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Collaborative practice in health care is when one member of the health care team consults with another member to provide patient care, typically involving doctors and nurses. According to Phipps and Schaag (1995), collaboration involves interdependence, trust, and respect for each other's perspectives. Effective collaborative practice among all health care team members leads to continuity of care, professional interdependence, quality care, patient satisfaction, and cost reduction. Ongoing collaboration promotes mutual respect, trust, and an understanding of each individual's role in achieving the shared goal of providing care.
This vignette will delve into collaborative care, differentiate between nursing diagnosis and collaborative problems, and address potential obstacles to successful collaboration.
JG is a 74 year old married Hispanic male diagnosed with colon cancer. He had a history of prosthesis placement of his left lower leg and is ambulatory. He is a diabetic on oral medications and previously worked as a farm laborer. He lives with his wife, who is a homemaker and does not speak English.
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He has a son who lives nearby and a nephew who periodically visits him. JG can understand some English but has difficulty expressing his health concerns to the staff due to his limited vocabulary. His son or nephew accompanies him to clinic appointments where he receives weekly chemotherapy at the outpatient oncology clinic. During my care for JG on week seven of his treatment, he arrived at the clinic with his nephew. His appearance indicated poor hygiene, dehydration, and fatigue, with reported bowel movements of eight stools per day and occasional abdominal cramping.
He denied nausea or loss of appetite but expressed extreme tiredness and inability to perform tasks at home.
His primary concern centered around his bowel movements, reporting frequent nocturnal bathroom visits and occasional bed soiling due to lack of urge. JG's reliance on adult diapers was becoming costly, as noted by his nephew who acknowledged the home disruption caused by JG's toileting issues. The nephew further revealed JG's financial constraints preventing him from purchasing medication for his diarrhea. In addition, JG expressed discomfort walking due to foot pain, likely from an ingrown toenail, and sought advice on obtaining a wheelchair for personal use at home. A physical assessment unveiled a necrotic area on the ball of his left foot, weight loss, poor skin elasticity, hyperactive bowel sounds, and slightly lower blood pressure compared to baseline.
In an ambulatory chemotherapy setting, patients may not always directly see their physician. Nurses need to know when they should collaborate with the physician regarding the patient's condition, response to treatment, or any severe side effects. It is essential for nurses to effectively communicate their observations to the physician.
Collaborative problems occur when the nurse evaluates the patient's condition and watches for any physiological issues that may arise. These issues can put the patient at risk, leading the nurse to follow both physician and nurse-directed protocols to prevent harm. Along with recognizing collaborative problems, the nurse also develops nursing diagnoses that detail the specific issue, its origin, and related symptoms. These diagnoses can target existing or possible problems, as well as potential risks or health considerations. Nursing diagnoses are essential for establishing a care plan and deciding on suitable interventions.
In JG's case, two collaborative problems were identified. I collaborated with the physician on addressing these two issues:
JG is currently suffering from toxicity caused by the chemotherapy, which may result in electrolyte imbalance and circulatory collapse.
The recent appearance of necrotic tissue on his foot is a new development in his current health condition, increasing the risk of potential infection.
Following collaborative discussions with JG's physician and nurse, the problems were quickly resolved. Instead of receiving chemotherapy, JG was given an injection of sandostatin LR to alleviate his diarrhea. A stat basic metabolic panel was conducted, and he received intravenous hydration with potassium. Furthermore, the doctor arranged for JG to see a podiatrist the next day to assess his left foot.
During my assessment, I have identified four potential nursing diagnoses, although there may be additional ones as well.
Chemotherapy-related diarrhea is identified by increased bowel sounds and the passing of eight watery stools.
Chemotherapy leads to a loss of rectal sphincter control, resulting in signs of bowel incontinence such as fecal odor, fecal staining of clothing, and urgency.
Changes in diet caused by colon cancer can lead to symptoms such as diarrhea and abdominal cramping.
4. JG continues to experience uncontrolled symptoms because he struggles to properly manage his treatment plan, mainly due to a lack of understanding about his condition.
Considering JG's financial status, overall physical appearance, and input from his nephew, I determined it was crucial to contact the social worker for additional support. I felt that either a home visit or a thorough evaluation of JG's living situation was warranted.
The social worker arranged for in-home support and helped the patient with insurance issues to obtain necessary supplies. In hindsight, I should have involved the dietician, who could have provided valuable insights on assessing JG's caloric intake and recommending optimal nutrition.
The collaboration demonstrated in the incident above between healthcare providers was notable. The physician was open to the nurse's observations regarding her ability to accurately assess the patient's condition and potential complications. However, barriers to collaboration exist within the healthcare industry as well. These barriers can arise in patient situations where the physician lacks empathy or distrusts the nurse's evaluation of the patient's condition. This may lead to the nurse feeling inadequate, lacking confidence, and not effectively communicating accurate information to the physician.
Conflicts in desired patient goals can create barriers to collaboration. A nurse once doubted a physician's aggressive treatment of a male patient with metastatic breast cancer, comparing his appearance to that of a survivor of a Nazi concentration camp. The nurse questioned the necessity of subjecting the patient to such aggression, believing it may be too much for him to tolerate. However, despite these concerns, the patient continued with the treatment and two years later had gained weight and successfully hiked to the summit of Mt. Whitney in October of the previous year.
Role conflict is a significant obstacle to collaboration in healthcare, particularly when institutions employ both nurse practitioners and physician assistants. This conflict occurs when practitioners hold different perspectives or anticipate different outcomes (Blais, Hayes, Kozier, & Erb, 2002), which can result in legal complications. Resnick (2004) noted that physicians are hesitant to collaborate with Nurse Practitioners on an informal basis due to concerns about being held liable for the Nurse Practitioner's decisions. It is crucial to establish clear roles for all practitioners in order to avoid misunderstandings.
Collaborative practice in healthcare involves nurses identifying patient issues that require collaboration and using effective communication skills to convey their observations. Working together as a team helps reduce potential risks of complications, ultimately preventing tragic outcomes and ensuring every patient receives high-quality care.
References
The following authors contributed to the book "Professional nursing practice" in 2002: Blais, K.K., Hayes, J. S., Kozier, B. & Erb, G.
The book titled "Concepts and perspectives" is in its 4th edition and was published by Prentice Hall in New Jersey.
The book "Medical Surgical Nursing Concepts and Clinical Practice," edited by Phipps, W.J., Cassmeyer, V.L., Sands, J. E., Lehman, M.K(Eds.), discusses perspectives for health and illness (Phillips, W.J., & Schaag, H.A., 1995, p. 19). St. Luis, MO: Mosby.
Resnick, B. (2004). Limiting litigation risk through collaborative practice. Geriatric Times.
5(4), 33. Retrieved March 21, 2004 from EBSCOhost database.
Enhancing Collaborative Practice in Healthcare. (2016, Jul 11). Retrieved from https://studymoose.com/collaborative-practice-in-health-care-essay
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