interdisciplinary approach in critical care nursing f sri x · interdisciplinary approach in...
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INTERDISCIPLINARY APPROACH
IN CRITICAL CARE NURSING
18rd INTERNATIONAL SYMPOSIUM ON
CRITICAL CARE AND EMERGENCY MEDICINE
Bali , 21 -23 July 2011
F.SRI SUSILANINGSIH
Universitas Padjadjaran
[email protected] 1ISCCEN
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People with life-threatening injuries and illnesses
COMPLEX & MULTI - INTERVENTION COMMUNICATION
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2
COMPLEX &
CRITICAL
PROBLEMS
MULTI - INTERVENTIONMULTI - DISCIPLINES
POLYFARMACY
COMMUNICATIONDECISION MAKING
TEAMWORK
POTENTIALLY FRAGMENTED CARE
PROBLEMS IN SAFETY,QUALITY
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Adverse events and serious errors are
common in critical care (Manojlovich, 2007)
communication between nurses and physicians may be the
most significant factor associated with excess hospitaL
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Errors occur frequently in intensive care units, with error rates as high as 1.7 per patient per day (Thomas,2003).
most significant factor associated with excess hospitaL
mortality in critical care settings.
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CLINICAL CARE GOVERNONCE
INTEGRATED AND COMPREHENSIVE
PATIENT CARE
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Holism, humanism and care
INTERDISCIPLINARY APPROACH
IN PATIENT CARE
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INTERDISCIPLINARY MODEL of PATIENT CARE
SYNCHRONIZED HEALTHCARE PROFESSIONALS in a
PARTICIPATORY,COLLABORATIVE and COORDINATED APPROACH TO SHARE
DECISION MAKING in delivering PROCESS OF CARE
CREATE A NEW CULTURE
To support integration and collaboration of care
practices
lack of coordination
role overlap
Fragmented careMINIMIZED
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INTERDISCIPLINARY APPROACH
Health care professionals GROW UP & LEARN in a situation,that
• SUPPORT MUTUAL TRUST
• WILLINGNESS TO SHARE DECISION MAKING
COHESSIVENESS
SHARE EXPERTISE > PERSONAL AUTONOMY
Collective Culture Expert Culture
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WHY COHESSIVENESS IS NEEDED ?
HISTORICALLY, IN MULTIDISCIPLINES :
The problem do exist in:The problem do exist in:
• ORGANIZATIONAL STRUCTURALISM
• POWER IMBALANCES
• ROLE SOCIALIZATION
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ORGANIZATIONAL STRUCTURALISM
Need to shift from RIGID BUREAUCRATIC STRUCTURED
FASILITATE Health Professionals providing Patient Centered Care
D-M to the level of practice where patients come to seek resolution
UNSTRUCTURED,SHARED,INFORMAL,FUNCTIONAL,EMPOWERING,
PARTICIPATIVE,CONSULTATIVE
POWER [email protected] 8ISCCEN
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POWER IMBALANCES
ROLE CONFLICT GOAL CONFLICT
Over lapping competencies &
responsibilitiesValue differences,dissimilar
philosophies
Identify Their Own Professional Group And Block Their
Ability To Consider The Opinions And Perspective Of Others
philosophies
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ROLE SOCIALIZATION
The development of identity and pattern of practice in
health profession is based on a process of socialization in
which knowledge,skills,values,roles and attitudes which knowledge,skills,values,roles and attitudes
associated with particular professional practice are
aquired
UNIQUE WAY OF THINKING AND ACTING
ITS OWN CULTURE
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COLLABORATIVE PRACTICE
Must learn to accept a blurring of practice boundaries
Trust other disciplin members in sharing patient care
process
Role Socialization Must Be Expanded To Include
Collaboration With Other Health Care Colleagues
ESTABLISH AN UNDERSTANDING THAT
RESPECT DIFFERENCES VALUES & BELIEFS
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INTERDISCIPLINARY MODEL OF PATIENT CARE
KEY INGREDIENTS:
Sense Of Control,information Sharing,attention To
Overlap & Responsibility,structuring Intervention
• INTEGRATED CARE PATH
• TEAMWORK
•INTEGRATED DOCUMENTATION
• Interdisciplinary ROUNDS or case
conference
Components of Model
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Personal autonomy
Shared expertice
Sence of control
Information sharing • Consensus buildingoutperforming competitionon
CONCEPTUAL FRAMEWORK: The essence of collaborative practice on
interdisciplinary Model of Patient Care
Information sharing
Attention to co-territory
Structuring Intervention
Expert culture Collective culture
• Consensus building
• Interdependencycompetition
Personal accountability
Quick decision makingCon
cern
on
Con
cern
on
13ISCCEN
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INTERDISCIPLINARY
APPROACH of PATIENT
CAREPERSONAL AUTONOMY
Sense of control
SHARE EXPERTISE
Sense of control
Information sharing
Attention to co territory
Structuring information
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INTERDISCIPLINARY MODEL OF PATIENT CARE
KEY INGREDIENTS:
• Sense Of Control,
• Information
Sharing,
• INTEGRATED CARE PATH
• TEAMWORK
•INTEGRATED DOCUMENTATION
• Interdisciplinary ROUNDS or
Components of Model
Sharing,
• Attention to
Overlap &
Responsibility,
•Structuring
Intervention
• Interdisciplinary ROUNDS or
case conference
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CASE
MANAGEMENT
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CASE
MANAGEMENT
COORDINATES AND LINKS HEALTH CARE SERVICES TO CLIENTS
A delivery – of – care approach
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TO CLIENTS
… A COLLABORATIVE PROCESS
Health care professional work together as an INTERDISCIPLINARY TEAM
…….From admission to discharge ……..
