Nursing & Collaborative Care

• Modern healthcare necessitates collaboration among professionals for optimal patient care.
• Collaboration involves pooling skills, knowledge, and resources to enhance patient outcomes.
• It's a dynamic process that includes patients working with healthcare providers (HCPs) to achieve health goals.
• Interprofessional Education (IPE) is gaining traction to prepare healthcare students for collaborative practice.

Nursing & Collaborative Care

• Virginia Henderson defined collaboration as a partnership among doctors, nurses, other HCPs, patients, and families.
• The QSEN competencies include teamwork and collaboration, patient-centered care, evidence-based practice, quality improvement, safety, and informatics.
• ANA standards emphasize collaboration as essential to nursing practice.
• The NLN advocates for interprofessional education in nursing programs.

QSEN: Teamwork & Collaboration

• Knowledge: Recognize personal strengths/limitations, understand roles of team members, communication styles, and the impact of team function on patient safety. Also, identify system barriers.
• Skills: Demonstrate self-awareness, function within your scope of practice, communicate effectively to resolve conflict, minimize risk during handoffs, and design supportive systems.
• Attitudes: Value collaboration, respect contributions, actively participate in conflict resolution, acknowledge transition risks, and value systems solutions.
• Essential Aspects: Grasp team roles, communication styles, the effect of team functioning on patient safety, and identify system barriers.

Interprofessional vs. Interdisciplinary Teams

• Interprofessional teams involve professionals from various disciplines.
• Interdisciplinary teams include paraprofessionals as well.
• The term 'interprofessional' encompasses all professionals, support staff, patients, and families.

Nurse as a Collaborator

• Collaboration occurs amongst nurses, between HCPs and patients (shared decision-making), and between HCPs from different backgrounds (team-based care).
• Nurses are involved in community initiatives, policy development, legislation, and health-related research.
• Registered Nurses (RN) use the nursing process to assess, identify concerns, and create care plans.
• Licensed Practical/Vocational Nurses (LPN/LVN) provide basic care under supervision.
• Advanced Practice Registered Nurses (APRNs) can diagnose and treat health problems. APRNs include Nurse Practitioners (NP), Clinical Nurse Specialists (CNS), Certified Registered Nurse Anesthetists (CRNA), and Certified Nurse Midwives (CNM).
• Unlicensed Assistive Personnel (UAP) provide supportive care under a licensed nurse's delegation.
• Complementary Healthcare Providers use non-mainstream practices alongside conventional medicine.
• Case Managers coordinate patient care across various settings to ensure quality and cost-effectiveness.
• Dentists promote oral health, diagnosing, and treating conditions of the teeth and oral cavity.
• Dietitians or Nutritionists manage medical nutrition therapy. Registered Dietitians (RD) are board-certified while Nutritionists may lack formal credentials.
• Information Technologists (IT) manage patient health information systems, ensuring data privacy and security.
• Occupational Therapists (OT) help individuals regain daily living and work skills.
• Medical Technologists perform diagnostic and therapeutic tests and analyze samples.
• Pharmacists prepare and dispense medications, educating patients and optimizing treatment plans.
• Physical Therapists (PT) assess and treat musculoskeletal conditions to enhance mobility and reduce pain.
• Physicians diagnose and treat diseases or injuries and aim to prevent/delay illness.
• Physician Assistants' (PA) scope of practice depends on state law and facility policies.
• Respiratory Therapists (RT) treat conditions affecting breathing.
• Social Workers provide counseling, advocacy, and resource referrals.
• Speech–Language Pathologists (SLP) identify and treat communication or speech disorders.
• Nurse supports patient autonomy, collaborates with peers and other HCPs, engages in research, and collaborates with nursing organizations and legislators.

Benefits of Collaboration

• For Healthcare Organizations: Increased efficiency, higher staff retention, and cost-effectiveness.
• For Patients: Enhanced safety, lower morbidity/mortality, increased autonomy & satisfaction.
• For Nurses: Greater autonomy, improved job satisfaction, increased professionalism.
• Health Policy: Leadership support for policies improves the working environment, increasing job satisfaction.
• Healthcare Systems: Enhanced team collaboration reduces service duplication and cuts costs; nurses should promote effective communication and join interprofessional committees.
• Professionalism: Nurse-physician collaboration fosters autonomy and professionalism; educate teams on nursing roles.
• Quality Improvement: Increased situational awareness and teamwork enhance QI; nurses identify safety threats through open communication.
• Safety: Collaboration reduces morbidity and mortality; nurses participate in team meetings and express concerns.

Core Competencies of Collaboration

• Values & Ethics: Mutual respect, trust, and respect for diversity.
• Roles & Responsibilities: Understand contributions of others to enhance patient care.
• Communication Skills: Standardized strategies include SBAR, Call-out, Check-back, CUS, Two-Challenge Rule, and I PASS THE BATON.
• Teamwork & Collaboration: Include patients and families as team members.

Conflict Prevention & Management

• Conflict is a normal part of the work environment.
• Types of Conflict: Intrapersonal, Interpersonal, Intergroup, Interorganizational.
• Responses to Conflict: Competing, Collaborating, Compromising, Avoiding, Accommodating.
• Conflict Competence: Ability to manage conflict depending on the situation.
• Responding to Conflict: Honesty, respect, objective statement, active listening, and focus on solutions.

Nurse-Physician Relationship

• Shift from subservient to collegial.
• Barriers: Power struggles, communication gaps, perspectives, hierarchal relationships.
• Solutions: Interprofessional education, interdisciplinary rounding, mutual respect, common goals.

Conflict with Patients & Families

• Causes: anxiety, fear, lack of knowledge, frustration, meds, dementia, pain, culture
• Management Strategies: Remain calm and empathetic, engage the patient, set boundaries, report escalation.

Workplace Conflict

• Prevention: Be aware of personal and situational cues.
• Strategies: Address issues, avoid criticism, maintain a calm demeanor, practice active listening.
• Prevention for Nursing Leaders: Allocate resources fairly, define roles, encourage feedback, acknowledge accomplishments.
• Stress reduction: know what triggers you, practice mindfulness
• Use TeamSTEPPS and Crew Resource Management.

Workplace Incivility & Bullying

• Incivility: Rude behaviors.
• ANA Code of Ethics: Promote civility, create a respectful environment and focus on patient centered care.
• Bullying: Verbal attacks, refusal to help.
• Bullying impacts patient, nurse, and organizational outcomes.
• Prevention: Education, codes of conduct, zero tolerance, reporting.
• Responding to Bullying: Prioritize the safety; respond with assertive, non-threatening language.
• Nurses must report bullying & incivility.
• AACN Healthy Work Environment Standards: Skilled communication, collaboration, decision-making, staffing, recognition, and leadership.
• Strategies to Prevent Bullying: Zero-tolerance policies, clear reporting systems, cognitive rehearsal, and TeamSTEPPS.

Interprofessional Collaborative Practice Models

• Objectives: Patient-directed care, continuity, satisfaction, cost-effectiveness, respect, communication.
• Benefits: Empowers patients, adherence, decrease costs, length of stay, improved staff skills.
• Settings: Hospitals, schools, mental health programs, elder care programs.