Topic 1 DQ 2:Based on your experience, explain how systems thinking helps leaders to build strong interprofessional and organizational relationships. Discuss some system thinking tools nursing leaders can apply to increase interprofessional collaboration to benefit patient outcomes or organizational initiatives. Make sure to incorporate the Interprofessional Education Collaborative (IPEC) competencies in your response
Designing healthcare delivery system change at the advanced nursing practice level will involve a number of leadership attributes. These attributes include an understanding of organizational behavior as well as an appreciation for the utility of various theoretical foundations necessary to support practice and research. According to Sargeant (2009), theories aid understanding and implementation of interprofessional education. Using complexity theory, Sargeant makes the case for future interprofessional collaboration among healthcare delivery system team members. As a leader in healthcare delivery system change and advancement of informatics in nursing practice, the advanced practice nurse can provide much-needed direction for the future of effective healthcare, but will need to evidence the knowledge, skills, and integrative abilities associated with such organizational theories as complexity, chaos, change, and innovation.
Thank you for such a great first week of discussions!
Sargeant, J. (2009). Theories to aid understanding and implementation of interprofessional education. Journal of Continuing Education in the Health Professions, 29(3), 178–184.
Physician shortages, increased demand for highly specialized nurses, a great emphasis on primary health care, and home-based services, and the increased acuity and complexity of hospitalized patients are among the issues motivating decision makers to rethink provision of health-care services. There is also a predicted global deficit of 12.9 million physicians, nurses, and midwives by 2035!
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Consider these factors contributing to international growth in advanced nursing practice:
· Escalating disease burden worldwide: Communicable and noncommunicable disease
· Increased inpatient acuity and complexity of treatment
· Impact of technological innovations and new therapeutic approaches
· Increased emphasis on PHC and community-based services
· Increasing requests for and complexity of home-based care
· General global shortage of health-care workers stimulating consideration of skill mix, task-shifting, and task reallocation options
· Physician shortages
· Increased demand for specialized nurses
· Nursing’s desire for a clinical career ladder and professional advancement
· Better-informed health-care consumers
· Intensified demand for options to address out-of-control health-care costs
· Search to improve quality of and access to health-care services
From this list, which would you consider close to your own personal goals for advancing your degree and developing your skills as an advanced practice nurse?
DeNisco, S. M. (2021). Advanced Practice Nursing: Essential Knowledge for the Profession. (4th ed.). Jones & Bartlett Learning
When looking at the prospective physician and nursing shortages, especially in specialty and high acuity areas, I think a systems approach is the best way to think about this situation. Many systems thinking tools allows for mapping and reflection of changes that have occurred (Wilkinson, et al., 2018). I am curious, “What has happened to all the nurses and physicians?” We can look at this system and try to find, are nurses leaving the profession? Are they simply moving to less acute areas in nursing? Are fewer people considering a career in nursing or medicine all together? The list of questions are endless! When looking toward the future as a nurse educator, I wonder what challenges lie ahead. How can we innovate RN entry education to create more advanced nurses? Can we make changes to the way we educate and view our students to encourage to improve nursing as a whole? Systems thinking in healthcare is still in early stages, but I think we will see a great increase in its need and implementation (Wilkinson, et al., 2018).
Wilkinson, J., Goff, M., Rusoja, E., Hanson, C., & Swanson, R. C. (2018). The application of systems thinking concepts, methods, and tools to global health practices: An analysis of case studies. Journal of Evaluation in Clinical Practice, 24(3), 607–618. https://doi-org.lopes.idm.oclc.org/10.1111/jep.12842
I really like all of the questions that you asked as I think they are all essential to figuring out how we move forward with our health care system. One of the biggest factors that I think needs to be incorporated in nursing and all medical professional education moving forward is self care. It is a term that is talked about often, but I think that employers need to do a better job of promoting and supporting it. I think many employers think that if they promote self care for their employees then people will just call in sick for mental health days all the time. What I’ve been learning recently is that self care is so much more than mental health days. It’s learning to take time to take a walk outside, eat a healthy meal, or listen to a favorite song. There are so many opportunities for employers to promote small acts of self care throughout bedside nursing shifts, in home care, or in long term care settings. I think this gets lost in the always increasing list of tasks that we all need to complete during our work days, but I really think that small moments of self care could have a profound impact on employee satisfaction. Increasing employee satisfaction leads to lower rates of turnover and could help to address the significant physician and nursing shortage that we are currently facing.
