1 Chapter 5 Interdisciplinary Rehabilitation Team Judi Behm Nancy Gray Learning Objectives NOT FOR SALE At the OR end of DISTRIBUTION this chapter, the reader will be able to Define the term interdisciplinary team. Recognize the benefits of team collaboration. Discuss the roles of each member of the interdisciplinary team. Contrast various team models used in rehabilitation. Describe characteristics of an effective NOT interdisciplinary FOR SALE team. OR DISTRIBUTION Recognize benefits and challenges of working within interdisciplinary teams. Key Concepts and Terms Advanced & practice Bartlett nurses Interdisciplinary model NOT Case FOR manager SALE OR DISTRIBUTION Interdisciplinary teams (IDTs) Physical Medicine and LL NOT Rehabilitation FOR SALE OR DISTRIBUT Collaboration Collaborative discussion Dieticians Medical model Multidisciplinary model Nurses Physical therapists Psychologists Speech-language pathologist Emotional intelligence Occupational therapists Social workers Group dynamics Physiatrists Team competence Background and History NOT FOR The interdisciplinary SALE OR DISTRIBUTION team continues to provide more Rehabilitation involves the successful and productive combined knowledge and skill, clinical expertise, sensitivity, interaction of many stakeholders. The patient and family, compassion, and understanding for individuals with disabilities than can be found in any other area of health physician, nurses, psychologists, therapists, social workers and case managers, care....the individual team members each bring a unique dieticians, chaplains, payers, and, perspective and expertise to the collective Jones planning of the LL at times, even lawyers and employers are all collaborators in a process of joint decision making with a goal of Easton, 1999, p. 31 group. But the team shares similar goals for the patient. achieving a sustainable outcome: return to the highest level of productivity possible for the patient. Central to contemporary rehabilitation philosophy, well-functioning interdisciplinary teams (IDTs) are critical for service literature supports Jones collaborative practice as a strategy Ample evidence in multiprofessional, peer-reviewed integration NOT FOR and SALE successful OR outcomes DISTRIBUTION (Strasser, Uomoto, & to produce NOT optimal FOR patient SALE outcomes, OR DISTRIBUTION and the IDT is Smits, 2008). The ever-increasing complexity of healthcare interventions and the myriad challenges that impede interdisciplinary healthcare teams were active in the mis- one vehicle to implement that strategy. As early as 1900, patients in their quest to return to productivity demand sion hospitals of India. In the United States the concept an interface between all healthcare professionals. of teamwork was advanced by nursing theorist, Dorothy..
2 52 Chapter 5 / Interdisciplinary Rehabilitation Team Rogers (1932), as a means of achieving professional acceptance for nursing and allied health professionals. The IDT, as it is known today, emerged after World War II in response to the complex needs of wounded soldiers who survived injuries due to advances Jones & in Bartlett medical care, such as antibiotics. The mandate NOT FOR to provide SALE comprehensive OR DISTRIBUTION treatment for service men and women with severe injuries and disabilities that could not be managed by a singlediscipline medical model gave rise to the notion that multiple healthcare professionals could effectively and NOT tation FOR bodies, SALE such OR as the DISTRIBUTION Joint Commission, Commission on Accreditation of Rehabilitation Facilities, state departments of health, and the Centers for Medicare & Medicaid (Box 5.1) have identified IDTs as necessary for patient safety and quality care, and each organization has specific criteria to demonstrate compliance related to IDT function. Box 5.1 Web Resources efficiently meet the needs of this population. From that The Joint Commission: point, NOT the IDT FOR (composed SALE of OR all members DISTRIBUTION of the treatment The Commission for Accreditation of Rehabilitation team as well as the patient and family) became the gold Facilities (CARF): standard for the care coordination process. Eventually, the IDT became the cornerstone of a new field of medicine, Institute of Medicine (IOM): Bartlett Physical Medicine and Rehabilitation (Strasser & NOT FOR et SALE al., 2008), OR which DISTRIBUTION focused on the restoration of patient NOT FOR The IDT SALE is widely OR accepted DISTRIBUTION in healthcare today, particularly in the areas of mental health and rehabilitation. capabilities. Concurrently, in the 1950s social and behavioral scientists made substantial contributions to the structure, The goal of the IDT is to provide well-coordinated care by marshaling the talents of multiple professionals in concert function, and process of small groups. Social psy- with the patient (Bokhour, 2006). Healthcare consum- chologist, Kurt Lewin (1951), Jones led & the Bartlett field of pioneers ers expect high-quality, transparent care with optimal LL in group dynamics by NOT proposing FOR that SALE a group OR is DISTRIBUTION more outcomes. Because of a variety NOT of available FOR World SALE Wide OR DISTRIBUT than the sum of individuals in it. Lewin offered a context whereby well-functioning groups could be evaluated and proposed that effective group process could be taught Web databases, consumers are able to shop for care that meets the necessary criteria. All payers, whether managed care organizations or government entities, challenge and developed. This heralded the recognition that team healthcare organizations & to Bartlett demonstrate efficacy and leaders NOT must FOR possess SALE particular OR skills. DISTRIBUTION Today, it is accepted value. Maintenance NOT FOR of provider payer SALE OR contracts DISTRIBUTION hinges that interpersonal skills, including communication and on providing