Nursing’s Role in Reducing Patient Suffering

As healthcare has evolved in this era of reform, so too has the need to redefine the patient experience in terms that acknowledge the anxiety, fear and distress that accompany it.

In our mission to deliver more patient-centered care, clinicians must seek to reduce patient suffering in order to improve the experience, increase engagement and impact outcomes.

Understanding patients’ perception of their care is paramount to the movement from a volume-based to a value-based delivery model.

Unlike buying a car, dining at a restaurant or vacationing at a theme park, the perception of patient care is much more than service delivery or even customer service.

Rather, the patient experience comprises every aspect of care – clinical, cultural, operational and behavioral – provided in every setting, by every caregiver, every day.

Decontructing Suffering

When we think about the patient experience in this way, it becomes evident that improving patients’ perception of their care entails much more than nurses making eye contact, smiling and pulling the curtain for privacy. It requires providing optimal, coordinated care across the continuum, under the overarching goal of reducing patient suffering.

While the word “suffering” evokes a visceral response in most caregivers, the fact that patients suffer cannot be ignored. Many clinicians resist talking about suffering, because the word feels emotionally charged and the experience of it is difficult to quantify.

It is possible, however, to deconstruct suffering into meaningful, measurable categories.

Our research has demonstrated that there are two very distinct categories of patient suffering: that which is inherent to a diagnosis or treatment, and that which is caused by dysfunction in the healthcare delivery system.

The former is a natural consequence of illness and treatment. The latter is a byproduct of process defects, e.g., excessive wait times, poor care coordination, and insufficient communication, for example – and reflects ways in which we, the people trusted to care for our patients, actually cause their suffering directly or indirectly (Figure 1).

It is incumbent upon us as nurses to mitigate the inherent suffering and eliminate avoidable suffering in order to provide patients with optimal care in every setting.

In order to do this, we must connect clinical excellence with outcomes, operational efficiency with quality, and behaviors with engagement of caregivers and patients. In other words, we must find a way to ensure the delivery of Compassionate Connected Care™ to every patient every day.

Fig. 1 Causes of Patient Suffering

Inherent Suffering

Arises from within the individual in response to his/her illness and will occur even within an optimally functioning care delivery system.

Varies based on individual differences in patient needs.

Is unavoidable but not un-addressable. Our goal should be to mitigate wherever possible.

Avoidable Suffering

Arises from the dysfunction present in the care delivery system.

Varies based on differences in how organizations provide care.

Is avoidable because it would not occur in an optimally functioning system. Our goal should be to reduce these defects to zero.

Connecting Care Compassionately 

We must also provide a foundation that connects the mission, vision and values of our organizations with engagement and action. Toward that end, our team conducted an affinity project with more than 100 clinicians, non-clinicians and patients to determine what Compassionate Connected Care looks like from their various perspectives.

Six themes emerged from this work, which we have interpreted into actionable improvement steps:

Suffering Must Be Acknowledged: We should acknowledge that our patients are suffering, and show them that we understand.

Body Language Matters: We must employ non-verbal communication skills and treat them as equally important as the words we use.

Anxiety is Suffering: We must acknowledge anxiety and uncertainty as negative outcomes and address them as part of the patient experience.

Care Should be Coordinated: We should show patients that their care is coordinated and continuous, and that “we” are always there for them.

Caring Transcends Diagnosis: We must embrace the reality that care goes beyond delivery of medical interventions to the patient.

Autonomy Reduces Suffering: We must help preserve autonomy as a means to ensure patient dignity.

When we make the reduction of suffering our goal and derive strategies to achieve it from these themes, patient experience scores and reimbursements will improve. Only by acknowledging patient suffering can we design a truly patient-centered care delivery system.

Christy Dempsey is Senior VP and Chief Nursing Officer, Press Ganey Associates, Inc.

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