M.A. Asimov, G.O. Orazbakova, S.Kh.

Madaliyeva,
F.A. Bagiyarova, G.B. Ispaeva, L.M. Adilova

THE REFERENCE TO THE MEDICAL PROFESSION.

BASICS OF CLINIC, LAW,
ETHICS AND COMMUNICATION

Textbook

Karaganda, 2017
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УДК 614 (075)
ББК 51.1я73
В 24
Approved and recommended for publication by the Methodical Council of the Kazakh
of S.D. Asfendiyarov Kazakh National Medical University
Reviewers:
D.O. Karibaeva - director of DPHPS, c.m.s., associate professor;
М. Kanushina - Doctor of PHD, MBA, AC Institute of international education.
Prague, Czech Republic.
In 24 M.A. Asimov, G.O. Orazbakova, S.H. Madalieva, F.A. Bagiyarova,
G.B. Ispayeva, L.M. Adilova.
The reference to the Medical Profession. Fundamentals of clinic, law, ethics and
communication: Textbook. / M.A. Asimov, G.O. Orazbakova, S.H. Madalieva,
F.A. Bagiyarova, G.B. Ispayeva, L.M. Adilova / - Karaganda: "Publishing house
"АНҰР". - 2017. - 244 pp.

ISBN 978-601-7894-88-7

This textbook is designed for medical students to study a new discipline in medical education -
"Introduction to the Profession". The study of this discipline is designed to instill in the student a
conscious . Attitude towards the profession from the first year of study. The textbook presents
general questions of the organization of medical institutions, the basics of first aid and patient
care. The concepts of proper relationship building with patients and their relatives using
communication skills, within the framework of ethics and law.
Studying these issues will enable the future physician to understand his or her place and role
in medicine and consciously explore ethical and legal aspects, communication skills, and all
clinical disciplines in subsequent stages of study

ISBN 978-601-7894-88-7 © Коллектив авторов, 2017

© ИП «АҚНҰР», 2017

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4.2 Teamwork and Team-Building

"There were two female employees working in the same department for quite a
long time. There were quarrels, offences; one of them was younger, but higher in
rank. And there were always disagreements on this basis. Specialists were experts
of the highest class. On one weekday a "grave" patient was admitted, resuscitation
measures were necessary. It was a patient of a younger colleague. She didn't
hesitate to call the second co-worker to help her to help, the second employee, who
had tremendous CPR experience. The patient was successfully rescued and
discharged from the hospital a few days later. But after that incident, the older
female staff member asked: "Why, of all the specialists she went to her?" because
they were in a quarrel, she replied, "It was important to me to save the patient, and
we're a team".

In today's medical environment, the ability to act in teamwork is one of the most
sought-after personal qualities specialists, juxtaposing this quality with
professionalism. The most important in effective work is considered to be the
ability of each member of the team to "achieve the overall result." Many
professionals mistakenly believe that a team is a group of people who need to be
commanded.

Dialogue "What do you think?"

Dialogue "And yet what is a team?"

"A team is considered a group of professionals in which in no way diminishes the

individuality of each member of the team. Also, all members should be interested
in achieving a common result." (Susan M. Heathfield, 2017).

Places in the team are allocated according to abilities, capabilities, knowledge, and
skills. All team members should feel important and irreplaceable, because these
factors are the most important conditions for professional satisfaction.

Dialogue: "What is teamwork for?"

If the team is functioning well, then the effectiveness of each member of the team
is greater by about 1,5-2 times

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0% of the time when talking about the team, they mean working groups, but that's
not true.

Group + Effort + Conditions = Team

(Polyakov A.)

But the band is this:

A team is considered a more complex structure than a group, and requires

continuous effort to function successfully

Team + ... negative factors = Group

Team Skills.

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 Distinguishing characteristics of a group and a team

Factor Team Group

Mutual Very strong Not available or weak
Interests General Personal
Goals General goals Personal goals
Priority Team -№1 Me - №1
Motivation From within (I want it From within (I want it
that way) that way)
Competition Outwardly From Within Group
Communication \ Open communication and Miscellaneous \ Open or
Information information sharing closed
Trust High level of trust Little trust in each other
In each other and the
group as a whole
Nuptiality 6-20 people Any
Leader \ Sharing of roles Yes\ yes Not always

In addition to the listed distinctions, specific skills are needed (Daniel P, 2012).

