Learning Contract for Nursing Professionals in Multidisciplinary Teams for Stroke Patients

This learning contract focuses on the development of skills required for nursing professionals working in multidisciplinary teams caring for stroke patients. The objectives include administration and management of thrombolysis, close monitoring of stroke patients, exploration of the perception of the nurses towards working in the multidisciplinary teams, and understanding the type of interaction that takes place in the multidisciplinary team meetings.

Running head: LEARNING CONTRACT
LEARNING CONTRACT
Name of the student:
Name of the university:
Author note:

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LEARNING CONTRACT
Introduction:
A stroke can be defined as the medical emergency where the flow of the blood to the
brain gets cut off. It might happen to any patient at any time. About every year, 9000 people
in the nation of the New Zealand suffer from stroke and require emergency medical treatment
and post stoke rehabilitation treatment (Clarke & Foster, 2015). Providing a faster treatment
to stroke patients help in ensuring less threatening situation of the patient and better patient
outcomes, reducing the chances of fatal consequences. Different nursing professionals have
to work in multi-disciplinary teams of doctors, physicians, and professional therapist like
physiotherapists, occupational therapists, speech therapists and many others (Middleton et al.,
2015). Therefore, as nursing professionals, I need to ensure that all important skills for
treating patients in the emergency conditions as well as effectively working as the member of
the team are present within me. I realised that I have four gaps which I needed to overcome in
order to provide care to patients and work as an effective team members. Therefore, my main
focus of the project would be to strategise ways by which I can overcome the gap and then
evaluate them to see how much I was successful. Therefore the objectives that I would be
hoping to achieve are the administration and management of thrombolysis, close monitoring
patient for any clinical changes as observations and patient care is a primary objective,
exploration of the perception of the nurses’ towards the multidisciplinary teamwork and
understanding the type of the interaction that takes place in the multidisciplinary team
meetings. This assignment will show how I have overcome the gaps and developed
knowledge that would help me to provide effective quality and safe care in future to patients
while working in the multidisciplinary team.

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First objective: administration and management of thrombolysis:
Purpose:
Thrombolysis is the procedure of using proper thrombolytic drugs that would help in
the breaking down as well as dispersing the clot that are causing prevention to the blood for
reaching to the brain who have suffered ischemic stroke attack (Anderson et al., 2017). It is
very important for the nursing professionals to administer the drugs within the first four and
half hours of the stroke symptoms. Very rare cases are there where doctors still think it to be
useful till 6 hours. It is very important for nurses to be quick and skilled in thrombolysis as
more the time passes, the less effective the thrombolysis will be (Zwicker et al., 2017).
Therefore, it is important for the staffs to be very quick from the times of the starting of the
symptoms. When, I was in the time of clinical placement, I saw a man suffered threatening
situation when my preceptor failed to administer the drugs in time due to improve time
management. Therefore, I want to be skilled in this aspect while working in the
multidisciplinary team caring for stroke patients.
Explanation of the objectives:
Thrombolytic therapy is one of the most crucial interventions that need to be
conducted by the emergency team of the nursing professionals immediately after the arrival
of the patient (Schwarz et al., 2018). This therapy has the capability for breaking the clits
formed during stroke in the patient and prevents disruption of the flow of the blood to stop
the chances of brain death (Mehta et al., 2018). Therefore, I needed to develop the skill as
mere basic knowledge is not sufficient to ensure safe administration of the drugs in the
patient. Therefore, I had joined an 8 month training session for becoming specialist stroke
nurse. This had helped me to develop the efficiency and skills required for effective
administration of the drugs through injections and get the standardized stroke specialist

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qualifications. Existing standardised framework for stroke patient protocols as well as
evidence based articles also support nurses in developing the knowledge required for the skill
(Coyne et al., 2016). After completing the training as well as gathering of the standardised
qualifications, I started working under the senior stroke specialist in the emergency team.
Clinical preceptoring and appropriate guidance of the skill management help novice nurses
gain a practical arena for experiencing their capabilities (Dreyer et al., 2016). The preceptor
guided me in every step and I became an expert in the skill management of thrombolysis and
could manage my time effectively as well. The feedback I received from my clinical
preceptor as well as the team members of the multidisciplinary helped me understand how
well I was developing. I took their feedback constructive and never became upset if they
criticised me. Constructive criticism in teamwork is essential for development of skill of
novice nurses (Horton et al., 2016). The different barriers that I had faced were my internal
fear that arose from my lack of confidence. I was not confident about the skill I had for
thrombolysis in stroke as well as lack of necessary skill mix required. My fear also included
of the hemorrhagic side-effects and consent issues. However, as days passed in training, I got
more confident and overcome the challenges. It required me 8 months and now I am quite
confident in the skill and had conducted 28 thrombolytic therapies in last three months.
Second objective: close monitoring of the stroke patients
Purpose:
One of the most important purpose for the development of this skill is that monitoring
during the early stages of the post acute stroke helps the nursing professionals to identify that
whether occurrences of neurological and medical complications had taken place or not
(Olaiya et al., 2017). Several human as well as animal experiments have revealed that various
negative symptoms can occur. Theses might be different disorders like hypotension, hypoxia,

