Taking teamwork to a deeper level
Dr. Eleanor Barbera
When we think of teamwork in long-term care, we envision a group of dedicated specialists working together to provide the best care for our residents. They read notes from other disciplines, bounce ideas off colleagues at the nursing station and convene care plan meetings.
In reality, teamwork in long-term care is much more complex.
Team members include not just clinical staff, residents and family members, but other workers who frequently have an influence on care, including housekeepers, laundry workers, maintenance staff and security guards. To enhance teamwork, these employees should be included in in-service trainings that might initially appear beyond their purview, such as customer service training and education about the medical and behavioral information they may need to relay to the nurses.
Teamwork is strengthened when team members understand the work of their colleagues and when it can best be utilized. For example, a lack of understanding of the difference between psychology and psychiatry services can cause delays in the receipt of needed treatment. Consider monthly training lunches that can boost morale, increase interdepartmental understanding and improve team functioning.
Team members also include those outside the facility, such as medical specialists, dialysis centers and hospitals, as well as consultants who provide onsite care such as psychiatrists, dentists, respiratory therapists and others.
Unifying all these team members requires uncomplicated and reliable conversation and correspondence. Communication can be enhanced in a variety of ways, including computerized records that eliminate paper consults and indecipherable handwriting, enhanced change of shift reports that include behavioral as well as physical information and a management commitment to staff retention to create the stability necessary for a solid team.
Taking it further
Once teamwork basics of role understanding, stable staffing and communication are covered, teams can begin to address teamwork at a deeper level.
Deep teamwork involves observing how the floor, unit or neighborhood is functioning as a whole over different shifts.
A team is not functioning well if a disruptive resident is keeping others awake at night or frightened during the day. Nor is it a high functioning team if two staff members are in a personal argument that's obvious to all who walk onto the floor.
Deep teamwork calls for observing the interactions of the team and intervening as necessary to guide them back on track.
For instance, one unit suffered the loss of several longstanding and beloved residents in succession, shortly after one of the aides lost a child. The team was in mourning.
As the psychologist, my interventions were multifaceted.
I offered my condolences to the grieving aide as well as to the staff members who had been close to the residents who died.
I spoke to the director of nursing and suggested that the facility do something special for the unit to acknowledge this difficult period.
I also encouraged a particularly lovely resident to move to that floor when she decided to stay for long-term care. I knew she would thrive on that unit, but I also felt that the staff needed her.
Your consulting psychologist might make similar suggestions because we're trained to observe team functioning, but we're typically in the facility to provide direct care to residents. Think of how much more frequent and effective these recommendations would be if a psychologically focused team member were enlisted to provide such services.
If attending to deep teamwork had been part of my job responsibilities in the prior example, I would have taken the workers' grateful surprise at my condolences as an indicator that the entire facility needed more and better ways to acknowledge grief and established community-wide rituals, training and support.
Deep teamwork is also necessary to address behavior problems on the unit. As psychologist Richard Juman, PsyD, pointed out in his excellent article on behavior management plans, without a unified team workers can inadvertently reward behaviors rather than eliminate them.
In order to establish a universal approach to addressing problem behaviors that is used consistently across disciplines and shifts, teams can start by holding behavior management meetings to identify problems and potential solutions. Additionally, there should be a system in place for communicating and training people on the plan.
Teamwork calls for facility-wide education on dementia, mental health, substance abuse, customer service and aggressive behaviors. Deep teamwork calls for training the staff on the East wing on how to work together to ensure that Mr. Jones isn't refusing personal care all day and getting donuts and coffee from the night shift.
As a consulting psychologist providing direct care to residents, I focus on helping them manage within a dysfunctional system. It's so much more effective, though, to make the system less dysfunctional.
For more tips on how to create a psychologically healthy environment, download my free report from my website, “Stop Agitating the Residents!”
Eleanor Feldman Barbera, PhD, author of The Savvy Resident's Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with over 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.