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Department: Pathway to Excellence®

2018 Pathway Award® winner

Harris, Patience BSN, RN; Li, Leann BSN, RN, CCM, CMCN; McHenry, Karen MSN, RN; Dans, Maricon MSN, RN

Author Information
Nursing Management (Springhouse): December 2019 - Volume 50 - Issue 12 - p 6-8
doi: 10.1097/01.NUMA.0000605192.89972.80
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When nurses are empowered to practice at their highest level, they can contribute to improving patient care and advancing evidence-based nursing practice. That's why in 2011, the American Nurses Credentialing Center launched the Pathway Award,® sponsored by Cerner. This award supports the efforts of Pathway-designated organizations to develop initiatives that promote the use of innovation and technology in their practice. Pentec Health earned the prestigious 2018 Pathway Award, which provided funding to implement its proposed integrative care project.

Pentec used the Pathway to Excellence® framework to advance its mission of providing exceptional patient care. To foster a culture of excellence, Pentec provided a foundation for frontline nurses to have a voice and empowered them to be innovative. Subsequently, Pentec nurses implemented a novel method to connect with their patients to reduce anxiety, increase empowerment, build trust and partnership, and improve adherence and safety. These elements were key to sustaining high levels of engagement among Pentec's nurses, motivating them to find communication methods to transform the patient experience.


Pentec is a unique home health organization with over 150 nurses that provide specialty care for patients with intrathecal pumps. Approximately 70% of Pentec's 5,000+ targeted drug delivery patients have chronic pain, which is a complex condition that affects all aspects of patients' lives—physical, emotional, socioeconomic, spiritual, and social.

When it comes to chronic pain management, many nurses across the healthcare continuum share the sentiment that they often struggle to make a difference for their patients because they witness their patients' continued suffering. Pentec nurses recognized that medical management alone to alleviate the discomfort of their patients' disease processes wasn't enough to address the extent of pain and anxiety their patients experience. The ideal model they imagined was a noninvasive, evidence-based approach that could be initiated by the patient to promote his or her autonomy, self-reliance, and adherence. This led to the development of Pentec's integrative care initiative.

The structures and processes in place at Pathway organizations support the nurses' ability to make an initiative happen. For example, one of the Pathway elements of performance requires organizations to demonstrate how nurses present an idea to their shared governance body and describe how the idea is evaluated for applicability and implementation. Pentec's first step was to hold a brainstorming session with the coordinating and integrating council, challenging the group to create methods to improve the patient experience and outcomes. Next, Pentec's professional council convened to discuss current standards of care and emerging trends and opportunities around this issue. Research of evidence-based practices indicated that integrative care could provide the desired outcomes, including improvement in patients' self-care and self-esteem. Nursing staff members were enthusiastic about this opportunity to practice at the top of their license.

To engage staff members and get people on board, nurse advocates for developing the initiative highlighted the positive impact that a movement toward holistic, multidimensional pain care could offer both the patient population and staff. A task force was then formed to develop a more comprehensive plan. This group eventually evolved into the integrative care exploration and development (ICED) team, which explored using a multidimensional pain assessment tool that looks at more comprehensive factors than the traditional visual analog pain scale.

Two certified clinical nurses researched the available multidimensional pain assessment tools and presented the final options for staff members to evaluate. Pentec nurses selected and implemented the Defense and Veterans Pain Rating Scale (DVPRS). This assessment tool standardizes pain description on a scale of 0 to 10 and addresses the impact of pain on sleep, mood, stress, and activity level. The tool was adopted throughout Pentec's nursing practice. The documentation development and improvement and nurse practice councils were confident that the DVPRS would open the door for comprehensive discussions with patients about how pain affects their overall experience. Pentec also launched an integrative care education plan, including the basic concepts of nurse coaching to help nurses have more productive conversations with patients.

Award proposal

Pentec's proposal for the Pathway Award was twofold: to teach nursing staff members the essential concepts of nurse coaching skills and to conduct a research study evaluating the evidence-based integrative care in the Pentec nursing practice care model. The research study intervention had patients use a tablet and headphones to watch a relaxing music video during the pump refill procedure. The music video was selected by researchers, and the same music video was used for all patients during all visits. The procedure included a needle-stick access to locate a small port under the skin and tissue, typically in the abdominal area, which lasted approximately 10 to 20 minutes.

