intra and interprofessional collaboration both focus on client centered care inter p 2921120

Intra and interprofessional collaboration both focus on client centered care Inter professional across disciplines (RN, RPN, LPN) etc. Intra professional only within RN for example What is interprofessional collaboration? – the process of developing and maintaining effective interprofessional working relationships with learners, practitioners, patients/clients/families and communities to enable optimal health outcomes Elements of collaboration include – respect

– trust

– shared decision making

– partnerships 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 – ability of teams to deal with conflicting viewpoints and reach reasonable compromises Examples in primary care of interprofessional collaboration – 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) Six Competency Domains 1. interprofessional communication

2. patient/client/family/community centered care

3. role clarification

4. team functioning

5. collaborative leadership

6. interprofessional conflict resolution Interprofessional Communication – learners/practitioners from different professions communicate with each other in a collaborative, responsive and responsible manner Elements of interprofessional communication – 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) The four communication skills 1. thinking

2. listening

3. speaking

4. non-verbal Verbal – speaking words, tone, accuracy of message – tone is more influential than the content Non-verbal – facial expression even more important than either tone or words used Attending – active listening; eye contact; non-verbal cues; full attention Responding – verbal/non-verbal acknowledgement of message; nod while listening; note message received Clarifying – restate, question and rephrase Confronting – work jointly with others to resolve problem or conflict Communication barriers – 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 Communication Pitfalls – 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 What are techniques developed by organizations to improve communication? 1. debriefings/huddles

2. assertive language

3. critical language Debriefings/huddles – 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 Assertive language – 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

Critical language – 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 SBAR situation, background, assessment, recommendation Patient/Client/Family/Community Centered Care – 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 Elements of Patient/Client/Family/Community Centered Care – 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 Role Clarification – 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 Elements of Role Clarification – 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 What are you allowed to do legally or not allowed to do? – 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 Team functioning – learners/practitioners understand the principles of team work dynamics and group/team processes to enable effective interprofessional collaboration Elements of team functioning – 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 When a group or team is formed… – Adjourning

– Forming

– Storming

– Norming

– Performing Dysfunctional Team Members 1. self appointed expert

2. criticizer

3. passive

4. detailer

5. controller

6. pleaser

7. shy

8. selfish Self appointed expert – knows it all and is righteous Cirticizer – find fault with everything; likes to argue Passive – really can’t take a stand Detailer – caught in facts; hard to see the big picture and move forward Controller – monopolize discussion Pleaser – wants to please everyone Shy – someone who doesn’t speak up Selfish – someone who doesn’t want to be a team player Collaborative leadership – learners/practitioners understand and can apply leadership principles that support a collaborative practice model Elements of collaborative leadership – 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 Interprofessional Conflict Resolution Learners/practitioners actively engage self and others, including the client/patient/family, in positively and constructively addressing disagreements as they arise Elements of interprofessional conflict resolution – 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 Preventing and Managing Conflict as Individuals (the iceberg of conflict) – issue

– personality

– emotions

– interests, needs, and desires

– self-perceptions and self-esteem

– hidden expectations

– unresolved issues from the past Preventing conflict – 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 Words that promote conflict – 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 Most conflict arises from simple misunderstandings, poor choices of language, ineffective conflict management styles, unclear roles and responsibilities, miscommunication and poor leadership Conflict Management Styles 1. Avoidance

2. Accommodation

3. Aggression, domination, and/or competing

4. Compromise

5. Collaboration Avoidance – withdraw from the situation; maintain neutrality; goal is to delay Accommodation – satisfy others’ needs and concerns over your own; maintain harmony; goal is to yield Aggression, Dominance, Competing – being assertive and pursuing your own concerns; win/lose power struggle; goal is to win Compromise – minimally acceptable to all; relationships undamaged; goal is to find middle ground Collaboration – expand range of possible options; achieve win/win outcomes; goal is to find a win/win solution Effective Management of Conflict – 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 Self Awareness During Conflict – 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 Leadership – preventing conflict – 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 Leadership – managing conflict – 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 The goal is find your own way … 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.

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