Nursing Roles and Communication Strategies for Effective Teamwork, Exams of Nursing

Download Nursing Roles and Communication Strategies for Effective Teamwork and more Exams Nursing in PDF only on Docsity! NR 201 FINAL EXAM STUDY GUIDE UNIT FOUR: TEAMBUILDING AND CONTINUITY OF CARE ROLE Professional Roles Professional nurses comprise the largest professional group of health care providers. They spend more sustained professional time with clients and families than any other hospital care professional. Since the time of Florence Nightingale, the professional nursing roles have steadily evolved from being that of being a functional “handmaiden of the physician” to current national expectations for nurses to assume leadership roles and to act as first-line providers in implementing health care reform initiatives. Nurses are no longer the instruments of another profession’s intent. Expanded Professional Roles Advanced practice and leadership roles for nurses are the wave of the future. Contemporary nurses are expected to take leadership roles, working with physicians, pharmacists, and other health professionals on an equal playing field to meet the challenges of health care reform. Advanced Practice Nurses (APRN) Communication Strategies for Effective Teamwork To help providers develop shared mental models to know what to expect, synchronize care, and mitigate errors, structured communication can ensure accurate information exchange and shared decision making. The nurse’s surveillance role often means he or she has information critical to care management. 1. SBAR a. Situation: patient information and brief sentence of what is happening now b. Background: diagnosis, relevant lab and assessment data, chief complaints c. Assessment: analysis of the problem, what is of concern d. Recommendation: form as a question of what may be a solution or request for help 2. Call-out: provider calls out critical information so all team members can hear during urgent situations to help anticipate next steps 3. Check-back: repeat back what is heard. 4. Mutual support: team members cross-monitor and help overloaded team members, redistribute tasks, offer verbal support, encourage others, and share information and safety alerts 5. Hand-off: checklists ensure the transfer of information, authority, and responsibility when transferring care along the continuum with opportunity to ask questions and clarify and confirm NR 201 FINAL EXAM STUDY GUIDE UNIT FOUR: TEAMBUILDING AND CONTINUITY OF CARE ROLE information 6. Critical language: providers are taught key phrases understood by all team members to mean, “Stop. We may have a problem.” a. Examples include CUS: I need CLARITY. I am UNCERTAIN. I have a SAFETY concern. b. Team members assertively voice a concern two times to ensure it was heard using the three Cs: I’m curious; I’m concerned; I’m still uncomfortable, let’s consult with a third party. Briefing The leader presents to the team a brief overview of what procedure is about to happen, identifies roles and responsibilities, plans for the unexpected, and increases each member’s awareness of the situation. The leader asks anyone who sees a potential problem to speak up. In this manner, the leader “gives permission” for every team member to speak up. This can include the client also, as many clients will not speak up unless specifically invited to do so. Huddle A huddle is a brief, informal gathering of the team to decide on a course of action. Huddles reinforce the existing plan of care or inform team members of changes to the plan. A team huddle can be called by any member. Debriefing Debriefing occurs after a surgery or critical incident. It is a callback or review during which each team member has an opportunity to voice problems that arose, identify what went well, and suggest changes that can be made. NR 201 FINAL EXAM STUDY GUIDE UNIT FOUR: TEAMBUILDING AND CONTINUITY OF CARE ROLE The B Background Comorbidities, previous episodes, current medications, family history A Actions Sate what actions were taken and why T Timing Level of urgency, explicit timing and priorities O Ownership Sate who is responsible N Next State the plan: what will happen next, any anticipated changes Nursing Teamwork The traditional client report from one nurse handing over care to another nurse needs to be accurate, specific, and clear, ad allow time for questions to foster a culture of client safety. Interdisciplinary Rounds and Team Meetings Contemporary health care teams use “interdisciplinary rounds” to increase communication among the whole team – physicians, pharmacists, therapists, nurses, and dieticians. Chapter 24: Communicating for Continuity of Care Current Challenges in Health Care Delivery The complexity of contemporary health care requires a different care process to match new health realities. There are several reasons: demographics of the population with greater ethnic and racial diversity, longer life spans, serious economic challenges, health