CONTINUING EDUCATION
Back to Basics: Patient and
Family Engagement 0.8
www.aorn.org/CE
LISA SPRUCE, DNP, RN, CNS-CP, ACNS, ACNP, ANP, CNOR
Continuing Education Contact Hours
Approvals
indicates that continuing education (CE) contact hours
are available for this activity. Earn the CE contact hours by
reading this article, reviewing the purpose/goal and objectives, and completing the online Examination and Learner
Evaluation at http://www.aorn.org/CE. Each applicant who
successfully completes this program can immediately print
a certificate of completion.
This program meets criteria for CNOR and CRNFA recertification, as well as other CE requirements.
Event: #15524
Session: #0001
Fee: Members $6.40, Nonmembers $12.80
The CE contact hours for this article expire July 31, 2018.
Pricing is subject to change.
Purpose/Goal
To provide the learner with knowledge of best practices related
to engaging patients and their family members in health care.
Objectives
1. Discuss common areas of concern that relate to perioperative best practices.
2. Discuss best practices that could enhance safety in the
perioperative area.
3. Describe implementation of evidence-based practice in
relation to perioperative nursing care.
Accreditation
AORN is accredited as a provider of continuing nursing
education by the American Nurses Credentialing Center’s
Commission on Accreditation.
AORN is provider-approved by the California Board of
Registered Nursing, Provider Number CEP 13019. Check
with your state board of nursing for acceptance of this activity
for relicensure.
Conflict-of-Interest Disclosures
Dr Spruce has no declared affiliation that could be perceived as
posing a potential conflict of interest in the publication of this
article.
The behavioral objectives for this program were created by
Helen Starbuck Pashley, MA, BSN, CNOR, clinical editor,
with consultation from Susan Bakewell, MS, RN-BC, director,
Perioperative Education. Ms Starbuck Pashley and
Ms Bakewell have no declared affiliations that could be
perceived as posing potential conflicts of interest in the publication of this article.
Sponsorship or Commercial Support
No sponsorship or commercial support was received for this
article.
Disclaimer
AORN recognizes these activities as CE for RNs. This
recognition does not imply that AORN or the American
Nurses Credentialing Center approves or endorses products
mentioned in the activity.
http://dx.doi.org/10.1016/j.aorn.2015.04.020
ª AORN, Inc, 2015
www.aornjournal.org
AORN Journal j 33
Back to Basics: Patient and
Family Engagement 0.8
www.aorn.org/CE
LISA SPRUCE, DNP, RN, CNS-CP, ACNS, ACNP, ANP, CNOR
ABSTRACT
Patient and family engagement is an active involvement in health care between patients, families, and
their caregivers. Perioperative nurses should be active proponents of implementing patient
engagement activities in the perioperative setting. This article introduces basic patient engagement
concepts and how they can be implemented in the perioperative setting. AORN J 102 (July 2015) 34-37.
ª AORN, Inc, 2015. http://dx.doi.org/10.1016/j.aorn.2015.04.020
Key words: patient engagement, patients, families, perioperative nurses, providers.
P
atient safety is in the forefront of efforts by caregivers
to prevent mishaps that increase suffering and cost
for patients. One way to help prevent these events is
for care providers to more fully engage with patients in the
planning and execution of their care. The following composite
case study illustrates the consequences of failing to engage
patients and family members in care decisions and outcomes.
Ms J is a 35-year-old woman scheduled to undergo exploratory
laparoscopic surgery for abdominal pain. When she arrives at
the facility and personnel begin preparing her for surgery, the
nurse asks routine questions about her history, including
medications. Ms J reports the medications that she routinely
takes, which includes occasional use of a narcotic pain medication, but she fails to mention that she also takes ibuprofen
for less intense recurrent abdominal pain or that her last dose
was two days ago. The nurse fails to ask about over-thecounter medications or alternative medications, and the
patient does not mention the ibuprofen and the multivitamin
she takes that includes vitamin E, believing they are not
important enough to mention.