metrics that support the value-added benefit negotiation skills, a willingness to compromise, and an ability to value and accept individual differences, are vital to the IDT process. Also understood is that effective team of IDT-based treatment programs. Ultimately, in an unpredictable economy it is imperative that multisystem interventions by an IDT use combined skills to meet the & membership Bartlett requires an awareness of one s own talents, rehabilitative needs of patients with complex injuries to NOT FOR limitations, SALE OR and DISTRIBUTION biases as well as an appreciation of the NOT ensure FOR optimal SALE outcomes OR DISTRIBUTION at the lowest cost in the shortest talents, limitations, and biases of other team members (Rossen, Bartlett, & Herrick, 2008). Interest in interdisciplinary collaboration has exploded possible lengths of stay. In the final analysis, the value of the IDT can be attributed to one basic fact: Decisions made synergistically in the past two decades due to the increasing produce higher quality solutions than those made inde- complexity of patient care and efforts to manage escalating healthcare costs. Research studies indicate that IDT of an IDT, it is important to understand pendently (Gage, 1998). To become an effective member NOT FOR not SALE only the OR DISTRIBUT collaboration enhances patient compliance, improves patient satisfaction, reduces costs, lowers mortality, reduces length of stay, and increases team member job satisfaction (Rubenfeld and Scheffer, 2010). That kind origins of the concept, but the variety of team models, members, and their roles and how to achieve IDT competence and success. of efficiency NOT FOR is necessary SALE in OR today s DISTRIBUTION healthcare climate Box 5.2 Web Exploration because consumers expect healthcare teams that are not only technically and emotionally competent, but that also are capable of blending professional boundaries when it is in the patient s best interest. Regulatory and accredi- Visit this interesting website that offers articles, games, activities, and books about team building at teambuildingportal.com..
3 NOT FOR SALE Team OR Models DISTRIBUTION Team Models 53 The healthcare field, like the corporate world, has identified that working together toward a common goal or project is cost effective and more & productive Bartlett than working individually. Looking for ways to improve quality and decrease the cost of health care has been an ongoing goal, and in pursuit of that goal four main models of professional teams have been developed and practiced over the years: medical, multidisciplinary, interdisciplinary, and transdisciplinary models. Medical Model In the medical model the physician directs all care (Figure 5.1). This model can be effective in physician offices and sometimes in acute care settings when few professionals outside of medicine and nursing are involved in Physical the patient s care. It is not an effective model in rehabilitation settings because the philosophy and goals are not Figure 5.2 Multidisciplinary model. consistent with rehabilitation practice, which includes all levels and disciplines of staff working together, communicating treatment plans, and collaborating on a consistent care setting when a physician orders physical therapy for LL An example of this model might be seen in an acute basis as they provide NOT care. FOR SALE OR DISTRIBUTION ambulation education and occupational NOT FOR therapy SALE to OR assess DISTRIBUT activities of daily living with a person who sustained a Medical Model Communication is more vertical than lower extremity fracture and sprained wrist as result of an accident. Each therapist would perform an assessment, treat according to their discipline, and document lateral Usually Jones physician & driven Bartlett Approach effective when Physician their interventions without any collaboration with other discipline is ordered as consult team members. Nurses Discharge planner Therapists Physiatrist Box 5.3 Social Worker Nurse Patient/family Dietician Don t Forget the Silent Team Member!! Psychologist Occupational Hovering in the background, but never far from the action, Figure 5.1 The medical model. are the payers: managed care entities (Blue Cross/Anthem, NOT FOR United SALE Health OR Care, DISTRIBUTION Aetna, etc.), Medicare, and Medicaid. They review team documentation, either concurrently Multidisciplinary Model (managed care) or retrospectively (Medicare), and base Professionals in the multidisciplinary model (Figure 5.2) hospital payment on outcomes achieved in a timely manner. The nurse case manager or utilization review usually work independently to & accomplish Bartlett disciplinespecific goals. Sharing information and making decisions nurse usually plays a pivotal role Jones in keeping & the Bartlett team LL aware of the requirements and NOT limitations FOR of SALE these silent OR DISTRIBUT based on that information, these team members may not team members as well as acting as an intermediary directly communicate with all team members regarding between the team and the payer. care planning (Albrecht, Higginbotham, & Freeman, 2001). Communication is more vertical than lateral, and team members & do Bartlett not usually participate in team conferences. NOT Sheehan, FOR SALE Robertson, OR and DISTRIBUTION Ormond (2007) note that The interdisciplinary NOT FOR model SALE (Figure OR DISTRIBUTION 5.3), which may also Interdisciplinary Practice Model members working independently often lack a common be referred to as an interprofessional model (Sheehan et understanding of issues that could influence interventions. Therefore, this model is not seen as being as effec- factor that makes this model different from the multi- al., 2007), uses a more collaborative approach. The key tive for rehabilitation programs as some others. disciplinary model is that team members work together..
