Concepts: Healthcare Team

Interprofessional team-based care:

- "Care delivered by intentionally created, usually relatively small work groups in healthcare who are recognized by others as well as by themselves as having a collective identity and shared responsibility for a patient or group of patients (e.g. rapid, responsive teams, palliative care," Interprofessional Education Collaborate (2016)

CUS words

- "I'm concerned, I'm uncomfortable, I don't feel like this is safe"

Interprofessionality

- "The process by which professionals reflect on and develop ways of practicing that provides an integrated cohesive answer to the needs of the client/family/population... It involves continuous interaction and knowledge sharing between professionals, organized to solve or explore a variety of education and care issues all while seeking optimize the patient's participation"

Which of the following are common barriers to effective discharge planning? (Select all that apply) 1. Ineffective communication among providers 2. members 3. SuLack of role clarity among healthcare team fficient number of hospital beds to manage patient volume 4. Patient's long-term disabilities 5. The patient's cultural background

- 1, 2. Barriers to effective discharge planning include ineffective communication, lack of role clarity among health care team members, and lack of resources. The presence of long-term disability is not a barrier but a characteristic of some patients who need greater discharge planning. A patient's cultural background is not a barrier unless you do not consider cultural factors in planning for discharge

Which of the following describe characteristics of an integrated healthcare system? (Select all that apply) 1. The focus is holistic. 2. Participating hospitals follow the same model of healthcare delivery. 3. The system coordinates a continuum of services. 4. The focus on healthcare providers is finding a cure for patients. 5. Members of the healthcare team link electronically to use the EMR to share the patient's healthcare record.

- 1, 3, 5. Integrated health care systems are shifting to more holistic approaches to health care. At the core of this shift is provision of a coordinated continuum of services for enhancing the health status of defined populations. There is no single model for an integrated health care system. Two types of integrated health care delivery systems are common: an organizational structure that follows economic imperatives and a system that supports an organized care delivery approach. Patient-centered medical home care is an example; members of the care team are linked by information technology, electronic health records, and system-best practices to ensure that patients receive care when and where they need it, and how they want it

Which of the following are examples of a nurse participating in primary care activities? (Select all that apply) 1. Providing prenatal teaching on nutrition to a pregnant woman during the first trimester 2. Assessing the nutritional status of older adults who come to the community center for lunch 3. Working with patients in a cardiac rehabilitation program 4. Providing home wound care to a patient 5. Teaching a class to parents at the local grade school about the importance of immunizations

- 1,2,5 Primary care activities are focused on health promotion. Health promotion programs contribute to quality health care by helping patients acquire healthier lifestyles. Health promotion activities help keep people healthy through exercise, good nutrition, rest, and adopting positive health attitudes and practices.

A nurse is providing restorative care to a patient following an extended hospitalization for an acute illness. Which of the following is an inappropriate goal for restorative care? 1. Patient will be able to walk 200 feet without shortness of breath. 2. Wound will heal without signs of infection. 3. Patient will express concerns related to return to home. 4. Patient will identify strategies to improve sleep habits.

- 1. Restorative interventions focus on returning patients to their previous level of function or on reaching a new level of function limited by their illness or disability. The goal of restorative care is to help individuals regain maximal functional status and to enhance quality of life through promotion of independence.

A nurse newly hired at a community hospital learns about intentional hourly rounding during orientation. Which of the following are known evidence-based outcomes from intentional rounding? (Select all that apply) 1. Reduction in nurse staffing requirements 2. Improved patient satisfaction 3. Reduction in patient falls 4. Increased costs 5. Reduction in patient call light use

- 2, 3, 5. Intentional rounding is an evidence-based practice used in an increasing number of hospitals today. Studies have shown that intentional rounding can reduce patient falls and call light use and improve patient satisfaction scores. Proactive problem solving can occur when using intentional rounding. Education for patients helps them understand the importance of this practice.

The school nurse has been following a nine-year-old student who has shown behavioral problems in class. The student acts out and does not follow teacher instructions. The nurse plans to meet with the students family to learn more about social determinants of health that might be affecting the student. Which of the following factors would be appropriate for this type of assessment? (Select all that apply) 1. The student's seating placement in the classroom 2. The level of support parents offer when the student completes homework 3. The level of violence in the family's neighborhood 4. The age at which the child first began having behavioral problems 5. The cultural values about education held by family

- 2, 3, 5. Social determinants include social support, exposure to crime and violence, and culture. The nurse should learn the child's age at which behavioral problems appeared, but this is not a social determinant. Seating placement is not a social determinant but could be a factor if the child has visual or other physical problems.

