Blog: How Do You Practice Intra- and Interdisciplinary Collaboration in Practice?

Blog: How Do You Practice Intra- and Interdisciplinary Collaboration in Practice?

My experience with intradisciplinary collaboration in my practice is being part of the hospital’s nursing shared governance. The critical concepts of nursing shared governance are shared decision making between the bedside nurses and nurse leaders, which includes areas such as resources, nursing research/evidence-based practice projects, new equipment purchases, and staffing. This type of shared process allows for active engagement throughout the healthcare team to promote positive patient outcomes and creates a culture of positivity and inclusion, which benefits job satisfaction (McKnight, 2022). Being a part of the nursing shared governance in my practice, gives me the opportunity to work with different nurses from different specialties.

One of the issues that we helped resolve was when it was brought to our attention that there was a rise in complaints of nurses not giving detailed report during shift change, which most times caused delay in care. We took a random survey of important information that needs to be passed on during every shift change report from about ninety percent of the nurses in the hospital, which allowed us to come up with a detailed universal report shift templates for all the nurses. Ninety days after the initiation of the project, we saw a decrease in the amount of complaint and saw an increase in nurses’ knowledge of their patients.

My experience with interdisciplinary collaboration in my practice is being part of the daily team rounds. Interdisciplinary rounding is a structured approach for integrating care provided by the staff nurse, hospitalist/attending physician, care manager and patient/family, creating a structure for more streamlined communication and planning (Reduce Hospital days and Dollars with Interdisciplinary Rounds, 2018). The key component in these rounds is communication, making sure that everyone involved in the patient’s care is on the same page. According to Busari et al (2017), the communication between nurses and physicians is a key factor for effective interprofessional collaboration and thus, for the assurance of the quality of care.

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Being a part of shared governance, having similar experiences and being at the fore front of patient care, makes it easier for us to implement ideas that changes the hospital’s policies and processes for better patient outcomes. It also allows us to become engaged due the positive outcome that results when these changes are being made. However, trying to get nurses involved outside of their working hours becomes hard sometimes. With interdisciplinary rounds, it improves communication with all parties involved for quality patient care. Patient’s issues are resolved in a timely manner. This can however be time consuming as it requires frequent meetings for it to be effective.

Like Henry et al. (2018) case study design approach, the interdisciplinary team rounds, allow each team member to see problems through the eyes of another. Before the interdisciplinary rounds became the norm in my facility, there were constant drop in communication and even while reading the physicians notes, there were so many decisions being made regarding the patient care that I did not understand. After attending the rounds, these decisions were talked about in depth as it pertains to each person’s field. This allowed even for better communication with not just the team but also with the patient.

Reference

McKnight, H. (2022, September 19). Nursing Shared Governance. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK549862/#:~:text=Definition%2FIntroduction,new%20equipment%20purchases%2C%20and%20staffingLinks to an external site..

Reduce Hospital Days and Dollars with Interdisciplinary Rounds. (2018, December 19). Premier. https://premierinc.com/newsroom/blog/reduce-hospital-days-and-dollars-with-interdisciplinary-rounds#:~:text=Interdisciplinary%20rounding%20(IDR)%20is%20a,more%20streamlined%20communication%20and%20planningLinks to an external site..

Busari, J., Moll, F., & Duits, A. (2017). Understanding the impact of interprofessional collaboration on the quality of care: A case report from a small-scale resource limited health care environment. Journal of Multidisciplinary Healthcare, Volume 10(1), 227–234. NCBI. https://doi.org/10.2147/JMDH.S140042Links to an external site.

Henry, B., Male, B., Garner, C., & Guernon, A. (2018). Teaching and learning about  interprofessional collaboration through student-designed case study and analysisLinks to an external site.Links to an external site.. International Journal of Teaching and Learning in Higher Education, 30(3), 560–570.

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 You referred to the interdisciplinary team as a partnership among various healthcare professionals. This is a great way to describe the healthcare team in reference to patient care. A partnership forces accountability, mutual respect, defined expectations, and communications.  According to Berry et.al (2021), for health care to reach its full potential as a service, trust must also include the notion of partnership, whereby patients see their clinicians as reliable, caring, shared decision-makers who provide ongoing “healing” in its broadest sense. 

