IMPROVISATION AS A STRATEGY TO PROMOTE INTERPROFESSIONAL COLLABORATION
A healthy nursing work environment yields several benefits that positively influence patient care delivery and nursing retention. Regard for another’s knowledge and skills, through purposeful and collaborative actions, promotes the principles of a high-performing team—and is an actual representation of a healthy work environment. Clinical nurse specialists (CNSs) are vital in improving outcomes within specific populations. Darmody and Coke1 described the role of the CNS as one that promotes positive healthcare outcomes, collaborates with the interprofessional team, and leads system change to enhance patient outcomes and organizational processes.
Nurse educators, both in academe and in the clinical setting, must instill leadership skills such as effective communication and conflict resolution in all levels of nursing to promote healthy work and learning environments. The transfer of knowledge from the classroom to the practice setting is an essential skill nurses must acquire. Communication skills are an imperative aspect of nursing competence as well. Open dialog, coupled with self-awareness, is necessary for enabling all practicing nurses to bring novel ideas into practice. Strategies for managing and, in some instances, resolving interprofessional discourse are needed.
With an intentional focus on collaboration within the interprofessional team, nurse educators are challenged to devise creative ways to impart concepts, inclusive of leadership and communication, to students with each academic encounter, from the classroom to the skills laboratory to the clinical setting. In the clinical setting, the nurse educator also needs to assist nurses in these concepts. The focus on collaboration and retention of information to demonstrate content mastery in courses and student engagement in the classroom and experiential learning environments is critical.
This education is particularly important when nurses reach the advanced practice level. The CNS is often in a lead role on the interprofessional team to impact collaboration in delivery of cost-effective, safe patient care based on best practices. The CNS is also a key stakeholder in process change and quality improvement initiatives where collaboration and effective communication are vitally important. There are many ways that the CNS can acquire these attributes. The use of role modeling has been described in the literature for decades as an effective way to demonstrate to students and nurses the best approach to resolving conflicts, effective communication, and negotiation skills. A newer strategy that is emerging is the art of improvisation. It has been shown that improvisation can help students and novice nurses learn these critical skills and their effective application in interprofessional interactions in the clinical setting.
IMPROVISATION AS A TEACHING LEARNING STRATEGY
Improvisation is a concept that has not been fully explored in nursing education but is emerging as an effective strategy. While associated with the liberal arts, improvisation is an innovative and valuable strategy. Improvisation, or “improv,” is a strategy that nurse educators can use to clarify difficult content and help students extend their learning from beyond the classroom with patients and collaboratively within the interprofessional team. Fisher and Barrett2 describe the essence of improvisation as “the ability as one encounters unforeseen obstacles, fumbles through potential solutions and uses the material at hand to solve the problem, ultimately arriving at alternative courses of action, influenced by new insights.” The noun virtuosity is defined as a “great technical skill of fluency.”3 Virtuosity, expressed through improvisation, demonstrates a nurse’s ability to recognize and adapt to unpredictable patient patterns and the healthcare environment in a manner that cultivates innovative approaches to the delivery of care.
According to Hanley and Fenton,4 improvisation is essential to frontline healthcare responders as they react to ever-changing clinical situations. Valuable solutions in organizations, such as real-time problem solving in fast-paced environments, including healthcare, are generated with improvisational strategies and responses to life-threatening crises beyond the scope of professional training.5,6 Research suggests that improvisation can be an important source of creativity and can bode lasting positive consequences for organizations.7,8 Using improvisation to develop scenarios of “what ifs” can help interprofessional teams determine multiple potential solutions and actions for clinical and organizational situations. Using improvisation may help to accomplish the recommendations for the future of nursing, such as practicing to the full extent of education and training by preparing a more skilled workforce in communication, leadership, and negotiation, as well as achieving higher levels of education and training through an improved education system.9 Nurses are encouraged to apply innovative knowledge and skills to address the diverse healthcare needs of the populations they serve.
BENEFITS TO USING IMPROVISATION
Historically, healthcare providers have utilized improvisation as a method of addressing the healthcare needs of their patients and shared accounts of using improvised equipment and supplies to address the needs of patients and resolve barriers to care delivery, such as resource allocation.10,11 Trust in one’s own abilities and an awareness of risks are foundational requirements of improvisation.3 Eventually, improvisation develops as a result of the deliberate application of knowledge and as skills become mastered. Improvisation is a strategy for integrating nursing art and science within the healthcare setting—beyond the classroom. When guided by minimal coordinated structures, typically provided by the preceptor or faculty, without a strict constraint of one’s actions, improvisation is an effective teaching-learning strategy.7,12 Being attentive to others and the overall situation, including patients and members of the interprofessional team, fosters successful outcomes through improvisation.13 Organizational culture and focus on teamwork facilitate the improvisation experience.14,15 Boosting confidence and building interpersonal communications skills are some of the benefits that students can derive from improvisation. Educators can benefit from the improvisational underpinnings and nurture a supportive learning environment committed to collaboration and teamwork, while harnessing a sense of focus through engaging one’s imagination, thus being open to creating and crafting new ideas.
A primary role of the nurse educator is to facilitate student learning through experiential educational activities. According to Paquette et al,16 the use of improvisational actors can enhance synthesis of knowledge acquired across the curriculum. Nurse educators require the use of influence and strategic agility when suggesting a new method of learning with their colleagues, just as clinical nurses strive to encourage patients toward making healthy lifestyle choices. Improvisation helps to develop agility, enhance communication skills, and promote professionalism, essential leadership competencies that promote patient-centered care.17–19
CLINICAL NURSE SPECIALISTS WITHIN THE INTERPROFESSIONAL HEALTHCARE TEAM
The foundations of improvisation within nursing education and practice require impulse control, listening, and being supportive. Instilling these practices into the learning environment is central to engaging the student learning experience, driving superior academic outcomes, and supporting the unique skill set of each member of the interprofessional team. Clinical nurse specialists can leverage their finely honed knowledge and skills when implementing process change and quality initiatives, directing care delivery for complex patients, and overtly articulating the outcomes of their advanced practice to communities of interest. When addressing the existing opportunity for the CNS to practice to the full extent of their education, certification, and licensure, the dialog must include the inherent ability of the CNS to translate research and best practices to interprofessional care settings within complex healthcare environments, thus impacting patient and healthcare provider safety, superior outcomes that improve the quality of healthcare. Improvisation can be an important strategy for achieving these goals.
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