Copyright © 2015. F.A. Davis CompanyCommunicating With .docx

Copyright © 2015. F.A. Davis Company
Communicating With Others and Working With the
Interprofessional Team
Chapter 6
*
CommunicationGiving information is only a small part of
communication.Occurs on several levelsInvolves different
factorsRequires active listening skills
*
Factors Affecting CommunicationEmotional state of
individualsOutside distractionsCultural backgroundSuperficial
listeningIndividual attitudes regarding the content of the
communication

*
Assertiveness in CommunicationAllows people to stand up for
themselvesRespects the rights of othersClearly states an
individual’s positionUses “I” statementsAssumes a greater
importance in the interprofessional environment
*
Interpersonal CommunicationMost daily communication falls
into this category.Interactions that occur on a personal
levelProcess that gives individuals the opportunity to construct
personal knowledgeUsed to establish relationshipsDiffers from
general communication
*
Interpersonal Communication (cont'd)Occurs on a more intimate
levelSystematic processIndividuals hold a specific role within
the communicationDynamic and ongoing process

*
Transactional Models of CommunicationDiffer from earlier
linear modelsConsider all individuals communicatorsAllow that
communication among and between individuals occurs
simultaneouslyAcknowledge that “noise” occurs in all
interactionsInclude the concept of time
*
Barriers to Communication Among Health-Care Providers and
Health-Care Recipients
*
ChallengesLow health literacyCultural diversityCultural
competence of health-care providersLack of interprofessional
communication education among providers
*

Electronic Forms of Communication
*
Information SystemsCommunication through the use of health
documentsThe Health Information Technology for Economic
and Clinical Health (HITECH)Electronic Medical Records
(EMRs)Electronic Health Records (EHRs)
*
Advantages of EMRTrack data over timeIdentify which patients
need preventive screenings or checkupsMonitor patient
statusEvaluate and improve overall quality
*
Advantages of EHRDocuments are shared among varying

institutions/individualsFocus on the total health of a
patientProvide a more inclusive view of a patient’s care over
timeDesigned to share information with other health-care
providersAssist in maintaining patient confidentiality
*
E-mailUsed both within and outside of organizationsSame
communication principles that apply to traditional letter writing
apply to e-mailRequires good writing skillsRules in the
workplace different from personal e-mail
*
Text MessagingEvolved as a quick method of
communicationBrief informal methodNo “texting
rules”Business consultants predict that this communication
method will evolveImportant to follow the same rules that apply
to e-mail
*

Reporting Patient Information
*
Hand Off CommunicationsPreviously referred to as “change of
shift” report in nursingMove toward an interprofessional team
philosophy has changed the way reports are givenEnsures
continuity of care from one area to anotherPart of the TJC
“National Patient Safety Goals”
*
Communicating With the Health-Care ProviderCommunicate
changes in patients’ conditions.Share pertinent
information.Discuss modifications in the treatment plan.Clarify
orders.
*
Before Calling the Health-Care ProviderHave all the

information available. Be prepared to provide general
assessment information.Pertinent informationMost recent vital
signs and trendsLaboratory valuesMedications and times the
patient received the most recent dose
*
After Calling the Health-Care
ProviderDocument time of the call in the patient
record.If the health-care provider needed to return the call,
document the time the call was returned in a health-care
provider call log.Follow the chain of command if a call is not
returned within an appropriate amount of time.
*
ISBARRIntroductionSituationBackgroundAssessmentRecommen
dationRead-back
*

Health-Care Provider OrdersWrittenTelephoneFaxEMR orders
*
Teams
*
PurposeBring professionals togetherCommon goal: quality
patient careCollaborative focus
*
Teamwork
QSEN definitionThe ability to “perform effectively within
nursing and interprofessional teams, fostering open
communication, mutual respect, and shared decision making to
achieve quality patient care.”

(http://qsen.org)
*
Learning to Become a Team PlayerRecognize that every
member brings value to the team.Treat each team member with
dignity and respect.Understand the role of each team
member.Support each other in achieving the team’s goals.
*
Building a Working TeamIdentify the team players.Make sure
the team members understand the goals and are committed to
achieving the outcomes.Act as a role model and exhibit
expected behaviors.
*
Interprofessional Collaboration and the Interprofessional Team

*
Interprofessional Collaboration
“Occurs when multiple health workers from different
professional backgrounds work together with patients, families,
caregivers, and communities to deliver the highest quality
care.”
(WHO, 2010)
*
Components of
CollaborationSharingPartnershipInterdependencyPower
*
Interprofessional CommunicationTJC attributes a high
percentage of sentinel events to breakdowns in communication
among health-care providers.Core competency for
interprofessional collaborative practiceISBARRTeam STEPPS

*
Team STEPPSLeadershipSituationMonitoringMutual
supportCommunication
*
Building an Interprofessional TeamCommunicate through
conferences.Focus on the needs of the patients and/or
clients.Each member has roles and functions that contribute to
patient care.Each member contributes and the contributions are
valued.Monitor and/or evaluate effectiveness of team goals.
*
Methods for the Hand-Off ReportTraditional face-to-
faceAudiotapeComputer reporting

*
ConclusionCommunication skills are needed to deliver safe,
quality, and effective patient care.TJC, IOM, QSEN, and
MAGNET promote interprofessional communication. Use of
Team STEPPS and IBARR promote interprofessional team work
and communication.
*
Delegation, Prioritization, and Decision Making
Chapter 7
*
Delegation of Client Care: Definition
The reassigning of responsibility for the performance of a job
from one person to another.

