Clinical Issues Facing Nurses In Multidisciplinary Teams: Reflection And Strategies

Communication Issues with Patients' Families

This paper reflects three clinical issues facing a nurse in her specific area of practice. My clinical objective is to communicate effectively with the patient's family, teach them and the patients properly and want to contribute efforts to the multidisciplinary team. The nurse has identified communication issues with the family of the patient. As the nurse needs to work in a multidisciplinary team, it is difficult to coordinate with other team members. In order to educate the patients and their families, it is hard to teach them about using medication schedules as many of them are not that educated. These three issues are mainly identified in this paper. However, I had shared my experience through the Gibbs reflective cycle.

As a nurse practitioner, I had the responsibility to examine the patients, diagnose health issues, analyse test results and administer medicines and treatments.  Also, I had to give education to the patient and his family that how to use the medical devices and how to follow each medicine. I had to work in a multidisciplinary team to implement the interventions. In my practice, I had to update the family about the health status of the patients. However, I faced three clinical issues during my practice. The first issue was that I was facing communication issues due to work pressure with the family of patients. In nursing practice, communication between the patients’ families and nurses is a vital aspect. It helps to reduce any kind of confusion or fear of the family members about the patient's health status. However, some evidence present that due to overloaded work pressure, sometimes, the nurses use verbal and psychological aggression in communication (Aalaa et al., 2017). It can be considered as an example that I had not given answers and ignored the families of those patients who were monitored under my supervision for the first two days due to my workload pressure. The family members had a mental state where they did not want to listen to any words or the psychological exhaustion was the main barrier. I was trying to make eye contact with them to make them relax but it was not possible to communicate with them each second as they had no idea about the gravity of the situation.

As per Adams, Mannix & Harrington, (2017), a multidisciplinary team can increase nursing skills. The second issue, I was struggling to work in a multidisciplinary team as they have not fixed the meetings correctly where we can discuss the interventions. I get to about the decisions of interventions after taking the decisions of others. For example, I had no idea what interventions were taken to cure the hypertension of Mr D, and suddenly, I realised that I had to monitor Mr D's health status which was disappointing and making more difficult for me to complete the practice. It was difficult for me to assume the interventions from earlier and for this reason, I could not take action or follow actions properly. Another important role of nurses is to provide education to patients and their families (Calha, Silva & Vieira, 2018).

Challenges in Working in Multidisciplinary Teams

However, there was another issue that I faced during practice. I had to give education or teach the family members and patients about the medications and medical devices. For example, Mrs A was coming from a remote area and she could not understand the medication schedule of her husband who had diabetes. I could not give her proper education regarding medication schedules and usage of medical devices such as glucometers. Moreover giving education on using medical devices was more difficult. For example, it was not so effective to give a demo on using a glucometer in diabetes as the patient and family had not that much understood. They were forgotten immediately after giving demo classes.

Initially, I felt sad as I had to struggle more in my practice. I was getting confused as I had to manage many roles and responsibilities. I had no prior experience in handling this type of clinical situation. I just need time to arrange everything one by one. However, after three to four days, the situation was normal for me. I had decided to solve the issues one by one. At first, I decided to focus one by one on the clinical issues. For the first clinical issue,  I had considered a particular time at which time I could talk to the family members for updating them about the health status of the patient. I had taken only 10 minutes to inform the patients and to solve their queries rather than considering their queries every time. It has made it more difficult for me to attend them every time. After the implementation of this strategy, I was able to give response to family members of the patients who are under my supervision.

For the next issue, I conveyed the coordination issue to my team members in the multidisciplinary team and tried to spend more time with them to discuss the intervention. I had started to observe the practices and actions that they had taken, which helped me to understand the link between the causes of taking decisions. I had proposed some intervention steps that had been liked by other members which encouraged me to involve deeply. Then I need to help them in the implementation of the intervention. I monitored each step of the team members and I was able to give medicines to Mr D properly. I had read all the medical history of Mr D and listened to the dietitian give a strict diet to Mr D. However, for the last issue, I had started to use visual aids and audio in the local language which helped me a lot to give proper information to the patient and his family about the names, times of intaking medicines and how they can use the medical devices for self-management. Taking support of healthcare education resources to enhance my communication skill and helped to give education to the families and patients. All issues had been sorted after making the strategies and planning properly. I feel satisfied as I have done all tasks and solved all clinical issues properly.

