ESSAY STRUCTURE AND CONTENT
TEAMWORK IS VITAL IF HIGH LEVELS OF PATIENT CARE AND SATISFACTION ARE TO BE ATTAINED
My name is , 25 years old, and has a BSC in nursing from the College of Nursing in India. My topic is all about teamwork. I choose this topic, in order to motivate nurses and other health care providers that they may try to collaborate with the personnel in their team or with other departments to deliver quality care to the patients. Quality care is not just about treatment of diseases nor meeting the needs, yet it’s about caring care – communicates respect of man’s individual uniqueness, it is being considerate of man’s wholistic needs through rendering efficient (doing the best you can be with the least time and energy); effective (to meet the objectives you have set); and safe nursing care.
In particular, we shall focus on the following: healthcare teams categorized as (unidisciplinary, multidisciplinary, interdisciplinary, cross-disciplinary, polydisciplinary, pandisciplinary, transdisciplinary, and virtual.) relating to rendering nursing care. Modalities of patient care will also be given an importance in terms of achieving team’s efficacy. The advantage of teamwork in relation to the use of operational communication (what makes communication effective?) that equates to quality nursing care rendered to the patients through which risk management can be applied, in which medication error is of common issue.
There will also be a discussion on conflict management regarding some pitfalls or setbacks when teams gone disarray. Aside from that, strategies to resolve conflict as a back up plan in continuance of the work started as a team.
Teamwork as quoted by Peter Drucker, “The leaders who work most effectively, it seems to me, never say "I." And that's not because they have trained themselves not to say "I." They don't think "I." They think "we"; they think, "Team." They understand their job to be to make the team function. They accept responsibility and don't sidestep it, but "we" gets the credit…. This is what creates trust, what enables you to get the task done.” The adage simplifies the essence of teamwork in a busy working environment. The individual who composes the team is challenged everyday to maintain such stability under pressure.
The health care team is subcategorized into the following: unidisciplinary health care team ( 1996) a group of health-care workers who have similar training. Their background would equip them to solve specific problems meaning their role is segregated along their professional boundaries. The characteristic of this approach is that it is Limited inter-professional communication, independent rather than collaborative goal setting, and minimal optimization of health care resources. Interdisciplinary health-care team, where in, health care workers from different professions assume roles and carry out responsibilities that share common goals for the client. Roles overlap and are flexible over time ( 1994). The very survival of healthcare institutions depends on our ability to bring our knowledge as professionals--physicians, nurses, pharmacists, therapists, nutritionists, and social workers--together into effective cross-disciplinary teams (1999). The goal, in healthcare as in business, is to produce much higher quality at lower cost through integrated, collaborative work. Interdisciplinary team members understand the educational backgrounds of one another, know each other’s areas of expertise, and are aware of the roles assumed by each profession ( 1994). All team members undertake goal planning and the implementation of tasks in an integrated manner. Communication among the professions is frequent and on going. Roles and tasks are assigned according to levels of competence rather than solely on the basis of traditional professional responsibilities (1994). Implementation of the teams’ shared; mutually agreed-upon goals during treatments often yield results greater than could be accomplished by separate profession-specific approaches (1993). Multidisciplinary or polydisciplinary health-care team (1996) is a group of health-care workers who are members of different disciplines, each one providing specific services to the patient. The disadvantage of this approach includes differing status accorded various disciplines and team members, unequal benefits of team participation for individuals at different stages of their careers and with different levels of academic credentials, variability in the organization and administration of each discipline resulting in tensions related to team participation. Goals and tasks are developed and implemented independently according to recognized professional boundaries. Multidisciplinary teams address separately each problem of the older adult. Purposeful integration of services and care goals is not a feature of this approach. Pandisciplinary / transdisciplinary health care team as multiple service workers meaning to say, health workers assume and able to perform other professional roles. Researches show that virtual teams have a lot of potential; however, it takes a great deal of more planning and initial effort to perform at the levels of face-to-face teams. It is predicted that in the future, virtual teams will be the fundamental organizational structure (2003). It must be noted that face-to-face meetings bring a special chemistry and greater power of communication (2002). However, in face-to-face type of giving of care, even though there are actually much time spent on arguing, at the point when the team gets a consensus, the team moves on as one. Face-to-face meetings within the traditional teams keep a much more personal meeting compared to virtual teams wherein means of communication are done either via email, video conferencing or phone ( 2002).
