Last week the Robert Wood Johnson Foundation published the The Guided Principles for Patient Engagement developed by the The Nursing Alliance for Quality Care. My first thought was, yeah yeah yeah yeah, someone has too much time on their hands. The article went on to describe many people and organizations were involved in the creation of these principles and I decided to give it a second look. Here they are.
- There must be a dynamic partnership among patients, their families, and the providers of their health care, which at the same time respects the boundaries of privacy, competent decision-making, and ethical behavior.
- This relationship is grounded in confidentiality, where the patient defines the scope of the confidentiality. Patients are the best and ultimate source of information about their health status and retain the right to make their own decisions about care.
- In this relationship, there are mutual responsibilities and accountabilities among the patient, the family, and the provider that make it effective.
- Providers must recognize that the extent to which patients and family members are able to engage or choose to engage may vary greatly based on individual circumstances. Advocacy for patients who are unable to participate fully is a fundamental nursing role.
- All encounters and transactions with the patient and family occur while respecting the boundaries that protect recipients of care as well as providers of that care.
- Patient advocacy is the demonstration of how all of the components of the relationship fit together.
- This relationship is grounded in an appreciation of patient’s rights and expands on the rights to include mutuality.
- Mutuality includes sharing of information, creation of consensus, and shared decision-making.
- Health care literacy is essential for patient, family, and provider to understand the components of patient engagement. Providers must maintain awareness of the health care literacy level of the patient and family and respond accordingly. Acknowledgment and appreciation of diverse backgrounds is an essential part of the engagement process.
Okay, so I’m still not overly fond of some of the academic language and some of this should be ingrained in us during nursing school. That is not to say that these guiding principles do not have merit.
Look at the second bullet. We got the confidentiality thing down – even before HIPAA. The second sentence goes on to say that ‘patients are the best and ultimate source of information about their health status…’ Okay, so nobody ever says anything aloud but isn’t this just a little different and little better than the attitude that the patients really don’t know what we know and as such, we take their information lightly? We have all been burned by bad information and outright lies from patients. Maybe the semi-truths and lies tell us as much about the patient as the credible information.
I love the idea of ‘mutual responsibilities and accountabilities’. We always hear about patient rights. I do not begrudge patients’ rights but as nurses, we have rights that should be respected by patients, employers and even clients.
Respecting boundaries was never an issue in the hospital. In home health, I have heard a lot of really interesting stories. The most extreme story was one where the patient tipped a nurse for extra services not covered by Medicare and are only legal in some parts of Nevada. Long before you reach that extreme, keeping a professional distance between yourself and your patient in the home environment can be difficult. You are treated like family and begin to feel like family and families don’t discharge each other simply because there is no Medicare skill.
Advocacy for patients is a fundamental role of nursing. I would estimate that half of all MSW referrals are issues related to advocacy that should be part of our job. We need to quit giving our jobs away. Usually we are pretty good about it but I have read far too many charts of patients who do not meet Medicare coverage guidelines discharged with no soft landing.
The last bullet says something very important as well. It is the one worth reading first:
Providers must maintain awareness of the health care literacy level of the patient and family and respond accordingly. Acknowledgment and appreciation of diverse backgrounds is an essential part of the engagement process.
I think that may be a way of saying we have to meet the patient where they are. In fact a lot of these guiding principles can be restated as ‘Meet the Patient where they are’.
I might have simplified the language a bit and included something about patient goals but I wasn’t invited to participate. Overall, I am grateful to the National Alliance for Quality Nursing Care and believe they have spoken very well on behalf of nurses.
We’ve come a long way from being the handmaiden of the physician. Thanks National Alliance for Quality Nursing Care. Next time y’all get together give me a call.
What do y’all think? Would you add anything? Delete a bullet or two? Do you think we need such a statement? Why or why not?