Learning Objectives
By the end of this section, you will be able to:
- Describe the roles of members of an interdisciplinary health-care team
- Identify best practices for effective communication methods
- Define critical thinking and clinical judgment
A team-based approach called intercollaborative care is designed to promote person-centered care to improve patient and health system outcomes. This is achieved through shared responsibilities, interactive planning, and collaborative decision-making. When a team of health-care providers works closely with the patient and their loved ones to make quality health decisions, it is possible to provide holistic, whole-person care that focuses on all the patient’s needs (National Center for Complementary and Integrative Health, n.d.).
There are many different generally, however, the goal of a collaborative care model is to manage patient care more effectively and to improve patient outcomes (Worsham, 2022a). Benefits of a collaborative care model include improved quality in care, reduced cost, and increased convenience to the patient. These benefits are achieved through a unified approach that uses data sharing, a streamlined referral process, and integrated scheduling.
The Intercollaborative Health-Care Team
Regardless of its specific composition, an intercollaborative care team aims to use PCC to achieve improved patient outcomes. The efficiency of the team is determined by each team member’s ability to work cohesively and in tandem, creating a streamlined workflow of communication and delivery of care.
An interprofessional heath care team comprises many individuals from a range of disciplines, such as nurses, physicians, social workers, and dietitians. As intercollaborative team members, nurses have a great impact on PCC and optimal patient outcomes. The nurse’s knowledge and experience contribute to the development, implementation, and ongoing improvement of quality care and patient safety as well as the associated initiatives within the health-care delivery system.
Members of an interprofessional team often work together in the same facility. However, teams may also include specialists who work in the community, such as pharmacists, chiropractors, and optometrists. Efficiency within the team structure is necessary for all members to work effectively together. To improve the efficiency of this process and create stronger teams, some practice groups choose to partner within the same location, such as a primary care group and a behavioral health group, to collaboratively provide holistic care. Furthermore, the increasing availability of telehealth has streamlined the collaborative patient care process by allowing providers to coordinate with additional team members as needed.
When PCC is not implemented, patients may experience a lack of individualized attention and consideration of their unique needs and preferences. For example: Mary, a 65-year-old female grappling with a chronic health condition, undergoes a challenging hospital admission during which the health-care team primarily focuses on the medical facets of her illness, focusing on one component versus the whole person.
Throughout her stay, Mary receives minimal information about her treatment plan, potential side effects, and anticipated outcomes, yet she directed about what to do. The health-care providers overlook inquiring about her preferences, because of the busyness on the unit, leaving Mary feeling like a mere statistic rather than an individual with unique needs. The lack of personalized attention and understanding of her background and values results in an impersonal and disconnected health-care experience for Mary. Subsequently, the treatment plan prescribed for Mary fails to consider her lifestyle, values, and cultural background. The oversight leads to a lack of motivation on Mary’s part to adhere to the prescribed regimen, which potentially could result in complications. The cumulative effect of neglecting preferences and Mary’s emotional well-being diminishes Mary’s trust in the health-care system, ultimately influencing her willingness to share crucial information and follow medical advice.
Communication
Communication is an essential component for establishing an effective workflow within the interprofessional team. Teams can set themselves up for successful communication by clearly defining each member’s role and outlining their expected responsibilities; teams should then meet regularly to confirm everyone is fulfilling their responsibilities and catch potential problems before they negatively affect patients. All these efforts help promote a coordinated effort when providing collaborative patient care.
Effective Methods of Communication
Effective communication requires more than just speaking and writing well. It includes nonverbal communication such as interpreting facial expressions and body language, listening attentively, and developing positive relationships with colleagues, patients, and family members.
A variety of software options are available to enhance effective communication between intercollaborative team members. One key tool is the electronic health record (EHR), a digital copy of a patient’s medical history. EHRs, which will be further discussed later in this chapter, allow each team member to read the notes of other health-care professionals, avoid duplication, and better implement the patient care plan. Additional benefits of EHRs include written and legible documentation and dashboards that offer alerts to help the team avoid potential adverse events—for example, from inadvertently prescribing incompatible medications. Some EHRs can be shared with patient portals, enabling patients and providers to communicate directly across multiple platforms.
ISBAR Technique
The ISBAR technique is a common tool clinicians use to structure written and verbal communication about a patient’s condition. It is easy to remember and helpful for highlighting the critical points that require immediate attention or action. Table 1.1 identifies the components that make up ISBAR.
| ISBAR Technique | Description | Example |
|---|---|---|
| I = Introduction | Introducing who you are, your role, where you are, and why you are communicating | Hi, This is Susie Jones. I am the registered nurse in the Emergency Department caring for Ms. Kennedy. I am calling to give her transfer report. |
| S = Situation | A brief statement describing the problem | Ms. Kennedy is an 80-year-old woman in Observation Bay 321, admitted last night at 22:30. She arrived via ambulance from Marshall’s Place Nursing Home, where she reportedly fell in the bathroom. |
| B = Background | A concise overview of the situation | Ms. Kennedy is diabetic and has Alzheimer disease. All supporting documentation has been entered into the chart, including a DNR. Family was notified of the fall by the nursing home. I contacted the son with an update after the admission. Family expected to meet with the physician this morning. |
| A = Assessment | Analysis or summary of what you observed or thought | Diagnostic X-ray reveals a left hip fracture. Physical examination shows bruising to the left hip. Skin warm, dry, intact. Patient reports severe pain. Morphine administered by emergency department staff at 01:30. |
| R = Recommendations | A suggested action to address the problem | Consultation scheduled with surgeon for this morning. Continue morphine as needed for pain. Follow-up with surgeon regarding next steps. |
ISBAR provides a simple structure that can be replicated by each team member to keep communication on track, creating a workflow for the intercollaborative team while also promoting patient safety.