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 Teamwork skills

Teamwork - a set of communication

and
Teamwork - the ability to build
Social skills. relationships with peers by working
together to accomplish assigned tasks
✓ Ability to communicate and
effectively
establish constructive dialogue
with any team member

✓ Support and help

✓ Make mistakes
✓ Trust

Teamwork is a skill that can be learned and practiced to automaticity.

Principles of teamwork:

✓ Team Organization
✓ Leadership
✓ Situation monitoring
✓ Communication
✓ Mutual support

It depends on the right organization of work in the team:

✓ Ensuring patient safety

✓ Patient satisfaction
✓ Patient Commitment to Treatment

Dialogue: "What do you think are the personal characteristics are necessary for
teamwork?"

Of course it is:

Knowledge (general mental model)

Employability (adaptability, accuracy,

Productivity, efficiency, safety)

Relationships formed (trust, professional orientation

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Dialogue: "Could there be obstacles to effective teamwork?"

Answer: "As mentioned, successful teamwork requires the efforts of each

member, so there are certain factors that can hinder effective work."

These factors are listed below:

• Incompatibility of team members

• Lack of time
• Lack of access to information
• Hierarchy
• Protective behavior
• Traditional thinking
• Negligence
• Lack of communication skills
• Conflicts
• Lack of coordination and feedback from peers
• Distractions
• Fatigue
• Excessive workload
• Misinterpretation of information
• Unclear roles and functions of team members

(team building) –
Is a complex process whose dynamics that doesn't have a straight line, it is ups and
downs, but always a road striving upward. The process of team building is not just
one training session, but a set of activities.
Is a set of trainings, aimed at the formation of effective teams capable of to achieve
high results in in any field of activity.
Teamwork of personnel on the example of emergencies
The medical team must always be prepared for contingencies, so an emergency
plan is developed in advance by team members. And after receiving a signal of an
emergency, the entire team must be guided by this plan. The team members are
different specialists. There is a hierarchy in the team, and everyone works
according to instructions that define the area of responsibility of each team
member. It is important to note that all team members need to be prepared for
increased resilience, psychological stress, endurance, self-discipline, the desire to
accomplish all tasks, and to develop skills of interaction and mutual support. In
addition, they should develop skills for cooperation and teamwork. Teams
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involved in emergencies should never show confusion or fear. This applies first
and foremost to the team leader, as he must immediately take action, mobilize the
team, and show personal discipline and "iron" restraint.
(I'm going to be a regular doctor, and I won't work in the Emergency
Department, why should I?)
"Never say never..."
I would like to answer this question with an example from my own life: When
there was an emergency in one of our cities, in one of the cities there was an
emergency situation, many professionals responded to this many specialists and
professionals responded to this grief. Everyone wanted to help. We flew into that
city at night, with a very difficult day ahead of us a very difficult day ahead of us.
After we were resettled, a staff was immediately organized.
After we got settled in, we immediately set up headquarters, which included all the
members of the team, and of course there was a leader who took responsibility for
organizing the help. All night long specialists developed a plan of joint actions,
each team member had responsibilities and every member of the team had
responsibilities and instructions about how to behave in every situation.
Multidisciplinary teams were formed which consisted of doctors, psychologists,
psychotherapists, and nurses. Each team had its own each team had its own area of
care. Thanks to the coordinated work of the team. Thanks to the well-coordinated
work of the team, the correctly made plan, the actions of the team leader, and the
skills of work in the team, we have successfully coped with all the tasks. And this
work was appreciated not by us, but by the victims and the relatives of the victims.
Although none of the team members had ever thought that they would have to
work in an emergency situation.
Case study task:
Vera Nikolayevna had an appointment for a scheduled mammogram. However, the
receptionist at the outpatient clinic where she was referred to told her that
However, the receptionist at the clinic where she had been referred to say that she
would have to pay for the examination because she was not registered at the clinic.
Vera Nikolayevna returned to her polyclinic and explained to the receptionist that
she had been denied the free examination.
She was particularly upset by the situation because
She was particularly upset by the situation because her mother had been diagnosed
with breast cancer several years ago. The receptionist assessed (1) the situation, (2)
the need to
(1) the situation, (2) the need to involve another team member (a financier), (3) the
environment environment (the patient was upset), and (4) achieving the goal (the
patient was assisted in providing the necessary service). The financier contacted

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another polyclinic, explained them the details of the agreement between the
organizations and Vera Nikolayevna was scheduled for a mammogram in the near
future.
1. What effective approaches to monitoring the situation were demonstrated in this
scenario
2. What alternative outcomes (positive and negative) of this scenario can you
suggest?
(Ricklefs V.P. 2012)
Role play: "You have all come to work in a department where patients do not want
to accept treatment. You need to show effective work by your team to make the
department cost-effective. Present and discuss the result."

