Teamwork and Collaboration in Nursing: Examples

Introduction

This essay “Teamwork and Collaboration in Nursing: Examples” will be a reflective piece aimed at portraying how and to what extent I have been able to apply my new knowledge of learning to re-occurring procedures of practice in the hospital ward I was placed for my 9 weeks clinical placement. The essay will expantiate on how I used the 6cs of nursing to deliver efficient and safe care; with particular emphasis on communication and interpersonal skills. For the purpose of this essay, I would use a patient whom I would refer to as AJ to maintain confidentiality. The Nursing and Midwifery Council (NMC) code of conduct stipulates several professional standards that nurses, midwives and all nursing associates must uphold. It states that “ As a nurse, midwife or nursing associate, you owe a duty of confidentiality to all those who are receiving care. This includes making sure that they are informed about their care and that information about them is shared appropriately. AJ is a 71 years old Asian man who is physically challenged due to a stroke. He also suffers neurodegenerative disease and is diabetic. His speech is blur and he does not speak any English. AJ cannot verbally communicate his pain and other needs to staff like other patients would do. As a result of this, he would get frustrated and angry. He would manifest that through some challenging behaviours. His family was very protective of him and worried about how staff would be able to address his needs and offer proper and safe care.

Nurses provide care to patients at every stage of life. The delivery of safe person-centered, high-quality, and evidenced-informed healthcare is a challenging expectation in today’s complex healthcare systems. In order to meet up with these standards, it is essential that nurses are equipped with sufficient knowledge and technical skills, as well as good interpersonal qualities. In a bid to ensure nurses practice with professionalism in all its ramifications, the NHS England chief nursing officer Jane Cummings drew up the 6cs and launched it in December 2012. The 6cs which are care, commitment, competence, courage, communication, and confidence underpin compassion in practice. They were developed as a way of articulating the values expected of nursing care.

The 6CS

The 6cs sets out the shared purpose of all health professionals; which is to deliver care and treatment in a way that puts patients at the center of everything they do.

• CARE: requires the provision of high-quality care and those receiving it wants that it should be satisfactory and consistent throughout every encounter.
• COMPASSION: refers to how care is given with a sympathetic feeling and concern towards another people’s pain. Respect and dignity.
• COMPETENCE: it is the ability to understand an individual’s health and social needs.it requires expertise in clinical and technical knowledge to deliver professional care based on research and evidence.
• COURAGE: enables us to do the right thing and speak up for the people we care for.
• COMMITMENT: to our vision of providing care in a professional manner despite any hurdles.
• COMMUNICATION: Use good and effective communication skills by listening and sharing decisions with the entire medical and other healthcare professionals, families, and patients.

To summarise the implementation of 6cs in nursing care, patients should be empowered by involving them in their care. They should be treated with equality, dignity, and diversity. Care should be evidence and research-based, and embody ethical responsibility geared towards ensuring the safety of all involved. Nursing staff should lead by example, influence the way care is provided in a way that is open, and respond to individual needs. All the above would not be attained if communication is not good. Good communication is the key to a good rapport between the staff team and patients alike. On this note, I would like to dwell on how I used communication and interpersonal skills during my clinical placements in care delivery. NMC Standards for competence for registered nurses domain 2 is on communication and interpersonal skills. It states that “ all nurses must use excellent communication and interpersonal skills in nursing practice”. Recommends that their communication must always be safe, effective, compassionate, and respectful. They must communicate using a wide range of strategies and interventions including the use of communication technologies. Where people have a disability, nurses must be able to work with service users and others to obtain the information needed to make reasonable adjustments that promote optimum health and enable equal access to services and care.

According to Balzer-Riley, communication involves the reciprocal process in which messages are sent and received between 2 or more people. Communication could be verbal or nonverbal.

Joseph defines interpersonal competence as the ability to communicate and interact effectively with others. These are sets of positive behavioral abilities vital for good teamwork.

Effective Communication as stated by McCabe and Timmins is the cornerstone of the development of nurses' professional and therapeutic relationships with patients, their families, and other health professionals. Nursing AJ was a bit challenging at the beginning considering his communication impairment and language barrier. He would refuse care, refuse to eat sometimes, and even refuse treatment. He would struggle to speak in Cantonese but none of us understood. This barrier was accentuated not only due to differences in language but also by cultural patterns of behavior and values. Difficulties communicating in the hospital are associated with an increased risk of patient safety incidents. Patients report experiencing negative emotions and resorted to fear, anger, frustration, depersonalization, and loss of control. AJ manifested challenging behavior by screaming and trying to jump out of bed after realizing no one was definitely providing what he may be asking for in his language. I quickly figured out that nursing had its own language. Although I did not understand his language, I could identify with his frustration. As such, I spoke with my mentor and others and squeezed time to just go in and rub his hands, smile, and nod when he spoke. He calmed down at such moments and I tried to use my nonverbal skills, gestures, and demonstrations to find out his needs. I later made some basic communication charts and it improved my understanding of his needs. This gesture built a therapeutic relationship between us and he will call me whenever I passed by and speak out about something which sometimes, I tried just to imagine. This initiative ties up with Costello’s recommendation that the development of augmentative and alternative communication solutions is vital for patients with communication impairments. Another aspect that I observed was intercultural differences. Robert and Savangi point out that regardless of whether English is a native language or not, different ethnic groups may use culturally specific styles of communication that differ from the local form of communication. The staff team decided to get the services of an interpreter sometimes to enable effective communication with AJ. Domelly and Neville maintain that effective communication helps vulnerable patients to cope and make better decisions about their care and treatment. After the interpreter’s visit, staff was able to improve on the care provided to AJ. We knew his needs, his likes and dislikes, preferences, and much more. From then on, AJ was happy, stopped manifesting challenging behaviors, and cooperated with the medical team. I learned he used to sing in the choir and would go and sing some songs to him during less busy moments in the wards. I ensured I put on the music radio channels and would sometimes engage in a conversation without necessarily understanding most of what he said. I, however, learned some basic words and whenever I used them, he would express joy. With all the information from his family when they visited and that obtained via the interpreter, we were able to treat AJ with maximum professionalism, compassion, and respect like all other patients who could communicate their needs. My experience with AJ reiterates the importance of adapting professional nursing care to the individual needs of patients by being creative, flexible, and humanistic. Being on the ward for 9 weeks and having a flashback on activities and routines, I strongly believe in McCabe and Timmins's statement “ although busy wards with high dependency patients are the norm in many acute care settings, any time spent in understanding the patient’s individual needs is indispensable”.

