Chapter 2: Nurse Qualities for Effective Collaboration
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Questions and Answers

What is the goal of case management?

  • Ignore continuity of care
  • Avoid fragmentation of care and control cost (correct)
  • Facilitate unnecessary costs and lengthy stays
  • Provide direct client care

    • Case manager nurses usually provide direct client care.

    False

    What is a referral in the context of healthcare?

    A formal request for a service by another care provider.

    Poor communication can lead to adverse outcomes, including sentinel events such as unexpected death or serious ________________.

    <p>injury</p> Signup and view all the answers

    What are some qualities that a nurse must have for effective collaboration?

    <p>Good communication skills, assertiveness, conflict negotiation skills, leadership skills, professional presence, decision-making and critical thinking</p> Signup and view all the answers

    Which of the following describes an interprofessional team?

    <p>A group of healthcare professionals from various disciplines</p> Signup and view all the answers

    Decentralized decision-making promotes job satisfaction among staff nurses. (True/False)

    <p>True</p> Signup and view all the answers

    Case management involves the coordination of care provided by an __________ team.

    <p>interprofessional</p> Signup and view all the answers

    Match the generations with their respective time periods:

    <p>Veterans (Silent Generation, Traditionals) = Born 1925 to 1942 Baby Boomers = Born 1942 to early 1960s Generation X = Born mid-1960s to early 1980s Generation Y (Millennial) = Born mid-1980s to 2000 Generation Z (Homelanders) = Born after 2001</p> Signup and view all the answers

    What is the purpose of discharge planning?

    <p>To ensure continuity of care and optimal client outcomes.</p> Signup and view all the answers

    What information should be included in a comprehensive discharge plan?

    <p>All of the above</p> Signup and view all the answers

    A client who leaves a facility without a prescription is not considered leaving against medical advice.

    <p>False</p> Signup and view all the answers

    The nurse should document all communication and __________ provided for the client.

    <p>specific advice</p> Signup and view all the answers

    What is the primary purpose of completing a referral form?

    <p>To obtain reimbursement for prescribed services</p> Signup and view all the answers

    Where should hand-off or change-of-shift reports be performed?

    <p>In a private area such as a conference room</p> Signup and view all the answers

    What is the primary role of a consultant in case management?

    <p>To provide expert advice in a particular area</p> Signup and view all the answers

    What is a critical component of maintaining continuity of care during client transfers?

    <p>Using communication hand-off tools</p> Signup and view all the answers

    What information should be included in a comprehensive transfer report?

    <p>Client medical diagnosis, care providers, demographic information, and overview of health status</p> Signup and view all the answers

    What is the primary goal of discharge planning?

    <p>To facilitate a smooth transition from one care setting to another</p> Signup and view all the answers

    What is the primary benefit of using communication hand-off tools?

    <p>Promoting continuity of care and client safety</p> Signup and view all the answers

    What is a critical component of a comprehensive discharge plan?

    <p>Client medical diagnosis, care providers, overview of health status, and recent progress</p> Signup and view all the answers

    What is the primary role of the nurse in case management?

    <p>To provide written and verbal reports of the client's status and care needs</p> Signup and view all the answers

    What is the primary goal of continuity of care?

    <p>To maintain consistency in client care across different settings</p> Signup and view all the answers

    What is the main benefit of decentralized decision-making in healthcare?

    <p>Enhanced job satisfaction among staff nurses</p> Signup and view all the answers

    What is the primary goal of fostering nurse-provider collaboration?

    <p>To create a climate of mutual respect and collaborative practice</p> Signup and view all the answers

    What is the advantage of using an interprofessional team in healthcare?

    <p>It allows for the achievement of results that a team member would be incapable of accomplishing alone</p> Signup and view all the answers

    What is a strategy a manager can use to promote change in healthcare?

    <p>All of the above</p> Signup and view all the answers

    What is the benefit of involving the client and their family/significant others in the development of an interprofessional plan of care?

    <p>It ensures that the client's needs and preferences are taken into account</p> Signup and view all the answers

    What is the primary goal of involving different levels of nurses and nurses with different areas of expertise in an interprofessional team?

    <p>To achieve a comprehensive understanding of the client's needs</p> Signup and view all the answers

    What is the primary benefit of using behavioral change strategies in healthcare?

    <p>It helps to overcome resistance to change</p> Signup and view all the answers

    What is the primary goal of nurse-provider collaboration?

    <p>To create a climate of mutual respect and collaborative practice</p> Signup and view all the answers

    What is the benefit of using an interprofessional team in healthcare?

    <p>It addresses multiple problems simultaneously</p> Signup and view all the answers

    What is the primary goal of promoting collaboration among healthcare providers?

