Week 2 #3 SBN Approach.pdf

NUR1 222 Strengths-Based Nursing & Professional Practice SBN Approach Maria Di Feo Reflection.. What is the link between the SBN Approach and Nursing Practice? 9/8/22 2 • Nursing Theories/Conceptual Models/Approaches Factors that Affect how Nurses Practice values Strengths-Based Nursing...

NUR1 222 Strengths-Based Nursing & Professional Practice SBN Approach Maria Di Feo Reflection.. What is the link between the SBN Approach and Nursing Practice? 9/8/22 2 • Nursing Theories/Conceptual Models/Approaches Factors that Affect how Nurses Practice values Strengths-Based Nursing Approach Provides nurses with a framework/lens to guide actions and decisions. Guides our nursing practice. 9/8/22 4 Strengths-Based Nursing Approach • From your readings • Your understanding? • Highlights? • An approach to nursing guided by eight core values. • A collaborative and strength-based approach. • An approach that considers the whole person • focuses on what is working/functioning StrengthsBased Nursing Approach • focuses on what the person does well/best • focuses on resources available to person To assist person/family deal more effectively with their life, health and health challenges. • Focus on what is working. • Avoids labels. • Uses strengths to build confidence to deal with concerns. StrengthsBased Care Approach Major Features (L. Gottlieb, 2013) • Person involved in choosing solutions. • Nurse supports, encourages person to find solutions. • Context critical. All issues are situated. • Positive language. Language of hope. • Collaborative partnership. • Values subjective information and objective information. StrengthsBased Care Approach Major Features (cont.) (L. Gottlieb, 2013) • Knowledge is created through experience and reflection. • Plan of care built on the person’s strength. • Nurse works in partnership with team and patient to plan and manage care. • Person and family determines outcome. • Places person at the centre of their own care (personcentered care). • Empowers people to achieve their own goals and find new meaning in their lives (empowerment movement). StrengthsBased Care Approach Overview (L. Gottlieb, 2013) • Encourages a person to take charge of and be responsible of their own health, recovery, and healing (health promotion, health prevention & self care). • Requires collaborative relationship between the person and health care provider (collaborative partnership). • Works with the person’s strengths to help them deal with challenges, meet goals and function as an integrated whole person. • A commitment to a person’s development. Foundations of SBN Copyrighted Material: Maria Di Feo ,Annie Chevrier and Laurie Gottlieb: Ingram School of Nursing, McGill University 9/8/22 10 Person/Family Centered Care • Institute of Medicine • “Providing care that is respectful of, and responsive to individual patient preferences, needs and values and ensuring that patient values guide all clinical decisions.” Person/Family Centered Care (con’t) • SBN places the person at the center of care • Person is engaged and involved in decision making around their care to the extent that they want to be at any given time • Person’s values and beliefs are respected • Person given opportunity to talk about his experience with living health challenges/illness • Care is tailored to his unique needs and concerns • Health challenges/illness understood within the person’s context (uniqueness of person/experience) Empowerment • Cheryl Gibson (1991), p. 359 defines, empowerment as “a social process of recognizing, promoting, and enhancing people’s abilities to meet their own needs, solve their own problems, and mobilize the necessary resources in order to feel in control of their own lives”. • In SBN the nurse creates conditions that enables a person to empower himself. By working with a person’s existing strengths, uncovering potential strengths, and sometimes helping them turn deficits into strengths, the nurse helps the person experience greater control over their health and helps them attain their health goals. Relational Care • JoEllen Koerner, (2011) states that Nursing is a relational phenomenon because everything a nurse sees, does, and experiences arises from the relationship with the person. • SBN values the nurse–patient relationship and restores it to its central place in health promotion and the healing process. We believe the way a nurse interacts with people can be just as powerful and long lasting, if not more, than other forms of interventions. • “I’ve learned that people will forget what you said, people will forget what you did, but people will newer forget how you made them feel.” Maya Angelou Innate Health and Healing • Individuals are born with capacities and “natural healing”” processes, and the potential to heal, grow and thrive. These innate abilities include (but are not limited to), the ability to form relationships (attachment) emotional regulation, curiosity, and the need for novelty (to learn). These abilities develop over a lifespan. They help an individual adapt, develop, and cope with adversity. • In the SBN approach nurses creates conditions for optimal health and healing. They promote, support, supplement, restore and help develop the person's capacities and natural healing processes. In SBN we refer to these innate capacities of health and processes of healing as a person’s inner strengths. Foundations of SBN • The Four Pillars • Person/Family Centered Care • Empowerment • Relational Care • Innate Health and Healing • Eight Core Values Copyrighted Material: Maria Di Feo ,Annie Chevrier and Laurie Gottlieb: Ingram School of Nursing, McGill