Agreed! I think there is a lot of talk and promotion around self-care, but very little useful support. I am noticing a trend toward “resiliency” and training staff to become more resilient, which I feel often shifts the blame onto nurses for being human. In the article sited below, Baker-Armstrong (2020) goes through different factors that play a role in resilience. Self-care, coaching, and having mentors play a positive role in improving resilience (Baker-Armstrong, 2020). It was also interesting to me to note that the author gave particular credit to nursing educators in promoting resilience in the coming generations of nurses (Baker-Armstrong, 2020). Baker-Armstrong states, “Teaching nursing students strategies of reflective learning and reflexive practice enables them to sustain their equilibrium during periods of adversity” (2020, p. 31). This is a great new perspective for me as I continue to prepare for nursing education. I also think we can and should be doing this as bedside nurses, and I have often listened to newer nurses tell me about situations that upset them. Afterward, we go over what could have been done differently or sometimes just being able to say, “That sucks!!!” and allowing them to vent is highly valuable.
Baker-Armstrong, J. (2020). Building nurses’ resilience. Kai Tiaki Nursing New Zealand, 26(3), 31–33. https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=142720743&site=ehost-live&scope=site
Dr. Buchanan, two things that I believe directly affect me are two that go hand in hand. I am currently employed at a skilled nursing facility, daily we admission coming in with comorbidities, but they cannot be admitted until we know their COVID 19 status. Are they COVID positive or negative, have they had their boosters, what level of precautions will they be on upon arrival and on isolation for how long. All the questions have to be attended to before we can even take care of their general state of health / reason for admission. The worldwide pandemic is still “in your face” nearly 3 years after we first experienced the horror of COVID 19. Once those issues are covered, we can then focus on a nursing care plan to promote healing or slow worsening of their actual diagnosis. I say diagnosis, but truthfully, these days it is never as simple as that. Comorbidities exist in nearly 100% of patients, even the ones just being admitted short term for therapy. There is truly an increase in acuity and complexity of treatments. A patient with a broken hip being admitted status post hip arthroplasty also has diabetes and congestive heart failure with orders for oxygen. It can be overwhelming. My goal is to work hard to implement a system to lessen the strain on the direct care nurse. Ultimately what I’d like to see is a change in the standard requirement of patient load. All too often our nurses burn out and this is a tragedy.
LaChrisa, you bring up a good point regarding the fact that an increasing number of patients who access our current healthcare system have an increasing number of comorbidities. Shi and Singh (2021) state that each chronic condition a patient has increases the cost of their medical care by a factor of three. This identifies a key area where intervention could lead to significant cost savings. In the area where I live a new program was started called “Hospital at Home” that helps to free up acute in patient beds by transferring patients home who are stable but still need frequent medical care. These patients almost always have multiple comorbidities and need more medical care than just being at home alone, but don’t necessarily need 24/7 nursing care. These patients get a physician visit daily and a nursing visit twice daily in their home. This program cuts down on the medical costs associated with in patient hospital stays, and seems to have the potential to help to manage patients with comorbidities more efficiently. This program typically acts as a bridge from acute in patient stays to either home care or hospice care. I think that more of these types of programs are needed to address the needs of both patients with multiple chronic comorbidities and patients who need acute in patient care.
Based on your experience, explain how systems thinking helps leaders to build strong interprofessional and organizational relationships. Discuss some system thinking tools nursing leaders can apply to increase interprofessional collaboration to benefit patient outcomes or organizational initiatives. Make sure to incorporate the Interprofessional Education Collaborative (IPEC) competencies in your response.
System thinking considers the entire system not just the individual. Each organization has a mission and vision, and to be successful everyone within the organization should be focused on achieving the same vision. System thinking begins with self-awareness and clinical reasoning focusing on the goal of patient safety and the good of the organization (Statler & Mota, 2018). As a leader it is imperative to increase awareness of safety, evidence-based practice, and patient-centered care. Utilizing closed-loop communication, building a resolute team, and promoting an interdisciplinary patient-centered care is vital to be a successful leader (Statler & Mota, 2018). By increasing collaboration of the entire system, the leader will benefit positive patient outcomes and the organization’s mission and initiatives.