4 54 Chapter 5 / Interdisciplinary Rehabilitation Team Nurse Dietician Physiatrist Speech Case Manager Patient/family Psychologist Social Worker Physical Occupational Figure 5.3 Interdisciplinary model. in goal NOT setting, FOR treatment, SALE decision OR DISTRIBUTION making, and ongoing therapists could NOT also FOR be the SALE primary OR provider. DISTRIBUTION Because problem solving to ensure continuity of care and a more of a blurring of roles, this model requires not only flexibility but willingness of all team members to function holistic approach (Albrecht et al., 2001). Patients and families are an integral part of the team. Communication between all members of the team is crucial to ensure all & members, Bartlett including the patient, are part of the decision Nurse Dietician NOT FOR and SALE care planning OR DISTRIBUTION process. In comparing the two most common models (interdisciplinary and multidisciplinary), it can be seen that in rehabilitation settings the interdisciplinary approach Speech Physiatrist is more effective because it allows for a more holistic, collaborative, and patient-focused approach. From the time of admission to discharge the patient and team work Patient/family together to establish, evaluate, and accomplish mutually agreed on goals. Social Worker Transdisciplinary Model In this NOT model FOR one team SALE member OR DISTRIBUTION is the primary provider (Figure 5.4). Guided by the other team members, the primary team member provides services to the patient. Team Physical Occupational members are cross-trained in several areas besides their own specialty. Although the nurse may be the primary provider, a therapist who receives direction from other Figure 5.4 Transdisciplinary model. Psychologist..
5 in this framework (Mumma & Nelson, 1996). Nursing home facilities may use this model in their restorative care program. If a resident has a change in status, a therapist may be ordered to reevaluate a resident and make recommendations. It is then the nurses & responsibility Bartlett to see that those interventions NOT are incorporated FOR SALE into OR the DISTRIBUTION resident s care plan and carried out on a daily basis. For this model to be effective, staff must be crosstrained to perform any duties that are normally discipline specific so the patient receives appropriate treatment regardless of & who Bartlett is caring for the patient. This is time consuming NOT FOR and SALE often presents OR DISTRIBUTION a level of discomfort for team members to learn skills that were not included in their basic educational program. However, in some instances, for example with infants and children, this model Members of the Rehabilitation Team 55 NOT FOR of ideas. SALE Sheehan OR et DISTRIBUTION al. (2007) found that more effective teams used inclusive language in their discussions. Other factors identified that can have an enormous impact on the success of a team include personality differences and emotional intelligence (McCallin & Bamford, 2007), addressed later in this chapter. Members of the Rehabilitation Team The interdisciplinary team consists of a number of disciplines and is Jones dictated & by Bartlett the service needs of the patient. The core NOT team for FOR most SALE inpatients OR DISTRIBUTION in a rehabilitation setting includes Patient and family Nurses: registered nurses and licensed practical can be an effective method to provide early intervention & nurses Bartlett NOT FOR SALE services, OR using DISTRIBUTION a developmental approach to interventions NOT FOR Advance SALE practice OR DISTRIBUTION nurses: clinical nurse specialists versus discipline-specific approach. and nurse practitioners Physiatrists: doctor of physical medicine and rehabilitation Benefits and Challenges of Models Therapists: Physical and occupational therapists, Benefits of functioning in an & effective Bartlett IDT include increased continuity NOT of services, FOR collaboration SALE OR toward DISTRIBUTION goal speech-language pathologists, recreational therapists, and respiratory therapists (as needed) achievement, shared understanding and problem solving Psychologists between professionals, valuing of team members, and Case managers (some facilities will have related greater patient, family, and staff satisfaction (Sheehan positions such as utilization review nurses, care coordinators, nurse navigators, MDS nurses, and coding et al., Jones 2007). Although IDT functioning offers numerous benefits NOT FOR to the SALE patient OR and family DISTRIBUTION as well as their team specialist NOT that FOR may SALE also be part OR of DISTRIBUTION the team) members, studies have shown there can be challenges as Social workers well. According to Strasser, Falconer, and Martino-Saltzmann (1994), two challenge areas are conflicts regarding Dieticians Chaplains professional boundaries and defensiveness from team members who believe their professional judgment is being Depending on the size of the facility/organization and NOT FOR SALE questioned. OR DISTRIBUTION The tendency to function within the professional boundaries in which one was educated can lead to services from vocational specialists, orthotists/prosthe- NOT FOR extent SALE of services OR provided, DISTRIBUTION patients may also receive disciplinary silos and impede efforts toward collaborative tists, biomedical engineers, and audiologists as needed. thinking (Herbert et al., 2007). Additionally, alternative services, such as music and pet Communication is a key factor in thinking and func- therapy, may be available. tioning collaboratively as a team, and discipline-specific language, or jargon, has been identified as a limiting Role of Team Members factor when creating a well-functioning team. Nurses, like other disciplines, are educated within certain domains and have their own language ; therefore, when we work with other members of the team there is potential difficulty NOT FOR in speaking SALE OR with DISTRIBUTION a unified, interdisciplinary voice. Bokhour (2006), in a study on communication in interdisciplinary team meetings, found that collaborative discussion occurs when team members step out of their discipline-specific framework and focus on patient s Professional members of the team may function in several roles: as a care provider, patient advocate, or a coordinator of care. Larger interdisciplinary teams, common in most rehabilitation units or facilities, often include both a social worker/discharge NOT FOR SALE planner OR and a DISTRIBUTION case manager. Case managers are routinely seen as the coordinator of care and may share the role of team leader with the physician. Each member of the team brings with them disciplinespecific expertise. Table 5.1 provides brief descriptions of each team member. needs, allowing for a more open dialogue and exchange..
