARE SPECIALIST WHO WORK WITH CLINICAL PATIENTS IN ADVANCED PRACTICE.^ SO I WANTED TO TAKE A MINUTE TO RECOGNIZE THESE PEOPLE. I AM GOING TO ASK THEM, IF THEY ARE HERE, IF THEY WOULD STAND UP. I'D LIKE TO PUBLICLY RECOGNIZE THEM. [APPLAUSE] SO I JUST REALIZED THEY STOOD SIP AND DIDN'T SAY THE NAMES OF DEBBIE AND AMY MATLOCK. OKAY JOB, WE'RE VERY PROUD OF THESE PEOPLE. AND THESE PEOPLE ARE GOING TO ALLOW US TO CONTINUE TO DO THE KIND OF WORK THAT WE DO, WHICH IS INNOVATION AND THEN EVALUATION AND DOCUMENTATION OF THE EFFECT OF THAT. SO, AS DR. GALAN SAID, WE'VE HAD FOR THE LAST SEVERAL -- SEVEN YEARS, I THINK, A GLOBAL AGENDA TO DEFINE AND SUPPORT THE PRACTICE OF NURSING IN CLINICAL RESEARCH. AND I GOT TOTALLY INVESTED IN THIS AFTER I BEGAN TO REALIZE THAT THE AMAZING WORK THAT WE DO HERE WAS UNDERSTOOD BY PEOPLE WHO COULD WITNESS IT, WHO COULD COME HERE AND SEE WHAT WE DO AS PATIENTS, WHO COULD EXPERIENCE IT. BUT WHEN YOU WENT EXTERNALLY AND TRIED TO DESCRIBE WHAT A CLINICAL NURSE, THERE WAS ARE NOT THE TERMINOLOGY OR THE FRAMEWORK OR ANY OF THE LANGUAGE TO DESCRIBE IT. SO WE TOOK IT AS OUR MANDATE TO TRY TO DO THIS AND IT'S AN APPROPRIATE THING FOR THE CLINICAL CENTER TO SET THAT KIND OF EXAMPLE FOR THE COUNTRY. SO BASICALLY WE TOOK CLINICAL RESEARCH NURSING, WHICH IS A SPECIALTY PRACTICE AREA, AND YOU CAN SEE ON THIS LITTLE PIE THAT THERE IS A PIECE OF THE PIE THAT'S PULLED OUT THAT THAT'S THE OBVIOUS PIECE, THAT'S CLINICAL PRACTICE. AND THE REST OF THE DIMENSIONS OF THAT PRACTICE SPECIALTY RELATE TO THE COMPONENTS THAT ARE FOR US UNIQUE TO OUR WORK WITH RESEARCH PARTICIPANTS. AND THAT INCLUDES STUDY MANAGEMENT, CARE COORDINATION AND CONTINUITY MANAGEMENT, HUMAN SUBJECT PROTECTION AND THEN OUR CONTRIBUTING -- ROLES CONTRIBUTING TO THE SCIENCE. AND THAT'S BECAUSE OUR WORK INVOLVES MORE THAN JUST HEALTHCARE. WE DO RESEARCH-BASED CLINICAL PROCEDURE AND FOLLOWUP CARE. WE MAY DO CLINICAL WORK ALONG TOS BUT THE REASON PEOPLE COME HERE IS TO PARTICIPATE IN RESEARCH. WE MANAGE CARE IN THE CONTEXT OF WHAT THE STUDY IS SO THAT IF A STUDY REQUIRES THAT A PERSON HAS REPEATED IMAGING OR MAYBE AN INVASIVE LINE PLACE, THOSE ARE THE THINGS THAT WE DO TO COLLECT RESEARCH DATA. WE COORDINATE CLINICAL CARE AND RESEARCH PARTICIPATION BOTH HERE AND THEN IF THE PERSON GOES BACK TO HIS OR HER COMMUNITY. AND AS YOU ALL KNOW, SOMETIMES THAT COMMUNITY IS A COUNTRY ON THE OTHER SIDE OF THE WORLD AND WE'VE HAD SOME EXTRAORDINARY EXPERIENCES TAKING OUR WORK WITH PEOPLE AND EXTENDING TO A COMMUNITY THAT HAS MAYBE VERY LITTLE UNDERSTANDING OF THE KIND OF CARE THAT THAT PERSON WILL REQUIRE. I THINK EVERYONE HERE WHO HAVE BEEN INVOLVED WITH THAT PATIENTS PROBABLY HAS A PERSONAL STORY ON THAT. WE HAVE TO BALANCE ETHICAL CONCERNS, RESEARCH REQUIREMENTS, AND MAKING SURE THAT THE PATIENT ON AN ONGOING BASIS UNDERSTAND WHAT'S GOING ON AND WHAT OUR OPTIONS ARE. AND ALL ALONG THE WAY WE ADD OUR CONTRIBUTIONS IN THE PROCESS. AND AS DR. EXACTLYAN MENTIONED, I STARTED HERE AS A STAFFER, AND I REMEMBER PROBABLY THREE OR FOUR YEARS INTO MY TENURE, WHICH IS ABOUT THE TIME WE SAY AS NURSES FULLY COMPETENT EXPERT AT THE CLINICAL PART OF OUR