Introduction
Interprofessional collaboration (IPC) occurs as a collaborative practice between two or more healthcare professionals from different professional backgrounds. The objective of IPC is to develop effective collaboration between professionals to improve professional practice and healthcare outcomes (Reeves, Pelone, Harrison, Goldman, & Zwarenstein, 2017). Mutual understanding and working as a team are necessary to avoid poor IPC and achieve the best results, enabling learning and exchange of experience. As a part of Interprofessional education (IPE), IPC focuses on improving that understanding bridging professionals of diverse training, roles, scopes of practice, and world views. IPC is a valuable experience in the life of a medical specialist.
Overview and Analysis of IPC
During the IPC activity, I have collaborated as a registered nurse (RN) with a registered respiratory therapist (RRT) who is a full-time RRT and has worked in this field for 50 years. The patient in care has been a 74 years old woman who has a continuing care history with a pulmonologist. She reported anxiety related to the new onset of shortness of breath (SOB). The patient has type II diabetes, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), obstructive sleep apnea (OSA), hyperlipidemia, primary hypertension, and obesity. Although the patient stopped smoking in 2008, she smoked 1.5-2 packs per day for 30 years.
Additionally, the patient is homebound because of the excess weight but has not followed the primary care provider’s (PCP) suggestion to see a registered dietician. The patient has used a nasal cannula at home to deliver supplemental oxygen (O2) at a rate of 2L/min, with her O2 saturation sitting at 89-91%. She has a history of carbon dioxide (CO2) retention with end-tidal CO2 of 53 mmHg.
The patient’s breath sounds suggested congestion, and crackles were present in the left base of the lungs. Diagnosis of pneumonia, unspecified organism, with 3-day course treatment by intravenous antibiotics was given at the hospital. IPC professionals noted acute-on-chronic respiratory failure with hypoxia. Although initially the patient was put on BiPAP in the hospital, she refused to continue positive pressure ventilation because of anxiety, feeling claustrophobic. As an alternative, supplemental O2 was prescribed to the patient to use continually. Consequently, the patient has had O2 at home at a rate of 2L/min and now needs only 1L/min.
The patient’s end-tidal CO2 was 60 mmHg and has decreased to 47 mmHg after the therapy. For COPD treatment, prescription of Advair, Incruse, and ProAir inhalers has been given to use every six (6) hours or as needed. Lasix (furosemide) and fluid restriction have been prescribed to reduce edema and CHF fluid. As of now, the patient is stable and can return home with a follow-up visit to pulmonary MD.
Problem List Comparison
Comparing RN’s and RRT’s approaches to diagnosis, it is crucial to understand that one is a nursing diagnosis while the other is medical. A nursing diagnosis deals with evident symptoms and patient reports focusing on actual or potential health problems. By contrast, a medical diagnosis tries to determine a specific disease or medical condition expressed by these symptoms and reports, and RN should not make such a diagnosis. Nevertheless, as noted by Ackley et al. (2021), “the use of identifying defining characteristics is similar” (p. 6) between both processes.
Table 1. Health Problem Lists.
RRT’s diagnosis is concrete and factual, using medical terminology to name diseases and associated conditions in a list without descriptive words. As per protocol, RN’s diagnosis uses descriptive language to note the patient’s problem with related factors and defining characteristics connecting them with phrases such as “related to,” “due to,” “as evidenced by” (Ackley, Ladwig, Flynn Makic, Martinez-Kratz, & Zanotti, 2021). RN’s problems and diagnoses often correlate with particular terms used by RRT. For example, impaired gas exchange and a decrease in ventilation correspond to respiratory failure and hypoxia. Shortness of breath, coughing, use of accessory muscles can be linked to acute exacerbation of pre-existing symptoms of pulmonary disease, as well as hypercapnia. In conclusion, RN’s diagnosis may help RRT with their diagnosis or vice versa, accelerating the process from identifying the underlying disease to its treatment or preventing possible complications during treatment.
Differences found in the problem lists reflect the RN’s and RRT’s roles at the medical facility. RN assesses human responses to health conditions, evaluates possible risk factors, and creates a nursing care plan to help treat a patient (Ackley et al., 2021). RN can diagnose and treat some conditions to stabilize patients or improve their well-being, but RRT’s involvement is required for the actual treatment. These factors influence RN’s choice of words lacking disease assumptions and RRT’s requirement to be specific, but both rely on an evidential basis. RN works following the strict protocol or under direct supervision by another healthcare provider, in this particular case, RRT.
Relationship Between the Experience and Future Practice
IPC is an invaluable activity on a variety of levels. It enables collaborating partners to get to know each other and learn from each other to broaden their minds (Freeth, Savin-Baden, & Thistlethwaite, 2018). Firstly, acquaintance and contact with other professionals are always inspirational. Working together with the same patient and with the same goal, I and RRT have shared our interests and values. It was reassuring to not work alone and to have the backing of an experienced medic.
Secondly, IPC has been immensely instructive because of the RRT’s professional background and role. By closely observing the work of RRT, it has been possible to learn about medical examination and diagnosis in cardiopulmonary medicine. In addition, nuances of the actual respiratory care plan and therapy for pulmonary diseases presented by the patient’s case have been noted. As for the RN’s role in IPC, I could provide my partner with some new insights on how RN operates, notably a nursing assessment, diagnosis, care plan, and implementation of care.
