6- Interprofessional Relationships

Definition of Interprofessional Relationships/Collaboration

• Refers to the cooperative effort and effective communication among healthcare professionals from different disciplines to optimize patient outcomes.

• An essential communication skill is the ability to adapt your own communication style to meet the needs of team members and to mindfully and continually scan changing situations.

What is necessary to function in nursing?

Proficient communication skills

Importance of Interprofessional Communication in Health Care

• Effective communication is the bedrock principle of quality care.

• Effective communication prevents errors of all magnitudes.

• Enhances patient safety and quality of care

• Improves Healthcare outcomes and Patient Satisfaction

• Facilitates comprehensive and holistic patient assessments

• Promotes efficient resource utilization

• Fosters interdisciplinary learning and professional growth

Standard for Healthy Work Environment

• shared mental model

• open communication

• collegiality

Shared mental model

Each team member needs to ‘buy in’ to the collaborative team concept

Open Communication

The ability for individuals to freely convey their thoughts and ideas to each other

Collegiality

The sharing of knowledge and responsibility amongst colleagues.

Elements of a Healthy Workplace Environment

• Must be as efficient in communication skills as they are in clinical skills.

• Nurses must be relentless in pursuing and fostering true collaboration.

• Nurses must be valued and committed partners in policy making, directing and evaluating clinical care, and leading organizational operations.

• Staffing must ensure the effective match between nurse competencies and the needs of people they care for.

• Nurses must be recognized and recognize others for the value they bring to the work of the organization.

• Nurse leaders must fully embrace the imperative of a healthy work environment, authentically livid and engage others in its achievement.

Teamwork and Communication

• Teamwork is both a role-focused process and a task-based process

• Team members have unique personalities, egos, and skill sets

• Playing to each team member's strength enhances the ability to provide safe, quality care

• Effective teamwork requires each member to have the requisite knowledge, skills and attitudes (collective efficacy, shared vision, team cohesion, mutual trust, and shared orientation)

Barriers to Effective Team Communication

• hierarchical structures,

• variations in communication styles,

• lack of time and competing schedules,

• defensiveness and conflict

Ineffective communication often

• leads to disagreements,

• injured feelings

• unsafe care.

• poor communication is one of the underlying causes of conflict.

Disruptive behaviour is defined as

a lack of civility or lack of respect that occurs in professional relationships.

Bad behaviours may include what?

rudeness, verbal abuse, intimidation, blaming or criticizing team members in front of others, and even physical confrontations.

Disruptive Behaviours in the Hospital

• Fairly common in hospital settings.

• 1/2 to 3/4 of nurses’ report being subjected to disruptivebehaviour at some time.

• Researchers have found more nurse-nurse disruptive behaviours than nurse-physician disruptive behaviours.

• Occur more often in high-stress areas such as operating rooms, emergency departments and psychiatric departments.

Outcomes of Disruptive Behaviour for patients

• Barrier to effective healthcare

• Serious medical errors

• Decreased Patient
  Satisfaction

• Increased levels of readmission to the hospital

Outcomes of Disruptive Behaviour for nurses

• Job stress and abandonment

• Lost productivity and task avoidance

• Poor morale and loss of confidence

• Adversely affect nurses' physical and mental health

Outcomes of Disruptive Behaviour for organizations

• Financial issues related to
  absenteeism

• Increased staff turnover

• Losses in productivity

• Increases in care errors and legal action

Psychological Safety refers to what?

an environment where individuals feel safe to express themselves, to take risks, and share ideas without fear of negative consequences

Benefits of Psychological Safety

• Enhanced Teamwork and Collaboration

• Increased job satisfaction andengagement

• Improved communication andinformation sharing

• Promotes learning and innovation

• Reduces stress and burnout

Factors Affecting Psychological Safety

• Trust: Building trust among team members and leaders.

• Respect: Treating others with dignity and valuing diverse perspectives.

• Open Communication: Encouraging open dialogue and active listening.

• Non-Punitive Environment: Fostering an atmosphere where mistakes are opportunities for learning, not punishment.

• Supportive Leadership: Leaders who model and promote psychological safety.