Difficulties in Educating Patients and Their Families

The things that worked well were my strategies and efforts. I had to use evidence-based strategies. Usage of educational videos for providing education to families and patients is one of the current best practices (Dalmolin et al., 2017). However, the support of patients, families and the team members of the multidisciplinary team encouraged me to complete this practice. Moreover, these clinical issues motivated me to work harder to resolve the issues and develop my professional skills. These issues contributed positively to the ethics of the nursing practice (Li et al., 2020). The thing that did not work was that I had assumed that all processes would go smoothly and perfectly. However, the lack of area was that I could not complete the practice by arranging work and leading other staff properly. I developed my communication, critical thinking and problem-solving skills during solving issues. I also developed time management skills as I had to take additional time for the patient's family, although I had a huge pressure of work. On the other hand, I lacked leadership skills, organisation and calm, cool skills. However, these reflective practices help analyse the strengths and weaknesses (Galutira, 2018).

I think initially, I was facing these issues because I was new in this practice and I was pretty sure that I had all skills to complete this nursing practice. Due to a lack of calm and cool skills, I faced issues with communication with the patient and family. I had insufficient skills in the organisation which was one of the reasons for chaos in my work. Moreover, I was confused and could not lead the multidisciplinary team. As a future registered nurse, leadership, time management, communication, critical thinking, organisation skill, and patience skill need to posses for managing everyday critical situations (Zajac et al., 2021). For this reason, I need to build an action plan to improve my other skills.

Conclusion

It can be concluded that this nursing practice has given me a wide range of experiences. I had applied all those things that I had to learn in only the theories such as ethical values, code of conduct and standards of NMBA. Although after this practice, I get a clearer picture of how to implement the standards in my practice. However, I need to focus on a few areas where I was the lack in.

The action plan aims to develop the clinical or professional skills that I could not develop during this practice. After developing these skills, I can apply them in future practice to overcome the clinical issues that I have found in the present scenario. This action plan is based on the SMART goals that can help develop the skills by implementing this action plan.

Table 1: Action Plan

(Source: self-created)

Conclusion

These clinical issues helped me to critically think and encouraged my confidence level. These clinical issues give the nurse a great experience and impact their personal and professional skills. The nurse gets the practical idea which is different from the theoretical practice. However, in future, the nurse can do better performance as the skills are developed during this nursing practice. The nurses will be able to face the clinical issues effectively after completing this practice and completing the action plan.

References

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Adams, A. M. N., Mannix, T., & Harrington, A. (2017). Nurses' communication with families in the intensive care unit–a literature review. Nursing in critical care, 22(2), 70-80. https://doi.org/10.1111/nicc.12141

Calha, A., Silva, A., & Vieira, N. (2018). Communication problems between nurses and patient's family. Rev. Rol enferm, 21-25. https://www.researchgate.net/publication/329454374

Dalmolin, A., Girardon-Perlini, N. M. O., Coppetti, L. D. C., Rossato, G. C., Gomes, J. S., & Silva, M. E. N. D. (2017). Educational video as a healthcare education resource for people with colostomy and their families. Revista Gaucha de Enfermagem, 37. scielo.br/j/rgenf/a/gCB5xxTX4wcSrGKfDBnDngQ/abstract/?lang=en

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Li, Y., Chen, W., Liu, C., & Deng, M. (2020). Nurses’ psychological feelings about the application of Gibbs reflective cycle of adverse events. American Journal of Nursing, 9(2), 74-78. https://pdfs.semanticscholar.org/deb5/86a11508fe8b5cc51f490596d98f7659bdcd.pdf

Zajac, S., Woods, A., Tannenbaum, S., Salas, E., & Holladay, C. L. (2021). Overcoming Challenges to Teamwork in Healthcare: A Team Effectiveness Framework and Evidence-Based Guidance. Frontiers in Communication, 6, 6. https://doi.org/10.3389/fcomm.2021.606445