Collaborative Practice Paper

Collaborative Practice Paper

Collaborative Practice Paper

A social policy statement by the American Nurses Association (ANA) describes collaboration as "true partnership, in which the power on both sides is valued by both, with recognition and acceptance of separate and combined spheres of activity and responsibility, mutual safeguarding of legitimate interests of each party, and a commonality of goals that is recognized by both parties" (ANA 1980, p. 7). Working relationships in a collaborative practice is based on many factors that serve for recognizing the shared and separate experience, knowledge, and skills of each provider. These factors are: Cooperation, assertiveness, responsibility and accountability, autonomy, communication, coordination, and mutual respect. Collaborative practice is client centered, and offers treatment to the whole rather than pieces of the whole, with each person providing care within the scope of their practice.

The patient that I am using as my case study is a twenty-two year old female who had a lengthy stay of thirty-five days on the medical-surgical telemetry unit for a cerebro-vascular accident which left her with severe motor and sensory deficits. She cannot be transferred to a skilled nursing facility or a rehabilitation facility because she had no financial resources and no insurance. She lived with her boyfriend and they have a one year old daughter. After she got sick, her boyfriend left her and her mother and stepfather took care of her child. She had severe dysphagia that resulted in aspiration pneumonia during the course of her hospitalization. After swallow studies performed by the speech pathologist, it was recommended that she should not be given anything orally because she is high risk for aspiration. Since she is not able to take anything orally, the dietitian was consulted regarding her caloric requirements and the patient was given nasogastric tube feedings of Choice DM 240 cc every 4 hours and TPN and Lipids was started intravenously to meet her nutritional needs. Since this patient is at high risk for skin breakdown, nursing was very vigilant with her care. A foley catheter was in place and when patient developed watery, loose stools from long term antibiotics, a rectal tube was in place to prevent any complications with skin breakdown. Physical, occupational, and speech therapists were consulted to get the patient on a daily exercise program so that her condition will not get worse from inactivity.

At first, the patient's family would make visits for half an hour each day, just to see how the patient is doing. They were not really active in her care. Nursing noticed that patient seemed sad and depressed every time the family leaves. So the attending physician and case management held a family conference and explained to the family what the patient is going through right now. Since patient cannot be transferred to a skilled nursing facility, the patient has to be discharged to the parents. So while patient is in the hospital, it will a good time for family to learn how to take care of the patient. When the family started to spend more time with the patient, her progress became apparent. The patient was more cooperative during therapy sessions and just the plain family interactions improved the patient's disposition.

After the patient exhibited normal lab values and remained afebrile, a gastrointestinal specialist was consulted and a gastrostomy tube was placed. The patient's discharge is now inevitable but the parents do not have any resources to afford for home care or any type of home therapy for the patient nor to buy the food supplement for tube feeding. So the social services called several food supplement suppliers if they give supplements for charity and one company gave Choice DM food supplement good for six months. They also called a home care agency that just opened and needed test patients for survey purposes and they gladly offered free nursing and therapy services for sixty days. Social services also assisted the patient's parents in filling out application to the Department of Health and Social Services so patient can get aid from Community-Based Assistance Programs (CBA). So, on the thirty-fifth day, we discharged the patient to her parent's care. Of course, we transported the patient via ambulance (and of course, the hospital paid the bill).

Nursing diagnoses for prioritizing the patient's needs were made, based on needed nursing interventions necessary in her care. Case management became involved immediately as is the policy of this hospital. They follow the patient from admission until the day of discharge or transfer to another facility. Case management works closely with nursing to ensure that patient is receiving all aspects of care based on their medical condition and health care needs both short term and long term. Social services' involvement was also instrumental in getting the patient ready for discharge to the community and making sure that patient is connected to all community resources that are available like the Metro-Lift transportation service which is important when patient makes follow-up visits with her doctors.

As this patient developed complications during the course of her hospitalization, several physicians were involved in her care. The admitting physician, who is a Medical Internist, a Neurologist, Pulmonologist, Infectious Disease Specialist, Gastrointestinal Specialist, and a Rehabilitation Specialist, as well as all of