Interdisciplinary Approaches in Advanced Practice Nursing

Transcription

1 1 Interdisciplinary Approaches in Advanced Practice Nursing What this means to me While reflecting on the meaning of an interdisciplinary approach, I think of collaboration and multidisciplinary interactions as related concepts. The concept of collaboration reminds me of: a. The ability to recognize that my client will benefit most from my care if I consult with and learn from other professional experts. b. The respect I have for the knowledge, skills and clinical reasoning abilities of other professionals and their willingness to share this with me. c. The importance of getting to know professionals from other disciplines, their education, experience and area of expertise. The concept of multidisciplinary interactions also relates to the points mentioned above but most strongly reminds me of the need to expand collaboration not only among a few select professional disciplines but to explore a multitude of disciplines, some of which I may be less familiar with. I think of it as a toolbox with multidisciplinary colleagues as the different tools available to me and how having a variety of tools in that box, instead of just a few old favorites, would give me many different options in providing the most appropriate, most innovative and best care for my clients. The concept of intra-disciplinary relationships reminds me of the collaboration we share with others in the nursing profession. Although this may appear initially as counterproductive to the concept of interdisciplinary partnerships, I think it is increasingly important to recognize the growing differentiation among members of our own profession and how we may capitalize on the expertise of a nursing colleague when we encounter clients with less common yet complex health care needs. Nursing colleagues working as team members in specialty clinics may be our key to access a whole new network of multidisciplinary professionals. Pondering my understanding of these related terms, the importance of providing high quality care for my patients and the realization that I will need partnerships with other health care professionals and

2 2 wellness experts to do so, became evident. It is, in my opinion, impossible for any health care professional to provide quality care to clients when working in isolation. Factors which facilitate the development of interdisciplinary partnerships include: a. The incredible increase in health-related knowledge, the development of new treatment modalities and technologies and our human inability to know it all. b. The growing complexity of patient concerns and the number of co-morbidities (both physiological and psychological) which must be considered even when treating an otherwise uncomplicated concern. c. Professionals committing to the delivery of high quality care to their clients through collaborative practice and forming partnerships with other care professionals to jointly design, deliver and evaluate the care of the patient. According to the National Joint Practice Commission (NJPC) joint practice (a product of interdisciplinary collaboration) results in increased quality of care, increased patient and provider satisfaction, decreased morbidity and mortality and decreased hospital stay (Buttaro et al., 2008). Effective interdisciplinary cooperation further also sets the stage for expanding the efforts to address patient concerns and when well coordinated, greatly increase the productivity of health care systems where resources, expertise and energy can be pooled. Could this something we need to focus on as we approach the implementation of health care reform? Related Course Outcomes My interpretation of how the course outcomes (Washburn University School of Nursing, 2011a) relate to interdisciplinary approaches to care, are summarized in Appendix A, table1. Related Program Outcomes All of the desired program outcomes (Washburn University School of Nursing, 2011b) for nurse practitioners in this advance practice nursing program can be related to interdisciplinary approaches to care. These relations are reflected in Appendix B, table 1.

3 3 How this topic relates to my current practicum The recognition of complex patient concerns, the benefits of teamwork and the increased efficacy of collaborative care have in my current practicum situation, facilitated the development of interdisciplinary teams of health care professionals. This rural primary care clinic is one of six locations within a community health care organization where health care professionals work together as members of an interdisciplinary team on a day-to-day base. I ve had the privilege to bear witness, on multiple occasions, to nurse practitioners, physician assistants and physicians consulting with each other but also with physical, occupational and speech therapists, with psychologists and social workers, nutritionists, radiologists and even laboratory technicians. When needed, the services of local clergy, fitness experts, chiropractors, local health department officials and providers of complementary wellness services (such as massage therapists) have also been sought. Within this health care system, I see a high level of interdisciplinary respect among the members of the different professions and a general willingness of professionals to share their clients with a colleague whose input will be of benefit to the client. Examples of these include frequent referrals to or discussions with a nurse practitioner with expertise in wound care and another with expertise in diabetes education and management. When patients are referred to home-health services, weekly case conferences occur through video-conferencing to discuss the treatment plan, progress and concerns of each home-health patient. In my mind, this represents what interdisciplinary approaches should look like. How my future advanced practice will be influenced by this topic Exposure to the idea of an interdisciplinary (or multi-disciplinary) team approach has fortunately been part of my nursing experience since the very beginning of my career. I ve seen it work in the very rural areas of Africa where I did a few clinical rotations, where even tribal healers and village elders functioned as part of the collaborating team. I believe the success of any interdisciplinary approach relies heavily on mutual trust, respect and understanding. Interdisciplinary health professionals should be able to trust fellow professionals with the care of their clients; should have respect for their colleagues and,