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pyrexia and dehydration that have the abilities to aggravate the neuronal damage that had
occurred due to stroke (Ohura et al., 2018). Therefore nursing professionals need to be very
careful and maintain constant monitoring of the patients to prevent any more negative
consequences adding to the suffering of the patients. Therefore, development of such skill is
extremely important for nursing professionals working in teams caring for stroke patients.
Explanation of the objective:
Close patient monitoring who have suffered stroke might help the nursing
professionals to understand the rate of recovery as well as different unperceived coping
difficulties faced by the patient. Invasive monitoring for inter-cranial pressure as well as
blood pressure and measuring of the abnormal findings help the nurses to realize whether the
patient is vulnerable to threatening situation on or that they are gradually recovering (Aoki et
al., 2016). Recordings of the blood pressure, temperature, pulse and the Glasgow comma
scale help to monitor the health of the patient time to time and dictate the chances of further
degradation of the physiological and neurological health of the patient. Fluid overload needs
to be assessed. Monitoring helps in benefitting the patients by early remedial intervention
(Luker et al., 2017). Therefore, I needed to develop the skill and patient by which I will
monitor the patient after the stroke in ways by which I can identify any deterioration
effectively. Therefore, I consulted with my mentor and he advised me with a number of
important books that had detailed description of the ways by which close monitoring can be
done and the different interventions and time needed to take from time to time. Moreover, I
also conducted huge evidence based studies through the nursing databases and came across
articles that helped me to gain knowledge. Evidence based articles help nursing professionals
to develop skills and make them up-to-date about the new interventions and working
procedures that are helping to provide more quality and safe care (Von Kodolisth et al.,

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2016). In order to evaluate myself, I used to maintain a reflective journal and after every
week used to consult my reflective journal with my mentor. He used to point out the part that
I could have done better and also encouraged me on the parts which I have done excellently.
His feedbacks helped me to evaluate myself successfully. Some of the barriers that I had
faced are lack of patience as well as time management. Caring for particular patient needs
patience and commitment and this might make the nurse feel restless in a busy shift.
Situations might get worse when the staff to patient ratio is also less (Luker et al., 2016). In
such cases, effective time management like caring for other patients as well as close
monitoring of stroke patient might result in burning out of the nurse of time management is
not done effectively (Ryan et al., 2017). I also faced these barriers and so advocated this to
the higher authority. However, I learnt the skill effectively and had been successfully
monitoring patients of stroke for last three months.
Third objective: exploration of the perception of the nurses towards working in the
multidisciplinary teams
Purpose:
In a multidisciplinary team, it is the responsibility of each of the team members to
understand their own roles to provide effective care to the patient. However, researchers are
of the opinion that only knowing about one’s own roles are not necessarily enough to ensure
effective teamwork. The nursing professionals who are one of the most important caregivers
in the multi-disciplinary teams have to be efficient in understanding other’s expert’s roles and
attitudes towards patients as well as the efficiency of the other nurses working in the team
(FErgusen & Hendriks, 2017). Therefore, every nurse would need to explore the perception
of the other nurses working in the team so as to assess that everyone is clear about the goals
to be achieved. The better everyone is able to understand what others are thinking it would be

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helpful in developing a common goal, prevention of feuds and negative feelings, medication
errors, missed interventions and thereby divide the team role of the nurses according to their
talents and skills (Roberts et al., 2018). This would ensure proper skill mix and all important
nursing requirements of the patients would be met.
Explanation of the objective:
It is extremely important to know about other nurses and health professionals view
points and way of treatment of client when working in a multidisciplinary team. Knowing
about what others are thinking in the team and about the actions in which they are or are not
comfortable would help in designing of the care planning that would allocate desired roles for
each of the nurses and professionals (Harrison et al., 2017). The better a nursing professional
identifies the perceptions and through procedures of others while working in team, it would
be helpful for her to align according to the desired behaviors and responsibility they expect
and therefore decrease the chances of development of negative feelings and feuds. This
would also help the nursing professional to understand each other’s talent, working style,
preferences and many others (Lange et al., 2017). This would prevent improper teamwork
interventions and will ensure smooth workflow with proper division of labor according to
specific skill mix of professionals. Therefore, in order to understand the perception of other
nurses, I consulted with my mentor and after his permission only, I developed an open-ended
questionnaire. I was able to capture the perception of the nurses through this questionnaire.
Open ended questionnaire is one of the best ways when individuals need to know detailed
information about a topic, perception, intervention and many others and is extremely useful
in qualitative research papers (Palley et al., 2018). In order to evaluate such broad answers
and to find out whether I had done this effectively or not, I consulted with my mentor. He
provided the feedback stating it was appropriate and that I should go through the perceptions

