Collaboration
involves discussion of client care issues in making health care decisions, especially for clients who have multiple problems. The knowledge and skills of the team are used to make a plan to address problems. By using a team you can do more than with a sin
Collaboration:
-nurse-provider collaboration should be fostered to create a climate of mutual respect and collaboration practice
-occurs among different levels of nurses and nurses with different areas of expertise
-should also occur between the interprofessional team,
Qualities by the nurse for effective collaboration include the following:
-good communication skills
-assertiveness
-conflict negotiation skills
-leadership skills
-professional presence
-decision making and critical thinking
Nurses role is to provide:
-coordination of the team
-an understanding of the client, the clients health care needs, and the health care system
-continuity of care over time and across disciplines
-the client with the opportunity help with plan of care
-information during rounds an
Decision making styles:
-vary in regard to the amount of data collected and the number of options generated.
Decisive, flexible, hierarchical, integrative
Decisive
minimum data, one option
Flexible
limited data, several options
Hierarchical
large amount of data and one option
Integrative
large amount of data and several options
centralized hierarchy
nurses at top make most of the decisions ...promotes job satisfaction among staff nurses
decentralized hierarchy
staff nurses who provide direct care are included in decision making process...large organizations benefit from this because high up nurses do not have firsthand knowledge
Behavioral change strategies (to promote change):
Rational-empirical
Mornative-reeducative
Power-coercive
Rational-empirical
manager provides factual info to support the change. used when resistance to change is minimal
Normative-reeducative
the manager focuses on interpersonal relationships to promote change
Power-coercive
manager uses rewards to promote change. used when individuals are highly resistant to change
Stages of team formation:
Forming
Storming
Norming
Performing
Forming
member get to know each other. Leader defines tasks and offers direction
Storming
Conflict arises, team members express polarized (different) views, rules established, roles taken
Norming
rules established, members show respect for one another and begin to accomplish some of the tasks
Performing
focus on accomplish of tasks
Generational differences
Veteran, baby boomer, generation X, generation Y
Veteran
1925-1942; supports status quo, accepts authority, appreciates hierarchy, loyal to employer
Baby boomer
1943-1960; accepts authority, workaholics, some struggle with new technology, loyal to employer
Gen X
1961-1980; adapts easily to change, personal life and family are important, proficient with technology, makes frequent job changes
Gen Y
1981-2000; optimistic and self confident, values achievement, technology is a way of life, at ease with cultural diversity
Case management
-coordination of care provided by an interprofessional team from the time a client starts receiving care until he/she is no longer receiving services
-focuses on managed care of the client through collaboration of the health care team in both inpatient an
Case manager:
-may be a nurse, social worker, or other designated health care professional (required to have advanced practice degrees or advanced training in this area)
-do not usually provide direct client care
-oversee a caseload of clients with similar disorders or
critical/ clinical pathway:
care map may be 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 such as Medicare and insurance companies
Nurse role in case management:
-coordinating care, particularly for clients who have complex health care needs
-facilitating continuity of care
-improving efficiency of care and utilization of resources
-enhancing quality of care provided
-limiting unnecessary costs and lengthy stays
-
continuity of care
consistency of care provided as clients move through the health care system. It enhances the quality of client care and facilitates the achievement of positive client outcomes
Documentation to facilitate continuity of care includes the following:
-graphic records that illustrate trending of assessment data such as 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 summar
A referral
a formal request for a special service by another care provider. It is made so that the client can access the care identified by the provider or the consultant
-inpatient setting or outside facility
-clients going home may require nursing care
-a need for
Nurses role in regards to transfers is to provide a written and verbal report of the clients status and care needs including:
-client medical diagnosis and care providers
-client demographic information
-overview of clients health status, plan of care, and recent progress
-any alterations that may precipitate an immediate concern
-most recent set of vital signs and medications,
Discharge planning
-started at the time of admission
-conducted with the client and clients family
-starting point for continuity of care, assess if needs support
-address additional services (home health, respite, etc.) to make sure in place when client arrives home
AMA
against medical advice". A client who leaves without a providers orders is AMA. If legally competent the client has the right to leave at any time.
-notify provider
-explain risks involved
-sign form
-document all communication/advice given
If try to stop someone from leaving the facility if they try to leave;
may face legal charges of assault, battery, and false imprisonment
Discharge instructions include:
-step-by-step instructions of procedures to be done at home (clients do a return demonstration to validate learning)
-med instructions, AE and actions to minimize them
-precautions to take when preforming procedures or administering meds
-indications of A
Nurses role with regard to discharge is to provide a written summary including:
-type of discharge (AMA or Provider)
-date/time of discharge, who accompanied client, and how ct transported (Wheelchair to car or stretcher to ambulance)
-discharge destination (home, long term facility)
-summary of condition at discharge (gait, diet, de