Transcript NURS 230 week 6 team work and collaboration

NURS 230/SPRING 2014
Week 6/Teamwork and Collaboration
Effective Care Teaming
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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
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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
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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
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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
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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
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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-BackgroundAssessment-Recommendation
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Framework for communication between members of
the health care team about a patient's condition.
Adopted in Healthcare with a patient safety focus.
SBAR
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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
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Background
Give the patient's Presenting Complaint
Give the patient's relevant Past Medical History
Brief summary of background
SBAR
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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
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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
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http://www.youtube.com/watch?v=CtdNQsfKg8&feature=relmfu
http://www.youtube.com/watch?v=fsazEArBy2g&f
eature=related
Case Presentation
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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
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What additional information do you need to gather
prior to contacting the physician?
Case Presentation
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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
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Vital signs and pulse oximetry
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T 37.5, P 108, R 24, O2 sat 82% (RA)
Name, dose and timing of pain medication
previously given
 Morphine
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sulfate 2 mg IV two hours ago
Any additional observations that you feel would be
helpful
 Patient’s
respirations seem somewhat labored
Case Presentation
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The resident physician asks that you obtain the
following tests:
 CXR
 ABG
 EKG
 Routine
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blood work
Is there any additional information you need to
know at this time?
Case Presentation
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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
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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
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If your effort at assertive communication does not
have the desired effect, what other options are
available to you?
When Assertiveness Doesn’t Work
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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
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Is not:
 Yelling
or bullying
 Accusatory
 Being disrespectful of authority
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Is:
 Focused
on patient
 Noting your perceptions
 Persistently raising concerns, intended to move toward
desired action
Effective Communication
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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
Examples of Good and Challenged
Collaboration:
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http://www.youtube.com/watch?v=GOj36LNUJRA
http://www.youtube.com/watch?v=4LlJFYgA2So&f
eature=related
NCLEX-QUESTION #1
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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
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#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
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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
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The client correctly demonstrating withdrawing and
administrating insulin suggests that the teaching
about medication was effective
NCLEX-QUESTION #3
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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
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#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