Link to Learning
The Institute for Healthcare Improvement provides this web page with information about SBAR, including downloadable guidelines and a worksheet for implementing the technique.
Influence on Critical Thinking, Clinical Judgement, and Decision-Making
Nurses are faced daily with complex situations and issues resulting from advanced technology, high-acuity care, ethical and cultural issues, and an aging population with complex disease processes. The decision-making process related to problem solving in health care is equally complex and requires critical thinking.
A multidimensional, systematic, and organized way of reasoning is known as critical thinking. It involves purposeful, outcome-directed thinking and requires mindfulness, effort, practice, and experience (Benner et al. 2008). Critical thinking skills develop over time as foundational knowledge and key concepts combine with nursing experience. Critical thinking enables the nurse to draw conclusions that lead to creative and appropriate decisions that promote effective solutions and positive outcomes. Components of critical thinking include
- asking questions and gathering information
- validating and analyzing information
- drawing on past clinical experiences
- maintaining a flexible attitude
- considering available options
- formulating decisions
Nurses use clinical judgment to make decisions about patient care based on observations, assessments, and interpretations of relevant information, goes beyond the application of technical skills and involves the integration of both empirical knowledge and practical wisdom. Two nurses with different levels of clinical judgment may review the same data from a patient and arrive at opposite decisions regarding care. The nurse with better clinical judgment will be more likely to understand the data and consequently to make a better decision that produces a better outcome for the patient (American Association of Colleges of Nursing, n.d.). The National League for Nursing has taken a firm stance that clinical judgement is a better problem-solving approach than the nursing process (Ignatavicius & Silvestri, n.d.).
Applying both critical thinking and clinical judgement in nursing care decisions is called clinical decision-making. Critical thinking enables nurses to sift through all the data and make evidence-backed decisions. Clinical judgement is the synthesis of the information, and clinical decision-making is the result. When nurses use this skill, they draw on their own experiences with patients as well as relevant, quality research they have gathered to choose the best course of action for a particular patient in a particular context.
Let’s summarize and provide applicable examples of critical thinking, clinical judgment, and clinical decision-making.
- Critical thinking: A nurse critically assesses a patient’s EHR, noting a sudden change in vital signs. Critical thinking is demonstrated as the nurse questions potential causes, considers relevant factors such as medications or recent interventions, and decides to gather additional information through direct patient assessment or by consulting with other health-care team members. The nurse analyzes the situation to form an initial hypothesis about the cause of the changes in the patient’s condition.
- Clinical judgment: In a fast-paced emergency department setting, a nurse is caring for a patient with chest pain. Clinical judgment comes into play as the nurse integrates subjective and objective data, recognizing the urgency of the situation. The nurse forms a comprehensive understanding of the patient’s condition, considering potential diagnoses and anticipating the need for prompt interventions such as an electrocardiogram or administration of medication. Clinical judgment guides the nurse in prioritizing actions to ensure the patient receives timely and appropriate care.
- Clinical decision-making: A nurse, after critically analyzing a patient’s laboratory results and using clinical judgment to understand the implications, engages in clinical decision-making. In this scenario, the nurse decides to collaborate with the health-care team to adjust the patient’s medication dosage and initiate additional monitoring. Clinical decision-making involves selecting the most appropriate interventions based on the analysis of data and the application of clinical judgment to improve patient outcomes. The nurse actively participates in creating and adjusting the patient’s care plan to address the evolving clinical situation.
Clinical Judgment Measurement Model
The National Council of State Boards of Nursing developed the Clinical Judgement Measurement Model as an evidence-based framework to identify and enhance the cognitive skills essential for nurses to make effective clinical judgments. The model comprises six key cognitive skills:
- Recognize cues: Identify relevant information or cues from the patient’s condition and the health-care environment.
- Analyze cues: Critically examine and interpret the collected cues to form a comprehensive understanding of the situation.
- Prioritize hypotheses: Evaluate potential hypotheses or explanations for the patient’s condition and prioritize them based on their significance and relevance.
- Generate solutions: Develop a range of possible interventions or solutions in response to the prioritized hypotheses.
- Take action: Implement the chosen interventions or actions on the basis of the generated solutions, considering the patient’s unique needs and the clinical context.
- Evaluate outcomes: Assess the effectiveness of the interventions by evaluating the outcomes and comparing them to the expected results. This step involves reflecting on the success of the chosen actions and making adjustments if necessary.
The Clinical Judgement Measurement Model outlines a systematic approach to clinical judgment, emphasizing the cognitive skills required for nurses to make informed and appropriate decisions in the complex health-care environment. The model guides nurses through the process of recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes. This structured framework supports nurses in developing and applying their clinical judgment skills, contributing to improved patient care and outcomes. This topic is discussed further in a later chapter.