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Discusa About The Effectiveness of a shared team approach between nurses and doctors for improved risk factor management in survivors of stroke:

First Objective: Administration and Management of Thrombolysis

A stroke can be defined as the medical emergency where the flow of the blood to the brain gets cut off. It might happen to any patient at any time. About every year, 9000 people in the nation of the New Zealand suffer from stroke and require emergency medical treatment and post stoke rehabilitation treatment (Clarke & Foster, 2015). Providing a faster treatment to stroke patients help in ensuring less threatening situation of the patient and better patient outcomes, reducing the chances of fatal consequences. Different nursing professionals have to work in multi-disciplinary teams of doctors, physicians, and professional therapist like physiotherapists, occupational therapists, speech therapists and many others (Middleton et al., 2015). Therefore, as nursing professionals, I need to ensure that all important skills for treating patients in the emergency conditions as well as effectively working as the member of the team are present within me. I realised that I have four gaps which I needed to overcome in order to provide care to patients and work as an effective team members. Therefore, my main focus of the project would be to strategise ways by which I can overcome the gap and then evaluate them to see how much I was successful. Therefore the objectives that I would be hoping to achieve are the administration and management of thrombolysis, close monitoring patient for any clinical changes as observations and patient care is a primary objective, exploration of the perception of the nurses’ towards the multidisciplinary teamwork and understanding the type of the interaction that takes place in the multidisciplinary team meetings. This assignment will show how I have overcome the gaps and developed knowledge that would help me to provide effective quality and safe care in future to patients while working in the multidisciplinary team.

Thrombolysis is the procedure of using proper thrombolytic drugs that would help in the breaking down as well as dispersing the clot that are causing prevention to the blood for reaching to the brain who have suffered ischemic stroke attack (Anderson et al., 2017). It is very important for the nursing professionals to administer the drugs within the first four and half hours of the stroke symptoms. Very rare cases are there where doctors still think it to be useful till 6 hours. It is very important for nurses to be quick and skilled in thrombolysis as more the time passes, the less effective the thrombolysis will be (Zwicker et al., 2017). Therefore, it is important for the staffs to be very quick from the times of the starting of the symptoms. When, I was in the time of clinical placement, I saw a man suffered threatening situation when my preceptor failed to administer the drugs in time due to improve time management. Therefore, I want to be skilled in this aspect while working in the multidisciplinary team caring for stroke patients.

Second Objective: Close Monitoring of Stroke Patients

Thrombolytic therapy is one of the most crucial interventions that need to be conducted by the emergency team of the nursing professionals immediately after the arrival of the patient (Schwarz et al., 2018). This therapy has the capability for breaking the clits formed during stroke in the patient and prevents disruption of the flow of the blood to stop the chances of brain death (Mehta et al., 2018). Therefore, I needed to develop the skill as mere basic knowledge is not sufficient to ensure safe administration of the drugs in the patient. Therefore, I had joined an 8 month training session for becoming specialist stroke nurse. This had helped me to develop the efficiency and skills required for effective administration of the drugs through injections and get the standardized stroke specialist qualifications. Existing standardised framework for stroke patient protocols as well as evidence based articles also support nurses in developing the knowledge required for the skill (Coyne et al., 2016). After completing the training as well as gathering of the standardised qualifications, I started working under the senior stroke specialist in the emergency team. Clinical preceptoring and appropriate guidance of the skill management help novice nurses gain a practical arena for experiencing their capabilities (Dreyer et al., 2016). The preceptor guided me in every step and I became an expert in the skill management of thrombolysis and could manage my time effectively as well. The feedback I received from my clinical preceptor as well as the team members of the multidisciplinary helped me understand how well I was developing. I took their feedback constructive and never became upset if they criticised me. Constructive criticism in teamwork is essential for development of skill of novice nurses (Horton et al., 2016). The different barriers that I had faced were my internal fear that arose from my lack of confidence. I was not confident about the skill I had for thrombolysis in stroke as well as lack of necessary skill mix required. My fear also included of the hemorrhagic side-effects and consent issues. However, as days passed in training, I got more confident and overcome the challenges. It required me 8 months and now I am quite confident in the skill and had conducted 28 thrombolytic therapies in last three months.

One of the most important purpose for the development of this skill is that monitoring during the early stages of the post acute stroke helps the nursing professionals to identify that whether occurrences of neurological and medical complications had taken place or not (Olaiya et al., 2017). Several human as well as animal experiments have revealed that various negative symptoms can occur. Theses might be different disorders like hypotension, hypoxia, pyrexia and dehydration that have the abilities to aggravate the neuronal damage that had occurred due to stroke (Ohura et al., 2018). Therefore nursing professionals need to be very careful and maintain constant monitoring of the patients to prevent any more negative consequences adding to the suffering of the patients. Therefore, development of such skill is extremely important for nursing professionals working in teams caring for stroke patients.

