Module 37: Collaboration
A nurse is working as the designated leader of a group of healthcare providers in a community clinic setting. The team members are working to decrease the number of adolescent pregnancies in the community. They have defined the problem and are now focusing on objectives and considering various viewpoints presented by the group. The nurse is tasked with helping the team stay focused in order to address the defined problem. Which of the competencies of collaboration does this describe? A) Decision making B) Mutual respect C) Trust D) Communication
A) Decision making Collaboration involves shared responsibility for decision making. The team must follow each step of the decision-making process, beginning with a clear definition of the problem. Team decision making must be directed at the objectives of the effort. It requires full consideration and respect for diverse viewpoints, and often guidance and direction from a group leader. Mutual respect occurs when two or more people show or feel honor or esteem toward one another. Trust occurs when an individual is confident in the actions of another individual. Communication occurs when two or more parties are committed to understanding each other's professional roles and appreciating each other as individuals. Although mutual respect, trust, and communication may indeed be part of this team's collaborative effort, the situation described here is most clearly illustrative of the competency of decision making.
A staff nurse learns before reporting to work that a close family member has been diagnosed with terminal cancer. When receiving the shift report, the nurse finds that this family member has been assigned as a client. The nurse who cared for this individual on the outgoing shift states that the client is very demanding and complains a lot. Which action by the staff nurse who is assigned care for the oncoming shift is appropriate? A) Discuss the situation with the charge nurse. B) Resolve to refrain from reacting negatively to the client. C) Tell the client to change the behavior. D) Ask the healthcare provider to help control the client.
A) Discuss the situation with the charge nurse. The best action to prevent conflict would be to explain the personal situation to the charge nurse and ask for a reassignment. The nurse can resolve to not react to the client, but the nurse should have the presence of mind to understand that the client's personal ability to cope is impaired. It would not be appropriate to confront the client at this time. The nurse should not ask anyone other than the charge nurse to intervene.
An experienced nurse is delivering a presentation to a group of nursing students about the importance of collaboration in the healthcare environment. The nurse wants to use evidence from the literature to support her argument. Which of the following are documented benefits of collaboration that the nurse should discuss in her presentation? Select all that apply. A) Improved client outcomes B) Reduction in duplication of healthcare services C) Increased overall cost of healthcare services D) Decreased client morbidity and mortality E) Higher level of job satisfaction
A) Improved client outcomes B) Reduction in duplication of healthcare services D) Decreased client morbidity and mortality E) Higher level of job satisfaction Research findings suggest that collaboration in healthcare among clients, family members, caregivers, and communities leads to improved client outcomes, a reduction in the duplication of healthcare services, and a decrease in client morbidity and mortality. Collaborative efforts have also been found to decrease, rather than increase, the overall cost of healthcare services, and to contribute to an enhanced sense of autonomy. This increase in sense of autonomy has been linked to greater job satisfaction among nurses.
Nurse leaders in a local hospital created a neurotrauma (NT) unit healthcare team focused on improving outcomes for stroke clients. This team includes acute care nurses, physicians, other care partners (e.g., physical therapists, social workers, case managers, dietitians), and representatives from the NT outpatient clinic. The team is led by a physician who makes treatment decisions based on the treatment plans developed by individual team members who each communicate with the clients, asking the same or similar questions to obtain data needed for the treatment plan. Which type of communication and action is represented in this scenario? A) Parallel communication B) Parallel functioning C) Information exchange D) Coordination and consultation E) Co-management and referral
A) Parallel communication This team is using parallel communication. Parallel communication occurs when each professional communicates with the client independently and asks the same or similar questions. It represents the lowest level along the continuum of communication and collaboration among health team members. Parallel functioning, information exchange, coordination and consultation, and co-management and referral all represent higher levels on the continuum. Parallel functioning occurs when communication may be more coordinated, but each professional has separate interventions and a separate plan of care. Information exchange involves planned communication, but decision making is unilateral, involving little, if any, collegiality. Coordination and consultation represent midrange levels of collaboration seeking to maximize the efficiency of resources. Co-management and referral represent the upper levels of collaboration, in which providers retain responsibility and accountability for their own aspects of care and clients are directed to other providers when the problem is beyond the initial provider's expertise.
