Module 37: Collaboration
List some actions to take in an effort to prevent conflict.
Address issues as they arise. Avoid destructive criticism, including harsh words, threats, and generalized condemnation of behaviors or performance. Treat others with respect, which will decrease defensiveness. Avoid arguments. Sometimes people do need to vent, and as long as it is done appropriately and in a private place, it may be helpful in decreasing tension. Actively listen to each other. Consider the other individual's point of view, including cultural beliefs and values.
Explain the role of decision making as a basic element of collaboration.
Collaboration involves shared responsibility for the outcome. To create a solution, 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 objects of the specific effort. Demonstration of mutual respect and timely, effective feedback facilitate the decision-making process. Sound decision making regarding patient care requires that the healthcare team focus on the patient's priority needs and organize interventions accordingly. The discipline best able to address the patient's needs is identified, given priority in planning, and held responsible for providing its interventions in a timely manner. Ideally, the collaborative team will ensure that the patient is part of the decision-making process, even if the patient is not able to be present.
Define collaboration.
Collaboration is defined as two or more individuals working toward a common goal by combing their skills, knowledge, and resources while avoiding duplication of effort. In a healthcare environment, the common goal of each collaborative team is to improve patient outcomes, whether the patient is an individual, a group, or a community.
Define collaborative care in nursing practice.
Collaboration may occur between nurses, between healthcare providers and patients, and between healthcare providers from different backgrounds. According to the ANA, collaborative inter-professional teams recognize each individual profession's value and contributions in an atmosphere of mutual trust and respect through open discussion and shared decision making. In addition to collaborating with professionals to provide individual patient care, nurses may also be involved in collaborating to develop community initiatives, write or revise legislation, or conduct health-related research. To fulfill a collaborative role, nurses need to assume accountability and increased authority in their practice areas. Each professional needs to understand how an integrated delivery system centers on the patient's healthcare needs rather than on the particular care given by any one group.
Describe the differences between covert and overt conflict.
In overt conflict, the individuals or group members who are in conflict address the conflict openly. Overt conflict is obvious, at least to most individuals, so coping with it is usually easier. Generally speaking, it is easier to arrive at an agreement that conflict is present and easier to describe the conflict if it is overt. Covert conflict occurs when the conflict is not discussed openly. It may be avoided or ignored, and can be expressed in reactive, repressive, or avoidant behaviors. Reactive behaviors include whining, complaining, agreeing with others without really listening to them, and passive-aggressive behavior. Gossip is another form of reactive behavior, and rumor mills are common in workplaces where covert conflict thrives. Repressive behaviors include absenteeism and tardiness. Although sustained avoidance is usually associated with negative outcomes, it is worth nothing that avoidance may be an effective method temporarily managing conflict. Avoidance can be appropriate when emotions are flaring and the individuals involved would benefit from taking the time necessary to regain composure. Sustained tactics of covert conflict result in increased stress, distress, and confusion about how to address the conflict.
Describe the continuum of inter-professional collaboration from lowest level to highest level.
Parallel communication occurs when each professional communicates with the patient independently and asks the same or similar questions. 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, where providers retain responsibility and accountability for their own aspects of care and patients are directed to other providers when the problem is beyond the initial provider's expertise.
The nurse wants to provide collaborative care for a client who has terminal cancer. Which action should the nurse include? A.) Consulting an oncology-certified nurse when planning care B.) Providing comfort interventions C.) Assessing the client's preferences regarding care D.) Giving the physician priority when delivering care
A, "Consulting an oncology-certified nurse when planning care." Seeking expertise from an oncology-certified nurse when planning care for the client with terminal cancer is consistent with providing collaborative care. Assessing the client's preferences regarding care and providing comfort interventions are nursing responsibilities that the nurse is required to meet, regardless of the care setting or the type of care being provided. It is not appropriate for the nurse to give one team member priority over another when delivering care.
An organization has goals to promote mutual respect within the inter-professional team and to improve client outcomes. Which action by the organization supports mutual respect? A.) Implementing inter-professional rounding B.) Promoting verbal acknowledgment of mutual respect C.) Placing physician leaders for each hospital department D.) Upholding the tradition of patriarchal nurse-physician relationships
A, "Implementing inter-professional rounding." Inter-professional rounding promotes mutual respect through collaboration on client-centered care. Verbal acknowledgement is not meaningful without nonverbal support. Physician leadership should have nursing counterparts to promote mutual understanding of authority. The traditional nurse-physician relationship must change to allow for mutual trust in collaboration.
