(I) Abstract
This paper will be discussing the various issues surrounding the public sector nursing organization. The aim of the paper is to be able to determine how these issues affect the performance of nursing teams. In addition, this paper will be focusing on issues that involve collaboration practices. The presence or absence of effective teamwork will be investigated in relation to collaborative practice theories. In the end, the paper will be making recommendations on how to resolve the issues. The major aim of the paper is to be able to encourage teamwork within public sector nursing teams so that they will be able to provide the best possible services to their patients.
(II) Introduction
Providing medical care to numerous patients on a daily basis is a complex task that requires close coordination between all of the parties involved. This suggests that team is indispensable in the medical profession. The presence of an effective teamwork among medical practitioners can lead to the delivery of high quality as well as safe care of patients (Leonard, Graham & Bonacum, 2004). The close coordination among medical practitioners will allow them to monitor the conditions of their patients in such a way that relevant and important information will be relied. In turn, this allows them to administer the appropriate treatment to them, thus eliminating some margins for error.
According to Leonard, Graham & Bonacum (2004), due to the inherent limitations of human performance margins for error are present. However, this is intolerable in the medical profession since the main objective of every medical practitioner is to uphold the right to life of all his or her patients. Earlier, it was expressed that one of the effects of close coordination is the ability of medical practitioners to relay relevant and vital information to other members of the team on time. This implies that one of the issues that are crucial in encouraging effective teamwork is fostering effective communication.
However, in order to attain effective attain effective communication among members of a team, it is important that other aspects that affects team performance must be assessed. For example, effective communication is dependent on the situation and the personality of the individuals within the team. This means that in order for the issues of communication to be resolved, problems such as the roles and responsibilities of the individuals within the team must be clearly defined. In turn, this will lead to the analysis and resolution of conflicts within the team.
This paper will be presenting an incident that affected the collaboration of the individual members of a nursing team. In order to understand the underlying problems that resulted from the incident. The understanding of the problems will help in the formulation of the necessary action plan needed to resolve the problem. In order analyze the incident related literature will also be presented. This literature will provide the theoretical platform to launch the discussion of the incident in relation to the collaboration.
In addition, issues such as definition of effects of leadership styles and effects of motivation will also be crucial the task of fostering effective communication within teams. The familiarity with the mentioned issues that affect teams within the medical profession, nursing in particular, will allow the paper to make recommendations in the end. These recommendations are aimed at improving the over-all performance of the group.
Even though, individual contributions to the team are valuable, it will not be used as the basis of evaluating the performance of a group. It should be taken into account that the failure of one is the failure of all and the success of an individual will be seen as the success of the whole team. This will be the predominant frame of mind in the length of this paper.
(III) The Incident That Challenges Collaboration
The incident that will be presented in this section of the paper will illustrate how miscommunication between members of a nursing can jeopardize their performance as medical professional. In addition, the incident will also show how the presence of communication problems can put the life of the patient in danger. The incident to be presented will not be mentioning any manes. Rather, it will only provide the details of the incident itself.
A patient was rushed to the emergency room of the hospital. The patient is a 55 year old male with a new atrial fibrillation. Due to this, the attending nurse placed him under diltiazem drip for rate control. He was then transferred to the cardiac care unit and upon arrival, it was observed that the patient was hypotensive. In order to address the problem, a saline bolus was ordered. At that moment, the nurse attending to the man told her co-worker to get the saline bolus. As the attending nurse’s co-worker went to get the saline bolus, she went on to check other patients.
Upon her return to the bedside of the man, she saw that an intravenous bag was already in place on the IV pole. The immediate though that crossed the attending nurse’s mind was that her co-worker had already returned with the saline bolus and administered it to the patient. With the belief that the patient needed a rapid infusion of saline, she opened the IV up.
Immediately after the attending nurse opened up the IV, her co-worker entered the room with the 500cc saline bolus. When the attending nurse saw her co-worker enter the room with the saline bolus, she quickly realized that she administered an IV bolus of diltiazem, which is more than 300mg. Because of the mistake, the patient suffered a severe case of bradycardia. This required the placement of a temporary transvenous pacemaker. In addition, a calcium infusion was also deemed necessary. Fortunately, the mistake did not cost that life of the patient and there were also no permanent harm done.
