Download Competency Model for Professional Rehabilitation Nursing

Competency Model for Professional
Rehabilitation Nursing
Behavioral Scenario
for
Competency 4.3: Foster Effective
Interprofessional Collaboration
Christine Cave, RN MSN CRRN HFS
Copyright©2015, Association of Rehabilitation Nurses
Competency 4.3:
Foster Effective Interprofessional Collaboration
Description/Scope: The rehabilitation nurse collaborates
with the client, family, and other members of the interprofessional team in providing exemplary client care.
Beginner Proficiency
Level Descriptors
Represents the
discipline of nursing
while participating on
the interprofessional
team
Communicates
pertinent information
regarding the client to
the interprofessional
team
Recognizes and
respects diversity and
roles within the
interprofessional team
Copyright©2015, Association of Rehabilitation Nurses
Behavioral Scenario
The rehabilitation team joins together for a team conference to discuss a
patient who has had an anoxic brain injury after a complex cardiac surgery.
The team agrees the patient will need three weeks to meet several goals of
independence. The therapists discuss the need for consistent gait training
and improving bed mobility skills given the patient’s cardiac precautions.
The therapists have set several goals and want to
establish a therapy schedule accordingly. Currently,
the patient has a complex medication regimen and
takes no food or medication by mouth. The patient
has continuous tube feeding running which must be
administered and managed by the nurse.
Copyright©2015, Association of Rehabilitation Nurses
Path 1 – Not Proficient
The nurse delivers a short update to the team about the
patient’s list of medications. The nurse reports the status of the
patient’s skin integrity and continence level. The nurse listens to
the team’s discussion about the goals of continued
independence but fails to share that the tube feeding is
scheduled at a continuous rate. The nurse isn’t too worried
though, because the doctor is in the room, and the nurse feels
that the doctor will probably want to manage the tube feeding
anyway. The nurse will just let the doctor handle it.
Copyright©2015, Association of Rehabilitation Nurses
Path 1 – Not Proficient
Observations & Outcomes
1. Even though the nurse listens to the report of the therapists and the proposed schedule, the nurse
does not consider how the therapy schedule will affect the time needed to administer the complex
medications. The nurse also fails to mention that the tube feeding is continuous, which will mean
that the therapists must incorporate the IV pole and tubing from the tube feeding pump into every
therapy session.
2. The team members will have to work around the tube feeding pump and tubing and wait for the
doctor to consult a dietician to evaluate the patient for a bolus schedule.
3. The nurse should come to team conference
prepared with a list of the nursing care needs
performed. The nurse must use the team
conference opportunity to share why the
medications are complex and how they tube feeding
may impact the work of the therapists. The nurse
should request for a dietician consult during team
conference to consider the patient’s candidacy for
bolus feeding.
Copyright©2015, Association of Rehabilitation Nurses
Path 2 - Proficient
The nurse comes to team conference prepared with a report that will
benefit all team members. The nurse reports on the complex medications,
some of which are intravenous. The nurse obtains a physician’s order to
consult a dietician to transition the patient from continuous to bolus
feeding. The team then discusses how the bolus feeding schedule and the
functional therapies can coordinate to still meet the nutritional needs of
the patient. The speech therapist shares that the patient is showing good
potential to tolerate semisolid foods. The nurse sets goals with the speech
therapist and physician to transition the IV medications to an oral route.
The team sets a long term goal of removing the G-tube, provided the
patient is able to consumes enough calories from an oral diet.
Copyright©2015, Association of Rehabilitation Nurses
Path 2 – Proficient
Observations & Outcomes
1. The proficient nurse comes to team conference prepared and embraces this moment as an
opportunity for patient advocacy. The nurse shares openly the complex medical needs of the
patient. The nurse describes how much time is needed to deliver care for the patient and anticipates
the impact this may have on the other team members. Complex medications and tube feeding will
require a plan for transition and the nurse initiates goals accordingly by recruiting the support of
speech therapy and the dietician.
2. As a result of effective collaboration, the interprofessional team is able to accommodate the care
needs of the patient. The nurse develops a plan of care that will meet short and long term goals for
independent, functional feeding.
3. To increase proficiency levels, the nurse meets with the
dietician or other specialized clinicians prior to the team
conference. The nurse formulates goals before team
conference so that the team discussions are effective and
collaborative.
Copyright©2015, Association of Rehabilitation Nurses
What Did You Observe?
How did the outcomes of this scenario differ?
Proficient Nurse
Non-Proficient Nurse
- Is prepared for team
conference
- Is not prepared for team
conference
- Is flexible and openly
discusses creative solutions
to establish the best goals
for each patient
- Waits for the physician to
manage a medical need
that is primarily managed
by the nurse
- Uses team conference to
share and obtain
information for patientcentered care
Copyright©2015, Association of Rehabilitation Nurses
Takeaways
1.
2.
3.
The new nurse respects the role of each discipline. The nurse
supports the skills and knowledge of each team member. The
nurse uses team conference to collaborate care among each
discipline to manage and meet the needs of the patient.
Interprofessional collaboration can improve outcomes and help
patients achieve goals. The speech therapist sees good potential
for the patient to tolerate an oral diet. The nurse coordinates a
plan to remove the IV and take oral forms of the medications.
Coordinated goals by the dietician, nurse, and speech therapist
will support the patient to eventually have the G-tube removed
before discharging home.
Team-oriented goals support care transitions. The nurse recruits
the input of other disciplines to set reasonable goals for discharge.
Copyright©2015, Association of Rehabilitation Nurses