NURS FPX 4010 Capella Interview and Interdisciplinary Issue Identification Presentation

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Interview and Interdisciplinary Issue Identification Sample Approach

NURS-FPX4010

Capella University

May 15, 2020

Interview and Interdisciplinary Issue Identification

Interview Summary

The interviewee for assessment two is an Advanced Certified Oncology Nurse Practitioner for a large cancer center. Due to the current situation with COVID-19, the interview was conducted via telephone, and the list of questions provided for the assessment was used as a basic guideline. The interview was performed in a semi-structured manner and was recorded.

The cancer center where the interviewee works is comprised of many different disciplines such as; surgical, radiation and medical oncologists, pain management specialists, social workers, psychologists, nurse practitioners, and nursing staff for each discipline. A vital aspect of this practice is that it has been recently acquired by the Christian Care Health System and went from being a stand-alone medical oncology practice to being part of an enormous healthcare corporation. Naturally, there is an ongoing cultural change for the once independent office. NURS FPX 4010 Capella Interview and Interdisciplinary Issue Identification Presentation

The primary duties for the NP interviewed are coordinating between disciplines, writing referrals and orders, managing chemotherapy, pain management, education, and follow up calls. The most relevant issue from the nurse practitioner’s perspective is the various professions overstepping their boundaries and interfering in the practice of other disciplines. She states there has been a lack of strong motivational leadership in helping the oncology practice adjust to its new role within the more massive corporation.

Additionally, collaboration on a large scale happens only when a patient is new to the cancer center. Upon diagnosis, a meeting is held with the patient, medical oncology, radiation oncology, surgical oncology, social work, nutrition, etc. After this initial meeting, collaboration is on an as-needed basis. For example, when chemotherapy is no longer shrinking a patient’s tumor, the medical oncologist, surgical oncologist, and radiation oncologist will meet to discuss alternative options. The organization promotes teamwork but not necessarily true interprofessional collaboration. There is a silo mentality, and the physicians often exude a sense of entitlement.

The interviewee attempted to work on a collaborative team. In one collaborative meeting, Christiana Care indicated it had never used Oncology Nurse Practitioners, and it would need to come up with a job description. Having thirty years RN and NP experience, the interviewee volunteered to assist but was dismissed and told they would let her know when the job description was completed. Hussain et al. (2015) suggests employee involvement is a crucial tool for overcoming resistance to organizational change, and it increases members’ input into decisions that affect the organization’s performance and well being.

Issue Identification

The issue identified during the interview is one discipline going outside its scope of practice and infringing on another discipline’s duties. For example, the medical oncology group manages a patient’s pain until it feels the patient’s pain is no longer controlled. The patient is then referred to the pain management group. Problems occur when a patient is having uncontrolled pain and mentions this at a visit with his/her medical oncologist. Does the practice adjust the pain meds? Or make the patient wait several days for an appointment with pain management? Similar problems occur among other disciplines as well. A multidisciplinary approach is appropriate for this problem, as it has the potential to disrupt patient care. Moreover, evidence supports the use of interprofessional practice as it leads to improved patient care, enhanced patient safety, and prevention of medical errors (Bosch & Mansel, 2015).

Change Theory

The journals used to research change theory were all scholarly and peer-reviewed and to ensure their relevance all were published in the last five years. Change theory offers methods for understanding an organization, its groups, the values and beliefs they possess, and how this set of beliefs influences the culture of the organization and its openness to change. Depending on the particular theory, suggestions are made on how best to alter that belief system to motivate change. NURS FPX 4010 Capella Interview and Interdisciplinary Issue Identification Presentation

Kurt Lewin’s Field  Theory offers a way of learning about group behavior by analyzing the relationships of interrelated environmental factors such as; the internal structure of the organization, its strategy, management and personnel, and external factors like policy or the economy. Understanding these forces allows practitioners to comprehend why groups act as they do and what forces need to be strengthened or diminished to bring about change (Hussain et al., 2016). Lewin’s theory is relevant because the culture of Christiana’s organization needs to be a target for change so that collaboration becomes the norm. This means thoroughly analyzing the groups within the organization and targeting their beliefs about their practices and the particular role they play in patient care and then presenting them with evidence supporting intercollaboration.

