Collaborative Practice

Collaborative Practice

In our ever changing health care system the need for collaboration is more needed than ever. Collaboration as defined on Wikipedia "is a process defined by the recursive interaction of knowledge and mutual learning between two or more people who are working together, in an intellectual endeavor, toward a common goal" (Wikipedia, 2007). Collaboration is a complex process that requires intentional knowledge sharing and joint responsibility for patient care. Sometimes it occurs within long-term relationships between health professionals. On other occasions, collaboration may involve short encounters. In these settings there is no second chance to collaborate effectively (Lindeke & Sieckert, 2005).

The challenge, then, is to make the most of all interactions in order to utilize the best knowledge and abilities of all the health team and produce positive patient outcomes. Each health care profession has information the other needs to possess in order to practice successfully. Neither can stand alone, making good collaboration skills essential (Lindeke & Sieckert, 2005). The purpose of this paper is to look at a case study illustrating collaborative practice between healthcare entities and how they interact or should have interacted more effectively.

Collaboration is multidimensional. It can occur in both face-to-face encounters and electronically via fast paced interactions such as voice mail and email. In whatever place or form, collaboration involves an exchange of views and ideas that considers the perspectives of all the collaborators, whether or not agreement is reached in the interaction (Coeling & Cukr, 1997). It is necessary to define what is not implied by the term Ð''collaboration'. It does not imply supervision nor is it simply a one-way or two-way information exchange. Effective professional collaborative relationships require mutual respect (Kramer & Schmalenberg, 2003). Collaboration may seem idealistic and perhaps even unrealistic. However Kramer and Schalenberg (2003) state that collaborative partnerships are worth the effort because they result in better outcomes for patient as well as personal growth for collaborators.

Case study: 44 yr old African American male brought to the CCU from the Emergency Department. Patient has history of coronary artery disease, hypertension, increased lipids, obesity and diabetes. Patient was on way to obtain pizza from local eatery when he went into coronary arrest. Paramedics were called to the scene where the victim was unresponsive, no pulse and not breathing. Patient was shocked per ACLS protocol at the time and pulse and breathing resumed. On arrival to the unit patient was breathing on his own and heart rhythm was sinus rhythm. Numerous marks on his chest indicated shocking by EMS personnel. The patient was receiving all meds through his IV since he was unresponsive.

The collaborative team in this case consisted of the Cardiologist, the Pharmacy, Nursing and Clergy. Later on Social services became involved for long term placement and continued care outside the hospital. Since nursing was at the bedside 24 hours a day the MD on the case relied on him/her to keep him informed of the patient's condition or needs. During this time the pharmacy was directly involved in discussion with the MD and nursing focusing on BP control, embolus prevention medications and other needed meds. During his stay in the unit there was also a PT/OT evaluation and consult. Since the patient was unable to function on his own OT signed off till further progression later on in the hospital stay. PT would be provided in the passive range of motion to prevent contractures and circulation. Respiratory therapy was called in to be involved to prevent pneumonia and secretion build up. Since the hospital was Ð''religious' based Clergy was involved to provide emotional support for the patient's family.

There is a direct link between the nursing care plans and the collaborative process. The nursing care plans identify areas that need to be covered by different entities in the patient's stay and are continually evolving as the patient progresses or digresses. Detailed care plans can help identify other health team members that need to be included in the collaborative process.

Care Plans:

Ð'* Cardiac output decreased related to patient's uncontrolled hypertension, diabetes and obesity.

Ð'* Knowledge Deficit related to disease process and lifestyle as evidenced by obesity, lack of exercise, food choices, exercise and uncontrolled blood pressure.

Ð'* Potential for infection related to immobility and prolonged hospital stay.

Ð'* Coping