The nurse is designing activities to promote skill building for nursing collaboration. Which activity should be included? (Select all that apply.) A.) Reviewing scope of practice for nurses B.) Performing a self-assessment of strengths C.) Analyzing different communication styles D.) Explaining how authority impacts care delivery E.) Acknowledging that barriers to team building will never change
A, B, C, D. QSEN (Quality and Safety Education for Nurses) identified characteristics related to teamwork and collaboration that support skill building for the nurse. The nurse should review scope of practice, self-assess strengths, analyze different communication skills, and understand how authority impacts care delivery. Barriers exist to team building, but they should not be viewed as insurmountable.
List strategies that those in leadership roles can take to prevent conflict.
Allocate resources fairly, including fair distribution of workload balance and intensity when assigning patient care. Clearly define role expectations for all team members. Encourage staff to provide feedback and identify potential concerns without the threat of punitive action. Acknowledge team members' accomplishments and achievements, as well as significant life events.
Which activities should the nurse recognize as supporting the building of skills for successful collaboration of inter-professional healthcare teams? (Select all that apply.) A.) Focusing care delivery on individual groups B.) Advocating for policy change with local legislation C.) Role playing scenarios to practice communication skills D.) Encouraging clinical problem solving through group work E.) Practicing with additional credentials to increase nursing authority
B, C, D, E. Nursing collaboration is supported by working in groups and having a voice in the community on health policy through advocacy, professional communication skills, and increased authority and accountability. Focusing care is an individual task.
The nurse is planning care for a client following a surgical procedure. Which collaborative action should the nurse include? (Select all that apply.) A.) Changing the medication order after speaking with the client about adverse effects B.) Informing the dietitian that the client is on a special diet and needs reteaching about the diet C.) Consulting the pharmacist regarding interactions between medications the client is prescribed D.) Informing the pharmacist that the client's blood pressure (BP) is low and to hold the BP medication E.) Updating the physical therapist regarding the client's physical activity and tolerance earlier in the day
B, C, E. Collaborative actions that are client centered lead to improved client outcomes. Consulting the pharmacist, updating the physical therapist, and informing the dietitian are all appropriate collaborative actions for the nurse to take. Telling the pharmacist to hold the client's medications without consulting the prescribing provider is outside the scope of practice of the nurse, as is changing the medication order. The nurse would report adverse effects or changes in the client's condition to the prescribing provider, who would be responsible for changing the medication order.
The collaborative team treating a client includes the cardiologist, dietitian, social services, and a nurse case manager. The team works together to establish a plan of care based on the client's goals. Which outcome is likely to result from this type of collaboration for the client? A.) Increased healthcare costs B.) Improved relationship between the physician and the client C.) Enhanced continuity of care D.) Decreased adherence with the plan of care
C, "Enhanced continuity of care." When effective collaboration occurs, quality of care improves; effective collaboration directly impacts client outcomes and enhanced continuity of care results. An increase, not a decrease, in adherence with the care plan is an outcome of collaboration. Healthcare costs will decrease, not increase, with collaboration. An improved physician-client relationship is not an outcome of collaboration; however, improved relationships do occur within the healthcare team as a result of collaboration.
The nurse wants to improve collaborative decision-making skills. Which action promotes collaboration between nurses and the inter-professional team? A.) Delaying feedback on results to ensure that all collected data were reviewed by the team first B.) Depending on physician leadership to ultimately make the decision for the team C.) Sharing responsibility of the outcome of the decision D.) Removing the client from the decision-making process
C, "Sharing responsibility of the outcome of the decision." Collaboration in decision making results in shared responsibility of the outcome of the decision. The client should be involved in decision making. The physician should hold a collaborative, not supervisory, position within the team. Feedback should be prompt to evaluate and make changes as needed.
A client tells the nurse that the pain medication is ineffective and causes too many side effects. Which inter-professional team member should the nurse consult? (Select all that apply.) A.) Dentist B.) Dietitian C.) Physician D.) Pharmacist E.) Complementary healthcare provider
C, D, E. The physician ordering pain medication is one inter-professional team member to involve, as they are aware of the ineffectiveness and adverse effects of the current medication ordered.The pharmacist is another inter-professional team member to assess interaction of all medications currently prescribed and recommend untried therapies.The complementary healthcare provider can provide adjunct therapies for pain like massage and reflexology. A dentist would be consulted for issues of the teeth, gums, and oral cavity. A dietitian would be consulted for nutrition needs.
Explain the role of communication as a basic element of collaboration.
Collaborating to solve complex problems requires effective communication skills. This is supported by the fact that miscommunication among providers has been identified as one of the most frequent root causes of sentinel events. True collaboration requires skilled communication and mutual respect in order to achieve desired patient outcomes. Instead of focusing on distinctions among members, each team must keep firmly in mind its common purpose, that of meeting the needs of the patient. Each member of the healthcare team should be sensitive to differences among communication styles and the effect that his or her own style has on successful collaboration. Team centered communication focuses on the work that, "we will do for this patient," as opposed to, "give this, do that," one-sided commands that do not invite dialogue or promote collaboration. Effective communication can only occur if every team member is committed to understanding each member's professional role and appreciating each member as an individual. Team-centered communication focuses on shared responsibilities.