During the preoperative assessment, the nurse does not
question the patient about social or religious constraints on the
use of blood and other products that come from animal or
human sources, and Ms J does not think to mention her
beliefs about a vegan lifestyle and not using animal products of
any kind. During the surgery, the patient experiences more
than normal bleeding, and because of the difficulty seeing the
field, the surgeon accidently nicks a vessel. As a consequence,
the surgery is converted to an open procedure, and the surgeon
uses hemostatic products that are porcine in origin.
Throughout the process, no one reports the turn of events to
the family members, who could have provided information
about the religious constraints against blood and other products and prevented their use.
Afterward, when Ms J learns about the surgical outcome and is
upset, personnel at the facility refuse to talk to Ms J or her family
members about what happened or the breakdown in communication. Ms J feels intimidated, fearful, and powerless when trying
to question them. She feels responsible for not mentioning the
medications and her beliefs to the staff and is quite distressed
about the use of the animal product. Because they are anxious that
the patient and her family might sue, staff members fail to reassure
her that they should have questioned her more thoroughly or
sought counseling from a family member.
Ms J loses confidence in the health care professionals caring for
her. Members of the health care system where she was treated
appear to be unable to see the event from the patient’s and
family members’ perspectives; they feel that they did what was
necessary to save the patient’s life.
This can happen when personnel at a facility, including surgeons, are afraid to discuss mistakes with patients or their
http://dx.doi.org/10.1016/j.aorn.2015.04.020
ª AORN, Inc, 2015
34 j AORN Journal
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July 2015, Vol. 102, No. 1
family members and when they work within a culture that
does not value the role that patient and family members can
play in helping to reduce medical errors and provide quality care.
Patient and family engagement is a new concept in health care
and has the potential to revolutionize traditional health care
delivery. The aim of engaging patients and families is to change
the care relationship.1 Patients need to take an active role in their
care, and caregivers need to form partnerships with patients.1 In
2007, a systematic review by Coulter and Ellins2 of research on
patient-focused quality interventions found that strategies to
promote patient engagement resulted in reduced care costs
and improved patient health. One of the aims should be to
focus on health literacy because it is an essential component
to allow patients to be engaged in their care. Improving
patient health literacy in turn increases their knowledge and
understanding of disease processes and will help them make
informed decisions about acute and chronic conditions.2 In
turn, health care professionals must develop and improve
communication skills and have resources to be able to work
collaboratively with patients and help patients and families
access and understand health information.2
Patient and family engagement opportunities can improve the
effectiveness of health care and help prevent tragic occurrences,
such as those experienced by the patient in the case study.
Patient engagement activities also help improve costeffectiveness and the ways in which health care is delivered.
HOW-TO GUIDE
The Macy Foundation Conference on Partnering With
Patients, Families, and Communities offered the following
recommendations to move toward engaging patients and
improving health care.3
Change how care providers, students, patients, and family
members are educated about health care and patient
engagement.
o Provide educational content that helps health care professionals learn to partner with patients, families, and
communities.
o Include student participation in clinical practice in inpatient and outpatient settings to prepare them to incorporate patient and family engagement into their practice
when they enter the clinical setting.
o Encourage patients and family members to coeducate
students and other health care providers about their
experiences, health status, and treatment.
Change health care organizations’ practices and education to
help personnel create a new vision and mission that
www.aornjournal.org
Back to Basics: Patient and Family Engagement
incorporates patients, families, and members of the community as partners.
Develop new skills and support mechanisms to create sustainable change.
Institute regulatory and health care payment reform to
support and sustain these changes in every payment delivery
model.3
Assumptions that patients do not have the expertise to
participate in the design and delivery of health care must
change; the goal is to move from the idea of “we are here to
make you feel better” to “we are partners with you, working
together for your optimal health.” To achieve this new way of
delivering heath care, new skills and new knowledge will
be required.
BENEFIT
Patients are a valuable resource for health care personnel in
helping to redesign processes of care. Patients experience
firsthand the care provided, and some may have had experiences that included harm, errors, or inconsistencies in care.
