Background
The inspiration behind Preferra began as a project for our nursing undergraduate degree. We were faced with the challenge of creating an innovation to address a gap in current health care. Reflecting on our clinical experiences, we noticed that our nursing curriculum heavily emphasized the importance of humanizing care and engaging with patient stories; however, this was not fully actualized in everyday practice. Too often a biomedical task-based environment existed, having a profound negative impact on patient satisfaction and we found that electronic health records played a key role in shaping this environment. Acknowledging care preferences holds vital importance across Canada, especially Ontario, as we host a culturally-diverse population, constituting a variety of different backgrounds and preferences that make individuals unique. In health care, it is a universal goal to ensure that patients receive a high standard of care, with their preferences upheld. College of Nurses of Ontario (2019) states, “Clients’ values and choices are of primary consideration when planning and providing care." Often, preferences are communicated through word of mouth or documented sporadically throughout electronic health records. As nurses, we know knowledge of patient preferences can establish therapeutic relationships and de-escalate situations. However, without a specific platform where patient preferences are documented and readily accessible by the interprofessional team, this key information is insufficiently communicated, leading to a lack of humanistic care.
COVID-19 has exacerbated the issues with a biomedical health care focus, especially in long-term care. With isolation restrictions and staffing shortages, residents are now, more than ever, encountering unfamiliar faces and experiencing care inconsistent with their desired routine. When health care providers are not informed of resident preferences, it threatens health and safety. For instance, a purse can have intrinsic value to a person living with dementia, hosting meanings of comfort, security, and identity that reduce anxiety, prevent negative behaviours, and retain a connection to identity.
Similar challenges exist for patients in the hospital when experiencing solely biomedical, disease-centred health care. When patients are most vulnerable, intubated with no voice, oftentimes a small act of humanism can make the world of difference, such as braiding the hair of a person who identifies as Metis, allowing quiet time for prayer, or simply the touch of a hand. Health care providers become the family for patients when their own family cannot be at the bedside. However, without an organized system in place to access patient preferences, vulnerable patients are further stripped of their autonomy and may receive care inconsistent with preference, decreasing quality of life. With a biomedical atmosphere, providers may even begin to lose sight of who they are caring for, who are in fact, people with stories and lives of their own.
Approach
Preferra is a patient-inclusive documentation tab, that can be integrated into existing electronic health records as a means of enhancing patient-centred care. Preferra utilizes the perspective that is gained through patient narrative, as it all starts with an interview conducted by the nurse with the patient and/or family when first admitted to a health care facility. Areas of focus would include gathering data on sensory/mobility preferences, spiritual/cultural preferences, toileting/hygiene preferences, meal preferences, sleep preferences, and additional preferences. This information would then be entered into the electronic health record into distinct preference categories. To provide an opportunity for feedback regarding the quality of care, the data would be regularly reviewed in partnership with the patient and/or family. In addition to showcasing collective preferences with a single click, Preferra includes a picture of the patient's face, serving as a reminder to health care providers that the patient is not just a pathology, but rather a whole person.
Impact
Preferra is dedicated to improving the patient experience and collaborative partnerships in health care. By utilizing Preferra in the initial encounter, it facilitates a positive atmosphere as health care providers show a genuine interest in the patient's story and the unique individuality of human preferences: whether it be preferred names, gender identity, cultural/spiritual rituals, diet, or even something as simple as untucking the blankets from the end of the bed. Thus, Preferra supports nurses in honouring their commitments, as College of Nurses of Ontario (2019) states, “...caring requires the recognition of clients as unique individuals whose goals nurses facilitate.” Preferra also encourages interdisciplinary communication, as all health care providers can access and update Preferra when new preferences are learned. Furthermore, initiating a discussion regarding the patient’s goals of care before treatment can bridge the gap between the health care provider, patient, and family. Identifying valued priorities empowers patients to lead their care by having their preferences upheld in the care they receive. This gives health care providers a starting point when creating plans of care to ensure a culturally-safe and therapeutic environment. An additional benefit of Preferra is in the event of a code yellow, which is when a patient is deemed missing. With Preferra, health care providers have an accessible picture or detailed description to aid them in identifying patient features, and preference information to aid in identifying their location. Ultimately, Preferra ensures that all care is informed and respectful of unique preferences, supporting patient autonomy.