6 56 Chapter 5 / Interdisciplinary Rehabilitation Team Table 5.1 Team Member Roles With Examples Discipline Primary Role in the Team Examples of Collaboration With Other Team Members Physiatrist Responsible for physical medicine and Often leads the team. rehabilitation management of patient s care. Orders assessment and ongoing treatment in collaboration with team. Staff nurse Physical therapist (PT) Occupational therapist (OT) Speech-language pathologist (SLP) Therapeutic recreation (TR) Respiratory therapist (RT ) Neuropsychologist Case manager Coordinates and provides day-to-day patient care. Educates patient/family regarding medical and health issues as well as skills needed to provide safe health care (i.e., catheterization skills, bowel programs, skin maintenance/wound management). Patient advocate. Maximizes patient function by working with patients to improve gross motor skills. Focuses on mobility, including ambulation, balance, W/C skills, Provides modalities for pain management. Assist patient gain maximal function in areas of ADLs. Evaluates and treats cognition, communication, swallowing disorders, and hearing deficits. Assists patients to reenter their community and helps patients adapt so they can enjoy leisure activities. Evaluates and treats a patient s breathing, including assist of ventilation as needed. Evaluates cognitive and behavior status, assists in the adjustment to illness/disability. Provides support to patient and family as they come to grips with issues related to illness/disability. Coordinates implementation of treatment plan, communicates insurance benefit information to patient/families and the team. Advocates for services. Acts as liaison between patient, hospital, and payer. Provides updated information to insurance companies. Coordinates optimal use of available benefits. Supports and coaches patients to practice newly learned skills. Cues them as needed. Provides feedback to therapists re: patient ability to follow through with skill and if there are cognitive, behavioral, or physical changes during the day that are impacting patient s ability to consistently perform on unit. PT and OT work together to develop strength, balance, and teaching skills needed for ADLs. Patient works on W/C transfers, whereas OT incorporates what PT has taught patient to practice toilet transfers, and instructs patient on clothing management, personal hygiene. OT and PT collaborate to assist patient to become functional with all components of skills/adls. Communicates with team regarding patient communication needs, how to cue patient when learning an activity, impact of cognitive deficits on ability to learn and retain information. Communicates with team regarding feeding and swallowing disorders and works with physicians, nurses, and dieticians about appropriate food and liquid consistencies, compensatory strategies to maintain safe swallow. Incorporates what patient has learned from other disciplines to assist patient with community reentry and leisure activities in preparation for patient discharge. Supports maintenance of respiratory status and prevention of complications related to inactivity. Works with PT to increase tolerance for increased mobility. Works with team regarding cognitive and behavioral needs of patients, developing appropriate plans of care related to cognitive and behavioral management. Coordinates team to look at patient days, status of insurance to assist in planning for discharge, and to keep members mindful of time allotted to accomplish goals..
7 Table 5.1 Team Member Roles With Examples Members of the Rehabilitation Team 57 (Continued) Discipline Primary Role in the Team Examples of Collaboration With Other Team Members Social worker/ Focuses on psychosocial support. Communicates patient/family wishes regarding discharge planner Prepares patients and families for discharge. necessary services. Collaborates with team Dietician Advanced practice nurse (CNS /nurse practitioner) Identifies supportive services, resources needed after discharge. Links patient/family to community physicians, services, home health care, long-term care facilities, and medical equipment providers. Oversees patient s nutritional status and works with physician to provide necessary dietary requirements; provides patient/family education on diets. Conducts comprehensive assessment. Integrates education, research, and consultation into clinical practice Chaplains Supports patients in their spiritual/religious practices. Provides encouragement and support. NOT Vocational FOR services SALE OR Evaluates DISTRIBUTION impact of illness/injury on vocation. Assists patients with adaptations to return to present vocation or retraining/education. ADLs, activities of daily living; CNS, Clinical Nurse Specialist; W/C, wheelchair. regarding patient s needs. Communicates status of services obtained. Works with case management in coordinating all written information that will go home with patient. Provides necessary information about patient to community providers to ensure continuity of care. Collaborates with team to adapt diet according to patient s needs. Monitors calories, labs as patient s needs change. Works with patient/family to provide foods of preference within dietary restrictions. Communicates nutritional status to team. Collaborates with nursing peers, interdisciplinary team, including physician, regarding evidenced-based practice. Integrates education, research and consultation into clinical practice. Guides team to provide support while coping with illness/disability, consistent with patient s faith/beliefs. Communicates status of patient s vocational needs. Works with therapists to develop, adapt, or improve skills required for return to work or school. Responsibilities of IDT Members Box 5.4 How to Achieve Team Competence Well-functioning and effective team members need to Technical competence is the focus of most professional understand their roles and responsibilities. Although programs in health care. roles are dictated partially by the discipline of each member, responsibility for an effective IDT falls on all team ensure safe patient care. Both technical and team competence NOT FOR are SALE critical to OR DISTRIBUT members. Members need to value and demonstrate a Healthcare professionals who understand each other s collaborative approach with patients, family, and other team members when setting goals, coordinating care, and providing & education Bartlett and discharge planning. Secrest roles and work together effectively provide higher quality care (Barnsteiner, Disch, Hall, Mayer, & Moore, 2007). (2007) NOT FOR describes SALE a number OR DISTRIBUTION of components required to Members NOT of collaborative FOR SALE teams OR enjoy DISTRIBUTION greater job satisfaction (Chaboyer & Patterson, 2001). have an effectively functioning team: trust, mutual respect, communication, coordination of care, knowledge, shared responsibility, and a commitment to each other. Freeman (2000) states there are three individual philosophies of teamwork that impact its role, comprehension, Box 5.4 provides additional information on IDT competence. and communication: directive, integrative, and elective...
