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Difficulty: Very hardCollaboration with Interdisciplinary Team

A nurse is utilizing the SBAR (Situation, Background, Assessment, Recommendation) framework during an interdepartmental handoff report for a 65-year-old client transferring to acute rehabilitation following a radical neck dissection. The client has a tracheostomy, receives continuous enteral feedings, and exhibits spinal accessory nerve damage causing profound ipsilateral shoulder weakness. During the 'Assessment' phase, the nurse highlights the client's severe frustration over the inability to manipulate the feeding pump controls or perform independent oral care. Additionally, the spouse tearfully states, 'I cannot manage all this medical equipment at home.' Which collaborative action should the nurse prioritize in the 'Recommendation' phase of the SBAR?

  1. Initiate an Occupational Therapy (OT) consult to provide adaptive strategies for upper extremity deficits impacting activities of daily living, and involve a Medical Social Worker (MSW) to evaluate caregiver resources.Answer
  2. B
    Prioritize a Physical Therapy (PT) evaluation to restore shoulder strength for independent ambulation, deferring the fine motor concerns until gross mobility is stable.
  3. C
    Recommend delegating the primary demonstration of enteral pump troubleshooting and stoma care to the Unlicensed Assistive Personnel (UAP) immediately upon admission.
  4. D
    Provide reassurance to the spouse that they will easily adapt to the home routine, and request a Speech-Language Pathologist (SLP) to adjust the caloric density of the enteral feedings.

Answer

Initiate an Occupational Therapy (OT) consult to provide adaptive strategies for upper extremity deficits impacting activities of daily living, and involve a Medical Social Worker (MSW) to evaluate caregiver resources.
The correct action directly addresses the two primary issues identified in the assessment: the client's inability to perform fine motor ADLs and the spouse's role strain. Occupational Therapy is the exact discipline responsible for modifying activities of daily living and providing adaptive equipment for upper extremity deficits. The Medical Social Worker is the appropriate professional to assess caregiver support needs and coordinate resources.

Step-by-Step Solution

1
Analyze the SBAR 'Assessment' data provided in the scenario.
The client has fine motor deficits affecting ADLs (pump controls, oral care) causing frustration, and the spouse is experiencing caregiver role strain.
Identifying the core clinical and psychosocial issues is necessary to determine the appropriate interdisciplinary referrals.
2
Differentiate the scope of practice for the allied health team members based on the identified needs.
Occupational Therapy (OT) addresses fine motor skills and ADLs. A Medical Social Worker (MSW) addresses coping, community resources, and caregiver support.
Accurate scope identification prevents inappropriate referrals (e.g., PT for fine motor tasks or SLP for caloric requirements).
3
Evaluate the distractors for safety, prioritization, and therapeutic communication violations.
Delegating initial teaching to a UAP is unsafe. Promising the spouse they will 'easily adapt' is nontherapeutic. Prioritizing ambulation ignores the immediate stated concerns.
Eliminating options with critical safety or communication errors isolates the safest and most effective collaborative action.

Key Concept

Interdisciplinary collaboration requires accurate identification of allied health scopes of practice, strict adherence to delegation principles, and therapeutic communication to address both client functional deficits and caregiver role strain.
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Collaboration with Interdisciplinary Team

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