A home health nurse is planning care for an adult client who is being discharged from the hospital after experiencing complications of diabetes mellitus. The client requires an extensive dressing change twice per day, help with activities of daily living, and comprehensive education. To ensure these needs are met, the nurse is coordinating home visits from aides and therapists. Which role is the nurse assuming by coordinating this client's care? A) Health educator B) Case manager C) Client advocate D) Health promoter
B) Case manager A case manager is responsible for ensuring that clients receive fiscally sound, appropriate care in the best setting. Part of the case manager's duties include identifying which services a client will require postdischarge, locating providers of these services, and coordinating visits from these providers. In this scenario, the home health nurse is assuming the role of case manager. Although the client requires education, the home health nurse's primary role is not that of health educator. Similarly, although case managers often engage in client advocacy and health promotion activities, these tasks account for just a portion of the nurse's duties in this scenario.
A case manager assembles a team of healthcare professionals, including a client's primary healthcare provider, physical therapist, and social worker, for the purpose of collaborative discharge planning and decision making. Which type of team did the case manager assemble? A) Intradisciplinary team B) Interdisciplinary team C) Interorganizational team D) Management team
B) Interdisciplinary team Interdisciplinary teams include professionals of varied backgrounds who share decision making. This is the type of team the case manager assembled. In comparison, an intradisciplinary team includes members of the same profession. An interorganizational team includes members from more than one organization, and the scenario doesn't mention whether multiple organizations are involved. A management team is an executive-level team that runs the day-to-day operations of a department or organization.
Which of the following individuals would be included on an interdisciplinary healthcare team but not on an interprofessional healthcare team? A) Nurse practitioner B) Laboratory technologist C) Pharmacist D) Physical therapist
B) Laboratory technologist The term interprofessional usually refers to professionals from various disciplines, whereas the term interdisciplinary is often used to denote that paraprofessionals or others (such as clients or family members) are also included. Nurse practitioners, pharmacists, and physical therapists are all professionals, so they could be part of both interprofessional and interdisciplinary teams. In contrast, a laboratory technologist is considered a paraprofessional, so he or she would be part of an interdisciplinary team but not an interprofessional team.
Which of the following is a primary barrier to effective nurse-physician collaboration that has persisted over time? A) The view among the general population that nurses' contributions to client care are less important to health and well-being than physicians' contributions B) Nurses' and physicians' perceptions of inequity in their roles, with nurses assuming a subservient role and physicians assuming leadership and a superior role in healthcare settings C) A general lack of education among health professionals about the ways in which nurse—physician collaboration improves healthcare quality D) A lack of published evidence regarding the effectiveness of collaborative efforts among and between nurses and physicians E) A lack of support at the federal level for efforts to improve healthcare among the general population through increased nurse-physician-client collaboration
B) Nurses' and physicians' perceptions of inequity in their roles, with nurses assuming a subservient role and physicians assuming leadership and a superior role in healthcare settings Over the years, a primary barrier to effective nurse-physician collaboration has been nurses' and physicians' perceptions of inequity in their roles, with nurses assuming a subservient role and medical providers perceiving their role to be superior in the provision of healthcare services. Evidence does not suggest that the general population views nurses' contributions to client care as less important than physicians' contributions; thus, this is not a primary barrier to nurse-physician collaboration. Likewise, because health professionals are in fact educated about the benefits of collaborative practice and published evidence has documented the effectiveness of collaboration in improving client outcomes, these are not barriers to collaboration. In addition, the federal government, as evidenced in particular by the Healthy People initiative, has promoted collaborative efforts among clients, nurses, physicians, other healthcare providers, and the larger community to improve the overall health of the U.S. population.
