Patricia Reid Ponte

Making patient-centered care come alive: achieving full integration of the patient's perspective.

A patient-centered model of care has profound implications for the way that care is planned, delivered, and evaluated. Although most leaders in healthcare organizations today embrace the basic tenets of a patient-centered philosophy, they often find that moving toward a patient-centered model requires an unanticipated level of commitment and significant adjustments in organizational structures. In this article, the authors describe how patients and families have been integrated into the care delivery model by involving them in planning, decision-making, and improvement processes at all levels of the organization.

Multidisciplinary approaches to reducing error and risk in a patient care setting

In 1995, a medication error at Bostons Dana-Farber Cancer Institute (DFCI) that received intense media scrutiny, transformed the Institute in many ways. Primarily, patient safety became a major priority that led to Institute-wide organizational learning. As a result, DFCI emerged as a national leader in the patient safety movement. A key factor believed to have contributed to this effort was the use of a multidisciplinary team approach to identifying and preventing errors, with the patient and family members as an integral part of the team. In addition to teamwork, other activities included implementing a new chemotherapy order entry system, transforming the culture to a non-punitive one where staff are encouraged to openly discuss errors and safety issues, and introducing a root cause analysis process for error/near miss investigations. Several guiding principles served as the foundation for the efforts including: 1) systems, not individuals, must be the focus of safety initiatives; 2) organizations must create a non-punitive culture; 3) changes must be hard-wired into systems; and 4) multidisciplinary participation, including patients and families, is critical to success.

Magnet recognition program: the next generation.

Twenty-five years ago, the foundation of the Magnet Recognition Program was established. Magnet designation has served as the hallmark of excellence for nursing practice, and research has demonstrated a profound impact on nursing practice and patient care. The purpose of this article was to forecast the direction of the Magnet Recognition Program. The authors discussed the results of a multivariate structural analysis of the forces of magnet and the subsequent future model for Magnet.

Interdisciplinary teamwork and collaboration: an essential element of a positive practice environment.

Interdisciplinary collaboration is critical to excellence in patient care delivery. There is a growing consensus that the basic education for all clinical professionals should include the knowledge, skills, and attitudes required to effectively participate in interdisciplinary teams, and that health care organizations should continue this education in the practice setting. The authors examine the large and growing evidence base regarding interdisciplinary collaboration and teamwork and explore the relationship between interdisciplinary collaboration and patient, workforce, and organizational outcomes. Antecedents and attributes of the construct are presented, as well as structures, models, and programs that are being implemented by health care organizations and academic settings to facilitate and advance interdisciplinary collaboration in clinical practice.

Reshaping the practice environment: the importance of coherence.

Todays nurse leader is challenged to create a practice environment that fosters multidisciplinary collaboration, professional development, and a culture of safety. Fostering a sense of coherence among staff nurses about their place within the nursing department and the departments place within the broader organization id essential to the development of such environments. When nurses have a sense of coherence about their work setting, they are more likely to feel confident that their care of patients and families is fully supported by the organization in which they work. The authors describe the concept of coherence, discuss findings from a preliminary study regarding attributes that may contribute to coherence in individual nurses, and describe systems ans programs that have been implemented in a large academic medical center to foster a sense of coherence in individual nurses, the nursing department, and the institution as a whole.

Provider Practice Models in Ambulatory Oncology Practice: Analysis of Productivity, Revenue, and Provider and Patient Satisfaction

Physicians, nurse practitioners, and physician assistants often work in teams to deliver cancer care in ambulatory oncology practices. This is likely to become more prevalent as the demand for oncology services rises, and the number of providers increases only slightly.