PRACTICE AND IS BEGINNING TO KIND OF PUT HIS OR HER NOSE,000 THE RESEARCH PROCESS AND UNDERSTAND A LITTLE BIT MORE ABOUT HOW THE RESEARCH STUDIES ARE DEVELOPED AND WHAT CAN BE DONE TO SUPPORT THAT PROCESS. AND I REMEMBER BEING ASSIGNED TO WORK WITH A FELLOW IN THE ARCHIVES AND THAT WAS MY CONTRIBUTION. I REALIZED I HAD JUST ABOUT AS MUCH TO OFFER IN TERMS OF THE RESEARCH QUESTION THAT MIGHT BE ASKED AND HOW THAT STUDY MIGHT BE DESIGNED AS THAT PERSON DID. WE BOTH HAD CLINICAL PREPARATIONS BUT I SEE THAT ALL THE TIME IN OUR STAFF AS WE LOOK AT WHAT NURSES DO IN CLINICAL RESEARCH. WE TOOK THIS ADVENTURE OF DEFINING CLINICAL RESEARCH IN NURSING ON THE ROAD, AND SO THAT GROUP IS A GROUP AT ROCKEFELLER UNIVERSITY IN NEW YORK. WE PARTNERED WITH THEM, WITH THE LEADERSHIP THERE TO HAVE SEVERAL THINK TANKS. WE PUT OUR WORK INTO A NURSING JOURNAL AND WE'VE INCLUDED WORK THAT LED TO THE CREATION. SO THAT'S THE KIND OF THING YOU DO WHEN YOU ARE TRYING TO BUILD A CLINICAL STUDY. ALSO LOOKED INSIDE AT WHAT IT TAKES TO PROVIDE THE CARE THAT OUR PATIENTS NEED AND ONE OF THE FIRST THINGS THAT I FETALFELT WAS REALLY IMPORTANT WAS TO TRY TO BLEND OUR UNDERSTANDING OF THE CLINICAL RESEARCH PROCESS. SO THIS DIAGRAM WE USE IN OUR ORIENTATION PROCESS TO TALK ABOUT CLINICAL RESEARCH TO SHOW -- AND THIS GOES BEYOND JUST NURSING. THIS GOES TO ALL THE DISCIPLINES, HOW WE START WITH A PROTOCOL APPROVAL, END WITH THE RESULTS AND PRETTY MUCH ALONG THE WAY YOU ARE WORKING IN PARALLEL WITH CLINICAL CARE. YOU CAN'T GET AWAY CAN FROM THE CLINICAL CARE PART BUT YOU KNOW IT'S BEING DRIVEN BY THE CLINICAL RESEARCH. ONE OF THE THINGS THAT WE HAD TO ADDRESS VERY QUICKLY AS WE BEGAN TO UNDERSTAND WHAT OUR WORK IS HERE IS WHAT'S THE PROCESS, OR THE MODEL OR THE A PROPOSE THAT WE HAVE TO TAKE PATIENTS AND NURSES IN THE CLINICAL RESEARCH ENVIRONMENT AND PUT THEM TOGETHER? WE CALL THAT OUR MODEL OF CARE, AND WE USED A RELATIONSHIP-BASED APPROACH, ALTHOUGH WE DIDN'T CALL IT THAT, BECAUSE OUR WORK WAS BASED IN THE CONCEPT OF PRIMARY NURSING, WHICH MANY PEOPLE HAVE WORKED HERE A LONG TIME WILL RECOGNIZE. WE REVISITED THE PRINCIPLES OF THAT WAY OF GIVING NURSING CARE, WHICH IS THE SINGLE NURSE AND WE RECOMMITTED TO IT AND WE DECIDED WE COULD WOULD CALL IT BECAUSE EVERYTHING WAS KWLIRNGICAL RESEARCH. SO THAT IS NOW THE PRIMARY ROLE OF TAKING CARE OF PATIENTS WHO ARE IN CONTACT WITH US FOR MORE THAN JUST THE RESEARCH AND THAT PERSON FOCUSES ON THE INDIVIDUAL CARE AND FAMILIES AND, ESTABLISHES A RELATIONSHIP THAT EXTENDS OVER TIME AND PLANS THE COHORT COORDINATED CARE. WE ALSO PUT IN PLACE A NURSE ON THE PATIENT CARE UNIT WHO SHEPHERDS NEW PROTOCOLS INTO THE UNITS AND WE CALL THAT ROLE A CLINICAL COORDINATOR. PROTOCOL THE LIASON NURSE, PROTOCOL NURSE. AND THAT PERSON FOCUSES PROTOCOL IN A SPECK AREA. ALL THE THINGS THAT NEED TO BE HAPPENING FOR THE INDIVIDUAL APPEARANCE THEY COME, ESTABLISH A RELATIONSHIP WITH THE RESEARCH TEAM, LOOKING AT WHAT NURSING CARE NEEDS TO BE PROVIDED AND FUNCTIONING AS A PRIMARY CLINICAL NURSE WHEN NEEDED. THOSE ARE THE TWO ROLES OF CARE. AND AS BARBARA AND I WERE TALKING IN DEVELOPING OUR TALK, IT WAS VERY CLEAR TO ME