Promotion of Teamwork in Nursing Clinical Situation

In traditional settings, nurses have been socialized into a profession in which the values of caring, compassion, obedience, and discipline were considered essential. Subservience to physicians and a strict nursing hierarchy were the norm. Today's professional nurse functions in a setting which is in many ways vastly different from that of her or his predecessors. The importance of knowledge and education is coupled with clinical competence and accountability. The modern nurse works in a complex health care system, with advancing technology that influences most aspects of client care. The nurse is subject to the fairly rapid changes taking place in health care and in the wider society. Many of the decisions and dilemmas faced by nurses today never needed to be considered by nurses in the past.

One of the most obvious organizational ailments caused by imbalances can be seen in the battles being fought among its members. Too many leaders, managers and organizational members spend an inordinate amount of time defending territory by arguing that their way is the best way (Adair, 1986). The concept of teamwork is the presence of people working together as a team towards the achievement of a common goal. It serves as a bridge to complement the gap among members of the working environment. In the daily undertaking of nursing, the role of teamwork is very important. All tasks are done in collaborative effort, hence, leadership and teamwork matters most. In particular, critical leadership in nursing management is vital to accomplish success. Nurses exhibit effective leadership to ensure maximum performance in relation to all the duties at hand. The promotion of group effort or teamwork is the key mechanism to create a more effective, successful and better service in clinical situations.

This paper presents the discussion of promotion of teamwork in nursing clinical situations. It will also provide literature accounts of the concept of leadership and teamwork, its importance, its promotion as well as its application in a clinical practice situation. Further, it also delves on how the concepts are applied among all the participants of the healthcare situation. The article likewise gives light on the perceived leadership and teamwork characteristics and indicators in the field and practice of nursing.

LITERATURE REVIEW

Nurses play important roles in implementing primary health care and the goal of "health for all by the year 2000" and beyond (WHO, 1983, p. 1). This has been emphasized in a diverse collection of nursing literatures from around the world and by the International Council of Nursing (Clarke, Beddome, & Whyte, 1993; Little, 1992; WHO, 1978). Several nurse writers have emphasized that nurses must possess leadership skills for empowerment of nurses in order to make a difference in the delivery of health care (Josten, 1989; Salmon, 1989; Shaw, 1989).

Meanwhile, teamwork is thematically defined as working together as team towards the achievement of a common goal. In reference to the wide scope of nursing studies conducted, there has been a limited attention given to the aspect of team promotion in nursing. Evidently, the concept of leadership and management is always the main focus of previous and present researches. Teamwork and its promotion are often associated with this concept as one of the responsibilities of the leader/manager. Hence, the latter accounts of literature are not direct studies in connection to teamwork instead it discusses leadership as the main idea that links teamwork as subordinate and supporting thought and by-product.

Leadership and Teamwork: its Idea, Relationship, and Approaches

Leadership is an important aspect of any organization. For decades, the issue on leadership has been undertaken in various studies and related discussion. In fact, the study on leadership dates back in 1921 (Hughes, Ginnett & Curphy, 1999). Drucker (1995) sees leaders as the basic resource for an organization as well as the key factor for a healthy growing economy and supply, which is critical to the survival and further development of any organizations. According to Gill, et al. (1998), the development of leadership theory has paralleled the development of organizational theory. Among the many definition of leadership, the most relevant definitions were given by Yukl (2002) and Schein (1992). Yukl (2002) defined leadership as the process of inspiring other people to comprehend and agree on what needs to be done and how to accomplish them effectively. In addition, leadership is also defined as the process of facilitating collective and individual efforts to fulfill shared objectives. Alternatively, Schein (1992) stated the creation of culture is the main essence of leadership and that both culture and leadership are two sides of a single coin. Relating leadership to nursing management, Schein believed that leaders tend to establish and change culture, while administrators, nurses, and patients live within the culture. While both related definitions differ from one another, both speak of the essential role leaders have to play in corporate culture especially in nursing perspective.

Furthermore, DeVito (1999) identify three major leadership styles: laissez-faire, democratic, and authoritarian leadership. Osborn and Motley (1999) have three groups similar to Devito's styles of leadership. It was been explained that free-rein (laissez-faire) leaders allow the group the freedom to decide what to do, how to do it, and when to do it; participative (democratic) leaders seek participation of the group in making decisions for the group; and autocratic (authoritarian) leaders make decisions without the assistance or approval of the group. Meanwhile, potential barriers to a successful leadership and collaboration in patient care are conflict, professional autonomy, and the fear of making mistakes. Conflicts, on team, others and even self, can cause failure to the practice.

Recent research in leadership has focused on developing leadership competencies. Tichy and Cohen (1997) have taken the competencies discussion one step further arguing that all leaders must be able to not only demonstrate the competencies, but teach them to others in their organization as well. The idea of teamwork and its promotion is vital in coping up with some cases of emergencies occurring in high risk and vulnerable population samples (Hutchison & Quartaro, 1993). Hence, training nurses to lead and to follow should be standardized.