Leadership Strategy

All journal articles used to research leadership were scholarly and peer-reviewed. Their relevance was secured by ensuring all were published in the last five years. Leadership strategy is an attempt to organize, guide, and maintain the sincere and ardent commitment of the people carrying out a business strategy. The research has shown that the leadership style best suited for driving change is the transformational style. These leaders are defined as charismatic and inspirational; they possess effective communication skills, motivate, engage, and empower the team (Bergstedt & Wei, 2020). The interviewee feels that the current leadership is weak, and there is a lack of communication and transparency. A transformational leader will possess the skills needed to move the cancer center towards an interdisciplinary approach.

Collaborative Approach

Throughout the literature, a familiar concept for driving successful intercollaboration is putting the patient first.  According to Tomasik et al. (2015), “Focusing on the patient from their unique perspective serves as an equalizer in that patients’ interests supersede the potentially competing interests of individual team members. It helps people “connect the dots” between their role, patient care, and the mission of their organization” (p15). This is particularly true for the cancer center as the physicians and individual practices tend to operate in a bubble, and it can be disruptive to patient care.

Additionally, Tomasik and Flemming ( 2015) calls for the use of active and respectful communication as a tool for building interprofessional collaboration. Healthcare professionals often have their own ideas about what constitutes successful communication. The authors argue that having a common language allows team members to avoid barriers to effective communication. The healthcare facilities successfully using interprofessional practice have uniform documentation, forums, emails, and meetings that involve all team members.

One example of standardized communication that is seen throughout organizations successfully using collaborative practice is interprofessional rounding. This is seen as a highly effective practice that allows individuals to understand both their own and others contributions to the team. Open and respectful communication can contribute to problem- solving as a group, and open discussion allows for different perspectives to be heard (Tomasik & Flemming, 2015). Interprofessional rounding at Christiana Care would be beneficial as many of the professions are often infringing on the practices of others. Daily collaborative rounding would alleviate this issue as well as give a unique insight into how to prevent it from happening in the future.

Conclusion

Change theory, leadership, and collaborative practice are all tools needed to improve the nature of healthcare, but none of these tools act independently. Change theory provides a mechanism for examining the culture of an organization and determining what it will take to produce change. However, change theory needs to be driven by effective leadership. The same is true for intercollaboration. The organization must be inspired and motivated towards this method of practice. Change theories might tell us how to get there, but ultimately it comes down to leadership style and being able to stimulate the workforce into accepting the concept of interdisciplinary practice.

References – NURS FPX 4010 Capella Interview and Interdisciplinary Issue Identification Presentation

Batras, D., Duff, C., & Smith, B. J. (2015, November 14). Organizational change theory: Implications for health promotion practice. Health Promotion International, 31, 231-241. http://dx.doi.org/10.1093/heapro/dau098

Bergstedt, K., & Wei, H. (2020, February ). Leadership strategies to promote frontline nursing staff engagement. Nursing Management, 48-53. http://dx.doi.org/10.1097/01.NUMA.0000651204.39553.79

Bosch, B., & Mansel, H. (2015, July). Interprofessional collaboration in healthcare: Lessons to be learned from competitive sports. CPJRPC, 176-179. http://dx.doi.org/10.1177/1715163515588106

Dyess, S. M., Sherman, R. O., Pratt, B. A., & Hanisko, L. C. (2016, January 14). Growing nurse leaders: Their perspectives on nursing leadership and today’s practice environment. The Online Journal of Issues in Nursing, 21(). http://dx.doi.org/10.3912/OJIN.Vol21No01PPT04

