Collaboration

Collaboration

2 or more individuals working toward a common goal by combining their skills, knowledge, and resources while avoiding duplication of effort In a healthcare environment, the common goal of each team is to improve client outcomes, whether the client is an individual, group, or a community Becomes a dynamic, interactive process in which clients (individuals, groups, or communities) work together with physicians, nurses, and other healthcare providers to meet their health objectives

Group

3 or more individuals who share a common purpose, and who interdependently interact with and influence one another

Verbal abuse

A form of workplace bullying that entails malicious, repeated, harmful mistreatment of an individual you work with, regardless of rank

Horizontal violence

A form of workplace bullying that involves aggressive acts committed against a nurse by one or more nursing colleagues EX: gossiping, speaking sarcastically to nurse who is the target, ignoring the individual

more members of a team often share the leadership role

A team's hierarchy is ___________ (more/less) flexible than that of a group

within; outside

According to ANA, collaboration in nursing practice includes identifying and acknowledging the expertise of individuals both __________ and _________ one's profession

Accommodation

Approach to responding to conflict in which an individual tries to make a situation better by cooperating with individual with whom he/she is in conflict with Goal is to eliminate the conflict ASAP, despite the fact that it will not resolve the conflict

Competition

Approach to responding to conflict in which power is used to stop the conflict You are forced to accept that it will be this way --> manager saying "This is the way it will be."

Avoidance

Approach to responding to conflict in which the individual withdraws from a stressful situation due to extreme levels of discomfort and inability to cope

autonomy

Both clients and nurses perceive a greater sense of _______________ when collaborative strategies are applied

increased

Bullying is linked to _____________ rates of employee absenteeism, work related injuries, and decreased productivity

1. miscommunication 2. inaccurate information 3. mistrust 4. ambiguous role expectations 5. ineffective teamwork 6. inadequate project planning 7. ineffective leadership 8. resistance to change

Causes of conflict include:

1. Common purpose and goals identified in beginning 2. Clinical competence of each provider 3. Interpersonal competence 4. Humor 5. Trust 6. Valuing and respecting diverse, complementary education

Characteristics of effective collaboration include:

reciprocal

Clients and healthcare professionals interact in a _______________ relationship -- instead of making decisions about the client's health care, healthcare professionals engage in joint decision making with the client

Self-determination

Clients have a right to _______-____________________ -- that is, the right to choose to participate or not to participate in healthcare decision making

Team based health care

Collaborative delivery of high-quality, interdisciplinary services to individual clients, families, and their communities by 2 or more healthcare providers working with clients towards a common goal

Parallel functioning

Communication may be more coordinated, but each professional has separate interventions and a separate plan of care

Parallel communication

Communication that occurs when each professional communicates with the client independently and asks the same or similar questions

1. effective communication skills 2. giving and receiving feedback 3. mutual respect 4. trust 5. decision making 6. conflict management

Competencies for collaboration include:

Interorganizational conflict

Competition between two organizations that exist in one market EX: two hospitals in the same community

Covert conflict

Conflict that is not discussed openly; avoided or ignored Exhibited in reactive, repressive, and avoidance behaviors

Intergroup conflict

Conflict that occurs between teams in competition or opposition to one another EX: Competition between nurses and physicians for the APRN act (control of who APRN's should be under)

Interpersonal conflict

Conflict that occurs between two or more individuals, could be due to differences, competition, control, or loss EX: misunderstanding of roles or responsibility of another team member

Intrapersonal conflict

Conflict that occurs within an individual, could present as stress or tension from real or perceived pressures for meeting goals EX: student nurses and grades OR choosing a job that interferes with family responsibilities

1. referral - highest level 2. upper-management 3. consultation 4. coordination 5. information exchange 6. parallel functioning 7. parallel communication - lowest level

Continuum of collaboration:

Case management

Describes a range of models for integrating healthcare services for individuals or groups; involves multidisciplinary teams that assume collaborative responsibility for assessing needs, planning and coordinating, implementing, and evaluating care for groups of clients from preadmission to discharge or transfer

Overt conflict

Discussed conflict openly

1. Local, national, or international professional organizations 2. Organizational teams working to improve the structure and processes related to health care 3. Teams involving the nurses in a single unit

Examples of nurse interdisciplinary teams:

morning rounds when change in client condition

Examples of nurses as members of intradisciplinary teams?

Positive feedback

Feedback characterized by a communication style that is warm, caring, and respectful

Intradisciplinary teams

Formed by members of the same profession who work toward achieving a common goal

Interdisciplinary teams

Formed by professionals with varied backgrounds who seek to achieve a common goal

1. high quality care 2. client satisfaction 3. limit costs 4. enhance continuity of care 5. promote mutual respect, communication, and understanding between client and members of healthcare team 6. provide opportunities to address and solve system-related issues

Goals of collaboration/interprofessional education include:

Interdisciplinary team

Group consisting of three or more individuals who share a common purpose and who interdependently interact with and INFLUENCE one another

high

Groups experience a _________ (high/low) level of accountability for each member

1. acknowledge, support, encourage, and advocate for clients' active involvement in healthcare decisions 2. encourage/empower client autonomy 3. provide the client with consultation in a collaborative fashion 4. effective collaboration for client promotes safety, resulting in decreased morbidity and mortality rates, increased autonomy which improves patient satisfaction

How do nurses collaborate with clients?