A group of nurses are in a staff meeting on a medical-surgical unit headed by the new unit nurse manager. The manager announces that nurses should not criticize and make fun of other nurses or there will be repercussions. Several nurses at the meeting suggest that the nurse manager talk to the individual nurses who are exhibiting this behavior. When assessing the staff's group dynamics, which action by the nurse manager is appropriate? A) Insist that this is an appropriate new policy. B) Recognize that the group already has defined behavioral norms. C) Discipline the staff nurses who spoke out. D) Request a transfer to another unit.
B) Recognize that the group already has defined behavioral norms. Behavioral norms are established by a group or the leader of the group. In this case, the manager should recognize that the group does not see this as an issue because it has already established behavioral norms. The new manager should simply offer support for any nurse who is unable to resolve such interpersonal conflicts. Insisting on initiating the new policy could be harmful to the goals of the group as a whole. Rather than transfer, the manager could observe the dynamics of the group and adapt to the findings. Disciplining those who spoke out would negatively affect the cohesiveness of the entire group.
A client with type 1 diabetes mellitus has developed an open sore on the shin and is having trouble meeting daily goals for exercise. The client is scheduled for discharge in a couple of days. When planning for this client's continued care, who will the nurse notify regarding the client's postdischarge needs? A) The pharmacy B) The case manager C) The occupational therapist D) The physical therapist
B) The case manager The client's needs and progress have changed, so the nurse should contact the case manager to coordinate appropriate modifications in the client's postdischarge care plan. A physical therapist may be needed, but the nurse would best coordinate care by notifying the case manager. Based on the information presented, the pharmacy would not be a necessary part of the care team at this time. An occupational therapist mainly deals with upper body areas that require rehabilitation, and the client currently does not require such assistance.
A school-age client is admitted to the pediatric intensive care unit (PICU), unconscious and with multiple traumatic injuries, after a skateboard accident that included a closed head injury. Many health professionals are involved in the client's care, and the scene is chaotic. The client's parents are extremely anxious and want to know what is happening. The case manager asks for an interdisciplinary team meeting to speak with the client's parents. Which is the rationale for this meeting? A) To allow for each specialty to practice independently B) To share and evaluate information for care planning and implementation, and to prevent priority conflicts, redundancy, and omissions in care C) To allow the primary healthcare provider to make all decisions regarding the client's care D) To prevent the client's parents from trying to change the plan of care
B) To share and evaluate information for care planning and implementation, and to prevent priority conflicts, redundancy, and omissions in care Interdisciplinary collaboration engages each professional's contribution to joint care planning, implementation, and accomplishment of client goals, often with less redundancy, more efficiency, and fewer care omissions. The parents of a minor child should be involved in all aspects of care and decision making.
A nurse is discussing the plan of care with a client who is preparing for discharge. The client has a strong objection to portions of the plan of care. The nurse recognizes that there is a conflict. Which response by the nurse indicates an understanding of the client's position and a willingness to collaborate regarding the discharge plan? A) "You are not being cooperative in your plan of care." B) "This plan of care was ordered by the physician." C) "Let's talk about your objections and possible solutions or alternatives." D) "I will ask your family to help convince you that this plan of care is best."