Hussain, S. T., Lei, S., Akram, T., Haider, M. J., & Hussain, S. H. (2016, July 14). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3, 125-127. http://dx.doi.org/10.1016/j.jik.2016.07.002

Tomasik, J., & Flemming, C. (2015). Lessons from the field: Promising interprofessional collaboration practices. Retrieved from www.rwjf.org/en/library/research/2015/03/lessons-from-the-field.html

Interview Summary – NURS FPX 4010 Capella Interview and Interdisciplinary Issue Identification Presentation

Summarize your interview in this section. Be sure to relate concise information about:

• the health care organization that was discussed in the interview.
• the interviewee’s role and duties.
• the relevant issues at the organization.
• any relevant comments on the actions taken by the organization or leadership previously and their effectiveness.
• the organizational culture related to collaboration.
• any relevant collaboration or interdisciplinary team experience you interviewee has had.

The goal of this section is to convey what was discussed at the interview and identify an issue to pursue throughout the rest of this assessment (and future assessments in this course), as well as have enough information to relate theories, strategies, and approaches to the situation at the organization.

Issue Identification

Identify the issue from the interview for which you consider an evidence-based interdisciplinary approach appropriate. Provide one or more specific reasons why an interdisciplinary approach would be appropriate for the issue.

Change Theories That Could Lead to an Interdisciplinary Solution

For this section, look to the literature and describe one or more change theories that would help to develop an interdisciplinary solution to the identified issue. Also, you should briefly note the relevance and credibility of the sources that you cite.

Another way to think through this section is:

• What is the change theory?
• How could it help create an interdisciplinary solution?
• How relevant is the theory to the specific identified issue?
• How credible is the source?

Leadership Strategies That Could Lead to an Interdisciplinary Solution

This section is similar to the previous one, except you will be looking to the literature to help you describe one or more leadership strategy that would help you develop an interdisciplinary solution to the identified issue. Also, you should briefly note the relevance and credibility of the sources that you cite.

Another way to think through this section is:

• What is the leadership strategy?
• How could it help create an interdisciplinary solution?
• How relevant is the strategy to the specific identified issue?
• How credible is the source?

Collaboration Approaches for Interdisciplinary Teams

Again, this section will be similar to the previous once, except that the focus will be on collaboration approaches. Depending on whether or not your interviewee’s organization uses interdisciplinary teams frequently, your focus in this section may be on how to establish interdisciplinary teams and a collaborative foundation or how to improve the collaboration within an already established teams. You should also briefly note the relevance and credibility of the sources that you cite.

Another way to think through this section is:

• What is the leadership approach?
• How could it help establish or improve collaboration?
• How relevant is the approach to the specific identified issue?
• How credible is the source?

References

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Interview and Interdisciplinary Issue Identification: Interview Guide

For the Interviews and Interdisciplinary Issue identification assessment, your first step will be to interview a classmate, a nursing colleague, administrator, business partner, or another appropriate person who could provide you with sufficient information regarding an organizational problem that they are experiencing or have experienced, or an area in which they are seeking improvements. This guide provides a selection of questions that you should consider asking your interviewee. They are by no means questions you must ask, or the only questions you should ask. Feel free to ask your own questions and follow-ups as the interview proceeds. These are merely a guide to get you started. NURS FPX 4010 Capella Interview and Interdisciplinary Issue Identification Presentation

Sample questions

• How would you describe your organization?
• What is your position within the organization?
• What are your primary duties in your position?
• How would you describe some current or past issues within your organization?
• How did or do these issues affect your ability to complete your duties?
• How have you, or the organization, attempted to address these issues?
  • What has been done and what were the results?
  • What has been the role or actions of leadership in any attempts to address these issues?
    • How effective do you think their actions have been?
  • What is the general attitude toward interdisciplinary collaboration at your organization?
  • Have you experienced working on an interdisciplinary or interprofessional team?
    • How would you characterize the experience?
    • To what degree do you think overall organizational attitudes toward collaboration influenced this experience?