Background: The emergence of the COVID-19 pandemic significantly impacted nursing care and patient satisfaction. The strategies used to reduce the spread of the virus unfortunately created a connection gap between patients and the health care team. The use of protective personal equipment and the changes in the organization's visitation policy not only affected nurse-patient interaction but also heightened the patient's sense of isolation. Research has shown that patient’s overall satisfaction is related to perception of quality interaction with caregivers. Nursing as a caring profession thrives in creating meaning connection with patients. To bridge the human connection gap and reduce patient isolation, the unit collaborated with the system delirium committee system quality and patient safety by utilizing the "what matters" concept innovatively to create a quality interaction with patient. What matters is one of four essential elements of the 4M framework, which includes medication, mentation, and mobility. The 4Ms are an evidence-based practice, high-level intervention bundle that address the complex needs of the older patient population. In this initiative, what matters is used to address all patient population in the unit. When "what matters" is applied in the context of caring theory, it enables the health care team to understand what matters to patients and provides patient-centered care by aligning care based on patient's preferences, therefore, creating an environment for a meaningful connection with patients and improving the unit's performance on patient satisfaction.
Purpose: The aim of this initiative is to improve the overall patient satisfaction score during pandemic by implementing what matters most to strengthen patient-centered care and promote nurse-patient connection.
Method: A plan-do-study-act cycle is used for process improvement. Unit nurses were educated about the age-friendly health system, 4M framework, and the what matters most initiative process including measurements. Process was measured by monitoring white board documentation compliance through daily leadership audits using the MyRounding tool. Outcomes are monitored monthly using the Hospital Consumer Assessment of Healthcare Providers and System survey (HCAHPS) scores on overall patient satisfaction. A pre- and post-implementation nursing survey was performed to determine the impact of the initiative on nurses.
Result: The overall patient satisfaction score increased from 78.5% to 96.3%, including the communication with nursing dimension, which increased from 75.1% to 90.4% during the implementation period. The post-implementation nursing survey showed improved nurse communication and nurses satisfaction in their role and improved nursing prioritization of care.
Evidence-based references 1. Caring Science and Human Caring Theory. (2021). Retrieved from: Caring Science & Theory - Watson Caring Science Institute. 2. Deriba BS., Galeta T., Beyane RS., Mohammed A., Tesema M., Jemal, K. (2020). Patient satisfaction and associated factors during covid-19 pandemic in North Shoa Health Care facilities. Patient prefer adherence, 14, 1923-1934. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7568627/pdf/ppa-14-1923.pdf 3. Institute for Healthcare Improvement. (2020). What Is an Age-Friendly Health System? http://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Pages/default.aspx • Kebede S. Ask patients “What matters to you?” rather than “What’s the matter?”. BMJ. 2016;354:i4045. doi: 10.1136/bmj.i4045. • Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370–396. https://doi.org/10.1037/h0054346 • Millsteins, J.H., Kindt, S. (2020). Reimagining the patient experience during the Covid –19 pandemic. Retrieved January 26, 2021 from NEJM Catalyst website: https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0349 • The power of four words: “What matters to you”. Available from: http://www.ihi.org/Topics/WhatMatters/Pages/default.aspx • van den Ende, E. S., Schouten, B., Kremers, M., Cooksley, T., Subbe, C. P., Weichert, I., van Galen, L. S., Haak, H. R., Kellett, J., Alsma, J., Siegrist, V., Holland, M., Christensen, E. F., Graham, C. A., Leung, L. Y., Laugesen, L. E., Merten, H., Mir, F., Kidney, R. M., Brabrand, M., et al (2021). Understanding what matters most to patients in acute care in seven countries, using the flash mob study design. BMC health services research, 21(1), 474. https://doi.org/10.1186/s12913-021-06459-4