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Mary Koloroutis, CEO of Creative Health Care Management, talks with Lois Swope, whose daughter Karly lived with Rett Syndrome until her death in 2012 at age 27. They spoke about the inestimable gifts of Karly’s life and the four lessons for people in health care that Lois learned while overseeing Karly’s care.

In 2012, Pennsylvania Hospital (PAH) was a long way from Magnet® designation. Despite a high caliber of nurses throughout the organization, RN satisfaction was achieving national benchmarks in only 4 of 11 domains. Patient satisfaction related to RN communication was below the 10th percentile. Four years later, this same hospital celebrated receiving Magnet designation with 3 exemplars. How did they do it?

Based on Kristen Swanson's theory of caring, Caring Assessment for the Care Giver has been traditionally used in preparation for Relationship-Based Care (RBC) implementation; however, its reliability and validity were not known. This article discusses the psychometric testing of the instrument. Caring is the essence of nursing practice, provides the practical dimension of professional nursing, and is an important predictor of satisfaction (Dingman, Williams, Fosbinder, & Warnick, 1999). Nurse theorists have recognized that caring is essential to an individual's overall sense of well-being, emotional safety, and satisfaction (Dingman et al., 1999; Koloroutis, 2004; Swanson, 1993; Watson, 2002). Human beings have a certain set of expectations and know when they feel cared for, which further promotes a sense of security (Duffy, 2003, 2005). When the individual's expectations match the behavior received, then satisfaction will occur (Dingman et al., 1999). Therefore, when the patient's, nurse's, and physician's needs are met, relationships are forged and satisfaction flourishes. Listening is a key component of caring behaviors and relationship building (McCrea et al., 2003). Listening requires that we know how to be present, to be silent, to observe, to listen, and to be heard within the context of trust and respect (McCrea et al., 2003). Alternatively, when clinical tasks become the priority of the nurse's work, relationships with medication carts, computers, and intravenous pumps are paramount, placing the development of human relationships secondary to the tasks at hand (Duffy, 2005). It is in this moment, when tasks supersede human connection, that nurses must reevaluate, become truly present and attentive to the needs and desires of another human being, and forge caring and responsive relationships with their patients (Arman & Rehnsfeldt, 2007). Developing this human caring process requires that nurses understand and value the mind-body-spirit connection, are aware of their own strengths and limitations, and know how to comfort with compassion and empathy within the context of a caring relationship (Watson & Foster, 2003). The technical and economic demands of the health care system do not diminish the need for crucial relational care; in fact, the need for higher level caring skills and knowledge has escalated (Benner, Sutphen, Leonard, & Day, 2010). It is through these human-to-human relationships that people live and die, heal and grow, and work and rest (Duffy, 2003; Koerner, 2007). RBC is a model with practical action steps espoused by education and leadership to promote effective change (Koloroutis, 2004). The RBC model includes concepts of Leadership, Teamwork, Professional Practice, Care Delivery, Resources, and Outcomes. Re-Igniting the Spirit of Caring (RSC) is one of the mechanisms by which an organization operationalizes the RBC model (Koloroutis, 2009). THEORETICAL FRAMEWORK The Caring Assessment for the Direct Care Giver (CACG) was developed as part of Re-Igniting the Spirit of Caring, a seminar designed for people who work in health care (Koloroutis, 2003). Initially used as an educational assessment during the course, the instrument was not intended for use in nursing research, nor had it been tested for reliability or validity. The CACG is based on Swanson's mid-range theory of caring, which asserts that caring involves interrelated processes between the nurse-as informed caregiver-and the patient (Swanson, 1991). Inherent in the theory are five caring processes: (a) Maintaining Belief, (b) Knowing, (c) Being With, (d) Doing For, and (e) Enabling/Informing. The first two processes- Maintaining Belief and Knowing-provide the philosophical foundation for establishing a respectful relationship with the patient and family built on their inherent human dignity and an authentic seeking to understand the experience of the patient and family (Koloroutis, 2009). …

In recent years, hospitals have established home-care programs to provide care on a continuum, meeting needs in the hospital and home setting, whichever is most appropriate and efficient in response to defined patient needs. Hospital-based home-care programs with specialization in perinatal nursing have been established to meet the care needs of patients and their families during antepartum, postpartum, and neonatal periods. One of the greatest advantages of a hospital-based program is the internal availability of highly knowledgeable and skilled nursing staff. Physicians are more likely to refer patients to a program that is staffed with nurses they know and trust from the hospital setting. More cost-effective and coordinated care is achieved through the appropriate use of resources across the continuum.