University 9/8/22 17 Strengths-Based Nursing Care: Values (L. Gottlieb, 2013) 1. Health and Healing 2. Uniqueness of the Person 3. Person and Environment are Integral 4. Holism and Embodiment 5. Objective/Subjective Reality and Created Meaning 6. Self-Determination 7. Learning, Readiness, and Timing 8. Collaborative Partnerships Copyrighted Material: Maria Di Feo ,Annie Chevrier and Laurie Gottlieb: Ingram School of Nursing, McGill University 9/8/22 18 Health and Healing Strengths-Based Nursing Care Values 1. Health and Healing • Nurses using an SBN approach work to promote health & healing and alleviate suffering. • Health involves being in a state of balance/harmony; it is not the absence of illness. Health encompasses one’s physical, psychological and spiritual wellbeing. • When a person is not in a state of equilibrium, they are healing—or restoring their state of harmony which is the optimal state for that unique person. 9/8/22 20 Uniqueness of the Person 2. Uniqueness of the Person • Nurses using an SBN approach respect and acknowledge a person’s uniqueness by getting to know the patients in their care. They are curious to know what makes a person who they are, what is different about their experience, what their symptoms are like for them, and how they have responded to similar situations in the past. StrengthsBased Nursing Care Values • What makes someone unique? • People are shaped by their biology, their life experiences and their environments. A person’s uniqueness includes their strengths and their weaknesses. Person and Environment are Integral 3. Person and Environment are Integral • Nurses using an SBN approach address the person’s environment in order to provide quality care. The internal, physical, cultural and social environments are all considered. StrengthsBased Nursing Care Values • The quality of one’s environment will affect one’s health and healing; people thrive when there is a goodness of fit between them and their environment. • How can a nurse impact a person’s environment? • Nurses are an integral part of the environment for both patient and family, so they must be aware of the environment they create; the person/family must trust the nurse, feel safe, and feel supported. Holism and Embodiment StrengthsBased Nursing Care Values 4. Holism and Embodiment • Nurses using a SBN approach, nurses view the person as a whole. Nurses explore all aspects of the individual’s health challenge or illness— how it impacts their psychological and physical states—because nurses recognize the mind-body connection. • Nurses know that when they attend to a certain concern (e.g., pain) that it will likely impact the other areas of the person’s life (e.g., mood, relationships, ability to work). Objective/Subjective Reality and Created Meaning StrengthsBased Nursing Care Values 5. Objective/Subjective Reality and Created Meaning • Nurses using a SBN approach look at the person’s objective data, the person’s subjective reality and the meaning they have created to understand the situation. • Nurses must explore the person’s understanding of his experience to create a complete picture of the person and provide care in a sensitive, meaningful and responsive way. • Does a person’s narrative about their situation matter? • A person’s narrative, which helps them make sense of their situation, will affect their actions/responses. Self-Determination StrengthsBased Nursing Care Values 6. Self-determination • Nurses using a SBN approach, nurses value the individual’s choices and believe that decisions are best made when individuals and families are well informed. • How can nurses create conditions where people feel able to make their own decisions? • The nurse recognises and respects the person’s right to express their free will and act in ways that are congruent with their values, beliefs and preferences. Learning, Readiness, and Timing StrengthsBased Nursing Care Values 7. Learning, Readiness, and Timing • Nurses using an SBN approach recognize that learning (acquiring new capabilities) is essential for a person to navigate his environment and to live to their fullest. • Nurses need to know their patients to be able to determine when an intervention is most likely to be successful. Readiness to change/learn is linked to timing: a person may become ready due to new circumstances. • What are indicators that a parson is ready to change (learn)? • A desire to change & taking actions to change (plan & follow it) Copyrighted Material: Maria Di Feo ,Annie Chevrier and Laurie Gottlieb: Ingram School of Nursing, McGill University 9/8/22 32 Collaborative Partnerships 8. Collaborative Partnership • Nurses using a SBN approach view the nurse-patient relationship as a collaborative partnership. Th nurse and the patient are both involved in setting patient goals, developing the plan of care, and evaluating outcomes. • Nurses learn from patients and patients learn from nurses. Patients often know what is best for them. StrengthsBased Nursing Care Values • Each partner brings her own knowledge, skill and experiences to the relationship and is open to learning from each other. It is a relationship built on mutual respect and trust. 9/8/22 34 • H- Health and Healing • E- Embodiment and Holism • L- Learning, Readiness & Timing • P- Partnership (Collaborative) • E- Environment Strengths Based Nursing Care… • D- Determination (Self) • U-Uniqueness • S-Subjective Reality & Created Meaning Collaborative Partnership (Gottlieb, Feeley, & Dalton, 2005) • “A collaborative partnership is the pursuit of personcentered goals through a process that requires the active participation and agreement of all partners. The relationship is one of partnership and the way of working together is collaborative.” • Many processes occur in a collaborative partnership (sharing thoughts and feelings, problem solving, negotiating, decision making). These processes involve a delicate balance among the needs, agendas, goals, perspectives and preferences of each partner. 