The incident presented above showed that the miscommunication, worse, the lack of communication could result to the inefficiency of the nurses. If the attending nurse verified the contents of the IV bag before opening the IV up, then the patient would have gone through the whole ordeal. This incident also suggests that the level of collaboration among the members of the nursing team is not enough to improve their performance and deliver the best possible service to the patients.
In addition, the failure of the attending nurse to verify the contents of the IV bag and the failure to communicate with her co-worker affected her decision-making. The information that she based her decision on were assumption and were not really based on any information gathered. Due to the inadequacy and inappropriateness of the information, the attending nurse arrived at a decision that was not the best or even not suitable in the case of the patient.
(IV) Roles of Communication in Collaboration Practice
The incident presented above implies that high levels of cooperation or collaboration among the members of a nursing team is important in order to function effectively. It also suggests that collaboration helps in decision-making process of the nursing team regarding the action that needs to be taken to help the patients under their care.
Collaboration is defining that work in partnership and cooperate together. It is a process that interdependent professionals working together to achieve the goal of towards patients’ care needs (Rodriguez et al., 2005). The term collaboration is simply defined as people working together. However, the simple definition of the term is not a reflection of its underlying conditions. Collaboration is a communicative approach that can be used in decision-making. This implies that collaboration is associated of the complex web of social learning theory. It is stated in the social learning theory that people tend to resist change naturally (Duffy, 2003). In addition, they have the notion that their opinions are the only possible and correct ones. This line of thinking is the kind that collaboration attempts to overcome.
According to Friedman (1987), collaboration is able to do this by connecting formal with practical knowledge through face-to-face dialogues between contending adversaries. This also means that theoretical knowledge is being transformed to informal, practical wisdom. In the process of collaborating, parties involved are discouraged to be seen as adversaries. Instead, they are being regard as participants in the process. The process attempts to formulate or suggest terms that are accepted by all the participants. It is also encouraged that civic dialogues are used in conveying the opinions of the participants. During the process of finding the middle ground, local knowledge, discourses and discussions are being fostered (Friedman, 1987).
It is important the every member of the group be considered as participants. This is the case since they are all stakeholders in the performance of the team (Avery, 2001). This implies that they have the right to be informed and take part in the decision process of the team. This being the case, allowing all members of the team to take part in the decision making process can result to the formulation of suggestion of alternative solutions for the problems. It is also the case that various experiences can be shared to draw lessons from as well as perceive the outcome of the decision based on varying circumstances.
The presence of more participants implies that the decision was based on a consensus of the participants. If the participants voice out their opinions during the process, there are better chances that the decision will be the fusion of the viewpoints of the participants (Myrna Associates, 2005). This will also allow the body to glimpse the underlying factor that affects the over all performance and manner of conduct of their members – personality. Through the discussions that will transpires in the process, each participant will be able to get to know each team member and in the process will be able to deal with the tendencies of each participant.
According to Selin and Chavez (1995), collaboration is effective in reaching decisions that will enable the team to solve their problems that would otherwise have been difficult to resolve in the individual level. In addition, it is believed that collaboration cultivates democratic proceedings and civic discourse. This is achieved through the cooperation that involves the widest possible number of participants and by establishing non-economic values in the process of decision-making (Dryzek, 1990).
(IV) Essential Elements of Communication in Collaborative Practice
Earlier, the incident illustrated that the lack of communication among members of a nursing team can result to actions that will jeopardize the performance of the team and the welfare of the patients. Because of the chaotic nature of hospitals, since many patients need attention all at the same time, confusion is also lurking. This means that nurses must be able to think clearly in front of all the things that they need to do and all of the patients they need to attend to. The case presented above showed that attending nurse failed to communicate with her co-worker to verify the contents of the IV bag and this resulted to administering the wrong dosage to the patient. This part of the paper will be discussing the importance of communication among members of the team.
As mentioned earlier, effective communication is seen as the key towards that improvement of the over-all performance of nursing teams. However, it has also been mentioned that the task of implementing effective communication among members of a team is a tedious one since it requires sub-issues to be resolved first. This sub-issues pertains to the factors that affects the communication among members of the nursing team. Examples of these sub-issues include conflict within teams and leadership styles among others. This section of the paper will be discussing the main problem along with the sub-issues. This will pave the way for making the connection between the sub-issues and the main problem. The discussions in this section will be basis of the recommendations that will be presented in the latter part of the paper.
