Collaboration in Anesthesia - Term Paper Example

Running Head: CONCEPT ANALYSIS ON COLLABORATION Concept Analysis On Physician Collaboration In Anesthesia .... Institute....... CONCEPT ANALYSIS ON COLLABORATION Abstract Every sector in every workplace benefits from the essentials of collaborative efforts. There is no more important an area than health care where the need for collaboration of those involved in the day-to-day care of patients is evident. Differences between nurses’ and physicians’ perceptions of collaboration have been a consistent theme in research.Studies of collaboration in the anesthesia setting remain scant. The purpose of this study was to compare the attitudes of anesthesiologist and nurse anesthetist toward collaboration with each other. Keywords: Collaboration, Anesthesia CONCEPT ANALYSIS ON COLLABORATION Concept Analysis On Physician Collaboration In Anesthesia General anesthesia is the induction of a balanced state of unconsciousness, accompanied by the absence of pain sensation and the paralysis of skeletal muscle over the entire body. It is induced through the administration of anesthetic drugs and is used during major surgery and other invasive surgical procedures. General anesthesia is intended to bring about five distinct states during surgery: analgesia, or pain relief amnesia, or loss of memory of the procedure loss of consciousness motionlessness weakening of autonomic responses Stages of anesthesia There are four stages of general anesthesia that help providers to better predict the course of events, from anesthesia induction to emergence. Stage I begins with the induction of anesthesia and ends with the patients loss of consciousness. The patient still feels pain in Stage I. Stage II, or REM stage, includes uninhibited and sometimes dangerous responses to stimuli, including vomiting and uncontrolled movement. This stage is typically shortened by administering a barbiturate, such as sodium pentothal, before the anesthetic agent. Stage III, or surgical anesthesia, is the stage in which the patients pupillary gaze is central and the pupils are constricted. This is the target depth of surgical anesthesia. During this stage, the skeletal muscles relax, the patients breathing becomes regular, and eye movements stop. Stage IV, or overdose, is marked by hypotension or circulatory failure. Death may result if the patient cannot be revived quickly. The concept of collaboration Collaborative efforts are necessary to achieve the best patient outcomes-Without collaboration, chaos occurs. Caring for patients, finding solutions to the problems of disease, and achieving outcomes that surpass the past cannot happen in isolation. The concept of collaboration in health care is not a new concept. Luther Christman spoke about the need for physician-nurse collaboration in the early 1970s. In those days, the idea stemmed from the concept that nurses of the future would have the knowledge and abilities to meaningfully participate as true partners in the management of patient care issues, decisions, and direction. In addition, nurses would be recognized for what they contribute to patient care. Today is that future that Dr. Christman spoke about, and nurses today do have these abilities. Physician-nurse collaboration began quietly at Rush Presbyterian-St. Lukes Medical Center in 1975. The concept of a physician and nurse working collaboratively to care for a specific population of patients emerged. Collaborative teams developed with the basic premises that each member of the team possessed different skills but had the same philosophical goals on patient care. Combining skills and defining roles allowed for a comprehensive approach to care of a specific group of patients. The initial development of these teams occurred in orthopedic surgery, pulmonary medicine, and oncology. The success of collaborative teams was validated and was supported by hospital administration. Three decades later, physician-nurse collaboration is not seen as unusual but rather the norm. Collaborative teams work in every locale, practice setting. and specialty. The way the team functions is defined by the participants on the basis of the needs of the population that are being cared for. Lack of communication and collaboration has been cited as a reason for poor patient outcomes. Programs have been put in place to enhance physician-nurse collaboration to ensure better outcomes for patients. Collaboration does not end with the physician- nurse relationship. Even more important is the nurse-nurse collaborative relationship that must flourish to ensure comprehensive, quality patient care.It is necessary to take the initiative to develop an atmosphere where collegial and collaborative activities are allowed to and must exist. Removing barriers to developing a collaborative atmosphere is essential. Barriers include * lack of clear role definition or acceptance of role definition; * concern about losing perceived power based on knowledge sharing; * lack of commitment by nurse participants to develop a collaborative relationship; * inadequate interpersonal skills by team members; and * limited administrative support for the development of collaborative teams. Identifying barriers that are present and methods to overcome them is essential to the development of a collaborative team and environment. If barriers cannot be overcome or modified, reorganization of the team or changes to the environment should be considered. Nurse-nurse collaboration has recently begun to be studied in an effort to determine the role of lack of collaboration in patient outcomes (Dougherty & Larson, 2010). This will be important information to validate the need to develop the environment that supports collaborative nurse relationships and the identification of nurses who would benefit from education on the skills necessary to be successful in this environment. The art of collaboration is essential in ensuring that every nurse has the information, environment, and support to successfully manage day-to-day patient issues. Building this type of practice relationship and setting will only help us achieve our goals of providing the excellent patient care we strive to give. Purpose of the study The purpose of this study was to compare the attitudes of anesthesiologist and