May 31, 2021
Incorporating the patient voice into nursing orientation and beyond
- In school, nurses learn how to communicate effectively with patients, but this tends to fade as nurses enter acute care settings.
- Adding the patient voice to our orientation program helped humanize patients and developed nurses’ compassion and respect.
- Virtual meeting platforms are an excellent way to collect and share patient stories and is more convenient than in-person meetings, especially for patients who had complex health histories.
Patients are the end users of the Canadian health-care system, and so it is important that their perspective be represented in the delivery of health care. At the Ottawa Hospital we have taken this concept one step further through the innovation of early incorporation of the patient voice in the design and implementation of education programs for health-care providers.
Specific to nursing, the need to incorporate the patient perspective came out of a year-long needs assessment of a large medicine-surgery nursing orientation program. This assessment identified curriculum gaps in the areas of viewing the patient as an individual (as opposed to a diagnosis) and acting as an advocate for them. The College of Nurses of Ontario (2019) revised their Entry-to-Practice Competencies for Registered Nurses to include the specific role of advocate, in which a nurse “assesses that clients have an understanding and ability to be an active participant in their own care, and facilitates appropriate strategies for clients who are unable to be fully involved” (p. 7).
While nurses are in school, they learn how to communicate with patients and collaborate with them in a holistic manner, but this approach tends to fade into the background as we hire nurses to acute care settings (Kostovich & Clementi, 2014). Hospital nursing orientations tend to focus on institution-specific policies, practices, and disease processes, where the focus is the patient as the recipient of nursing tasks.
Kostovich and Clementi (2014) also reported improved patient satisfaction scores one year after implementation of a nursing orientation program that included patient-centred approaches, such as “being with” them, in addition to performing nursing tasks. What the researchers learned was that the art of nursing is lost in many orientation programs, as was shown also in our own needs assessment of the medicine-surgery nursing orientation program. Thus, the need to bring the patient voice back into our nursing orientation program became the goal of this pilot project.
As a pilot project, we decided to incorporate videos of patients sharing their stories in the nursing orientation program of Jennifer’s inpatient surgery unit. We found that having the patient voice provides context to the content being taught humanizes it while encouraging nurses to develop more empathic skills, such as compassion and respect for the individual, that align with the Ottawa Hospital’s core values.
Over the span of six weeks, we created five patient story videos. The topics were:
- The importance of family member presence during times of vulnerability
- Creating a positive discharge experience
- Ensuring the nurse is mentally and emotionally present with the patient
- Using empathy to understand that pain is subjective, especially in the context of chronic pain medication use
- Being human: interacting with patients as human beings, not just a set of nursing tasks
The idea of incorporating patient story videos into nursing orientation came to Jennifer in early March 2020. The idea followed the presentation of a needs assessment to nursing education leadership at the hospital, with the intention of having the videos recorded onsite. Then the COVID-19 pandemic happened and forced us to rethink how to achieve this goal. Claudia and Jennifer decided to proceed with the project using the virtual platform of Microsoft Teams.
Initial inquiry was sent by Claudia via email, seeking participants from the Ottawa Hospital’s patient and family advisors group of 200. Five patient advisors volunteered to participate. Followup telephone meetings with the advisors were completed to discuss the project. Five-minute videos were created, with each video approved by the advisor in it prior to use in the nursing education program. The videos were added to orientation modules and used in a virtual critical thinking session by Jennifer.
All the nurses indicated the videos would change their practice, with one stating, “I will ensure that the patient’s voice is heard and use their concerns as part of my assessment.”
Overall, the experience of incorporating patient voices into the orientation program had positive impact for everyone involved. The five advisors were very eager to participate right from the beginning, with one saying she was “delighted to be included” and another indicating she “would be pleased to participate.”
After each recording session was completed, we expressed our gratitude to each of the advisors for sharing their personal stories and reiterated to them the value of having them in the nursing orientation program, especially for nurses who had recently graduated. In the final approval email for the videos, one advisor closed with “It’s my pleasure and obligation and keeps me feeling useful — thank you!”
Four nurses participated in this project in June 2020. The nurses completed an anonymous short online survey regarding the use of the patient story videos. They rated the videos as 4.25 out of 5 stars, and all felt they were applicable to the orientation. All the nurses indicated the videos would change their practice, with one stating, “I will ensure that the patient’s voice is heard and use their concerns as part of my assessment. Seeing the patient as a whole person, not just a list of tasks or machines. Collaborating with the patient as a care partner.”
- Patients want and are eager to share their story for the betterment of nurses and other health-care providers.
- Online meeting platforms, such as Microsoft Teams, are an excellent way to share patient stories and are more convenient than in-person meetings.
- Patient and family advisors often had complex health histories, so sharing their stories from the comfort of their homes was actually better for them.
- Patient stories were an excellent addition from an educational perspective. Including the human element, as opposed to strictly knowledge and skills training for orientation, linked the nurses to the care recipient, helping them develop empathy for the person in the bed or chair.
The concept of incorporating the patient voice into care exists within the Ottawa Hospital in our hourly rounding and bedside shift report policies and procedures. But hearing these standards from an educator or a nurse leader does not provide enough context to the new nurse. Having a patient share their story leads to more meaningful context.
Jennifer plans to continue to use these videos in orientation and also in refresher education sessions at the unit level in areas (such as bedside shift reports) where procedural drift is observed, on an as-needed basis. Specific to this initial group of new nurses who completed the unit orientation program with the patient voice incorporated, Jennifer plans to follow up, after three or four months, with each nurse and ask whether and how they think these videos influenced their practice.
As this was only one nursing orientation program of many at the Ottawa Hospital, we will share our results within our own organization and with nursing educators at large. Based on the strongly and broadly positive experience, we plan to continue incorporating patient stories and expand to corporate orientation, medical education events, and curriculum, board, and senior leadership meetings. Claudia will also be collaborating with another health-care organization in Canada to create patient story videos to be used at a national conference.
As an organization, the hospital’s patient and family advisors are becoming more involved in committees and policy development. Most recently, an advisor participated in developing the processes for return of visitors and caregivers to the organization during the pandemic.
College of Nurses of Ontario. (2019). Entry-to-practice competencies for registered nurses. Retrieved from http://www.cno.org/globalassets/docs/reg/41037-entry-to-practice-competencies-2020.pdf
Kostovich, C. T., & Clementi, P. S. (2014). Nursing presence: Putting the art of nursing back into hospital orientation. Journal for Nurses in Professional Development, 30, 70–75. Retrieved from https://doi.org/10.1097/NND.0000000000000045