Purpose: A Comment to Discussion 

Thing to Remember:

• Answer this discussion with opinions/ideas creatively and clearly. Supports post using several outside, peer-reviewed sources. 
• 1 References, find resources that are 5 years or less
• No errors with APA format.

 Discussion:

           An effective team is one that can communicate. This comes from an understanding of the general scope of practice for the team member. Often times though, an effective team is one that has worked together previously, and is able to read the other team members subtle cues of intent and frustration; which comes from time spent in the workplace. Mutual trust and respect is another important aspect to an effective team. One study suggests that each workplace conducts a thirty-one-item questionnaire to help discover where faults in teamwork may lie. Seven categories in the Primary Care Team Dynamics are: conditions for team effectiveness, shared understanding, process for accountability, process for communication and information exchange, process for conflict resolution, acting and feeling like a team, and perceived team effectiveness (Song et al, 2015). Using this survey can potentially discover areas of strength and weakness in the workplace in terms of inter-professional collaboration.

           Situations that make the team difficult to work together can be new team members, outside or environmental stressors, or even a situation where emergent teamwork is required, such as a code blue. A failure to collaborate effectively will end up affecting the patients, families, and the clinicians adversely. It will inhibit effective patient care, decrease job satisfaction, and instill a sense of hostility and competitiveness in the workplace (Hamric, Hanson, Tracy, & O’Grady, 2014). A lack of leadership and direction can also serve to fragment teamwork over time. Overlapping scopes of practice can lead to a difference of opinions on what is needed clinically to treat the patient and cause infighting to ensue. This wastes time, resources, and decreases patient outcomes as the healthcare team struggles to come to an agreement on the choice of action. In fighting can also stem from seemingly innocent avenues like patient advocacy. Being a patient advocate can sometimes place the nurse in a position of opposition of family, and the rest of the healthcare team. As nurses, we have a sense of duty to accommodate the patient autonomy in their choice of treatment, even at the expense of the other members of the team. This can create barriers to communication and a breakdown of the team dynamics.

           Teamwork is a difficult accomplishment, especially in the healthcare field. Effective teamwork can be even more difficult, as competing factors come into play, such as patient advocacy, patient autonomy, differing perspectives of disciplines, and personality conflicts. A base understanding and acceptance of each other’s disciplines is vital to the success or failure of the teams. The advanced practice nurse has the unique opportunity to improve patient outcomes using their graduate preparation in medical knowledge, position, clinical experience, and communication abilities. One potential solution is the act of teaming, instead of forming a set team. Teaming is temporary, possibly geographically dispersed groups of people who use innovation to overcome a clinical challenge before moving on to the next challenge with a different group (Ulrich, 2017). Using teaming, the “team” is forced to focus only on the problem at hand. This can eliminate the problem of personality or perspective conflicts in long term teams.

Reference:

Hamric, A. B., Hanson, C. M., Tracy, M. F., & O’Grady, E. T. (2014). Advanced practice nursing: An integrative approach (5^th ed.). St. Louis, MO: Elsevier.

Song, H., Chien, A. T., Fisher, J., Martin, J., Peters, A. S., Hacker, K., Rosenthal, M. B., & Singer, S. J. (2015). Development and validation of the primary care team dynamics survey. Health Services Research, 50(3), 897-921. doi:10.1111/1475-6773.12257

Ulrich, B. (2017). Using Teams to Improve and Performance. Nephrology Nursing Journal, 44(2), 141-152.

Principalism is a system of ethics based on the four moral principles of autonomy, beneficence, nonmaleficence, and justice (Childress, 2001). This is a set of rules that are presumptively binding, and is uses for the balance of ethical challenges in the medical field when faced with such challenges, and to be used when appropriate. The question seems to be how to balance the four and which principle takes precedence over the other principles. Principalism is to be used in context with the doctor or nurses scope of practice to those in which we hold obligations to serve (Meilaender, 2013). Autonomy is respect of person, and free will or agency along with one’s autonomous choices including informed consent, and having permission (Childress, 2001). This is ranked highest because without permission the other principles would have a hard time to follow. Beneficence is the “golden rule” it means to do good, it is taking the good vs. the bad, it is the benefit vs. the risk (Childress, 2001). Nonmaleficence is the negative side of beneficence and is the risk side, and means to do no harm (Childress, 2001). Justice is to act fairly, and is a social distribution of benefits and burdens, and would help to consider how to provide healthcare to those that cannot afford (Childress, 2001). It is extremely hard to rank the principles, because they all seem to help to try to answer the ethical questions that can arise in the medical profession, and with so many different worldviews how do one ask the right question, or apply the correct principle? I feel the remaining three principles hold the same value with again autonomy being the strongest principle, because without permission what do we have to go on. In Christian Biblical narrative, it has been said that Christians should reflect God’s image by following the 10 commandments, and embody the character of Jesus (Grand Canyon University, 2017). In applying a biblical principle when faced with ethical or other dilemmas it will allow one to allow the Holy Spirit to guide you and do good for all in trusted in your care (Grand Canyon University, 2017).

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