NCM 103

CONCEPT-
FINALS

NANCY USMAN-GUINTA, RN MAN

 TOPIC 1:

EVIDENCE-BASED
PRACTICE IN ROLES
RESEARCH-RELATED NURSING
AND
RESPONSIBILITIES
Two research findings that I like and I
want to share:

1. The more senses used, the better is the learning.

-This means when you listen, read the texts and write down notes, the
more you will learn on the topics.
2. Successful persons are those who take their breakfast regularly.
-This means that if you want to become a successful nurse someday, take
your breakfast regularly to have the necessary glucose to start your day.
Course Outcome
At the end of the course, students
will be able to apply guidelines
and principles of evidence-based
practice in the delivery of nursing
care.
Learning Outcomes:
At the end of this video-lecture, the students will be able
to:
1. Define Evidence-based Practice (EBP);
2. Identify major sources for information on EBP;
3. Determine the American Nurses Association’s Standards
of Professional Performance Pertaining to Research;
4. Discuss some examples of nursing studies; and
5. Explain research-related roles and responsibilities
References
Berman, Audrey, Snyder, Shirlee, Kozier, Barbara, and Erb,
Glenora (2008). Kozier & Erb’s Fundamentals of Nursing 8th
ed. Singapore: Pearson Education South Asia Pte. Ltd.
Tan, Crestita (2011). A Research Guide in Nursing Education:
Building an Evidence-Based Practice 4th ed. Pasay City: Visprint
Inc.
Jimmy, Beena and Jose, Jimmy (2011). Patient Medication
Adherence: Measures in Daily Practice
ncbi.nlm.nih.gov/pm/articles/PMC3191684
journals.lww.com
Evidence-based Practice
(EBP)
-is the process of collecting, processing,
and implementing research findings to
improve clinical practice, the work
environment, or patient outcomes.
(Jolinda, C. et al 2014).
In EBP, the nurse integrates
research findings with clinical
experience, the client’s
preferences, and available
resources in planning and
implementing care.
Cochrane Database of Systematic
Reviews

–a significant source of EBP data.

Cochrane Collaboration
– is an international not-for-profit
organization dedicated to making
up-to-date, accurate information about
the effects of health care readily
available worldwide.
EBP started back in 1970s with
Archie Cochrane who was an
epidemiologist in United
Kingdom.
– Utilizing the EBP
approach to nursing
practice helps us provide
the highest quality and
most cost-efficient
patient care possible.
When you incorporate up-to-date
information from new EBP research,
you’ll be able to question current
practices. You may ask questions
such as:
“Are my current nursing
interventions the most effective or
safest for my patients?” or
“ Could we utilize this new EBP
interventions in my work area?”
– According to research, the mercury in the
previous glass thermometer is poisonous
and harmful to the kidneys, lungs, and
brain when swallowed. Then they
discovered the digital thermometer which
has no mercury in it therefore safer to use
for patients.
Other major resources for information
on EBP are:
1. Healthlinks search engine at the University of Washington
2. Academic Center for Evidence-based Nursing at the University of
Texas Health Science Center at San Antonio
3. National Guideline Clearinghouse (www.guideline.gov), a public
resource for evidence-based clinical practice guidelines
ANAs Standards of Professional
Performance Pertaining to Research

STANDARD 13: RESEARCH

Measurement Criteria
The registered nurse:
Utilizes best available evidence, including
research findings, to guide practice decisions.
Actively participates in research activities at various
levels appropriate to the nurse’s level of education
and position. Such activities may include:
1. Identifying clinical problems specific to nursing
research (patient care and nursing practice)
2. Participating in data collection (surveys, pilot
projects and formal studies
3. Participating in a formal committee or program
4. Sharing research activities and/or findings with peers
and others
5. Conducting research
6. Critically analyzing and interpreting research for
application to practice
7. Using research findings in the development of policies,
procedures, and standards of practice in patient care
8. Incorporating research as a basis for learning
RESEARCH ON TAKING A BATH AS
FEVER MANAGEMENT