Hint:

Who are the members of your interdisciplinary teams?

How do you interact with each other?

How do you share critical patient information?

If you had a magic wand, what would you change about the work of the team? And
would you make any changes?

Any health care professional needs skills when working in emergency and urgent
care. To do this, we need to break down a few algorithms for teamwork in an
emergency.

Algorithm of teamwork in emergency and urgent care

1.1 Defining the team's goal and action plan

The team leader declares a goal and an action plan to the team members

1.2 Use of resources (people, information, time, equipment)

The responsibilities of the leader are to: determine the available resources and
needs (What and who we have), prioritize on the tasks to be completed (What to do
first?), Collaborating within or across teams to develop a resource plan (Who is
working with whom/what?), anticipating possible problems with the plan (What
could go wrong?), revising the plan as needed (What to do if something doesn't
work out?)

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 1.3 Allocation of Roles, Responsibilities

The leader assigns roles and responsibilities so that everyone understands and
knows what they will be doing.

1.4 Balancing workloads within the team

Distributes the workload within the team according to each member's expertise

1.5 Encouraging teamwork

Activities:

• Conducting briefings (planning session)

• On-site meetings
• Debriefings (meeting after a project or event)

The leader in the briefing should clarify such issues:

✓ Who is on the team?

✓ Have all team members understood and agreed to the goals?

✓ Are the roles and responsibilities understood?

✓ Plan of action?

✓ Is the staff available?

✓ Workload?

On-site meetings

are held as necessary - as a result of a sudden problem or change in circumstances,

when there is a concern expressed by one of the team members, followed by a brief
meeting "on the spot" in which the problem is resolved.

Debriefing is necessary for the following:

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stimulating effective teamwork,

facilitate team interaction, work on mistakes.

Debriefing includes:

- Accurately listing and documenting what happened

- Analyzing why it happened, what worked and what

- not

- Discussing the lesson learned (the outcome of the event) and how it will affect
the action plan next time

- Creating a method formally (officially, legally)

To change the action plan in relation to the lesson learned

Questions for discussion:

✓ Is the communication clear?

✓ Are the roles and responsibilities clear?

✓ Is everyone aware of the situation?

✓ Is the workload distributed?

✓ Has support been requested or offered?

✓ Were mistakes made?

✓ What was done well, what needs to be changed, and what needs

✓ to be improved?

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Monitoring the situation (with the patient)

S - Patient Condition.

Every team member should monitor the situation, not just the leader! If one notices
a change in one of of these 4 points, he or she should let the others know, thereby
influencing progress toward the goal. Thereby influencing the progress of the goal

Patient condition - any changes in the patient's condition

T - Team Members.

Any change on the part of team members - fatigue, affecting performance of

duties, workload imbalance,

Delay in completing their part of the action plan, etc.

E - Environment.

Anything that can affect the patient's condition and the condition of the team
members - open window and noise coming from it,

Lack of any necessary equipment, broken cuffs, etc.

P - Progress toward the goal

Each team member, after a brief briefing, should know who is doing what and
what they need to accomplish, so if they see that the other team member is falling
behind in achieving the goal, he or she should take some action by reporting it. For
example, the nurse can't get into a vein, the doctor notices this and offers either his
help or an alternate place to administer medication, or a change of duties in the
team (he/she performs the injection).

Assertive behavior

is an approach in which you respect your choices and the choices of the person
with whom you are communicating.

Assertive behavior is not at all aggressive or not a desire to make a colleague bend
to his or her will.

Rather, it is about learning and exchanging opinions, developing a full

understanding of the situation, and working out a mutually beneficial solution.

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Algorithm of assertive (confident) behavior - DESC - conflict behavior

Describe - describe the situation, present specific facts

Express your feelings and why it bothers you

Suggest - offer alternatives and find a compromise

Consequences/Consensus - implications for accomplishing goals of the

team's work, to reach consensus

Emergency work requires a clear and correct understanding of each step, which is
why methods such as "Short Queries/Responses Out Loud"

А. "Pulse?"

Б. "80 over 40."

A. "Pupils?"

Б. "Constricted."

"Communication check," closing the "loop" of communication.

А. "Adrenaline."

Б. "Got it."

А. "One cc in a vein, bolus."

Б. "One cc in a vein, dribbled, done."