This can affect how they perceive care, but the information
they report can be invaluable for identifying areas for
improvement. Oftentimes, patients with chronic diseases are
experts in their own care, are knowledgeable about the conditions which with they live, and can provide valuable,
sometimes crucial, information to caregivers.4 LavoieTremblay et al4 implemented a transforming care at the
bedside (TCAB) project and explored health care team
members’ perceptions about the effects of patient input.
The project was implemented on five units at three
hospitals in Montreal. Each unit had a TCAB team
consisting of frontline caregivers, management, patient
representatives, and a TCAB facilitator. The goal was to
engage staff members, patients, and families to redesign
care delivery systems. The study team conducted focus
groups and individual interviews of the health care workers,
asking how the TCAB experience affected them; they
found that the teams benefited from seeing the point of
view of the patient because they were better able to
understand the patient’s perspective and it gave them
valuable information that helped them tailor the
care provided.4
STRATEGIES FOR SUCCESS
An example of a successful patient engagement initiative
comes from Beth Israel Deaconess Medical Center, Boston,
Massachusetts.1 Personnel at the medical center decided to
make the facility more patient centered and adopted an
open, transparent reporting process of significant medical
AORN Journal j 35
Spruce
events. With this process, hospital personnel reduced
harmful patient events from 22.5% in 2006 to 11.5% in
2010 and reduced the number of surgical site infections
from 79 in 2010 to 47 in 2011. They also achieved an
80% reduction in unexpected death rates. The hospital
attributed the success in part to the efforts to make the
hospital more patient centered. The hospital implemented
a patient care committee that set up patient and family
advisory councils. Their mission was to make sure that
communication was improved and the patient’s voice was
heard. From what they learned through this council, they
were able to create innovations that enhanced the patient
care experience. One example of this was the development
of a web-based portal through which patients can
communicate with their physicians, check test results,
review their medication and allergy information to identify
potential errors, and make sure the information is
accurate. In addition, patients can request appointments
and medication refills using the portal. Patients are given
access to their clinical records to encourage them to
engage in their care. Patients have reported feeling more in
control of their health care with access to these types
of tools.1
The National Patient Safety Foundation (NPSF) provides
recommendations for health care leaders, clinicians, policy
makers, and patients to promote partnerships and safer care.5
The NPSF recommends that leaders establish patient and
family engagement as a core value, involve patients and
family members as equal partners in all patient-related
activities, educate all personnel to be partners with peers and
patients and their family members, and partner with
communities and patient advocacy groups.
Health care clinicians should engage and support patients and
family members by engaging in their care, partnering in health
care redesign and safety improvements, and alerting patients
and families when errors are made or when something goes
wrong. Health care policy makers should
involve patients in all health care policy committees and
organizations,
develop and implement safety metrics that are based on the
best available evidence and standardized, and
involve patients in research planning and participation.
In addition, the NPSF recommends that patients ask questions
regarding the risks and benefits of treatment and keep asking
until a satisfactory answer is given. Patients should take
36 j AORN Journal
July 2015, Vol. 102, No. 1
someone with them to the hospital or physician’s office to help
retain and understand diagnoses and instructions, and they
should always know the names of any medication taken, why
it was prescribed, and how it is taken. To help understand the
plan of care, patients should
repeat what clinicians are saying so misunderstandings can
be quickly corrected,
obtain recommended laboratory tests before a physician’s
visit or surgery so the results are available for review, and
identify who is in charge of the care that is provided.
WRAP-UP
In the perioperative environment, clinicians can engage
patients and family members by encouraging patients to
participate in the site marking process, explain the procedure they will undergo, and share their health history to
ensure safe care. Encouraging patient participation when
discussing medical errors or complications is another way
to engage patients in care. Advocating for the family when
patients are unable to participate (eg, when under sedation
or anesthesia), ensuring that family members are involved
in the decision-making process when the patient is unable
to do so, and understanding the patients’ and family
members’ levels of understanding about proposed care and
how it relates to patient circumstances and cultural beliefs
is key.
Patients can play an important role in health care safety.
