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"In Our Unit" highlights unique practices, innovations, research, or resourceful solutions to commonly encountered problems in critical care areas and settings where critically ill patients are cared for. If you have an idea for an upcoming "In Our Unit," send it to CRITICAL CARE NURSE,101 Columbia, Aliso Viejo, CA 92656; fax, (949) 362-2049; e-mail, ccn{at}aacn.org.
Masterful communication and collaboration are not optional because patient care is too complex; none of us acting alone could ever meet those multifaceted needs.1
Our surgical intensive care unit (ICU) is part of an urban, academic territory medical center. Referrals are sent from all over the Southeast in order to access the high level technology and specialty services our organization provides. Our critical care team members are trained in disciplines that are relatively constant, such as respiratory and intensive care, anesthesia, surgery, pharmacy, and operating room and pain management. Our exemplar, however, focuses on a situation in which a mother-child dyad drove our critical care unit to more complex interactions with almost every service available in our organization. Team competence was demonstrated at new levels because our healthcare system was driven by the needs of the mother and her unborn child. Our exemplar is organized around the information that Debbie Brinker presented in her opening address at NTI 2006.1
Communication Amid Multifaceted Needs
The mother entered our system as a referral from a small, outlying rural area. She was accepted for care by our obstetrical staff and the medical intensive care team. It was quickly evident, however, that a woman with pneumonia and adult respiratory distress syndrome receiving mechanical ventilation and who was 27 weeks pregnant, probably experiencing eclampsia with active lupus, coagulation disorders, and failing kidneys, was a challenging patient for our tertiary team. Because of her condition, our team had to form a dynamic plan for possible vaginal or caesarean delivery, and because of the geographic proximity of the surgical ICU to the operating room, the plan was to transfer her from the medical ICU to the surgical ICU.
As shown in the Figure
, there were at least 30 identified variables converging in complex interactions that would require the healthcare team to work synergistically to produce a good outcome. Because caring for 2 patients simultaneously with conflicting needs was a new experience for our surgical ICU team, our maternal child colleagues helped us focus on the joint needs of the mother and her unborn child. Multiple departments and services were involved in caring for them (see Table).
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The high-risk labor and delivery nurses placed their phone numbers on the fetal monitoring equipment and helped the staff learn the urgent things that might need their expertise. They graciously let us know that they also appreciated our attentiveness to the multiple infusions of medications foreign to their aspects of practice. The operating room charge nurse rounded every 8 hours and updated her staff on the status of the patients. The anesthesia staff collaborated with medical and surgical specialists to optimize prescriptions that would be most effective with the pulmonary, coagulation, and renal impairments of the patient. Neonatologists daily discussed with the family the risks associated with prematurity and how those risks might affect the child’s future. Team members from the different specialties sought out each other to discuss their points of view on each clinical decision. The critical care nurses acted like air traffic controllers, making sure that all medical teams and disciplines were in constant communication with the patient, her family, and each other. Together, we learned new respect for the depth of knowledge and skill set each team member possessed.
Everyone Leads
During this experience, we found that we were exhibiting some of the behaviors that Debbie Brinker described after she read Everyone Leads.2 Depending on the urgency of the patient characteristics of the mother-child dyad at any one time, different subsets led the team. Listed below are examples of these behaviors; no one was excluded from discussion.
Everyone Inspires
Caring for these patients was an energizing experience. Each person involved in their care demonstrated attentiveness to other team members. Because we successfully navigated both patients through several life-threatening episodes, we learned we could work with synergy to achieve the best possible outcomes. The baby’s father was very encouraging to each healthcare team member. When the mother recovered, she asked the nurses to share her story to teach healthcare members and to encourage other patients with overwhelming health problems. The patient affirmed how much she appreciated the chance to live and to raise her children.
Everyone Cares
Team competence is more than a knowledge base and skill set; it was the element of caring that helped our competent team work effectively. Our aim, no matter what the outcome, was to demonstrate that our team cared, even if there was no instant cure or way to change the conflicting needs of the mother and child. This experience demonstrated that caring is not dependent on service line or skill set. Everyone cared about the patients and the healthcare team.
This experience gave us new insights and reasons to celebrate our nursing practice. Our critical care unit staff views our publication of this team experience as another way to recognize the value of our contributions to patients in our healthcare organization. Measuring all the dimensions of team competence is not in our grasp at this time. This article is our attempt to share our description of a time when our teamwork exhibited attributes much like geese soaring in flight.
References
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