Feb 23, 2024 Blog: How Do You Practice Intra- and Interdisciplinary Collaboration in Practice?
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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NURS 8002 Blog: How Do You Practice Intra- and Interdisciplinary Collaboration in Practice?
NURS 8002 Blog How Do You Practice Intra- and Interdisciplinary Collaboration in Practice essays
Case study design is a great idea towards fostering critical thinking skills needed in nursing practice, this leads to fostering collaboration among various disciplines and understanding more of what they do, and expanding thoughts and problem solving skills for students to help guide them in the real world once they graduate. IPEC (2011) as cited by the National League of Nursing (2015) noted team training in educational programs lag behind the actual practice of working in teams, which is a gap that exists between the realities of practice and the utilization of teamwork skills to deliver patient-centered care. Implementing these case study designs are effective when needing to truly commit to learning and expanding the knowledge base of the nursing student. Collaboration with different professionals allows the student to better understand the dynamics of each individual professional area, work as a team and allow them to actually see what role that discipline plays in implementing improved care for the patient. Developing a relationship to work together while understanding each discipline’s role in patient-care assists in building respect, better partnerships and better health outcomes. Barr (1998) as cited in Henry et al. (2018) points out competency based interprofessional education relevancy stages include recognizing and respecting the roles of other professionals. This is an important piece with collaboration and making it work to be effective.
Professional collaboration is used to address the needs of patient care by way of using a team of professionals making decisions based on the specific needs of the patient’s, in order to improve the care they receive. Interprofessional case conferences is one way the article uses an analysis of the case at hand. Coming together to combine knowledge that exists among the various disciplines to brainstorm and problem solve is just one way collaboration is incorporated to provide what is needed. As Henry et al. (2018) points out, seeing problems through the eyes of another, is a way of requiring students to transfer their problem solving strategies in new ways (Hmelo-Silver, 2004). This contributes to the education students need to expand on their foundational knowledge broadening their understanding of what is involved with treating the patient as a whole.
I recall my first experience with interdisciplinary collaboration as a new nurse in an orthopedic unit. Once a week the patient’s primary nurse, the physician and referral partner (ie. cardiologist, internist), the social worker, dietician and charge nurse would do grand rounds on the patients, then sit for a conference to determine what the patient needed at that time and upon discharge, and we would then review how we would make it all happen. Collaboration was found essential for the goal of faster recovery, shorter hospital stays and improved care after discharge to prevent negative outcomes in the long run. Ansa et al. (2020) points out interprofessional collaboration in healthcare is a partnership among diverse health professionals to provide quality care to patients, families and caregivers. It is an effective measure to provide teamwork to problem solving complex health issues one patient at a time.
Initially, thirty years ago I saw those rounds as just an additional task at work. When I was placed into the position of charge nurse, I began to understand more clearly how significant each role was within that collaboration and how it ultimately impacted the patients. This is proof of the need for case study design in education to prepare nurses for the real world of collaboration. Once within the professional setting I would suggest placing nurses weekly with a member of the interdisciplinary team, to get a more personal view and understanding of what each discipline involves and how they function to assist with patient care. Then ultimately involve the nurse and a member of the team to work together to problem solve and resolve issues of care for a patient. Keeping a goal in mind for the patient and teaming up a nurse with a team member weekly may allow for a more focused application of care for the patient, and allow for more focused collaborative thinking with the team member.
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, 8(3), 1-14.
https://doi.org/10.3390/healthcare8030323
Barr, H. (1998). Competent to collaborate: Towards a competency-based model for
Interprofessional education. Journal of interprofessional Care, 12, 181-187.
doi:10.3109/13561829809014104
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 and Learning in Higher Education, 30(3), 560-570.
Hmelo-Silver, C. E. (2004). Problem-based learning: What and how do students learn?
Educational Psychology Review, 16(3), 235-266.
