0133427269 Module37 Collaboration LectureOutline

Module 37 Collaboration The Concept of Collaboration Collaboration ( two or more people working toward a common goal by combining skills, knowledge, resources Avoids duplication of effort Goal improve client outcomes See Box 371, CHARACTERISTICS AND BELIEFS BASIC TO COLLABORATIVE HEALTH CARE, p. 2376 Nurse as collaborator Intrinsic to nursing Nurses and physicians work together and independently No group can claim total authority over the other Different areas of professional competence ( continuum of care See Table 371, COLLABORATIVE MEMBERS OF THE HEALTHCARE TEAM, p. 2376 Collaboration included in the ANA Nursing Scope and Standards of Practice See Box 372, THE NURSE AS A COLLABORATOR, p. 2377 Theories (Kim, Dalton) include collaboration with client, nurse, family caregiver Collaborative practice Overall objectives ( high-quality client care and client satisfaction Specific objectives Provide client-directed, client-centered care using a multidisciplinary, integrated and participative network Enhance continuity of care across the continuum of health, from wellness and prevention through acute illness to recovery or rehabilitation Improve client and family satisfaction with care Provide high-quality, cost-effective, research-based care that improves client outcomes Promote mutual respect, communication, understanding between clients and members of healthcare team Provide opportunities to address and solve system-related issues and problems Develop interdependent relationships among clients and providers Provides care with less redundancy, more efficiency, fewer omissions Care becomes client centered and client directed See CONCEPTS RELATED TO COLLABORATION, p. 2379 Competencies basic to collaboration Communication skills Healthcare team needs to clearly establish goals and objectives, specify roles Communication styles important Communicator style ( manner in which one communicates and the way in which one interacts Attentive style Make eye contact while communicating Refrain from other activities during communication Repeat back what is said Avoid contentious style Develop judgment to determine when it is best to ignore a comment that is not essential Recognize when it is necessary to stop conversation and ask for clarification Avoid dominant style Do not monopolize conversations Mutual respect and trust Mutual respect ( two or more people show and feel honor and esteem toward one another Trust ( occurs when person confident in actions of another Must be expressed both verbally and nonverbally Decision making Team must follow each step of decision-making process Requires full consideration and respect of diverse viewpoints Team focuses on clients priority needs Team should ensure that client part of this process Conflict management Conflict can be an impetus for better communication, stronger team relationships, and healthy change Case Study A ( Betty Bradley, 87 years old, is a client in a long-term care facility, p. 2381 Collaboration and the healthcare consumer Healthy People 2020 ( major public health concerns in the U.S. Number of factors influence provision of health care Focus of health care changing Consumers demand comprehensive, holistic, compassionate, affordable health care Todays healthcare consumers more knowledgeable about their health Healthcare consumers assuming more responsibility for health Collaboration becoming more important Failure to collaborate may result in serious consequences for client Review The Concept of Collaboration Relate Link the Concepts Refer Go to Nursing Student Resources Reflect Case Study Exemplar 37.1 Case Management Overview Case management ( range of models for integrating healthcare services for individuals or groups Case manager may be nurse, social worker, or other professional Critical pathway ( standardized plan that helps track care See Box 373, RESPONSIBILITIES OF CASE MANAGERS, p. 2382 Care management model focuses on needs of integrated delivery system Similar to case management Client focus is population based, not individual client based Goal is to integrate continuum of clinical services Case management may be used as cost-containment strategy in managed care Critical pathways often used to track client progress Standardized plan that helps track care provided to clients with similar, predictable medical conditions Also called critical paths, interdisciplinary plans, action plans Nurse as case manager Organizes client care by diagnosis-related groups (DRGs) With DRGs, nurses work toward client outcomes within specific time frames and resources Requirements for nursing case management Collaboration of all healthcare team members Identification of expected outcomes within specific time frames Use of principles of continuous quality improvement Promotion of professional practice Nursing case managers Coordinate and monitor care provided Client involvement key Caseload of 1015 clients in acute care Follows clients progress through system Essential elements for successful implementation of case management Support by key members of organization Qualified nurse case manager Collaborative practice teams Quality management system Established critical pathways Case Study B ( Martha Ellison is an RN with 10 years of experience and a masters degree in nursing, p. 2383 Critical pathways Also called care map Refers to the collaboratively developed expected outcomes and care strategies Provide direction for managing care of specific client during specified time period Quickly orients nurse to the outcomes that should be achieved for client for that day Variance ( altering time frames or interventions Case manager tracks all variances Features included on all critical paths Medical diagnosis Expected length of stay Client identification data Appropriate time frames for interventions Client outcomes A means to identify variances easily See Table 372, CRITICAL PATH WITH ACTUAL/RISK NURSING DIAGNOSES FOR TOTAL HIP REPLACEMENT, p. 2384 See Table 373, CLIENT/FAMILY EDUCATION PATH FOR TOTAL HIP REPLACEMENT, p. 2386 Review Case Management Relate Link the Concepts and Exemplars Refer Go to Nursing Student Resources Reflect Case Study Exemplar 37.2 Conflict Resolution Overview Conflict ( agreement cannot be reached with regard to significant issues and concerns or when emotional opposition creates discord within an individualized or individuals, groups or organizations Four levels Intrapersonal( incompatibility between one or more role expectations ( takes place within an individual Role conflict Interpersonal ( between two or more individuals Intergroup ( teams that