The coaching process enabled me to take time away from my reactive day to think and plan and imagine. -Clinical Nurse Manager My telephone coaching practice began with a request from a chief nursing officer (CNO) to help a clinical manager who had been with her organization for less than a year. The manager was a skilled clinician, highly motivated and capable, with a strong commitment to professional nursing practice, but new to the manager role. She was dealing with staff conflict and dissension on the patient care unit, as well as an extremely tenuous and difficult relationship with a couple of key physicians. The CNO was a supportive mentor to the manager but recognized that the neutrality and objectivity of an external coach would provide a safe venue to engage in the personal reflection required for the manager to succeed and thrive. The CNO contacted me because of my background in relationship-based care and my experience as a nurse leader mentoring and supporting the growth of individuals and organizational teams. The manager and I committ ed to a year-long telephone coaching relationship. We identified as priorities, * exploring ways to improve care and morale on the unit, * improving relationships with medical staff , * clarifying the meaning and purpose of her work as a clinical nurse leader, and * learning how to grow and thrive in her leadership role and to balance competing requirements. Telephone coaching off ers distinct advantages for leadership support and development. Recipients report appreciating the ease of access and efficiency, the neutrality and safety of distance, the increased sense of ownership in guiding their own development, and the discipline of sett ing a time for themselves to reflect and gain clarity within the context of their work day. At first, recipients expressed concern about scheduling the time in an already busy work day. However, their concern quickly became a valued time set aside to focus on themselves, receive support, gain perspective, and identify strategies for calmer and more intentional leadership. The coaching time became one of reflection and stress reduction. IMPORTANCE OF CARE AND SUPPORT FOR THE CLINICAL MANAGER Clinical managers are vital to the quality of care delivered in their patient care areas and thus to the achievement of the organization's mission. Through the manager's leadership, standards of behavior and performance are articulated, expectations for patient care delivery are established, and accountability is sustained. Clinical managers are responsible for creating a unit culture that promotes healthy teamwork, professional nursing practice, and competent and compassionate care and service. Because their role is crucial to the successful provision of care and the success of the organization as a whole, many managers experience a chronic struggle to balance the demands of all the constituencies with which they are involved (Figure 1). In the course of facilitating leadership seminars, I have queried clinical managers and those they report to about how managers spend their time. The findings have been revealing. Most report that 80%-90% of their time is spent meeting the requirements of the broader organization: responding to organizational priorities, preparing quality data and other writt en reports, and att ending organizational meetings. The remaining 10%-20% of their time must be divided among activities devoted to leading care delivery, supporting their clinical staff s, and inspiring professional practice. These activities include hiring and retention; scheduling/staffing; counseling, coaching, and mentoring staff ; competency development and education; sett ing expectations and standards; dealing with the crises that inevitably surface; and following up with patient and family concerns. Some state that this portion of their time is oft en overtime hours. A smaller number of managers report spending as much as 40%-60% of their time leading and supporting clinical staff and directing care; these managers report clear boundaries that permit them to prioritize their time and to access some much-needed off -time and respite. …

Objectives 1. Describe the need and opportunity to improve the quality of dying in the intensive care unit (ICU). 2. Describe specific tools for high-quality family meetings, managing the transition to comfort care, and ensuring optimal pain and symptom management for actively dying ICU patients. 3. Describe how to create an environment within the ICU for the family that not only supports their grieving but also provides an opportunity to celebrate the uniqueness of their loved one’s life. Because up to 30% of hospital deaths occur in the intensive care unit (ICU), improving endof-life care in the ICU must become a priority to meet the needs of patients and their families. In this multidisciplinary, interactive, case-based workshop, participants will learn methods for the primary cardiac care unit team to integrate palliative care into daily work including tools to improve an actively dying patient’s pain and symptom management, safely discontinue mechanical ventilation, implement standardized evidence-based multidisciplinary family conferences, and effectively involve formal palliative care consultation into care. Participants will also learn how to support the patient’s family and friends through their sadness and grief while also exploring ways to create an environment within the ICU to recognize and celebrate the uniqueness of each patient’s life.