Weekly Tidbit #4 - Reflections on Collaborative Care
by Abigail Lehman
Hi Everyone,
Tonight's Weekly Tidbit is the last of a four-part series of perspectives on collaborative care. This week's tidbit is a reflection from Abigail Lehman, a critical care nurse who cared for Vicki's husband a month ago.
I am happy to report that Vicki's husband is slowly improving. He has been transferred to another facility for the next steps of his recovery. Vicki writes, "He is very slowing showing signs of healing and strengthening.
_________________________ Hi Everyone,
Tonight's Weekly Tidbit is the last of a four-part series of perspectives on collaborative care. This week's tidbit is a reflection from Abigail Lehman, a critical care nurse who cared for Vicki's husband a month ago.
I am happy to report that Vicki's husband is slowly improving. He has been transferred to another facility for the next steps of his recovery. Vicki writes, "He is very slowing showing signs of healing and strengthening.
Abigail -- nurse -- reflections on collaborative care
"I came on to this patient's care rather
late. He had been here for quite some time and very ill. So, a lot of things were
already in place, a lot of things had
already been done, before I came on board.
I felt the white board on the wall was a tremendous
advantage to me. I could see where we had been and where we were going on a
patient this complicated. It allowed me to know a lot of things as soon as I
hit the door, without spending a lot of time in chart.
I had just been very generally aware that there had been
some tension in the care of the patient. Generally, in my experience, when
there is that sort of tension, staff tends to respond by withdrawing--there is
some avoiding and some withdrawal from the patient's family. It is not bad
intention on the part of the staff, I just think it is an avoidance, not
knowing how to respond. It generally becomes a 'terrible circle' where staff
doesn't want to say anything wrong. I
feel like it creates a situation where there is breakdown of trust. So, you
have staff members who want to take care of the patient, but they become paralyzed
by the dysfunction of the communication. You have the family who wants what's
best for their loved one, which is very appropriate and very correct, but then
the withdrawal of the staff makes them more concerned and more anxious.
Because collaborative care had been in place for several
days when I came on, I felt that it put me in the best possible position to
interact with this family. It allowed the family to speak to me on behalf of
their family member, and without causing any defensiveness or blame to be cast.
They felt they could offer in good faith if I didn't know something had already
been tried. They felt like they could speak with me and tell me that. They
didn't blame me for not knowing.
After I took care of them for multiple days I spent some
time reflecting on it. I took into consideration multiple variables that were
present with this patient. The remarkable thing was, there wasn't a big change
in the care he was receiving. He still was facing the same challenges, the same
set of staff was caring for him, the physicians caring for him in large part
remained the same--which led me to believe that it was collaborative care that
was the game changer, not other variables.
I felt that it
fostered a change in relationship between the patient's wife and myself. We
were working in common toward the goal for this patient. Instead of being a
relationship with me above and her below--even if I don't want it that way, that's how it ends up, with them asking
me for information--I felt that now we were horizontal, equal. And, because of
that, she was able to share with me what was important to her in her husband's
care. That allowed me to organize his cares and prioritize what we were doing,
as it was appropriate, to align with that. It also gave me a language to speak
back to her in, so I was able to share with her when I was able to be
successful in our mutual goals, and what areas I still found challenging.
I don't know how to explain to people how frustrating and
how important this is. I don't mean to be immodest, but communication is one of
my strong points. So when you see a situation degrade in large part because of
communications, in such a stressful and emotional time for the patient and
family, it is heart breaking. To see it able to be reversed, to see the trust
restored, was amazing.
What is collaborative care? To me, collaborative care
creates a space...through equality. It helps move the conversation from tasks
to goals. It allowed me to take care of my patient with clear intention. Since
I knew what our goals were, if I encountered a challenge or a little block, it
allowed me to consider other possibilities and to adapt, since knew where I was
going.
The rounds where we all sat down and discussed things,
helped the flow of communication. People involved in his care were on the same
page. Collaborative care gives everyone time to reflect on the
patient--multiple sets of eyes from multiple disciplines to reflect on the
patient--and the family is there, too.
I think every nurse is aware of the need for that, every
medical professional. Without collaborative care, this is mostly experienced as
negative grumbling when the process breaks down. You don't always have a
positive way to deal with it. That often leaves people feeling like they are a
cog in the wheel, engenders helplessness, and people feel unable to effect
change.
One of the big advantages of collaborative care is the
empowerment it gives. It promotes positivity. Instead of setting a minimum
standard, I believe it fosters growth. Let's say I have a job to do--let's say
give an antibiotic. When I do collaborative care we no longer just say we are
giving the antibiotic. With collaborative care, we're asking, are we giving the
best one for this situation? So, the pharmacist shares his knowledge, and I
learn. I hope when I share my knowledge, someone else might learn. With
collaborative care, you are constantly engendering staff to advance and deepen
their knowledge.
I give thought to, when I'm a nurse practitioner, how
might I promote this, how might I use this? I think about that to myself. In
the State of Kansas you have a collaborative agreement--that's exactly what you
call it--so as I think about potential physicians I may work with, I consider
if they have a good give and take with me.
I guess I would like to say that the amazing part was the
restoration of trust, of how much the emotions changed. My husband and I raise
our children, but we also raise other people's children. We bring very damaged
children into our home. It can take a long time to build that community of
trust between people. I have seen it take so long to teach that to a
child. That was some of my amazement,
how quickly this was reversed. Even
though I had not interacted with the family, when I started caring for this
patient I was deeply concerned that the trust was un-repairable. And so, to see
that restored was just so beautiful to me."
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