Award Date

5-1-2015

Degree Type

Dissertation

Degree Name

Doctor of Nursing (ND)

Department

Nursing

First Committee Member

Lori Candella

Second Committee Member

Susan VanBeuge

Third Committee Member

Richard Tandy

Number of Pages

181

Abstract

Executive Summary

Leading advisory agencies have long advocated that health care must be safe and effective (Institute of Medicine [IOM], 2001). In order for health care to be safe and effective, good communication and collaboration are essential. Research has found that in health care, poor communication and teamwork failures are the major contributors to adverse events (Cornell, Townsend-Gervis, Vardaman, & Yates, 2014; The Joint Commission, 2011; O’Leary, 2012). Such communication-related adverse events can cause avoidable injury, loss of life, and financial devastation. In light of advanced practice nurses’ (APN) increasing contribution in care management, and in order to ensure delivery of high-quality patient care, hospital administrators and nurse executives in particular, must foster improved communication and collaboration between APNs and RNs. The potential benefits of improving APN–RN teamwork are multiple. For example, Naylor et al. (2013) have reported that, in their study, nurse-led interdisciplinary interventions resulted in quality improvement and cost savings.

One solution for improving communication within the health care team pertains to bedside rounding. Daily bedside rounding presents an opportunity for care team members to cooperatively develop and communicate care strategies. Staff nurses are typically not included in physician led patient rounds. This exclusion is unfortunate because, during rounds, nurses could provide essential nursing expertise and knowledge about patients’ health status; furthermore, nurses are uniquely positioned to encourage patients’ proactive participation in their own health care team.

The primary objective of the DNP project described in this doctoral project paper was to develop a structured learning module to improve collaboration and communication between APNs and RNs through the implementation of APN–RN patient bedside rounding. To establish a basis for creating the learning module, the DNP project began with an in-depth literature review of research on (a) APN–clinical nurse communication and collaboration and (b) the contributions of APNs and clinical nurses to the quality of patient care. Evidence-based best practice recommendations guided the development of the learning module to instruct APN and clinical nursing staff on proper communication and collaboration in conjunction with the use of a daily goals sheet to facilitate structured APN–RN–patient beside rounding. (For example, the use of bedside rounding with daily goal reminder sheets has demonstrated improved communication in patient-centered care.) King goal attainment theory provided the underpinning for this project with Knowles’ conceptual framework of andragogy provided a methodology, framework, and mechanism that informed the learning module’s design.

After an initial draft of the module was completed, it was sent to three of the hospital’s APNs for their review; all of these APNs had had prior experience with APN–RN rounding at other hospitals. Following the APN’s review, the main modifications of the learning module included expanding the explanations of (a) breakdown of communication (specifically, nonverbal communication), (b) roadblocks to collaboration, and (c) inclusion of the patient’s family in rounding discussions, when possible discussion, when possible.

Bedside rounding presents a daily opportunity for health care team members to cooperatively strategize and to communicate the plan and goals of care to the patient and family; this cooperative activity reflects a concerted team effort to achieve the patient’s goals. Effective communication and collaboration are requisite for building a patient centered care partnership. The learning module developed in this DNP project can assist APNs and RNs in improving their communication and collaboration.

Keywords

Collaboration; Communication; Communication in medicine; Communication in nursing; Health care teams; Intraprofessional; Nurse and patient; Nurse practitioners; Nurses

Disciplines

Communication | Health Communication | Nursing

Language

English


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