FINAL-The CNL and Family Involvement in Intrdisciplinary Rounds-BROWN

Running Head: FAMILY INVOLVEMENT IN INTERDISCIPLINARY ROUNDS The CNL and Family Involvement in Interdisciplinary Rounds Bronson Brown University of Maryland School of Nursing507 Abstract Family engagement in interdisciplinary rounds has been highly recommended to improve communication and patient care but is not often used in most hospital settings (Strathdee, Hellyar, Montesa & Davidson, 2019). This paper will evaluate the importance of family involvement in an adult Critical Care Unit at an acute Tertiary Care Hospital, which focuses on adult patients with acute disease processes. These disease processes include but are not limited to illnesses such as hypertension, stroke, knee and hip replacement and newly diagnosed diabetic patients being evaluated during interdisciplinary bedside rounds. This is a present problem in that, many healthcare professionals will not involve family members in interdisciplinary bedside rounds (Strathdee et al.,2019). By allowing family involvement during interdisciplinary rounds, outcomes may reveal reduced stays in the ICU and increased patient satisfaction. This will assist in outlining the Clinical Nursing Leaders (CNL’s) ability to participate in the identification and collection of care outcomes, along with the development and leveraging of human, environmental, and material resources (Wienand et al., 2015). Keywords: Interdisciplinary rounds, Clinical Nursing Leaders, Family engagement Discussion In a Medical/Surgical Intensive Care Unit (MSICU) there are patients with many different problems such as but not limited to hypertension, stroke, and hyperglycemia. Patients in MSICU are not often able to speak for themselves or express their concerns. In most MSICU’s, there are interdisciplinary rounds. Interdisciplinary rounding has been identified as a way to improve patient care by promoting health care provider communication which will lead to greater shared knowledge of a patient’s status, smoother patient care flow, decreased length of stay, and enhanced patient and staff satisfaction (Reimer & Herbener, 2014). In addition, a multidisciplinary approach acknowledges the complexities of modern critical care and the important role of communication between health care providers in delivering comprehensive care. The multidisciplinary approach model is endorsed by the American Association of Critical-Care Nurses and has proven to be most effective. In an MSICU setting, the interprofessional team may be composed of physicians, advanced practice providers, bedside nurses, case managers, respiratory, physical and occupational therapists, pharmacists, and chaplains. Each member of the team offers a unique background of information, training, and technical skill which can improve patient care and ICU outcomes (Sharma, Hashmi & Friede, 2019).One of the core members of this team is the Clinical Nurse Leader (CNL). The Clinical Nurse Leader is a relatively new nursing role, introduced in 2003 through the American Association of Colleges of Nursing (AACN) (Bender, 2014). The CNL is a critical member of the interprofessional team who helps guide patients through today’s complex healthcare system and acts as a resource for solving complex nursing-related problems (Bender, 2017). The CNL leads interdisciplinary rounds for all admitted patients daily and is responsible for reviewing the patient plan of care established by the team through any previous interdisciplinary rounding meetings (Wienand et al., 2015). Although this approach has worked for many years, it has not always involved family members or more importantly asked for family input in the care of their loved ones. In fact, many family members have been left with the assumption that they do not have enough knowledge about the healthcare field to participate. However, with the evolution of the internet and more health information being able, many family members are becoming more educated and have a desire to participate (Burns, Misak, Herridge, Meade, & Oczkowski, 2018). Therefore, it would be in CNL’s best interest to not only work with those in the interprofessional team, but with family members as well in order to present a substantial and wholistic care plan for the patient. Design and Implementation of Evidence Based PracticeOne of the major core competencies of a CNL is the design and implementation of evidence-based practice(s). In fact, the need for meaningful patient and family engagement in health care and research is gaining momentum (Berger, Flickinger, Pfoh, Martinez & Dy, 2014). Healthcare institutions and research funding agencies increasingly encourage clinicians and researchers to work actively with patients and their families to advance clinical care and research. Engagement is increasingly mandated by healthcare organizations and is becoming a prerequisite for research funding. (Burns et al.,2018). During a study at a twelve-bed Medical-Surgical ICU at an acute Tertiary Care Hospital, there was a measure to improve adherence to standard quality. This was performed by using what is called the ABCDEF Bundle that represents an evidence-based guide for clinicians to approach the organizational changes needed for optimizing ICU patient recovery and outcomes. The standard quality approach to rounds was made to emphasize the F(Family) element of the ABCDEF Bundle. (Marra, Ely, Pandharipande & Patel, 2017). The study was nurse-lead and demonstrated that families who are present when planning patient care, understand the treatment their loved ones are receiving and want to assist in order to ensure positive patient outcomes (Strathdee, et al., 2019).Lateral Integration of CareAnother core competency of the CNL is the lateral integration of care within the healthcare setting. The CNL utilizes lateral integration of care, which means he/she works with the nursing staff, physicians and other ancillary departments to ensure efficient and effective patient care, which has been demonstrated to improve patient care and outcomes (Joseph & Huber, 2015). This is because there are several different groups that are involved in patient care including case managers or the CNL. Lateral integration of client-centered care focuses on collaboration with other health care disciplines. Establishing partnerships between education and practice is a vital element to successful preparation and the implementation of healthcare success (Moore, Schmidt & Howington, 2014). This can