8 58 Chapter 5 / Interdisciplinary Rehabilitation Team Those who have a directive philosophy view their role as a team leader. Persons with an integrative approach are often therapists, social workers, and nurses who view NOT follow FOR alterations SALE in OR team DISTRIBUTION structure. During these times the group may experience an interruption in cohesiveness as members seek renewed commitment to the goals and purposes of the group. IDT members most likely to assist the group to understand these shifting dynamics are the their role as upholding collaboration and being a team player. Those with an elective Jones philosophy favor brief communications and work NOT more FOR autonomously. SALE OR Differing DISTRIBUTION psychologist, the clinical nurse NOT specialist, FOR and SALE the nurse OR DISTRIBUT philosophies among team members can contribute to turf care coordinator (case manager) or social worker. The issues and negatively impact attempts to have a cohesive registered nurse is in an excellent position to prompt the and collaborative team. The responsibility of addressing team to refocus their shared commitment on the care of any negatives within the team falls on each member of patients and families. the team; often there are senior, more experienced team members NOT who FOR understand SALE and OR practice DISTRIBUTION the philosophy of interdisciplinary and collaborative care who will assume a leadership role to address issues. Characteristics of an effective team are discussed in the following section. NOT FOR Characteristics SALE OR DISTRIBUTION of an Effective IDT It is important that IDT members relinquish their perceptions of NOT perceived FOR professional SALE OR boundaries DISTRIBUTION and nurture a mutual respect for the value other members bring to the team. Even in teams highly skilled in working collaboratively, conflict is inevitable. However, if moments & of Bartlett conflict are viewed as opportunities to come NOT together FOR and SALE achieve OR synergistic DISTRIBUTION solutions, both the team and patients benefit. Well-educated professionals, taught to be assertive and think critically, will have conflicts. The key is to accept conflict as a natural outcome when creative energies collide and work to resolve it (Hall & In rehabilitation one thing is certain: No one discipline and no single approach can provide the comprehensive services needed to facilitate recovery from complex injuries and mitigation of Jones multiple & deficits. Bartlett However, in Weaver, 2001). Box 5.5 provides keys to preparing for LL IDT membership. recent years empirical research has emerged identifying the well-functioning IDT as one of the determinants of improved functional gains for rehabilitation patients. Optimal outcomes require the integration of complex medical, financial, & psychosocial, Bartlett educational, and vocational NOT resources FOR across SALE diverse OR specialties DISTRIBUTION and multiple systems in a highly visible setting with patients and families involved at all levels (Strasser et al., 2008). Rehabilitation can be a lengthy and often frustrating process. Rehabilitation professionals have the dual chal- Box 5.5 How Do You Prepare for Membership on an IDT? Appreciate your own discipline and its unique contribution to rehabilitative care. As a student, seek every opportunity to observe and/or be part of an IDT. Do not be afraid to stretch outside the comfort zone of your own discipline. Participate in committees or groups that include other healthcare professionals. Experience with interdisciplinary collaborative practice as a student has been shown to be a determinant of positive attitudes about IDTs as students enter the job market (Florence, Goodrow, Wachs, Grover, & Olive, 2007). & lenge Bartlett of helping families remain hopeful while preparing NOT FOR them SALE for scenarios OR DISTRIBUTION that may be disappointing. At the same time, being part of an IDT can be exhilarating, with daily collaboration among skilled professionals implementing exciting and creative, evidence-based care. Personal commitment to the team and a willingness to put notions about differing status of members aside are Team Competence prerequisites of effective IDT membership. Collaborative discussion demands communication skill and an ability to transcend professional jargon, shed the expectation Team competence derives from the ability of multiple of physician dominance, and become comfortable with disciplines to behave as a single system. Moving beyond blurred professional boundaries. Negotiation skills and task focus, IDTs are capable of achieving a level of team an appreciation NOT FOR and SALE valuing OR of diversity DISTRIBUTION and individual thinking and NOT an environment FOR SALE of creative OR DISTRIBUTION inquiry that differences are desirable traits for IDT members. exceeds what can be accomplished by individuals operating in professional silos. IDTs can be somewhat fluid, with members entering and leaving, as personal and professional lives change. Brookfield and Preskill (1999) describe habits of collaborative discussion inherent in interdisciplinary teams Ideally, senior members of the IDT will assist the group to process the changes in group dynamics that inevitably as group talk, a blending of conversation, discussion,..
