Module 9 Student Led Case Presentation By Annie Chung IPE/HRSA Fall 2015

Case Study  Ms. J.J. is a 57-year-old Caucasian female with a past medical history of uterine cancer, breast cancer, gastric bypass sleeve, and hysterctomy  Primary language is English  Came in for breast exam and pap smear  Detection of essential hypertension of (1) 148/100 mm Hg and (2) 147/103 mm Hg on day of care  Discovered that patient was suffering from depression  Patient was crying. She shared with me the situations underlying her depression and what has and has not helped for her.

IPC Competency  TT8. Reflect on individual and team performance for individual, as well as team, performance improvement

Problems  No care coordinator in early morning. Thus, there is no one to connect the patient to resources.  Physician simply did not know that patient was suffering from depression altogether. There was nothing much the physician could do or did.  Lack of complete understanding of clinic protocol as far as connecting patient to resources and services.  Other than nursing student, no one else is present to hear patient’s story. It really is a matter of physician seeing patient for “clinical” issues only.

Solutions  Listened to patient’s story  Healthcare professionals use patients’ stories in clinical settings to direct focus on the patient-centered care and to communicate with one another about a patient’s concerns  “Taking a history, presenting a case, and conferring with colleagues all involve the creation, co-creation, and recreation of oral and written patient narratives on the part of providers” (Clark, 2014, p. 34).  Discussed with physician regarding patient’s situation; attempted to determine with the physician what could be done for the patient.  Discussed with care coordinator later in the day so that she could call the patient and offer a psychological/counseling services, community resources, or social worker.

Solutions con’t  If interprofessional education is where two or more professions come together to learn with, from, and about one another to improve patient care then narrative approaches become significant for interprofessional communication in its practice.  “Use of a narrative approach has the analytical power to reveal and provide insight into the multiple layers of professional practice and their interrelationships that strengthen one’s sense of self, enhance one’s relationship with the patient, and enable better communication with one’s team members” (Clark, 2014, p. 38).  Since I knew that the patient felt “so much better” after talking to me, I felt that a resource for support groups would be beneficial for her. I proposed this idea to the care coordinator.

Solutions con’t  In the context of a patient’s narrative/story on her situation, interprofessional collaboration of multiple and shared voices has an influence in “achieving the kind of integrated communication required for effective collaboration. Such a process can enhance team cohesion and even lead to improved team effectiveness and patient outcomes” (Clark, 2014, p. 37)  Every healthcare team member has a voice, knowledge in his/her own specialty, and can contribute insight and ideas in order to formulate a collective, team-effort solution for the patient.  As a nursing student wherein I fill in the gaps of patient education, I also played a role in relaying information to the provider and care coordinators so that continuity of care is given, and filling in gaps when needed.  Discussed with care coordinator the need to follow-up with this patient to offer counseling consultation services and resources such as support group.  Care coordinator agreed to contact patient (as I discussed what I observed and experienced with the patient, the care coordinator made notes about her to follow-up and call)  Social worker may be assigned to patient  On my next clinical day, I will follow-up with cc to see if contact has been made with patient.

What did you learn?  I learned that interprofessional collaboration requires listening to a patient’s story. The patient’s story creates the context for the interprofessional team to step in and fill in the gaps with the application of specialty knowledge and insight.  There is a holistic set of needs to be met, by all types of professionals in various disciplines, if only time is spent to listen to and relay a patient’s story.  Cannot stress enough how important communication is among healthcare team members. Collecting and relaying adequate and accurate account of patient’s story is necessary for planning and coordinating care that is aligned with patient’s feelings, values, beliefs, and goals.  As the author stated it best, “There will be a growing emphasis on the quality, and not simply the length, of life” (Clark, 2014, p. 36)

How did you feel?  I thought it was extremely unfortunate that when I discussed the patient’s situation with the physician, she merely stated “she should come back for a psychological consultation.” Besides me being present and offering some advice, nothing was being done for the patient while the care coordinator was not in yet. It was also unfortunate that the physician had no idea that the patient was dealing with this. Who else would have detected that patient was depressed if it weren’t for a nursing student to stay in the room to build a relationship and gain insight on an underlying issue related to her high blood pressure?  From my experiences thus far, it seems as though physicians are in patients’ rooms for at most 10 minutes, but mainly to address clinical problems only.  It was also unfortunate that a care coordinator was absent when she was most needed.  Depression, a serious illness, would have easily been unforeseen. This could have led to detrimental circumstances for the patient had this not been addressed.

My experiences…  As a team member: I relayed an accurate account of patient’s story to the physician and care coordinator. I made sure that by the end of the day, the care coordinator understood the need to reach out to the patient and to coordinate a visit for further evaluate her depression and to determine the best option specifically for her.  As a team leader: I addressed the issues and offered an idea to a solution such as providing a resource for a support group since patient stated numerous times that she felt so much better after talking to me.

3 Practical Take Away’s  Spend time with the patient, be present, and listen to their story.  Communicate: be persistent about addressing the issue(s) to physician and care coordinators and ensuring that appropriate attention and care are provided for the patient. Offer solutions that align with patient’s values, feelings, and goals.  Strive for patient-centered care: fill in the gap(s) to the best of your ability with the knowledge, insight, and experiences that you have.

Reference Clark, P. G. (2014). Narrative in interprofessional education and practice: implications for professional identity, provider-patient communication and teamwork. Journal of Interprofessional Care, 28(1): doi: /