Dynamics within the Profession BNUR 1001 PDF

Dynamics within the Profession BNUR 1001 October 22, 2024 Peter Kennedy RN, BScN, MBA Learning Objectives  Explain the RNAO Conceptual Model of Healthy Work Environments  Describe the roles, values, and behaviours that support intra-professional collaborative practice in nursing  Describe t...

Dynamics within the Profession BNUR 1001 October 22, 2024 Peter Kennedy RN, BScN, MBA Learning Objectives  Explain the RNAO Conceptual Model of Healthy Work Environments  Describe the roles, values, and behaviours that support intra-professional collaborative practice in nursing  Describe the parameters, settings, and professionals involved in interprofessional care  Describe the nurse’s role on an interprofessional care team  Identify enablers and barriers to intra-professional and interprofessional care  Explain the process of delegation and the requirements for accepting a delegation from other health care providers  Identify Conflict Management strategies to apply with intra-professional and interprofessional care teams  Describe the impact of communication style on group dynamics among professionals Practice Standard: Code of Conduct (CNO, 2023) Principle 4: Nurses work respectfully with the health care team to best meet clients’ needs In this principle, nurses are accountable to one another and are expected to build and maintain respectful relationships with the health care team. To do this, nurses are expected to model the following core behaviours:  4.1 Nurses self-reflect on how their privileges, biases, values, belief structures, behaviours and positions of power may impact relationships with health care team members.  4.2 Nurses identify and do not act on any stereotypes or assumptions they may have about health care team members.  4.3 Nurses address health care team members by their preferred name, title and pronoun.  4.4 Nurses recognize many identity factors and personal attributes, including those identified in the Ontario Human Rights Code, may impact a health care team member, their lived experience and perspective on nursing and health care.  4.5 Nurses demonstrate professionalism and treat all health care team members with respect in all contexts, including on social media. Practice Standard: Code of Conduct (CNO, 2023) Cont’d Principle 4: Nurses work respectfully with the health care team to best meet clients’ needs  4.6 Nurses collaborate and communicate with the health care team in a clear, effective, professional and timely way to provide safe client care.  4.7 Nurses do not physically, verbally, emotionally, financially, or sexually harass or abuse health care team members.  4.8 Nurses support, mentor and teach health care team members.  4.9 Nurses assess the learning needs of health care team members they are teaching, supervising and/or assigning. Nurses determine whether individuals have the proper knowledge, skill and judgment to perform safe nursing care.  4.10 Nurses delegate nursing care so it upholds the expectations outlined in the Nursing Act, 1991. Nurses do not direct health care team members to perform nursing care they are not adequately educated for or competent to perform.  4.11 Nurses provide and accept feedback from the health care team to support positive client outcomes and effective team performance.  4.12 Nurses contribute to a safe organizational culture.  Healthy Work Environments (RNAO) "a practice setting that maximizes the health and well-being of nurses, quality patient outcomes and organizational and system performance".  Evidence shows that healthy work environments yield financial benefits to organizations in terms of reductions in absenteeism, lost productivity, organizational health-care costs and costs arising from adverse patients/clients outcomes (Aldana, 2001). Conceptual Model of Healthy Work Environments for Nurses (RNAO) Conceptual Model of Healthy Work Environments for Nurses (RNAO)  The Conceptual Model for Healthy Work Environments for Nurses presents the healthy workplace as a product of the interdependence among individual (micro level), organizational (meso level) and external (macro level) system determinants as shown in the three outer circles.  At the core of the circles are the expected beneficiaries of healthy work environments for nurses, patients/clients, organizations and systems, and society as a whole, including healthier communities.  The lines within the model are dotted to indicate the synergistic interactions among all levels and components of the model.  Collaborative Practice A joint venture or cooperative endeavour that ensures a willingness to participate. This relationship involves shared planning and decision making, based on knowledge and expertise rather than on role and title (RNAO). Collaborative Practice (WHO)  The World Health Organization defines collaborative practice in health-care as occurring “when multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, carers and communities to deliver the highest quality of care across settings,” and interprofessional education as occurring “when two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes.”  World Health Organization, 2010 as cited in Canadian Nurses’ Association, n.d. Intra-professional Collaboration Individual/Team  Learn about supportive teams, what is teamwork, collaborative practices, open honest and transparent communication, supportive learning environments Organizational  Enable teamwork, have policies to support, assess effectiveness of work – staffing, absenteeism, infection rates, eliminating obstacles RNAO Intraprofessional collaborative practice  Interprofessional Collaboration Why is interprofessional collaboration an essential component within the nursing profession?  