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Fundamentals · chapter 15 · Evidence-Based Research, Quality Improvement, and Collaborative Practice

Collaborative Practice

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. ANA collaboration standard

    Collaboration is so essential to nursing practice that it is the eleventh standard in the American Nursing Association’s (ANA) scope and standards of practice (2021).

  2. Collaborative practice elements

    It involves mutual respect and trust, shared decision-making, and effective working relationships (McLaney et al., 2022).

  3. Physician-nurse collaboration outcomes

    Successful collaboration between physicians and nurses improves patient outcomes such as length of stay, mortality, and patient satisfaction (McLaney et al., 2022). It is also linked to increased nurse perception of quality of care.

  4. Communication and sentinel events

    A 2013 report by The Joint Commission noted that communication issues were the top cause of mortality related to treatment delays (O’Keefe, 2020). Also, communication was found to be the third most common cause of sentinel events.

  5. Hierarchy and communication barriers

    This is mainly because healthcare settings have historically been structured hierarchically, with physicians at the top, creating power imbalances that have negatively impacted communication and, as a result, collaboration.

  6. Patient care team accountability

    Members of the patient care team are accountable to each other for their actions on the team. They must stay informed and engaged in the process to ensure effective team functioning (AHRQ, 2019).

  7. Rounds and patient safety

    When all members of a care team are present during rounds, for example, patient safety and healthcare quality increase, as does communication between nurses, physicians, and other healthcare team members (Rosen et al., 2018).

  8. Patient responsibilities

    Patients are accountable for being honest and accurate when providing information, speaking up if they are concerned about a proposed plan of care, complying with a plan of care if they agreed to it, and reporting any change in their condition in a timely fashion.

  9. Team leader tasks

    Leaders must ensure all members are familiar with their roles and responsibilities, set up and monitor the care plan, keep the team on task, model appropriate behavior, and hold members accountable for performing their roles (AHRQ, 2019).

  10. Open team information sharing

    Team members should be able to openly share information within a team without criticism. Regardless of who leads, each member should feel comfortable monitoring the situation and sharing their insights with the entire team, without fear of criticism.

  11. Teamwork failures

    Teamwork failures occur when individuals fail to share information with the team, do not ask for information they need, or fail to include the patient or their family in discussions (AHRQ, 2019).

  12. Clear roles and skills

    This requires team members to have clear roles and responsibilities and complementary skills that are similar enough to work well together but not identical (McLaney et al., 2022).

  13. Patient-centered goal setting

    This patient-centered approach to setting goals allows the healthcare team to align its goals with the needs and abilities of the patient rather than the wishes of the healthcare professionals.

  14. IPEC competency categories

    The IPEC core competencies fall into four categories: values and ethics, roles and responsibilities, communication, and teams and teamwork (IPEC, 2023b).

Terms to know

collaborate
Each member of this large team must collaborate, or work effectively together, to ensure the patient has the best outcomes possible.
collaborative practice
A collaborative practice, also known as interprofessional or interdisciplinary practice, results from healthcare workers from different professions working and communicating effectively to provide patient care and improve healthcare quality and patient safety.
team
A team is a coordinated group of two or more people, each with a specific role, who interact to achieve a common goal.
team structure
A team structure is the makeup of a single team or a multiteam system, including identification of a team leader and other members.
cultural humility
IPEC also emphasizes the importance of cultural humility, which encompasses both the ability to self-reflect on one’s background and culture and the willingness to learn from team members of other cultures.
team science
Keep in mind that IPEC’s definition of teams includes patients, caregivers, community members, advocacy groups, and other interested parties, and was influenced by team science, a collaborative effort to address a scientific challenge by engaging the strengths of team members with different areas of expertise.

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

The graded version needs JavaScript. Every question is below anyway, with the answer and why.

Every question here, with the answer

  1. A nurse is preparing for a care team meeting with a client and family. Which strategy best encourages the family to participate?

    1. Ask about their concerns before beginning discussion of the client's status.
    2. Decide in advance how involved the family should be.
    3. Ask the family to hold questions until the providers have finished.
    4. Use precise medical terminology so the family receives accurate information.

    Answer: Ask about their concerns before beginning discussion of the client's status.

    Asking about concerns first helps the client and family listen when needed, and the team should ask how involved they want to be. Jargon should be avoided or explained, family members should be encouraged to ask questions, and the nurse should ask rather than decide the family's level of involvement.

  2. During a code, the team member whose skills most closely match the task at hand takes the lead for that task. What does this reflect?

    1. A strict hierarchical structure with the physician always leading
    2. Interdependent and adaptive interactions in a high-functioning team
    3. Lack of role clarity
    4. A breakdown in team structure

    Answer: Interdependent and adaptive interactions in a high-functioning team

    In a high-functioning team, leadership may shift based on the group's needs, and the member with skills most aligned to the task often leads it. This is not a breakdown or a lack of role clarity, and a strict hierarchy has historically hurt communication.

  3. A client with a diabetic foot ulcer tells the care team that walking his daughter down the aisle in two months is what matters most. How should the team organize its goals?

    1. Around the client's and family's goals
    2. Around the goals set at admission, without later changes
    3. Around the attending physician's schedule
    4. Around the wishes of the healthcare professionals

    Answer: Around the client's and family's goals

    The team's work must be organized around the client's and family's goals, aligning with the client's needs and abilities rather than the professionals' wishes. Teams should also regularly evaluate whether the goal needs to change, so fixed admission goals are wrong.

  4. A nurse notices that the plan of care changed overnight, but the nurse tech caring for the client was not told. What does this represent?

    1. Appropriate delegation
    2. A teamwork failure
    3. Adaptive leadership
    4. Personal accountability

    Answer: A teamwork failure

    Teamwork failures include individuals not knowing the plan or not being told that the plan has changed. This is the opposite of appropriate delegation, accountability, or adaptive leadership.

  5. A nurse is teaching a newly admitted client about the client's own responsibilities as a member of the care team. What should the nurse include? Select all that apply.

    1. Be honest and accurate when giving information.
    2. Comply with a plan of care you agreed to.
    3. Follow any plan of care, even one you did not agree to.
    4. Report any change in your condition in a timely way.
    5. Speak up if concerned about a proposed plan of care.

    Answer: Be honest and accurate when giving information., Comply with a plan of care you agreed to., Report any change in your condition in a timely way., Speak up if concerned about a proposed plan of care.

    Clients are accountable for honest, accurate information, speaking up about concerns, complying with a plan they agreed to, and reporting changes in a timely way. Compliance applies to a plan the client agreed to, not to any plan.

  6. A nurse is chosen to lead a unit care team. Which tasks are the responsibility of the team leader? Select all that apply.

    1. Hold members accountable for performing their roles.
    2. Make every decision alone to save time.
    3. Assist with conflict resolution.
    4. Set up and monitor the care plan.
    5. Ensure all members know their roles and responsibilities.

    Answer: Hold members accountable for performing their roles., Assist with conflict resolution., Set up and monitor the care plan., Ensure all members know their roles and responsibilities.

    Leaders ensure members know their roles, set up and monitor the care plan, keep the team on task, hold members accountable, and help resolve conflict. On the best teams, members are encouraged to share expertise, so deciding everything alone is not the leader's role.

Where every quote comes from

Section 15.5 Collaborative Practice of Fundamentals of Nursing by Christy Bowen, Lindsay Draper, Heather Moore, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.