Specifically, the importance of successful collaboration in nursing practice is well documented in the study conducted by Reese and Sontag (2001).The role of leadership and teamwork is also proven in the study conducted by Lanza (1997) especially to the field of psychiatric nursing. In a study conducted in Uganda, leadership and teamwork promotion is important (Anvango et al. 1997). After the study and in reference to the findings, the researchers recommended a need to further develop the leadership and management skills of all the members of the healthcare community. Today, evidences of the growing support for greater interdisciplinary collaboration and teamwork has been articulated by several national organizations and commissions (Clark & Drinka, 2000). On an earlier study conducted by Drinka and Ray (1992) that reviewed the extent of using team in geriatrics, it resulted to a cross-sectional review of the geriatrics literature for any articles that related to health care teams. The promotion of teamwork aims for continuous improvement through inclusive cooperation and involvement of frontline workers, systematic analysis of problems and data collection, and subsequent modification of hospital structures and processes. This is also evident in the research conducted by Lebrasseur (2002) and colleagues in terms of implementation of transactional leadership and continuous quality improvement in hospitals in Canada. In some studies, alternative structures in leadership such as program management (Morris, et al., 1994) and patient-focused care (Mang, 1995) are more client-centered and teamwork oriented.

The Concept of Team and Teamwork

The conception of developing global competencies in nursing management was been widely understood by developing one factor that really considered in the success of many organizations – leadership and teamwork. Trevor Clay, in his speech on a management symposium in 1992 claimed that the values which underpin nursing are those of “partnership, teamwork and collaboration’ (Nursing Standard News, 1992). Many nursing leaders today, when asked, argue that the single most pressing issue facing practicing nurses is their need to be able to articulate their activities and provide evidence of their effectiveness (Traynor, 1999). Since teamwork is directed for improvement, health care teams (consists of nurses, doctors, physicians, social workers, etc.) should be “multidisciplinary, interdisciplinary, cross-disciplinary, polydisciplinary, pandisciplinary, transdisciplinary, and virtual” (Cleverly, 2003). Thus, appropriately differentiated models for collaboration in interdisciplinary and intradisciplinary groups should be employed to promote teamwork (Feletti, 1993).

Basically, the concept of teamwork relies on the ability of every team player to communicate with all the members of the clinical situation. The role of communication is very significant in promotion of teamwork. For instance, if nursing practitioners are not sure who is on the team and they are a member of the team, it is difficult to know what, how, when, or with whom to communicate. Thus, the identification of position and maintaining a level of hierarchy is also necessary.

The benefits of teamwork are hard to measure. Additionally, the intuitive application of teamwork produces positive contributions to organizational performance. According to Firth-Cozens (1998, 2001), the perceived advantages of teamwork to the organization are the following:

- improvement in the financial outcomes;

- reduction of employee turnover and absenteeism;

- enhancement in the quality of care;

- diminution of conflict; and

- optimal patient outcomes.

Furthermore, teamwork is also attributed to the positive effects upon the psychological health and well-being of organizations member (Carter & West, 1999). Decrease amount on the level of stress and increase on effectiveness, productivity and innovation in the primary health care and community mental health practices are also associated in the quality of teamwork (Borrill et al., 2002).

Understanding of the importance of the concepts will be limited to the group in focus. When team forms, a “team mind” also forms through the sharing of information and pooling of knowledge (Stokes & Kite, 1997). Thus, when the focus is on only one subgroup of the team the team will not truly form, and there will be no “team experience,” with all members participating in problem solving, decision making, and conflict resolution. Nurses must ensure that the organizational commitment to effective teamwork is consistent, strong and visible. Meanwhile, nurses and social workers work in similar fields (Coopman, 2001). Hence, the promotion of teamwork and leadership as professional care providers is seemingly interconnected (Raymer & Reese, 2004: Bronstein, 2002). By implementing promotion of teamwork among participants of the nursing practice as well as to the related fields, the organization is capable in undergoing important changes in this contemporary and competitive environment especially to clinical situations that requires expertise (Anson, 2000).

APPLICATION

Nursing is the process of caring for, or nurturing, for an individual known as the “patient”. More specifically, nursing refers to the functions and duties carried out by persons who have had formal education and training in the art and science of nursing. To promote the restoration and maintenance of health in their clients, nurses become more particular in enhancing their knowledge through integrating with health and biological sciences (Gubrium, 1993).

As an applied discipline, the vocation of nursing evolves within a dynamic body of knowledge. The quality of nursing practice is dependent on the knowledge of individual practitioners as well as their willingness to engage in professional relationships and behaviors. Nurses are required to have the skills and know-how to explore, confirm, and direct the progress of nursing practice. Within this model, five value concepts uphold professional development, the knowledge base, which is the foundation knowledge base upon which clinical practice decisions are made, continuing education which comprise of the continuing learning activities that are crafted to benefit the individual and the profession, mentoring and networking which are the professional relationships that are instituted with the intent of supportive growth for the individual as well as the profession, research which is the qualitative and/or quantitative investigation of the factors which affects the professional nursing practice, and lastly career development which are purposeful, planned strategies that are designed to boost short and long term professional goals.