benefit family’s members greatly as they have access to more resources and can get different points of view of one’s care in addition to being able to properly discuss plans of care. Resource StewardshipResource stewardship is another CNL core competency. This refers to the careful and responsible management of resources under one’s control (Hall, 2018). In fact, resource stewardship is an efficient use of human environmental and material resources as it often uses people such as families or non-license providers to fill in gaps in patient care where license providers cannot. The role of the CNLs is to implement this non-licensure resource by allowing families to be more involved with patient care. Additionally, healthcare that involves patients and their families has been recommended to improve patient safety and quality (Berger et al., 2014). Research demonstrates that family support also helps patients overcome feelings of vulnerability in hospitalized settings. (Lolaty, Bagheri-Nesami, Shorofi, Golzarodi & Charati, 2014). By allowing families to become involved in resource stewardship, the length of stay could possibly be reduced as family members become more involved in the patient outcomes and care. At present, there is not substantial evidence to show how much money a healthcare organization would save by utilizing these resources. A CNL could establish guidelines to document this type of data involving cost savings by utilizing resource stewardship and demonstrating the financial outcomes that are yielded from implementation.Patient AdvocacyPatient advocacy is another major CNL core competency involving patients and the health professional team. Nurses are trusted and respected by patients and the health care industry as evidenced by the 2018 Gallup survey on honesty and ethics as the profession with the highest ethical standards (Demarinis, 2019). This is one of the many reasons why people trust CNLs to be an advocate for patient care. CNL advocates ensure that patients’ autonomy and self-determination are respected. Serving as the link between patients and the healthcare system, they also contribute to the patient/family decision-making process and speak up when problems go unnoticed or when the patient or family can’t or won’t address them (Gerber, 2018). Advocacy is not just limited to the bedside. In fact, the American Nurses Association encouraged nurses to become more involved in the fight to change healthcare for the better. CNL’s can also advocate for the communities that they are involved in. Socially and economically disadvantaged populations, or colloquially the ‘have-nots’ in society, are the most affected by public policy and can therefore benefit the most from policies that aim to improve social conditions that impact health (Williams, Phillips & Koyama, 2018). Socially and economically disadvantaged groups are less likely to be in good health, less likely to have access to quality healthcare services, and more likely to die prematurely when compared with socially and economically advantaged (Williams, et al.,2018). Therefore, CNL’s have a duty to advocate for their patients and families who might not be able to take care of themselves outside of the hospital. Conclusions and Future Insight CNL’s have an important role in helping to bring together families and healthcare professionals in order to bring about better patient care outcomes. Family engagement in interdisciplinary rounds can provide unique insight into a patient’s response to treatment and can also suggest treatment plans which may bring about positive patient outcomes. These outcomes can provide real-time communication among nurses, families and physicians as treatment plans are often constructed during interdisciplinary rounds. (Strathdee, et al.,2019). Finally, patients in acute care settings and most particularly in ICU’s are in a vulnerable state. Having family members participate in planning care which is efficient, effective and involves all members of the interdisciplinary team may produce positive patient outcomes and ultimately a healthier patient which in return brings a healthier community. ReferencesBender, M. (2014). The Current Evidence Base for the Clinical Nurse Leader: A Narrative Review of the Literature. Journal of Professional Nursing, 30(2), 110-123Berger, Z., Flickinger, T., Pfoh, E., Martinez, K., & Dy, S. (2014). Promoting engagement by patients and families to reduce adverse events in acute care settings: a systematic review. BMJ Quality & Safety, 23(7), 548-555. Burns, K., Misak, C., Herridge, M., Meade, M., & Oczkowski, S. (2018). Patient and Family Engagement in the ICU. Untapped Opportunities and Underrecognized Challenges. American Journal of Respiratory and Critical Care Medicine, 198(3), 310-319. Demarinis, S. (2019). Nurses Outpace Other Professions for Honesty and Ethics Again. EXPLORE, 15(3), 175-177. Gerber, L. (2018). Understanding the nurseʼs role as a patient advocate. Nursing, 48(4), 55-58. Joseph, L., & Huber, D. L. (2015). Clinical leadership development and education for nurses: prospects and opportunities. Journal of Healthcare Leadership, 55. Lolaty, H., Bagheri-Nesami, M., Shorofi, S., Golzarodi, T., & Charati, J. (2014). The effects of family-friend visits on anxiety, physiological indices and well-being of MI patients admitted to a coronary care unit. Complementary Therapies in Clinical Practice, 20(3), 147-151. Marra, A., Ely, E., Pandharipande, P., & Patel, M. (2017). The ABCDEF Bundle in Critical Care. Critical Care Clinics, 33(2), 225-243.Moore, P., Schmidt, D., & Howington, L. (2014). Interdisciplinary Preceptor Teams to Improve the Clinical Nurse Leader Student Experience. Journal of Professional Nursing, 30(3), 190-195. Sharma, S., Hashmi, M., & Friede, R. (2019). Interprofessional Rounds in the ICU. Retrieved 23 October 2019, from https://www.ncbi.nlm.nih.gov/books/NBK507776/ Strathdee, S., Hellyar, M., Montesa, C., & Davidson, J. (2019). The Power of Family Engagement in Rounds: An Exemplar with Global Outcomes. Critical Care Nurse, 39(5), 14-20. Wienand, D., Shah, P., Hatcher, B., Jordan, A., Grenier, J., & Cooper, A. (2015). Implementing the Clinical Nurse Leader Role: A Care Model Centered on Innovation, Efficiency, and Excellence. Nurse Leader, 13(4), 78-85. Williams, S., Phillips, J., & Koyama, K. (2018). Nurse Advocacy: Adopting a Health in all Policies Approach. OJIN: The Online Journal of Issues in Nursing, 23(3).

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