4 4 have a very good understanding of the education, expertise, scope of practice and ethical principles of their fellow professionals. Equally important is that I need to practice in such a way that my fellow professionals will trust and respect me and that they will have an accurate understanding of my education, expertise, scope of practice and ethical or moral standards. After reflecting on this topic (and on everything I ve learned in my previous courses and clinicals) I am convinced that my clients will benefit most from my care if I am willing to admit that: (a) I need other expert professionals to grow into an expert myself, and (b) even experts need the input, help and reflection other professionals can offer. I believe the interdisciplinary team approach offers our clients and their families the best a group of interdisciplinary expert clinicians can offer. It combines the best of our knowledge, abilities, intentions and efforts and reflects our commitment to the highest quality of primary care. I aspire to make this my goal. References Buttaro, T.M. Trybulski, J., Bailey, P.P. and Sandberg-Cook, J. (2008). Primary care: A collaborative practice (3 rd ed.). St. Louis, MO: Mosby Washburn University School of Nursing (WUSON). (2011, Fall). Course syllabus: NU602 Adult Health Practicum I. Retrieved September 12, 2011 from Washburn University Angel website: Washburn University School of Nursing (WUSON). (2011). MSN Student Handbook Retrieved September 12, 2011 from Washburn University Angel website:

5 5 Appendix A Table 1 Relation of course outcomes to interdisciplinary approaches in advanced practice nursing Course Outcomes 1. Integrate knowledge from previous courses to care for diverse adults in primary care settings. 2. Apply critical thinking skills in the development of differential diagnoses related to select health problems encountered by adult populations. 3. Exhibit advanced communication skills in interdisciplinary settings. 4. Develop culturally appropriate, individualized patient education programs. 5. Design therapeutic interventions to maximize health and wellness in diverse adult populations. 6. Evaluate diagnostic test results in collaboration with interdisciplinary teams. 7. Apply ethical and legal principles to care of adults in primary care settings 8. Utilize research in providing culturally competent care. How I relate this to an Interdisciplinary Approach 1. Professional Role Development course developed understanding of different roles of the APN as well as importance of collaborative practice with other professionals 2. Approaching client s health problems with an interdisciplinary mindset (collaboration, case discussion, appropriate referral) allows not only for critical thinking but also being able to compare my critical thinking skills with those of other professionals and learning from them. 3. Effective communication the cornerstone of successful interdisciplinary team experiences. Know what to ask, how to ask and how to present your clients to a fellow professional. 4. Consulting with professionals experienced in dealing with certain cultural groups to design a culturally appropriate treatment plan/education program for clients of different cultural groups. 5. Working with a diverse variety of other healthcare and wellness professionals facilitates the development of maximally beneficial therapeutic interventions. 6. As a novice I regard it as essential to compare my evaluation of diagnostic test results with the opinion of expert fellow professionals. Expertise in different fields allows us to look at the same set of results from different points of view hopefully decreasing the likelihood of any diagnoses being missed. 7. I regard it as my ethical obligation towards my clients to seek the opinions of other experts in order to ensure the highest quality of care. 8. Knowledge resources from different professionals can be pooled to allow for more effective utilization of research in designing, delivering and evaluating culturally competent care.

6 6 Appendix B Table 1 Relation between MSN program outcomes and interdisciplinary approaches in advanced practice nursing Program outcomes 1. Provide organizational leadership demonstrating knowledge of health policy and health care systems 2. Integrate knowledge and theory into evidence-based practice and research. 3. Collaborate with interdisciplinary groups within the role and scope of advanced practice nursing. 4. Demonstrate sound critical thinking and clinical decisionmaking. 5. Provide holistic care that is culturally proficient with diverse groups and communities. 6. Incorporate ethical and legal principles in health care policies. 7. Integrate effective communication in advanced nursing roles. Relation to an Interdisciplinary Approach 1. Effective leaders know the limits of their knowledge and expertise and in consulting with fellow professionals, demonstrate their respect of the knowledge and roles of others. 2. Knowledge resources can be pooled for more comprehensive, more effective and more efficient integration of knowledge & theory into evidence based practice. 3. Effective interdisciplinary collaboration increases the quality of patient care evident in increased patient satisfaction and provider satisfaction and decreased morbidity & mortality. 4. Sound critical thinking also includes the ability to recognize that I don t know enough about something and instead of making clinical decisions based on my own limited knowledge or experience, am able to consult with other more experienced professionals. 5. In order to provide holistic care, the provider who designs the care should have a variety of tools/approaches available. If lacking in some specific area, collaboration with a fellow professional will provide the tool needed (example- knowledge regarding complementary treatment modalities) to equip the provider to provide truly holistic care. 6. Collaborating with other professional disciplines should always occur within the ethical and legal boundaries of our profession. Collaboration may neither compromise patient privacy rights nor overstep the scope of practice of any of the professional disciplines involved. When policies governing interdisciplinary collaboration are designed, the ethical and legal principles of each profession should be kept in mind. 7. Once again, effective communication is the key to mutually satisfying and productive interdisciplinary relationships.