Engaging patients improves safety and can help leaders and
clinicians create a system that is safer and more patient
centered. When miscommunication happens, as it did in the
case study, clinicians have the opportunity to engage patients
in the conversation and invite them to participate in a process
to help improve practice instead of leaving the issue unresolved. The perspectives and insights that patients can provide
can initiate ideas on how to change practices to improve patient care. Patients who are engaged in their care can become
more confident in their interactions with health care providers
and take an active role in health care decisions. There is an
urgent need for alignment and collaboration among patients,
families, leaders, providers, and organizations to reform health
care and improve the delivery of safe care.5 Perioperative
nurses can advocate for patient engagement. To help
encourage this, AORN has convened a Patient Engagement
Task Force to research and compile resources for
perioperative nurses to implement and support patient
engagement activities. These resources will be available in
2016 on AORN’s web site.
www.aornjournal.org
References
1. Laurance J, Henderson S, Howitt P, et al. Patient engagement: four
case studies that highlight the potential for improved health outcomes
and reduced costs. Health Aff (Millwood). 2014;33(9):1627-1634.
2. Coulter A, Ellins J. Effectiveness of strategies for informing,
educating, and involving patients. BMJ. 2007;335(7609):24-27.
3. Partnering With Patients, Families, and Communities: An Urgent
Imperative for Health Care. Josiah Macy Jr. Foundation, 2014.
http://macyfoundation.org/docs/macy_pubs/JMF_ExecSummary_
Final_Reference_web.pdf. Accessed February 5, 2015.
4. Lavoie-Tremblay M, O’Connor M, Harripaul A, et al. The perceptions
of health care team members about engaging patients in care
redesign. Am J Nurs. 2014;114(7):38-46.
5. Safety Is Personal: Partnering with Patients and Families for the
Safest Care. National Patient Safety Foundation. http://www.npsf
.org/?page¼safetyispersonal. Accessed February 5, 2015.
Resources
A Leadership Resource for Patient and Family Engagement. Hospitals in
Pursuit of Excellence. http://www.hpoe.org/resources/hpoehretaha
-guides/1407. Accessed February 5, 2015.
About the Partnership: Patient and Family Engagement. Centers for
Medicare & Medicaid Services. http://partnershipforpatients.cms
.gov/about-the-partnership/patient-and-family-engagement/the-patient
-and-family-engagement.html. Accessed February 5, 2015.
Guide to Patient and Family Engagement in Hospital Quality and Safety.
AHRQ. http://www.ahrq.gov/professionals/systems/hospital/engaging
families/. Accessed February 5, 2015.
www.aornjournal.org
Back to Basics: Patient and Family Engagement
NeHC Patient Engagement Webinars. HIMMS. http://www.himss.
org/ResourceLibrary/TopicList.aspx?MetaDataID¼2845. Accessed
February 5, 2015.
Nursing Alliance for Quality of Care. http://www.naqc.org/WhitePaper
-PatientEngagement.
Patient & Consumer Engagement. PCORI. http://www.pcornet.org/task
-forces/patient-consumer-engagement-in-research. Accessed February
5, 2015.
What is Patient Engagement? Center for Advancing Health. https://
www.youtube.com/watch?v¼AO-YwwISruI. Accessed February 5,
2015.
Lisa Spruce, DNP, RN, CNSCP, ACNS, ACNP, ANP, CNOR,
is the director of evidence-based
perioperative practice at AORN,
Inc, Denver, CO. Dr Spruce has
no declared affiliation that
could be perceived as posing
a potential conflict of interest
in the publication of this article.
AORN Journal j 37
print & web 4C/FPO
July 2015, Vol. 102, No. 1
EXAMINATION
Continuing Education:
Back to Basics: Patient and
Family Engagement 0.8
www.aorn.org/CE
PURPOSE/GOAL
To provide the learner with knowledge of best practices related to engaging patients and their family
members in health care.
OBJECTIVES
1.
2.
3.
Discuss common areas of concern that relate to perioperative best practices.
