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QSEN - Teamwork and Collaboration

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by

Monica Lu

on 29 October 2013

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Transcript of QSEN - Teamwork and Collaboration

Quality and Safety Education for Nurses
Teamwork and Collaboration
Team Members
Scenario
Myself as a Team Member
Cindy Calvo

Tammy Huynh

Liliana Lacayo

Audra Lehman

Monica Lu

Kaylee Salo

Katie Shea

Emily Vance
Teamwork and Collaboration
Definition: Function effectively within nursing and inter-professional teams, fostering open communication mutual respect and shared decison-making to achieve quality patient care.
Client is a 5 day old neonate suffering from hyperbilirubinemia after family did not comply with phototherapy when they initially left the hospital.

Client's parents want him to leave the hospital even though he still needs phototherapy and blood tests to determine whether therapy has been effective.

Both the nurse and physician educated and explained to parents the importance of phototherapy in reducing bilirubin to preventing brain damage. A social worker also provided information to parents and explained that if the parents are not compliant, they will be reported to CPS.
Strengths: As a student nurse, I serve as an additional support member of the health care team. In doing this, I am able to enhance patient care by creating additional time for the nurse to spend with her patients and their families. I am also able to provide useful knowledge from a fresh perspective, which can often be helpful in helping team members to think outside the box.
Knowledge (cont.)

Limitations: As a first year nursing student, I lack the insight that only many years of experience can bring. I am still in the process of learning and at times must refer to the RNs and additional members of the healthcare team for direction and guidance.

Values: My values at this time are focused on being a team player amongst the hospital staff in order to meet the needs of the patients. I value the input of both the medical staff as well as the input of the patients and their families.
Skills

Strengths: I was a source of support and comfort for the family during this confusing and stressful time. I used therapeutic communication techniques such as active listening to provide an environment in which the parents could freely express their thoughts and feelings surrounding their child's situation, thus enhancing the nurse-client relationship. My attempt at patient-teaching was to further strengthen the medical team's initial instruction.

Limitations: Unfortunately the family chose not to continue with light therapy in the hospital, but instead went home with a bilirubin blanket. As a student nurse, I was unsuccessful in persuading them to continue with in-patient care, as recommended by the health care team.
Skills (cont.)

Plan for Self-Development: Afterwards I spoke with the health care team to learn how to better handle these situations and change their outcome to best serve the patients in the future. I look forward to growing and learning as a member of a team.

Team Respect: Despite disagreeing with the parents’ decision to take the child home, I honored their wishes and behaved in a professional manner. I continued to treat them with kindness and respect despite our differences in opinions, and encouraged them to call the hospital if any questions arose regarding the in-home use of the biliblanket.
Attitudes
Potential to Contribute to Team Functioning: As a new student I naturally have a novel approach that can provide opportunities for other team members to have a different and potentially innovative insight into the situation. Exploring all available options amongst the team is beneficial to the patient's care overall.

Appreciating Collaboration: Each member of the health care team plays an important and vital role in providing the best individualized plan of care for their patients. When we work together effectively as a team the combined result is greater than our individual input. When we extend beyond our professional team, we strive to include the patient and their family to provide the ultimate collaborative care.
Health Care Team Members
Scope of practice: Physician is to explain the diagnosis to jaundice and his/her recommendations for treatment. Nurses recommend the treatment plan suggested by physician and are patient's advocate. Social worker will provide resources to parents in order to achieve patient's health goals.

Strategies for Overlap: Each team member needs to be aware of their limitations to prevent overlap in roles and accountabilities.

Other Contributions: recognizing family adherence to outpatient treatment of jaundice.
Skills
Physician: Explaining jaundice to parents (including lab results), include his/her recommendations for treatment, and send referral for visit from social worker.

Nurse: Draw labs before discharge, check color and consistency of stool, take vital signs, continue patient teaching with parents about jaundice. The nurse can also give general guidelines for home health care preparation.