As interdisciplinary rounding becomes part of the standards for improving patient care and outcomes, we realize the importance each discipline plays and how much we begin to rely on daily rounding. During patient discharge, we all know case management is the discipline that ensures many of the patient’s needs are met beyond discharge.  As a nurse, I see the concern many of my patients have about care implemented beyond their hospital stay. I often have solace in knowing I can give them an adequate update about care for discharge.

This is due to interdisciplinary teamwork and rounding. If I don’t have immediate answers, it is comforting knowing case management can be called in to visit a patient and address concerns they may have. Henry et al. (2018) study allowed participants to gain respect and appreciation for what each discipline brings to a team.  The study also allowed professionals to see problem-solving from a different perspective.  In retrospect, we use the Henry et al. (2018) study as a model daily.

       As a supervisor, you mentioned pairing nurses with other healthcare providers to give them an opportunity to experience what each discipline does in their role.  Prior to implementing this effort, you also mentioned thinking interdisciplinary rounding was an extra responsibility. The differences in the views and attitudes of healthcare professionals regarding the importance of collaboration indicate that there is a need for changes in formal education in the field of interprofessional collaboration (Sanc and Prason 2022). Not understanding roles leads to conflict and overstepping boundaries. We have a general idea of what each team member brings, but we don’t always know what goes on behind the scenes to see what is required to meet patient needs. Sometimes understanding and respecting what one brings means stepping into their position. Ultimately gaining more knowledge and respect as to what each discipline brings to the team.

References 

Berry, L. L., Awdish, R. L. A., Letchuman, S., & Steffensen, K. D. (2021). Trust-Based Partnerships Are Essential — and Achievable — in Health Care Service. Mayo Clinic Proceedings, 96(7), 1896–1906. https://doi.org/10.1016/j.mayocp.2021.03.035

Henry, B., Male, B., Garner, C., & Guernon, A. (2018). Teaching and Learning about Interprofessional Collaboration Through Student-Designed Case Study and Analysis. International Journal of Teaching & Learning in Higher Education, 30(3), 560–570.

Sanc, P., & Prosen, M. (2022). Interprofessional collaboration in interdisciplinary healthcare teams: A quantitative descriptive study. Medpoklicno sodelovanje v interdisciplinarnih zdravstvenih timih: kvantitativna opisna raziskava Obzornik Zdravstvene Nege, 56(1), 9-21. https://doi.org/10.14528/snr.2022.56.1.3106

You are the DNP-prepared nurse responsible for overseeing a large intensive care unit (ICU). You have noticed that in the last 3 months, the number of nosocomial, or hospital-acquired infections (HAIs), has dramatically increased among patients who have undergone cardiovascular procedures. You would like to initiate a practice study to determine the source of these HAIs and to improve patient outcomes in your ICU. 

Photo Credit: Andrey Popov / Adobe Stock

What types of interdisciplinary collaboration might be needed to support the goals of your practice study?

As outlined in the scenario, the likelihood to engage in interdisciplinary collaboration to enhance healthcare delivery and nursing practice is high. In fact, it is likely that the DNP-prepared nurse in the scenario presented may need to collaborate with an infection prevention specialist (who may be a PhD-prepared nurse or PhD-credentialed healthcare professional). While this represents only one potential area in which interprofessional collaboration may take place in advanced nursing practice, it is important to keep in mind that when disciplines work together toward a shared goal that focuses on the patient, the quality and cost of care delivered will be optimized (Johnson & Johnson, 2016).

For this Blog Assignment, review the Learning Resources and reflect on strategies that may be used to foster interdisciplinary collaboration in nursing practice. Reflect on strategies and approaches you might recommend that support interdisciplinary collaboration in practice.