    <p>To create a climate of mutual respect and collaborative practice</p> Signup and view all the answers

    Study Notes

    Nurse Qualities for Effective Collaboration

    • Good communication skills
    • Assertiveness
    • Conflict negotiation skills
    • Leadership skills
    • Professional presence
    • Decision-making and critical thinking

    The Nurse's Role in Coordinating Client Care

    • Coordinate the interprofessional team
    • Have a holistic understanding of the client, their health care needs, and the health care system
    • Provide the opportunity for care to be provided with continuity over time and across disciplines
    • Provide the client with the opportunity to be a partner in the development of the plan of care
    • Provide information during rounds and interprofessional team meetings regarding the client's status
    • Provide an avenue for the initiation of a consultation related to a specific health care issue
    • Provide a link to post-discharge resources that might be needed

    Collaboration with the Interprofessional Team

    • An interprofessional team is a group of health care professionals from various disciplines
    • Collaboration involves discussion of client care issues in making health care decisions, especially for clients who have multiple problems
    • The specialized knowledge and skills of each discipline are used in the development of an interprofessional plan of care that addresses multiple problems

    Variables that Affect Collaboration

    • Hierarchical influence on decision-making
    • Decision-making is also influenced by the facility hierarchy
    • In a centralized hierarchy, nurses at the top of the organizational chart make most of the decisions
    • In a decentralized hierarchy, staff nurses who provide direct client care are included in the decision-making process

    Planned Change

    • Planned change is important in health care because it enables the interprofessional team to replace unproven methods with evidence-based ones
    • Planned change might be a proactive way to improve care quality
    • Change might also be required by a regulatory board
    • Variables that affect whether change can fully take place include individual and organizational willingness, competing demands, and whether the change is meaningful
    • Lewin's change theory is a common model for promoting planned change, which has three stages: unfreezing, change/movement, and refreezing

    Pathway to Excellence Recognition

    • The American Nurses Credentialing Center awards Magnet Recognition to health care facilities that provide high-quality client care and attract and retain well-qualified nurses
    • The term magnet is used to recognize the facility's power to draw nurses to the facility and to retain them
    • Facilities must create a culture that uses 14 foundational forces of magnetism and model five key components

    Case Management

    • Case management is the coordination of care provided by an interprofessional team from the time a client starts receiving care until they no longer receive services
    • The goal of case management is to avoid fragmentation of care and control cost
    • Case managers collaborate with the interprofessional health care team during the assessment of a client's needs and subsequent care planning
    • Case managers follow up by monitoring the achievement of desired client outcomes within established time parameters

    Continuity of Care

    • Continuity of care refers to the consistency of care provided as clients move through the health care system
    • Continuity of care is desired as clients move from one level of care to another, from one facility to another, or from one unit/department to another
    • Nurses are responsible for facilitating continuity of care and coordinating care through documentation, reporting, and collaboration
    • A formal, written plan of care enhances coordination of care between nurses, interprofessional team members, and providers### Discharge Planning
    • Begin discharge planning upon the client's admission to ensure continuity of care.
    • Evaluate client/family competencies in relation to home care prior to discharge.
    • Involve the client and family in care planning to achieve optimal results.
    • Collaborate with other health care professionals to ensure all health care needs are met and necessary referrals are made.

    Hand-off or Change-of-Shift Report

    • Performed with the nurse who is assuming responsibility for the client's care.
    • Describes the current health status of the client.
    • Informs the next shift of pertinent client care information.
    • Provides the oncoming nurse the opportunity to ask questions and clarify the plan of care.
    • Should be given in a private area to protect client confidentiality.

    Transfers

    • Clients can be transferred from one unit, department, or one facility to another.
    • Continuity of care must be maintained during transfers.
    • The nurse's role regarding transfers is to provide written and verbal report of the client's status and care needs.

    Consultations

    • A consultant is a professional who provides expert advice in a particular area.
    • Consultants provide expertise for clients who require a specific type of knowledge or service.
    • The nurse's role regarding consultations is to initiate necessary consults, notify the provider of the client's needs, and provide the consultant with all pertinent information.

    Report to the Provider

    • Recommendations for changes in the plan of care.
    • Clarification of prescriptions.
    • Assessment data integral to changes in client status.

    Discharge Instructions

    • Step-by-step instructions for procedures to be done at home.
    • Medication regimen instructions for home, including adverse effects and actions to take to minimize them.
    • Precautions to take when performing procedures or administering medications.
    • Indications of medication adverse effects or medical complications that the client should report to the provider.
    • Plans for follow-up care and therapies.

