Proactive communication

MSN Essential VII: Interprofessional Collaboration for Improving Patient and
Population Health Outcomes

Recognizes that the master’s-prepared nurse, as a member and leader of interprofessional teams, communicates, collaborates, and consults with other health professionals to manage and coordinate care.

Management of patient care requires collaboration with practitioners in other specialties to ensure that the patients needs are met and the best outcome is achieved for the patient. Being able to recognize when referral is necessary is an important part of nursing practice. A patient with multiple comorbidities increases the complexity of the care needed, and thus requires effective communication and collaboration between healthcare professionals (Homeyer et al., 2018). However, just because coordination of care is established, does not mean the patient will follow through. One patient presented to the clinic to establish care. While performing a physical exam, adventitious breath sounds were auscultated in the left lower lobe. This patient has a long history of smoking and is a current one pack per day smoker. The patient was referred for a chest x-ray and instructed to return in two days. The patient returned for her visit but did not get the chest x-ray. The patient was then referred to the hospital for immediate follow up due to concerns of pneumonia. Two weeks later, the patient returned to the clinic to report that she was feeling much better but never went to the hospital. She attributed her lung sounds to her roommate who refuses to smoke outside.

On a regular basis in the clinic, we are writing prescriptions for referrals to achieve best outcomes for the patient. One such patient presented to the office with stage 4 kidney failure, but she had yet to follow through with the referral to the nephrologist we gave her at her last visit. She was educated on the importance and severity of her situation, we called the nephrologist office for her while she was there and got her an appointment that afternoon. We called the next day, and she had missed her appointment. Even with best intentions and coordination of care, the outcome is determined by the attitude or desires of the patient.

Nurse Practitioner Core Competencies

# 8 Ethics Competencies

  1. Integrates ethical principles in decision making.
  2. Evaluates the ethical consequences of decisions.
  3. Applies ethically sound solutions to complex issues related to individuals, populations and systems of care

Ethical decision making is a difficult task. Patients are interested in getting care that best meets their own values, and clinicians do not want to be compelled to act against their best judgement of their professional responsibilities (Bosslet et al., 2015). Proactive communication along with involvement of expert consultation is the best method to achieve ethical decision making in difficult situations (Bosslet et al., 2015). Ethical communication involves establishing a trusting relationship, discussion of the patient’s diagnosis and potential outcomes, establish the patient’s own desires, values, and principals, and involve the patient in the decision-making process (Bosslet et al., 2015). By establishing a trusting relationship and involving the patient in the decision-making process, there is less likely to be conflict, and all care is directed towards achieving the best patient outcome.