A nurse is assigned to care for 82-year-old patient who will be transferred from the hospital to a rehabilitation center. The patient and her husband have selected the rehabilitation center closest to their home. The nurse learns that the patient will be discharged in three days and decides to make the referral on the day of discharge. The nurse reviews the recommendations for physical therapy and applies the information to fall prevention strategies in the hospital. What discharge planning action by the nurse has not been address correctly? 1. Patient and family involvement in referral 2. Timing of referral 3. Incorporation of referral discipline recommendations into plan of care 4. Determination of discharge date

- 2. The nurse must make the referral as soon as possible. The other elements of discharge planning, including knowing the discharge date, involving the patient and family in decision-making, and incorporating the referral discipline's recommendations for the patient's care are part of discharge planning.

Which of the following nursing activities is provided in a secondary healthcare environment? 1. Conducting blood pressure screenings for older adults at the senior center 2. Teaching a patient with chronic obstructive pulmonary disease pursed-lipped breathing techniques at an outpatient clinic 3. Changing the postoperative dressing for a patient on a medical- surgical unit 4. Doing endotracheal suctioning for a patient on a ventilator in the medical intensive care unit

- 3. In secondary care the diagnosis and treatment of illnesses are traditionally the most common services. Secondary services are usually provided in an acute care setting. Inpatient medical-surgical units provide secondary care. Critical care units provide tertiary care.

Which activity performed by a nurse is related to maintaining competency in nursing practice? 1. Asking another nurse about how to change the settings on a medication pump 2. Regularly attending unit staff meetings 3. Participating as a member of the professional nursing council 4. Attending a review course in preparation for a certification examination

- 4. Attending a review course in preparation for a certification examination - Maintaining ongoing competency is a nurse's responsibility. Earning certification in a specialty area is one mechanism that demonstrates competency. Specialty certification has been shown to be positively related to patient safety.

Which of the following statements is true regarding Magnet status recognition for a hospital? 1. Nursing is run by a Magnet manager who makes decisions for nursing units 2. Nurse in Magnet hospitals make all the decisions on the clinical units. 3. Magnet is a term that is used to describe hospitals that are able to hire the nurses they need. 4. Magnet is a special designation for hospitals that achieve excellence in nursing practice.

- 4. Magnet® status is a process and review that hospitals go through that shows achievement of excellence in nursing practice. The designation is given by the American Nurses Credentialing Center and focuses on demonstration of quality patient care, nursing excellence, and innovations in professional practice.

Building a Nursing Team

- A strong nursing team works together to achieve the best outcomes for patients - Effective team development requires team building and training, trust, communication, and a workplace that facilitates collaboration

QSEN Building Competence in Patient-Centered Care Nathan, a new graduate nurse, Is assigned to care for a patient who had surgery yesterday for cancer. The plan is for the patient to be discharged home in two days. Identify strategies that Nathan can use to meet his patient's expectations.

- Answer: Nathan knows that meeting patient expectations is part of delivering patient-centered care. He first asks the patient about his expectations for his hospitalization but also for discharge. He also discusses to what extent the patient wants to be involved in decision making. Nathan can talk with the case manager/discharge planner regarding the patient concerns related to discharge. Nathan can work with the case manager/discharge planner to ensure that the patient has the resources and equipment needed for home care.

Assignment

- Assignment by a registered nurse (RN) to another register nurse (RN), For licensed vocational nurse (LVN or LPN) - Each state designates what can be delegated

How can interprofessional collaboration be accomplished?