disparities associated with social determinants of health, globalization and significant skilled provider shortages, and most notably, physicians and nurses. Clients are discharged earlier and sicker, often with complex medication and treatment regiments to be followed in the community in primary care settings. Technology advances in diagnosis and treatment, discovery of novel medications and workable treatments have eradicated the incidence of premature death from previous health conditions. People now self-manage previously untreatable cancers and other conditions as chronic health conditions with a good quality of life for longer periods of time as the rule rather than the exception. This attention has turned to chronic disease management, early detection and interventions to enhance lifestyle health behaviors within a shared care process. The 2010 passage of PPACA provides a new urgency for development of coordinated NR 201 FINAL EXAM STUDY GUIDE UNIT FOUR: TEAMBUILDING AND CONTINUITY OF CARE ROLE community based COC health initiatives. Not only does this act dramatically increase the number of individuals eligible for affordable care; it enlarges the scope of reimbursable health promotion and disease prevention activities available to people and provides new consumer protections. An unprecedented number of people will now be eligible for care, require a tighter understanding and implementation of care continuity in the community. Using an integrated service framework based in the community capable of providing a continuum of aggregated services offers the most comprehensive option for care of clients with chronic physical and mental conditions. Continuity of Care Concepts Continuity of care (COC), describes a multidimensional longitudinal construct in health care, which emphasizes seamless provision and coordination of client-centered quality care across clinical settings. COC operates across three dimensions: relational, informational, and management continuity. These dimensions are interdependent essential components of client care. Relational continuity is defined as a therapeutic relationship with a practitioner that spans more than one episode of care and leads, in the practitioner, to a sense of clinical responsibility and an accumulated knowledge of the client’s personal and medical circumstances. Informational continuity refers to the use of data to tailor current treatment and care to each client’s evidenced needs. The concept includes accurate record sharing and technology to allow real time communication exchanges between providers and with clients in remote sites. Management continuity refers to a consistent, coherent care management approach, which can be flexibly adjusted, as client needs change. Care coordination and case management have emerged as significant methodologies associated with management continuity. The COC construct is explained as a series of connected client-care events both within a health care institution and among multiple settings. The overarching goal of COC is to ensure reliable coordinated transition of clients from one health care setting to another, such that care in each setting continues to provide a secure healthy safety net for individuals and families that they can rely on for support and information. COC decreases the potential for service duplication, conflicting assessments, gaps in service, and reduces the use of preventable acute care services. Improved continuity lessens medication and treatment errors, provides timely follow-up, and can ease transitions between care settings. For 4 4 4 4 NR 201 FINAL EXAM STUDY GUIDE UNIT FOUR: TEAMBUILDING AND CONTINUITY OF CARE ROLE chronically ill and elderly clients, COC means that they are more likely to have health care providers familiar with their overall history, who can notice subtle changes in health status. COC: Treatment Pathway An advanced practice nurse (APRN) is a licensed skilled practitioner holding a minimum of a master’s degree in a clinical specialty with the expert knowledge base, complex decision- making skills and clinical competencies required for expanded specialty practice. Specialized training allows APRNs to diagnose and independently manage care including prescriptive authority and medication management. Advanced practice roles build upon nursing practice competencies. Core Professional Role Competencies Nurses also provide leadership and coordination in health care improvement through education and participation in research. NR 201 FINAL EXAM STUDY GUIDE UNIT FOUR: TEAMBUILDING AND CONTINUITY OF CARE ROLE Nursing management includes planning, giving direction, and monitoring and evaluating nursing care of individuals, groups, families, and communities. Researcher Although the majority of researchers in nursing are prepared at the doctoral and postdoctoral levels, an increasing number of clinicians with master’s degrees are participating in research as a part of their advanced practice