1. Competency Model for Professional Rehabilitation Nursing Behavioral Scenario for Competency 4.3: Foster Effective Interprofessional Collaboration Christine Cave, RN MSN CRRN HFS Copyright©2015, Association of Rehabilitation Nurses

2. Competency 4.3: Foster Effective Interprofessional Collaboration Description/Scope: The rehabilitation nurse collaborates with the client, family, and other members of the inter- professional team in providing exemplary client care. Represents the discipline of nursing while participating on the interprofessional team Communicates pertinent information regarding the client to the interprofessional team Recognizes and respects diversity and roles within the interprofessional team Beginner Proficiency Level Descriptors Copyright©2015, Association of Rehabilitation Nurses

3. Behavioral Scenario The rehabilitation team joins together for a team conference to discuss a patient who has had an anoxic brain injury after a complex cardiac surgery. The team agrees the patient will need three weeks to meet several goals of independence. The therapists discuss the need for consistent gait training and improving bed mobility skills given the patient’s cardiac precautions. The therapists have set several goals and want to establish a therapy schedule accordingly. Currently, the patient has a complex medication regimen and takes no food or medication by mouth. The patient has continuous tube feeding running which must be administered and managed by the nurse. Copyright©2015, Association of Rehabilitation Nurses

4. Path 1 – Not Proficient The nurse delivers a short update to the team about the patient’s list of medications. The nurse reports the status of the patient’s skin integrity and continence level. The nurse listens to the team’s discussion about the goals of continued independence but fails to share that the tube feeding is scheduled at a continuous rate. The nurse isn’t too worried though, because the doctor is in the room, and the nurse feels that the doctor will probably want to manage the tube feeding anyway. The nurse will just let the doctor handle it. Copyright©2015, Association of Rehabilitation Nurses

5. Path 1 – Not Proficient Observations & Outcomes 1.Even though the nurse listens to the report of the therapists and the proposed schedule, the nurse does not consider how the therapy schedule will affect the time needed to administer the complex medications. The nurse also fails to mention that the tube feeding is continuous, which will mean that the therapists must incorporate the IV pole and tubing from the tube feeding pump into every therapy session. 2.The team members will have to work around the tube feeding pump and tubing and wait for the doctor to consult a dietician to evaluate the patient for a bolus schedule. 3.The nurse should come to team conference prepared with a list of the nursing care needs performed. The nurse must use the team conference opportunity to share why the medications are complex and how they tube feeding may impact the work of the therapists. The nurse should request for a dietician consult during team conference to consider the patient’s candidacy for bolus feeding. Copyright©2015, Association of Rehabilitation Nurses

6. Path 2 - Proficient The nurse comes to team conference prepared with a report that will benefit all team members. The nurse reports on the complex medications, some of which are intravenous. The nurse obtains a physician’s order to consult a dietician to transition the patient from continuous to bolus feeding. The team then discusses how the bolus feeding schedule and the functional therapies can coordinate to still meet the nutritional needs of the patient. The speech therapist shares that the patient is showing good potential to tolerate semisolid foods. The nurse sets goals with the speech therapist and physician to transition the IV medications to an oral route. The team sets a long term goal of removing the G-tube, provided the patient is able to consumes enough calories from an oral diet. Copyright©2015, Association of Rehabilitation Nurses

7. Path 2 – Proficient Observations & Outcomes 1.The proficient nurse comes to team conference prepared and embraces this moment as an opportunity for patient advocacy. The nurse shares openly the complex medical needs of the patient. The nurse describes how much time is needed to deliver care for the patient and anticipates the impact this may have on the other team members. Complex medications and tube feeding will require a plan for transition and the nurse initiates goals accordingly by recruiting the support of speech therapy and the dietician. 2.As a result of effective collaboration, the interprofessional team is able to accommodate the care needs of the patient. The nurse develops a plan of care that will meet short and long term goals for independent, functional feeding. 3.To increase proficiency levels, the nurse meets with the dietician or other specialized clinicians prior to the team conference. The nurse formulates goals before team conference so that the team discussions are effective and collaborative. Copyright©2015, Association of Rehabilitation Nurses

8. What Did You Observe? How did the outcomes of this scenario differ? Proficient Nurse - Is prepared for team conference - Is flexible and openly discusses creative solutions to establish the best goals for each patient - Uses team conference to share and obtain information for patient- centered care Non-Proficient Nurse - Is not prepared for team conference - Waits for the physician to manage a medical need that is primarily managed by the nurse Copyright©2015, Association of Rehabilitation Nurses

9. Takeaways Copyright©2015, Association of Rehabilitation Nurses 1.The new nurse respects the role of each discipline. The nurse supports the skills and knowledge of each team member. The nurse uses team conference to collaborate care among each discipline to manage and meet the needs of the patient. 2.Interprofessional collaboration can improve outcomes and help patients achieve goals. The speech therapist sees good potential for the patient to tolerate an oral diet. The nurse coordinates a plan to remove the IV and take oral forms of the medications. Coordinated goals by the dietician, nurse, and speech therapist will support the patient to eventually have the G-tube removed before discharging home. 3.Team-oriented goals support care transitions. The nurse recruits the input of other disciplines to set reasonable goals for discharge.