C) "Let's talk about your objections and possible solutions or alternatives." The nurse attempts to resolve the conflict with the client by listening to the client's concerns and then negotiating with the client. This action helps build the client's trust in the medical team. Telling the client that these orders were made by the physician continues the conflict and brings the physician into it. The nurse would not want to include the client's family in the conflict and cause problems between family members. Telling a client that he or she is being uncooperative is likely to anger the client and cause further conflict
The nurse is preparing for the discharge of a client who will require physical therapy (PT) for rehabilitation following a total knee replacement. After reading the healthcare provider's order for PT, what should the nurse do next? A) Set up outpatient appointments for the client with the hospital's PT department B) Call home health and schedule a therapist to visit the client's home for PT C) Inform the client about the settings in which PT may occur and have the client choose the venue D) Teach the client's family the exercises that will be included in the client's PT regimen
C) Inform the client about the settings in which PT may occur and have the client choose the venue Major objectives of interdisciplinary collaborative practice include providing client-directed, client-centered care; improving client and family satisfaction with care; and promoting mutual respect, communication, and understanding between the client and members of the healthcare team. Of the choices listed here, the option that best supports achievement of these objectives is informing the client about the settings in which PT may occur and having the client choose the desired venue. The nurse would not refer the client for outpatient therapy or schedule home PT unless the client specifically requested either form of therapy. Also, because the client requires therapy that must be performed by a professional physical therapist, providing teaching about exercises that will be included in the client's PT regimen encroaches on the expertise of another healthcare professional.
________ occurs when two or more individuals show or feel honor or esteem toward one another, and it is an important element of successful collaborative practice. A) Trust B) Conflict management C) Mutual respect D) Effective communication
C) Mutual respect Mutual respect, trust, conflict management, and effective communication are all important elements of successful collaborative practice. Mutual respect occurs when two or more individuals show or feel honor or esteem toward one another. Trust occurs when an individual is confident in the actions of another individual. Conflict management involves addressing, containing, and resolving disagreements among team members in a constructive way. Effective communication involves sharing information and ideas both clearly and in a way that demonstrates respect and appreciation for other team members.
A home healthcare nurse is planning care for an older adult client. Which interdisciplinary program would best support the needs of an older adult client within the community? Select all that apply. A) Assertive community treatment (ACT) B) YMCA C) Programs of All-Inclusive Care for the Elderly (PACE) D) Outpatient clinic E) Meals on Wheels
C) Programs of All-Inclusive Care for the Elderly (PACE) D) Outpatient clinic Interdisciplinary teams are used in many settings outside the hospital, including schools, workplaces, and long-term care facilities. PACE supports and facilitates the provision of numerous services for older adults. Outpatient clinics frequently coordinate medical care, supplies, and social services referrals. ACT is a mental health support and treatment program, not an interdisciplinary eldercare program. The YMCA is a fitness facility, not an interdisciplinary eldercare program. Meals on Wheels provides a service to older adult clients but is not an interdisciplinary program.
The nurse managers in a community hospital have been charged with reviewing the job descriptions of unlicensed assistive personnel (UAP), and they have questions about the delegation of certain client care activities to UAP by nurses. To which group, organization, or individual would the committee members direct their questions to obtain definitive answers about the parameters of nurse delegation to UAP? A) The hospital's Chief Nursing Officer B) The hospital's Chief Executive Officer C) The state board of nursing D) The American Nurses Association
C) The state board of nursing The parameters of nurse delegation to UAP are delineated by state boards of nursing and statutes contained in state administrative codes.
A nurse who is caring for an adult client in the intensive care unit (ICU) is given a verbal prescription by a first-year medical resident. The nurse determines that the best course of action is to check with the attending healthcare provider before implementing the prescription. What is the most likely reason why the nurse is experiencing conflict regarding this situation? A) The resident seems unsure of the prescription. B) The nurse only takes prescription orders from attending healthcare providers. C) The nurse does not like first-year residents. D) The nurse may not trust the resident to make the best care decisions.
D) The nurse may not trust the resident to make the best care decisions. This type of conflict is most likely related to a lack of trust in the resident on the part of the nurse. Nurses who work in critical care learn to validate orders given by residents because mistakes can take a client's life. The nurse may not like residents, but that is not a reason to question their orders. There is no evidence here that the resident is unsure of the order given. Residents can give orders, preferably written, but the nurse is wise to confirm the order with the managing physician.
Nurses who demonstrate mindsight are able to A) focus on being "in the moment" so that they can dedicate their full attention to the events and emotions they are currently experiencing. B) predict events that will occur in the future with reasonable certainty. C) interpret events and emotions from another person's perspective. D) recognize their personal triggers to stress that result in conflict, then retrain their brain to respond differently.
