Although building an interprofessional team seems practical, it requires a commitment and collabora- tion among members of all the disciplines (O’Daniel
& Rosenstein, 2008). The IOM (2010), the National League for Nursing (NLN) (2012), the American Association of Colleges of Nursing (AACN) (2011), and the American Organization of Nurse Executives (AONE) (2012) issued state- ments supporting collaboration among all members of the health-care team with the purpose of provid- ing safe, effective care and achieving positive patient outcomes. Research demonstrates that patient care provided by integrated teams composed of health- care professionals who understand each other’s functions and goals results in better clinical out- comes and greater patient satisfaction (Hale, 2011).
As simple as this concept seems, it takes an inte- grated and dedicated approach to form a collabora- tive interprofessional team.
Interprofessional Collaboration
The World Health Organization (WHO) (2010) defines interprofessional collaboration as occurring when “multiple health workers from different pro- fessional backgrounds work together with patients, families, caregivers, and communities to deliver the highest quality care.” Collaboration differs from cooperation. Cooperation means working with someone in the sense of enabling: making them more able to do something (typically by providing information or resources they wouldn’t otherwise have). Collaborating (from Latin laborare, to work) requires working alongside someone to achieve something (Martin, Ummenhofer, Manser, &
Spirig, 2010).
The fundamental difference between collabora- tion and cooperation is the level of formality in the relationships between agencies and/or stake- holders. For many years members of other health- care disciplines cooperated with each other. Nurses and physicians cooperated with each other in patient care delivery. However, inequalities existed between the disciplines regarding shared expertise and power (Robert Woods Johnson Foundation, 2013).
A true collaborative effort comprises the follow- ing key components: sharing, partnership, interde- pendency, and power (O’Brien, 2013). Collaboration
assumes that members share responsibility, values, and resources. To engage in partnership, members need to be honest and open with each other, dem- onstrate mutual trust and respect, and value each other’s contributions and perspectives. Members of an interprofessional team are dependent on each other and work with each other to achieve a common goal. Finally, power is shared among the members. The health professionals recognize their own individual scope of practice and skill set, while demonstrating an appreciation for the other members’ capabilities and contributions. They also share in the accountability for the delivery of patient care. This shared effort among health-care professionals helps to coordinate care and promote patient safety.
Interprofessional Communication
Breakdowns in verbal and written communication among health-care providers present a major concern in the health-care delivery system. The Joint Commission (www.tjc.org) attributes a high percentage of sentinel events to poor communica- tion among health-care providers (2009, 2013).
Communication is considered to be a core compe- tency to promote interprofessional collaborative practice. Using a common language among the pro- fessions assists in understanding and overcoming barriers to interprofessional communication.
The SBAR method was discussed earlier in the chapter. A team-related method of communication, Team STEPPS, developed by the Department of Defense (DoD) and the Agency for Healthcare Research and Quality (AHRQ), is another method.
The purpose of this teamwork system is to improve collaboration and communication related to patient safety (AHRQ, 2013). This method includes four skills: leadership, situation monitoring, mutual support, and communication. The program goals focus on (a) creating highly effective medical teams that optimize the use of information, people, and resources to achieve the best clinical outcomes for patients; (b) increasing team awareness and clarify- ing team roles and responsibilities; (c) resolving conflicts and improving information sharing; and (d) eliminating barriers to quality and safety. The program is composed of training modules available to health-care institutions.
With the goal of collaboration among health- care professionals, to promote continuity of care and facilitate communication, many health-care
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institutions have created a position known as the
“nurse navigator.” The function of the navigator is to coordinate patient care by guiding pati ents through the diagnostic process, educating and sup- porting them, integrating care with other members of the interprofessional team, and assisting them in making informed decisions (Brown, Cantril, McMullen, Barkly, Dietz, Murphy, & Fabrey, 2012).
Nurses remain an integral part of the interpro- fessional health-care team. Nurses usually have the most contact with the patients and their families.
They often find themselves in the particularly advantageous position to observe the patient’s responses to treatments and report these back to the interprofessional team. For example:
Mr. Richards, a 68-year-old man, was in a motor vehicle accident and sustained a traumatic brain injury. He had right-sided weakness and dysphagia.
The health-care provider requested evaluations and treatment plans from speech pathology, physical therapy, and social services. The speech pathologist conducted a swallow study and determined that Mr.
Richards should receive pureed foods for the next 2 days. The RN assigned an LPN to feed Mr. Rich- ards a pureed lunch. The LPN reported that although Mr. Richards had done well the previous day, he had difficulty swallowing even pureed foods today.
The RN immediately notified the speech patholo- gist, and a new treatment plan was developed.
Building an Interprofessional Team
Effective interprofessional teams include several characteristics and focus on the needs of the patient or client, not the individual contributions of the team members. Each member understands the characteristics of collaboration and demonstrates a willingness to share, recognize the others’ expertise, and participate in open communication. Members of a team share information through verbal and written communication in an interprofessional team conference. The characteristics of an effec- tive interprofessional health-care team are listed in Box 6-5.