Signs of Psychologically Safe Workplace

• Open and inclusive communication

• Willingness to ask questions and seek clarification

• Acceptance of diverse opinions and feedback

• Constructive conflict resolution

• Support for professional growth and development

Strategies to Promote Psychological Safety

1. Encourage participation: Create opportunities for everyone to contribute and share their ideas.

2. Active listening: Practice attentive listening and validate others' perspectives.

3. Foster collaboration: Promote teamwork and emphasize the value of collective effort

4. Provide constructive feedback: Offer feedback in a supportive manner to help individuals improve without feeling criticized.

5. Address and learn from mistakes: Encourage a learning culture where mistakes are seen as opportunities for growth and improvement.

Factors that Affect Nurse’s Behaviour towards other Team Members

• Gender: redefining traditional gender stereotypical behaviours

• Hierarchy: Differences in power, perspective, education, status and pay may be barriers to workplace communication

• Communication Silos: each healthcare profession was educated separately, evolving their own unique vocabulary

• Generational Diversity: members of older and younger generations differ in their preferred communication styles

Conflict resolution can be

• A positive force for change.

• Instead of picturing a straight line of either "you win" or "I win" envision the outcome as a triangle, with the outcome of mutual resolution as the peak, where you have both built something greater together.

Steps for conflict resolution

1. Identify sources of conflict

2. Set goals

3. Implement solutions

Conflict Management Communication Techniques

• Reframe

• Assume responsibility

• Identify your goal

• Obtain factual data

• Intervene early

• Avoid negative comments affecting self- esteem

• Consider the other’s viewpoint

• Ex: DESC script

DESC script

Used for interprofessional conflict that happens

D- Describe the behaviour

E- Express concerns about the action

S- Specific causes of action and suggest alternatives

C- Consensus: agree on plan

Change ineffective communication to Effective interprofessional communication

Communication in silos → Common language with focus on person problems

Communications based on status → Open team-centred communication

Disruptive communication → Mutual goals (develops shared mission and values)

Dominate, order → Role clarity, collaborative model (mutually respects expertise, teamwork, leadership)

Team STEPPS

Team

Strategies and

Tools to

Enhance

Performance and

Patient

Safety

Ex: SBAR, teach back methods

SBAR

Situation

Background

Assessment

Recommendation

Strategies to remove barriers to interprofessional communication

Individual Strategies to Deal with Workplace Conflict: Attitudes such as respect, valuing others, willingness to collaborate, open communication

Model Behaviours that Convey Respect: You have an ethical responsibility to treat co- workers with respect

Mentor New Nurses: Nurses need effective mentoring, support, orientation and teamwork to feel accepted as a colleague

Clarify Communication: If miscommunication occurs, seek clarity by owning your own part in the misunderstanding. Use formats such as SBAR to communicate

Clarify Roles: Along with understanding and describing own role, have an understanding of other roles in the healthcare team

Other Conflict Resolution Strategies

• Self- Reflection

• Take Stress-Reduction Measures

• Commit to Collaborative Resolution Process

• Develop Process to responding to put- downs

• Use Standardized Communication Tools and Lists

• Criticize constructively

• Document and Report Disruptive Behaviours

• Develop a Support System

Responding to Put-Downs

• Once a put-down is recognized, you need to respond in an assertive manner, as soon as possible after the incident has taken place.

• At the same time if your anger is likely to dominate the response wait a few minutes for the anger to cool and then present the message in a reasoned manner.

You can respond to put-downs in the following way

• Address the objectionable or questionable disrespectful behaviour first.

• Briefly state the behaviours and its impact on you.

• Once the put-down has been dealt with, you can discuss any criticism of your own behaviour on its own merits

• Prepare a few standard responses. Examples might include: "I found your comments very disturbing and insulting", "I feel what you said as an attack. That wasn't called for by my actions."

How to give constructive criticism

1. Express caring

2. Describe the behaviour

3. State expectations

4. List the consequences

How to receive constructive criticism

1. Listen and paraphrase

2. Acknowledge that you are taking suggestions seriously

3. Share your story about the behaviour without being defensive

4. Develop a plan for the future

Organizational Strategies for Conflict Prevention and Resolution

• Organizational climate

• Promote opportunities for interdisciplinary communication

• Promote understanding of organizational system

• Promote clear policies