nurse anesthetist toward collaboration with each other.Additional analyzes failed to show a significant difference based on sexual gender. The results of this study provide some evidence that the divergent perspectives regarding collaboration previously demonstrated between physicians and nurses may also exist in the specialty field of anesthesia. This study provided no support for the supposition that gender contributes to the differences in attitude toward collaboration between physicians and nurses. when anesthesiologist and nurse anesthetist work together, the nature of their interactions has the potential to influence the patient care they provide.Collaboration describes interactions in which professionals work together cooperatively, with shared responsibility and interdependence. Collaboration among health care workers has been advocated as a way to improve care delivery in an increasingly complex health care system.Physician nurse collaboration has beneficial and desirable effects for patients and providers. Uses of the concept Many positive correlations between physician-nurse collaboration and patient satisfaction, staff satisfaction, staff retention, patient outcomes, and reduced costs can be found in comprehensive reviews of the literature.Collaborative physician-nurse interactions have been associated with improved patient care delivery, including lower than expected intensive care unit (ICU) patient mortality.Collaboration has been shown to maximize output and efficiency in business, making physician-nurse collaboration appealing to health care managers. Physician-nurse collaboration has been called an ethical imperative, because of its association with patient care quality. Yet, nurses and physicians view collaboration differently. Physicians have rated collaboration levels higher than their nursing counterparts and nurses have valued collaboration more significantly than physicians. In a multi center study of surgeons, anesthesiologist, nurse anesthetist, and operating room nurses, physicians were more satisfied with physician-nurse collaboration than nurses. Communication failure, particularly associated with hand-offs in health care, can be a source of adverse events affecting patient safety.The Institute of Medicine’s report in 1999 estimated that medical error may be anywhere from the fifth to the eighth leading cause of death in the United States. In the operating room, the potential for communication failure is increased due to the mix of professional cultures, the complex therapeutic interventions, and mental overload. Consequently, organizations have been encouraged to look for areas of improvement to communication. Essential Attributes: The physician who lacks one or more of the following attributes is not considered qualified to practice anesthesiology safely. 1. . Demonstrates high standards of ethical and moral behavior. 2. . Demonstrates honesty, integrity, reliability, and responsibility. 3. . Learns from experience; knows limits. 4. . Reacts to stressful situations in an appropriate manner. 5. . Has no documented current abuse of alcohol or illegal use of drugs. 6. . Has no cognitive, physical, sensory or motor impairment that precludes acquiring and processing information in an independent and timely manner. 7. . Demonstrates respect for the dignity of patients and colleagues, and sensitivity to a diverse patient population. Patient Care: 1. . Demonstrates patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health. 2. . Respects patient privacy. 3. . Demonstrates appropriate concern for patients and a commitment to carrying out professional responsibilities. 4. . Is an advocate for quality care. 5. . Demonstrates use of a sound background in general medicine in the management of problems relevant to the specialty of anesthesiology. 6. . Recognizes the adequacy of preoperative preparation of patients for anesthesia and surgery, and recommends appropriate steps when preparation is inadequate. 7. . Selects anesthetic and adjuvant drugs and techniques for rational, appropriate, patient-centered and cost-effective anesthetic management. 8. . Recognizes and responds appropriately to significant changes in the anesthetic course. 9. . Provides appropriate post-anesthetic care. 10. . Provides appropriate consultative support for patients who are critically ill. 11. . Evaluates, diagnoses, and selects appropriate therapy for acute and chronic pain disorders. Medical Knowledge: 1. . Possesses an appropriate fund of medical knowledge. 2. . Is appropriately self-confident; recognizes gaps in knowledge and expertise. 3. . Demonstrates medical knowledge about established and evolving biomedical, clinical, and cognate sciences, as well as the application of this knowledge to patient care. 4. Practice-Based Learning and Improvement: 5. . Demonstrates learning and improvement that involves the investigation and evaluation of care for patients, the appraisal and assimilation of scientific evidence and improvements in patient care. 6. . Is committed to practice-based learning and improvement. 7. . Possesses business skills important for effective practice management. Is complete, accurate and timely in record keeping. Interpersonal and Communication Skills: 1. . Demonstrates effective interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families and other health care professionals. 2. . Is adaptable and flexible. 3. . Is careful and thorough. Professionalism: 1. . Demonstrates a commitment to carrying out professional responsibilities. 2. . Adheres to ethical principles. 