What makes teamwork a necessity? Nurses who work in teams are less stressed than their more isolated colleagues and deliver better and more innovative patient care with lower hospital mortality rates, according to new research for the UK Government. According to the study, team membership buffers individuals from the negative effects of organizational conflict in National Health Service (NHS) hospitals. Team members were clearer about their job descriptions, communicated and negotiated better with colleagues and felt better about their organizations. Without teamwork, there will be Lack of clear leadership led to poorer quality patient care, less innovation and higher stress levels; the study suggests (2002).
The fundamental member of the health team is the patient that is why as a nurse we are guarded with our ethical standards in protecting the patient's voice and guarding the patient's secrets. We therefore are required to cope with dilemmas when there are conflicting interests, including conflicts between the patient and the interdisciplinary team regarding options for care. The health care team models helps every team members in identifying what model is appropriate in a particular setting thus, allowing the use of knowledge and skills in an optimum level. If the use of any health care team model is successful enough in delivering the care then, we can’t question their attitude towards teamwork. But if it fails, there must be something wrong with the flow of communication that shattered their bond as a team. This would result to disruption of the smooth flow of activities in the ward or any clinical setting that is evidenced by negative feedbacks or complaints from the patients. There are certain types of care given by the nursing team this is called Patient Care Modalities where in we have the case method, functional method, team nursing and the primary nursing. The Case Method, where in one nurse is responsible for the total patient care on the number of patients. The disadvantage of this modality is that there is a possibility that efficient care won’t be given due to less time of interaction with every patient she has cared for. This is usually handled by nurse case managers who are effective enough in helping in managing coexisting medical conditions, providing support, providing education, giving assistance with activities of daily living (ADLs), and helping to navigate through the health care system ( 2003, May – June). The second modality is the Functional Method, this refers to less nurses compared to patients to be cared for. They must provide total patient care. This modality is good if every registered nurses function, therefore teamwork is a must need in this modality. In the comparison abstract of Gardner, differentiated Team Nursing and Primary Nursing in three different areas: quality of care, impact on nursing staff and cost (1991). It confirmed confirm that primary nursing does result in a higher quality of nursing care than team nursing and that nurse retention is improved in primary nursing. Team Nursing – this involves 2 teams, does team conferences before, during, and after duty. Supervise by the team leader who made the nursing care plans before the day of duty. This is a good modality if there are enough members of nurses who render total nursing care. Lastly, Primary Nursing – in this modality, the head nurse or the team leader makes a 24 – hour nursing care plan for the entire patient in total care from the day of admission to the day of discharge. At the end of duty, he associate nurse will take over the role of the head nurse and is guided by the nursing care plan prepared by the previous head nurse on duty. She in turn, would give total care throughout the duty but makes adjustments to the care, in case there are necessary changes but must report to the head nurse so that she can make the necessary changes to the nursing care plan. In regards to this type of patient care, teamwork works at its zenith. Why? Because there won’t be any pressure since, they already have a 24-hour nursing care plan. In connection with the study of Gardner, primary nursing reduces costs when compared to team nursing (1991). This was supported by , A; where in the interaction of primary nursing with supervisor support was more predictive of performance: if supervisor support was high, performance was substantially higher than if supervisor support was low. In addition, nurses' perceptions of the costs of seeking support had a detrimental impact on their performance (January, 2004). What they need is be flexible in meeting with the changes and be the best one can be, if that happens. Teamwork is not just about cooperation, coordination but it is about people who yearn for the betterment of the group, in any circumstances they are in. If this is the case, ethos is maintained among them, achieving a quiet and harmonious working environment with competent staff and efficacy of the delivery of actual patient care.
In order to be heard, one must learn the art of effective communication. How? Foremost, we must understand the intricate details of communication; it comprises of the sender (encoder) – message – channel (means) – receiver (decoder, noting the tone of voice, facial expression, and body language of the receiver). Behind the façade of listening is; understanding that is to go beyond what eyes can see but what the heart (feelings to be grasp) dictates the mind (comprehending) in knowing the details of the message perceived. What does this imply? According to Lawrence Birkner, effective communication is a chain of events in which the message serves as the basic link. Successful communication must be received, get the receiver's attention, be interpreted correctly and be acted upon appropriately (2001). Means to say, that it is a two – way process that overcomes the barriers of communication which are the (1) lack of common foundation of experience between the speaker and the listener, (2) failure of the speaker to clearly distinguish between symbols and things they represent, and (3) the speaker may not use concrete words (sends an abstract message). This is according to; in his article Organizational communication and abuses (2004).
