Community Health Issue - Vaccines

Collaborative Practice Paper

In today’s world of healthcare, collaborative efforts are in place between all members of

the healthcare team. Collaboration exists to help initiate improved outcomes for the patient in

the healthcare delivery system. Today, providers and patients work together in care. At one

time, the healthcare model was doctor dominated and solely focused on just the pathophysiology

of the patients illness, not the patient as a whole. Doctors, nurses, physical therapists, social

workers, case managers, nurse practitioners and dieticians all make up members of the

collaborative healthcare team. A joint collaborative practice among all healthcare team members

leads to continuity of care, decreased costs, quality care and patient satisfaction. Ongoing

collaboration between healthcare members results in mutual respect, trust and an appreciation of

what each individual brings to the overall goal in care of the client. (Blais & Hais, 2006). The

following case study will provide the foundation for the discussion of when collaborative care is

provided, the difference between nursing diagnosis and collaborative problems, and potential

barriers to successful collaboration.

FM is an 80 year old married Caucasian female diagnosed with congestive heart failure

(CHF). She had a longstanding history of diabetes with a right below-the-knee amputation,

coronary artery disease with stenting and valve replacement, chronic renal failure and dialysis

dependent, fibromyalgia and colon cancer that has just been discovered to have metastasized

to the spine. She is non-ambulatory due to her amputation and does not have a prosthetic. She

lives with her very supportive husband of over 40 years, who takes care of her, along with a

hired caregiver that is at the house for 12 hours a day to help FM with activities of daily living.

FM is a retired nurse who spent most of her career working in critical care. FM has three step-

children, two of which live in the immediate area and offer to help out when they can. During

this hospitalization, FM is very short of breath. The week before, FM received a steroid shot in

her left deltoid. Since that time, her left arm has swollen to “three times its size.” Due to FM’s

nursing background, she is very aware of all of the medical treatments that she has received and

has decided that she no longer wants to try chemotherapy or radiation. FM has lived with

chronic pain for the past 40 years and states that her pain has gotten worse with the discovery of

cancer metastasis to her spine. FM rates her pain at 8/10 that is usually unrelieved by oral pain

medications. FM states she constantly has nausea and has recently suffered from a loss of

appetite with a 30 pound weight loss over the past few months. FM states, “I am ready to go to

heaven. I’ve suffered enough during this lifetime. It’s time for me to go.” Per her husband’s

request, FM is still a full-code with all resuscitative measures in place. FM disputes this when

she is awake, however, the doctor states, “She’s just not feeling well. When we treat her for the

CHF she will feel better towards life.”

Physical assessment of FM reveals crackles at the bases of her lungs. She is using her

accessory muscles to breathe and sitting upright. She is lethargic, but arousable to verbal

stimulation. Her left arm has 3+ pitting edema unrelieved by elevation on pillows. She has 3+

pitting edema to her left lower extremity. FM also has a stage II pressure ulcer to her coccyx.

When re-positioning FM, she cries out in pain. FM’s oxygen saturation is 94% on 2 liters nasal

cannula and she is unable to be weaned to room air. Heart rate is 112, and a systolic murmur can

be heard. FM’s heart rhythm is sinus tachycardia at this time. Her bowel sounds are hypoactive

and FM states that she hasn’t had a bowel movement in “4 days.”

In the acute care setting at the facility that FM was admitted to, she has several doctors

working on her case. FM has a main doctor who is overseeing her care that she is familiar with.

FM also has a pulmonologist, cardiologist and renal doctor assigned to her case while in the

hospital. These doctors are making rounds on FM daily. The nurse caring for the patient must

always collaborate with the doctor on the patient’s status and response to treatment. The nurse

has the key role of monitoring the patient’s status closely to evaluate for any complications that

could