Weekly Tidbit #2 - Reflections about Collaborative Care

by Noni Strand

Weekly Tidbit #2 continues a short series of perspectives about collaborative care.

Last week's Tidbit was a reflection from Vicki, the wife of a patient, about how meaningful collaborative care was for her and her family. This week's Tidbit is from Noni, chaplain, about caring for Vicki and her husband, and about Noni's experiences with collaborative care, as a chaplain new to health care.
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 Noni – chaplain – reflections on collaborative care 

            "This particular patient, in his care there was such a shift in the care. It became so obvious how important collaboration is. When Vicki could tell me how much they appreciated having the information and being included, I knew we were on the right track.

            There are two moments that stand out for me.

            One was several days after Vicki's husband was readmitted to ICU, as people were looking at the drainage from his incision. I could just read on everyone's faces that this was just not what should be going on. The family knew this was not going in the right direction. To have that affirmed and taken seriously, and to have measures taken to address that, it seemed like everyone was pulling in the same direction as equal partners because we had equal information.

            The second moment was the day of the tracheostomy, in the morning when we met for rounds. What I loved was the nurse feeling empowered to speak her perspective that came out of constant care for her patient--she was empowered and she was respected for her input. The respiratory therapist also was treated as an equal partner and spoke her perspective, which varied a little bit, but again, was a welcomed voice in the conversation. And Vicki was able to share her concerns about the possible alternatives--whether to intubate or possible tracheostomy -- so that, together, there was a consensus decision that did not place Vicki in the position of having to make that decision all alone, or that set the doctor up to be the only expert in the room.

            For me as chaplain, that was the power of the Holy Spirit in the group. A shared decision with ownership by everyone in the room created a plan of care that was carried out and led to marked health for the patient. I became--the group became (pause)...there is singularity in that, that transports you to a different level of...I don't know how to explain it. The sum is greater than the parts. What was created, together, became powerfully healing for the patient and for everyone in the room. Everybody has a personal investment, and, we all felt we were a part of the healing process.

            Healing is not an event, it is a process for all of us who are part of it. There can be a helplessness, and this helps to address that. I'm not a doctor, but I can contribute from my area of expertise. I know I am much more effective in a 'community of care.' Collaborative care is a very hope-filled, and helping, and empowering, process. It is not the outcome that predicts how you feel about it. It is the process that helps and heals, and provides hope. So often we forget how integral the family and loved ones are in a patient's healing process. They have to be part of the process for the patient to heal well.

            I see so often patients who don't understand their diagnosis, don't know the name of their doctor, who feel at the mercy of this hospital system that can be very intimidating. It is not because the doctors don't care, or they're not told, it is not intentional. But, so often, this is like a very scary, unknown world that people enter without a lot of guidance. I remember when I first started here, it was like a whole different planet. Providing patients and their families with complete information--which sometimes needs to be repeated--in the company of all their care givers, gives them a sense of confidence and security in the midst of so much that is unknown. So many patients are just so lost. Some of the older patients don't know how to advocate for themselves. Is that the kind of system we want?

            I learned collaborative care very early on in my time in the hospital. What it did for me was, I immediately got to know the people who I work with. To be around that circle in the weekly meetings--here was a small circle and I was part of that! That was huge for me. It takes a long time to get to know people if you don't do that intentionally. And collaborative care is a place to do that.

            I still remember a patient with thin skin, and how tape ripped it off. In our meeting, Dan and everyone figured out how to care for him. They worked it out, and made sure everyone knew. Even though he eventually died, that made a huge difference. It was so important to them that we recognized that. And, to get to know the nurses in the meetings in the room. To get to know the nurses by name, was SO important in those early days for me. And that did not happen so easily in other areas of the hospital where I work. Because those bonds were built so early, there was a trust built immediately that helped in all areas of my work. Knowing those nurses was huge for me, and collaborative care made that possible.

            Collaborative care has created relationships that have helped my work with other patients and other families. It has contributed to my own confidence in my role as chaplain. It has been very affirming. I have learned so much, and I have learned what NOT to do. So it has been hugely helpful to my formation as a professional in the hospital.

            Last week I told my husband about when you asked for my advice. He said, 'A cardiothoracic surgeon came to talk with you?' First of all, that my opinion is valued means a lot to me. Chaplains don't always get asked. Everybody has this piece of the total truth. It can be so helpful. What would it have been like if I had started here without collaborative care? This resonates with me so deeply in my soul, about how we are to care for one another and use the gifts that God has given us. It has shaped my ministry, I know it has, in profound ways. It has given me courage to ask questions, AND, I know which questions to ask!

            That day recently was amazing, when two patients and their families needed this so much. It is such truth telling. Everything is on the table. There are no secrets, and no guesswork. That's what helped the families get through this so gracefully. They appreciated the honesty. Doctors don't need to be superhuman. It is the collaborative wisdom that is so important. Things aren't going to go well all the time, but we can minimize the times they don't by doing this. Are we uncovering every stone? Does everybody feel fully able to speak? Time...the willingness to stop and take time to talk...I feel that catches things very early.

            In Vicki's husband's situation, what has been so helpful for me is seeing the growth of a process which everyone became included in decisions, in care, and in what was best for him. Every perspective was valued and needed for his care. And, because of it, I think we have provided an opportunity for him to fully recover. I don't know if that would have happened without the collaborative care.

            Again, for me as a chaplain, to be able to pray around the bedside--with the patient, family members, doctor,  nurse practitioner, physician assistant, nurse, respiratory therapist--created a level of (pause)...I'll use the word 'commitment'...that we were all working together with God's guidance for the patient's recovery. I knew as chaplain how important prayer was for the family, and I knew that would be welcomed by the group. I also knew that the family needed clear communication and inclusion in his care to feel confident that everything was being done for him.”