1. Competency Model for Professional Rehabilitation Nursing Behavioral Scenario for Competency 4.1: Develop Interprofessional Relationships Mary Ullrich, MSN, RN, CRRN & Kristen L. Mauk, PhD, DNP, RN, CRRN, GCNS-BC, GNP-BC, FAAN Copyright©2015, Association of Rehabilitation Nurses

2. Competency 4.1: Develop Interprofessional Relationships Description/Scope: The rehabilitation nurse builds and maintains interprofessional team relationships using effective communication and strategies such as client conferences, huddles, etc. Recognizes the role of the interprofessional team members Participates in the interprofessional team process Beginner Proficiency Level Descriptors Copyright©2015, Association of Rehabilitation Nurses

3. Behavioral Scenario Candy is a 24 year old female who lives alone in a one bedroom apartment on the 12 th floor of her building. She works full time as a software engineer, starting her workday around 9 am. She has a very active social life after work and on weekends. Candy was admitted from the acute care facility to the inpatient rehabilitation unit 10 days ago following a dirt bike accident resulting in a C6 incomplete spinal cord injury with resultant quadraparesis. Spinal shock is resolving, but Candy has been having difficulties with bowel incontinence despite her every night bowel program. Candy stated her bowel movements were very regular premorbidly every morning before work. Copyright©2015, Association of Rehabilitation Nurses

4. Path 1 – Not Proficient Because of conflicts with therapy schedules, Candy had been put on an every night bowel program. Initially, the nurse and tech had been getting Candy up on the commode for the bowel programs, but since her leg spasms are worsening, the nurse feels it is unsafe to get Candy up on a commode so the bowel program is being done at night in bed. Recently, Candy has experienced some bowel incontinence during the day. As a result of these incontinent episodes, Candy is beginning to refuse therapy stating that she is so humiliated by these incontinent episodes, she cannot leave her room. She has even cancelled a Therapeutic Recreation outing to her favorite restaurant for fear of having an incontinent episode. The nurse explains to Candy that the therapy schedule is difficult and would be hard to change. She tells Candy that her spasticity is causing a safety concern, so it is better to keep the bowel program being done in bed in the evening. Copyright©2015, Association of Rehabilitation Nurses

5. Path 1 – Not Proficient Observations & Outcomes 1.The nurse recognized the role of the interprofessional team by working with the nurse tech and therapy to accomplish the bowel program within the unit schedule. She showed a willingness to accommodate the needs of the therapist’s schedule by performing an evening bowel routine. 2.However, changing the bowel program for this patient to an evening routine was the not in the best interests of the patient and resulted in daytime incontinence and frustration for the patient. 3.In order to be a proficient beginner, the nurse needs to consult with PT regarding the spasticity of the patient that is making transfers more difficult. The PT can also assist with positioning techniques for Candy to further increase her safety and comfort while up on the commode. The nurse should introduce this discussion in team conference for the entire team to problem solve regarding therapy scheduling so that Candy can have a morning bowel program, providing more patient-centered care. Copyright©2015, Association of Rehabilitation Nurses

6. Path 2 - Proficient Candy stated her bowel movements were very regular premorbidly every morning before work. The proficient nurse is able to balance concern for safety issues with her knowledge that a morning bowel program using the commode is most appropriate for Candy and is what Candy prefers. This bowel program will allow assistance from gravity and provide privacy in performing the program. The nurse recognizes that she needs to coordinate with the therapists to implement her plan of care within the interprofessional team. The nurse also knows that the best chance of a successful bowel program for Candy would be a morning bowel program. The nurse sees Candy’s PT in the hallway and asks if they can meet to discuss the difficulties with transfers and positioning related to spasticity to help Candy establish a more appropriate bowel program. The PT agrees to meet with the nurse and Candy the next evening for Candy’s bowel program. The next day during team conference the RN explains to the team that Candy needs a morning bowel program and there is a need to change Candy’s therapy times to accommodate an 0900 start time. It was decided that Candy’s bowel program would be entered onto her daily schedule for 0800 and therefore no other appointments could take precedence. Copyright©2015, Association of Rehabilitation Nurses

7. Path 2 – Proficient Observations & Outcomes 1.The rehabilitation nurse facilitated team function by taking a leadership role in establishing the most appropriate bowel program for this patient. This required coordination of the team schedule to meet the patient’s need for a morning bowel routine. The rehabilitation nurse used her knowledge about establishing a bowel management program that worked best for this patient and enhanced the team’s understanding in this essential area. She communicated effectively with other team members in the interprofessional team to advocate for her patient. 2.The positive outcomes were a more effective bowel program for Candy that allowed her to continue active participation in her therapies and gain confidence that she could manage her bowel program at home. The nurse also fostered a stronger collaborative relationship with the PT, and there may be ripple effects of that relationship that positively affect other members of the team. Taking the issue to team conference strengthened the RN’s perception of herself as an equal member of the team as well as improved her credibility as a valuable patient-focused member within the interprofessional team. Copyright©2015, Association of Rehabilitation Nurses

8. What Did You Observe? How did the outcomes of this scenario differ? Proficient Nurse - Took a leadership role in implementing an appropriate bowel program for this patient - Consulted with PT and other members of the team, sharing at team conference and recognizing her own valuable contribution to the interprofessional team - Assisted in more positive quality of life outcomes for the patient Non-Proficient Nurse - Recognized the role of team members, but did not maximize their role nor her own. This led to the patient being incontinent and beginning to withdraw from life - Did not take a leadership role within the team - Did not coordinate any implementation of the plan of care Copyright©2015, Association of Rehabilitation Nurses

9. Takeaways The rehab nurse should maximize the contributions of each team member in promoting an appropriate plan of care. The proficient nurse coordinates implementation of the interprofessional plan of care by collaborating with team members. The nurse should assume a leadership role in her specialty domain, communicating essential information to facilitate effective team function. Copyright©2015, Association of Rehabilitation Nurses