The idea of system thinking was built upon the Interprofessional Education Collaborative (IPEC) four core competencies. These four competencies focus is on maintaining a climate of respect and values, utilizing the knowledge of the individual’s role to address the need of the patient, effectively communicating with everyone involved, and applying effective team dynamics and values to perform effectively for the overall good of patient and community (Interprofessional Education Collaborative, 2016). As a leader it is imperative that mutual respect and shared values are established to create a positive team environment. It takes the entire interdisciplinary team to provide safe care and create positive patient outcomes. Everyone must know their role, but when respect is present individuals of the team can bring personal insight that could positively affect the care and treatment of the patient or community. Open communication and mutual respect are imperative in the system thinking approach to healthcare. When the organizations vision and mission coincide with their employees’ goals and aspirations positive outcomes for the patients will occur.
Interprofessional Education Collaborative. (2016). Core competencies for interprofessional collaborative practice: 2016 update. https://www.ipecollaborative.org/ipec-core-competencies
Stalter, A., & Mota, A. (2018). Using systems thinking to envision quality and safety in healthcare. Nursing Management, 49(2), 32-39. https://doi.org/10.1097/01.NUMA.0000529925.66375.d0
Healthcare delivery is extensive and involves more activities besides regular patient-provider engagement. Due to its complex nature, health practitioners must understand how different systems are interconnected and how they can work together to optimize patient outcomes. Systems thinking is centered on the tenet that health care professionals are a part of a large system whose components must work together to achieve a shared goal.
Systems thinking helps leaders build strong interprofessional and organizational relationships in health practice by promoting interdependence between teams. As McNab et al. (2021) noted, adopting systems thinking implies exploring the characteristics of a system’s components and interconnecting them to improve understanding, interactions, and outcomes. From a leadership perspective, a systems approach is characterized by examining the strengths of complex systems and coupling the components that can work together to provide the best care possible. In exploring how systems work, Henry (2019) suggested that healthcare professionals must understand that they are part of complex, adaptive systems comprised of independent parts. However, these parts should work together efficiently for the entire system to work effectively. Leaders who understand the relationships between complex systems establish solid connections and support them to thrive, improving patient outcomes and achieving other crucial objectives.
Nursing leaders can use different system thinking tools to increase interprofessional collaboration. When thinking of interprofessional collaboration, nurse leaders should seek to improve four Interprofessional Education Collaborative competencies for collaborative practice: interprofessional communication, teams and teamwork, roles and responsibilities, and values and ethics for interprofessional practice (Brashers et al., 2019). Tools that are relevant to nursing practice include concept maps and tree diagrams. While concept mapping helps leaders improve teams’ critical thinking, tree diagrams demonstrate possible outcomes when various system components work together. Another valuable tool is the spider diagram, which can be used to visualize ideas and outcomes when organizing teams and predicting outcomes.
Brashers, V., Haizlip, J., & Owen, J. A. (2019). The ASPIRE Model: Grounding the IPEC core competencies for interprofessional collaborative practice within a foundational framework. Journal of Interprofessional Care, 34(1):128-132. https://doi.org/10.1080/13561820.2019.1624513
Henry, T. A. (2019). Why you need to be a systems thinker in health care. American Medical Association. https://www.ama-assn.org/education/accelerating-change-medical-education/why-you-need-be-systems-thinker-health-care
McNab, D., McKay, J., Shorrock, S., Luty, S., & Bowie, P. (2020). Development and application of ‘systems thinking’ principles for quality improvement. BMJ Open Quality, 9(1), e000714. https://doi.org/10.1136/bmjoq-2019-000714
I agree with you that system thinking goes beyond individual assessment. The whole system is considered in system thinking. Therefore, system thinking focuses on organizational goals, vision, and mission. Successful organizations stick to their organizational goals. As a result, system thinking provide elaborate information that helps in decision-making process (Martín et al., 2020). System thinking begins with self-awareness and clinical reasoning focusing on the goal of patient safety and the good of the organization. Self-awareness enables people to be inform about the strengths and weaknesses before turning their attention to other players (Kutty et al., 2020). Successful self-awareness routine expose healthcare professionals to the reality about themselves. The information may reveal the reasons for individual performance and what to integrate to boast individual and organizational performances. The idea of system thinking was built upon the Interprofessional Education Collaborative (IPEC) four core competencies. The four core competencies are assumed to be integral in determining performance levels. In healthcare settings, people are reminded to know their positions and obligations. System thinking allows healthcare professionals to stick to their mandates.
