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Teamwork means trusting others to do things you can't
always do yourself, Way said. For instance, she said,
nurses in the department often are torn between helping
distressed family members and attending their patients
at the bedside. When the chaplains come in, Way said,
she sometimes worries that they feel awkward about getting
in the way of the medical care. But nurses trust and
rely upon them to take care of family members while
nurses attend to the patients, she said.
The interdisciplinary team approach may not work as
well in some outpatient settings, where patients are
transient, billing may be confusing or clinics may not
have the resources to include specialties like social
workers or mental health specialists on their staffs.
In these areas, say some health educators, a parallel
approach may work better, with physicians or nurse practitioners
referring to or calling in other specialties as they
need them.
Carolyn Nowosielska, MSW, RN, a student in the family
nurse practitioner program at Washington State University
in Vancouver, said she loved working with students from
other disciplines as part of a project she did for the
Oregon Burdick Interdisciplinary Team Training (ORBITT)
program, out of the Oregon Health & Science University.
She and fellow team members-a pharmacy student, a public
health student and a nurse-midwife student-created a
group-visit program for patients with chronic illness
at a rural Oregon clinic.
But although she came to appreciate the expertise of
people in other health fields and calls on them regularly
in her job at a county health clinic, she doesn't think
her clinic would have the resources to hire a team of
health workers who would regularly meet and discuss
patient care.
Kay Roberts, Ed.D., FNP, FAAN, professor at the school
of nursing at the University of Louisville in Kentucky
and project director of the Harambee Nursing Center,
reported similar results from a study of interdisciplinary
teams of nurse practitioner students, social work students
and medical residents who worked with low-income patients
with chronic illness in outpatient clinics.
The students enjoyed working together and learned a
lot about each other's disciplines.
Many were sad when the project ended. Some residents
said they wanted to hire the nurse practitioner students
after they graduated, Roberts said. But the entire team
saw few patients more than once. Most didn't return
to the clinic for follow-up visits, and those who did
were not able to return at a time when the entire team
could meet with them together.
"If you don't have a patient, you don't have a
team," Roberts said. Roberts has had great success
with interdisciplinary teamwork with geriatric patients
in nursing homes.
"I learned a lot about trying to do interdisciplinary
practice in a primary care setting. You have to have
the consistency of interaction," she said.
One of the most important aspects of teamwork is learning
to communicate not just opinions and ideas, but the
reasoning behind the thinking, Darby said. It is also
important to learn at least some of the language of
each other's fields, he said.
Concerned about patients who reported nausea after
joint replacement surgery, Stubbs decided to persuade
the anesthesiologists to become part of the joint replacement
center team. She gathered data on the nausea complaints
and presented them to the anesthesiology department.
She also gained the support of the center's medical
director on the need to address the problem. The anesthesiology
department was surprised by the numbers and impressed
by the support of the medical director.
"They said, 'We want to help,' " Stubbs said.
They made changes in medications and now call every
week to see how patients are doing and to find out when
the next team meeting will be, she said.
When team members disagree, they should keep conflicts
from becoming personal, Darby said, or using passive-aggressive
behavior if they feel they have been slighted. He recalled
how when he was a night shift nurse and he felt a physician
had treated him badly, he made sure to find a reason
to call the culprit at 3 a.m. That, he said, is not
the way to solve problems.
At the same time, he said, nurses should not back down
from giving clear, strong opinions on patient care.
"A nursing judgment is a valid judgment, based
on a valid knowledge base," he said.
Teamwork does not mean giving up autonomy, say those
who have worked with interdisciplinary teams. Karen
Newton, MPH, the director of the Louisville study, said
students who seemed to feel the most confident in their
own disciplines contributed the most to their teams.
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