We asked our patients, "What is the most important thing I can do for you today?" and analyzed the self-identified patient needs. Eleven themes emerged; we used these findings to drive a unit-based project and a hospital-based project, hard-wiring strategies into the infrastructure of Relationship-Centered Care to build relationships between patients/families and staff and to establish a healing and caring environment.
A patient once said to a nurse at our hospital, "Patients don't care what you know. They want to know that you care." How do patients know that we care? The nurse-patient relationship is key to answering this question.
Our 476-bed, inner-city community teaching hospital serves a culturally diverse population; 50% of our patients are Latino and 25% are Chinese. While our patient satisfaction ratings were reasonable, we knew they could be better, even on a tight budget. Recently we had begun an ambitious initiative to implement Relationship-Based Care (Koloroutis, 2004) using the I2E2 leadership change model ( Felgen, 2007).
The vision of our program, which we called Relationship-Centered Care (RCC), was as follows: "Nursing envisions a caring place, where patients and their families feel comforted and safe, staff feels supported, and where there is a continuous focus on healthy, healing relationships." Three kinds of relationships at the heart of Relationship-Centered Care are especially nurtured: the relationship of the nurse to himself or herself, the relationship to colleagues, and the relationship to patients and their families.
Aft er the rollout of this program, we sensed that our nurses could do better in building caring relationships with their patients, even though they had been given many new tools to do this. Nurse managers expressed concern about the disconnect they saw between nurse and patient, and believed that preprinted care plans did not adequately support the nurse-patient relationship.
We needed simple, effective, inexpensive techniques that could quickly establish a real connection with our patients, One technique we developed involved nurses asking each of their patients at the beginning of every shift , "What is your most important need today?" This article reports how the technique was implemented and what we learned from the responses patients gave.
DESCRIPTION OF THE CHANGE
Two units were chosen for the first wave of RCC implementation. One was an acute care unit specializing in the care of patients with orthopedic and neurological needs; the second was a 30-bed acute rehabilitation unit. These units are located geographically next to one another and share an understanding of each other's needs and protocols.
To educate the staff about our RCC principles, we began by meeting with them in small groups (8-15 at a time) for a designated hour session. These meetings were conducted in a forum with the staff sitting in a circle. Relationship- Centered Care groups included all members of our nursing team from all shift s: unit clerks, nursing assistants, patient-care technicians, and registered nurses. We began by presenting some very basic principles of RCC. We discussed the three relationships that we wanted to foster: relationship to self, relationship to colleagues, and, most importantly, the relationship to patients and families. We based the establishment of relationships on caring. We talked about the many faces of caring: listening, being present, assisting, touching, and communicating. We talked about how caring feels to the recipient and to the caregiver. These sessions have always been enlightening and confirming. Sharing time with each other in a circle of this intent strengthens our direction and commitment to our practice of RCC.
We knew that one of the challenges we had to meet head-on was how to create a mind-set and environment that would inspire our nurses in building relationships with their patients. Our initial nursing interview with the patient on admission uses a database to collect information and develop a plan of care based primarily on medical diagnoses. …