Kutty, A. A., Abdella, G. M., Kucukvar, M., Onat, N. C., & Bulu, M. (2020). A system thinking approach for harmonizing smart and sustainable city initiatives with United Nations sustainable development goals. Sustainable Development, 28(5), 1347-1365. https://doi.org/10.1002/sd.2088
Martín, E. G., Giordano, R., Pagano, A., van der Keur, P., & Costa, M. M. (2020). Using a system thinking approach to assess the contribution of nature based solutions to sustainable development goals. Science of the Total Environment, 738, 139693. https://doi.org/10.1016/j.scitotenv.2020.139693
Systems thinking is the process by which the nurse has self-awareness and the knowledge of the confines specific to reliance on authority, clinical reasoning, personal effort, and cognizance of interdependencies (Stalter & Mota, 2018). Given today’s nursing is more complex than years ago, nurses realize that patient care involves the collaboration of interdisciplinary teams to meet the needs of patients. This often demands more than a single specialty working towards positive health outcomes for the patients (Bridges et al., 2011).
The field of nursing in the prison system offers the ability to collaborate with other interdisciplinary healthcare professionals as all medical, dental, mental health, and optometry exist inside the prison. Juvenile patients which serve their sentence are automatically qualified for encompassing healthcare through the state of Kansas. Many of these patients arrive with complex healthcare needs which require a collaborative effort between all four disciplines to meet their needs. The interprofessional perspective provides participation between different experts to achieve restoration and maintenance of patient health and improvement of those outcomes while merging resources (Bridges et al., 2011). For example, as the intake nurse, it is my job to disperse the patient’s needs based on the initial assessment. Information is shared amongst the other interdisciplinary team members and the patient needs are accommodated. For instance, during this admission assessment, the patients mental health needs may become the area of focus, and this information is passed on to the psychiatrist and psychologist onsite. The sharing of knowledge allows for collaborative practice including accountability, coordination, assertiveness, autonomy for the patient, communication between the team, and responsibility to improve patient care (Bridges et al., 2011).
Interprofessional Educational Collaborative Competencies (IECC) seek to guide this interprofessional collaborative practice among healthcare professionals (IEC, 2016). The four domains of competency include values/ethics for interprofessional practice, roles/responsibilities, interprofessional communication, teams/teamwork. Throughout my experience as an intake nurse at a juvenile detention center, I have witnessed first-hand the positive outcomes of interprofessional collaborative practice with professionals from various backgrounds to promote and deliver high-quality care for this population. Qualities such as open communication, equal distribution of resources, and recognizing and appreciating each member’s role are vital in providing higher quality care in the prison system (Bridges et al., 2011). As the interdisciplinary professionals engage in working together for the juvenile patient’s respect and shared values are cultivated. Throughout the intake admission, medical expertise and skills are used however, the patient is also assessed for further care needed from mental health, optometry, or dental. Communicating with the other interdisciplinary members in a timely and responsible manner helps to provide efficient and effective care. Follow-up care is required for our patients which entails additional collaboration with team members to verify if the needs of the patient have been met and what further care provision is required (IEC, 2016).
Bridges, D., Davidson, R., Odegard, P., Maki, I., & Tomkowiak, J. (2011, April 8). Interprofessional collaboration: Three best practice models of interprofessional education. Med educ online. Retrieved October 1, 2022, from doi:10.3402/meo.v16i0.6035. PMID: 21519399;PMCID: PMC3081249.
Stalter, A., Mota, A., & . (2018). Using systems thinking to envision quality and safety in healthcare. Nursing Management, 49(2), 32–39. Retrieved October 1, 2022, from https://doi.org/doi:10.1097/01.NUMA.0000529925.66375.d0
Interprofessional Education Collaborative. (2016). Core competencies for interprofessional collaborative practice: 2016 update. https://www.ipecollaborative.org/ipec-core-competencies
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