Role & Scope Exam 3 Study Guide (NUR 2868)

Role & Scope Exam 3 Study Guide (NUR 2868)

Modul e 07 - Interdiscipl inar y Col labo rat ion

"Alone we can do so little; together we can do so much."

Teamwork Happens Daily

The above quote comes from Helen Keller (Lash, 1980). Nurses can certainly attest to this fact, for without teamwork and collaboration between departments, patient care would be severely jeopardized.

Nurses work in teams every day. Nursing care on the hospital floor is supported by nurse's aides, LPNs, RNs, who all must work together to get the daily care accomplished. But there is often more care necessary than the nurse can

provide: Respiratory, Dietary, Physical Therapy, etc.

Who, then, assesses the need for and coordinates these care issues? The provider may or may not have prescribed collaborative care but it often falls upon the nurse to further assess and suggest the inclusion of interdisciplinary care.Effective interdisciplinary teams require collaboration, which is often led by the nurse, who needs to avoid an authoritarian approach. If team members work in an authoritarian environment, they may be hesitant to make decisions for themselves and may fully depend upon the authoritarian leader. Creativity will be dampened, and creativity is mandatory for team progress.

Categories of Collaborative Care

Collaborative care falls into several categories:

• Nurse to Patient Collaboration. Nurses coordinate with patients the many issues surrounding health

promotion and disease prevention, treatment methods, lifestyle changes, and end-of-life decisions. Even Florence Nightingale taught collaboration with the patient, assessing what is needed or wanted.

• Nurse-Nurse Collaboration (Intraprofessional). Nurses work in teams in hospitals, in clinics, and in

communities that provide collaboration and support in patient caregiving. Nurses from various units, fields, and with different experiences also collaborate: nurse managers, nurse researchers, nurse educators, advanced practice nurses, as well as novice nurses with expert nurses! Mentoring is one example of this collaboration.Shift "hand-offs" are also exemplars.

• Interprofessional Collaboration. This is the category that often comes to mind when thinking about

collaborative care. Nurses form partnership between a team of health providers from medicine, pharmacy, occupational therapy, physical therapy, dentistry, social work, education, and even law. The ANA code of ethics and QSEN both address interprofessional collaboration as an important part of nursing care.

• Interorganizational collaboration. Nurses must be aware of and utilize resources and information between

organizations which will benefit patients at the local, national, or global levels. Examples of this are Hospice Care at the local level, and Health Care Consortiums at the national level.

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Nurses Are at the Forefront of this Collaboration

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So why are nurses at the forefront of this care system? What makes them uniquely qualified to address this important piece of patient care?

The nurse typically knows the patient's needs best, having assessed them at the beginning of their relationship. They have a holistic understanding of the patient and his health care wishes. Having access to post-discharge resources, nurses often coordinate suggested plans of care. Nurses own the attributes of professionalism, ethical behavior, and communication skills necessary to accomplish all the goals. They also should have an understanding of, and access to, the resources needed to formulate a partnership between patient, nurse, and the member of the incoming team. Consider

the following case:

You have worked on the medical surgical floor for ten months and have noticed the same patient returning many times with the same problem: uncontrolled diabetes. You don't feel as though the client understands the nature of, or the treatment for, the condition. You share this observation with your nurse-manager who requests that "someone" assemble a team to look closer at this problem. You have volunteered to be a member of the team. Who will you invite? A pharmacist? A diabetic educator? A nutritionist? Why were these people selected for your team?

Now think about the information these people will report back to you. What will you do with this information? (Hint: remember the Nursing Process!) Develop a plan of care with your patient, of course! You, the nurse, are uniquely qualified to disseminate this information into a working care plan for your patient to achieve optimal health. This means you must understand the various roles and backgrounds of each discipline with which you work. At the same time, you may be leading teams of different disciplines of nursing. Here again, it is critical to understand everyone's role and job description.In addition, the collaboration needed in interdisciplinary teams cannot be created without mutual trust and respect among the members. We each have a job to do. Nurses need to remember this when assembling interdisciplinary care teams; no one job is more important than another when we are all working together for patient care!