Communication within the Team
Failure to communicate is one of the leading causes of unintentional harm to patients (Smetzer, 2001). Given the complexity of care that most patients need and the number of people that needs to administer care, it is important that each member of the team be able to assess the situation based on the findings of other members’ of the team. This way the patients’ condition will be better evaluated. Although, historically the medical care given to patients are have been structured based on individual expertise.
Due to this, the presence of effective communication is only assumed. In reality, there is a lack of formal training to begin with. Medical practitioners were not taught to develop and exercise team qualities as a means of delivering high quality service to patients. In addition, once practice begins there is no actual assessment being performed to determine the impacts of team qualities in the performance of the individual and the entire medical team as well.
Based on the study conducted by McLain (2004), there is distortion in the communication process within medical teams. He attributed this to both the physicians and the nurses. In relation to collaborative practice, McLain believes that there are three elements that contribute to the success of the said practice.
1. Readiness to go beyond the fundamental exchange of information during interactions between nurses and physicians.
2. Readiness and capability to dispute the distortions as well as the assumptions made regarding the relationships within the team.
3. The presence of a belief system that is based on self-reflection.
In lieu of this, Blancett and Flarey (1995) suggested a framework that can be used to develop the relationship among professionals in the healthcare industry. The framework is founded on the organizations formal structures. These structures include policies, reporting relationships, committee structures and procedures. Furthermore, it is stated that the framework suggested by Blancett and Flarey encompasses the expectations and personal values of the individual. This is the case since the members of the team have aligned themselves with the vision of the organization in order to attain their objectives.
The framework is also based on the perceived role of communication in improving the performance of the team. The table below will be summarizing four levels of the framework starting from the reactive to the high performance team. Through the presentation of the framework, the development of the team into an effective group of medical practitioners can be observed. It is also the case that through the presentation of the steps towards achieving an effective communication among the members of the team will be revealed.
Professional Communication
Define as both verbal and non-verbal contacts that delineate relationships
Reactive
- communication is forced
- it travels from the top ranks to the bottom
- there are no recognized expectations for communication on a personal level
Responsive
- the focus of communication is the development of conflict management skills
- the culture of giving and receiving feedback is fostered
- build interpersonal relationships in order to foster cooperation among members of the team
- expectations in the professional communication and interpersonal level are similar to the that of the organization
Proactive
- open dialogue among and between all levels is present
- this fosters a positive professional communication
High Performance Team
- there is synergetic relationship that lows in all levels of the team
Roles and Responsibilities within Teams
It is inevitable that every team has designated or recognized team leaders. This power may be vested through formal and informal means. One example of formal designation is through rank filing, where head nurses are the duly designated leaders of the teams. However, it is the case that nursing teams are further divided into unit or a shift team; the role of the head has changed dramatically. Instead of being the over all coordinator, the head nurse is now seen as a consultant and management educator of the smaller nursing teams (Stevens-Barnum & Kerfoot, 1995).
Clear delineation of the roles and responsibilities among the members of the team will help in avoiding overlapping of jurisdiction. In addition, it will also ensure that everybody within the group knows his/her task. Task distribution is very important since it allows members to finish a task faster and no one member of the team will be burden by the responsibility of handling one task alone. Drawing the line on where one’s responsibility ends and the other’s begin is crucial in ensuring the effective handling of roles within the team. It is a matter of conserving resources as well as ensuring the smart use of valuable time.
Conflict within Teams
Failure to communicate properly also results to the surfacing of conflict among members of the group. One common type of conflict cause is miscommunication. Earlier, it has been stated that providing medical care to patients is a complex task that requires the knowledge of various medical professionals with different specializations. This specialization can also be causes of differences in views in the practice. In addition, it is a fact that every individual has different personality that will not automatically jive with the personalities of the other team members.