- Can be accomplished through referrals to or consultations with other health care specialist and through patient care conferences involving members of all healthcare disciplines

Interprofessional Theory: Cognitive Continuum Theory (CCT)

- Can be used as a framework to assist interprofessional teams with clinical decision making

Patient centered care

- Care that is respectful of and responsive to individual patient preferences, needs, and values and ensures that patient values guide all clinical decisions - Critical component is the nurse, patient (Empower patient to become active participant in their care), and family caregiver partnering to Identify patient's healthcare needs

Nurse's Role in Interprofessional Collaboration

- Communicate patient needs to all members of the healthcare team - Clarify priorities - Ensure continuum of care

Communication: SBAR

- Formal method of hand-off communication between two or more healthcare team members

Supervision

- Guidance or direction, evaluation, and follow-up to ensure a task/activity is performed appropriately and safely - Examples: Turning and positioning, Vital signs, Intake and output measurements

Comparison of teams

- Inter (between) - Intra- inside of, within - Professional- One who is a specialist in a particular field or occupation - Inter-professional or Multidisciplinary - Multiple health workers from different professional backgrounds work together with patients, families, caregivers, and communicate to deliver the highest quality care - Responsibility for decision-making and problem-solving is shared - Leadership is based on expertise that matches the situation

Interprofessional Collaboration

- Is a complex process that is formed between two or more people from various professional fields to achieve common goals for a patient

Interprofessional Consultation

- Is a process in which a specialist is sought to identify methods of care or a treatment plan to meet the needs of a client

Teamwork

- Is defined by the Quality and Safety Education for Nurses (QSEN) initiatives as "functioning effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and share decision making to achieve quality patient care.

When is interprofessional consultation needed?

- Is needed when the nurse encounters a problem that cannot be solved using nursing knowledge, skills ,and available resources

Interprofessional collaboration is increasing as a result of ______________?

- More complex needs associated with chronic diseases - Increasing complexity of skills required to deliver care - Knowledge required to provide comprehensive care to patients - Increasing specialization within health professions

What is critical for interprofessional collaboration?

- Open communication, cooperation, trust, mutual respect, and understanding of team members roles and responsibilities are critical for a successful interprofessional collaboration

Delegation

- Process of transferring a task/activity to UAP (unlicensed assistive personnel) - The nurse is always accountable for the task/activity delegated!

Benefits of an Interprofessional Team

- Resource- more efficient use of resources ("All hands on deck") - Accountability- Increased - Shared responsibility- Increases accountability, resources, efficiency and team member buy-in - Cost- Decreased cost

Check Backs

- Restate what the person said to verify understanding by all team members

Call Outs

- Shout out important information for all team members to hear at one time

What are the four steps of SBAR?

- Situation - Background - Assessment - Recommendation/Request

Two-Challenge Rule

- State a concern twice as needed; It's ignored follow chain of command to get concerned addressed

Team STEPPS

- Team Strategies and Tools to Enhance Performance and Patient Safety

Features of successful teams

- Team members speak freely - Support each other - Effectively solve problems collaboratively - Work toward a common goal - Have clear roles and responsibilities - Have adequate information - Have adequate resources - Trust each other - Hold themselves mutually accountable for achieving the goal!

What are some other examples of interprofessional consultation?

- The rapid response team and the house supervisor (I nurse that helps determine where the patients go)

T/F Building an empowered nursing team begins with the nurse executive

- True - Transformational leadership

The World Health Organization (Who)

- Two or more people working interdependently toward a common goal

Interprofessional Education Collaborative (IPEC) Competencies

- Values/ethics for interprofessional practice - Role-responsibilities - Interprofessional communication (Communicate with everyone!) - Teams and Teamwork (Build on values and team dynamics; differences need to be strength)

Team

- a small number of people with complementary skills who are committed to a common purpose, performance goals and approach for which they are mutually accountable

Interprofessional collaboration involves all professionals bringing different points of view to the table to __________, __________, and __________ complex patient problems together, providing integrated and cohesive patient care.

- identify, clarify, and solve

Principles of Patient-Centered Care

-Respect for patients' values, preferences, and expressed needs -Coordination and integration of care -Information, communication, and education -Physical comfort -Emotional support and alleviation of fear and anxiety -Involvement of family and friends -Transition and continuity (where are they going when they leave the hospital) -Access to care

5 Rights of Delegation (TCPCS "Two Can Play Cops Suzy!")

1. Right task 2. Right circumstance 3. Right person 4. Right communication 5. Right supervision

TEEAMS

Time Empowerment Enthusiasm Appreciation Management Support

T/F Interprofessional consultation May be made to healthcare providers as medical specialist, surgeons, wound care specialist, Physical therapist, Occupational therapist, Social workers, clergy, hospice care, home health...

True

T/F: Interprofessional collaboration critical to the delivery of, safe patient care, and the creation of as positive work culture for practitioners.

True