Critical for improving access to client centered CNA Position care in Canada Statement: Interprofessional Collaboration https://www.cna- https://www.cna-aiic.ca/en/nursing/nursing-tools-and-resources/interprofessional-collaboration aiic.ca/en/nursing/nursing-tools-and- https://www.cna-aiic.ca/en/nursing/nursing-tools-and-resources/interprofessional-collaboration resources/interprofessional- https://www.cna-aiic.ca/en/nursing/nursing-tools-and-resources/interprofessional-collaboration collaboration https://www.cna-aiic.ca/en/nursing/nursing-tools-and-resources/interprofessional-collaboration  Benefits to Interprofessional Collaboration  Improved communication  Improved patient outcomes  Improved efficiency (both human and economic resources)  Provides a more holistic approach to patient care  Fosters a culture of non-hierarchy  System, organizational and individual/team  Effective interprofessional teamwork is part of a healthy work environment Interprofessional Collaboration Framework This framework comprises a set of six competency domains that focus on the development and integration of attitudes, behaviors, values, and judgments necessary for collaborative practice. These domains are:  Role clarification  Team functioning  Interprofessional communication  Patient/client/family/community- centered care  Interprofessional conflict resolution  Collaborative leadership Canadian Interprofessional Health Collaboration (CIHC) Value Proposition Interprofessional Collaboration (CNA)  Client centered care – collaboration amongst clients’ nurses and other care professionals to optimize health and wellness of clients.  Evidence informed decision making- use of best practice guidelines, protocols and resources will support  Access to the most appropriate health care provider at the right time and the right place, support continuity of care and the continuity of the health care provider  Epidemiology- using demographics and health status of clients will ensure the relevance of health services and the identification of health professionals  Social justice and equity – linking interprofessional collaborative care to social justice, equity and determinants of health, supports health promotion  Ethics- each profession brings own set of competencies – learn from each other in ways that enhance the effectiveness of their collaborative efforts  Value Proposition Interprofessional Collaboration (RNAO)  More effective teams produce better outcomes  Collaborative teams are more effective than individual health-care providers  Patients/clients are an integral part of interprofessional teams  The total expertise of team members is greater than the sum of its parts and produces better outcomes  Services are holistic and coordinated across the full spectrum of providers  The reward of improved patient/client outcomes is the best incentive for high-functioning interprofessional teams  There are ingrained power and status differentials that are discussed by the team to support effective team functioning  The power differential between health-care providers and between patients/clients needs to be acknowledged and addressed through policies  Financial frameworks and incentives advance interprofessional team-based health services Interprofessional Collaborative Practice Enablers and Barriers Enablers Barriers  Mutual respect  Interdisciplinary rivalry  Shared commitment  Lack of…  Understanding of roles  Nurse physician relationships  Relationships  Boundary infringements  Communication  Language differences  Equitable power relationships  Perceived lack of organizational support  Professional ethics  Role conflict Interprofessional Collaboration: Managing Risk A nurse is working for a home care agency. While completing a visit, he receives a call from a Personal Support Worker (PSW) working with another client the nurse is to visit later during the day. The PSW reports that the patient’s Foley catheter has come out during the night and that she was planning to reinsert it assuring the nurse that she had done this before. The RN objects to the procedure, stating that she wasn’t able to delegate this task properly over the phone to the PSW. They both agree that the RN will reinsert the catheter when she visits later during the day. When the nurse arrives for this particular visit, the patient is distraught. He convinced the PSW to reinsert the catheter since he ‘didn’t want to be a bother to the nurse’. The catheter is causing intense pain to the patient’s urethra. After removing the catheter and completing his assessment, the nurse realizes that the catheter has caused damage to the patient’s urethra that he is unable to reinsert it properly. Delegation Practice Standard Scope of Practice (CNO, 2023) Delegation by nurses  Nurses who are authorized to perform controlled acts can delegate them to certain individuals, including other regulated health professionals or unregulated care providers, for example, family members of clients. A nurse who delegates a controlled act is responsible for the decision to delegate and for ensuring the delegatee is competent to perform the controlled act. Delegation to nurses  Nurses can receive delegation for controlled acts they are not authorized to perform. Nurses who