Taking a bath can help bring down your fever, but

the really important part is that it can’t be a cold
bath. Although that might seem like it would help
more than taking a lukewarm water bath, getting in
cold or ice water will cause shivering which can
actually increase your internal temperature.
(October 4, 2017 study)
–Taking a lukewarm water (32.2 C –
35 C) bath and wearing of lightweight
clothing promote body heat loss.
In a study entitled “The Role of Medication
Noncompliance and Adverse Drug Reactions in
Hospitalizations of the Elderly”, results showed that
the consequence of non-adherence is waste of
medication, disease progression, reduced
functional abilities, a lower quality of life, increased
use of medical resources such as nursing homes,
hospital visits and hospital admissions.
This means we should promote medication
compliance to our patients.
RESEARCH in general, is a
systematic inquiry that uses
disciplined methods to answer
questions or solve problems
(Polit & Beck, 2011).
–The ultimate goal
of research is to
develop, refine
and expand a body
of knowledge.
ROLES OF NURSES IN
RESEARCH

1. As Principal Investigator
2. As Member of a Research Team
3. As Evaluator of Research Findings
ROLES OF NURSES IN
RESEARCH

4. As Consumers of Research Findings

5. As Client Advocates in a Research
Study
6. As Subjects of Research
As Principal Investigators

-Nurses need special research

preparation and training to conduct a
scientific study. As principal
investigators, they need to
thoroughly read the literature on the
chosen topic or problem.
As nurses, we see our patients and we
are done with them. When we conduct
research, we become a part of making
cancer history, for example. We get to
be a part of development process and
this could be very rewarding.
As Member of a Research Team
– A nurse may be the collector to conduct
an experimental investigation which is
all considered as part of one’s normal
workload. Sometimes, it is better to be
part of a team to help lighten the load of
researching but definitely the
responsibility attached as a researcher is
never diminished.
When we participate in research
by distributing and collecting
questionnaires on a cancer
research for example, we become
a part of something innovative
even if we are behind the scenes.
As Evaluator of Research Findings

– A nurse must determine the

usefulness of research findings in
the practice of nursing and
continuously relate these findings
to actual situation which in turn
may lead to another investigation.
– To become an evaluator requires the
conduct of research through one’s own
efforts. This ensures that the evaluator
knows what to look out for. The
evaluator may be a referee of a research
paper or a panelist in a forum where a
research is presented for critiquing.
Careful planning is important so that the
sources identified stand the best chance of
being RELEVANT.
The most comprehensive electronic database
for nurses is CINAHL (Cumulative Index of
Nursing and Allied Health Literature).
As Consumers of Research Findings

– Nurses are research users and

beneficiaries and are apt to put these
findings into use in their practice.
However, this must be judiciously done to
prove reliability of research findings. The
nurse must be voracious consumer of
research findings for an enlightened
practice.
We all want to learn and we
should be willing to learn. When
there are new nursing
interventions, new treatments,
we should not be afraid to ask
questions before we apply those.
As Client Advocates in a
Research Study
– Nurses must explain thoroughly to
clients who are involved in the study
the nature of the research and answer
their questions satisfactorily. The
welfare of the clients must be a priority
in the conduct of the research. The
ethics of research must always prevail.
The research nurse should
understand the study that they
are assigned to so that they can
verify if a patient is eligible for a
certain study.
The nurse should continuously
assess the patient if there are
side effects, like in clinical
trials and update the physician
immediately.
PROTECTING THE RIGHTS OF
STUDY PARTICIPANTS
All nurses who practice in settings where research is being conducted with human
subjects or who participate in such research play an important role in safeguarding
the following rights:
1. RIGHT NOT TO BE HARMED
2. RIGHT TO FULL DISCLOSURE
3. RIGHT TO SELF-DETERMINATION
4. RIGHT TO PRIVACY
RIGHT NOT TO BE HARMED

The RISK OF HARM to a research subject is exposure to the

possibility of injury going beyond everyday situations. The
risk can be immediate or delayed and can be physical,
emotional, legal, financial, or social in nature. Risks can
also involve psychological factors such as exposure to
stress or anxiety, or social factors, such as loss of
confidentiality or loss of privacy. Potential risks of
participating in a study need to be detailed in informed
consent documents.
RIGHT TO FULL DISCLOSURE