Discuss best practices that could enhance safety in the perioperative area.
Describe implementation of evidence-based practice in relation to perioperative nursing care.
The Examination and Learner Evaluation are printed here for your convenience. To receive
continuing education credit, you must complete the online Examination and Learner Evaluation
at http://www.aorn.org/CE.
QUESTIONS
1.
Implementing strategies to promote patient engagement
can reduce care costs and improve patient health.
a. true
b. false
2.
Patient and family engagement opportunities can help
1. improve the effectiveness of health care.
2. prevent tragic occurrences.
3. improve cost-effectiveness.
4. improve the ways in which health care is delivered.
a. 1 and 3
b. 2 and 4
c. 1, 2, and 4
d. 1, 2, 3, and 4
3.
What should occur to change how care providers, students, patients, and family members are educated about
health care and patient engagement?
1. Educational content should help health care professionals learn to partner with patients, families,
and communities.
2. Students should be excluded from participating in
clinical practice in inpatient and outpatient settings.
3. Patients and family members should be encouraged
to coeducate students and other health care
providers.
38 j AORN Journal
a. 1 and 2
c. 2 and 3
b. 1 and 3
d. 1, 2, and 3
4.
Why are patients a valuable resource to help redesign
processes of care?
1. Patients experience care firsthand.
2. Some may have had experiences including harm,
errors, or inconsistencies in care.
3. The information patients report can be invaluable for
identifying areas for improvement.
4. Patients with chronic disease are experts in their own
care and are knowledgeable of the conditions which
with they live.
5. Patients can provide valuable information to caregivers.
6. Including patients in health care decisions helps to
reduce facility and care provider liability.
a. 1, 3, and 5
b. 2, 4, and 6
c. 1, 2, 3, 4, and 5 d. 1, 2, 3, 4, 5, and 6
5.
Researchers found that health care teams benefited from
seeing the point of view of the patient because they were
better able to understand the patient’s perspective and
tailor the care provided.
a. true
b. false
www.aornjournal.org
LEARNER EVALUATION
Continuing Education:
Back to Basics: Patient and
Family Engagement 0.8
www.aorn.org/CE
T
his evaluation is used to determine the extent to
which this continuing education program met
your learning needs. The evaluation is printed here
for your convenience. To receive continuing education credit,
you must complete the online Examination and Learner
Evaluation at http://www.aorn.org/CE. Rate the items as
described below.
6.
Will you be able to use the information from this article
in your work setting?
1.
Yes
2.
No
7.
Will you change your practice as a result of reading this
article? (If yes, answer question #7A. If no, answer
question #7B.)
7A.
How will you change your practice? (Select all that apply)
1. I will provide education to my team regarding why
change is needed.
2. I will work with management to change/implement
a policy and procedure.
3. I will plan an informational meeting with physicians to
seek their input and acceptance of the need for change.
4. I will implement change and evaluate the effect of
the change at regular intervals until the change is
incorporated as best practice.
5. Other: __________________________________
7B.
If you will not change your practice as a result of
reading this article, why? (Select all that apply)
1. The content of the article is not relevant to my
practice.
2. I do not have enough time to teach others about the
purpose of the needed change.
3. I do not have management support to make a change.
4. Other: __________________________________
8.
Our accrediting body requires that we verify the time
you needed to complete the 0.8 continuing education
contact hour (48-minute) program: ______________
OBJECTIVES
To what extent were the following objectives of this
continuing education program achieved?
1. Discuss common areas of concern that relate to perioperative best practices.
Low
1.
2.
3.
4.
5.
High
2.
Discuss best practices that could enhance safety in the
perioperative area.
Low
1.
2.
3.
4.
5.
High
3.
Describe implementation of evidence-based practice in
relation to perioperative nursing care.
Low
1.
2.
3.
4.
5.
High
CONTENT
4.
5.
To what extent did this article increase your knowledge
of the subject matter?
Low
1.
2.
3.
4.
5.
High
To what extent were your individual objectives met?
Low
1.
2.
3.
4.
5.
High
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AORN Journal j 39