Interprofessional teams communicate by engag- ing in conferences. The conference begins with the presenter stating the patient’s name, age, and diag- noses. Each team member then explains the goal of his or her discipline, the interventions, and the intended outcome. Effectiveness of treatment, development of new interventions, and the setting
of new goals are discussed. All members contribute and participate, demonstrating mutual respect and valuing the expertise of the others. A method to oversee the implementation of the plan is devised in order to assess outcomes, and make adjustments as needed. The nurse (or nurse navigator) is often the individual who assumes the responsibility for this oversight. The key to a successful interprofes- sional conference is presenting information in a clear, concise manner and ensuring input from all disciplines and levels of care providers, from nursing assistive personnel (NAP) to health-care providers.
Conclusion
The responsibility for delivering and coordinating patient care is an important part of the role of the professional nurse. To accomplish this, nurses need good communication skills. Being assertive without being aggressive and interacting with others in a professional manner enhance the relationships that nurses develop with colleagues, health-care provid- ers, and other members of the interprofessional team.
A major focus of the national safety goals is improved communication among health-care pro- fessionals and the development of interprofes- sional health-care teams. In an effort to improve patient safety, health-care institutions have imple- mented communication protocols referred to as the SBAR method or Team STEPPS. SBAR sets a specific procedure that reminds nurses how to relay information quickly and effectively to the patient’s health-care provider, which ultimately leads to improved patient outcomes. Team STEPPS, developed by the DoD, assists health-care institu-
1. Members provide care to a common group of patients/clients.
2. Members develop common goals for patient/client outcomes and work together to achieve the goals.
3. Members have roles and functions and understand their roles and the roles of others.
4. The team develops a mechanism for sharing information.
5. The team creates a system to supervise the
implementation of plans, evaluate outcomes, and make adjustments based on the results.
box 6-5
Characteristics of Effective
Interprofessional Health-care Teams
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tions in promoting patient safety through com- munication and coordination of patient care.
Collaboration and teamwork encourage inter- professional collegial relationships that promote safe quality patient care. Key nursing organizations, the IOM, QSEN, and MAGNET criteria address the need for collaboration and teamwork. Nurses act as the key players in ensuring interprofessional communication and collaboration in patient care delivery.
Finally, health-care institutions need to be com- mitted to creating an environment that promotes communication and team collaboration. This needs to come from the top down and the bottom up to create an organizational culture that promotes patient safety. Nurses are in a unique position to act as change agents within their organizations by practicing safe, effective patient care, promoting collegial communications, and committing them- selves to interprofessional collaboration.
Study Questions
1. This is your first position as an RN, and you are working with an LPN who has been on the unit for 20 years. On your first day she says to you, “The only difference between you and me is the size of the paycheck.” Demonstrate how you would respond to this statement, using assertive communication techniques.
2. A health-care provider orders “Potassium Chloride 20 milliequivalents IV over 20 minutes.”
You realize that this is a dangerous order. How would you approach the health-care provider?
3. A patient is admitted to the same-day surgical center for a breast biopsy. Her significant other, who has just had an altercation with an admissions secretary about their insurance, accompanies her. The patient is met by a nurse navigator who notes that the mammogram and blood work are not in the electronic medical record. The patient’s significant other says, “What is wrong with you people? Can’t you ever get anything straight? If you can’t get the insurance right, and you can’t get the diagnostic tests right, how can we expect you to get the surgery right?” How should the nurse navigator assist the patient and her significant other?
4. Your nurse manager asks you to develop an interprofessional team on the unit. This team is to serve as a model for other nursing units. How would you start the process? What qualities would you look for in the team members?
Case Study to Promote Critical Reasoning
Corel Jones is a new nursing assistive personnel (NAP) who has been assigned to your acute rehabilitation unit. Corel is a hard worker; he comes in early and often stays late to finish his work. However, Corel is gruff with the patients, especially with the male patients. If a patient is reluctant to get out of bed, Corel often challenges him, saying, “Hey, let’s go. Don’t be such a wimp. Move your big butt.” Today, you overheard Corel telling a female patient who said she did not feel well, “You’re just a phony. You like being waited on, but that’s not why you’re here.” The woman started to cry.
1. You are the newest staff nurse on this unit. How would you handle this situation? What would happen if you ignored it?
2. If you decided to pursue the issue, with whom should you speak? What would you say?
3. What do you think is the reason Corel speaks to patients this way?
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chapter 7
Delegation and Prioritization of Client Care
OBJECTIVES
After reading this chapter, the student should be able to:
■ Define the term delegation.
■ Define the term prioritization.
■ Differentiate between delegation and prioritization.
■ Define the term nursing assistive personnel.
■ Discuss the legal implications of making assignments to other health-care personnel.
■ Discuss barriers to successful delegation.
■ Make appropriate assignments to team members.
■ Apply priority setting guidelines to patient care.
OUTLINE