FULL DISCLOSURE, the act of making clear the client’s role

in a research situation, is a basic right.
This means that deception, by either withholding
information about a client’s participation in a study or
giving the client false or misleading information about
what participating in the study involve, must not occur.
Example

There was a study entitled “Effect of

Music Therapy to the Level of Anxiety of
Pre-operative Clients”.
Thorough explanation of the procedure
was given to the participants before
letting them sign the informed consent.
RIGHT TO
SELF-DETERMINATION
Many clients feel pressured to participate in studies. They
believe that they must please the physicians and nurses
who are responsible for their treatment and care.
The RIGHT TO SELF-DETERMINATION means that
participants should feel free from constraints, coercion, or
any undue influence to participate in a study.
RIGHT TO PRIVACY
Privacy enables a client to participate without worrying about later
embarrassment. The anonymity of a study participant must be
ensured even if the investigator cannot link a specific person to the
information reported.
CONFIDENTIALITY means that any information a participant relates
will not be made public or available to others without the
participant’s consent.
Measures may include the use of pseudonyms or code numbers or
reporting only aggregate or group data in published research.
As Subjects of Research
– Nurses may also be study respondents
who will provide data for the research,
intended to change and or improve
nursing practice. They themselves can
become subjects of a research too. As
nurses, they can provide insights about
the profession and its education in
general.
Melnyk and Finecout-Overholt
(2004) advocate asking clinical
questions in the PICOT format.
One strategy for stating the problem you wish to explore is to
use the PICOT format:
P – Patient, population, or problem of interest
I - Intervention of therapy to consider for the subject of
interest
C – Comparison of interventions, such as no treatment
O – Outcome of the intervention
(Additional: T- Time of Study and another T- Type of Study
– Example:
– A 55 year old female has just come into the hospital. She has been
diagnosed with high blood pressure. She exercises and eats right.
You need to decide with your team whether she needs to be on
beta-blocker or an ACE-inhibitor.
P- 55 year old female with high blood pressure
I- beta blocker
C- ACE-inhibitor
O- symptom relief, blood pressure control
Research Question after PICO

– In 55 year old women with

hypertension, are beta-blockers more
effective than ACE-inhibitors in
controlling high blood pressure?
Learning Outcomes:
At the end of this video-lecture, the students will be able
to:
1. Define Evidence-based Practice (EBP);
2. Identify major sources for information on EBP;
3. Determine the American Nurses Association’s Standards
of Professional Performance Pertaining to Research;
4. Discuss some examples of nursing studies; and
5. Explain research-related roles and responsibilities
–Let us all apply
evidence-based practice in
the clinical area to
improve patient
outcomes.
THANK YOU. HOPE YOU
LEARNED SOMETHING. KEEP
ON LEARNING.
 TOPIC 2: DOCUMENTATION AND
REPORTING

GUIDELINES/PROTOCOLS/TOOLS
IN REPORTING RELATED TO
CLIENT CARE
Make them one of your inspirations. You will
graduate, too In Shaa Allah.
Course Outcome

At the end of the course, students should

be able to communicate and document
effectively to include reporting
up-to-date client care accurately and
comprehensively.
Learning Outcomes:

At the end of this video-lecture, the students will be able to:

1. Define Report;
2. Identify some Types of Report;
3. Discuss Change-of-Shift Report;
4. Explain ISBAR, Incident Report, Referral System and
Healthcare Electronic Databases
References
Berman, Audrey, Snyder, Shirlee, Kozier, Barbara, and Erb, Glenora (2008). Kozier & Erb’s
Fundamentals of Nursing 8th ed. Singapore: Pearson Education South Asia Pte. Ltd.
Cardon, Drew (2014). Healthcare Databases: Purpose, Strengths, Weaknesses
healthcatalyst.com/insights/healthcare-database-purposes-strengths-weaknesses
El-Sheemy, Hatem Refaat (2016). Referral System slideshare.net/HatemAlSheemy/referral-
system-69752157
Hynes, JoElla (2009). Charting Checkup: Don’t be Intimidated by Incident Reports
https://www.nursingcenter.com/journalarticle?Article_ID=843476&Journal_ID=522928
&Issue_ID=843475
REPORT