Thirty-two patients who required pump refills were evaluated over three visits. The first visit provided a baseline with no intervention and the second and third visit used the music video intervention. To determine whether the patient experienced a change in anxiety and/or pain with the intervention, a clinical nurse collected pre- and postprocedure vital signs (BP, heart rate, and respiratory rate) and used two validated research tools selected with input from a research expert: the State Trait Anxiety Inventory (STAI) and the DVPRS.

After preliminary review, the nurses reported that compared with the initial visit with no intervention, patients experienced decreased anxiety scores (STAI) and lowered pain ratings (DVPRS) after the intervention. Further evaluation of the data is pending. Through verbal reports and poststudy questionnaires, patients indicated that the technique was a positive experience and they would use it for other stressful times in their lives. The nurses participating in the study also reported positive experiences, some of which were profound. For example, a nurse researcher had a patient who expressed feeling extreme anxiety during her refills due to negative past experiences with a severely painful refill procedure. The music video intervention helped calm the patient to the point of falling asleep during the procedure. Not only was this positive for the patient, it was also beneficial for the nurse. As a result of the patient's relaxation, the nurse reported feeling less anxious, allowing more intense focus on completing the procedure safely.

Project outcomes

Pentec's strategic plan to create and foster a positive practice environment empowered nurses to drive their own practice. When the nurses focused on an issue, identified the problem, and researched and implemented the foundation of integrative care, the dynamics of the intrathecal refill procedure were transformed. Nurses found a new method to connect with their patients in a way that benefitted both the patients and themselves. And these techniques were easily transferrable to other patient populations, especially pediatric patients.

As the integrated care program continued to evolve, additional skills training for basic nurse coaching methods was adopted. The nurses who participated in this program have found that their improved communication skills allow them to facilitate better patient understanding of the pain experience and general health, which facilitates the nurse-patient partnership toward individualized and healthier goal setting and supports improved patient results.

Pentec's nurse leaders are committed to ensuring exceptional patient outcomes and nurse satisfaction and expanding the integrative care educational program and processes for nurses organization-wide. The ongoing training is particularly feasible at Pentec, given its organizational structure, the implementation of the Pathway framework, and its extensive network of technology and robust communication among remote teams.

Pentec's nursing strategy involves a commitment to provide all clinical nurses with education on basic nurse coaching techniques and further develop its integrative care techniques and materials for staff and patients. This strategy aligns with Pentec's corporate core values of quality, transparency, respect, and innovation. The many interrelated factors that impact patients' pain experiences continue to motivate efforts to enhance the communication techniques in use, such as through motivational interviewing, strength identification, and targeted goal development. Basic integrative techniques, such as controlled breathing and awareness, music therapy, mindfulness, meditation, and guided imagery, will continue to be used. These techniques will be further evaluated for effectiveness as the nurses and patients become more experienced with them. Pentec continuously seeks opportunities to analyze and validate its practice and share its successes.

Nursing implications

The Pathway standards identify foundational elements for a positive practice environment that can translate to quality patient care and safety. This type of supportive work setting focuses on collaboration, career development, and accountable leadership to empower nurses. Pathway organizations like Pentec integrate evidence-based practices in their quality initiatives, focusing on improving patient outcomes through interprofessional collaboration. In a positive practice environment, the essence of nurses having a voice is that it fosters free thinking, which lends support to nurses exercising their creativity.

Through collaboration, innovation, research, and a successful Pathway Award proposal, Pentec nurses designed a cultural shift in the dynamics of their nurse-patient relationships during the pump fill procedure, thereby decreasing patients' experience of pain and anxiety and the nurses' stress level. Pentec's commitment to supporting a positive practice environment promoted the ability of its nurses to leverage evidence-based research as a basis for innovation. The synergy of shared decision-making led nurses to explore their ideas and propose a creative and compelling project that could advance nursing practice in the area of pain management.

Pentec's research is limited to a specialized patient population. Exploration and research of a broader target population can provide further evidence and identify more options for improving pain control and anxiety around medical interventions. More organizations are encouraged to tap into their nursing staff members' expertise to explore patient-centered innovations to improve the quality of patient care.

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