WHAT SHE WAS TALKING ABOUT WHAT WAS GOING ON IN THE EXTERNAL ENVIRONMENT AND HERE AS WE LOOKED AT OUR MODEL OF CARE ARE EXACTLY THE SAME THING. SO IT WAS REALLY NEAT TO SEE HOW THOSE THINGS WERE THE SAME. THE INTENDED OUTCOMES OF OUR MODEL IS THAT IT WILL AFFECT CLINICAL OUTCOMES, IT WILL BE ABLE TO DO A BETTER JOB GIVING HIGH-QUALITY CARE, THAT BY HAVING NURSES ASSIGNED IN THIS WAY BE ABLE TO EFFECT RESEARCH PROTOCOL EFFECTIVENESS. HOW LONG IT TAKES TO GET A PROTOCOL UP AND RUNNING, HOW GOT DATA ARE AND HOW WELL WE'RE ABLE TO RETAIN SUBJECTS, THAT WE'LL HAVE AN IMPACT OF THE PATIENT AND FAMILY EXPERIENCE BECAUSE OF THE RELATIONSHIPS THAT WE'VE ESTABLISHED, THAT WE'LL MAKE THE CARE MORE SEAMLESS TO THE PERSON AND WILL ENSURE CONTINUITY AND EFFICIENCY. BUT THE RESEARCH TEAM WILL ACTUALLY BE ABLE TO WORK BETTER BECAUSE OF WHAT WE DO AND MAKE MORE EFFICIENT DELIVERY CARE SYSTEM. SO THOSE ARE THE THINGS THAT AS WE WORK WITH OUR PERFORMANCE IMPROVEMENT COMMITTEE TO BEGIN TO PLAN OUR OWN EVALUATION, INFORMED BY THE KINDS OF THINGS THAT BARBARA IS GOING TO SHARE WITH US. SO I AM GOING TO TURN IT OVER TO HER. SHE'S GOING TO TALK ABOUT HER PROJECT AND THEN WE'RE GOING TO COME BACK TOGETHER. >> THANK YOU, CLAIRE. AND I AM SO HONORED TO BE ABLE TO SPEAK WITH YOU TODAY AND SHARE SOME OF THE WORK THAT I DID. IT WAS A LITTLE BIT OF DIFFERENT WITH A DOCTOR OF NURSING PRACTICE DEGREE, INSTEAD OF DOING A DISSERTATION, IT IS AN EVIDENCE-BASED PROJECT CALLED THE CAP STOP, THAT WE COMPLETE. AND SO IT'S REALLY WHAT WE DO EVERY DAY. WE LOOK AT THE EVIDENCE AND WE APPLY INTERVENTIONS AND SEE WHAT THE OUTCOMES ARE AND THAT'S WHAT I DID IN THIS PROJECT. AND SO I THINK IT'S IMPORTANT TO SHARE WHAT IS RELATIONSHIP-BASED CARE? RELATIONSHIP-BASED CARE IS STARTED AS A NURSING DESIGNATED MODEL, BUT REALLY, IT CAN BE APPLIED TO ANYBODY. AND THERE IS THE RELATIONSHIP BETWEEN THE CARE PROVIDER AND THE PATIENT AND FAMILY, AND THAT'S THE ONE THAT I FOCUSED ON. AND THERE IS ALSO THE RELATIONSHIP BETWEEN CARE PROVIDER AND CARE PROVIDERS. WE TALK ABOUT INTERDISCIPLINARY REALMS, CARE, THE TEAMWORKING TOGETHER TO PROVIDE CARE TO THE PATIENT. THAT MAKES IT APPLICABLE TO ALL DIFFERENT TYPES OF CARE PROVIDERS. AND FINALLY, THERE IS THE RELATIONSHIP BETWEEN CARE PROVIDER AND SELF AND THAT WAS WHAT CLAIRE WAS TALKING ABOUT WITH HER INTERESTS IN LOOKING AT THE HEALTHY BEHAVIORS AS NURSING. AND I AM SO PLEASED MY FORMER CNO WHO I WORKED FOR ALSO DID HER ROBERT JOHNSON FOUNDATION FELLOWSHIP PROJECT ON THE SAME THING, BECAUSE WE AS CARE PROVIDERS, WERE SO FOCUSED ARE NOT ON OUR PATIENTS OUR OR OUR SUBJECTS THAT OFTENTIMES WE DON'T TAKE CARE OF OURSELVES. NOW, THIS IS FROM MARIE MAN FE, WHO IS A NURSING SCIENTIST AND REALLY TALKING ABOUT RELATIONSHIP-BASED CARE AND IT'S A THERAPEUTIC RELATIONSHIP. WHEN THE NURSES FOCUS ON THE PATIENT. NOW I AM GOING TO SPEAK ABOUT NURSING A LOT BUT THIS CAN BE APPLIED TO ANYBODY -- PHYSICIAN, OUR HEALTH UNIT COORDINATOR, THERAPEUTIC THERAPISTS, IT'S APPLICABLE TO ALL. BUT ONE OF THE THINGS THAT ALSO COMES OUT IS THAT PATIENTS COME TO FACILITIES FOR NURSING CARE AND DEVELOP THESE RELATIONSHIPS BECAUSE THEY TRUST NURSES. IN RECENT YEARS WITH THE GALLUP POLL LOOKING AT MOST TRUSTED PROFESSIONS, NURSING HAS BEEN RECOGNIZED IN THE GALLUP POLLS AS NUMBER ONEMENT AND NURSES ARE WITH PATIENTS 24 HOURS A DAY SO THERE IS A LOT MORE INTERACTION AND TIME WITH THE PATIENTS. SO THE GOAL OF THE PROJECT THAT I DESIGNED, AND I AM GOING TO BE REFERRING TO TWO NORTH. WOE DON'T HAVE THE TWO NORTH HERE. THIS TWO NORTH WAS AT MY PREVIOUS HOSPITAL. IT IS A $6.