Retaining Oncology Nurses: Strategies for Today's Nurse Leaders

Carolyn Hayes, PhD, RN, is director of clinical initiatives at Dana-Farber/Brigham and Women’s Cancer Center in Boston, MA; Patricia Reid Ponte, DNSc, RN, FAAN, is senior vice president of patient care services and chief of nursing at Dana-Farber Cancer Institute and director of hematology/oncology/bone marrow transplantation nursing and clinical services at Brigham and Women’s Hospital in Boston; Amanda Coakley, PhD, RN, is a staff specialist in patient care services at Massachusetts General Hospital in Boston; Escel Stanghellini, MS, RN, is a nursing coordinator at Brigham and Women’s Hospital; Anne Gross, MS, RN, CNAA, is vice president of adult ambulatory service and director of adult ambulatory nursing, Sharon Perryman, BSN, MHA, RN, is a nurse executive fellow in diversity, and Diane Hanley, MS, RN, BC, is director of cancer care education, practice, and quality, all at Dana-Farber Cancer Institute; Nancy Hickey, MS, RN, is director of personnel and resource applications at Brigham and Women’s Hospital; and Jacqueline Somerville, MS, RN, is associate chief nurse in patient care services at Massachusetts General Hospital. The authors received writing and editing assistance with this article.

The power of partnership: Addressing cancer health disparities through an academic-service partnership

Partnerships between universities and healthcare organizations help foster interdisciplinary collaboration and can yield programs to address pressing needs in both sectors. In spite of these benefits, such partnerships remain more the exception than the norm. This article describes a partnership between a comprehensive cancer center and a university-based college of nursing and health sciences that serves a diverse student population. With the support of U-56 funding, the 2 organizations collaborated to develop a new, 87-credit BS-to-PhD in Nursing program and to enhance the universitys traditional PhD in nursing program. Both PhD programs prepare nurses for careers in teaching, health policy, and research related to cancer health disparities. In addition to an innovative curriculum, the programs include a mentorship that leverages the research expertise and scholarly resources of both organizations and a community outreach component that gives students experience in planning and implementing educational and risk-reduction programs addressing cancer health disparities.

A Patient- and Family-Centered Care Model Paves the Way for a Culture of Quality and Safety

Over the past 13 years, the Dana-Farber Cancer Institute has embraced a patient- and family-centered model of care and culture of quality and safety. The authors discuss how their care delivery model and quality and safety efforts reinforce one another, and how they have shaped the organizations practice environment, governance structures, and systems and processes that support care delivery. The authors also discuss key values, structures, and processes that must be upheld to assure the advancement of patient- and family-centered care and quality and safety efforts within an institution.

Addressing the Confusion Related to DNS, DNSc, and DSN Degrees, With Lessons for the Nursing Profession

PURPOSE This article examines the evolution of Doctor of Nursing Science (DNS or DNSc) and Doctor of Science in Nursing (DSN) degrees, including their emergence as research-intensive doctoral degrees in the 1960s, efforts to distinguish the degrees from the Doctor of Philosophy (PhD) and Doctor of Nursing Practice (DNP) degrees, the recent decline in program numbers, and implications for degree holders. APPROACH The article reviews the U.S. history of doctoral education in nursing, research examining similarities and differences between the PhD and DNS, DNSc, or DSN degrees, and how the DNS, DNSc, or DSN degree differs from DNP programs. The article also examines the confusion regarding the focus of the DNS, DNSc, or DSN degree among nurses, patients, and potential funders; and describes actions taken by universities to address the confusion, with examples provided by academic deans, nurse leaders, and nurse researchers. FINDINGS Longstanding confusion about the research merits of the DNS, DNSc, or DSN degree, and the growing prominence of the similarly-titled DNP degree, has created confusion about the focus of DNS, DNSc, or DSN programs and the capabilities of degree holders. Many universities have addressed this confusion by converting their DNS, DNSc, and DSN programs to a PhD or retroactively converting degrees to a PhD. Other universities have chosen not to pursue this route. CONCLUSIONS The DNS, DNSc, or DSN experience highlights the importance of clarifying and standardizing the purpose and goals of nursing education programs and the repercussions for degree holders when such clarity is lacking. The international academic nursing communities have consistently pursued one doctoral-level nursing degree and therefore have not shared this challenging landscape in nursing education. CLINICAL RELEVANCE Findings and recommendations presented in this article have implications for schools of nursing and professional groups that oversee the development of educational programs and pathways for nurses.