Patient-centered Hospitals and Nursing Care

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By E’Louise Ondash, RN, contributor

Three decades ago, patient-centered hospital care was the mantra of a select few hospitals. They had discovered that when patients’ needs have priority over the institution’s, patients and nurses are happy and health really is the priority.

Now patient-centered care is the creed of many more healthcare facilities and the Planetree model has become the gold standard. Patients say it’s paradise; nurses call it nirvana.

“I was working at Alliance Community Hospital (in Alliance, Ohio) when Planetree came there in 2002,” said Jeanette Michalak MSN, APRN, BC, now Planetree’s vice president of consultation services in Lyon, Michigan. “I was a clinical nurse specialist in med-surg at the time, and Planetree was a life-changing experience.”

Since it was founded in 1978, the Planetree model has become synonymous with patient-centered care. Argentina native and San Francisco resident Angelica Thieriot created it after what she called several “dehumanizing” experiences in the hospital. The philosophy is named after the sycamore tree – also known as a planetree – under which Hippocrates taught medicine, and takes the word “holistic” to heart.

“Much of what other hospitals call patient-centered care is really customer service,” Michalak said. “Planetree is comprehensive.”

Under the Planetree umbrella are many components that work toward making the healing environment optimal. These include the architectural design of buldings; patient and family education; food and nutrition; the inclusion of gardens and art; emphasis on spirituality; the availability of complementary therapies such as massage and clinical aroma therapy; and interaction with the community.

Each hospital is free to implement those components that fit with their community, said explained Susan Stone, Ph.D., RN, chief nurse and operating officer of Sharp Coronado Hospital and Healthcare Center. The complex sits on Coronado Island across the bay from San Diego and has a commanding view of the city’s skyline and surrounding waterfront. The 204-bed facility had 59 acute care beds; the remainder are long-term care, rehabilitation and hospice.

“In 1999, our facility had a search to help us identify an approach and change our care model, and we found that Planetree incorporated the needs of the community,” Stone said. “We reside in a resort community, so people are familiar with complementary therapies.”

Patients at Sharp Coronado can have massage, clinical aroma therapy, healing touch and other complementary therapies for no additional charge. They do pay extra for acupuncture. And the hospital has chosen to create a more patient-friendly environment by eliminating overhead paging and instituting unlimited visiting hours. Friends and families may come and go at their convenience and be involved in the patients’ care to the extent they wish. And while visitors are at the hospital, they are likely to feel more at home with smell of cookies baking permeating the halls.

Adapting the Planetree model at Sharp Coronado was a consumer-driven decision, which is usually the case, Michalak said.

“Aging boomers are starting to need health care and are looking for things that are different from our parents. We even have affiliates in the Netherlands and many in Canada. They are different health systems but they are looking for the same thing.”

Planetree doesn’t advertise, but the word gets out about things like open access to charts, she added. Patients and families like being informed and want to be a part of the decision making. It’s also beneficial to physicians and hospital staff.

“The patients can read the chart in the presence of professionals who can explain things. It’s a huge enhancement to safety because we can really educated and communicate with the patient. Sometimes patients can find inaccuracies in the chart – for instance, the allergies that are listed. It gives patients and families an opportunity for asking questions.”

In 2003, there were about 80 hospitals, long-term care facilities, clinics and health care resource centers that had incorporated Planetree tenets. Today, there are about 140, according to Michalak.

The holistic philosophy touches the staff nurses, too.

“Some Planetree hospitals provide chair massages for the nurses delivered during shifts on a quarterly basis,” Michalak said. “They can use them for rewards and recognition. That’s better than blankets and key chains.”

Periodic massages aren’t the only reason nurses flock to Planetree facilities, Stone said.

“They say ‘This is why I wanted to become a nurse. It gets me back to what I wanted to be doing. I want to have interaction with patients. I touch them. I spend time with them.’ You become involved with the patient and the family. In other hospitals, they are very focused on technology.”

Nurses in Planetree hospitals and health centers also like the emphasis on continuity of care and patient nutrition, patient education, family involvement, and the low nurse-to-patient ratio. All these factors mean that nurse-turnover at Planetree facilities is generally less than at other health care facilities.

“We have about 300 nurses here and right now we have no openings,” Stone said. Resource: “Putting Patients First: Designing and Practicing Patient-Centered Care” (Jossey-Bass; $48) by Susan Frampton, Laura Gilpin, and Patrick Charmel (of Griffin Hospital, the first to implement the Planetree Model in 1991). The book offers a practical approach to implementing the Planetree Model within any health care organization.

For more information on Planetree, visit www.planetree.org, or call (203) 732-1365.

© 2008. AMN Healthcare, Inc. All Rights Reserved.