    Discharge Planning

    • A comprehensive discharge plan includes a review of the client's current health and prognosis.
    • Mobility status and goals.
    • Sensory, motor, physical, or cognitive impairments.
    • Support systems and caregivers.
    • Potential supports and resources in the community.
    • Internal and external home environment.
    • Financial resources and limitations.
    • Need for assistance with transportation or home maintenance.
    • Need for therapy, wound care, or other services.

    Leaving Against Medical Advice (AMA)

    • A client who leaves a facility without a prescription from the provider is considered leaving against medical advice.
    • The nurse should immediately notify the provider.
    • If the client is at risk for harm, it is imperative that the nurse explains the risk involved in leaving the facility.
    • The individual should sign a form relinquishing responsibility for any complications that arise from discontinuing prescribed care.

    Standardized Nursing Care Plans

    • Standardized nursing care plans provide a starting point for the nurse responsible for care plan development.
    • Standardized plans must be individualized to each client.
    • All documentation should reflect the plan of care.

    Communication and Continuity of Care

    • Poor communication can lead to adverse outcomes, including sentinel events.
    • Communication is required anytime there is a transfer of care, whether from one unit or facility to another, or at change-of-shift.
    • Guidelines on transfer reporting contain details on what to communicate when transferring client care.

    Case Management

    • Case management is the coordination of care provided by an interprofessional team from the time a client starts receiving care until they no longer receive services.
    • The goal of case management is to avoid fragmentation of care and control cost.
    • A case manager collaborates with the interprofessional health care team during the assessment of a client's needs and subsequent care planning.

    Principles of Case Management

    • Continuity of care refers to the consistency of care provided as clients move through the health care system.
    • Continuity of care enhances the quality of client care and facilitates the achievement of positive client outcomes.
    • Case management focuses on managed care of the client through collaboration of the health care team in acute and post-acute settings.

    Transfers and Referrals

    • Clients can be transferred from one unit, department, or one facility to another.
    • Continuity of care must be maintained as the client moves from one setting to another.
    • The use of communication hand-off tools promotes continuity of care and client safety.
    • The nurse's role regarding transfers is to provide written and verbal report of the client's status and care needs.

    Referrals

    • A referral is a formal request for a service by another care provider.
    • Discharge referrals are based on client needs in relation to actual and potential problems and can be facilitated with the assistance of social services, especially if there is a need for nursing care.

    Consultations

    • A consultant is a professional who provides expert advice in a particular area.
    • The nurse's role regarding consultations is to provide written and verbal report of the client's status and care needs.

    Critical Pathways

    • A critical or clinical pathway or care map is used to support the implementation of clinical guidelines and protocols.
    • These tools are usually based on cost and length of stay parameters mandated by prospective payment systems (Medicare and insurance companies).
    • Critical pathways are often specific to a diagnosis type and outline the typical length of stay and treatments.
    • When a client requires treatment other than what is typical or requires a longer length of stay, it is documented as a variance, along with information describing why the variance occurred.

    Documentation

    • Documentation to facilitate continuity of care includes graphic records that illustrate trending of assessment data (vital signs).
    • Flow sheets that reflect routine care completed and other care-related data.
    • Nurses' notes that describe changes in client status or unusual circumstances.
    • Client care summaries that serve as quick references for client care information.
    • Nursing care plans that set the standard for client care.

    Collaboration

    • Collaboration involves discussion of client care issues in making health care decisions, especially for clients who have multiple problems.
    • The specialized knowledge and skills of each discipline are used in the development of an interprofessional plan of care that addresses multiple problems.
    • Collaboration occurs among different levels of nurses and nurses with different areas of expertise.
    • Collaboration should also occur between the interprofessional team, the client, and the client's family/significant others when an interprofessional plan of care is being developed.
    • Collaboration is a form of conflict resolution that results in a win-win solution for both the client and health care team.

    Variables That Affect Collaboration

    • Hierarchical influence on decision-making: in a centralized hierarchy, nurses at the top of the organizational chart make most of the decisions.
    • In a decentralized hierarchy, staff nurses who provide direct client care are included in the decision-making process.
    • Large organizations benefit from the use of decentralized decision-making because managers at the top of the hierarchy do not have firsthand knowledge of unit-level challenges or problems.
    • Decentralized decision-making promotes job satisfaction among staff nurses.

    Promoting Change

    • Three strategies a manager can use to promote change are the rational-empirical, normative-reeducative, and the power-coercive.
    • Often the manager uses a combination of these strategies.
    • Rational-empirical: the manager provides factual information to support the change, used when resistance to change is minimal.

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    Description

    This quiz assesses the knowledge of nurses on effective collaboration and communication skills for quality client care. It covers aspects like good communication skills, assertiveness, and coordination in healthcare settings.

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