Interprofessional Education Collaborative Expert Panel (IPEC). (2011). Core competencies
For interprofessional collaborative practice: Report of an expert panel. Washington,
DC: IPEC
National League for Nursing. (2015). Interprofessional collaboration in education and practice.
http://www.nln.org/docs/default-source/default-document-library/ipe-ipp-vi-sion.pdf?sfvrs
n=14
When I reflect on my own experiences with intra- and interdisciplinary collaboration in my current place of employment, I find that the experiences have been positive and educational. Within my role as a clinical review nurse, I have to review and gather relevant data from clinical documentation in support of a decision to approve or deny authorization for cardiac procedures. There are often many denials or partial denials which necessitate the involvement of one of our team physicians who specialize in
cardiology and its subspecialties. Although all of our interdisciplinary communication is via e-mail, I have found that when I am uncertain or even wrong about a decision, many of the physicians are willing to explain the purpose behind the policy requirements and in some cases we are able to discuss a need for further policy development in cases that are becoming more common and less easy to rule upon such as May-Thurner’s syndrome. Our system allows us to communicate with doctors in various states and I have benefited from some of the explanations they provide from their specialized concentrations within cardiology considering that cardiac material was never my strong suit.
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The intradisciplinary collaboration I have experienced working virtually alongside a team of both LPNs and RNs in various states and from various backgrounds has also benefitted me as many of them are learning cardiac reviews as well but bring their own unique experiences to the table thus helping our team become more concise and efficient in reviewing cases accurately. I’ve found that as we communicate throughout the day in our virtual nurse’s station, we are providing one another with valuable resources, quick references, and lessons through our successes and mistakes. Similarly, when an outside physician disagrees with a decision we have made concerning the authorization of their procedure, they have the opportunity to participate in a peer-to-peer call with a cardiologist from within our organization to either overturn or uphold the decision. In some instances, due to insurance restrictions, this peer-to-peer interaction is only for educational purposes and not to affect the original decision. This clearly is also a form of intra-professional communication. While other specialty teams within the company have very clear policies and guidelines that are easy to apply, the newly developed cardiac team has found that there are many gray spaces that come with experience and practicing the review of multiple cases. Essentially, policies can be adjusted and created through this process and the communication between nurses and from nurses to physicians is much more frequent as the cases often require more subjective review at times. I recommend the virtual environment as I have found that there is much more confidence and less apprehension when it comes to communicating with nurses of various skill levels and providers from various specialties.
The scenarios described above parallel the second stage of the student-designed case study described by Henry et al. (2018) which is inter-professional collaboration in case analysis. This stage is intended to create opportunities for improvement among health care systems and more specifically to highlight areas in which coordinating is essential. Rationales concerning approaches to actual issues are reviewed and solutions are, as a result, more comprehensive in nature. As Henry et al. (2018) concluded, this kind of inter- and intra- professional collaboration results in a respect for other roles within the profession and within other professions. In my example, there is a mutual respect amongst the nurses and between the nurses and physicians when it come to the strengths we each bring to the table whether it involves critical thinking and detailed review or specialized knowledge and outside-of-the-box considerations. Another result of the study was that students learned to see problems from another’s perspective. I agree that this is the case as we, as nurses, at times find ourselves reviewing clinicals that span the course of months or sometimes years and begin to understand the reasoning behind a provider’s course of action and how our team of providers based on their specific nuancies may view these choices. It helps as we package our summary of details in support of the authorization decision. Overall, I can agree with the outcomes of the study that speak to the development of not only collaborative competencies but confidence in solving intricate problems through collaboration as well.
While nurse-physician collaborations are quite common, one less common interprofessional interaction, as Celio et al. (2018) point out, is the pharmacist-nurse collaboration. As is mentioned, both pharmacists and nurses play an integral role when it comes to medication adherence and continuity of care and both are in positions to assess a patient’s understanding, learning or implementation barriers, and motivations when it comes to following a prescribed treatment plan. With the common goal of promoting medication adherence and increasing knowledge amongst patients concerning their treatment plans, this is one collaborative relationship that would benefit from more interaction in the interest of the patients.
References
Celio, J., Ninane, F., Bugnon, O., & Schneider, M. (2018). Pharmacist-nurse collaborations in medication adherence-enhancing interventions: A review. Patient Education and Counseling, 101(7), 1175–1192. https://doi.org/10.1016/j.pec.2018.01.022
Henry, B., Male, B., Garner, C., & Guernon, A. (2018). Teaching and learning about inter professional collaboration through student-designed case study and analysis. International Journal of Teaching and Learning in Higher Education, 30(3), 560–570.
NURS 8002 Blog: How Do You Practice Intra- and Interdisciplinary Collaboration in Practice?
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
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