(ANA, 1996)
*
Concepts of DelegationThe responsibility of the task is
transferred.Accountability remains with the
delegator.Delegation may be direct or indirect.
*
Direct DelegationUsually verbal directionRN decides which
staff member is capable of performing a specific task.
*
Indirect DelegationContained in an approved listing of tasks
established by an institutionPermitted tasks may vary from
institution to institution

*
Assigning TasksThe RN may assign a more skilled individual to
perform a task.The RN may not assign an individual to perform
an activity outside a job description or the scope of practice.
*
Delegation vs. Supervision
*
SupervisionSupervision is usually more direct than delegation.It
requires directly overseeing the work or performance of
others.It includes checking with individuals during the day.It
may entail delegation of tasks and activities.The nurse manager
performs both.
*

The Nursing Process and Delegation
*
AssessmentAssess client needs.Set client-specific goals.Match
the personnel with the appropriate skills to care for the client.
*
PlanningMentally identify who is best suited for the task or
activity.Planning prevents later problems.
*
ImplementationAssign the appropriate personnel who have the
level of expertise necessary to deliver the care or carry out the
activities.

*
EvaluationOversee the care or activities.Determine if client care
needs have been met.Allow for feedback.
*
Coordinating
Assignments
*
Methods to Help Organize Care Critical pathwaysComputerized
information sheetsPersonalized worksheetsDelegation tree
*

Tips for Organizing CarePlan time around activities that must
be performed at a certain time.Perform high-priority activities
first.Cluster activities that may be performed together.Consider
your peak time when performing optional activities.
*
The Need for Delegation
*
Changes in the Health-Care EnvironmentNursing
shortageHealth-care reformIncreased need for nursing
servicesDemographic trendsUse of unlicensed assistive
personnel
*
Unlicensed Assistive Personnel (UAPs)Individuals trained to
function in an assistive role to the nursePerform delegated

tasksUnder direct supervision of the RNMay or may not be
certified
*
Delegation to UAPs
*
Examples of TasksVital signsSkills learned through special
trainingBlood drawingECGsMeasuring intake and outputNon-
nursing duties
*
Safe Delegation
*

Criteria for Safe DelegationPotential for harmComplexity of the
taskProblem-solving and innovation necessary to complete the
task or activity
*
Considerations for Safe DelegationAbility of the
individualFairness of the task
*
Guidelines for
Delegationhttps://www.ncsbn.org/delegation_grid_NEW.pdfhttp
s://www.ncsbn.org/contcaregrid.pdfhttps://www.ncsbn.org/Work
ing_with_Others.pdf
*

Task-Related Concerns
*
Primary Concern
Does the individual assigned to the task have the ability to
perform the task?
*
Other Task-Related
ConcernsAbilityPrioritiesEfficiencyAppropriateness
*
Relationship-Oriented ConcernsFairnessLearning
opportunitiesHealthCompatibilityPreferences
*

Summary of Expectations of ProfessionalsRespect of othersA
reasonable workloadAppropriate wagesDetermining his/her own
prioritiesAsk for what he/she wantsAccountabilityGive and
receive information as a professional
*
Barriers to Delegation
*
BarriersExperienceLicensureQuality of careAssigning work to
others
*
The Five Rights of DelegationRight taskRight

circumstancesRight personRight direction/communicationRight
supervision/evaluation
*
Conclusion
*
Points to ConsiderDelegation is not new.The role is essential
for good working relationships.Organizational skills are a
prerequisite for delegation.Understanding client needs is
essential for appropriate delegation.
*
The RN Needs to UnderstandThe State Nurse Practice ActThe
capabilities of each staff memberThe tasks that may be
delegatedThe concept of accountability in delegation

*
Communicating With Others and Working With the
Interprofessional Team
Chapter 6
*
CommunicationGiving information is only a small part of
communication.Occurs on several levelsInvolves different
factorsRequires active listening skills
*
Factors Affecting CommunicationEmotional state of
individualsOutside distractionsCultural backgroundSuperficial
listeningIndividual attitudes regarding the content of the
communication
*

