NURS 230/SPRING 2014 Week 6/Teamwork and Collaboration

Effective Care Teaming  Shared goals  Respectful-encourages participation  Open discussion of conflicts  Usually decision making by consensus  Frequent, constructive criticism  Shared Governance  Assignments Clear and accepted by all  Feelings frequently expressed  Frequent and ongoing focus on solutions

Nurse-Physician Communications  Frequent occurrence  Communication across a hierarchy can be intimidating  Gender or cultural issues may complicate further  Often named as cause of nurse job dissatisfaction  Critical for patient safety

Communication with Other Healthcare Workers  Step 1 - Gather and clarify all of the information you need to provide to the physician:  Nature of the problem  Supporting information or data  Clarify in your mind what you would like for the patient to do

Communication with Other Healthcare Workers  Step 2 – State concisely to the physician the problems that the patient is experiencing.  Nature of the problem  Supporting information or data  Question or issue on which you need his/her input  SBAR

Communication with Other Healthcare Workers  Step 3 – Actively listen to information communicated by the physician/healthcare worker  Listen to the plan of care  Clarify areas which are unclear by asking appropriate questions

Communication with Other Healthcare Workers  Step 4 – Know how to tactfully use assertive communication when necessary  State your concern  State information that supports your concerns  Suggest a course of action  Recap why you feel this action is best option

SBAR( Situation-Background- Assessment-Recommendation  Framework for communication between members of the health care team about a patient's condition.  Adopted in Healthcare with a patient safety focus.

SBAR  Situation  Identify yourself, and the site you are calling from Identify the patient by name, DOB, Age, Sex reason for report Describe reason for phone call

SBAR  Background  Give the patient's Presenting Complaint Give the patient's relevant Past Medical History Brief summary of background

SBAR  Assessment  Vital Signs - HR, RR, O2sats, BP, Temp, system by system concerns List if any VS are outside of parameters Clinical Impression Severity of Patient, additional concern

SBAR  Recommendation  Explanation of what you require, how urgent and when action needs to be taken Make suggestions of what action is to be taken Clarify what action you expect to be taken

SBAR communication  sfKg8&feature=relmfu sfKg8&feature=relmfu  eature=related eature=related

Case Presentation  You are assigned to care for a 68 year old lady for the evening shift. She is two days post-op following hip fracture surgery. No problems were noted at nursing sign-out other than c/o pain, for which she was receiving pain medication.  When you perform your initial assessment on this patient, you find her to be confused.

Case Presentation  What additional information do you need to gather prior to contacting the physician?

Case Presentation  Additional information you might gather:  Vital signs and pulse oximetry  Name, dose and timing of pain medication previously given  Any additional observations that you feel would be helpful

Case Presentation  Vital signs and pulse oximetry  T 37.5, P 108, R 24, O2 sat 82% (RA)  Name, dose and timing of pain medication previously given  Morphine sulfate 2 mg IV two hours ago  Any additional observations that you feel would be helpful  Patient’s respirations seem somewhat labored

Case Presentation  The resident physician asks that you obtain the following tests:  CXR  ABG  EKG  Routine blood work  Is there any additional information you need to know at this time?

Case Presentation  The CXR suggests pneumonia, and the resident orders an IV antibiotic.  Two hours later, as you start the antibiotic, you note that the patient is more short of breath. You request that the resident re-evaluate the patient.

Case Presentation  The patient’s O2 sat is now 88% on 50% face mask, and her respiratory rate is 30/minute.  You feel she needs almost 1:1 nursing, and are worried about how you will care for your other three patients.  You ask the resident if the patient should be moved to the ICU, but he states he wants to first see how she responds to the antibiotic.

Case Presentation  If your effort at assertive communication does not have the desired effect, what other options are available to you?

When Assertiveness Doesn’t Work  Restate your concerns in another way  Engage another healthcare worker (i.e. Respiratory Therapy)  Engage your supervisor  Engage another physician on the team

Assertive Communication in Patient Care  Is not:  Yelling or bullying  Accusatory  Being disrespectful of authority  Is:  Focused on patient  Noting your perceptions  Persistently raising concerns, intended to move toward desired action

Effective Communication  Essential for real teamwork  Essential for long term career satisfaction  Essential for patient safety and quality care

Collaboration and effective education/communication is the link to Advocacy

  eature=related eature=related Examples of Good and Challenged Collaboration:

NCLEX-QUESTION #1  A nurse is instructing parents who are of Mexican origin, on administering their toddler’s oral medication. What is the best method for the nurse to use to ensure the toddler will get the prescribed amount of medicine at the appropriate times?  1. Have an interpreter available to translate information to the parents.  2. Have a parent demonstrate the medication administration process prior to discharge  3. Initiate a referral to a home care agency for a follow-up visit.  4. Provide written instructions to the parents on how to administer the medication

Answer  #2:  Rationale  In adult learning theory return demonstration or demonstrating ability to do the task is the most effective means of evaluating performance

NCLEX-QUESTION #2  A nurse is evaluating teaching for a client who has diabetes and is beginning insulin therapy. Which behaviors suggests that the teaching about medications was effective?  1. The nurse showing the client a video that explains the effects of insulin and mechanism of action  2. The client reading a handout that describes the different types of insulin  3. The nurse demonstrating the correct procedure for drawing medication from a vial  4. The client withdrawing insulin from the vial and injecting self correctly on the second attempt.

Answer  #4  The client correctly demonstrating withdrawing and administrating insulin suggests that the teaching about medication was effective

NCLEX-QUESTION #3  A client who does not speak or understand English has an interpreter at the bedside assisting a nurse with an admission interview and assessment. Which action is most appropriate for the nurse while utilizing the interpreter?  1. Asking questions directly to the interpreter  2. Asking questions directly to the client  3. Asking the interpreter to step out of the room while completing the assessment  4. Allowing the interpreter to rephrase questions and responses instead of interpreting each word

Answer  #2:  Asking the questions directly to the client allows the client and the nurse to develop a relationship and allows the client to feel included in their plan of care.

Questions