_{Reference:
Johnson & Johnson. (2016). The importance of interprofessional collaboration in healthcare.
https://nursing.jnj.com/getting-real-nursing-today/the-importance-of-interprofessional-collaboration-in-healthcare}

To prepare:

• Review the Henry et. al. (2018) article in this week’s Learning Resources about collaboration through case study design.
• Reflect on how the approach of case study design may apply toward fostering intra- and interdisciplinary collaboration in practice.
• Select at least one of the articles from this week’s Learning Resources and reflect on how professional collaboration is executed to address the needs described in the article.
• Reflect on your own experiences with intra- and interdisciplinary collaboration in your practice.

By Day 3 of Week 6

Post a response to your Blog describing your own experiences with intra- and interdisciplinary collaboration in your practice. What were the strengths and weaknesses of this collaboration? How might your own experiences mirror the perspectives and viewpoints presented in the Henry et al. (2018) case study design approach? Be specific and provide examples.

By Day 5 of Week 6

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by expanding on your colleague’s post or suggesting an alternative viewpoint/perspective on the experiences described by your colleagues.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 6 Blog Rubric

Post by Day 3 of Week 6 and Respond by Day 5 of Week 6

To Participate in this Blog:

Week 6 Blog

To develop the critical thinking abilities required for nursing practice, case study design is a great idea. This encourages collaboration among different disciplines and helps students understand more about what they do as well as expands their thinking and problem-solving abilities, which will help them once they graduate and enter the real world. According to an article quoted by the National League of Nursing (2016), there is a gap between the realities of practice and the use of teamwork skills to provide patient-centered care. This gap is between team training in educational programs and the actual practices of working in teams. Implementing these case study methods is beneficial when a nursing student needs to make a sincere commitment to studying and broadening their knowledge base.

Working as a team and understanding the dynamics of each specific professional discipline are made possible by collaboration with other professionals. This also enables students to observe firsthand how each discipline contributes to the implementation of better patient care. Building respect, stronger relationships, and improved health outcomes are facilitated by establishing a working relationship while comprehending each discipline’s role in patient care (Almendingen et al., 2021). The first stages of competency-based interprofessional education, according to Barr (1998), as referenced by Henry et al. (2018), involve understanding and respecting the roles of other professionals. For teamwork to be successful, this is a crucial component.

 As an illustration, I previously cared for a patient who had several chronic conditions. Working together with the other specialists on the care team, we were able to create a comprehensive plan of care that satisfied all the patient’s needs. It was essential that we build a strong rapport with the patient and their family to deliver the best care. While working together, tension and disagreement might arise. There may be disagreements about care procedures and varying priorities among the team members.

For instance, a doctor would prefer to focus on treating a patient’s medical condition, whereas a social worker could be more concerned in addressing the patient’s social concerns. To better meet the needs of patients, professional Collaboration is used to deliver what is required in a variety of ways. One way is by bringing people together to pool their knowledge from different disciplines to discuss and solve problems. According to Henry et al. (2018), viewing difficulties from the perspective of another person forces students to adapt their problem-solving techniques in new ways (Henry et al., 2018), This helps students receive the information they need to build on their fundamental knowledge and increases their comprehension of what goes into treating the patient.

Another good illustration was When I was a posted to surgical unit as a student nurse in Africa. I recall my first encounter with an interdisciplinary team.  Once a week, the patient’s primary nurse, the doctor and referral partner (such as a cardiologist or internist), the social worker, dietician, and charge nurse would conduct grand rounds on the patients.

After that, we would convene for a conference to discuss what the patient would need at that time and after discharge, and we would go over how we would make it all happen. To achieve the goals of a quicker recovery, shorter hospital stays, and enhanced care after release, collaboration was found to be crucial for averting unfavorable long-term outcomes.

Interprofessional collaboration in healthcare is a partnership of various health professionals to deliver high-quality treatment to patients, families, and carers. According to Ansa et al. (2020). Working as a team to solve difficult medical problems for one patient at a time is an efficient strategy.

 Initially, twenty-five years ago, I considered those rounds to be only an additional responsibility for staff. When I was given the responsibility of supervisor, I was able to see more clearly how important each function was within that partnership and how it ultimately affected the patients. This demonstrates the necessity of case study design in nursing education to educate nurses for collaboration in the real world.