perform controlled acts delegated to them are responsible for the decision to carry out the controlled act and for the performance of the act. Delegation Practice Standard Scope of Practice (CNO, 2023) Delegation restrictions  Nurses cannot delegate a controlled act that has been delegated to them. This is referred to as sub- delegation  Nurses in the Temporary Class and the Emergency Class are not permitted to delegate or accept delegation  Nurses in the Special Assignment Class are not permitted to delegate to other health care professionals Registered Nurses and RPNs cannot delegate these controlled acts  Treating, by means of psychotherapy technique, delivered through a therapeutic relationship, an individual’s serious disorder of thought, cognition, mood, emotional regulation, perception, or memory that may seriously impair the individual’s judgement, insight, behaviour, communication or social functioning  Dispensing a drug. How is delegation applicable to a first-year student? Requirements for Delegating Controlled Acts, Practice Standard Scope of Practice (CNO, 2023) Requirement 1: The nurse has the authority under the Nursing Act, 1991, to perform the controlled act. Requirement 2: The nurse has the knowledge, skill and judgment to perform the controlled act safely and ethically. Requirement 3: The nurse has a nurse-client relationship with the client for whom the controlled act will be performed. Requirement 4: The nurse has considered whether the delegation of the controlled act is appropriate, bearing in mind the best interests and needs of the client. Requirement 5: After taking reasonable steps, the nurse is satisfied that sufficient safeguards and resources are available to the delegatee so that the controlled act may be performed safely and ethically. Requirement 6: The nurse has considered whether delegation of the controlled act should be subject to any conditions to ensure that it is performed safely and ethically and has made the delegation subject to conditions. Requirement 7: After taking reasonable steps, the nurse is satisfied that the delegatee is a person who is permitted to accept the delegation and is:  member of CNO who has a nurse-client relationship with the client; health care provider who has a professional relationship with the client; a person in the client’s household; a person who routinely provides assistance or treatment for the client. Requirements for Delegating Controlled Acts, Practice Standard Scope of Practice (CNO, 2023) Cont’d Requirement 8: When the delegatee is a nurse or other regulated health professional, the nurse must be satisfied that the delegatee has the knowledge, skill and judgment to perform the controlled act safely and ethically. When the delegatee is not a regulated health professional, the nurse must be satisfied that the delegatee has the knowledge, skill and judgment to perform the controlled act safely and ethically and that the delegation is appropriate for the client. Requirement 9: If the nurse has delegated a controlled act but has reasonable grounds to believe that the delegatee no longer has the ability to perform the controlled act safely and ethically, the nurse must immediately cease to delegate the controlled act to that delegatee. Requirement 10: The delegating nurse shall:  ƒensure that a written record of the particulars of the delegation is available in the place where the controlled act is to be performed, before it is performed; ƒensure that a written record of the particulars of the delegation, or a copy of the record, is placed in the client record at the time the delegation takes place or within a reasonable period of time afterwards; ƒrecord particulars of the delegation in the client record either at the time the delegation takes place or within a reasonable period of time afterwards; Any record of the particulars of a delegation must include: ƒthe date of the delegation ƒthe delegator’s name, if the controlled act was delegated to the nurse; ƒthe delegatee’s name, if the controlled act was delegated by the nurse ƒthe conditions, if any, applicable to the delegation.  Expectations for Nurses Who Work with UCPs (CNO) A nurse who teaches, assigns duties to or supervises UCPs must:  Know the UCP is competent to perform the particular procedure or activity safely for the client in the given circumstances.  When teaching a UCP, a nurse is expected to have first-hand knowledge of the UCP’s competence.  A nurse who assigns or supervises is expected to verify that the UCP’s competence has been determined.  Ensure that the UCP: Understands the extent of her or his responsibilities in performing the procedure(s); knows when and who to ask for assistance, and; knows when, how and to whom to report the outcome of the procedure; ensure that there is an ongoing assessment of the client’s health care needs, develop a plan of care, evaluate the client’s condition and judge the ongoing effectiveness of the UCP’s interventions.  