-BED TELEMETTRY UNIT THAT FOCUSES ON CARDIAC AND STROKE CENTER OF EXCELLENCE AND SO THIS WAS THE UNIT THAT WE CHOSE. THIS IS A RAPID TURN YOEFRP OF PATIENTS SO YOU DON'T HAVE -- LIKE HERE WE HAVE PATIENTS FIRE LONG TIME. BUT THERE, THE LENGTH OF STAY ON THAT UNIT AVERAGED ABOUT THREE DAYS. VERY DIFFERENT WORLD IN THE OTHER HOSPITALS SO WE'RE MANDATED TO GET PATIENTS OUT SOONER. SO WHAT I CHOSE TO LOOK AT BY IMPLEMENTING THIS MODEL WAS AN INCREASE IN PATIENT SATISFACTION, INCREASED SATISFACTION, WHICH I DID MEASURE WITH A TOOL, REDUCING PATIENT FALLS, BECAUSE WITH FORMULATING AND REALLY FORMING THIS RELATIONSHIP, WE REDUCE PATIENT FALLS AND ALSO REDUCE STAFF TURNOVER. SO I CHOSE IN THIS MODEL TO INTRODUCE A CARING THEORY. THERE ARE VARIOUS THEORIES BUT DR. SWANSON IS CURRENTLY THE DEAN AT THE UNIVERSITY OF NORTH CAROLINA. SHE HAS THIS CARING THEORY THAT I THOUGHT WAS TWHAN COULD EXPLAIN TO ANYBODY WHO HASN'T HAD THE INTRODUCTION N NURSING SCHOOL, WE WERE TAUGHT THE VARIOUS CARING THEORIES, BUT NOT EVERYONE HAS GONE TO NURSING SCHOOL, BECAUSE IN MY PROJECT IT WASN'T JUST NURSES, IT WAS ALSO THE NURSING ASSISTANTS, IT WAS THE UNIT CLERK AND ALSO MONITOR DECKS. THIS INVOLVED ALL OF THEM. BUT I WANTED TO SHIRE WITH YOU THE CARING THEORY BECAUSE THIS WAS THE CORNERSTONE. SO WITH DR. SWANSON, HER ELEMENTS ARE KNOWING, AND WE KNOW AND UNDERSTAND WHAT THIS INDIVIDUAL'S GOING THROUGH. THERE IS BEING THERE, THAT WE'RE THERE FOR THEM, BECAUSE WE UNDERSTAND THAT THIS IS NOT SOMETHING NORMAL IN THEIR LIFE. IT'S EITHER PART OF THEY'RE HERE AS A RESEARCH STUDY OR THEY'RE ILL. AND THIS ENVIRONMENT IS NOT THEIR HOME. THEY ARE IN A DIFFERENT ENVIRONMENT. PEOPLE ARE SICK. THEY MIGHT NOT BE ABLE TO BRUSH THEIR TEETH OR COMB THEIR HAIR. AND WHEN PEOPLE ARE IN THE HOSPITAL, THEY JUST WANT TO WATCH WASH THEIR HAIR AND WHEN SOMEONE IS REALLY SICK AND HAVE BEEN IN THE HOSPITAL A LONG TIME AND REALLY DON'T FEEL GOOD, THE MOST WONDERFUL THING IS WHEN SOMEBODY WASHES YOUR HAIR. ENABLING, YOU'RE HELPING THE INDIVIDUAL THROUGH WHATEVER THEY'RE GOING THROUGH. THEY'RE GOING THROUGH A RESEARCH PROJECT AND THIS IS NEW FOR THEM. THEY'RE HAVING SERIAL BLOOD DRAWS AND LEARNING ALL THE LINGO HERE AND WE HELP THEM THROUGH THIS. AND MAINTAINING BELIEF THAT WE UNDERSTAND THAT THEY ARE AN INDIVIDUAL AND THEY ARE CAPABLE AND HAVE IT WITHIN THEMSELVES TO GET THROUGH THIS, TO EITHER UNDERSTAND THIS NEW DIAGNOSIS THAT THEY HAVE OR THIS NEW TREATMENT, BUT WE BELIEVE THAT THEY, AS AN INDIVIDUAL, OR THE FAMILY, CAN GET THROUGH THIS. NOW, PART OF DOING THE RESEARCHES TO LOOK AT THE EVIDENCE. SO IN MY LITERATURE REVIEWS, LOOKING THROUGH WHAT IS IT ABOUT THE NURSE-PATIENT RELATIONSHIP? AND ACCORDING TO MARY COLITIS, WHO IS THE