- is oral, written, or
computer-based communication
intended to convey information to
others.
SOME TYPES OF REPORT

1. CHANGE-OF-SHIFT REPORT
2. INCIDENT REPORT
3. REFERRAL SYSTEM
CHANGE-OF-SHIFT REPORT

- a report given to all nurses

on the next shift.
CHANGE-OF-SHIFT REPORT

- also termed as ORAL

REPORT, ENDORSEMENT
and HANDOFF
COMMUNICATION.
ENDORSEMENT

- Purpose is to provide continuity of care for clients for

24 hours.
- -The outgoing nurses give endorsements to the incoming
nurses.
- - Oral reports are initially given in a private area at the
Nurses’ Station, free of interruptions. Some details may be
given orally at the client’s bedside during the nursing
rounds.
PRESENCE OF MIND is very much
needed during the endorsement
despite some distractions for better
patient outcomes.
KARDEX

-is used for the endorsement as quick

visual guide to ensure that
information is current and updated
on a regular basis.
EXAMPLE OF A KARDEX

CRMC KARDEX includes sections for:

A. INTRAVENOUS FLUID/BLOOD
TRANSFUSION
B. LABORATORY/DIAGNOSTIC
EXAMINATION
C. MEDICATION
D. TREATMENT
CONTENT OF ENDORSEMENT OR
HANDOVER:

1. Name of Patient – Surname first

2. Age, Sex, Religion (Optional)
3. Attending Physician
4. Diagnosis –Community Acquired
Pneumonia
5. Diet – Diet as Tolerated (DAT)
6. IVF Rate and Incorporations – with PNSS 1 liter at 30 drops per
minute
7. Other Contraptions – e.g. with oxygen inhalation via nasal
cannula at 2 L/min, with on going
2nd unit of BT PRBC of Blood Type O, serial
number ________, with
foleycatheter (FC) attached to urine bag
(UB) draining to dark yellowish
urine, with nasogastric tube (NGT)
8. Laboratory Studies – e.g. still for Complete
Blood
Count (CBC), Plt count q
hours
9. Other Treatment – e.g. For Pulmonary Function
Test (PFT) at 2 pm today,
VS q 4, MIO q shift
10. New Orders – e.g. for Sputum Exam tomorrow
11. Latest Vital Signs –T, P, R, BP, O2 Sat
SAMPLE:

Good afternoon. I am Bautista, Carol U., BSN 1A student of

NDU. Endorsing to you my patient in Room D:
Dela Cruz, Joanne
45 years old, Female, Roman Catholic
Under the service of Dr. Gomez
With the diagnosis of Benign Paroxysmal Positional Vertigo
and Anemia
With the diet of DAT (Diet as Tolerated)
With an IVF (Intravenous Fluid) of PNSS
(Plain Normal Saline Solution) 1 liter at 20
drops per minute
With oxygen inhalation via nasal cannula at 2
L/min
Still for FBS (Fasting Blood Sugar) and Lipid
Profile
Still for Full Abdomen UTZ (Ultrasound)
With new orders of:
-To secure 5 units of PRBC (Packed Red Blood
Cells) of patient’s blood type and transfuse once
available after proper cross-matching
-For FOBT (Fecal Occult Blood Test)
-Start Lactulose 30 cc po now then 30 cc OD (Once a
Day) HS (Hour of Sleep)

VS q 4, MIO q shift
With latest vital signs of:
Temperature – 36.8 C
Pulse Rate – 92 bpm (beats per minute)
Respiratory Rate – 18 brpm (breaths per minute)
Blood Pressure – 120/70 mmHg (millimeters of
mercury)
Oxygen Saturation (O2 Sat) – 96 %
Thank you.
Patient care is dependent on effective
communication-including telephone
communication between all staff
involved in the care of the patient.
Ineffective telephone communication
can compromise patient care.
SBAR (or ISBAR or ISBARR)

-is a structured method for

communicating critical
information that requires
immediate attention and action.
I – Identify
S - Situation
B - Background
A - Assessment
R - Recommendation
R - Readback
I – “Hi, I’m Carol, a staff nurse in Acute ward today.”

