Intra and Interprofessional Collaboration: Delegation of Nursing Care – Flashcards
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Intra and interprofessional collaboration both focus on
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client centered care
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Inter professional
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across disciplines (RN, RPN, LPN) etc.
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Intra professional
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only within RN for example
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What is interprofessional collaboration?
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- the process of developing and maintaining effective interprofessional working relationships with learners, practitioners, patients/clients/families and communities to enable optimal health outcomes
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Elements of collaboration include
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- respect - trust - shared decision making - partnerships
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The integration of role clarification, team functioning, collaborative leadership, and a patient/client/family/community centered focus to care or provide services is supported through interprofessional communication
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- ability of teams to deal with conflicting viewpoints and reach reasonable compromises
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Examples in primary care of interprofessional collaboration
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- family health teams - CCAC - community health centres - nurse practitioner led clinics - children's outpatient centres - CLSCs (quebec) - Shared care model - family practice nurses and family practice physicians (NS) - primary care network (AB)
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Six Competency Domains
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1. interprofessional communication 2. patient/client/family/community centered care 3. role clarification 4. team functioning 5. collaborative leadership 6. interprofessional conflict resolution
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Interprofessional Communication
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- learners/practitioners from different professions communicate with each other in a collaborative, responsive and responsible manner
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Elements of interprofessional communication
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- establish team work communication principles - active listening to other people - including patients/clients/families - ensure common understanding of care decisions - develop trusting relationships - effectively use ICT (information, communication and technology)
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The four communication skills
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1. thinking 2. listening 3. speaking 4. non-verbal
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Verbal
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- speaking words, tone, accuracy of message - tone is more influential than the content
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Non-verbal
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- facial expression even more important than either tone or words used
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Attending
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- active listening; eye contact; non-verbal cues; full attention
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Responding
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- verbal/non-verbal acknowledgement of message; nod while listening; note message received
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Clarifying
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- restate, question and rephrase
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Confronting
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- work jointly with others to resolve problem or conflict
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Communication barriers
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- language - cultural barriers - age, gender, generation gap, values, and religion - lack of insight/knowledge - not knowing skills and competencies of other professions - power imbalance - stress - distractions - emotions and personality - poor planning - workload - level of experience
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Communication Pitfalls
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- getting emotionally involved - judging the person prior to letting them speak - defensive - always blaming other people for mistakes - making others wrong - advice giving - patronizing - giving false reassurance - constantly questioning a colleague - blaming others
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What are techniques developed by organizations to improve communication?
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1. debriefings/huddles 2. assertive language 3. critical language
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Debriefings/huddles
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- used to identify what happened in a particular circumstance, what was learned, and what can be done better next time - allow team to determine how members are feeling about processes and recognizes opportunities for improvement
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Assertive language
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- persistent, polite, timely, clear and solution focused - two challenge rule: concern is stated at least 2 times to ensure it has been heard i.e. CUS = - I'm CONCERNED - I'm UNCOMFORTABLE - This is a SAFETY issue
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Critical language
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- flags the immediacy of a concern to members of the team - ensures that specific, relevant, critical information is communicated each time a patient is discussed - SBAR is used in clinical handovers, valuable with nurse-physician communication
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SBAR
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situation, background, assessment, recommendation
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Patient/Client/Family/Community Centered Care
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- learners or practitioners seek out, integrate and value as a partner, the input and the engagement of the patient/client/family and/ or the community in designing and implementing care and services
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Elements of Patient/Client/Family/Community Centered Care
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- support their participation - share information with patients/clients in a respectful manner and in such a way that it is understandable, encourages discussion and enhances participation in decision making - ensure that appropriate education and support is provided to patients/clients, family members - listen respectfully to the expressed needs of all parties in shaping and delivering care or services
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Role Clarification
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- learners/practitioners understand their own rule and the roles of those in other professions and use this knowledge appropriately to establish and achieve patient/client/family and community goals
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Elements of Role Clarification
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- describing their own role and that of others - recognizing and respecting the diversity of other health and social care roles, responsibilities and competencies - performing their own roles in a culturally respective way - communicating roles, knowledge, skills and attitudes using appropriate language - accessing others' skills and knowledge appropriately through consultation - considering the roles of others in determining their own professional and interprofessional roles - integrating competencies/roles seamlessly into models of service delivery
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What are you allowed to do legally or not allowed to do?
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- its within the law and interpreted by the CNO - CNO defines role clarification - employer then decides the specific roles with regards to scope of practice
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Team functioning
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- learners/practitioners understand the principles of team work dynamics and group/team processes to enable effective interprofessional collaboration
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Elements of team functioning
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- understand the process of team development - develop a set of principles for working together that respects the ethical values of members - effectively facilitate discussions and interactions among team members - participate and be respectful of all members' participation in collaborative decision making - regularly reflect on their functioning - establish and maintain effective and healthy working relationships whether or not a formalized team exists - respect team ethics, including confidentiality, resource allocation and professionalism
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When a group or team is formed...