Requirements for Accepting Delegation of Controlled Acts, Practice Standard Scope of Practice (CNO, 2023) Requirement 1: The nurse has the knowledge, skill and judgment to perform the controlled act safely and ethically. Requirement 2: The nurse has a nurse-client relationship with the client for whom the controlled act is to be performed. Requirement 3: The nurse has considered whether performing the controlled act is appropriate, bearing in mind the best interests and needs of the client. Requirement 4: After taking reasonable steps, the nurse is satisfied that there are sufficient safeguards and resources available to ensure that the controlled act can be performed safely and ethically. Requirement 5: The nurse has no reason to believe that the delegator is not permitted to delegate that controlled act. Requirement 6: If the delegation is subject to any conditions, the nurse has ensured that the conditions have been met. Requirement 7: Nurses who perform a controlled act that was delegated to them must record the particulars of the delegation in the client record, unless ƒa written record of the particulars of the delegation is available in the place where the controlled act is to be performed ƒa written record of the particulars of the delegation, or a copy of the record, is in the client record ƒthe particulars of the delegation have already been recorded in the client record  Any record of the particulars of a delegation must include: ƒthe date of the delegation ƒthe delegator’s name, if the controlled act was delegated to the nurse ƒthe delegatee’s name, if the controlled act was delegated by the nurse ƒthe conditions, if any, applicable to the delegation Conflict and Group Process Teams “A collection of individuals who are interdependent in their tasks, who share responsibility for outcomes, who see themselves and are seen by others as an intact social entity embedded in one or more larger social systems and who manage their relationships across organizational boundaries.” Groups  Three or more individuals who have a common purpose, interact with each other, influence each other and are interdependent (Adams & Galanes, 2003)  Groups share needs and goals  Peer, social, religious, work, political  Group dynamics or group process is the way in which groups function Group Work  What are the advantages and disadvantages of working with others?  What are the most common complaints about group work from students and from faculty?  What can we do about them?  Where does collaboration and Interprofessional education fit in? Group Attributes Influencing Functioning  Physical and emotional climate  Involvement  Interaction  Group cohesion  Productivity  Other? Tuckman (1965) Model of Group Development  Group Functioning and Dynamics  Groups need to define member roles and standards for decision-making, assign work, determine what is acceptable behaviour and ground rules.  Usually there is conflict – when conflict becomes the focus the productivity declines.  Consider appointing a rotating ethics monitor, i.e., at the conclusion of each meeting, the monitor will speak to whether the meeting was conducted in a respectful manner, evidence of collaboration and good conversation with courteous differences in opinions coming forward, etc. Group Roles  Each member has a role within the group  Help accomplish goals, purpose, keep group focused  Information or opinion seeker/ giver, recorder, facilitator  Group building or maintenance  Coordinator, harmonizer, compromiser  Dysfunctional or individual oriented roles  Blocker, aggressor, recognition seeker, dominator  Description of Interactive Styles Avoiding Accommodating Competing Collaborating Compromising Unassertive and Unassertive and Assertive and Assertive and Moderate assertive uncooperative - I cooperative- I value uncooperative. cooperative. I’m and cooperative- will be quiet and our relationship sure if we work This isn’t important listen. It’s not that more at this point. together, we can enough to fight over. big a deal. I’d rather Let’s just get this come up with a I don’t want to be just forget it. over with so we can better answer that unreasonable. If I get on to other either of us give them this, things. Fine, I will individually. maybe they will give give in, have it your me that. We could way. both live with that. Conflict Management Utilize management tools/strategies for management and mitigation of conflict such as the following (RNAO):  Listen empathetically and responsively  Allow the other person to express their concern  Search beneath the surface for hidden meanings  Acknowledge if you are at fault and reframe emotions  Separate what matters and what gets in the way  Learn from difficult behaviours  Lead and coach for transformation  Negotiate collaboratively to resolve an issue Conflict Management Focus on Focus on the positive A few thoughts… Use Use language that suggests cooperativeness  Act in ways that build people up, not tear them down  Let go of the belief that that Allow Allow opportunity for each person to have their voice your way is always right Refer back Refer back to established norms Keep Keep your eye on the prize Group Conflict Resolution Management Process  Recognize the disagreement in the group  Listen to the varying points of view  Consider what is valuable in each viewpoint  Present reasons for disagreeing with each dissenting viewpoint  Discuss the importance of each dissenting viewpoint A few thoughts…  Come to a cooperative group decision to resolve disagreement  Suggest a time-limited pilot or test-run of a solution when consensus is not achieved…  If the solution does not produce the desired outcome, move on to next option. Collaborative Leadership “Occurs when all members of a team, including the client/family, symbiotically accept their capacity to lead the group by demonstrating mindfulness of the value in working together, and using their shared assets to assist the clients to reach achievable and desired health outcomes” (Orchard et al., 2019, p. 21).