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of each members of the team to knowledge about their perceptions and psychology and
thereby gains idea about to strategize my team working style. The barrier I faced was time
management as taking out time to conduct interviews in busy shifts were becoming difficult.
I gained knowledge about the perceptions effectively and learnt ways to implement my
practicing styles in ways by which I do not disappoint any. It took me around two weeks to
conduct this.
Fourth objective: Understanding the type of the interaction that takes place in the
multidisciplinary team meetings
Purpose:
With the advancement of the generation, complex disorders that require various types
of expert interventions and help are also increasing. Therefore, a single nursing professional
can never successfully be able to complete all the necessary interventions within the specific
timings and according to needs and requirements of the patients. Therefore, teamwork
containing all experts specialized in their own fields and caring for each specific requirement
of patients is important (Harrison et al., 2017). Therefore, teamwork is necessary. However,
in order to conduct necessary teamwork, specific team working skills are important to ensure
effective interaction among team members and ensure safe and quality care for patients.
Therefore, effective communication, feedback exchange procedures, self-regulation, self
awareness, empathy and transparency are very important to ensure that every team members
are interacting with each other without any hard feelings (Luker et al., 2016). I needed to
explore such attributes and understand how such attributes help in effective interaction
among the team-members and how they contribute to collaboration and coordination.

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LEARNING CONTRACT
Explanation of the objective:
Researchers are of the opinion that when interaction among the team members of the
multidisciplinary team is well developed, there would decreased chances of medication
errors, missed interventions, clashing of timeslots for experts, duplication of nursing
interventions, threatening situations, accidents (Aoki et al., 2016). They also stated that it
also ensures increased chances of patient satisfaction and meeting all the needs and
requirements of the patient and ensuring safety and quality care (Dreyer et al., 2016).
Therefore, I needed to gain more knowledge on the concepts of effective interaction between
the members and check out whether I have the proper attributes to ensure effective team
working. Therefore, I often took up the task of close observation of the interaction that was
carried out by every team members and note it down in my diary. I also started to observe the
relationship shared by each other and how bonding influenced better interaction and outcome
on their health. I also conducted an interview where I tried to find out from them that what
enablers and barriers they considered in development of effective communication and
teamwork. Later, I analyzed their opinions and consulted them with evidence based practices.
This helped me to understand the different factors that influence interaction among members.
The main barriers that I faced were my introvert nature which prevented me from interacting
openly with team members to take their opinions. Time was also the barrier. However, I
closely analyzed the attributes and developed the knowledge about the attributes that I need
to possess and harbor for carrying out effective interaction among embers and ensure safest
care to the patients. This took me two week for completion.
Conclusion:
The main purpose of the assignment was to ensure how well I have been able to
identify the learning requirement needed to work in the multidisciplinary team and then

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develop strategies to develop the skill. I have learnt that perception of nurses in working in
multidisciplinary teams, concepts of interaction in the teams, development of thrombolysis
skills, close monitoring of the skills are very important, accordingly with help of my mentor,
I took actions like training sessions, certification courses, quality based interviews, evidence
based studies and many others to achieve the goals. Initially, I faced a number of barriers that
affected my enthusiasm but I did not let them make me feel down. I accumulated my zeal and
enthusiasm and continued to work towards my goals. I had set myself a timeframe for about 8
months and accordingly planned my schedules to meet the goals. These helped me to develop
some of the most important skills which are indeed helpful for worming in multi-disciplinary
teams who provide care and support to patients suffering from ischemic stroke. As a part of
the future recommendations, I would always take active part in reflective actions where I will
maintain reflective journal as this would help me to develop my expertise and identify the
skill that need father training. I would also take part in continuous professional development
where I would be able to make my knowledge and skill to be up-to-date and thereby learn the
most modern methods and interventions which would help me to become a stroke expert
professional.

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References:
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nonphysician stroke specialists into the stroke team. Stroke, 48(11), e323-e325.
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Nishikawa, Y. (2016). The multidisciplinary swallowing team approach decreases
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