9 Evaluating Team Effectiveness 59 NOT FOR SALE dialogue, OR and DISTRIBUTION cooperation. Although group talk is part NOT FOR on discipline-specific SALE OR DISTRIBUTION knowledge and is demonstrated by of team competence, it does not ensure effective team team acceptance of different viewpoints and knowledge function. Group talk is only useful if team members bases. recognize, identify, and share important clinical and Professional synergy is realized when team members psychosocial cues. Nurses, Jones with 24-hour presence and relinquish autonomy in favor of using & resources Bartlett available within the entire team. NOT Becoming FOR comfortable SALE OR with DISTRIBUT LL accountability, are NOT in a key FOR position SALE to enhance OR DISTRIBUTION effective team function through the timely transfer of critical team-ness, described by Shaw et al. (2008) as the ebb information (Miller, Riley, & Davis, 2009). and flow of teamwork, is a process. In the rehabilitation Equally important to the ability to recognize and dance, team members, comfortable with the talents they communicate critical information is emotional intel- bring to the IDT, allow members with expert knowledge ligence, defined as the ability to perceive emotions, to NOT access FOR and generate SALE emotions OR DISTRIBUTION so as to assist thought, to understand emotions and emotional knowledge, and to reflectively regulate emotions to promote intellectual growth (Mayer & Salovey, 1997, p. 6). The concept of to step in and guide the team when it is in the best interest of the NOT patient. FOR SALE OR DISTRIBUTION IDT members have a responsibility to contribute to the learning culture of the team and should demonstrate the capacity to learn from other team members. Embracing & knowledge Bartlett transfer and reciprocity (professional emotional intelligence, introduced by Daniel Goleman NOT FOR SALE (1995), OR asserts DISTRIBUTION that an effective team needs more than NOT FOR professional, SALE professional patient, OR DISTRIBUTION patient professional), technical and clinical skills. Nurses, to maximize their IDT members avoid the pitfalls of rote performance: contribution to the IDT, need to be aware of the role doing things the same way because that s the way they emotional intelligence plays in team function. Nurses have always been done. Instead, there is an understanding that team function and patient outcomes can will benefit from supplementing their technical educa- always tion with training designed Jones to & refine Bartlett interactional skills be better. that emphasize increasing NOT FOR awareness SALE of OR the DISTRIBUTION impact of team diversity and individual personality differences on team working relationships. Emotional intelligence is the quality that allows IDT members to & engage Bartlett in dialogue, transcend stereotypes, and NOT collaborate FOR SALE to achieve OR synergistic DISTRIBUTION solutions. Although little is known about nurse performance on IDTs (Institute of Medicine, 2003), studies by Glaser (1998) and McCallin (2001) support the notion that nurses ability to IDTs have leadership but not necessarily one leader. Successful team relationships, forged in the midst of practice, allow leaders to emerge when their expertise is needed and then blend again into team-ness. This is the dynamic nature Jones of teams. Professionals on the IDT are accountable NOT both FOR as individuals SALE OR and DISTRIBUTION team members. New team members benefit from mentorship to ease the transition from discipline-specific practice to an environment where collaboration is expected. The nurse considering becoming part of an IDT will want to inquire develop cohesive relationships within the IDT is pivotal to their success. about & orientation Bartlett to the process and available education NOT FOR SALE Individual OR DISTRIBUTION clinical performance skills (task training) NOT FOR to enhance SALE these OR skills. DISTRIBUTION and the behaviors necessary for effective IDT function The final, but perhaps most important, requirement should ideally be taught simultaneously and valued by for team competence is this: embracing the idea that the the organizations and professionals delivering care. The patient is not simply part of the IDT but the center of it. skills that enable IDTs to effect change in process and Healthy People 2020 (2009), a report detailing national outcomes need to be taught at the team level. Whether health promotion and disease prevention agendas, defines by interactive workshops, structured online training, one of the determinants of health as individual behavior or group education connecting outcome data to team and personal choice. Involving patients and families interventions, hospital systems and the various entities in decisions regarding their care, to the greatest extent delivering patient care must endeavor to demonstrate the possible, along with coordinated, concurrent education value placed & on Bartlett competent IDT function. from all involved Jones team members, is key for successful NOT The FOR primary SALE action OR of DISTRIBUTION the IDT takes place in the patient recovery. team meeting and during IDT rounds. Whatever the arena, the themes of consensus, professional synergy, and Evaluating Team Effectiveness fostering a learning culture are of major importance for the IDT to achieve team competence (Shaw, Walker, & There is no one prescription for effective team development, and no one model that can be deployed with a Hogue, 2008). Commitment to consensus avoids reliance..