AUTHOR OF THE RELATIONSHIP-BASED CARE EDITOR -- IT WAS THE CORNERSTONE OF NURSING PRACTICES, THIS RELATIONSHIP THAT NURSES HAVE WITH THEIR PATIENTS AND THEIR FAMILIES. AND BEING PRESENT WITH THE PATIENT MEANS TRULY BEING PRESENT. HOW I EXPLAIN TO PEOPLE IS WHEN -- WE'RE BUSY. NURSES ARE BUSY, DOCTORS ARE BUSY, EVERYONE'S BUSY, AND YOU HAVE A FEELING OF I HAVE ALL THIS STUFF I HAVE TO GET DONE DURING THE DAY, SO I AM NOT GOING TO DO IT HERE BECAUSE IT WILL THROW OFF THE VIDEO OF THIS PORTION, BUT I SHOWED THEM RUNNING AROUND. AND I ASKED PEOPLE, BEFORE YOU GO INTO THAT PATIENT'S ROOM, STOP AND TAKE A DEEP BREATH AND WALK INTO THE ROOM. DON'T WALK IN A FAMILY -- PATIENT HOW BUSY YOU ARE. YOU HAVE TO TRULY BE THERE FOR THEM. FU GO IN THERE TO HANG NEW IV, THAT WE'RE PAYING ATTENTION TO THE PERSON IN THE BED AND NOT THE TEST THAT WE'RE STOCKING AND THAT'S WHAT IT MEANS TO BE PRESENT IN THE MOMENT. THEY'RE NOT GOING TO ASK YOU FOR HELP. SO YOU BETTER JUST KEEP IT ALL INSIDE. YOU STILL KNOW YOUR BUSINESS, BUT DON'T LET IT SHOW. AND THEN FORGIVE ME, I'VE NEVER MASTERED HER LAST NAME. BUT SHE'S A NURSE RESEARCHER WHO DEVELOPED A NURSE-PATIENT CARING THEORY BASED ON THE PATIENT'S FIRST PERSPECTIVE, WHICH IS INTERESTING. AND PATIENTS DESCRIBE THEIR RELATIONSHIPS WITH NURSES AS SPIRITUAL AND CARING, BUT ALSO IF THEY BELIEVE THAT NURSES ARE COMPETENT AND WISE, THAT IT REALLY HELPS THEM AS FAR AS BEING ABLE TO TRUST THAT THE NURSE -- SO IF SOMEBODY COMES FLYING IN A ROOM, OH, I'VE NEVER DONE THIS BEFORE, IF YOU THINK ABOUT IT BEING THE PATIENT IN THE BED, THAT'S THE LAST THING YOU WANT TO HEAR. AND SO THOSE KINDS OF THOUGHTS AND FEELINGS WE NEED TO KEEP INSIDE AND NOT SHARE WITH THE PATIENT. ALSO THE PATIENT SATISFACTION LITERATURE. AND DR. AL WANNI AND OTHERS DID AN INTEGRATIVE LITERATURE REVIEW LOOKING AT PATIENTS SATISFACTION AND WHAT WE THEY FOUND WITH PATIENTS SATISFACTION -- A LOT OF FACILITIES IN THE UNITED STATES USE GAINEY AND THAT'S WHAT I'VE BEEN FAMILIAR WITH AND THEY FOUND THAT THE CORRELATION BETWEEN A PATIENT'SOVER ALL-SATISFACTION WITH THE INSTITUTION WAS MOST CLOSELY LINKED WITH THE RESPONSIVENESS OF THE STAFF, AND THAT CAN BE ANYBODY. FOLLOWED BY THEIR SATISFACTION WITH THE NURSING CARE AND THEN THE SATISFACTION WITH THE PHYSICIANS. SO THOSE THREE ELEMENTS HAD THE GREATEST IMPACTS.^ SO OFTENTIMES WE'RE FOCUSED ON THE CLEANLINESS OF THE FACILITY. IT'S VERY IMPORTANT, ON THE FOOD THAT THE PATIENT HAS, BUT IT'S THE SATISFACTION WITH THEIR CARE PROVIDERS THAT REALLY INFLUENCES THEIR OVERALL SATISFACTION WITH THE HOSPITAL. SO I ALSO WAS LOOKING FOR LITERATURE ON PHYSICIAN RELATIONSHIPS AND WHAT I FOUND WAS THAT THERE IS NOT A LOT OF LITERATURE OUT THERE. SO THIS IS A GREAT RESEARCH OPPORTUNITY. I DO FIND A STUDY THAT WAS DONE, A MILITARY-BASE AND IT WAS DONE IN ISRAEL. BUT THEY FOUND THAT SATISFACTION WITH THE PHYSICIAN'S COMMUNICATION SKILLS AND TIME SPENT WITH THEM HAD A GREATER IMPACT ON THEIR SATISFACTION WITH THE PHYSICIAN. THEY EXPECT US TO KNOW WHAT WE'RE DOING WHACHLT PATIENT COMES INTO A HOSPITAL OR INTO A CLINIC, THEY COME TO US AND THEY KNOW THAT WE'VE GONE THROUGH TRAINING, THAT WE