Effective teams participate in effective problem solving, increased creativity, and safe and improved health care (Yoder- Wise, 2011). In effective teams, members are required to work together in a respectful, civil manner. They must all be committed to providing input that generates in a positive outcome for the patient. In later modules, we will explore what happens when teams do not work well together, but for now, realize the nurse's potential in bringing about all of the key players needed to address the needs of the patient.

Modul e 08 - Comm unicat ion

Listening

It has been said that Listening is the greatest tool to good Communicating. What does that mean to you as a nurse? Well, to be a good listener, a nurse needs to show attentiveness through eye contact and body language. Active listening means postponing judgment about what is being said and listening to all that is said (and not just the first or last words). It is motivated by a genuine desire to learn about the other person. These skills give the speaker some feedback-non-verbal communication - to indicate that what is being said is understood.

Verbal and Nonverbal Skills

Verbal and nonverbal skills are mandatory personal communication strategies; the ability to assess these messages is also critical (Yoder-Wise, 2011). Many of the messages we communicate to others are nonverbal, and when nonverbal and verbal messages are in conflict, the nonverbal message is regarded as the most powerful.

Professional nurses are constantly required to communicate patient information to other members of the nursing team.The SBAR (Situation, Background, Assessment, and Recommendation) system was developed by professionals to enhance direct, respectful communication skills among professionals with the aim of quality patient care.

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Barriers to Communication

Although this may sound easy, there are several potential barriers to this communication. These barriers may be physical (too much ambient noise in the area), psychological (anxiety on the part of any of the participants), or semantic (misunderstandings based upon language and words). Nurses need to know how to discriminate between them in order to find the blockage.

Unfortunately, there seems to be an increasing amount of hostility and conflict experienced by nurses in the workplace.Why do these conflicts occur? Health care brings people of different ages, gender, income levels, ethnic groups, educational levels, lifestyles, and professions together for the purpose of caring for the patient. Sometimes, conflicts are task related. Others are primarily related to personal and social issues; these are relationship conflicts and may be more difficult to assess and solve. Disagreements over professional "territory" can occur in any setting (Whitehead, Weiss & Tappen, 2010), but often occur in the hospital. Communication strategies, practiced by nurses everywhere, but particularly in the mental health setting, can be very beneficial. Effective teams share a vision of commitment to the same goals; communicating that vision may be formal (decrease catheter-associated infection rates) or assumed (patient safety).

Dealing with Breakdowns in Communication

Nurses must recognize any breakdown in the communication process and immediately deal with it. Conflicts are often based on attempts to protect a person's self-esteem or to perceived inequities in power. For example, when a nurse manager discovers conflict between two floor nurses with whom he or she is working, the following may help:

• Assess and identify the triggers of the event or incident.

• Discover the history and the context for each person.

• Assess how much or how little they rely on working with each other.

• Identify the issues, goals, and resources involved in the situation.

• Uncover any previously considered solutions that may or may not have worked.

This may seem time consuming, but assessing the level of working relationship between the conflicted parties is essential, particularly if they work together on a regular basis (Yoder-Wise, 2011). And nurses need to realize that some differences in ideas, perceptions, and approaches are quite normal, and often can lead to creative solutions and deepened human relationships.

Individuals develop their communication styles over the course of their lives in response to many experiences and factors (Catalano, 2013). There are two predominant styles of communication: assertive and nonassertive.

Assertive versus Nonassertive Communication

Assertive communication is honest and direct. It accurately expresses the person's feelings, beliefs, ideas, and opinions. Assertiveness does not mean that a person will always get his way in every situation, and it is likely the individual will handle some situations better than others. A win-win goal is achieved when both parties have the ability and willingness to negotiate. Any nurse-leader can learn to use an assertive communication style.

Nonassertive behaviors fall into two categories: submissive and aggressive. Whereas assertive communication permits individuals to honestly express their ideas and opinions while respecting the opinions of others, aggressive communication strongly asserts the person's legitimate rights and ideas with little regard or respect for the rights and opinions of others.