Collaboration and Teamwork

What is collaborative health care?

Client-centered approach where members of different health care professions work toward improving or restoring a client’s health

What does collaborative health care involve?

Communication, leadership, and shared decision making

What are benefits of interprofessional teams?

Improved access/coordination of services, greater efficiency, increased quality, decreased complications, LOS, sentinel events, mortality, and staff turnover

What occurs during interprofessional care rounds?

Each team member provides an assessment of client progress and contributes to developing/revising the plan of care

Who provides spiritual care?

Chaplains, pastors, rabbis, priests

When to include spiritual support staff?

Patient requests communion, spiritual support or prayer, end-of-life support; also available to support the team

What does the registered dietitian do?

Assess, plan for, and educate regarding nutritional needs; design diets; calculate caloric/nutrient needs; supervise meal preparation

When to involve a registered dietitian?

Low prealbumin, weight loss, poor appetite, inadequate protein intake, non-healing wound, requires enteral nutrition, newly diagnosed diabetes/HF/HTN/kidney disease

What does the lab tech/phlebotomist do?

Obtain specimens, perform diagnostic tests, process/analyze samples, operate lab equipment, sterilize equipment

When to involve the lab tech/phlebotomist?

Need to process a lab specimen; difficulty with venipuncture

What does the pharmacist do?

Provide and monitor medications; promote medication safety such as interactions and therapeutic levels

When to involve the pharmacist?

Questions about med interactions, difficulty swallowing pills (needs liquid), check IV compatibility, confirm dosing

What does the OT do?

Assess/plan for regaining ADLs, especially upper extremity motor skills; promote independence/productivity

When to involve the OT?

Difficulty using eating utensil after stroke; OA/RA patient having trouble dressing/bathing

What does the PT do?

Assess/plan to increase musculoskeletal function and maintain mobility; works especially on lower extremities

When to involve the PT?

Knee replacement assistance, learning to ambulate after LE amputation, balance or stamina issue

Who is considered a provider?

MD, DO, APRN, PA

What do providers do?

Assess, diagnose, treat, monitor disease and injury

What does the radiology technologist do?

Position patients for x-rays/imaging tests; images are reviewed/interpreted by providers

When to involve radiology tech?

Hip pain after fall (x-ray), difficulty breathing (bedside CXR), stroke symptoms needing urgent CT

What does the respiratory therapist do?

Evaluate respiratory status; provide treatments (CPT, inhalers, mechanical ventilation, nebulizers); may intubate

When to involve RT?

Asthma with SOB needing neb; patient requires intubation during code blue

What does the social worker do?

Coordinate inpatient/outpatient/community resources; evaluate support system, circumstances, strengths, risks

When to involve social work?

Family needs help obtaining SNAP; patient is homeless and needs safe discharge plan

What does the SLP do?

Evaluate and make recommendations for speech, language, swallowing disorders; teach techniques/exercises; perform swallow evals

When to involve SLP?

Cognitive impairment with difficulty swallowing thin liquids; toddler not meeting speech/language milestones

What degree and advanced education does an APRN have?

Master’s degree in nursing; advanced education in pharmacology, pathophysiology, and physical assessment

What is required for APRN practice?

Certified in specialty area of practice

What are the four APRN roles?

CNS, NP, CRNA, CNM

What does a Clinical Nurse Specialist (CNS) do?

Specialize in a practice setting or population; focus on patient care, nurses, and system-level care

What does a Nurse Practitioner (NP) do?

Assess, diagnose, treat acute/chronic illnesses; focus on health promotion and maintenance; collaborative agreement with physician (state dependent)

What does a Certified Registered Nurse Anesthetist (CRNA) do?

Administer anesthesia and provide care during operative procedures; collaborative agreement with anesthesiologist

What does a Certified Nurse Midwife (CNM) do?

Deliver care to maternal/newborn patients and families in collaboration with physician

What does a case manager/discharge coordinator do?

RN who coordinates patient care from admission to beyond discharge; works closely with social work

When to include a case manager?

Patient needs placement in a rehab facility after a total hip replacement

What does a nurse educator do?

Teaches in nursing schools, staff development, and client education programs

What does a nurse administrator do?

Provide leadership to nursing departments, units, facilities, systems

What is a consultation?

When one provider formally requests another provider’s input or advice about how to approach or treat a condition

What is a referral?

When a client is referred or requests a referral—provider is delegating responsibility for management of a specific condition to another provider

What is transfer of care?

Systematically turning care over to another provider

What is the nurse’s role in consultations/referrals?

Nurse’s input/actions reduce gaps in care and avoid delayed diagnoses and treatment

What is discharge planning?

Coordinated detailed planning for a client’s discharge or change in level of care that prevents gaps or oversights

What are the benefits of effective discharge planning?

Improve self-management, decrease LOS, avoid readmission, decrease costs, increase reimbursement

When does discharge planning begin?

On admission to a health care facility

Example of early discharge planning actions (post-op day 1)?

Provider anticipates discharge date; PT/OT evaluates; case manager evaluates home needs; RN begins self-care teaching

Barrier: Hierarchy of professions example?

Providers historically made all decisions with little input

Barrier: Lack of knowledge of roles example?

NPs can write prescriptions, other nurses cannot; PT vs OT differences

Barrier: Communication example?

Negative tone or nonconstructive feedback

Barrier: Lack of trust example?

Refusing help due to not trusting team members' abilities

Barrier: Lack of cultural competency example?

Team member upset that patient refuses care due to religious beliefs

Barrier: Inability to resolve conflicts example?

Harboring resentment, avoiding another individual

Barrier: Structural factors example?

Unable to attend rounds because providing care elsewhere

What does ANA’s Code of Ethics say about incivility and bullying?

They hinder optimal care and client safety

What is incivility?

Gossiping, spreading rumors, rudeness, refusing to help a coworker

What is bullying?

Recurring unwelcome behavior intended to harm, humiliate, or distress

What is lateral violence?

Peer-to-peer incivility

What is vertical violence?

Incivility between supervisor and subordinate

Examples of uncivil behaviors?

Embarrassing others, rudeness, gossiping, eye-rolling, inappropriate tone, avoiding report, sarcasm, raised voice, exclusion from decisions, calling someone incompetent, refusing to help

Impacts of incivility?

Insecurity, anxiety, stress, distress, depression, self-doubt, medical errors, staff turnover, decreased quality of care, poor outcomes

Prevention strategies?

Zero-tolerance policy, onboarding education, accountability culture, action on report

What is conflict management?

Settling disagreements peacefully/respectfully through compromise, accommodation, shared goals, avoiding competition

What are strategies to promote collaboration?

Zero tolerance to incivility, conflict management, cognitive rehearsal, emotional intelligence

Best action for an inexperienced nurse witnessing incivility affecting care?

D. Report the situation to the nurse manager, noting potential impact on patient care

What is interpersonal communication?

Person-to-person communication skills within personal and professional relationships

Why are interpersonal communication skills important?

Enable effective communication with clients/families/coworkers/providers; reduce errors; improve outcomes; increase satisfaction