role. Nurses at the baccalaureate and associate degree levels are also participating in research. These nurses may be assisting with data collection, critiquing research findings, and using the findings in practice. Coordinator of the Interprofessional Health Care Team Collaborative practice relationships among several disciplines of health care professionals Coordination between and among disciplines involved in providing client care Advanced Practice Nursing APN includes NPs, nurse midwives (CNMs), nurse anesthetists (CRNAs), and CNSs. Are educationally prepared through master’s level education to assume responsibility and accountability for the health promotion, assessment, diagnosis, and management of client problems, including the prescription of medication. Nurse Practitioner Typically, NPs assess, diagnose, and manage medical and nursing problems. Health promotion and maintenance, in addition to disease prevention, are the emphases of the practice. Job responsibilities of NPs include taking client histories, conducting physical examinations, ordering, performing and interpreting diagnostic tests, and prescribing pharmacologic agents, treatments, and therapies for the management of client condition. Clinical Nurse Specialist APNs who possess clinical expertise in a defined area of nursing practice for a selected client population or clinical setting. Functions as an expert clinician, educator, consultant, researcher, and administrator. The CNS monitors the care of clients and collaborates with physicians, nurses, and other members of the interprofessional team. The emphasis is to provide clinical support that improves client care and client outcomes. Certified Registered Nurse Anesthetist Established in the late 1800s, is recognized as the first clinical nursing specialty. Since WWI have been the principal anesthesia providers in combat areas. NR 201 FINAL EXAM STUDY GUIDE UNIT FOUR: TEAMBUILDING AND CONTINUITY OF CARE ROLE Certified Nurse Midwife Primary care providers of women’s health care, focusing particularly on pregnancy, childbirth, the postpartum period, care of the newborn, and the family planning and gynecologic needs of women. Nurse Administrator or Nurse Executive Although not formerly considered an APN, has an important advanced role within nursing. It is vital that individuals be knowledgeable about the business of health care system and the profession of nursing. Nursing administration unites the leadership perspective of professional nursing with the various aspects of business and health administration. The practice focuses on the administration of health care systems for the purpose of delivering services to groups of clients. Nursing administration is concerned with establishing the costs of nursing care and examining relationships between nursing services and quality client care. Interprofessional Health Care Team Members Nurse (RN) NR 201 FINAL EXAM STUDY GUIDE UNIT FOUR: TEAMBUILDING AND CONTINUITY OF CARE ROLE Physician (MD or DO) Pharmacist (RPh or PharmD) Physician Assistant (PA) Dietitian (RD or LD) Physical Therapist (PT) Speech-language Therapist (SLP) Occupational Therapist (OT) Respiratory Therapist (RT) Social Worker Chaplain or Pastoral Representative Develop A Support System Collegial relationships are an important determinant of success as professional men and women entering nursing practice. Although there is no substitute for outcomes that demonstrate professional competence, interpersonal strategies can facilitate the process. Integrity, respect for others, dependability, a good sense of humor, and an openness to sharing with others are communication qualities people look for in developing a support system. Form a reliable support system at work. Mutual support networks that share information, ideas, and strategies with colleagues add a collective strength to personal efforts and minimize the possibility of misunderstanding. Seek Opportunities for Interdisciplinary Communication Creating opportunities for interdisciplinary groups to get together is a highly effective strategy for enhancing collaboration and communication. Ideas include collaborative rounds, huddles, team briefings and debriefings, and committees to discuss problems. Understand the Organization System Whenever you work in an organization, you automatically become a part of a system that has norms for acceptable behavior. Each organizational system defines its own chain of command and rules about social processes in professional communication. Even though your idea may be excellent, failure to understand the chain of command or an unwillingness to form the positive alliances needed to accomplish your objective dilutes the impact. Although sidestepping the identified chain of command and going to a higher or more tangential resource in the hierarchy may appear less threatening initially, the benefit of such action may not resolve the difficulty. Furthermore, the trust needed for serious discussion