Good communication is also vital in maintaining working ethos that involves staff development by avoiding risk and resolving conflicts within. When a team works they communicate by various reasons. It may be they want to chill from a stressful task, or one wants to know how well the person is coping or most probably, they want to clarify regarding a specific task; either IV computation, feedings, procedures to be done like bone marrow aspiration or simply with regards to medication. Medication error () is the most common reported cases in the ward; this is a result of lack of communication and teamwork. Thus, delaying the care and at the same time, endangers the safety of the patient and a question to the competency of the nurse. In order to avoid present and futuristic injuries and / or problems, risk management offers process of measuring, or assessing risk and then developing strategies to manage the risk. In general, the strategies employed include transferring the risk to another party, avoiding the risk, reducing the negative effect of the risk, and accepting some or all of the consequences of a particular risk. Common risk areas in the health care setting are medication error, complication from a diagnostic exam, falls, patient or family dissatisfaction with care and the refusal of treatment/ refusal to sign consent for behavior (2002). If this happen, God forbid! Measures such as incident reports are made. This provides as documentation and follow- up as an accurate and comprehensive report on what has happened. This is essential to protect the organization and care giver from litigation (1993). However, it is better to avoid such risk by obeying always rules and regulations, doing the procedure properly, keep in mind patients are human beings with human rights and always remember to do aseptic techniques.
The other side of ineffective teamwork is conflict. This happens when two or more parties, with perceived incompatible goals, seek to undermine each other's goal-seeking capability, which is sometimes characterized by physical violence. In order to maintain the smooth flow of activities in the ward or in a clinical setting conflict management must be applied. Conflict management, is the way person handles grievances, how they stand for their right or on what they believe in, it may be either positive or negative response, but this utterly depends on the person experiencing the conflict, this is an on going process that may or may present a solution to a problem. These are the conflict management styles that are practiced in every situation, ( 2000); cooperative problem-solving style enables people to work together so everyone can win. Using this style, people try to find a solution that will help everyone meet their interests and help everyone maintain a good relationship. Competitive style means that a person is putting his/her interest before anyone else's interests. In fact, sometimes people who use the competitive style try so hard to get what they want that they ruin friendships. The moment people choose the compromising style when it is important for them to satisfy some of their interests, but not all of them. People who compromise are likely to say "let's split the difference" or "something is better than nothing.” The avoiding style does not get involved in a conflict. A person choosing the avoiding style might say "you decide and leave me out of it." Lastly, an accommodating style put their interests last and let others have what they want. Many times these people believe that keeping a good friendship is more important than anything else. However, conflict management is entirely different from conflict resolution. The latter, refers various solution to the present problem. In here, discernment and appropriate decision – making must be done for its goal is to solve disputes before it gets bigger and likely, more people might get involve.
All that was mentioned above are the processes that we go through with teamwork; some may have a positive or the not-so-good feedback. Nevertheless, it is always an adventure to be flexible and accommodating with the current norm one is in. There’s no harm in trying to put up what’s best for the group. It was never a question of what the group can offer to you, but it is what you can give to the group. Keeping that in mind would generate like-minded individuals who would do the best as one can be in every setting he/she is in.
I could mention an example in our ward where in we practice teamwork. There was a time when we use the Team Nursing patient care modality because there was an increase number of patient compared to the previous days. We handled it effectively since, the tasks were divided among us and we cared for a specific patient that enables to establish rapport and gain their trust all through out the hours of duty. It is known that we should know our patient well in order to care wholistically. It is indeed a superb experience since, we are able to maintain the ambiance of ward, no conflict of any sort and no incidence of medication error was reported. It was indeed a nice experience due to the fact that I was assigned in another team that most of its members are not that familiar to me, I was able to gain new friends at the same time learned the value of teamwork in every setting. It was nice knowing that I can be flexible in any way, which I thought I am not capable of.
The title, generally present the idea that success would be possible if only teams work together, hand-in-hand in maintaining working ethos in delivering safe, efficient and effective care to the patients. Team leaders are always there to guide, determine or dictates the attitude and relationship of every staff or may be due to command responsibility assigned unto him/her, but regardless of which, the team entirely depends on every individual.
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