10 60 Chapter 5 / Interdisciplinary Rehabilitation Team guaranteed outcome. However, team function can be evaluated, both objectively and subjectively. Objective data supporting team success can be found NOT worker) FOR convened SALE OR for a conference DISTRIBUTION to discuss her status, findings of their evaluations, and set up a plan of care and tentative discharge date. Each member of the team gave a report on their findings. The PT identified goals for mobility, the OT stated goals for activities of daily in the analysis of changes in functional independence measures that, when correlated with & length Bartlett of stay, speaks to rehabilitation program NOT success FOR and SALE team efficacy. OR DISTRIBUTION The living, and the speech-language NOT pathologist FOR SALE addressed OR DISTRIBUT Commission on Accreditation of Rehabilitation Facilities swallowing and communication goals. The nurse addressed the status of Sally s bowel, bladder, and skin and The Joint Commission, in their accreditation surveys of program implementation and outcomes, look specifically at IDT function and, in fact, require IDT to be part a tentative discharge date. It was discussed that and stated goals for management. The team then chose because of programmatic & design Bartlett (see Box 5.2). Specific NOT FOR outcome SALE measures, OR DISTRIBUTION gleaned from length of stay, patient satisfaction, and return to productivity data, demonstrate team and individual effectiveness. When patients report satisfaction and show measurable Sally s husband was Jones still working outside the home, Sally would need either NOT to FOR be fairly SALE independent OR DISTRIBUTION and able to be left alone for 7 to 8 hours a day or to have additional assistance in the home while he worked. Going to a long-term care facility was not an option Sally or her husband & wanted Bartlett to explore at this time. A psychosocial & improvement, Bartlett IDT members experience enhanced job NOT FOR satisfaction. SALE OR Mikan DISTRIBUTION and Rodger (2005) describe effective teams as having a well-defined purpose, identifiable the home had five steps to enter but there were railings NOT assessment FOR SALE completed OR by DISTRIBUTION the social worker indicated that goals, good leaders, regular patterns of communication, on both sides. and an environment of mutual respect all qualities that After the conference the case manager went to Sally s can be observed and evaluated. room to discuss plans for her stay and give her the ten- Effective teams also require Jones an & opportunity Bartlett for team tative discharge date. The nurse case manager noted LL that the patient s managed care NOT plan FOR had authorized SALE OR 7 DISTRIBUT days, but daily progress toward home discharge would be necessary. maintenance, often accomplished offline and separate from patient discussion. Taking time to reflect on teamwork successes or failures, appraise performance, and identify programmatic plans are hallmarks of a team that is Scenario 2 proactive, Jones & not Bartlett merely reactive. Effective teams design NOT strategies FOR based SALE on data OR and DISTRIBUTION best practice evidence Bill is a 21-year-old NOT FOR man who SALE sustained OR DISTRIBUTION a C7 8 spinal and implement necessary program changes. Having a cord injury as result of a motor vehicle accident. Once willingness to adjust to ever-evolving challenges is what medically stable, he was transferred to a rehabilitation ultimately defines effective teams. unit. Within 24 hours of admission the physician, nurse, therapists, dietician, case manager, and social worker had completed an assessment based Critical Thinking on their discipline NOT and FOR role on SALE the team. OR Bill DISTRIBUTION attended his first conference Read the two scenarios and answer the questions that with the team approximately 1 week after admission to follow by applying the material from this chapter. discuss their findings, set goals, and develop a plan of care. The case manager shared what Bill and she had Scenario 1 discussed related to the goals he wanted Jones to & accomplish Bartlett LL Sally is a 67-year-old married woman who was admitted to the rehabilitation unit after being hospitalized for plan was to return home to his parent s house and that while on the unit. The social worker shared that Bill s left-sided ischemic stroke 4 days ago. Upon admission, his parents were agreeable. House accessibility was also the rehab nurse completed an admission assessment and discussed. The PT and OT discussed what activities they initiated care planning. Later that afternoon, the physical had worked on the past week and future plans to help therapist (PT), occupational therapist (OT), and speech- language NOT pathologist FOR SALE completed OR DISTRIBUTION their assessments with what changes NOT would FOR need SALE to occur OR to make DISTRIBUTION the house facilitate his ability to be as & independent Bartlett as possible and Sally. Sally s husband came in during the session with the more accessible. PT and assisted Sally in answering questions. Bill expressed his concerns regarding bowel and bladder management, sharing he did not want his parents to On day 4 of Sally s stay the team (including PT, OT, nurse, physician, psychologist, case manager, and social have to do this unless absolutely necessary. The nurse, OT,..
