Nursing Collaboration, Communication, and Advocacy

Collaboration, Communication and Advocacy

Objectives

• Collaboration and Advocacy:
    - Discuss professional behaviors consistent with nursing practices.
    - Explain the significance of accountability and responsibility in nursing roles.
    - Explore the nurse’s role in advocacy.
    - Illustrate the purpose of interprofessional collaboration.
    - Identify methods of communication used within the interprofessional team to promote optimal client outcomes.
    - Discuss strategies to enhance interprofessional collaboration.
    - Describe barriers to interprofessional collaboration.

Methods of Communication

• Closed Loop Communication:
    - Utilizes standardized terminology and procedures to ensure that messages are received, clarified, and correctly interpreted between the sender and receiver.

• I-SBAR-R:
    - A standardized communication tool structured by the acronym ISBAR-R, which stands for:
      - Introductions: State your name and client care role; ask the receiver for their name and role.
      - Situation: Describe what is currently happening to the client that needs addressing.
      - Background: Provide relevant clinical background information.
      - Assessment: Offer a brief evaluation of the current situation.
      - Recommendation: Suggest care options.
      - Read back/Repeat: Summarize the information, allowing time for questions and repeating or reviewing as necessary.

Handoff Report

• Bedside Report:
    - Enables verification of the client’s condition by seeing it firsthand.
    - Facilitates addressing or questioning of issues directly.
    - Allows client participation in their own care.
    - Enhances communication among teams.
    - Prioritizes patient care effectively.

Receiving and Transcribing Orders

• Medication Reconciliation/Verification:
    - Ensure all medications are accurately listed and available with the right doses.

• Transcribing Prescriptions:
    - Upon receiving a provider’s prescription, verify or read back the order and then document it correctly in the client’s Health Electronic Record (HER).
    - Always use the 7 rights when documenting orders.
    - Note that verbal orders carry a higher risk of medication errors.

Errors in Nursing Practice

• Types of Errors:
    - Commission: Error occurs when the nurse performs the wrong action or makes a mistake.
      - Example: Performing a procedure on a patient with a documented latex allergy.
      - Example: Administering medication to the wrong patient.
    - Omission: Errors due to actions that are not taken or important steps that are missed.
      - Example: Failing to lock the wheels of a bed during client transfer.
      - Example: Not turning a bedridden patient every 2 hours, leading to the development of a pressure ulcer.

Collaboration in Nursing

• Definition:
    - Collaboration involves the cooperation among healthcare professionals from various disciplines who utilize their diverse knowledge, skills, and attitudes to provide optimal care for the client.
    - Disciplines involved can include doctors, nurses, physical therapists, speech therapists, and chaplaincy, among others.

• Promoting Collaboration:
    - Methods include simulation training, clinical practices, and mock codes.

• Core Competencies:
    - Values/Ethics:
      - Emphasizes mutual respect, shared values, and shared decision-making among team members.
    - Roles & Responsibilities:
      - Recognize and respect the scope of practice across various professions to meet client needs.
    - Interprofessional Communication:
      - Effective communication among clients and professionals from all disciplines involved in client care.
    - Teams and Teamwork:
      - Utilize relationship-building principles to ensure effective, safe, timely, and client-centered care.

Barriers to Collaboration

• Complex Population:
    - Patients with multiple comorbidities necessitating involvement of various professionals, leading to potential barriers and care errors.
      - Example: A heart attack patient with diabetes, hypertension, hyperlipidemia, and a stroke history.

• Hierarchical Professional Structures:
    - Historical context where decisions were primarily made by providers, with little input from other team members.

• Lack of Knowledge:
    - Team members may not be aware of each other's roles, titles, and scopes of practice.
      - Example: Nurse Practitioners can prescribe medications but not all nurses can.

• Poor Communication:
    - Instances where team members respond negatively or provide non-constructive feedback to others.

Barriers to Communication

• Trust Issues:
    - Lack of trust in the competencies of other team members leads to refusal of assistance or suggestions.

• Cultural Competency Deficiencies:
    - Frustration among healthcare teams when patients refuse treatments due to religious beliefs.

• Conflict Resolution Challenges:
    - Team members may harbor resentment, leading to avoidance of others or conflict.

• Structural Constraints:
    - Time limitations that prevent participation in interdisciplinary rounds or meetings.