Once in the workplace, I would advise pairing nurses up with an interdisciplinary team member once a week so they can have a more in-depth grasp of what each discipline entails and how it contributes to patient care. Finally, enlist the nurse and a team member to collaborate on finding solutions to problems and resolving patient care difficulties. By setting a goal for the patient and pairing a nurse with a team member once a week, it may be possible to provide the patient with treatment that is both more targeted and more collaboratively thought out.

References: 

Ansa, B. E., Zechariah, S., Gates, A. M., Johnson, S. W., Heboyan, V., & De Leo, G.

       (2020).  Attitudes and behavior towards interprofessional collaboration among

        healthcare Professionals in a large academic medical center. Healthcare, Vol 8, Iss

        323, p 323 (2020). DOI: 10.3390/healthcare8030323

        https://doaj.org/article/aca411b3c5614eb29109661d321f014eLinks to an external site. 

Barr, H. (1998). Competent to collaborate: Towards a competency-based model for 

         Interprofessional education. Journal of Interprofessional Care, Vol 12(2), May,

1998. Special Issue: Competent to practice. pp. 181-187. DOI:

        http://dx.doi.org/10.3109/13561829809014104Links to an external site. 

Henry, B., Male, B., Garner, C., & Guernon, A. (2018). Teaching and learning about interprofessional collaboration through student-designed case  study and analysis Links to an external site.Links to an external site..

International Journal of Teaching and Learning in Higher Education, 30(3), 560–570.

Almendingen, K., Sparboe-Nilsen, B., Kvarme, L. G., Benth, J. S., & Saltyte Benth, J.

       (2021).Core competenciesfor interprofessional collaborative practice: Journal of

        Multidisciplinary Healthcare; Aug2021, Vol. 14, p2249-2260, 12p DOI:

       10.2147/JMDH.S325086

National League for Nursing. (2016). Interprofessional collaboration in education and

      practice. Nursing Education Perspectives. Jan 01, 2016, 37(1):58-58. DOI:

      10.1097/01.NEP.0000476111. 94472.a6

Ceballos et al. (2020) conducted a cross sectional descriptive study to analyze the characteristics, related factors and consequences of physical violence and verbal abuse against nurses.  The study included nurses in Brazil who worked in the three largest 24 hour emergency rooms.  Ceballos et al. (2020) defined workplace violence as a set of behaviors, practices or threats, which can cause damage to a worker.  They also defined verbal abuse as any form of mistreatment, explicitly spoken or implied, which can cause feeling of devaluation or humiliation (Ceballos et al., 2020).

Their research discovered there a set of factors which can determine a high or low risk for abuse.  These factors included working greater than 5 years as a nurse, being a female nurse, and working the night shift (Ceballos et al., 2020).  The study reported 36.4% of nurse worldwide suffer from physical abuse, and 67.2% from non-physical abuse.  Ceballos et al. (2020) concluded most cases of abuse are underreported due to fear of retaliation and lack of management support.  Most cases of physical abuse were from the patient, whereas verbal abuse was more likely received from a patient’s companion.  Nurses who experienced verbal abuse were most likely to suffer from sadness, those who were physically abuses developed low-self- esteem, and elevated stress (Ceballos et al., 2020). 

In contrast, a cross-sectional descriptive study done in Pakistan by Khan et al. (2015) focused on female nurses and female doctors.   Khan et al. (2015) noted in Pakistan, the profession of nursing is not seen as acceptable, and does not hold the same level of esteem as a female doctor.  The study included a mix of female doctors and nurses, and found 77.8% of the participant’s experienced physical abuse, and 97.1% of participant’s experienced verbal abuse (Khan et al., 2015).  The risk factors related to the incidence of abuse, had to do with the ability of the female nurse or doctor being able to accommodate both home and work life (Khan et al., 2015).  Most incidences of abuse occurred from in-laws/spouses, and most did not report abuse due to fear of retaliation (Khan et al., 2015). 