1. recognizes contribution that each member has in interdisciplinary team 2. listens to each individual's view 3. shares healthcare responsibilities with other team members to explore care options 4. participates in interdisciplinary research to increase knowledge of a clinical problem 5. if effective, increased effiency and cost effective

How do nurses collaborate with other healthcare professionals?

1. Share personal expertise and knowledge with other nurses 2. elicits expertise of others to ensure high quality care 3. develops trust and mutual respect with peers 4. recognizes unique contributions of others 5. If effective at collaborating, increased sense of perceived autonomy and professionalism and greater job satisfaction

How do nurses collaborate with peers?

1. Set limits - "I can see you are upset and I want to help you, but I need you to stop using that language." 2. Active listening and clear communication 3. Empathy and consideration are helpful but abusive behavior is never acceptable 4. Report any aggressive acts immediately to the team leader or charge nurse

How to manage conflict with clients and families:

Negative feedback

Implies not negative content but feedback given in rather a negative communication style, such as an attitude of condescension

LISTEN

In order to receive and give meaningful feedback, one must:

Interprofessional teams

Interdisciplinary teams that are composed of individuals with a variety of professional backgrounds

Information exchange

Involves planned communication, but decision making is unilateral, involving little if any collegiality

Multidisciplinary team approach

Members typically work together to deliver client care, but a single team member -- usually the physician -- makes the treatment decisions

verbally; nonverbally

Mutual respect and trust must be expressed both ______________ and ________________ EX: may verbalize respect or trust but demonstrate a lack of trust/respect through their actions

client peers other healthcare professionals

Nurses are collaborators with who?

Conflict

Occurs when agreement cannot be reached on significant issues and concerns Can be between individuals, nurses, healthcare team members, family members, patient; can be on a unit or between departments on a unit

Trust

Occurs when an individual is confident in the actions of another individual

Mutual respect

Occurs when two or more individuals show or feel honor or esteem toward one another

Collaboration

Positive approach to responding to conflict where all parties attempt to reach an acceptable solution; involves some compromise

Critical pathways (AKA care maps)

Refer to the expected outcomes and care strategies developed through collaboration by the healthcare team Accommodate the unique characteristics of the client and the client's condition while making use of the predictable characteristics of the course of the client's disease or injury

Collegial relationships

Relationships with equality of power Each group's power is different but equal

Collaborative relationships

Relationships with mutual power but the physician's power is greater

Coordination/consultation

Represent midrange levels of communication seeking to maximize the efficiency of resources

decreased

Sound application of collaborative strategies lead to ______________ client morbidity and mortality rates

1. accountability 2. scope of practice 3. role boundary issues

Sources of conflict include:

Team

Specialized group of people; individuals who agree to work in tandem to accomplish a common goal

Covert

Sustained _____________ (overt/covert) conflict results in increased stress, distress, and confusion about how to address conflict

TRUE

T or F: Although clients lack expert knowledge, they have their own ideas about health and illness and healthcare professionals need to understand these ideas to be able to effectively help the client

TRUE

T or F: Collaboration involves negotiating and seeking consensus rather than questioning and ordering

TRUE

T or F: Conflict cannot be eliminated, but can be managed

FALSE! Not always Can be an impetus for better communication, stronger team relationships, and healthy changes

T or F: Conflict is destructive

TRUE

T or F: Conflict is inevitable

TRUE

T or F: Effective communication can only occur if each team member is committed to understand each member's professional role and appreciating each member as an individual

FALSE

T or F: Group is synonymous with team

TRUE

T or F: Groups exist to help individuals achieve goals that might not be attainable by individual effort alone

TRUE

T or F: Placing the head of the nursing department on an equal managerial level with the chief of physicians has been found to improve mutual respect between physicians and nurses, thereby improving their relationships

TRUE

T or F: Responsibility for the client's health falls on the client rather than the healthcare professional

TRUE

T or F: There is greater overall job satisfaction and greater overall satisfaction of care with collaboration

TRUE

T or F: Today's healthcare consumers have greater knowledge about their health than consumers did in the past; as a result, they increasingly are influencing healthcare delivery and assuming more responsibility for their health

TRUE

T or F: Within an interdisciplinary team, a nurse can play a variety of roles including team leader, client advocate, data gatherer, policy writer, and educator

intradisciplinary teams

Teams formed by members of the same profession

interdisciplinary teams

Teams made up of professionals with varied backgrounds

Collaboration

The development of partnerships to achieve the best possible outcomes that reflect the particular needs of the patient, family, or community requiring an understanding of what others have to offer

Communicator style

The manner in which one communicates and includes the way in which one interacts

Feedback

The response the receiver of a message gives to the message's sender

Co-management/referral

Upper levels of collaboration, where 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

increases decreases decrease

When clients become informed consumers and actively participate with the healthcare team in the decision making process, quality of life improves and everyone - including the organization and healthcare system - benefits Adherence to therapeutic regimen _____________ Length of stay _____________ Overall costs to the system ___________

Nurse-physician relationship

Which relationship needs to be one of the strongest relationships for nurses to meet the needs of clients, but is often times not?

Because it is discussed openly

Why is coping with overt conflict easier?

equality

______________ among human beings is desired in collaborative healthcare relationships -- the ideas of both clients and healthcare professionals receive an equal hearing