The Clinical Situation

The most common situations needing teamwork in collaborative nursing care are life-and-death conditions. It could be emergencies such as accidents, disasters, outbreaks, and highly detrimental and life-threatening attacks. Almost everyday, clinical cases in the health care environment requires constant amount of attention. It is always a standard operating procedure (SOP) to attend to the needs of every patient who needs treatment. Hypothetically, a clinical situation in which teamwork is considered to be evident is an emergency treatment of casualties of a vehicular accident. Taking this situation in consideration is the foundational reference of the following discussion. However, this case is possible to happen in relation to nursing and health care.

Synthesis

Considering the aforementioned hypothetical clinical situation, the concept of teamwork is palpable. The collaborative practice occurred as early within the admission of the patient in the hospital. With the assistance of the nurse or any healthcare provider to the physician or surgeon, collaborative practice was present. As the patient continues to be inside the premises of the hospital, there are several assistances offered by every healthcare practitioner attending to him/her. Team promotion in this situation is characterized by the immediate application of treatment, cooperation and collaboration in attending to patients, unified achievement of goals, and continuous commitment for service. Basically, teamwork was manifested when nurses work with the doctors (and/or physicians, and co-nurses) in applying treatment to the victims of the accident. It is also present among the nurses themselves. Extending help to one another in attending to patients’ needs is a clear picture of teamwork. The pursuit of immediate relief and medication to all the casualties is the main objective of the whole team.

The leader/manager (it could be the doctor, physician, or chief nurse) delegate tasks and the subordinates follow the chain of command. The leader/manager must define the most urgent and appropriate healthcare application for the patients. He/she emphasizes the importance and sense of urgency to this particular emergency situation. Further, he/she also reiterates the vital role of collaboration and group effort. In relation to the above concepts of teamwork, its application to this instance is fundamental. The presence of teamwork among the members of the health care service is the key on effective realization of goals. The leader/manager must see to it that the collaborative effort among the group is successful and effective.

The nurse and/or healthcare practitioner regardless of their number played a significant role in the collaborative practice. As stated above, from admission of the patient up to the operation was finished and even up to the discharge of the patient’s dead body, everyone was engage in the practice. The individual healthcare professional’s ability to do what is proposed with proper competence and skills is crucial in ensuring safe clinical care. But professional competence is only a part of the picture. Good people, with good skills and good intentions, sometimes make mistakes. As part of this professional issue, to be a nurse is to observe a dynamic process of caring based on a theoretical body of knowledge. The role of a nurse as a vital member of the healthcare team through collaborative professional practice must always give priority through caring its patient. The primary goal of being a nurse is to assist individuals in the achievement of an optimal level of wellness. The focus of nursing practice is on individual’s specific needs based on their healthcare choices related to physiological, psychological, socio-cultural, developmental and spiritual dimensions of individual lifestyles. Therefore, a good nursing practice in relation to teamwork is one that involves the overall workforce that consist the patient’s welfare and care.

RECOMMENDATIONS

It is important for professional nurses to recognize what professional values they hold, and how these values influence their practice. The values of the profession are reflected in codes of ethics, (which are broad based and demonstrate to the community the values held by the profession), and codes of practice (which are more specific in their relation to nursing practice and the professional nurse). Primarily, the development of the leadership skill among nurses is the first step in promoting teamwork. Clay (1992) and Haynor (1996) noted that leadership is a skill that must be emphasized if nurses are to truly make a difference in health care in the future.

In clinical situations, the nurse need to be proficient in social dynamics to be able to foster teamwork and cooperation (Cleverly, 2003). By possessing such characteristics, the group can enjoy the synergic benefits that come from active collaboration and be equally adept at defusing any conflict that might arise as a consequence of the close association of diverse, perhaps antagonistic, personalities. The characteristics of a powerful leader are charismatic, ability to take reasoned actions, sense of self and strong self-concept (Lanza, 1997).

Leadership and teamwork is the secret to success in clinical situations. It is not just some individual’s or professional’s business but it is everyone’s business. They are also about building personal relationships. It is unquestionable to say that to have good leadership and teamwork is a challenge and most people are having hard time achieving this. It is important that the leader or the management must know what style of leadership to be used in order to make the flow of the organization towards the goal or the objective set by the organization utilizing the authoritative style of leadership.

Nowadays, nurses are facing a very real challenge in terms of the development of future leaders for the nursing profession. The nursing field has too few people who possess the passion, critical-thinking, communication, and leadership. People’s skills that are required to enable this profession to triumphantly carry out the increasingly challenging agenda before us are scarce. Nursing students may very well be one of those people whom the public will soon be counting on to provide leadership and teamwork for such job and promise. Big health institutions in particular require nurses with humanistic characteristics to become leaders so as to deal accordingly with the tasks assigned and the demand of the job as well. As to better communication with the people who are involve and partake in the undertakings of the team, nurse leaders who imbibe with characters such as competence, good character, composure and care can ensure that the responsibilities of the institution are taken care of. In the nursing profession, the humanistic approach of leadership will work well since the common aim of the practice to provide care and good well-being to people.

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