А. "Excellent."

"Information Pass."

I Introduction Introduce yourself and introduce yourself to your

Role/Position.

P Patient Name, age, gender, location of patient.

A Assessment Basic complaints, vital signs, symptoms and diagnosis.

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S Situation Current condition/circumstances, patient's level of awareness of
condition, recent changes, and

Reaction to treatment.

S Safety Concerns Critical indicators, socioeconomic factors, allergies, risk factors.

Also: THE algorithm

B Background Co-morbidities, previous exacerbations, current treatment, family

history

A Actions Explain what has been done or needs to be done. Justify

T Timing Level of urgency, time limit,

T Timing Level of urgency, time limits, priority of action

O Ownership Who is responsible for what (person/team), including patient and

family members

N Next What next? What is the treatment plan? What needs to happen? Is there a
back-up plan?

Consider the following algorithm for emergency and emergency care - SBAR.
This is the basis, the framework of information transfer for team members to each
other.

Situation What is happening to the patient? "I'm calling

about the patient Sokolova in room 230. Her chief complaints are of

sudden onset of shortness of breath and chest pain."

Background (context) - What is the clinical context? "The patient is 62 years old
and had abdominal surgery 24 hours ago. Prior to

No history of cardiac or pulmonary disease."

Assessment - What do I think the patient's problem is?

"Auscultatively on the right side, decreased breathing and pain is localized to the
right side. We need to rule out pneumothorax."

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Recommendation and Request - What

I would recommend? "A patient urgently needs help. Could you come to room
230?"

Types of emergency and urgent care information that every team member
needs

Information complete, concise, understandable and timely

- Complete: Communicate all relevant information while avoiding unnecessary

details that could lead to confusion.

Leave enough time for patients and their families to ask questions, and fully
answer questions.

- Understandable: Information that is clearly understood (avoid using medical

jargon and terminology with patients and family members).

Use common or standard terminology when

Communicate with team members.

- Concise: Be concise.

- Timely: Be prepared to respond to a request to provide information.

Avoid delays in relaying information that may jeopardize the patient's situation.
Note the timing of observations and interventions in the patient's history. Inform
the patient and family members frequently Verify information if it was supposed to
be

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Test Control:
1. The process of purposeful formation of a special way of interaction of
people in an organized group, allowing the effective realization of their
energetic, intellectual and creative potential in accordance with the
strategic goals of the organization, is called:
A) team building;
B) group cohesion;
C) value-oriented unity.
2. The state of effective group interaction in the process of work of
employees of the organization, clearly aware of the relationship between
the goals, methods of work and the process of successful performance of
tasks, is called:
A) cohesion;
B) a group;
C) a team.
3. a small group of people striving to achieve a common goal, constantly
interacting and coordinating their efforts, is called:
A) a team;
B) a working group;
C) a pseudo-team.
4. A person who leads others, sets the direction and pace of movement,
energizes, inspires, leads by example, draws people to himself, aims at
transformation and development - Is:
A) a manager;
B) a leader;
C) a manager; C) a leader.

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5. A person's self-image as a member of a particular group or several
groups, is called:
A) collectivistic self-concept;
B) group identity;
C) group cohesion.
6. The factors that provoke splits in a team include:
A) life crises;
B) failure of activities;
C) competition with other groups;
D) all answers are correct.
7. The conditions that ensure effective performance of the team include:
A) a supportive environment;
B) qualification and clear understanding of the roles performed;
C) team rewards;
D) open communication. 8.
8. At this stage of team building, the team constantly monitors how
effectively it is progressing is called:
A) familiarity;
B) positioning;
C) reflection.
9. The initial stage of team building, in which purposeful selection of
team members based on the principle of maximum homogeneity of
participants, taking into account the requirement of complementarity:
A) team composition;

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B) formation of a common vision;
C) acquaintance.
10.A system of agreed ideas of the team members about of what to strive
for is called:
A) forming a shared vision;
B) familiarity;
C) institutionalization

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Literature:
1. Polyakov A. Team building and teamwork skills Speech at the
business forum "Innovations in education:
Practical skills - your way to success" MGIMO.
2. Susan M. Heathfield, 12 Tips for Team Building in the Workplace,
2017.
3. Ricklefs. V.P. Interdisciplinary teams in
PHC and inpatient care (practical session). Karaganda State Medical
University.
4. Daniel P. Marlowe, Eron G. Manusov, and Deborah J. Teasley.
A Team-Building Model for Team-Based Care. 2012.

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