HAVE EXPERTISE IN THIS AREA. HOW THEY VIEW SATISFACTION IS HOW THEY ARE TREATED, AND THAT'S WHAT THEY WILL REMEMBER WHEN THEY LEAVE IS THAT SOMEONE TOOK THE TIME TO LISTEN TO THEM AND ACKNOWLEDGE WHAT THEY WERE SAYING. THAT'S -- THAT THE PATIENTS -- THAT'S WHAT PATIENTS REALLY CARE ABOUT. SO WHEN I DEVELOPED THIS PROJECT, THERE IS A BUNDLE THAT I USED WITH THE STAFF OF TWO NORTH, AND REALLY FOCUSED ON THAT INITIAL INTERACTION WITH THE PATIENTS. AND WHEN SOMEONE COMES ON SHIFT, INTRODUCING YOURSELF. WE ALL WEAR OUR NAME TAGS BUT NO ONE CAN READ THEM AND IT'S NO DIFFERENT IN OTHER HOSPITALS EITHER. SO IT'S VERY IMPORTANT THAT WE INTRODUCE UFLZ AND THAT WE HAD A PATIENT COMMUNICATION CAN BOARD INSTALLED IN THE ROOMS AND THAT THEY FILLED OUT THE BOARD SO THE PATIENT KNEW WHO THE NURSE WAS FOR THAT DAY, WHO THEIR NURSING ASSISTANT WAS BY NAME. THEN WE DID MUTUAL PATIENT IDENTIFICATION, WHICH IS REALLY IMPORTANT. WE HAVE OUR GOALS, BUT WHAT IS THAT PATIENT'S GOAL? WE HAVE TO TAKE THE TIME AND ASK THE PATIENT WHAT THEIR GOAL IS. AND WHAT I ENCOURAGE PEOPLE TO DO, AND THIS HAS BEEN VALIDATED IN THE LITERATURE AND THROUGH STUDIES, IS WHEN YOU SIT DOWN AT THE PATIENT AND FAMILY'S LEVEL, IT CHANGES THAT WHOLE ENCOUNTER. RIGHT NOW UNDERSTANDING. SO I HAVE THIS AUTHORITARIAN STANCE. THAT'S WHY I AM A LITTLE SHORT FOR THIS. SO WHAT QUI SAY? BUT WHEN WE GO TO SOMEBODY'S EYE LEVEL, THE PERCEPTION IS DIFFERENT WITH THAT ENCOUNTER. IF YOU'VE NOTICED, WE DON'T HAVE ANY RELATIONSHIP, FU NOTICE AT SOME OF THE RESTAURANTS THE SERVER COMES DOWN AND THEY ARE AT THE LEVEL OF THE TABLE. WHAT ARE THEY DOING? THEY'RE AT YOUR EYE LEVEL. SO BY DOING THAT, IT CHANGES THAT ENCOUNTER THAT THEY ARE ENGAGED AND CARE BUT. THAT'S A RESTAURANT. SO WHEN WE DO THAT WITH A PATIENT AND FAMILY, IT CHANGES THE WHOLE PERSPECTIVE. THE LITERATURE HAS SHOWN IS THE PATIENTS FEEL THAT THEY SPENT A LONGER TIME WITH THEM. SO WE WERE TEACHING OUR STAFF AND PHYSICIANS TO SIT DOWN, BECAUSE IT CHANGES THAT WHOLE EXPERIENCE. AND THEN WHAT THEY WOULD DO, WHAT THE NURSES WOULD DO, YOU WROTE THE GOAL ON THE COMMUNICATION BOARD, SO EVERYBODY KNEW THE PATIENT'S GOAL. MOST OF THEM WANTED TO BE DISCHARGED BUT SOME JUST WANTED TO EAT JELL-O OR THEY WANTED THEIR FAMILY MEMBER TO GET SOME REST. IT WAS REALLY HEART-WARMING WHAT SOME OF THE GOALS.^ AND WHICH PREVIOUSLY HAS BEEN DONE IN THIS ORGANIZATION. AND I DO KNOW THAT WE HAVE HUDDLES HERE. SO HERE IS WHAT WE FOUND. I USED THE DATA FROM THREE MONTHS BEFORE THE EDUCATION INTERVENTIONS, AND THEN THROUGH THE PROJECT TO A MONTH AFTER THE PROJECT ENDED AND WHAT WE WERE ABLE TO SEE -- THE PATIENT SATISFACTION DATA -- IS THAT WE DID HAVE AN INCREASE FROM OCTOBER THROUGH MAY OF 2012 AND WE LOOK AT ALWAYS -- WE DON'T LOOK AT THE SOMETIMES OR NEVER REPLIES. WE LOOK AT THE ALWAYS AND THAT'S WHAT WE LOOK AT FOR THE PATIENT SATISFACTION DATA THAT OTHER HOSPITALS ARE NOW RIM BURSTED OR NOT BEING REIMBURSED ON. THESE ARE THE SUBQUESTIONS THAT COME INTO THAT CATEGORY. NURSES TREAT WITH COURTESY AND RESPECT. WE SAW AN UPWARD TREND IN THAT. NURSES LISTENED CAREFULLY TO YOU. AND WHEN TH ONE WAS STATISTICALLY SIGNIFICANT FOR THE INCREASED FROM PRE-PROJECT TO POST. AND AGAIN FROM THAT SITTING DOWN AND TALKING WITH THE PATIENT, DEVELOPING THAT RELATIONSHIP. AND NURSES EXPLAIN THINGS IN WAYS YOU UNDERSTAND. AND THIS IS SOMETHING WE'RE ALL GUILTY OF AND HAVE TO WATCH THE JARGON THAT WE USE, BECAUSE MANY OF OUR PATIENTS, EVEN THOUGH THEY ARE BECOMING MORE SAVVY, I JUST USED NPO.