S – “I would like you to come and see a 21 year old

man who has had a significant skin reaction
to an antibiotic.”

B- “He was admitted this morning for treatment of an

appendectomy wound infection. He is a
type 1 diabetic. He has just had his first dose of
Gentamicin, Metronidazole and Ampicillin.”
A- “He is anxious and appears flushed
with an erythematous rash on his chest
and arms. His blood pressure is normal.”

R- “Are you able to see him urgently?”

“What would you like me to do in the
meantime?”
INCIDENT REPORT
INCIDENT REPORT (IR)

(also called an EVENT REPORT

or OCCURRENCE REPORT)
- is a formal report written by
practitioners, nurses, or other staff
members.
In most healthcare facilities, injuries,
patient complaints, medication
errors, equipment failure, adverse
reactions to drugs or treatments, or
errors in patient care must be
reported.
Some agencies also report other
incidents, such as the occurrence
of client infection or the loss of
personal effects.
 When filling out an incident report, include the following
information:

1. the exact time and date;

2. the names of persons involved and any witnesses;
3. factual information about what happened; and
4. other relevant facts, including your actions (such as notifying
the health care provider) and any corrective actions taken.
The report should be completed
as soon as possible and filed
according to agency policy,
usually within 24 hours.
The person who identifies that the
incident occurred should complete
the incident report.
This may not be the same person
actually involved with the
incident.
EXAMPLE

The nurse who discovers that an

incorrect medication has been
administered completes the form
even if it was another nurse who
administered the medication.
INCIDENT REPORT FORM I

Client’s Name:
Date of Report:
Date & Time of Incident:
Describe how incident occurred as related by
person injured or person in attendance.
Describe nature and extent of apparent injury.
Reported by: Reported to Physician:
Time and Date:
Emergency treatment given:
Date: Time:
Signed: _____________________________ M.D.
Steps taken to prevent recurrence of incident:
CI Submitting Report

Name of Institution:
Sometimes the clinical instructors may ask
student nurses to make incident reports related
to some events like cheating during exams,
inaccurate intake and output monitoring of a
patient in the clinical area and others that may
need further investigation. The student nurse
should fill out the Incident Report Form II.
INCIDENT REPORT FORM II

Name: ______________________________________ Level: ________________

Area of Assignment: _______________________
CI: _________________
Date of Incident: _______________
A. Describe in detail the event as they occurred.

B. Action taken:
__________________________

Student Signature
REFERRAL SYSTEM

- is defined as the process in which the

primary health care physician who has
lesser facilities to manage clinical
condition seeks the assistance of
specialist partner with resources to
guide in managing clinical episode.
Referral does not mean
transferring responsibility but it is
sharing responsibility in patient
care.
Factors affecting referrals:

1. Availability of qualified consultants

2. Physician specialty
3. Length of training
4. Unexplained findings
5. Uncertainty of diagnosis
6. Patient characteristics (e.g. attitude of wanting the
best possible care )
7. Reimbursement plan (e.g. NDU has Insular health
insurance)
Referral Letter Outline:

1. Patient details (name, age, sex and

location)
2. Details of family physician (name of
physician making request and name of
physician being consulted
3. Reasons for referral
4. Degree of urgency for appointment
5. Clinical problem
6. Important previous history
7. Findings on physical examination
8. Findings on investigation
(photocopies of results should be
included)
9. Medication and drug sensitivities
10. Expected outcome and
desirable follow up
Types of Referral:
1. ROUTINE
-Seeking expert opinion for diagnosis and prognosis
(e.g. referring to a pulmonologist for patient’s
cough)
-Seeking hospital admission and management for the
case (e.g. patient from CRMC being referred to
Davao Doctors’ Hospital)
-Seeking further investigations
2. EMERGENCY
-To reach the expert on time before occurrence of
deterioration with providing all expected information in
referral letter

Usually, the patient is accompanied by a physician and

a nurse in an ambulance after thorough physical
examination and that patient’s condition can tolerate the
travel.
3. OPPORTUNISTIC
-For expert opinion (e.g. self-
referral)
-Investigations
-Admission
-Management
It can be classified according to the case:

1. MANDATORY
- in which the patient is likely to suffer harm if
not referred.

2. ELECTIVE
- where the patient is unlikely to suffer harm if
not referred.
Modern Classification:
1. Interval – e.g. patient with myocardial
infarction (MI) admitted in hospital for a period of time then
return for continuity of care

2. Split-referral- multi-specialty in the same

center (e.g. Medicine Department to Surgery
Department)

3. Collateral- e.g. diabetic patient with glaucoma referred to

ophthalmologist
4. Cross-referral- self-referral
HEALTH CARE
ELECTRONIC
DATABASES
HEALTH CARE ELECTRONIC
DATABASES

- are systems into which healthcare

providers routinely enter clinical and
laboratory data.
DATABASE

- is any collection of data organized

for storage, accessibility, and retrieval.
HEALTHCARE DATABASE

- serves to replace the paper

documents, file folders, and filing
cabinets.
ELECTRONIC HEALTH RECORDS (EHRs)

- one of the most commonly used

forms of healthcare databases.
ONLINE TRANSACTION PROCESSING
(OLTP) DATABASE

- most commonly used type of

healthcare database.
EXAMPLES

-When a patient presents at the front

desk, you search for her name in the
EHR and instantly see a result.
- When you enter the patient’s blood
pressure into the EHR, the information is
instantly stored there.
Practitioners enter routine clinical and
laboratory data into EHRs during
usual practice as a record of the
patient’s care.
The OLTP database structure accommodates the
creation of a wide range of transactional
applications:
1. EHRs
2. Lab systems
3. Financial systems
4. Patient satisfaction systems
5. Patient identification
6. Administration
7. Billing and payment processing
8. Research
9. HR
10. Education
Learning Outcomes:
At the end of this video-lecture, the students will be able to:
1. Define Report;
2. Identify some Types of Report;
3. Discuss Change-of-Shift Report;
4. Explain ISBAR, Incident Report, Referral System and
Healthcare Electronic Databases
THANK YOU. HOPE
YOU LEARNED
SOMETHING. KEEP ON
LEARNING.
Topic 3: CONCEPTS AND
PRINCIPLES OF
PARTNERSHIP,
COLLABORATION
AND TEAMWORK
• Be happy always.
 A. DEVELOPMENT OF TEAMWORK AND
COLLABORATION
1. SELF-AWARENESS
2. DYAD
3. GROUP
4. TEAM
-Health Care Team and Multidisciplinary Team
B. TOOLS FOR
FACILITATING
TEAMWORK
C. ROLES OF THE NURSE
 Learning Outcomes
At the end of this video-lecture, the students will be able to:
1. Define Teamwork and Collaboration;

2. Discuss Self-awareness, Dyad, Group, and Team;

3. Explain the Key Elements of Teamwork;

4. Determine the Tools for Facilitating Teamwork; and

5. Identify the Different Roles of the Nurse

 References
• Salgado, Hanna Teresa (SY 2018-2019). NCM 103 Fundamentals
of Nursing Practice, College of Health Sciences, Notre
Dame University, Cotabato City

• businessballs.com/self-awareness/Johari-window-model-and-
free-diagrams/

• nursingce.com/ceu-courses/teamwork
• nursingtimes.net
•The Quality and Safety Education for Nurses
(QSEN) Institute defines teamwork and
collaboration as the ability to “ function effectively
with nursing and interprofessional teams, fostering
open communication, mutual respect, and shared
decision-making to achieve quality patient care”
(QSEN, 2019)
 SELF-AWARENESS

•-is a process of objective examination

of oneself.
•Eckroth-Bucher (2010), defines the
concept as “Self-awareness involves the
cerebral exercise of introspection (a
looking into one’s own thoughts, feelings,
beliefs, values, behaviors, limitations and
the feedback from others).
•Self-awareness is getting to know about one self as a
person and the important things in life which influences us
in different ways.

•It also includes the reflection of how our attitude and

belief can influence others.

•If we get the awareness of our own life then we can

understand another person better.

•We will be able to recognize that everybody is unique.