3. Demonstrates sensitivity to a diverse patient population. Systems-Based Practice: 3. . Demonstrates an understanding of the health care system and the ability to effectively call on system resources to provide optimal patient care. 4. . Demonstrates an awareness of and responsiveness to the larger context and system of health care. Clinical Skills: 1. . General preparation 2. . General anesthesia 3. . Regional anesthesia and pain management 4. . Special procedures Overall Clinical Competence: The grade for Overall Clinical Competence can be satisfactory only if the grade for every Essential Attribute is satisfactory. A Board certified physician must be capable of performing independently the entire scope of anesthesiology practice without accommodations or with reasonable accommodation. Model Case Operating room teams do not often meet to discuss a case prior to entering the operating room so that not all team members have the same information. The outcome may be adequate for a routine case, but may lead to an unsafe situation if a crisis arises. Nurse Anaesthetists are part of this team and their information is usually obtained from the medical record and patient interview. However, interpersonal skills training are not part of the nurse anesthesia curriculum These skills include speaking up against authority, clarifying messages sent/received, and attentiveness to roles and relationships. Nurse anaesthetists and anaesthesiologists provide the bulk of anesthetics in the US, either solo or collaboratively. They are often providing anesthesia to patients who are unable to communicate important medical history facts, leaving the provider with inadequate information unless it is documented on the medical record. Medical records are often difficult to read and lack vital information. The lack of communication from other professionals involved in this patient’s care may lead to serious errors by the anesthesia provider, such as having inadequate blood available for an invasive procedure. Additionally, there is no standardized form used to hand-off patients in the post anesthesia care unit (PACU), which may lead to the omission of critical information from the anesthesia provider to the nurse taking over this patient’s care. Information that is not clarified regarding the patients condition can lead to erroneous decisions. Errors related to patient misidentification may cause a surgical procedure to be performed on the wrong site of the body. In the US, root cause analysis of 126 cases of wrong site surgery showed seventy-six percent involved surgery on the wrong body part; 13 % involved surgery on the wrong patient; and 11% involved the wrong surgical procedure. Factors that may have contributed to an increased risk of wrong site surgery include communication failure, illegible handwriting, and the use of abbreviations. However, teamwork does not happen automatically; it requires practice. Many institutions are providing training programs based on the Crew Resource Management (CRM) from aviation. This approach is based on the empirical evidence that individual performance is not enough to ensure optimum safety and that simulation is beneficial to all levels of expertise. Several examples of team training have been utilized by health care providers using the principles of “Crew Resource Management” including Advanced Trauma life support, emergency department triage, and safety protocols for general anesthesia. The principles of crew training hinge on the qualities of leadership, followership, communication and cooperation. A number of studies have measured improvements in communication . Messmer used three instruments to determine the level of nurse-physician collaboration during three simulated scenarios. One of the instruments used was the Kramer and Schmalenberg Nurse-Physician Scale (KSNPS) which uses a 5 point Likert scale to categorize relationships, with 1 being excellent or positive and 5 being negative or hostile. The KSNPS is designed to elicit respondents’ perceptions about interactions between nurses and physicians Kramer and Schmalenberg established reliability and validity of the scale over two decades. Another measurement tool that has been used to determine the quality of communication during PACU admission is the Hand off Scoring Form1. This form is completed by the nurse as the anesthesia provider is giving report on a patient coming from surgery. Aggregate results of observations of actual hand offs are fed back to clinicians to reinforce desired behaviors. Despite the apparent benefits of simulation, its use in health care is currently the exception, unlike the aviation industry that mandates regular simulation training. In a survey of 154 anaesthesiologists, ninety percent reported at least one potential barrier to simulation including lack of time, lost income, and lack of training opportunities. Simulation training is a common element of nurse anesthesia training with ninety six percent of program directors indicating they use some form of simulation. Often simulation is utilized primarily for task training such as airway management rather than for nontechnical skills such as communication. The Joint Commission has highlighted patient safety by asking providers to improve communication among providers. Malpractice carriers are offering significant reductions in insurance for teams that participate in simulation training. Given the impact of poor communication on patient safety in the peri operative period, a systematic review will contribute to the understanding of the effect of this training and identify the areas for further research. performed a systematic review of articles focused on physicians hand offs to identify features of structured hand offs that have been effective. They concluded that “despite the negative consequences of inadequate physicians hand offs, very little research has been done to identify best practices.” REFERENCES . Orthopaedic Nursing. July/August 2010.Collaboration Not Just a Catch Phrase. Retrieved 16 FEB 2010 from http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=1042197. . Taylor CL.2009 Oct.Charleston Area Medical Center, School of Nurse Anesthesia,Retrieved 16 FEB 2010 from http://www.ncbi.nlm.nihgov/pubmed/19911643. . Cassandra L. Taylor.n.d, theaba.org. Retrieved 18 FEB 2010 from www.aana.com/aanajournal.aspx. . Clancy, C. The importance of simulation: preventing hand-off mistakes. AORN Journal. 2008; 88 (4), 625-627. . Hunt, E., Kristen, N., Shilkofski, N. Simulation in medicine: addressing patient safety and improving the interface between healthcare providers and medical technology. Biomedical instrumentation & Technology. 2006; , 339-404. . Edozien, L. Patient safety in the operating theatre: an overview. Clinical Risk. 2005; 11, 177-184. . Linda.L.Lindeke.n.d, Retrieved 17 FEB 2010 from http://www.nursingworld.org/mods/mod775/nrsdrfull.htm . Jones TS, Fitzpatrick JJ.2009 Dec.Case Western University, USA.Retrieved 12 FEB from http://www.ncbi.nlm.nih.gov/pubmed/20108729. Read More