Incivility, Lateral Violence, and Bullying

• Definition:
    - Incivility: Negative workplace behaviors that harm or humiliate others.
    - Lateral Violence: Refers to peer-to-peer negative behavior.
    - Vertical Violence: Involves negative behavior from supervisors to employees or vice versa.
    - Bullying: Recurring harmful behavior aimed at distressing others, which can escalate from incivility.

• Zero Tolerance Policy:
    - Many organizations adopt this policy to completely prohibit incivility, bullying, harassment, and intimidation.

Conflict Management and Negotiation

• Conflict Management:
    - A respectful method to resolve disagreements through compromise, accommodation, and a focus on shared goals.

• Cognitive Rehearsal:
    - A technique often involving simulation that helps individuals envision and manage anxiety-inducing situations.

Handling Conflict Strategies

• Accommodation:
    - Maintains peace by smoothing over differences.

• Collaboration:
    - Encourages creativity and new ideas by evaluating all perspectives objectively.

• Compromise:
    - Offers a temporary solution, addressing relationship preservation.

• Avoidance and Competition:
    - Short-term strategies; avoidance is useful in tense situations, while competition applies when multiple decision-makers exist.

Definition of Nursing

• Overview:
    - Nursing combines the art and science of caring, focusing on health protection, promotion, and optimization; illness and injury prevention; healing facilitation; and alleviation of suffering through compassion.
    - It represents the diagnosis and treatment of human responses, advocating for individuals and communities in recognition of our shared humanity.
    - Reference: ANA, 2021, "Nursing: Scope and Standards of Practice, Fourth Edition, p. 1."

Accountability and Responsibility in Nursing

• Accountability:
    - Defined as the acceptance of responsibility for ethical conduct and honesty in nursing practices.

• Principles of Accountability:
    - Reflection and Deliberation: Continuous self-reflection on nursing conduct.
    - Transparency: Openness in nursing practices and decisions.
    - Participation: Engaging in collaborative decision-making.
    - Response: Responsiveness to the needs of clients and team members.
    - Integrity: Upholding honesty and strong moral principles in practice.

Nursing Advocacy

• Definition:
    - Advocacy includes any actions that support, recommend, argue for, or defend a cause on behalf of others.

• Benefits of Nursing Advocacy:
    - Improves public health.
    - Enhances collaboration among healthcare professionals, patients, and their families.
    - Elevates care quality.
    - Increases safety for vulnerable patients.
    - Empowers patients by enhancing their control over health decisions.
    - Supports improved access to healthcare.

Nursing Advocacy at the Patient Level

• Actions:
    - Conduct error reviews and scrutinize healthcare information.
    - Connect patients to necessary resources.
    - Facilitate patient care conferences.
    - Ensure interdisciplinary teams are aligned.
    - Request ethics consultations for concerns.
    - Empower patients through voice and presence during consultations.
    - Provide patient education on health management.
    - Protect the rights of patients, including adherence to HIPAA regulations.

ANA Code of Ethics Provisions

• Provision 1:
    - Nurses must practice compassion and respect for the dignity, worth, and unique attributes of every individual.

• Provision 2:
    - The primary commitment of nurses is to the patient, irrespective of the patient's demographics.

• Provision 3:
    - Nurses are responsible for promoting, advocating for, and safeguarding the rights, health, and safety of patients.

• Provision 4:
    - Nurses bear authority, accountability, and responsibility for their practice and must act in ways that provide optimal patient care.

• Provision 5:
    - Nurses owe the same duties to themselves as to others, promoting health and safety, and maintaining personal integrity and competence.

• Provision 6:
    - Nurses have a collective responsibility to enhance the ethical environment and safe quality conditions within their workplaces.

• Provision 7:
    - Nurses are encouraged to advance the profession through research, standards development, and policy advocacy.

• Provision 8:
    - Importance of interprofessional collaboration to advocate for human rights and reduce health disparities.

• Provision 9:
    - Collective efforts of the profession to articulate nursing values and integrate principles of social justice into health policies.

• Provision 10:
    - Participation in global nursing and health communities to promote well-being and public health.

Resources

• ATI: https://codeofethics.ana.org/provisions

• HPU Blog on Nursing Advocacy: https://online.hpu.edu/blog/nursing-advocacy