Final Exam (Weeks 7-12) Flashcards
Define Interprofessional Collaboration
It is an expected standard of practice for all healthcare professionals to ensure the delivery of safe, quality health and social care services
In their concept analysis of interprofessional collaboration and chronic disease, Bookey et al., use Rodger’s method. Define this method.
Rodger’s method emphasizes the role of time and context in understanding concepts and considers the perspectives of multiple disciplines.
According to Bookey et al., what are the antecedents of interprofessional collaboration?
- Role awareness: understanding your role and the roles of others (most frequently cited)
- Interprofessional education: members of different teams coming together to build knowledge for patient care
- Trust between team members: having confidence in and being able to rely on other members of the care team
- Belief that interprofessional collaboration improves care: develops when collaborator themselves have the belief and make the effort to work collaboratively
- Organizational support
According to Bookey et al., what are the attributes of interprofessional collaboration?
- an evolving interpersonal process
- shared goals, decision-making and care planning
- interdependence
- effective and frequent interpersonal communication
- evaluation of team processes
- involving older adults and family members in the team
- diverse and flexible team membership
According to Bookey et al., what are the consequences of interprofessional collaboration?
- redefining team composition: team members who may not originally have been included (i.e., homecare) may now be involved
- comprehensive care planning and coordination of services
- improved provider knowledge
- confidence and job satisfaction
How do Bookey et al., define interprofessional collaboration?
An evolving interpersonal process, involving a diverse team of health care and other community providers who interdependently engage in frequent communication and shared decision-making, for the purposes of providing optimal health and social care services to clients and their families. Team composition and team processes are flexible and consistently evaluated to effectively and efficiently meet client needs.
How is a role defined?
A multi dimensional psychosocial concept defined as a traditional pattern of behavior and self expression performed by or expected of an individual within a given society.
As nurses, clinical practice blends our knowledge, skills, and attitudes with caring for people.
Professional and work relationships have distinctive expectations for your role participation as a member of an organization.
According to Arnold & Boggs, what are the standards for a healthy work environment?
- A share mental model: agreed upon collaborative effort and effective team work
- Open communication
- Collegiality: effective blending of collective competencies of each provider to deliver health care. In relation to nursing, collegiality includes:
- efficient communication
- fostering collaboration
- recognizing value of self and others
- embracing the imperative of a healthy work environment
Describe the difference between ineffective and effective communication
- Communication in silos –> common language with a focus on personal problems
- Communication based on status –> Open team centered communication
- Disruptive communication –> mutual goals (develops shared mission and values)
- Dominate, order –> Role clarity, collaborative model (mutuality respects expertise, teamwork, leadership)
What are barriers to effective communication?
- Not sharing information among team members
- Hierarchical structure inhibiting some members from speaking up
- Variations in communication styles or vocabulary
- Complacency
- Defensiveness
- Conflict
Define reflexivity
Reflexivity is a way to frame individual actions and behaviors with reference to the effect of the actions and behaviors of others and the context in which these actions occur.
Outcomes of reflexivity activities include:
* concise and structural dissemination of information during shift report
* Nurse engagement during interprofessional clinical discussions
* Collective clinical confidence
What are some tools that can be used to enhance team communication?
- SBAR: situation, background, assessment, and recommendation/request
- Check-back
- Briefs and de-briefs
- Huddles
What is IPASS?
Illness severity: how sick is the patient/how worried are you? (stable, watch, unstable) indicate resuscitation status
Patient summary: what is the patient here with? What other relevant medical problems do they have?
Action items: what are you asking your colleague to follow-up on? List what needs to be done, by whom and when
Situation Awareness and Contingency Planning: what to look out for and what to do if it does happen
Synthesis by Receiver
Define workplace incivility and its consequences
Defined as low-intensity social behaviors that are generally considered unacceptable in the workplace and may intend to cause harm.
Consequences of workplace incivility:
* medication errors
* financial constraints
* post-traumatic stress disorder
* increased nursing turnover
What are the steps to conflict resolution?
- Identify sources of conflict: who was involved, what happened, etc.
- Set goals: reframe a situation, assume responsibility, obtain factual data, intervene early, consider the other’s view point, etc.
- Implement Solutions
Describe the difference between ‘Compliance’ and ‘Adherence’
The term compliance carries an undertone of paternalism and, in the context of a patient’s expected compliant behavior, also suggests that blame lies with the patient when their behavior does not meet with the healthcare professional’s recommendations. In early literature, the term compliance was used to describe the patient’s obedience to recommendations with prescribed treatment. Supports an ideology of professional power of HCP over the patient.
The WHO attempted to change the undertone of blame associated with compliance by introducing the term, adherence. Adherence implies that the patient agrees with the prescribed recommendations rather than passively obeying.