Assertiveness in CommunicationAllows people to stand up for
themselvesRespects the rights of othersClearly states an
individual’s positionUses “I” statementsAssumes a greater
importance in the interprofessional environment
*
Interpersonal CommunicationMost daily communication falls
into this category.Interactions that occur on a personal
levelProcess that gives individuals the opportunity to construct
personal knowledgeUsed to establish relationshipsDiffers from
general communication
*
Interpersonal Communication (cont'd)Occurs on a more intimate
levelSystematic processIndividuals hold a specific role within
the communicationDynamic and ongoing process
*

Transactional Models of CommunicationDiffer from earlier
linear modelsConsider all individuals communicatorsAllow that
communication among and between individuals occurs
simultaneouslyAcknowledge that “noise” occurs in all
interactionsInclude the concept of time
*
Barriers to Communication Among Health-Care Providers and
Health-Care Recipients
*
ChallengesLow health literacyCultural diversityCultural
competence of health-care providersLack of interprofessional
communication education among providers
*
Electronic Forms of Communication
*

Information SystemsCommunication through the use of health
documentsThe Health Information Technology for Economic
and Clinical Health (HITECH)Electronic Medical Records
(EMRs)Electronic Health Records (EHRs)
*
Advantages of EMRTrack data over timeIdentify which patients
need preventive screenings or checkupsMonitor patient
statusEvaluate and improve overall quality
*
Advantages of EHRDocuments are shared among varying
institutions/individualsFocus on the total health of a
patientProvide a more inclusive view of a patient’s care over
timeDesigned to share information with other health-care
providersAssist in maintaining patient confidentiality
*

E-mailUsed both within and outside of organizationsSame
communication principles that apply to traditional letter writing
apply to e-mailRequires good writing skillsRules in the
workplace different from personal e-mail
*
Text MessagingEvolved as a quick method of
communicationBrief informal methodNo “texting
rules”Business consultants predict that this communication
method will evolveImportant to follow the same rules that apply
to e-mail
*
Reporting Patient Information
*
Hand Off CommunicationsPreviously referred to as “change of
shift” report in nursingMove toward an interprofessional team
philosophy has changed the way reports are givenEnsures
continuity of care from one area to anotherPart of the TJC

“National Patient Safety Goals”
*
Communicating With the Health-Care ProviderCommunicate
changes in patients’ conditions.Share pertinent
information.Discuss modifications in the treatment plan.Clarify
orders.
*
Before Calling the Health-Care ProviderHave all the
information available. Be prepared to provide general
assessment information.Pertinent informationMost recent vital
signs and trendsLaboratory valuesMedications and times the
patient received the most recent dose
*
After Calling the Health-Care
ProviderDocument time of the call in the patient
record.If the health-care provider needed to return the call,
document the time the call was returned in a health-care

provider call log.Follow the chain of command if a call is not
returned within an appropriate amount of time.
*
ISBARRIntroductionSituationBackgroundAssessmentRecommen
dationRead-back
*
Health-Care Provider OrdersWrittenTelephoneFaxEMR orders
*
Teams
*
PurposeBring professionals togetherCommon goal: quality

patient careCollaborative focus
*
Teamwork
QSEN definitionThe ability to “perform effectively within
nursing and interprofessional teams, fostering open
communication, mutual respect, and shared decision making to
achieve quality patient care.”
(http://qsen.org)
*
Learning to Become a Team PlayerRecognize that every
member brings value to the team.Treat each team member with
dignity and respect.Understand the role of each team
member.Support each other in achieving the team’s goals.
*
Building a Working TeamIdentify the team players.Make sure
the team members understand the goals and are committed to
achieving the outcomes.Act as a role model and exhibit

expected behaviors.
*
Interprofessional Collaboration and the Interprofessional Team
*
Interprofessional Collaboration
“Occurs when multiple health workers from different
professional backgrounds work together with patients, families,
caregivers, and communities to deliver the highest quality
care.”
(WHO, 2010)
*
Components of
CollaborationSharingPartnershipInterdependencyPower
*

Interprofessional CommunicationTJC attributes a high
percentage of sentinel events to breakdowns in communication
among health-care providers.Core competency for
interprofessional collaborative practiceISBARRTeam STEPPS
*
Team STEPPSLeadershipSituationMonitoringMutual
supportCommunication
*
Building an Interprofessional TeamCommunicate through
conferences.Focus on the needs of the patients and/or
clients.Each member has roles and functions that contribute to
patient care.Each member contributes and the contributions are
valued.Monitor and/or evaluate effectiveness of team goals.
*

Methods for the Hand-Off ReportTraditional face-to-
faceAudiotapeComputer reporting
*
ConclusionCommunication skills are needed to deliver safe,
quality, and effective patient care.TJC, IOM, QSEN, and
MAGNET promote interprofessional communication. Use of
Team STEPPS and IBARR promote interprofessional team work
and communication.
*
*
*
*
*
*
*
*
*
*

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