^ A PATIENT WILL EVENTUALLY UNDERSTAND WHAT THAT MEANS BUT NOT INITIALLY. ANOTHER OUTCOME THAT WE SAW WAS THAT WE DID SEE A DECREASE IN FALLS. EVEN THOUGH I CAN'T TAKE FULL CREDIT. THERE WAS ANOTHER FALL INITIATIVE GOING ON AT THE TIME BUT WE DID SEE A DECREASE IN FALLS ON THE UNIT. THERE WERE SOME THINGS WITH THE STAFF SATISFACTION THAT WERE IMPROVED AND SO VIEW OF THEIR MANAGER AND BEING RECOGNIZED FOR THINGS THAT THEY DO. SOMEONE WAS STATISTICALLY SIGNIFICANT. WE REALLY DIDN'T SEE ANY CHANGE IN TURNOVER. SO THAT WAS OUR PROJECT. SO I AM GOING TO TURN THINGS OVER TO DR. HASTEINGS. >> WE'RE GOING TO HAVE A LITTLE BIT OF A BACK AND FORTH OF TWO THINGS AND OWN THEN OPEN IT UP FOR QUESTIONS AND COMMENTS AND HOPEFULLY SOME DIALOGUE. SO QUESTION IS WHAT IS THE APPLICATION OF SOME OF THESE IDEAS? BARBARA HAS DONE A REALLY NICE JOB GETTING HER INFORMATION APPLIED TO US. BUT WE WERE THINKING OF CONCRETE EVIDENCE. FIRST OF ALL, FOR OUR PATIENTS, DOES IT MATTER WHAT WE DO? AND YOU KNOW WE DON'T COLLECT VERY GOOD INFORMATION ON THIS AND SO AS I WAS PREPARING TRYING TO FIGURE OUT HOW WOULD WE ACTUALLY KNOW IN MORE THAN JUST GENERAL SATISFACTION, I HAD TO GO INTO A LOT OF DIFFERENT DOCUMENTS AND WE DID HAVE ONE SET OF WRITE-UPS FROM LOFT SPRING, WHEREBY THE INDIVIDUAL UNITS WROTE UP WHAT THEIR MODEL OF CARE, HOW THAT WAS GOING. AND SOME OF THE UNITS PUT COMMENTS, AND I REALLY LIKE THIS ONE FROM THREE NORTHWEST. PEOPLE HERE HAS A REPUTATION FOR BEING VERY SUPPORTIVE WITH THEIR PATIENTS. AND WHAT IT SAYS AND I AM GOING TO READ THIS ONE BECAUSE I LIKE TO READ THIS KIND OF THING. "PATIENTS WILL TELL YOU THAT THEY LOVE THE CONTINUITY OF CARE AND BENEFITS, THE COMMUNICATION BETWEEN THEIR TEAM MEMBERS OFFER THEM."^ IN OTHER WORDS, IF YOU ARE AN UNDERSTANDING OF HOW THEY LIKE THINGS DONE, THEIR RESTAURANTS, WHAT WORKS FOR THEM AND ARE THEY WILLING TO ADJUST, THEIR FAMILY DYNAMICS, HAVING NURSES THAT THEY KNOW AND HAVING A RELATIONSHIP WITH AND HAVING THEIR OWN NURSE. THE IDEA THAT THE PERSON WHO IS COMING IN EVERY DAY, IS SOMEBODY THAT YOU CAN KNOW AND YOU CAN KIND OF CLAIM A RELATIONSHIP AND OWNERSHIP WITH. I THOUGHT THIS WAS REALLY A NICE ONE. AND WE LOOKED AT OUR SATISFACTION DATA THAT IT'S HARD TO SEE REALLY MUCH GOING ON HERE. BUT YOU CAN SEE THAT OVERALL OUR PATIENTS REALLY LIKE THE CLINICAL CENTER. THAT'S THE ONE UP ON THE RIGHT-HAND SIDE. AND YOU CAN SEE THAT ONE OF THE NURSING ONES, THE ONE, THAT PATIENTS ARE TREATED WITH RESPECT AND DIGNITY IS HIGH ALSO. WE HAVE A LITTLE BIT OF ROOM THE THERE. AS WE GO THROUGH THROUGH THE MOVED CARE AND IMPLEMENTATION, WE WILL BE LOOKING AT THOSE RESULTS IN MORE DETAIL. AND SO THEN I THOUGHT IT WOULD BE HELPFUL TO TAKE A CHIEF EXAMPLE OF A PATIENT WHO IS AN EXAMPLE OF A PERSON WHO IS IN HERE FOR PROBABLY A PROTOCOL THAT YOU NEED -- THAT'S UNIQUE TO THE CLINICAL CENTER WHO DOESN'T REPRESENT ANY KIND OF OUTLIER CATEGORY. IN OTHER WORDS, THIS PERSON IS KIND OF THE EXPECTED STAY, WHICH IS LONG, BUT IS SICK, IS HAVING A VERY INNOVATIVE TREATMENT AND HAS LOTS OF HEALTHCARE ISSUES. SO IF YOU LOOK AT -- THIS IS AN EXAMPLE OF AN 18-YEAR-OLD YOUNG WOMAN WHO IS FROM OUT OF THE COUNTRY. I DON'T KNOW THE LANGUAGE SITUATION. WHO HAS A DIFICIENCY, WHICH IS A GENETIC DISORDER THAT CREATES ALL KINDS OF HAVOC WITH THE IMMUNE SYSTEM. AND AS EVERYONE KNOWS, RECURRING INFECTION SAYS AND WHOLE SET OF MAL ADIES THAT ARE LIFE-THREATENING. AND THERE HAS BEEN SOME RECENT WORK DONE TO BEGIN TO USE STEM CELL TRANSPLANTATION PATIENT POPULATION. AND THIS PERSON, WHO I AM NOT SURE IF THIS PERSON IS STILL HERE OR NOT, BUT THEY WERE HERE FOR 46 DAYS WHEN IT REPORT WAS RUN AND THEY HAD PROGRESSED TO THEIR PROTOCOL AND THEY HAD THEIR TRANSPLANT AND THEY WERE HAVING -- SO I WOULD CALL THIS A PRETTY POSITIVE EXAMPLE SO FAR. AND SO AGAIN, THERE IS NOTHING THAT REALLY RELATES TO IT AS A CHALLENGING -- WE HAVE SOME PATIENTS WHO HAVE CHALLENGES WITH STEM CELLS. BUT THERE IS A WHOLE LIST OF PROBLEMS THAT THE PERSON IS DEALING WITH. AND WHEN YOU THINK OF COMMUNICATE WITH THE PERSON, PUBLIC A RELATIONSHIP, DEALING WITH FAMILY IN A TERRIBLY DISTRESSED STATE, YOU CAN SEE THAT HAVING THAT CORE SET OF RELATIONSHIPS IS GOING TO BE REALLY IMPORTANT TO HOW THIS PATIENT GETS MANAGED. AND ONE OF THE OTHER THINGS THAT BARBARA TOUCHED ON AND THAT WE'VE BEEN TALKING ABOUT IN OUR GROUP AS WE LOOK TO IMPLEMENT THIS KIND OF THING IS THE RELATIONSHIP THAT THE CAREGIVER -- AT THE CAREGIVER LEVEL. WE KNOW IT'S REALLY, REALLY IMPORTANT THAT THE PEOPLE IN THE PEDIATRIC UNIT ARE TALKING WITH EACH, THAT THE PEOPLE IN THE ICU, THIS PERSON DID NOT GO THERE BUT THAT THERE ABE TRANSITION BACK AND FORTH WITH COMMUNICATION THERE AND THAT THE RELATIONSHIP BETWEEN THE NURSES AND ALL THE PHYSICIANS INVOLVED WITH THE CARE BE REALLY POSITIVE AND SUPPORTIVE OF COMMUNICATION. SO THAT'S AN EXAMPLE. SO SOME THOUGHTS? >> SURE. SO RELATIONSHIP-BASED CARE REALLY SITS VERY NICELY WITH THE PRIMARY NURSING MODEL, BECAUSE AGAIN YOU'RE ESTABLISHING THAT RELATIONSHIP WITH THE PATIENT AND HIS OR HER FAMILY. FAMILY IS VERY IMPORTANT AND I KNOW FAMILY IS VERY IMPORTANT HERE AS WELL. AND SO BECAUSE AGAIN, THEY ARE OUT OF THEIR NATURAL ENVIRONMENT, AND IN THIS SETTING. AND SO I THINK DO WONDERFUL THINGS TO SUPPORT THE FAMILY. I'VE BEEN TO THE CHILDREN'S ROOM AND IT'S VERY IMPRESSIVE AND WE HAVE TO SUPPORT THEM BECAUSE IF THEY'RE WELL-SUPPORTED, THEN WE HAVE GOOD PARTICIPATION IN THE RESEARCH AND THE DATA CAN BE COLLECTED THAT NEEDS TO BE COLLECTED. SIMPLE CHANGES, AND I WANTED TO BRING PHYSICIANS AS WELL, THAT PHYSICIANS CAN MAKE WHEN TAKING CARE OF PATIENTS IS REALLY DOING THE SITTING DOWN AND THE COMMUNICATING AND LETTING THE PATIENTS TELL THE STORY. SOMETHING THAT WE HEAR ESPECIALLY IN TODAY'S WORLD. THEY CAN ONLY BOOK 15 MINUTES AND THERE IS ALL THESE THINGS BUT THE PATIENT HAS A STORY THAT THEY WANT TO TELL AND WE ENCOURAGE THEM TO DO THAT, NOT JUST GIVING THEM PERMISSION, BECAUSE WE CAN LEARN SO MUCH FROM THEM.