Monday, September 28, 2015

Weekly Tidbit #1 – Reflections on Collaborative Care

by Vicki R
Hi Everyone,

Tonight is the first Weekly Tidbit of the newly created Collaborative Care Learning Network.

This Tidbit introduces several perspectives on collaborative care. Tonight's Tidbit is an interview with the wife of a patient I am helping to care for in the intensive care unit where I practice. I wrote down her thoughts with pencil and paper this afternoon in her husband's room. He is critically ill, sedated on a ventilator. She has given permission to share these experiences and reflections with all of you.

Initially, her husband was cared for in a more traditional way by a very competent and caring cardiac surgeon who handed surgical responsibility over to me when it was my turn to be on call. My partner is very down to earth, and is thought of very highly by his patients and their families. He gave a careful sign out, reviewing every detail of the patient's medical condition and noting respectfully that the patient's family had some concerns that needed attention. At that point onward, we began using full collaborative care, similar to the collaborative care you saw in the simulations in San Antonio. Today is the fourth day of collaborative care.

As you read Vicki's comments, keep in mind that her husband has been cared for throughout his hospital stay by very good people who have worked hard to provide excellent care and to communicate with the family using patterns they are comfortable with. Her husband is still being cared for in the same intensive care unit by essentially the same people who have cared for him throughout his hospital stay...the only thing of significance that has changed is the pattern of care that is now being used. Over the next four weeks we will explore perspectives from other members of the care team, starting next week with thoughts from Noni, the chaplain.
Vicki – wife – reflections on collaborative care
            "At the beginning of this whole thing I felt very alone, very frightened, and I did not feel there was any kind of a resource for me to gain answers or to be able to even communicate. I felt that I was lucky if I managed even to find a moment with the physician or any of the medical personnel that were willing to answer my questions.
            I asked every shift of nurses to feel very free to call me day or night if I was not here. I wanted to be a part of my husband's illness and anticipated recovery. Several times I was called after the fact by a person that I did not know.  I did not feel that I could trust the very people that I needed to be able to trust.
            The turning point began when I talked with my family, and my son, Brad, who is a nurse, contacted the 'total care coordinator' for the hospital, asking for just what that person's title implied--coordinator.  So many people were working from so many directions that it was not possible for me to hear or see an overall picture. The care coordinator made the medical team aware of our discomfort and the lack of communication and sense of direction that we had.
            Now, everything is in motion. I watched that happen. It was effective immediately. What once felt random and seemed to lack direction and coordination now felt like a well-oiled machine. And that machine had heart (pardon the pun)!
            So, I could elaborate more, but it gave me new hope and new security and new respect for the medical team and the hospital.
            I love the introducing of each person, because that person immediately becomes a real person, not just a person in a white coat or nurses scrubs. Sitting down is so much more non-threatening. Its more friendly. I love the way the conversation is opened--thoughts and concerns are asked--I felt always a very kind and non-judgmental atmosphere.
            To me personally, the gathering around, laying of hands, touching the patient and each other, praying with the chaplain, made an unbelievable connection with each person there. I think it even made family members draw closer to each other and feel equally a part of the loved one. I like the board--because during all this you can feel so muddled. But the board is like a focus point that does just that--keeps you focused.
            The safety checklist--that is excellent. One of the things I appreciated, that I don't think has been done here with regularity, is not using restraints. I think they have been taught to use them. I said, 'He's been tied up. He's quiet now. Do we need to tie him up?' She said, 'OK, I just do it out of habit.' To me, I understand the need--it is very much a safety thing--but I worry it is put in place to make it easy.
            I think this is SO important. It is part of the medical science that is many times overlooked. I do know this much--from the time this was put in place there was a total change in communication. I had always tried to be sure they knew I was their friend, that I wasn't their adversary --how much I wanted to be informed of my husband's condition. My husband and I are hands on with each other in all things. With collaborative care we were given the opportunity to be present for rounds, which allowed us to not have to just hope that our paths might cross with assorted members of the medical team. Where before I was feeling disconnection and even anger at the care--in being able to watch all of the parts of the caregiving in one unit, with a mutual goal, I felt renewed confidence in the hospital setting.
            The start of collaborative care was an absolute turning point for our whole family. We were informed, we felt our loved one was valued, we were educated, we watched the team members educate one another, and many of the parts of our--many areas of our concern--were addressed including emotional and spiritual voids or gaps that we had been experiencing. A critical illness is not the time when that part should be turned off or unavailable.
            I would be honored to be a part of anything that would enable this to be offered to anyone. If I were part of a medical staff, I would love something like this.
            I've felt like this for a long time. My son had necrotizing fasciitis. He was in the ICU for several months. They would come in and say, 'We are taking him to the OR today.' There was no communication. Something like what we have put together here could have made all the difference."

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