11 and PT addressed Bill s present functional level and plans to further assess his ability to perform skills, including transfers and assistive devices. The team discussed with Bill what goals could realistically be accomplished during his stay and together prioritized what goals NOT should FOR SALE be focused OR on DISTRIBUTION initially, stating that each week they would reevaluate his status and goals and make adjustments accordingly. References References 61 Albrecht, G., Higginbotham, N., & Freeman, S. (2001). Transdisciplinary thinking in health social science research: Definitions, rationale, and procedure. Health Social Science: A Transdisciplinary and Complexity perspective, 4, Barnsteiner, J. H., Disch, J. M., Hall, L., Mayer, D. & Moore, S. M. (2007). Promoting interprofessional education. Nursing Outlook, 55(3), Bokhour, B. (2006). Communication in interdisciplinary team meetings: What are we talking about? Journal of Interprofessional Care, 20(4), Brookfield, NOT S. D., FOR & Preskill, SALE S. (1999). OR Discussion DISTRIBUTION as a way of teaching: Tools and techniques for democratic classrooms. San Francisco: Jossey-Bass. Chaboyer, W. P., & Patterson, E. (2001). Austrailian hospital generalist and critical care nurse s perceptions of doctor-nurse collaboration. Nursing and Health Sciences, 3(2), Florence, J. A., Goodrow, B., Wachs, J., Grover, S., & Olive, K. E. (2007). Rural health professions education at East Tennessee State University: Survey of graduates from the first decade of the community partnership program. Journal of Rural Health, 23(1), Freeman, L. C. (2000). Visualizing social networks. Journal of Social Structure, 1(1). Retrieved from edu/project/insna/joss/vsn.html Gage, M. (1998). From independence to interdependence. Creating synergistic health care teams. Journal of Nursing Administration, 28(4), Glaser, B. G. (1998). Doing grounded theory: Issues and discussions. Mill Valley, CA: Sociology Press. Goleman, D. (1995). Emotional intelligence: Why it can matter more than IQ. New York: Bantam Books. Hall, P., & Weaver, L. (2001). Interdisciplinary education and teamwork: A long and winding road. Medical Education, 35(9), Healthy People (October 30, 2009). Retrieved from www. healthypeople.gov/hp2010 Herbert, C. P., Bainbridge, L., Bickford, J., et al. (2007). Factors that influence engagement in collaborative practice: How 8 health professionals became advocates. Canadian Family Physician, 53, Institute of Medicine. (2003). Health professions education: A bridge to quality. Washington, DC: National Academies Press. Lewin, K. (1951). Field theory in social sciences. New York: Harper. Mayer, J. D. & Salovey, P. (1997). What is emotional intelligence? In P. Salovey & D. Sluyter (Eds). Emotional development and emotional NOT intelligence: FOR SALE Implications OR for DISTRIBUTION educators (pp. 3 31). New York: Basic Books. McCallin, A. (2001). Interdisciplinary practice a matter of teamwork: An integrated literature review. Journal of Clinical Exercises 1. Jones Choose the scenario you believe has a functioning NOT and FOR effective SALE IDT. OR DISTRIBUTION 2. Identify the behaviors or actions that led you to your decision and what behaviors/actions were missing from the other scenario. 3. What evidence of collaboration did you find in the Jones NOT FOR SALE chosen OR DISTRIBUTION scenario? 4. Compare and contrast the level of patient involvement in each scenario. 5. If you were the patient, which scenario would make you feel more involved in the decision-making process of your rehab stay? Why? 6. What strategies NOT were FOR used by SALE each team OR DISTRIBUTION to identify problems and set goals? 7. What advice would you give to the team not chosen to help them function more collaboratively? 8. Jones Based on & your Bartlett answers, what type of team do you NOT believe FOR the SALE other scenario OR DISTRIBUTION depicted and why? Personal Reflection Have you ever been a member of an interdisciplinary team? Reflect on that experience. Was the patient a Jones NOT FOR SALE part OR of DISTRIBUTION the team? Were any members of the team more dominant than others, and if so, why? Were team goals explicit? Were goals mutually established? Were the team goals accomplished? Which team members do you most associate with your role as a NOT rehabilitation FOR SALE nurse? Why? OR DISTRIBUTION What type of model does your facility or organization use? Do you believe this is the most effective model for patient care? What is the one characteristic of an effective IDT that most describes the team with which you work? Think of one area that you personally could improve upon in your role as a rehabilitation nurse to help the team function more effectively. Nursing, 10,
12 62 Chapter 5 / Interdisciplinary Rehabilitation Team McCallin, A., & Bamford, A. (2007). Interdisciplinary teamwork: Is the influence of emotional intelligence fully appreciated? Journal of Nursing Management, 15, Mikan, S. M., & Rodger, S. A. (2005). Effective health care teams: A model of six characteristics developed from shared perceptions. Journal of Interprofessional Care, 19(4), Miller, K., Riley, W., & Davis, S. (2009). Identifying key nursing and team behaviours to achieve high reliability. Journal of Nursing Management, 17, Mumma, C. M., & Nelson, A. (1996). Rehabilitation nursing: Process and applications (2nd ed., pp ). St. Louis, MO: Mosby. Rogers, NOT D. (1932). FOR Teamwork SALE within OR the DISTRIBUTION hospital. American Journal of Nursing, 32, Rossen, E. K., Bartlett, R., & Herrick, C. A. (2008). Interdisciplinary collaboration: The need to revisit. Issues in Mental Health Nursing, 29, Rubenfeld, G. M., & Scheffer, B. K. (2010). Critical thinking tactics. Sudbury, MA: Jones and Bartlett Learning. Secrest, J. (2007). Rehabilitation and rehabilitation nursing. In K. L. Mauk (Ed.), The specialty practice of rehabilitation nursing: A core curriculum (5th ed., pp. 2 12). Glenview, IL: Association of Rehabilitation Nurses. Shaw, L., Walker, R., & Hogue, A. (2008). The art and science of teamwork: Enacting a transdiciplinary approach in work rehabilitation. Work, 30, Sheehan, D., Robertson, L., & Ormond, T., (2007). Comparison of language used and patterns of communication interprofessional and multidisciplinary teams. Journal of Interprofessional Care, 21(1), Strasser, D. C., Falconer, J. A., & Martino-Saltzmann, D., (1994) The rehabilitation team: Staff perceptions of the hospital environment, the interdisciplinary team environment, and interprofessional relations. Archives of Physical Medicine and Rehabilitation, 75, Strasser, D. C., Uomoto, J. M., & Smits, S. J. (2008). The rehabilitation team and polytrauma rehabilitation: Prescription for partnership. Archives of Physical Medicine and Rehabilitation, 89,
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