Ceballos et al. (2020) found that 36.4% of nurse experienced physically abuse, while Khan et al. (2015) found that 77.8% of nurses and female doctors experienced physical abuse.  Both studies also report verbal (or non-physical abuse) is more prevalent with 67.2% of nurses experiencing verbal abuse in the Ceballos et al. (2020), and 97.1% of the research participants in the Khan et al. (2015) experiencing some form of verbal abuse.  These studies together confirm that physical and verbal abuse is a prevalent issue in nursing, despite the cultural background. 

Synthesis is the ability to take multiple pieces of data or evidence, and showing the similarities between two sources, or how they relate to each other.  The aim of synthesizing data or evidence is to draw a conclusion about the body of evidence you are exploring (Higgins et al., 2019, p. 229).  The starting point of synthesizing evidence, is to perform a thorough summarization of your readings (Higgins et al., 2015).  This allows one to review text, and articulate the main points in your own words. 

References:

1. Ceballos, Joyce Borges, Frota, Oleci Pereira, Nunes, Hevelyn Francielle Soares Souto, Ávalos, Patricia Lima, Krügel, Camila de Carvalho, Ferreira Júnior, Marcos Antonio, & Teston, Elen Ferraz. (2020). Physical violence and verbal abuse against nurses working with risk staratification; characteristics, related factors, and consequences. Brazil Journal of Nursing, 73(Suppl. 5), e20190882. Epub December 21, 2020.https://doi.org/10.1590/0034-7167-2019-0882
2. Khan, A. J., Karmaliani, R., & Ali, T. S. (2015). Interpersonal Verbal and Physical Abuse against Female Nurses and Doctors in Karachi, Pakistan. International Journal of Nursing Education, 7(2), 290–295. https://doi-org.ezp.waldenulibrary.org/10.5958/0974-9357.2015.00121.X
3. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (2019). Summarizing study characteristics and preparing synthesis. In J.E. McKenzie, S. E. Brennan, R.E Ryan, H.J Thompson & R.V. Johnston (Eds). Cochrane Handbook for Systematic Reviews of Interventions (2^nd ed, pp. 229-240). Chichester (UK): John Wiley & Sons.  https://doi.org/10.1002/9781119536604.ch9

 You referred to the interdisciplinary team as a partnership among various healthcare professionals. This is a great way to describe the healthcare team in reference to patient care. A partnership forces accountability, mutual respect, defined expectations, and communications.  According to Berry et.al (2021), for health care to reach its full potential as a service, trust must also include the notion of partnership, whereby patients see their clinicians as reliable, caring, shared decision-makers who provide ongoing “healing” in its broadest sense. 

As interdisciplinary rounding becomes part of the standards for improving patient care and outcomes, we realize the importance each discipline plays and how much we begin to rely on daily rounding. During patient discharge, we all know case management is the discipline that ensures many of the patient’s needs are met beyond discharge.  As a nurse, I see the concern many of my patients have about care implemented beyond their hospital stay. I often have solace in knowing I can give them an adequate update about care for discharge.

This is due to interdisciplinary teamwork and rounding. If I don’t have immediate answers, it is comforting knowing case management can be called in to visit a patient and address concerns they may have. Henry et al. (2018) study allowed participants to gain respect and appreciation for what each discipline brings to a team.  The study also allowed professionals to see problem-solving from a different perspective.  In retrospect, we use the Henry et al. (2018) study as a model daily.

       As a supervisor, you mentioned pairing nurses with other healthcare providers to give them an opportunity to experience what each discipline does in their role.  Prior to implementing this effort, you also mentioned thinking interdisciplinary rounding was an extra responsibility. The differences in the views and attitudes of healthcare professionals regarding the importance of collaboration indicate that there is a need for changes in formal education in the field of interprofessional collaboration (Sanc and Prason 2022). Not understanding roles leads to conflict and overstepping boundaries. We have a general idea of what each team member brings, but we don’t always know what goes on behind the scenes to see what is required to meet patient needs. Sometimes understanding and respecting what one brings means stepping into their position. Ultimately gaining more knowledge and respect as to what each discipline brings to the team.

