Case Scenario

Collaborative Practice The following paper is a case study of how collaboration practice has taken place for a patient in the hospital. The case study will be explained then different methods of collaborating with other disciplines will be identified.

Common situations when collaborating patient care will be identified and barriers to collaborating will also be identified. Case Study An 87 year old white female was admitted to a regional hospital from her assisted living apartment. The patient had fallen in the bathroom sustaining evident external head injuries.

The patient was brought to her local hospital where a CT scan was performed identifying bilateral traumatic subarachnoid hemorrhages with bilateral temporal and frontal contusions. The patient was then transferred to a regional hospital for further evaluation by a neurosurgeon. The neurosurgeon admitted the patient to the ICU due to her rapidly declining status and the possible need for intubation.

The surgeon discussed with the family the severity of her injuries and code status. The family wanted to discuss the code status and get back to the surgeon.

The same day the patient was admitted the neurosurgeon consulted the hospitalist to assist with patient’s medical issues including, hypertension and atrial fibrillation. The patient was seen by physical, occupational, and speech therapy throughout her hospital stay. The patient was seen daily by therapies, but continued to make no progress and remained basically unresponsive.

Case management was brought into to help with discharge planning as it was apparent that the patient was not going to be able to return to her assisted living arrangements.

The discussion was made with the case management team and physicians to bring in the palliative care team as patient continued to receive nutrition via nasogastric tube feedings and it was apparent her swallowing would be impaired for quite sometime. The palliative care team became involved and worked with the family in deciding which direction to go with the patients care. The decision was difficult for the family, but they decided to remove all supportive treatments and have the patient on comfort cares.

Healthcare and Social Service Groups Collaborated The first collaboration that was done between healthcare professionals was at the patients’ local hospital and with the neurosurgeon at the regional hospital that accepted her admittance.

The physicians are required to have a doctor to doctor contact for acceptance. During the initial visit the surgeon had with the family, the surgeon collaborated with family in discussing the severity of the patients’ injuries and outcomes. The surgeon discussed code status with the family as well.

These are both examples of how the surgeon collaborated with the family. Once the patient was at the hospital, and in the ICU, the surgeon than collaborated with the hospitalist to help manage the medical aspects of the patients care.

The hospitalists also collaborated with family regarding patients’ code status and the possible need for a feeding tube. Case management became involved due to the extent of the patients’ injuries and the fact that the patient lived alone in an apartment and would likely require nursing home placement.

When patients are going to nursing home, social workers also become involved to help with the social aspects of the patients’ transfer. The case management team (case manager and social worker) collaborate together, with family, physicians, and therapies to work on a plan of care. The dietician was also collaborated within this case as the patient needed alternative nutrition and the dietician’s expertise was needed. When the patient was not progressing and it was identified that a decision needed to be made the case management team along with the hospitalist collaborated with the palliative care team.

The palliative care team consists of a certified nurse practitioner, chaplain, hospitalist, and social worker. The hospitalist and a social worker were already involved, so the team relied on the chaplain and the nurse practitioner. All these disciplines then collaborated with the family to come up with a plan to best meet the patients’ needs. There are many other examples of collaboration practice in this patients’ care, but some of the main ones have been identified. The staff nurses have collaborated with the physicians, case management team, and therapies.

The case management team then collaborated with nursing facilities that would be able meet the patients’ needs.

Common Collaborative Practices According to the ANA, collaboration is defined as collegial working relationship with another healthcare provider to carry out patient care. Collaborating may include discussing the patient’s diagnosis and management of the plan of care for the patient (Blais, Erb, Hayes, ; Kozier, 2006). Through reading Chapter 12 in Professional nursing practice, a common thread arose when discussing collaboration.

The overall goal for collaborating was identified to provide high quality patient care and satisfaction (Blais et al, 2006). In order to obtain this, the physicians need to collaborate with the patient.

It is not clearly defined what group is common, but this would be one big example, because without the patient there is no one to collaborate with. Next, I believe would be the nurses collaborating with the physician and patient. Nursing diagnosis and collaborating problems At times it may seem that many nursing diagnosis may be linked to the collaborative problem.

One has to remember; however, that nursing diagnosis is defined as a clinical judgment about a patient, family or community’s response to actual and potential health problems (Bulechek, Butcher, Dotchterman, Maas, Moorhead, & Swanson, 2006). Nursing diagnosis is used to develop nursing interventions (Bulechek et al.

, 2006). A physician’s medical diagnosis is determined and his medical treatment interventions are then implemented. It is possible that the different disciplines are attempting to treat and intervene on the same illness, for example, a patient who is not breathing effectively.

The physician’s diagnosis may be COPD and will order medical treatment to help lessen the COPD exacerbation. The nurse may use ineffective breathing pattern related to medical disease as evidenced by shortness of breath and low oxygen saturations, then develop nursing interventions that will help the patient cope with the exacerbation.

Barriers to collaborating Blais et al identified the key features to effective collaboration to be: communication skills, mutual respect, trust, giving and receiving feedback, decision making and conflict management (2006).

Of these, one of the biggest barriers in collaborating is communication. Without effective communication the patients care can be compromised, length of stay increased and an increase in cost to the patient and/or the health care system. Oftentimes a goal and objectives are not established and this is one of the keys to collaborating (Blais et al. , 2006).

If the physician is planning and doing one thing and the nurses or the case management team is doing another, then the patient plan of care becomes ineffective.