There are several benefits and challenges of IPC that affect the overall experience. The benefits of IPC are that it enhances the expertise and skills of collaborating partners and allows for more efficient performance and results in healthcare practice. As for the challenges, poor IPC can lead to adverse effects on services and care provided to a patient (Reeves et al., 2017). Poor IPC can occur because of miscommunication between partners, inconsistent approaches to problems, conflicts of ideas, and insubordination. It is challenging to be a part of interprofessional groups due to the diverse interests, concerns, and range of knowledge (Freeth et al., 2018).
However, IPC nonetheless brings more benefits and efficiencies than challenges. This experience taught me how to work with colleagues emphasizing the roles and functions and how to adapt personal expertise to different healthcare objectives. It will be helpful in my future practice as a nurse practitioner.
Relationship between the Experience and Necessary Competencies
Interprofessional Education Collaborative (IPEC) ensures that current healthcare providers are proficient in competencies essential for IPC through implementing necessary education. Brashers et al. (2020) note that there are four (4) IPEC competencies:
- Values/Ethics for Interprofessional Practice,
- Roles/Responsibilities,
- Interprofessional Communication, and
- Teams and Teamwork.
Analyzing personal collaboration with RRT, it becomes evident why values and ethics are mentioned first. Different values and ethics may lead to serious conflicts in the team, so it is necessary to respect the differences. As for roles and responsibilities, knowing what one can and cannot do and what competencies one has is a key factor in the success of IPC. An example of definite roles which are complementary is a registered nurse and a registered respiratory therapist. Such combinations of roles as RN and RRT can effectively work as a team. Still, the ability to communicate thoughts unequivocally is needed as well as teamwork and tolerance.
Although IPEC undoubtedly improves the quality of IPC healthcare and the competence of healthcare providers, there are a variety of studies exploring the general success of IPC and the IPC outcomes. A critical, broad-based review of such studies suggests that the IPC outcomes are mostly positive, but the results are somewhat contradictory (Pomare, Long, Churruca, Ellis, & Braithwaite, 2020). That can be explained by variations in the contexts of each IPC studied. Variations include professionals, patients, fields of healthcare, and methodological approaches used by researchers. As such, Pomare et al. (2020) advise studying IPC depending on the context. Evidently, IPC described in this paper has had positive outcomes for all parties involved.
Reflection on the Experience
Reflecting on the IPC activity, working with RRT was enlightening and even exciting regarding the huge gap between our professional experiences. Fifty years in the field of respiratory health is a substantial contribution that empowers RRT to teach, give advice, and be credible. That alone influenced my respect for RRT, which ultimately resulted in our well-coordinated work. Social and cultural interactions between us were limited, but they were polite without overstepping boundaries. Undoubtedly, the collaborating partner influences the experience, and it becomes more pleasant and efficient if one can find common ground with their partner. Assuming RRT would be intrusive, rude, and overbearing, IPC would be unprofessional and extremely uncomfortable, impairing work and jeopardizing patient’s treatment.
Conclusion
Interprofessional collaboration is the practice of working as a team with one or more healthcare professionals to achieve greater efficiency or address difficult healthcare situations. As part of the Interprofessional education program, the IPC activity helps prepare the students for possible IPCs in the future. During this activity, I worked as a nurse with a respiratory therapist, assessing, diagnosing, and treating a patient with cardiopulmonary health problems. As part of the activity, two lists of diagnoses were formulated, one being from the nurse’s point of view and another one from the therapist’s point of view.
Analysis of these lists shows the differences between those roles and their responsibilities. The experience was valuable and provided insight into the work of the respiratory therapist, including specifics of a patient interview and the actual treatment, and the activity corresponded with IPEC competencies, being mutual and fruitful. The IPC activity improved my competence as a healthcare provider, and the acquired knowledge will be used in future nursing practice.
References
Ackley, B. J., Ladwig, G. B., Flynn Makic, M. B., Martinez-Kratz, M., & Zanotti, M. (2021). Nursing diagnosis handbook: An evidence-based guide to planning care, 12th edition revised reprint with 2021-2023 NANDA-I® updates [eBook edition]. Elsevier.
Brashers, V., Haizlip, J., & Owen, J. A. (2020). The ASPIRE Model: Grounding the IPEC core competencies for interprofessional collaborative practice within a foundational framework [Abstract]. Journal of interprofessional care, 34(1), 128–132. Web.
Freeth, D., Savin-Baden, M., & Thistlethwaite, J. (2018). Interprofessional education. In T. Swanwick, K. Forrest & B. C. O’Brien (Eds.), Understanding medical education: Evidence, theory, and practice (3rd ed, pp. 191–206). John Wiley & Sons. Web.
Pomare, C., Long, J. C., Churruca, K., Ellis, L. A., & Braithwaite, J. (2020). Interprofessional collaboration in hospitals: A critical, broad-based review of the literature. Journal of Interprofessional Care, 34(4), 509–519. Web.
Reeves, S., Pelone, F., Harrison, R., Goldman, J., & Zwarenstein, M. (2017). Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews. Web.