Group Process

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Group Process Interdisciplinary Teams

• Emerging Models of
• Health Care Delivery

2
Definition of Group

• It is a gathering of 2 of more individuals who
  share a common purpose
• Meet over a substantial time period
• In face to face interaction
• To achieve an identifiable goal

3
Developing Group Process Awareness in Nursing

• Groups are an integral form of communication and
  strongly influence a persons physical,
  emotional, and social development.
• In the work setting, groups represent an
  effective mechanism for discussing staff issues,
  effecting change and establishing new work
  policies.

4
Why do nurses need to be concerned with group
process?

• Nurses are involved in group activities in most
  areas of practice
• Examples of Groups
• Nursing teams, interdisciplinary teams
• Support groups (for nurses or clients)
• Activity or project focused
• Education

5
Primary and Secondary Groups

• Primary groups are more spontaneous and linked to
  the values of an individual.
• Usually represent informal and social connections
  
• Can be automatic group associations (e.g.
  family), or freely chosen because of common
  interest (Nursing Society, RNAO, CNA,
  Collaborative Program)

6
Secondary Groups

• Secondary Groups are generally not spontaneous
• Planned, time-limited association
• Prescribed structure
• Designated leader
• Specific identified purpose
• Focus group, therapy groups, discipline-specific
  work group.

7
Group Dynamics determine group success and
membership satisfaction

• Group Dynamics
• Communication Variables
• Clarifying, Reflecting, Linking,
• Paraphrasing, Summarizing

Member Variable Motivation Functional
Similarity Leadership Style
Group Variables Purpose Norms, Role
Functions Cohesiveness Decision Style
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Group Process

• Focuses on the structural development of the
  group or life cycle
• One theory of group formation (5 phases)
• Forming 4. Performing
• Storming 5. Adjourning/Reforming
• Norming Tuckman (1965)
• Expanded on next slide ?

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Forming contracting specifics (time, date,
place, nature of the interaction, behavioural
expectations of members) Storming group
members struggling with power and control
issues Norming feedback is spontaneous ,
shared leadership responsibility, behavioural
standards, personal information is shared, goal
alignment occurs, membership accountability
occurs Performing Cohesiveness, goal
accomplishment, affirmation Adjourning /
Reforming Termination or adjournment because
the group has achieved the desired outcome
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Key considerations in group development

• Matching client needs with group goals
• Establishing types of group membership
• Creating the appropriate environment
• Determining appropriate group size
• Acceptance
• Fostering mutual identification
• Establishing the group contract
• Managing the storming phase

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Group Decision Making

• Often yields a better product than individual
  solutions for three reasons.
• Why? ?
• Knowledge (increased input)
• Skills (experience/education)
• Resources of all participants

12
Compassion and building teamwork will be two of
the most important characteristics leaders will
need for success a decade from now.

• Nurses need to develop a strong understanding of
  the group process, group dynamics and associated
  communication skills to use the group medium
  effectively in meeting both client goals and the
  goals of the nursing as a profession.

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• MODELS OF HEALTH CARE DELIVERY

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Types for todays discussion

• Functional Method of nursing care delivery
• Team Nursing
• Primary Nursing
• Critical Pathways
• Case Management
• Program Management

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• Functional Method of nursing care delivery
• Each member performs a specific task for a large
  group of clients. Assembly line care (Med nurse,
  IV nurse, treatment nurse, RPN vital signs,
  etc.)
• Team Nursing
• Group of clients assigned to a team leader who
  then assigns tasks to the team staff.
• Must have good team environment and good
  leadership skills or reverts to functional.
• Primary Nursing
• Adaptation of the case method. One Nurse is
  responsible for clients care from admission to
  discharge

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Care Management and Critical Pathways

• In an acute care setting, one care provider
  coordinates care from admission through discharge
  
• A single multidisciplinary plan is implemented.
• All members of the health care team work with one
  plan to achieve the same client goals/outcomes.

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Critical Pathways

• Tool used in case management
• Members of all disciplines care for a particular
  client type and develop the critical pathway.
• Critical Pathway outlines day to day-expected
  outcomes, as well as discharge outcomes
  (assessments, treatments, procedures, dietary
  interventions, activity exercise therapies,
  patient education, etc.).
• If the client does not proceed as predicted the
  health care team analyzes the variances to revise
  the plan of care.

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Case Management

• A case manager (RN) oversees the management a
  certain case type client (stroke, renal failure)
  and is usually held accountable to some standard
  of quality care and cost management
• Manage the case across the continuum of health
  care,
• Clients are high risk with complicated medical
  treatments
• Case managers are clinical nurse specialists,
  nurse practitioners, or expert primary care
  nurses

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Case Management (contd)

• The case manager develops a plan of care with the
  client, attempting to ensure diagnostic and
  treatments are delivered promptly without
  duplication.
• Coordinates any consults, monitors the case maps.
• Updates the family on progress and status.
• Case manager must have the skills and knowledge
  of negotiating, obtaining and coordinating
  services and resources, advocating and analyzing
  trends

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Program Management

• Programs which cross health care system sectors
  and utilize concepts from all levels of care and
  prevention.
• Primary, secondary and tertiary care and
  rehabilitation all contained within a single
  program.
• Across multiple sites and may be defined to
  certain diseases or populations or sectors of
  society.
• Nurses will be involved in every aspect

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The Role of the Nursein Interdisciplinary
Health Care TeamsCNOs Position on
Accountability
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The Varied Roles of an RN on a Health Care Team

• Direct care giver
• Educator
• Consultant
• Facilitator
• Communicator
• Collaborator

• Coordinator
• Researcher
• Social Marketer
• Community Developer
• Policy Formulator  

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CNO Fact SheetPractice Guidelines Working in
Different Roles

• Read CNO Fact Sheet in Registration section of
  the Compendium of Standards
• Nurses are accountable for their own conduct and
  practice.
• Accountability comes with registration and
  remains an obligation for all nursing roles that
  you fulfill
• An RN working in an RPN role or as an unregulated
  care provider is still accountable as an RN
  (e.g. RN working in a new unregulated
  complementary therapy role)

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THE ROLE OF THE NURSE ON THE HEALTH CARE TEAM

• Is to keep focused on the centre of the team
•  THE CLIENT