Social Worker: Set up home health nurse visits within 2-3 days for patient to evaluate feeding, elimination patterns, and jaundice. Provide medical equipment company to provide phototherapy.
Attitudes
As a part of an interdisciplinary team, health care workers need to identify the patient's needs and how that pertains to their skills and knowledge.

Each team member is relying on one another to contribute within their scope of practice in order to accomplish optimal care for this patient.

The healthcare team should always include the patient's family in the care of their loved one and be able to understand the family's dynamic as well as cultural differences.
Knowledge
Knowledge
Communication is Key
Knowledge
The goal of effective communication is to understand the message being sent with all of its implications. Effective communication requires the use of simple terms that can be be understood by all parties involved.

The basic principles of consensus building and conflict resolution are effective communication, an array of available options, and working closely with all team members including the client and their family.

The nurse plays an important role in coordinating care for the client by integrating the management and delivery of treatment, encouraging health promotion and improving the quality of service being provided by taking into consideration the client, client's family and other team players.
Skills
Nurses, physicians and social workers must analyze their own communication style before addressing the situation with parents and be sure to be respectful to cultural and socioeconomic circumstances for example take into consideration the fact that the parents may not have adequate child care for other children at home.

The team members goal must be to resolve conflict by providing alternative options that incorporate the family's beliefs and values regarding patient care.

All team members including the student nurse must communicate the care being provided to the patient at each step of care for example explaining the steps involved when assessing the client.
Attitudes
A key component of communication is to evaluate the situation and the outcomes

Physicians, nurses, social workers and all other team members must reevaluate whether their communication skills were effective in reaching a resolution

What can individual team members change or improve when a similar situation presents itself again

Team members must come together to discuss any gaps in communication and how to effectively resolve these if conflicts are present
Teamwork and Safety Quality of Care
Knowledge
The most critical contribution of the healthcare team to patient safety, in any setting, is the ability to coordinate and integrate the multiple aspects of quality within the care directly provided by nursing, and across the care delivered by others in the setting.

Patient safety practices that can prevent harm to reduce negative outcomes of mortality and morbidity
Teamwork provides the necessary surveillance and coordination that helps increase the quality and safety of care
Skills
Teamwork provide better safety and quality of care for patient by:

Follow standard operating procedures without skipping steps

Accurate communication between patient and all health care members who are participating in the care

Teach patient of self management by providing simple and direct information

Focus on the main objectives of care
Overlooking or ignoring individual fallibility.
Attitudes
Evaluating the impact of nursing care on positive quality indicators, such as appropriate self-care and other measures of improved health status.

Operate the transition from one team member to the next with clear communication to prevent errors and improve the quality of care

Teamwork is key in providing adequate safety and quality of care for all patients
Barriers to Teamwork
Knowledge
Barriers and Facilitators to Team Functioning: As the family was already in an unfamiliar and scary situation, perhaps the repeated communication from various team members was overwhelming. Perhaps the child’s parents did not understand the role of the student nurse and therefore underestimated the credibility and value in the insight I provided. Open and honest communication between the health care team and the family facilitated a better understanding of the situation as a whole.

How to Improve Team Functioning: To avoid overwhelming the parents, a point person could have been chosen to effectively communicate with the family. This person would be a member of the team who had established a rapport with the family and whom they trusted. Another strategy would be to present the information in an alternative format such as pamphlets, videos and medical journals.
Skills
Designing Teamwork Systems: To maximize effective teamwork, the group gathered prior to meeting the parents to define clear objectives and reach a consensus on how to educate the family regarding their child's condition. Each member of the team, including the doctors, nurses and myself, contributed to the preparation with ideas from their unique perspectives. Each subsequent patient teaching session built upon the foundation of the previous team member's explanations.
Attitudes
Value of Effective Team Functioning: In designing support systems, I value equal representation and encouragement of collaborative brainstorming. I also value establishing goals and outcomes that the team clearly communicates and works towards achieving.
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