Team Work and Nurse-Physician

Relationship

Team Work

The way in which the team members function and coordinate to produce synchronized output ( patients outcomes ).

Team Process

Poor team work is causal factor underlying critical care incidents.

Team effectiveness Communication

Performance Leadership

Errors Coordination

Patient outcomes Decision Making

Team Communication

Definition :

The way in which the team members function and coordinate to produce a synchronized output.

Poor team work is a causal factor underlying critical care incidents in ICU’s

Team Communication information transferred accurately during written

and verbal handover. Information disseminated on newly admitted patients. Information distributed on patient treatment plan.Appropriate information requests during

emergencies.Team member acknowledge communications.Clear and direct requests made for team assistance. Junior team members show speaking –up behavior

Team Communication/ Literature Review

Communication is linked to safety and performance.

Errors are concentrated after communication events such as shift changes and hand over.

37% of these errors are associated with communication between nurses and physicians.

Researches demonstrate that the ICU’s with high level of group development (e.g. mutual trust and absence of interdisciplinary conflict) have a lower risk adjusted morbidity rate.

Team Leadership

Definition :

The guidance of a team and involves defining goals, expectations, organizing team resources and coordinating team activities.

Efficient Leader Encourage team input.Stating and evaluating plans.Asserting opinions when appropriate.Listen to staff feedback.Delegate tasks effectively.Prioritizing aspects of care.Ensure team members comfort with assigned

duties.

Team Leadership/ literature Review

Real time observation had shown association between rating of performance and leadership behavior.

Researches have indicated that the leadership style of the team leader influence team work.

e.g leader inclusiveness ( Listening and encouraging Junior nurses ideas) has been shown to increase team members involvement in PI.

Team Coordination

Definition:

Concerted and synchronous performance of work activities by team members with each team member maintaining an awareness of one another work.

Examples of team coordination

Nurses cross check physician generated patient care plan.

Physicians and nurses providing “heads-up” alerts to each others.

Team Decision Making

Definition :

Relates to decision making by the leader by integrating information and perceptions from the members of the team.

Team Decision Making/ Literature Review

collaborative decision making has been linked to improved patient outcomes.

units with higher level of collaboration between nurses and physicians during transfer decisions have a lower rates of risk adjusted mortalities and higher level of nurse and physician job satisfaction.

Team ProcessT•Team Communication •Team Communication

•Team Leadership•Team Leadership

•Team Coordination•Team Coordination

•Team Decision Making•Team Decision Making

•Team Outcomes:

• Team satisfaction

• Job satisfaction

• Staff Morale

• Stress

•Burnout

• Staff turnover

•Team Outcomes:

• Team satisfaction

• Job satisfaction

• Staff Morale

• Stress

•Burnout

• Staff turnover

• Output

•Patient Outcomes:

•Adverse events

•Patient mortality

• Length of stay

• Unit Efficiency

• Compliance with protocols

•Patient Outcomes:

•Adverse events

•Patient mortality

• Length of stay

• Unit Efficiency

• Compliance with protocols

Nurse Physician Relationship

Is it Important ….WHY?

Nurse – Physician Relationship

Collaborative Nurse- Physician Relationships are associated with improved patients , Nurse and physician outcomes.

Patient Outcomes

Improved patient satisfaction.Improved patient transferred and satisfaction

decisions.Improved patient care. Decrease length of stayReduce medication errors.

Nursing & Physician Outcomes Improved job satisfaction. Decrease job associated stress. Lower nurse turnover rate.Improved communication amongst care

giver. Improve understanding of the nursing role.Improved Efficiency.

Barriers to Nurse-Physician Collaboration

Role misunderstanding: real and precieved differentials in power.

Position and respect.

Varying perceptions of decision making input and autonomy.

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