References 

Berry, L. L., Awdish, R. L. A., Letchuman, S., & Steffensen, K. D. (2021). Trust-Based Partnerships Are Essential — and Achievable — in Health Care Service. Mayo Clinic Proceedings, 96(7), 1896–1906. https://doi.org/10.1016/j.mayocp.2021.03.035

Henry, B., Male, B., Garner, C., & Guernon, A. (2018). Teaching and Learning about Interprofessional Collaboration Through Student-Designed Case Study and Analysis. International Journal of Teaching & Learning in Higher Education, 30(3), 560–570.

Sanc, P., & Prosen, M. (2022). Interprofessional collaboration in interdisciplinary healthcare teams: A quantitative descriptive study. Medpoklicno sodelovanje v interdisciplinarnih zdravstvenih timih: kvantitativna opisna raziskava Obzornik Zdravstvene Nege, 56(1), 9-21. https://doi.org/10.14528/snr.2022.56.1.3106

Recently, at work, on a day we were working short, which is becoming our new standard due to it happening frequently, my coworker yelled to come into a patient’s room because I am the charge nurse, and she had an urgency to her voice. I rushed to the room and asked her what was wrong. She replied that her patient passed out briefly and came back alert and that he started moaning softly. The patient’s diagnosis is alcoholic cirrhosis, and he got paracenthesis the day prior. I immediately told her to get a set of vital signs, and I contacted the rapid response nurse and the patient’s primary care physician. The rapid response nurse came immediately and started helping us assess the patient. She inserted another intravenous line, drew blood cultures and lactate, and did other things that helped lessen our burden with what we might have to do for the patient. The patient’s vital signs were low but within normal limits. The patient’s oxygen saturation was 88% on room air. We put the patient on 3 liters of oxygen via a nasal cannula, and his oxygen went up to 94%. However, he looked very sick. The doctor, too, came within six minutes, and we made him aware of the situation. The patient did not look stable at all when you looked at him. I informed the doctor to consult the medical intensive care unit (MICU), and he said nothing. Within ten minutes later, the rapid response nurse told all of us that the patient’s lactate result was >6 with a venous blood gas. Lactate level shows the severity of a patient’s illness, and septic shock is likely with a serum lactate level >2 mmol/L (Christopher et al., 2021). The doctor was still staring at the patient while the primary nurse and rapid response nurses were still working on the patient to make him comfortable. I urged the doctor again to consult MICU and reminded him that the patient’s lactate was greater than six, and he replied, OK. Three MICU doctors came soon after, and I informed them that the patient passed out briefly and told them the patient’s lactate result. The MICU doctors evaluated the patient, and they and the primary care doctor went outside the patient’s room; I followed them out and saw them looking into the patient’s chart for history and trends in vitals and labs. The MICU doctors accepted the patient right away. The rapid response nurse, primary care nurse, primary care doctor, and I transferred the patient to MICU. Within three hours of moving the patient to MICU, we heard a code blue announced with the room number we just placed the patient in.

Strength and Weakness

Effective interprofessional collaboration (IPC) is vital in every healthcare structure (Ansa et al., 2020). The strength of everyone in my scenario is that we all worked well together and played our roles based on what we were already assigned when we came to work. We listened to each others’ concerns and did not dismiss anyone. Someone could have said that the patient was stable and we did not need to worry due to his stable vital signs. The only weakness I can see now is that the primary doctor did not alert MICU faster and only did so because I insisted that he consult MICU.

How own experiences mirror the viewpoints presented in the Henry et al. (2018) case study

One similarity between the Henry et al. (2018) case study design approach and my experience at work is that we were understaffed the day the patient had a change in his condition. The primary care doctor did not initially listen to my concern about consulting the MICU team. He only consulted them due to my urging him to contact them and reminding him of the patient’s lactate results. The doctors from the Henry et al. (2018) case study design doctors did not listen to the concerns of the nurses about the officer possibly having a head injury.