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- Adjourning - Forming - Storming - Norming - Performing
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Dysfunctional Team Members
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1. self appointed expert 2. criticizer 3. passive 4. detailer 5. controller 6. pleaser 7. shy 8. selfish
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Self appointed expert
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- knows it all and is righteous
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Cirticizer
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- find fault with everything; likes to argue
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Passive
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- really can't take a stand
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Detailer
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- caught in facts; hard to see the big picture and move forward
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Controller
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- monopolize discussion
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Pleaser
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- wants to please everyone
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Shy
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- someone who doesn't speak up
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Selfish
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- someone who doesn't want to be a team player
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Collaborative leadership
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- learners/practitioners understand and can apply leadership principles that support a collaborative practice model
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Elements of collaborative leadership
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- work with others to enable patient/client outcomes - advancement of interdependent working relationships among all participants - facilitation of effective team processes - facilitation of effective decision making - co-creation of a climate for shared leadership and collaborative practice - application of collaborative decision-making principles - integration of the principles of CQI to work processes and outcomes
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Interprofessional Conflict Resolution
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Learners/practitioners actively engage self and others, including the client/patient/family, in positively and constructively addressing disagreements as they arise
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Elements of interprofessional conflict resolution
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- valuing the potential positive nature of conflict - recognizing the potential for conflict to occur and taking constructive steps to address it - identifying common situations that are likely to lead to disagreements or conflicts - knowing and understanding strategies to deal with conflict - setting guidelines for addressing disagreements - effectively working to address and resolve disagreements - establishing a safe environment in which to express diverse opinions - developing a level of consensus among those with differing views; allowing all members to feel their viewpoints have been heard no matter what the outcome
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Preventing and Managing Conflict as Individuals (the iceberg of conflict)
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- issue - personality - emotions - interests, needs, and desires - self-perceptions and self-esteem - hidden expectations - unresolved issues from the past
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Preventing conflict
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- promote a respectful work environment - mentor, support and integrate new staff members into the practice setting - reflect on personal attributes, motivators, values and beliefs that affect relationships with colleagues, identify personal areas in need of improvement - recognize that personal stress may affect professional relationships and take steps to manage that stress
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Words that promote conflict
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- you must/should - it's your fault - do NOT do this - sarcastic/endearing terms - false reassurance - slurs/inappropriate language - this is so typical of you - you always/you never - the problem is - you'll never change
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Most conflict arises from
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simple misunderstandings, poor choices of language, ineffective conflict management styles, unclear roles and responsibilities, miscommunication and poor leadership
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Conflict Management Styles
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1. Avoidance 2. Accommodation 3. Aggression, domination, and/or competing 4. Compromise 5. Collaboration
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Avoidance
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- withdraw from the situation; maintain neutrality; goal is to delay
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Accommodation
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- satisfy others' needs and concerns over your own; maintain harmony; goal is to yield
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Aggression, Dominance, Competing
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- being assertive and pursuing your own concerns; win/lose power struggle; goal is to win
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Compromise
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- minimally acceptable to all; relationships undamaged; goal is to find middle ground
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Collaboration
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- expand range of possible options; achieve win/win outcomes; goal is to find a win/win solution
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Effective Management of Conflict
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- Address conflict directly rather than avoiding or postponing its resolution - Focus on the behaviours that lead to the conflict rather on the colleague personally - Validate assumptions through open dialogue with colleagues rather than acting on misperceptions or assumptions - Collaborate with colleagues to identify the underlying cause of the conflict - In some situations, a neutral party may be necessary
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Self Awareness During Conflict
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- listen, ask questions, make a commitment to resolving the conflict - pay attention to the way you are when in conflict - choose to listen and learn - both to your own internal voice and to the voice of your colleague - alter the way you act, by exploring options, separating problems from people, exploring the reasons for your own resistance - decide to be a leader in your own conflicts
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Leadership - preventing conflict
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- make conflict resolution a priority among all staff members - empower staff members to resolve problems - provide nurses with greater autonomy by participating in decision making and opportunities for professional development - foster positive relationships, trust and respect - recognize contributing factors to conflict - help staff members to develop conflict-management interventions - recognize that change can precipitate conflict - seek learning opportunities
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Leadership - managing conflict
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- offer a confidential environment for staff to report episodes of conflict - deal with reports promptly, fairly and confidentially - ensure that appropriate follow up procedures are in place
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The goal is find your own way ...
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by moving into your conflicts, seeing what works, what needs to be done differently and being courageous enough to learn and alter your approach as you go