are in competition or opposition to one another. Interorganizational(competition between two organizations that exist in one market Covert and overt conflict Overt ( conflict addressed openly Covert ( conflict not discussed may be ignored or avoided Reactive behaviors Whining Complaining Agreeing with others without really listening Passive-aggressive behavior Gossip Repressive behaviors Absenteeism Tardiness Avoidance behaviors Avoiding contact with others Withholding information Disappearing from work Conflict may be viewed as potentially useful May be an engine of innovation and change Some conflict is inevitable Causes of conflict Typical causes Miscommunication Inaccurate information Mistrust Ambiguous role expectations Ineffective teamwork Inadequate project planning Ineffective leadership Resistance to change Three primary sources of conflict in healthcare settings Role boundary issues Scope of practice Accountability The nurse-physician relationship Should be strongest relationship nurses have in order to meet the needs of the client But often it is not ( both sides can contribute to inadequacies in the relationship Collegial relationships ( equality of power Collaborative relationships ( mutual power, but the physicians is greater Positive professional communication is critical Preventing conflict Clear communication essential Clear understanding of roles and responsibilities Other strategies Address issues as they arise Avoid destructive criticism Treat others with respect Avoid arguments Listen to each other Consider the other individuals point of view Allocate resources fairly Clearly define role expectations for all team members Encourage staff to provide feedback and identify potential concerns without threat of punitive action Acknowledge team members accomplishments and achievements Nurses must recognize their own tension or stress level in workplace Responding to conflict Typical responses Avoidance Individual withdraws from stressful situation Typically occurs when one side perceived as more powerful than other Accommodation Individual tries to make situation better by cooperating with the individual with whom she or he is in conflict Goal to eliminate conflict as quickly as possible Competition Power is used to stop the conflict Collaboration All parties attempt to reach acceptable solution Often involves some compromise Guidelines Demonstrate honesty, trustworthiness and respect State the issue objectively and provide a factual basis for the concern Avoid emotion-based discussions Be open to hearing all individuals viewpoints and avoid passing judgement Allow all individuals involved to express their concerns without interruption Apply active listening techniques Focus on identifying solutions Recognize that the delivery of safe, effective client care is the central concern Aggression in the workplace Managing conflict in the workplace Aggressive behavior ( hostile behavior ( may lead to conflict First response ( communicate control to the staff member Insert calm into the situation Try to move hostile staff member to private place May need to simply walk away Managing conflict with clients and families Setting limits can be effective Clients or families should never be allowed to demonstrate anger inappropriately Inappropriate demonstrations of anger, including hostile verbal or physical behaviors should be reported immediately to the team leader or charge nurse Workplace bullying Verbal abuse (workplace bullying) ( malicious, repeated, harmful mistreatment of an individual with whom one works Behaviors Berating Humiliating Ridiculing Blaming Threatening May occur between clients and staff, nurses, physicians and nurses, and all other staff Horizontal violence describes aggressive acts committed against a nurse by one or more colleagues Victims of bullying suffer adverse emotional effects such as depression, anxiety and a sense of isolation Reports of bulling should include Date Time Description of events Identification of witnesses Conclusion Conflict unavoidable in nursing Nurses must learn to deal with conflict effectively ( decrease workplace stress and create an environment for providing safe client care Review Conflict Resolution Relate Link the Concepts and Exemplars Refer Go to Nursing Student Resources Reflect Case Study IV. Exemplar 37.3 Interdisciplinary Teams Overview Group ( three or more individuals who have a common purpose, interact and influence each other, and are interdependent Group dynamics ( ways in which group functions Group dynamics must be effective for group work to be accomplished Groups and teams in health care Help people achieve goals that might be unattainable by individual alone Group members share responsibilities for groups action and consequences of those actions Types of teams Intradisciplinary Members of the same profession who work toward achieving a common goal Interdisciplinary Comprise professionals with varied backgrounds Combining interdisciplinary expertise through teamwork Interprofessional Provide collaborative and comprehensive care by providing a full range of expertise Decisions made by group Multidisciplinary team approach A single team member-usually a physicianmakes the treatment decisions Little communication between other individual professionals on the team Process of interdisciplinary collaboration Parallel communication Each professional communicates with client independently Each asks same or similar questions Parallel functioning Communication may be more coordinated Each professional has separate interventions and plan of care Information exchange Planned communication Unilateral decision making Coordination and consultation Midrange level of collaboration Seeks to maximize efficiency of resources Co-management and referral Upper level of collaboration Providers retain responsibility and accountability for their own aspects of care Clients directed to other providers when problem beyond initial providers expertise See Figure 372, CONTINUUM OF COLLABORATION, p. 2393 Future of interdisciplinary teams The Accordable Care Act includes an increased focus on interdisciplinary collaboration ACA creates incentives for the integration of healthcare delivery and coordinated provision of care ACA allows for allocation of grants or direct contracting between USDHHS and states or state-designated entities for the establishment of community-based interdisciplinary healthcare teams Review Interdisciplinary Teams Relate Link the Concepts and Exemplars Refer Go to Nursing Student Resources Reflect Case Study 2015 by Education, Inc. 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