Collaborative Practice in Health Care

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Collaborative Practice in Health Care

Collaborative practice in health care occurs when a member of the health care team consults with another member to provide patient care. Collaboration most often occurs between doctors and nurses. "Collaboration is defined as a relationship of interdependence; the ability to work together involves trust and respect not only of each other but of the work and perspectives each contributes to the care of the patient" (Phipps and Schaag, 1995, p. 19). Effective collaborative practice amongst all health care team members leads to continuity of care, professional interdependence, quality care and patient satisfaction and decreased costs. Ongoing collaboration between health care members results in mutual respect, trust and an appreciation of what each individual brings to the overall goal in rendering care to the client. The following vignette will provide the foundation for the discussion of collaborative care, differentiating between nursing diagnosis and collaborative problems, and potential barriers 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; he is ambulatory. He is a diabetic on oral medications. He worked as a farm laborer. He lives with his wife she does not speak English she is a homemaker. He has a son who lives nearby and a nephew who periodically visits him. JG can understand some English. He does have some difficulty expressing his health concerns to the staff because of his limited vocabulary. His son or nephew brings JG to his clinic appointments. He receives weekly chemotherapy at the outpatient oncology clinic. The day I cared for JG he arrived at the clinic accompanied by his nephew. This was week seven of his treatment. His clothing was dirty, he smelled of stool, his fingernails were dirty, hair uncombed, he appeared to be dehydrated. He reported bowel movements of eight stools per day with complaints of occasional abdominal cramping. He denied nausea or loss of appetite. He stated that he was very tired and was not able to do much at home. His main concern was the frequency of his bowel movements. He reports having to go to the bathroom two to three times during the night and has episodes of soiling the bed. He reports that sometimes he does not feel the urge to go. JG was wearing adult diapers. He expressed concern that it was getting expensive for him to purchase. The nephew confirmed that JG toileting has created a problem in the home. His nephew verbalized that JG had medication for diarrhea but ran out of it and he did not have the money to purchase the medication. When questioned why he was using a wheelchair he stated that his foot hurt to walk the distance from the lobby to the treatment room. He mentioned that it was probably due to an ingrown toe nail. He also asked how he could obtain a wheel chair for his personal use at home. Physical assessment revealed that he had a necrotic area on the ball of his left foot with surrounding redness, lost 12 pounds in six weeks, poor skin turgor, hyperactive bowel sounds, and his blood pressure was slightly lower than baseline.

In the ambulatory chemotherapy setting, the clients do not always see their physician every time they receive treatment. The nurse must ascertain when to collaborate with the physician on issues regarding the patients status, response to treatment, or toxicities that may be life threatening. It is essential that the nurse is capable to communicate effectively her-(Be careful with gender bias, nurses come in both genders.) observations to the physician.

Collaborative problems are detected from the nurse's assessment of the patient. The nurse's monitoring of the patient status is to evaluate physiological complications that may threaten the patient's integrity. Management of collaborative problems will include implementing physician prescribed and nurse prescribed actions...
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