D) recognize their personal triggers to stress that result in conflict, then retrain their brain to respond differently. Mindsight is a term that describes being self-aware of one's triggers to stress that can result in conflict, and purposefully "retraining" the brain to respond differently. Improving one's self-awareness is salient to growing as a leader and being able to redirect the typical response and course of action in a given situation. Taking steps to decrease or manage stress levels helps to reduce the likelihood of initiating conflict.
In arranging community services for a client who is diagnosed with schizophrenia, the nurse case manager discusses options with the assertive community treatment (ACT) team. Which team disciplines should the nurse expect will be part of the client's ACT interdisciplinary team? A) Psychiatrists, nurses, social workers, employment counselors B) Speech pathologists, occupational therapists, nurses, physicians C) Teachers, school administrators, psychiatrists, nurses D) Transportation providers, nurses, physicians, social workers
A) Psychiatrists, nurses, social workers, employment counselors ACT provides mental health and support services in the community for individuals with serious mental illness, such as schizophrenia or bipolar disorder, to promote optimal functioning at home and within the community. Professionals participating in an individual client's care team may include psychiatrists, psychologists, social workers, pharmacists, advanced practice nurses, employment counselors, and peer support specialists. A client with schizophrenia would not require speech pathology remediation, occupational therapy, teacher assistance, or school administration intervention. Although transportation providers may be used, they would not be part of the ACT team.
Which of the following conflict-related communication styles involves attempting to satisfy the concerns of others while neglecting the self? A) Compromising B) Accommodating C) Avoiding D) Competing
B) Accommodating The five main styles of conflict-related communication are competing, collaborating, compromising, avoiding, and accommodating. Accommodating involves attempting to satisfy the concerns of others while neglecting the self. In comparison, competing is an assertive, power-oriented approach where one focuses on the self; collaborating is a cooperative approach that involves gaining insight to the perspectives of others; compromising is an approach where both parties are partially satisfied; and avoiding is refusing to address a conflict.
The nurse is discussing follow-up care with a client who is being discharged. The client and his family cross their arms and state angrily that the care team's suggestions are not acceptable. Which response by the nurse is appropriate? A) "We will leave you alone to discuss your options." B) "We only want what's best for you." C) "Let's discuss other options that might work well for you and your family." D) "Perhaps you did not understand the recommendations."
C) "Let's discuss other options that might work well for you and your family." Major objectives of interdisciplinary collaborative practice include providing client-directed, client-centered care; improving client and family satisfaction with care; and promoting mutual respect, communication, and understanding between the client and members of the healthcare team. Of the choices listed here, the response that best supports achievement of these objectives is "Let's discuss other options that might work well for you and your family." Leaving the room might lead the client and family to feel abandoned by the healthcare team. Stating that the team "only wants what is best" sends the message that the client does not know what is best, when, in fact, a well-informed client does know what is best and should be able to make the correct choice. Suggesting that the client and family do not understand the recommendations may be interpreted as demeaning, even if it is true.
The nurse is caring for a client with rheumatoid arthritis who expresses the desire to remain active as long as possible. In order for the client to meet this goal, what should the nurse prepare to do? A) Teach the client about nutrition and joint exercises. B) Ask the client about the reasons for this goal. C) Tell the client that activity limitations are inevitable with rheumatoid arthritis. D) Provide referrals to other professionals who can help the client meet this goal.
D) Provide referrals to other professionals who can help the client meet this goal. When a client expresses the desire to live as normally as possible, the nurse should refer the client to professionals who can help the client meet that goal. The nurse can provide the client with some teaching about nutrition and joint exercises but cannot go into the depth that this client would require. A client with a chronic disease should not be told there is no hope but should be helped toward reaching desired goals. Asking the client the reason for the desired goal is irrelevant to the situation.