The effects of personal values and personality its self can take a toll on the performance of the team. This happens when the values and belief system of an individual is not aligned with the objectives of the organization. This will cause certain lapses in judge during the performance of his/her duty as a medical worker. However, there is also a common ground where the personal and the organizational can meet. Finding this common ground is main role of conflict resolution. Once conflicts have been resolved, the team can move in one synchronized motion, towards the attainment of the organization’s goal (Gleason, 1997).
(V) How to resolute Communication Problems in Collaborative Practice
The discussion made above is not isolated or not applicable in textbooks alone. Issues within nursing teams in relation to collaboration usually erupt. It is fact that the task that nurses need to carry out is complex and rigorous. After long hours of running here and there to tend to the needs of a number of patients, it is inevitable that nurses experience a certain degree of fatigue and stress that can affect the way they interact with the rest of the nursing team. In turn, this change in interaction behavior can result to issues.
Interactions among members pf a nursing team is closely related to collaboration. Therefore, it can be stated that some problems that affects interactions will also affect collaboration within the nursing team. For example, communication is carried out through interactions. If members of the nursing team have problems interacting with each other, it is also the case that they have problems interacting with each other.
However, as presented in the previous section of this paper there are many more reasons why failure to communicate within nursing teams become present. These various stimulants of collaboration problems also results to different collaboration problems.
According to Rice (2000), collaboration problems may take the form of dominance of one member over the other, lack of consideration of the skills as well as the roles of the others members, the feeling of autonomy brought about by professional education and territorial issues. However, this list will not be complete without the mention of communication barriers. This proves that communication plays a very important role within nursing teams. However, it is also the case the communication is lacking among members of nursing teams.
The lack of communication results in errors. There are two ways of understanding how and why errors happen. The first way is through the person approach. According to Reason (2000), the person approach focuses or blames the individual’s failures including carelessness or forgetfulness. On the other hand , there is the approach which focuses on systems and the manner in which they contribute to errors (Reason, 2000).
In a study carried out by the Agency for Healthcare Research and Quality, they found out that error within the healthcare industry for a number of reason. On top of the list is the lack of effective communication not just within nursing teams but in all levels of healthcare workers. This is followed by the insufficient information flow from one team member to the other or from one level to the other. Also included in the list is the lack of appropriate procedures and policies that will serve as the guide of healthcare workers.
Since the lack of communication is one of the major causes of inefficiency among and between nursing teams, it is very important that the source of the problem be addressed. Early resolution of the problem can lead to improved performance of the teams. This means that patients will be able to experience the kind of healthcare that they needs and deserve. However, in order for the action plan to work effectively, it must be noted that the actions must be directed towards the source of the problem. Superficially, resolving the problem will only result to more complications in the future. This means that nursing teams must address the lack of effective communication within the nursing teams if they want to address the cause of the other issues within the team.
The next section of this paper will be discussing the recommended actions that nursing teams can use in order to resolve the issue of lack of effective communication, verbal, non-verbal and written. The recommendations posted below are based on the earlier discussion of the framework as suggested by Blancett and Flarey as well as other related literature.
(VI) Recommendations
Communication among members of a team, especially in a nursing team, is crucial in delivering the best possible service to the people. This is the reason why it is important that every nursing team foster a culture of effective communication. It is being recognized that there is uneven development. There are those who are relatively underdeveloped compared to the rest. However, it is the task of the advance units to help others. This should be the kind of thinking present in every nursing team. Each member must recognize the importance of one another to the team. It is through this recognition that each member will extend a helping hand to others. It is through this that each member will open up to others and start communicating effectively.
In addition, all members of nursing teams must be able to identify and report errors immediately. After all, these errors cannot be deal with if they are not recognized. It is also important to recognize and report errors because every member of the team can learn from the mistakes committed. They will be able to draw from experience the next time they are faced with the same dilemma.
Change should not be rushed. As presented in the framework above, there are four stages. There is no need to immediately jump form stage one to stage three. It is important the before going top the stage, lessons learned will be used to fix previous mistakes. Personalities have been molded for very long time, that is why there is a need to recognize that it cannot be changed overnight. It is important that every member of the team be able to make guided realization. It is the role of leaders to guide their members. However, it is up to the members to make the changes in their perception. The main concern for all is the time it will take to realize the changes that needs to take place. This is where the support of the rest of the teams comes into play. Everyone have each others’ back always.
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