Third Objective: Exploration of Nurses' Perception towards Multidisciplinary Teamwork

Close patient monitoring who have suffered stroke might help the nursing professionals to understand the rate of recovery as well as different unperceived coping difficulties faced by the patient. Invasive monitoring for inter-cranial pressure as well as blood pressure and measuring of the abnormal findings help the nurses to realize whether the patient is vulnerable to threatening situation on or that they are gradually recovering (Aoki et al., 2016). Recordings of the blood pressure, temperature, pulse and the Glasgow comma scale help to monitor the health of the patient time to time and dictate the chances of further degradation of the physiological and neurological health of the patient. Fluid overload needs to be assessed. Monitoring helps in benefitting the patients by early remedial intervention (Luker et al., 2017). Therefore, I needed to develop the skill and patient by which I will monitor the patient after the stroke in ways by which I can identify any deterioration effectively. Therefore, I consulted with my mentor and he advised me with a number of important books that had detailed description of the ways by which close monitoring can be done and the different interventions and time needed to take from time to time. Moreover, I also conducted huge evidence based studies through the nursing databases and came across articles that helped me to gain knowledge. Evidence based articles help nursing professionals to develop skills and make them up-to-date about the new interventions and working procedures that are helping to provide more quality and safe care (Von Kodolisth et al., 2016). In order to evaluate myself, I used to maintain a reflective journal and after every week used to consult my reflective journal with my mentor. He used to point out the part that I could have done better and also encouraged me on the parts which I have done excellently. His feedbacks helped me to evaluate myself successfully. Some of the barriers that I had faced are lack of patience as well as time management. Caring for particular patient needs patience and commitment and this might make the nurse feel restless in a busy shift. Situations might get worse when the staff to patient ratio is also less (Luker et al., 2016). In such cases, effective time management like caring for other patients as well as close monitoring of stroke patient might result in burning out of the nurse of time management is not done effectively (Ryan et al., 2017). I also faced these barriers and so advocated this to the higher authority. However, I learnt the skill effectively and had been successfully monitoring patients of stroke for last three months.

In a multidisciplinary team, it is the responsibility of each of the team members to understand their own roles to provide effective care to the patient. However, researchers are of the opinion that only knowing about one’s own roles are not necessarily enough to ensure effective teamwork. The nursing professionals who are one of the most important caregivers in the multi-disciplinary teams have to be efficient in understanding other’s expert’s roles and attitudes towards patients as well as the efficiency of the other nurses working in the team (FErgusen & Hendriks, 2017). Therefore, every nurse would need to explore the perception of the other nurses working in the team so as to assess that everyone is clear about the goals to be achieved. The better everyone is able to understand what others are thinking it would be helpful in developing a common goal, prevention of feuds and negative feelings, medication errors, missed interventions and thereby divide the team role of the nurses according to their talents and skills (Roberts et al., 2018). This would ensure proper skill mix and all important nursing requirements of the patients would be met.

It is extremely important to know about other nurses and health professionals view points and way of treatment of client when working in a multidisciplinary team. Knowing about what others are thinking in the team and about the actions in which they are or are not comfortable would help in designing of the care planning that would allocate desired roles for each of the nurses and professionals (Harrison et al., 2017). The better a nursing professional identifies the perceptions and through procedures of others while working in team, it would be helpful for her to align according to the desired behaviors and responsibility they expect and therefore decrease the chances of development of negative feelings and feuds. This would also help the nursing professional to understand each other’s talent, working style, preferences and many others (Lange et al., 2017). This would prevent improper teamwork interventions and will ensure smooth workflow with proper division of labor according to specific skill mix of professionals. Therefore, in order to understand the perception of other nurses, I consulted with my mentor and after his permission only, I developed an open-ended questionnaire. I was able to capture the perception of the nurses through this questionnaire. Open ended questionnaire is one of the best ways when individuals need to know detailed information about a topic, perception, intervention and many others and is extremely useful in qualitative research papers (Palley et al., 2018). In order to evaluate such broad answers and to find out whether I had done this effectively or not, I consulted with my mentor. He provided the feedback stating it was appropriate and that I should go through the perceptions of each members of the team to knowledge about their perceptions and psychology and thereby gains idea about to strategize my team working style. The barrier I faced was time management as taking out time to conduct interviews in busy shifts were becoming difficult. I gained knowledge about the perceptions effectively and learnt ways to implement my practicing styles in ways by which I do not disappoint any. It took me around two weeks to conduct this.

