Professional Caring and Ethical Practice Study Guide for the CCRN

Collaboration

Collaboration among nurses, healthcare providers, patients, and their families makes the healthcare system work the way it needs to. Being part of the collaborating team is an important part of being a nurse.

AACN® Synergy Model

The AACN Synergy Model discusses what it means to be part of a collaborating team. The healthcare team can include prescribing providers, nurses, families, social workers, therapists, dieticians, community resources, clergy, and other interdisciplinary members. Nurses must have respect for and be willing to work with all the moving parts of the team.

The AACN further distinguishes the different levels of collaboration.

• In Level 1, the nurse will participate in collaborative events and learn from others with a mutual respect of the other providers.

• Level 3 collaboration advances the basis of collaboration by including nursing initiation of collaboration and active attempts to find learning opportunities to improve collaborative efforts.

• The highest collaboration level, Level 5, consists of mentoring and teaching others after achieving a good grasp of collaborative efforts and continuing the learning process to improve upon previously gained knowledge.

Communication and Collaboration

Collaboration cannot occur without communication. Using effective communication skills improves the collaborative effort.

Nurse and Patient/Family

There are several skills that nurses should master to ensure an effective communication base between nurses and patients. Nurses should use an assertive approach to disseminate information and patient instruction. Without being threatening, the nurse must clearly and confidently state opinions and instructions. Nurses should also practice casual conversation to help build personal connections with the patients. Using open-ended questions, engaging in discussion involving real-life events, and actively listening to the patient and responding appropriately can all help to build relationships with patients.

Nurses must also be competent in public speaking. Being comfortable presenting ideas, opinions, research, and other valuable information to larger groups of people helps to facilitate learning. Public speaking can also help nurses gain credibility in their work. Written communication can be used to help translate and document verbal communication on paper. Ensure that documents are written professionally with correct grammar and clear statements.

Collaboration

Collaborative efforts must use communication skills as well as nursing knowledge to improve patient care. Nurses should be active in creating the integrative network caring for patients as well as gathering evidence-based practice to support the nursing role. Important skills to have when working with collaboration include ability to compromise, clear communication, maintaining task orientation, teamwork, and identifying barriers to advancement/collaboration.

External Collaboration

Patient care often requires collaboration with external agencies. Nurses must be competent in accessing these agencies and be able to coordinate care to ensure smooth patient transitions. External agencies that may be involved in patient care include pharmacies, long-term care facilities, medical care payers, community groups, political agencies, and public health officials.

Teamwork

Nurses must work together with an extensive team when treating patients. This team can consist of medical personnel, patients, families, and community members. The goal of teamwork is to improve and maximize patient care.

Delegation

Nurses have the ability to delegate specific tasks to unlicensed assistive personnel. Nurses must be responsible with this delegation, however, and ensure that the assigned personnel are trained appropriately for the tasks and those tasks are within their scope of practice. Appropriate delegation improves the flow of patient care and helps the nurse to manage busy workloads. Nurses must know that all delegated tasks are ultimately the responsibility of the nurse. Nurses must also provide appropriate supervision and assess outcomes of the interventions performed by assistive personnel.

Before delegating a task, nurses must ask themselves these questions:

• Is the task appropriate to be delegated?
• Does the person who will be performing the task have the training to complete the task safely and correctly?
• Is the patient’s condition stable enough to have the task performed by an assistive personnel?
• Has the patient been properly assessed by the nurse prior to delegation of the task?
• Can the nurse provide ongoing supervision of the delegated task?

Nurses should properly and thoroughly communicate with the assistive personnel when delegating a task. Closed-loop communication can be used to ensure the task is understood and the nurse is notified upon completion of the task. The nurse must document the task including what was done, when it was done, and the duration of the event. If the assistive personnel is unable to complete the task by himself/herself, then the nurse should be available to assist.

Five Rights of Delegation

In all patient cases where delegation is considered, nurses must ask themselves if the task meets the five rights of delegation. These rights include: right task, right circumstance, right person, right direction, and right supervision. If the patient or assistive staff member has any doubts about these rights, the task should not be delegated.

Failure to Delegate

Failure to delegate specific tasks can be detrimental to the healthcare team. If nurses overburden themselves with tasks that could otherwise be delegated, they run the risk of rushing through patient care or being unable to recognize significant patient changes. Sharing the workload among all the appropriate team members is necessary for safe and effective patient care.