Discuss how ‘Concordance’ differs from ‘Adherence’
Concordance implies the development of an alliance between patients and healthcare providers based on realistic expectations as opposed to misunderstanding, distrust and concealment. The term also may suggest that patients and healthcare providers have come to a mutually agreed upon regimen through a process of negotiation and shared decision-making.
Use of the term concordance, the newest and perhaps theoretically different approach, is an attempt to equalize the power balance between healthcare professionals and patients, while at the same time placing patients’ expectations about treatment recommendations as equal to or even more important than healthcare professional’s expectations.
What are the 5 dimensions of non-adherence?
- Health system & HCT factors
- Social/economic factors
- Therapy-related factors
- Patient-related factors
- Condition-related factors
Define Adherence
Adherence is a complex, multifaceted concept. It is defined by the WHO as: “the extent to which a person’s behaviors-taking medications, following a diet, and/or executing lifestyle changes-corresponds with agreed recommendations from a health care provider”
Consists of a collaborative decision. The client does not passively agree to the HCP decision.
What are the 3 consequences of adherence?
- Patient related: improved morbidity, reduced mortality, conflict resolution, attributional uncertainty, empowerment and improvement in QoL.
- Health care professional related: ambivalence towards a patient’s adherence behavior, misinterpretation, disempowerment, acceptance or avoidance of the adherence behavior.
- Health care system related: decrease in cost and health care service use
What is the Social Cognition Theory and what does it posit in regard to adherence?
SCT emphasizes and individual’s social learning/knowledge (i.e., the ability to be influenced by one’s own environment) and the assumption that we learn new behaviors by observing the behaviors of others. If the behavior results in positive rewards individuals are more likely to imitate it. Conversely, if a behavior results in negative rewards individuals are less likely to imitate it.
What is the Health Belief Model and what does it posit in regard to adherence?
The most widely used, HBM explores the client’s attitudes and perceptions to adherence behaviors. This model tries to under stand the reason that patients do not adopt preventative behaviors. It proposes that clients follow the prescribed treatment regimen based on the following 4 elements and the client’s understand of them:
i. perceived threat of disease
ii. perceived benefits of the health behavior
iii. perceived barriers to that behavior, and;
iv. cue to action
What is the Theory of Planned Behavior and what does it posit in regard to adherence?
Looks at patient’s perceived behavioral control
What is the Protection Motivational Model and what does it posit in regard to adherence?
Non-adherence is a product of patient’s maladaptive coping mechanisms - denial or avoidance can be a protective factor for them.
What is Leventhal’s Common Sense Model and what does it posit in regard to adherence?
CSM explores the client’s subjective experiences of their illness to understand the way they cope and adapt to their illness. Describes the dynamic interaction among the variables that influences health behaviors. It is useful to understanding the client’s adherence response over time. It consists of 4 dimensions of psychosocial adjustment.
What is the Theory of Reasoned Action and what does it posit in regard to adherence?
Emphasizes the importance of social norms
How did Herrera et al., (2017) come to define adherence after exploring various conceptual definitions and theoretical understandings?
The authors state that non-adherence or resistance is not necessarily irrational but an expression of “conflict between different internal motivations or voices” of the patient. Some patient voices are coherent with adherence; others are not. Associated with patient values and must be acknowledged and expressed.
They further described pro-adherence explanations, including:
1. Self-worth (“I do this for myself because I care for myself”
2. Well-being (“I control my Hypertension because I want to have good health”)
3. Noticing benefits (“I continue my treatment because I have noted how my blood pressure goes down and I feel healthier”)
4. Fear of consequences (“I follow the doctor’s orders because I am terrified of what will happen to me if I do not”)
5. Being even better (“I know if I adhered more I would feel even better”)
6. Autonomy (“I do this because if I do not take care of myself, nobody will”)
7. Affiliation (taking care of others, sharing with others, being cared for, not a big effort)
and anti-adherence voices
1. Self-worth (“I am not weak or a hypochondriac, so I do not need any special care”)
2. Quality of life (“If I adhere more I will make my own life miserable and not worth living”)
3. Health of protecting from iatrogenic effects (“I will not adhere more because I fear the negative effects of the treatment”)
4. Autonomy (“I do not like to be slaved by the treatment or the doctor or anybody”)
5. Hopelessness (“This is too much for me, it is not worth the effort because I just cannot”)
6. Affiliation (“If I was alone I could do what the doctor ordered, but I am not alone”)
Why are objective measures (i.e., pill counts, lab values, and blood tests) not an effective way of measuring non-compliance?
Objective measures have their importance but often fail to take sufficient account of the social context of patient’s lives. It cannot be assumed that non-compliance is only a matter of patients choosing not to follow advice. Choice may be constrained by the social context in which the person lives, which needs to be explored further and validated.