With the advancement of the generation, complex disorders that require various types of expert interventions and help are also increasing. Therefore, a single nursing professional can never successfully be able to complete all the necessary interventions within the specific timings and according to needs and requirements of the patients. Therefore, teamwork containing all experts specialized in their own fields and caring for each specific requirement of patients is important (Harrison et al., 2017). Therefore, teamwork is necessary. However, in order to conduct necessary teamwork, specific team working skills are important to ensure effective interaction among team members and ensure safe and quality care for patients. Therefore, effective communication, feedback exchange procedures, self-regulation, self awareness, empathy and transparency are very important to ensure that every team members are interacting with each other without any hard feelings (Luker et al., 2016). I needed to explore such attributes and understand how such attributes help in effective interaction among the team-members and how they contribute to collaboration and coordination.

Researchers are of the opinion that when interaction among the team members of the multidisciplinary team is well developed, there would decreased chances of medication errors, missed interventions, clashing of timeslots for experts, duplication of nursing interventions, threatening situations, accidents (Aoki et al., 2016).  They also stated that it also ensures increased chances of patient satisfaction and meeting all the needs and requirements of the patient and ensuring safety and quality care (Dreyer et al., 2016). Therefore, I needed to gain more knowledge on the concepts of effective interaction between the members and check out whether I have the proper attributes to ensure effective team working. Therefore, I often took up the task of close observation of the interaction that was carried out by every team members and note it down in my diary. I also started to observe the relationship shared by each other and how bonding influenced better interaction and outcome on their health. I also conducted an interview where I tried to find out from them that what enablers and barriers they considered in development of effective communication and teamwork. Later, I analyzed their opinions and consulted them with evidence based practices. This helped me to understand the different factors that influence interaction among members. The main barriers that I faced were my introvert nature which prevented me from interacting openly with team members to take their opinions. Time was also the barrier. However, I closely analyzed the attributes and developed the knowledge about the attributes that I need to possess and harbor for carrying out effective interaction among embers and ensure safest care to the patients. This took me two week for completion.

Conclusion:

The main purpose of the assignment was to ensure how well I have been able to identify the learning requirement needed to work in the multidisciplinary team and then develop strategies to develop the skill. I have learnt that perception of nurses in working in multidisciplinary teams, concepts of interaction in the teams, development of thrombolysis skills, close monitoring of the skills are very important, accordingly with help of my mentor, I took actions like training sessions, certification courses, quality based interviews, evidence based studies and many others to achieve the goals. Initially, I faced a number of barriers that affected my enthusiasm but I did not let them make me feel down. I accumulated my zeal and enthusiasm and continued to work towards my goals. I had set myself a timeframe for about 8 months and accordingly planned my schedules to meet the goals. These helped me to develop some of the most important skills which are indeed helpful for worming in multi-disciplinary teams who provide care and support to patients suffering from ischemic stroke. As a part of the future recommendations, I would always take active part in reflective actions where I will maintain reflective journal as this would help me to develop my expertise and identify the skill that need father training. I would also take part in continuous professional development where I would be able to make my knowledge and skill to be up-to-date and thereby learn the most modern methods and interventions which would help me to become a stroke expert professional.

References:

Anderson, E., Fernandez, S., Ganzman, A., & Miller, E. C. (2017). Incorporating nonphysician stroke specialists into the stroke team. Stroke, 48(11), e323-e325.

Aoki, S., Hosomi, N., Hirayama, J., Nakamori, M., Yoshikawa, M., Nezu, T., ... & Nishikawa, Y. (2016). The multidisciplinary swallowing team approach decreases pneumonia onset in acute stroke patients. PloS one, 11(5), e0154608.

Clarke, D. J., & Forster, A. (2015). Improving post-stroke recovery: the role of the multidisciplinary health care team. Journal of multidisciplinary healthcare, 8, 433.

Coyne, I., Comiskey, C. M., Lalor, J. G., Higgins, A., Elliott, N., & Begley, C. (2016). An exploration of clinical practice in sites with and without clinical nurse or midwife specialists or advanced nurse practitioners, in Ireland. BMC health services research, 16(1), 151.

Dreyer, P., Angel, S., Langhorn, L., Pedersen, B. B., & Aadal, L. (2016). Nursing roles and functions in the acute and subacute rehabilitation of patients with stroke: Going all in for the patient. Journal of Neuroscience Nursing, 48(2), 108-115.

