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  1. McCrea, Mary Anne BSN, MS

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Patient's Point of View: Tonic for a Health Care Renaissance

A rock pile ceases to be a rock pile the moment a single man contemplates it, bearing within him the image of a cathedral.


-Antoine de Sanit-Exupery, French novelist 1


The mandate for nursing leadership in today's health care structures is to look at the pile of broken systems, dissatisfied consumers, and distraught caregivers and contemplate a new image and vision. It is imperative that this vision is based on what the patient and family wants as well as what will support the current workforce. As nurse executive leaders we have a responsibility to create, articulate, and chisel the vision for the future of our health care systems. We have exactly what it takes because it is rooted in our experiences and our dreams as we pondered our early career choice. Our professional paths are forged with visions and experiences steeped in relationship. These relationships echo the needs of patients, families, and staff. Our profession has its roots in relationship, caring, and focusing on what the patient needs.


A focus on the patient's point of view is a focus on relationships. I have spent my career meeting with patients and families. I quickly found that asking the question, "Share with me an experience when things really worked and you received great care," provides keen insight into the patient's and family's point of view. I have never received an answer or description of high technology, comments about physicians, or physical surroundings. I have always received descriptions of relationship with the caregiver. Families and patients describe a touch, hand, or smile, which bonds the nurse with their experience. They describe in detail and with emotion, the connection of the caregiver with their lived human experience.


The Picker/Commonwealth Program for Patient Centered Care included information from more than 8,000 patients and care partners to outline the dimensions associated with patient-centered care. 2 As a result of their data analysis, they have identified the number one dimension of patient-centered care to be "Respect for patients' values, preferences, and expressed needs." Also included in the seven dimensions is "Emotional support and alleviation of fear and anxiety." 2 Working through relationships and communication are the means to meet these dimensions of patient-centered care. This classic study outlines the vision as well as the challenges to establish and focus and support the relationship between patient and caregiver. This is the challenge for nursing leadership today.


There is almost a daily deluge of information about the nursing shortages and we all look forward to experiencing a 1 million RN shortfall in the year 2010 and a steady increase to a shortfall of 1.5 million RNs by the year 2020. 3 Where are the answers? How do we contemplate that image of a cathedral when viewing a pile of rocks? How do we have the courage to return to our roots and the "soft stuff"? More questions to ponder. Why did we choose nursing as our profession? Why have we stayed in this profession and taken on more and more commitment and responsibility? I can only speak for myself. It is because of those early experiences in which I established a relationship with a patient or a family. Over the years, I have heard it numerous times during reflections by colleagues. Those moments of relationship and connection forged our life-long commitment to a profession and fortified us against the rubble and chaos that abounds within health care today.


In this issue of Nursing Administration Quarterly, Jean Watson shares an invitation to examine the heart and soul of nursing. She gives us a nontraditional "reminder" that tugs at the deep human experiential level. The metaphor of "hand" is woven through the discussion of reconnection to our roots as we "emerge from a professional passage." The poignant descriptions of our connections to our humanity are the backdrop for the descriptions of healing. Jean Watson relies on her personal experience to describe the success and strength of her vision for relationship between caregiver and patient as the bonds for healing-healing both for our profession and our patients.


Norma Hagenow describes the "Challenges of Care" in the systems that we have created. She asks, "Why not person-centered care?" and describes the challenges of implementation in current healthcare institutions. In her role as chief executive officer at Genysys Health System, she is creating a culture based on relationships and "person-centered care." She shares a triad for cultural transformation that focuses on the relationship between caregiver and patient rather than the business of health care.


In "Caring: Core Value, Currency, and Commodity [horizontal ellipsis] Is it Time to Get Tough About 'Soft'?," Jayne Felgen shares an antidotal overview of the impact of relationship on a family, patient, and a member of a health care team. She describes caring theories, practical steps, and techniques for highlighting and enhancing the caring relationship. I was personally involved with the "Bernie story" and can attest to the transformational experience for the entire care team. Relationship between the care team members changed the way they delivered care and they established care delivery models based on relationship with patients and families on their unit.


In addition to building our current organizations, we must build a future workforce. The future is dependent on focusing on the patient. The preparation and foundation for academic training must focus on assessing what the patient wants as well as supporting a relationship model of care. Wendy Woodward describes the use of Modeling and Role Modeling theory as it is integrated into the Bachelor of Science in Nursing Program at Humboldt State University in Arcata, California. The theory base is grounded in relationship with patient. Her descriptions of clinical use of this theory create a sense of connection and relationship rather than the typical passive medical assessment that is so prevalent in our current practice.


Anne Boykin et al. describe a practice model change and the outcomes associated with it. The vision for their project was "shaped out of love of nursing and an acute awareness of the challenges facing nurses in acute care settings." Intended outcomes for the patients included "the experience of knowing their special stories were heard" and the outcomes for the staff included "relating grounded in caring." The outcomes of the project demonstrated increased patient satisfaction as well as a transformational effect on the staff.


A story of implementing a "healing environment" for both staff and patients is described by Herb Geary. Good Samaritan Regional Medical Center implemented the model of healing in a large, inner-city, tertiary/quaternary level 1 trauma center. The basis of "healing in both models is founded in relationship with the environment, the team members, and the human spirit." It is based on healing environments to focus on the mind, body, and the spirit of humanity. The challenges, the accomplishments, and the learning are shared as this hospital implemented a healing model.


The final article is a narrative from the heart. The passion for nursing practice that the authors share is the essence of their vocations. I admire all staff nurses who practice nursing based on a model of caring relationships between caregiver and patient. This may not be the vogue practice model, or the most efficient, or the most honored, but it is the most healing for both patient and caregiver. From a patient's point of view, a caring relationship is the soul of healing


Every article in this issue constructs a different perspective of relationships and caring behaviors shared with patients and families. It is the heart, the spirit of a patient's point of view. The staff chronicles describe in memorable detail the relationship between patient, family, and caregiver. These stories share the joy of making a difference in someone's life. If we were to ask those patients and families if their needs had been met, we would hear an affirmation of satisfaction, connection, and perception of healing.


We face the future of our profession fortified with what we have learned from our past. We must reflect on the importance of what our patients and families tell us. We must bathe in the quiet warm memories of those special relationships with patients and families that keep our commitment to our profession burning brightly. We all have a memory that would best respond to "share with me an experience when things really worked and you delivered great care." As health care leaders trained in the science of nursing and caring, we need to listen to our inner wisdom and ourselves. I end with a quote from The Tao of Leadership


The wise leader speaks rarely and briefly. The leader teaches more through being than through doing. Be still. Follow your inner wisdom. In order to know your inner wisdom, you have to be still. Remember that the method is awareness of process. Reflect. Be still. 4(p45)




1. Bridges, William. Managing Transitions, Making the Most of Change. Reading, MA: Perseus Books; 1991. [Context Link]


2. Gerteis M, Levitan-Edgman S, Daley J, Delbanco TL, eds. Through the Patient's Eyes, Understanding and Promoting Patient-Centered Care. San Francisco, CA: Jossey-Bass Publishers; 1993. [Context Link]


3. Barney S. The nursing shortage: Why is it happening? Journal of Healthcare Management. 2002;47: 153-155. [Context Link]


4. Heider J. The Tao of Leadership. Atlanta, GA: Humanics New Age; 1985. [Context Link]