A self-aware nurse is able to respect and
avoid projecting his or her own beliefs onto
others, to suspend judgment, focus on the
needs of the client, even if they differ from
those of the nurse and will not force other
people to agree with what she believes in.
Johari Window
 Four Regions of the Johari Window:
• 1. OPEN/FREE AREA – what is known by the person about
him/herself and is also known by others
• 2. BLIND AREA- what is unknown by the person about
him/herself but which others know
• 3. HIDDEN AREA- what the person knows about him/herself that
others do not know
• 4. UNKNOWN AREA- what is unknown by the person about
him/herself and is also unknown by others
 DYAD
-refers to a pair of persons in an
interactional situation.
-For example, a patient and a nurse, nurse and
the doctor, nurse and watcher among others.
 GROUP

- two or more people who interact with one

another, share similar characteristics, and
collectively have a sense of unity.
 TEAM

- “is a group of people who are interdependent with respect

to information, resources, and skills and who seek to
combine their efforts to achieve a common goal”, as
defined by Professor Leigh Thompson of the Kellogg
School of Management.
 HEALTH CARE TEAM

- also referred to as the providers of health care

or health professionals, are nurses and health
personnel from different disciplines who
coordinate their skills to assist clients and their
support people.
 Patient: 73-year old with heart failure, short of
RN- develops nursing care plan
breath
CASE MANAGER- communicates care plan to family and other providers
MD- develops medical care plan, prescribes medications and treatments
RESPIRATORY THERAPIST- provides breathing treatments
DIETITIAN- creates low-salt diet
OCCUPATIONAL THERAPIST- designs self-care activities that reserve
client’s energy
 CASE MANAGER

- her or his role is to ensure that clients receive

fiscally sound, appropriate care in the best
setting, the one most involved in the client’s
care who may be a nurse, a social worker or any
member of the health care team.
 MULTIDISCIPLINARY TEAM

- is a group of health care workers who are

members of different disciplines (professions
e.g. psychiatrists, social workers, accountants
etc.) each providing specific services to the
patient.
Multidisciplinary Team
 KEY ELEMENTS OF TEAMWORK

1. Communication
2. Situational Awareness
3. Leadership
4. Mutual Support
•These form the basis of TeamSTEPPS
(Team Strategies and Tools to Enhance
Performance and Patient Safety), a
training programme from the US that has
been shown to improve team effectiveness
and patient safety.
 COMMUNICATION

•One likely cause of errors is when a health

professional communicates with a colleague
but does not check whether that colleague has
correctly received the message, and/or when
the colleague does not check that they have
understood it.
 SITUATIONAL AWARENESS

•Situational Awareness – is defined as an

“accurate awareness or understanding of the
situation in which the team is functioning”
(Alonso and Dunleavy, 2013).
•In simple terms, it is knowing what is
going on around us.
•We maintain our situational awareness by
scanning our environment for clues about
what is happening.
 LEADERSHIP

•Sometimes errors happen because staff are not

comfortable raising concerns or clarifying ambiguous
messages or situations. If you are a team leader, you can
create a positive culture by telling your team you want
them to raise any concerns and ask any questions they
may have, however trivial, without fear.
 MUTUAL SUPPORT

•Failure to offer, ask for or accept help leads to stress and

work overload, increasing the risk of errors and harm. We
must become better these things as patient safety may
depend on them. Staff need to feel that it is acceptable to
ask for help if they feel overwhelmed, that they will not be
deemed ineffective or unable to manage their time.
 TOOLS IN FACILITATING TEAMWORK:
1. CLOSED-LOOP COMMUNICATION
2. READBACK
3. SBAR TOOL
4. CHECKLISTS
5. SAFETY HUDDLES
6. DEBRIEFS
7. HUMAN FACTORS
 CLOSED-LOOP COMMUNICATION
•-is a technique that reduces the risk of errors
arising from misunderstandings and wrong
assumptions.
• Both the sender and receiver confirm that the
information has been correctly passed on and
understood.
 READBACK

•-involves reading back to the sender

information they have given to you in
order to check you have correctly
understood it.
•Readback can also help clarify who is
responsible for what, as this can be
unclear at handover and important
interventions might thus be missed or
delayed.
 SBAR Tool
•Situation
•Background
•Assessment
•Recommendation
 CHECKLISTS