9/8/22 36 Cooperation is Not Collaboration • Cooperation is planning and working together in a helpful way. (going along….) • A person can be unassertive, passive and yet be cooperating. • Collaboration requires cooperation, but it also requires assertiveness and active involvement. • “Collaboration means understanding who the person is and what he wishes to discuss and share and what he would like to change or accomplish in his own life. The agenda for work derives from the person in front of you. The agenda for work is not nurse driven.” Nurse Lucia Fabijan (Gottlieb, 2013) 9/8/22 37 Essential Ingredients of a Collaborative Partnership (Gottlieb, Feeley, & Dalton, 2005) Sharing Power Being SelfAware and Reflective Open and Respectful Collaborative Partnership Living with Ambiguity Being Nonjudgemental 9/8/22 38 Essential Ingredients of a Collaborative Partnership (Gottlieb, Feeley, & Dalton, 2005) 1. Sharing Power • • • • The heart of a collaborative partnership. Both partners set agenda and determine plan of action. Both partners share responsibility for what happens. Information and knowledge flow in both directions. (Shared) “A collaborative partnership involves moving away from the nurse in the dominant role to a situation where the nurse is in a different type of role, such as that of a facilitator who has expertise in certain things. I think the clients are also experts, obviously, on where they’ve been, what they want to learn about, what they’ve already tried, and what’s important to them. Both partners have expertise.” Nurse Deborah Moudarres (Gottlieb, 2013) 9/8/22 39 2. Open and Respectful Essential Ingredients of a Collaborative Partnership (Gottlieb, Feeley, & Dalton, 2005) • Willingness to develop a relationship with each other. • Both partners are willing to share information, ideas, and perspectives with each other. • Willingness to experiment, change and learn something new. • Each partner values and respects the knowledge, skills, experience and expertise of the other. • Honouring differences (thoughts, opinions, perspectives) and looking for common ground to manage differences in ways that will best benefit the patient. “There needs to be an openness in a collaborative partnership. And one aspect of that is to start where the person is. For me, I’m going to want to learn more about their issues and concerns and their readiness to work on them. I try to keep things open so thy can explain what’s important to them.” Nurse Margaret Eades (Gottlieb, 2013) 9/8/22 40 Essential Ingredients of a Collaborative Partnership (Gottlieb, Feeley, & Dalton, 2005) 3. Being Non-judgemental and Accepting • Showing tolerance for another person’s beliefs, values, behaviors, or perspectives. • Try to understand the other person’s perspective. “It is important right from the start, in terms of both engaging the person and developing a collaborative partnership, to have an accepting attitude.” Nurse Deborah Moudarres (Gottlieb, 2013) 9/8/22 41 Essential Ingredients of a Collaborative Partnership (Gottlieb, Feeley, & Dalton, 2005) 4. Living with Ambiguity • There are two drivers. • Not clear to either partners how situation will unfold. • Both partners must be able to tolerate uncertainty and unpredictably for a period of time. • Both partners need to be flexible and adaptable. “ The nurse needs to learn how to be comfortable with situations that are not that clear. The nurse will be dealing with the give and take, and you have to take the cues from them.” Nurse Heather Hart (Gottlieb, 2013) 9/8/22 42 Essential Ingredients of a Collaborative Partnership (Gottlieb, Feeley, & Dalton, 2005) 5. Being Self-Aware and Reflective • A collaborative partnership requires both self awareness and an awareness of the other person. • Need to be aware of the dynamics going on in the relationship and the impact that one’s behavior is having on the other. • Gaining self awareness through reflection (tool). “There really is a need for the nurse to have some level of self-awareness and to really reflect on what she says and does, and the impact that she has on the person. The nurse needs to think about the content of what she’s discussing and also how the process is unfolding.” Nurse Cindy Dalton (Gottlieb, 2013) 9/8/22 43 Collaborative Partnership (Gottlieb, 2013) • Facilitates the person to become empowered because it shifts attention: • From focusing on deficits to working with person’s strengths. • From doing for the person to working with the person. • From focusing on disease/treatment to focusing on living and coping with challenges. • From the nurse as a teacher to both the nurse and person as learners. • From measuring a set of specific outcomes to allowing the person to determine their own goals and their own measures of success. 9/8/22 44 Excerpt from 2013 Nursing Explorations promotional video http://youtu.be/HxydcvqnRfY Copyrighted Material: Maria Di Feo ,Annie Chevrier and Laurie Gottlieb: Ingram School of Nursing, McGill University 9/8/22 45 References Gibson, C. H. (1991). A concept analysis of empowerment. Journal of advanced nursing, 16(3), 354-361. Gottlieb, L.N. (2013). Strengths-based nursing care. Springer Publisher Canada Koerner, J. G. (2011). Healing presence: The essence of nursing. Springer Publishing Company.