Ferguson, C., & Hendriks, J. (2017). Partnering with patients in shared decision-making for stroke prevention in atrial fibrillation.

Harrison, M., Ryan, T., Gardiner, C., & Jones, A. (2017). Psychological and emotional needs, assessment, and support post-stroke: a multi-perspective qualitative study. Topics in stroke rehabilitation, 24(2), 119-125.

Horton, S., Lane, K., & Shiggins, C. (2016). Supporting communication for people with aphasia in stroke rehabilitation: transfer of training in a multidisciplinary stroke team. Aphasiology, 30(5), 629-656.

Lange, M. C., de Araujo, T. F., Ferreira, L. F., Ducci, R. D., Novak, E. M., Germiniani, F. M., & Zetola, V. F. (2017). Comparing the Comprehensive Stroke Ward Versus Mixed Rehabilitation Ward—The Importance of the Team in the Acute Stroke Care in a Case–Control Study. The Neurohospitalist, 7(2), 78-82.

Luker, J. A., Bernhardt, J., Graham, I. D., Middleton, S., Lynch, E. A., Thayabaranathan, T., ... & Cadilhac, D. A. (2017). Interventions for the uptake of evidence?based recommendations in acute stroke settings. Cochrane Database of Systematic Reviews, (1).

Luker, J. A., Craig, L. E., Bennett, L., Ellery, F., Langhorne, P., Wu, O., & Bernhardt, J. (2016). Implementing a complex rehabilitation intervention in a stroke trial: a qualitative process evaluation of AVERT. BMC Medical research methodology, 16(1), 52.

Mehta, T., Strauss, S., Beland, D., Fortunato, G., Staff, I., & Lee, N. (2018). Stroke simulation improves acute stroke management: a systems-based practice experience. Journal of graduate medical education, 10(1), 57-62.

Middleton, S., Grimley, R., & Alexandrov, A. W. (2015). Triage, treatment, and transfer: evidence-based clinical practice recommendations and models of nursing care for the first 72 hours of admission to hospital for acute stroke. Stroke, 46(2), e18-e25.

Ohura, T., Higashi, T., Ishizaki, T., & Nakayama, T. (2018). Occupation-based differences in shared perceptions of older resident needs within multidisciplinary care teams: a cross-sectional study of care workers, nurses, and therapists linked to older residents. Journal of physical therapy science, 30(6), 866-873.

Olaiya, M. T., Kim, J., Nelson, M. R., Srikanth, V. K., Bladin, C. F., Gerraty, R. P., ... & Thrift, A. G. (2017). Effectiveness of a shared team approach between nurses and doctors for improved risk factor management in survivors of stroke: a cluster randomized controlled trial. European journal of neurology, 24(7), 920-928.

Paley, L., Williamson, E., Bray, B. D., Hoffman, A., James, M. A., Rudd, A. G., & SSNAP Collaboration. (2018). Associations Between 30-Day Mortality, Specialist Nursing, and Daily Physician Ward Rounds in a National Stroke Registry. Stroke, STROKEAHA-118.

Roberts, A. W., Penfold, S., Joint British Diabetes Societies (JBDS) for Inpatient Care, Allan, B., Dhatariya, K., Flanagan, D., ... & Malik, R. (2018). Glycaemic management during the inpatient enteral feeding of people with stroke and diabetes. Diabetic Medicine, 35(8), 1027-1036.

Ryan, T., Harrison, M., Gardiner, C., & Jones, A. (2017). Challenges in building interpersonal care in organized hospital stroke units: The perspectives of stroke survivors, family caregivers and the multidisciplinary team. Journal of advanced nursing, 73(10), 2351-2360.

Schwarz, M., Coccetti, A., Murdoch, A., & Cardell, E. (2018). The impact of aspiration pneumonia and nasogastric feeding on clinical outcomes in stroke patients: A retrospective cohort study. Journal of clinical nursing, 27(1-2), e235-e241.

von Kodolitsch, Y., Rybczynski, M., Vogler, M., Mir, T. S., Schüler, H., Kutsche, K., ... & Kölbel, T. (2016). The role of the multidisciplinary health care team in the management of patients with Marfan syndrome. Journal of multidisciplinary healthcare, 9, 587.

Zwicker, J., Martineau, I., Walsh, S., Lavoie, J., Weger, E., & Scott, J. (2017). Improving the comfort of nurses caring for stroke patients at the end of life. International journal of palliative nursing, 23(5), 248-254.

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