COMFORT*

2. COMFORT* • Communication (narrative) • Orientation and opportunity • Mindful presence • Family • Openings • Relating • Team * Wittenberg-Lyles, E., Goldsmith, J., Ferrell, B., & Ragan, S. (2012). Communication and palliative nursing. New York: Oxford.

3. Objectives • Describe the main principles of interdisciplinary team collaboration • Recognize team meetings as a place to collaborate and resolve conflict • Identify a communication skill to practice with interdisciplinary team members • Identify a communication skill to practice to ensure effective team meetings

4. Interdisciplinary Collaboration • Sharing resources • Shared power • Respect credibility/expertise • Focus on task and relational communication

5. Model of Interdisciplinary Collaboration Interdependence & flexibility • Characterized by interaction in order to: • Accomplish Goals and Share information • Maintain flexibility for each new case • Psychospiritualcare (Grey, 1996): • meets psychosocial, spiritual, and coping needs of patients/families laboring with terminal illness Grey, R. (1996). The psychospiritual care matrix: a new paradigm for hospice care giving. Am J HospPalliat Care, 13(4), 19-25.

6. Model of Interdisciplinary Collaboration Newly created tasks & responsibilities • Emerge through information sharing • Collaborate to maximize members’ expertise • Work collaboratively to serve patient & family • Accessibility allows frequency/ease of contact

7. Model of Interdisciplinary Collaboration Collective ownership of goals • Share responsibility to produce holistic care • Team joined by experience • Patient/family viewed as important part of team • Shared common purpose 7

8. Model of Interdisciplinary Collaboration Reflection on process • Awareness of collaborative processes • Collectively review team processes • Evaluate own process *Least ranked aspect of collaboration 8

9. The Nurse’s Role on the Team • Facilitate problem-solving by finding creative solutions • Advocate for patient and family in care plan discussions • Help family understand and find meaning • Articulate patient/family wishes (Stratford, 2003) 9

10. Team Meetings • Enables communication to produce plan of care for each patient • Allows elements of interdisciplinary collaboration to emerge • Collaborative process involves conflict 10

11. Groupthink • Cohesive group members • Emphasize unanimity • Focus on group cohesion/relations over decision-making • Leads to poor decision-making and lack of collaboration • Obstructs effective group discussion and conflict resolution

12. When Groupthink Occurs • Embrace least effective decisions • Suppressed disagreements • Perceive conflict as more work • Unable to consider: • All aspects of information • Alternative solutions • Fail to understand risk of failure 12

13. Aspects that influence groupthink • Relational Factors • Self-Censorship • Organizational influences • Structural constraints 13

14. Ways to combat Groupthink • Discussions should start by stating the patient’s goal of care • Designate a team member to play devil’s advocate • Rotate leadership of team meeting Adapted from: Wynne Whyman (2005). A question of leadership: What can leaders do to avoid groupthink. Leadership in Action, 25(2), 12.

15. Assessing team experiences • Do discussions include family, other healthcare professionals involved? • Does the team have designated time for sharing frustrations about plans of care (e.g., specific patient/family)? • Does the team address patient safety issues?

16. Nurse Challenges to Team Communication • Role ambiguity between nurse and physician • Inaccurate physician expectations • Lack of consistency in communication from other team members • Role overload, strain