Teamwork

Nursing care depends on teams to carry out its objectives. The merits and importance of effective teamwork in nursing cannot be overemphasized. Healthcare is a multidisciplinary profession in which doctors, nurses, nursing associates, and all other health professionals from different specialties must work together, communicate often and share resources with a common goal of quality care to patients. When nurses work on effective teams, they are more productive and less stressed, the quality of care delivered is higher, fewer errors are made and patients are more satisfied. It is very important to liaise with all the people that would make an impact in achieving positive health outcomes for patients. These include family and patients as well. Teamwork is vital to ensure continuity of care whilst in the hospital as well as after discharge. Quality health care depends on every health care worker doing his or her part. Well-coordinated teamwork across the health professions can provide effective and cost-effective patient care. Researchers have found that working together reduces the number of medical errors and increases patient safety. Teamwork reduces issues that lead to burnout especially nowadays when workloads are always overwhelming due to shortages of staff. Hence, when an entire team collaborates in patient care and wellbeing, the outcome is most often successful and satisfactory for patients. Without teamwork in the ward, AJ might not have benefitted from professional care like other patients. Collaboration between all other staff, the family, the interpreter, and my mentor’s consent for me to spend time with AJ resulted in better and satisfactory care for him. West and Dawson 2011 concluded that from research carried out in previous years, “ by giving staff clear direction, good support and treating them fairly and supportively, health care leaders create cultures of engagement, where dedicated staff, in turn, can give of their best in caring for patients”.

Conclusion

Nursing is a communicative intervention and is founded on effective communication. To be a good nurse, excellent communication and interpersonal skills are essential. The ability to communicate and interact with patients and other health care professionals can help build rapport, prevent mistakes and provide quality care.

It is recognizable that nurses are often overwhelmed by the high demands of work. As a result, they have limited time to practice the art of nursing which embodies a demonstration of care, compassion, courage, commitment, competence, and effective communication. That notwithstanding, the NMC standards recommend and urge nurses to practice professionally to ensure the provision of high-quality compassionate care.

There is a need for nurses to strive to achieve a balance between the science and the art of nursing to make a difference and maintain patient safety. Such balance can only be gotten via practicing good communication and interpersonal skills during nursing care.

Reference

1. Baker, Jeff.P, Sigrid Gustafson, Jeff Beaubien ‘’Medical teamwork & patient safety; the evidence- based relation.’’ Rockville, MD: Agency for healthcare Quality, 2005
2. Virani, Tazim ‘’Interprofessional collaborate teams’’ Canadian Health Services Research Foundation, 2012
3. Manser, T. ‘’Teamwork & Patient safety in dynamic domains of healthcare: a review of the literature “Acta Anaesthesiologic Scandinavia 53, no.2 (2009): 143-151
4. McCabe C, Timmins F (2013) Communication skills for Nursing Practice 2nd edn. Palgrave Macmillan
5. Roberts, C, Sarangi, S. (2005). Theme- Orientated discourse analysis of Medical encounters. Medical Education 39, 632 -640
6. Donnelly E, Neville L (2008) Communication & Interpersonal skills, Reflect Press, Exeter.
7. Department of health (2012) Compassion in Practice; Nursing, Midwifery and Care staff. Our vision and strategy. The statutory office, London.
8. Nursing and midwifery council (2015) The code: standards of conduct, performance and ethics for nurses and midwives. NMC, London.
9. Brooks W Heath R (1985) speech communication, seventh edition, Madison, Oxford.
10. Candlin S; Roger P. (2013). Communication & professional relationships in healthcare practice Bristol, UK: Equinox
11. DEMPSEY, C ; Reilly B; Buhlman, M Real-world strategies for engaging nurses. Journal of Nursing Administration, 44, 142-15.
12. Riley J.B (2011) Communication in Nursing (7th edition) St. Louis: Mosby
13. The interpersonal Communication book Global edition by Joseph A Devitor Pearson Education Limited 2018-08-15
14. Sharpe B Hemsley B (2016) Improving nurse-patient communication with patients with communication impairments; hospital nurses views on the feasibility of using mobile communication technologies. Applied Nursing Research Volume 30 May 2016, pp. 228-236
15. McCabe, C and Timmins F. (2006) Communication skills for nursing practice. Basingstoke; Palgrave Macmillan Cited in; American journal of Educational Research 2014 vol. 2, No 7, 441-446
16. Beatrice J Kalish, Sallie J Neaver Eduado Salas. What does Nursing teamwork look like? A qualitative study Journal of Nursing care quality vol. 24, No 4 pp 298- 307.
17. West M. A,; Dawson, J.F (2011) NHS staff management & health service quality. Retrieved from www.dh.gov.uk/health/2011/08/nhs-staff management.