When delegating tasks, nurses should be able to determine if a task is appropriate for the assistive personnel to complete. If it is, the task should be assigned with clear instructions. The instructions should include the nurse’s goals and expected outcomes regarding the task to be done. Without micromanaging, the nurse should continue his or her involvement in the patient’s care and communicate frequently with the assistive personnel to ensure the task was completed and had the intended outcome. Finally, documentation of the work done needs to be completed.

Common Vision

The entire healthcare team should work together in patient care to develop a plan for the patient. Having a “common vision” helps healthcare workers and families establish the patient’s treatment plan. Nurses may be part of creating this team or may be automatically included due to the patient/nurse relationships that develop.

To create a common vision, everyone must be included in the preparation and organization of that vision. This includes both nursing and non-nursing personnel. Decisions are often not made singularly but rather based on a consensus of several discussions, team meetings, and broad conversations that help to identify and collaborate with different viewpoints. The team should be encouraged to practice creative thinking skills to improve upon and meet goals set regarding the common vision. Nurses must also have an appreciation for the fact that common visions are not set in stone. Visions can change with time and should be regularly reevaluated. This helps to create a vision that best meets the needs of the staff, organization, patients, and families.

Team Building

Team building skills are necessary for strong performances in patient care. In order to create a successful team, several dynamics must be addressed. In the early stages of team building, team members need to establish strong interactions and relationships to become comfortable with one another and improve group cohesiveness. Power issues and role confusion should be addressed early on to ensure that all roles are covered and the team is well balanced. The team should have an organization system established to ensure that all problems are being solved and the concept of the team is working actively toward mutually set goals. Throughout the process, improved relationships, team rapport, and overall support will strengthen the working environment. Great leadership within a team will result in positive outcomes, committed team members, and high standards of work or patient care.

Intra and Interdisciplinary Teams

Two general types of teams exist in the healthcare world. These are intra and interdisciplinary teams. Intradisciplinary teams are teams made of healthcare professionals from the same discipline. Interdisciplinary teams include team members from several disciplines that work together for a common good. Each has their own importance in patient care management and healthcare development.

Nurses will find themselves in both of these types of groups. Nurses must practice open mindset and open communication. They should avoid jumping to conclusions and work on active listening skills to make sure ideas and processes are heard and understood. When disagreement develops within the team, use factual information and good judgment to have a constructive conversation without reacting emotionally. Any confusion should be clarified as well.

Leadership

Leadership styles vary as much as learning styles. Each leadership style has its place in leading and directing people. Charismatic leaders use personal charisma to improve likability and influence people. Bureaucratic leaders use their leadership skills to follow rules exactly as written and work with the people they are leading to do the same. Autocratic leaders are similar to bureaucratic leaders in that they follow the rules, but autocratic leaders make decisions with or without the support of others.

Consultative leaders consult with the members of their group but rarely change their presented decisions regarding the issue. This helps the group members to feel engaged and supportive of the leader. Participatory leaders, on the other hand, consult with the group first and make decisions based on the presentations of the group members. This can be exhausting and time-consuming. Decisions from participatory leadership may also involve compromise that does not fully address the needs of the situations that are presented.

The democratic leadership style revolves around a collaborative effort to develop solutions to presented problems. The leader, after the solutions have been presented, will choose the solution to treat the problem. The final leadership style, laissez-faire leadership, is more of a hands-off approach. Leaders with this type of style do not try to control the solution process and allow group members to develop the solutions and implement the plan. Very little is accomplished in this type of leadership because the leader does not lead the group and lacks needed management skills.

Conflict

There will be times when a nurse will be confronted with conflict. As part of a team, the nurse may become a leader and be responsible for conflict resolution. Sometimes conflict is necessary for growth. Keeping an open mind regarding all sides and opinions regarding the conflict, being an active listener, and evaluating the facts of the conflict can help with conflict resolution.

Conflict resolution requires several steps. First, both sides of the conflict should be presented to the group. The conflict should be discussed in detail and a compromise or negotiation should develop among the opposing opinions. Avoid arguments and non-productive comments. The negotiations should be considered and re-evaluated as needed to reach a conclusion that meets the expectations of both parties.