List the characteristics of effective inter-professional collaboration.
Common purpose and goals identified at the outset. Clinical competence of each provider. Interpersonal competence. Humor. Trust. Valuing and respecting diverse, complementary knowledge.
The nurse manager wants to promote communication skills for successful collaboration among the nursing staff. Which communication style should the nurse use? A.) Parallel communication B.) Dominance in conversation C.) Status-based communication D.) Active listening
D, "Active Listening." Active listening is attentive communication that decreases miscommunication. Parallel communication is the lowest level of communication and does not support collaboration like higher levels of information exchange or consultation. Status-based communication does not support collaboration, but team-centered communication does support collaboration. Dominance and argumentative styles of communication do not promote collaboration.
The nurse has ideas on how to streamline charting in the electronic medical record. Which inter-professional team member should the nurse consult? A.) Complementary healthcare provider B.) Paramedical technologist C.) Unlicensed assistive personnel D.) Information technology expert
D, "Information Technology Expert." The information technology expert would be the collaborative partner to explore changes and to enhance the electronic medical record.The paramedical technologist would be consulted for laboratory and imaging issues. The unlicensed assistive personnel can help with delegated tasks of hands on care.The complementary healthcare provider would be consulted for complementary medical therapies such as acupuncture.
Describe the four levels of conflict.
Intrapersonal conflict occurs within an individual, expressed as stress or tension that results from real or perceived pressure generated by incompatible expectations or goals. This may occur when an individual is expected to do something that produces both desirable and undesirable consequences. Interpersonal conflict occurs between two or more individuals. It can a arise from differences in goals or personalities, competition, or concern about territory, control, or loss. Interpersonal conflict may occur in the workplace when one staff member misunderstands the roles or responsibilities of another. Other interpersonal conflicts can arise as the result of bullying, when a member of the team belittles another or attempts to coerce other into behaving in ways that cause frustration, guilt, or other types of conflict. Inter-group conflict occurs between teams that are in competition or opposition to one another. In some cases, the groups are competing for rewards or scarce resources. Groups can also be emotionally opposed to one another. Inter-organizational conflict is most commonly considered to involve competition between two organizations that exist within one market. For example, hospitals within the same community may demonstrate inter-organizational conflict.
Explain the role of mutual respect and trust as basic elements of collaboration.
Mutual respect occurs when two or more individuals show or fell honor or esteem toward one another. Trust occurs when an individual is confident in the actions of another individual. Both mutual respect and trust imply a shared process and outcome. They must be expressed both verbally and non-verbally. Magnet hospitals are an example of successful efforts by healthcare organizations to foster respect among professionals. Placing the head of the nursing department on an equal managerial level as the chief of physicians has been found to improve mutual respect between physicians and nurses, thereby improving their relationships.
Describe the objectives of inter-professional collaborative practice.
Provide patient-directed and patient-centered care using an inter-professional, integrated, participative framework. Enhance continuity of care across the continuum of health, from wellness and prevention through acute illness to recovery or rehabilitation. Improve patient and family satisfaction with care. Provide high-quality, cost-effective, evidence-based care that improves patient outcomes. Promote mutual respect, communication, and understanding between the patient and members of the healthcare team. Provide opportunities to address and resolve system-related issues and problems. Develop interdependent relationships and understanding among providers and patients.
Describe some of the common general causes of conflict.
Typical causes include miscommunication, inaccurate information, mistrust, ambiguous role expectations, ineffective leadership, and resistance to change. Role boundary issues and and accountability have also been identified as two primary source of conflict in healthcare. Role boundary issues include a lack of understanding of the value of all team members, include those outside of the nursing and medicine disciplines, relative to the care of the patient. Role boundaries also create conflicts with regard to awareness of which tasks each team member was authorized to perform. In the realm of accountability, conflict arises particularly when healthcare team members did not hold themselves accountable for their actions.
Describe the benefits of inter-professional collaboration.
WHO has linked inter-professional collaboration with a number of improved patient outcomes ranging from infectious disease to chronic disease as well as patient safety indicators such as complications, error rates, patient length of stay, and mortality. When quality improves, adherence to therapeutic regimens increases, lengths of stay decrease, and overall costs to the system decline. Sound application of collaborative strategies leads to decreased patient morbidity and mortality rates. When professional interdependence develops among healthcare providers, collegial relationships emerge and overall job satisfaction increases.