•As well as maintaining our situational awareness and

sharing observations with colleagues, we need to be
aware of our own vulnerability and potential for making
errors. This can be done through a simple self-checking
exercise using either the I’M SAFE checklist or the
“three bucket” model.
• The I’M SAFE checklist, which is a TeamSTEPPS tool, stands for:

• I: Illness

• M: Medication

• S: Stress

• A: Alcohol and Drugs

• F: Fatigue

• E: Eating and Elimination

•Going through the list, you ask yourself whether or
not you might be affected by any of these factors.
For example, if you have had too much alcohol the
night before, your ability to perform certain tasks
may be hampered the next morning. The more
positive answers you obtain, the more likely you are
to make an error.
• The “three bucket” model works as follows:

• The “self” bucket fills if you are late, hungry, stressed, unwell, and so on;
• The “context” bucket fills if your ward or department is understaffed, poorly
led or lacking equipment.

• The “task” bucket fills if the tasks assigned to you are unfamiliar or
technically demanding.
•The fuller each bucket is, the greater the likelihood of you
making an error.

•As a team, all staff can run through one of these two
checklist at the beginning of a shift, for example. If you
feel vulnerable and therefore prone to errors, you should
share this with your colleagues so they can keep an eye on
you.
 SAFETY HUDDLES

•A safety huddle is a brief coming together of staff, once or

more in a shift, aimed at maintaining situational
awareness, sharing observations and going through risks.

•Which patients are causing concern?Is anyone at risk of

deterioration? How is staffing? How is workload?
 DEBRIEFS

•Debriefs are short meetings at the end of a shift to

review how the team has performed. Debrief can
be done towards the end of the shift, rather than
once it has ended. The nurse in charge of the shift
may lead a debrief.
 HUMAN FACTORS

•Human Factors is defined as the

environmental, organizational and job
factors, and individual characteristics
which influence behavior at work”.
 C. ROLES AND RESPONSIBILITIES OF A
PROFESSIONAL NURSE
1. Caregiver
2. Teacher
3. Counselor
4. Change Agent
5. Client Advocate
6. Manager
7. Researcher
 Caregiver/Care Provider

•-the traditional and most essential role,

functions as nurturer, comforter,
provider
• “mothering actions” of the nurse
•provides direct care and promotes comfort of
client
•activities involve knowledge and sensitivity to
what matters and what is important to clients
•shows concern for client welfare and
acceptance of the client as a person
 Teacher
•provides information and helps the client to learn
or acquire new knowledge and technical skills
•encourages compliance with prescribed therapy
•promotes healthy lifestyle
•interprets information to the clients
 Counselor

•-helps client to recognize and cope with

stressful psychological or social problems; to
develop an improved interpersonal
relationships and to promote personal growth
•provides emotional, intellectual and
psychologic support
•focuses on helping a client to develop new
attitudes, feelings and behaviors rather than
promoting intellectual growth
•encourages the client to look at alternative
behaviors, recognize the choices and develop a
sense of control
 Change Agent

•-initiate changes or assist clients to

make modifications in themselves or
in the system of care
 Client Advocate
•-involves concern for and actions in behalf of the
client to bring about a change
•promotes what is best for the client, ensuring that
the client’s needs are met and protecting the client’s
rights
•provides explanation in clients language and
supports client’s decisions
 Manager

•-makes decisions, coordinates activities of others,

allocates resources, evaluates care and personnel

•plans, gives direction, develops staff, monitors

operations, gives rewards fairly and represents both
staff and administrations as needed
 Researcher
•-participates in identifying significant researchable
problems
•participates in scientific investigation and must be a
consumer of research findings
•must be aware of the research process, language of
research, and sensitive to issues related to
protecting the rights of human subjects
 Learning Outcomes
At the end of this video-lecture, the students will be able to:
1. Define Teamwork and Collaboration;

2. Discuss Self-awareness, Dyad, Group, and Team;

3. Explain the Key Elements of Teamwork;

4. Determine the Tools for Facilitating Teamwork; and

5. Identify the Different Roles of the Nurse

•THANK YOU.HOPE YOU
LEARNED SOMETHING. KEEP
ON LEARNING.