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CASE
MANAGEMENT
..Integrated care path as clinical guidelines …
CASE MANAGERClinical Nurse Specialist
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Clinical Nurse SpecialistROLE DIMENSIONS
CLINICAL/PATIENT CAREMANAGERIAL/ LEADERSHIP
INFORMATION MANAGEMENTFINANCIAL
PROFESSIONAL DEVELOPMENT
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CASE
MANAGEMENT
COORDINATES AND LINKS HEALTH CARE SERVICES TO CLIENTS
A delivery – of – care approach
[email protected] ISCCEN 18
TO CLIENTS
… A COLLABORATIVE PROCESS
Health care professional work together as an INTERDISCIPLINARY TEAM
…….From admission to discharge ……..
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focusing on daily evaluation of client progress towards specific outcomes, modifying care based on their evaluation and preparing clients for timely discharge or transition to other areas
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In Interdisciplinary model of patient care,
physicians and nurses work cohessively in a partnership collaboration
CONCLUSION
COHESSIVE PROFESSIONAL PRACTICE CLIMATE
LEARNING CLIMATE
toward collaborative professional partnership.
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REFERENCESBertholf,L.,1998,Clinical Pathway from Conception to Outcome,Modern HealthCare.19:30-35Bislev,S.,2006,CODEC Collective Development of Culture,NEST-2005-PathCul. [email protected],B.,2006,Instructional Design and Assessment:An InterdisciplinaryApproach to Introducing ProfessionalismClark,P.G.,Drinka,T.J.K.,2000,Health Care Teamwork : Interdisciplinarypractice and Teaching.West Point:Auburn HouseCohen,M.B.,2005, Why Culture Matters in Health Care,paperpresentedatCohen,M.B.,2005, Why Culture Matters in Health Care,paperpresentedatCommunity Voices Summit:Health Care in a Multicultural Society. Available athttp://www.communityvoices.orgKatzenbach,J.R.,Smith,D.K.,1993, The Wisdom of Teams:Creating the Highperformance Organization,New York:McKinsey&Co,Inc.Leonard,M.,Graham,S.,Bonacum,D.,2004, The Human factor: The CriticalImportance of Effective Teamwork and Communication in Providing Save Care.Qual Saf Health care,13:85-90
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Luthans,F.,1995,Organizational Behavior,7thed.,New York:McGraw-Hill,Inc.Milligan,R.A.Gilroy,J.,Katz,K.S.,Rodan,M.F.,1999, Developing a SharedLanguage: Interdisciplinary Communication among DiverseHealth CareProfessionals. Holistic Nursing Practice; 13:47-53Mitchell,P.H.,Crittenden,R.A.,2000,Interdisciplinarry Collaboration: Old Ideaswith NewUrgency.Washington PublicHealthOrchard,C.A.,Curran,V.,Kabene,S.,2005, Creating a Culture forInterdisciplinarry Collaborative Professional Practice. Med.Educ.Online; 10:11Available athttp://www.med-ed-online.orgSullivan,E.J.,1999,Creating Nursing’s Futures:Issues,Opportunities andSullivan,E.J.,1999,Creating Nursing’s Futures:Issues,Opportunities andchallenges. St Louis:Mosby,Inc.Walker,T.,2005, Colaborative Care.Managed Health Care Executive; 15:171-173Whorly,L.W.,1996,Evaluating Health Care Team Performance:Assessment ofJoint problem Solving Action,The Health Care Supervisor.Gaithersburg,14:71-77nn.nd.Cultural Factors:The Expert Culture and the Collective Culture.Available athttp://www.ache.org/pubs/4atchchat.pdf
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