Introduction
Nursing care is an important part of healthcare, directly impacting the patient’s prognosis and outcomes. Notably, registered nurses do not work in isolation, as other professionals, including doctors, dieticians, physiotherapists, laboratory technicians, and psychologists, work with patients in a hospital setting. Given the central role of nurses in healthcare delivery, a slight error may result in poor outcomes such as readmissions, disabilities, complications, and increased mortality rate (Pentecost et al., 2019).
Case Study Summary
Gabby Trunk, 78, was recently hospitalized for a chest infection and COPD exacerbation but has been readmitted with suspected recurrent infection. She is frail, underweight, and cachectic, requiring oxygen on admission. Gabby lives on a rural property with her 82-year-old partner Paul, who has early dementia.
The patient struggles with breathlessness, fatigue, and medication adherence, though she wishes to remain independent and care for her husband. Her niece Desiree provides occasional support. On arrival to the ward, Gabby is on a non-rebreather mask, has a skin tear on her forearm, and appears unwell, while Paul seems confused. Elderly patients with chronic diseases, such as Gabby Trunks, represent a vulnerable group due to decreased functioning and low immunity. Registered nurses (RN) should demonstrate effective leadership and teamwork when caring for patients.
Critical Appraisal of RNs’ Role in Multidisciplinary Team
Professional collaboration is inevitable, given that most senior citizens with chronic conditions have multiple medical concerns. Research findings show that there is little continuity of care, which causes high readmission rates of patients diagnosed with Chronic Obstructive Pulmonary Disease (COPD) (Press et al., 2019). The RN can help improve the patient’s outcome by understanding and executing their roles.
For instance, the RN can help ensure Gabby adheres to her medication using strategies such as the teach-back method, given that she has a history of non-adherence. The RN must communicate effectively for a collaborative care plan (“Nurses in collaborative care teams,” 2020). The nurses should be able to document each of their activities, such as the medication taken and time, vital signs, symptoms, and complaints (Ofsti et al., 2023). Moreover, it is the responsibility of the RN to ensure that there is continuity of care.
The other important role of the RN is to safely admit and discharge the patient if there is a need to make referrals to other clients. In Gabby’s case, during the readmission, her body weight dropped from 54 kg to 51 kg within a month of discharge. The RN can refer her to a dietitian, who can provide her with a proper meal plan to maintain a normal weight.
The RN must help with client evaluation from the expected outcome to support the collaborative interventions (“Nursing”, 2022). The nurse should customize the data to suit Gabby’s specific details, such as heightened breathlessness and fatigue, which make household activities difficult. Gabby can gain many benefits from having a collaborative RN working with a team of dieticians, psychologists, physiotherapists, and other relevant professionals.
Collaboration can help the nurses effectively use each team member’s competencies (“Nurses in collaborative care teams,” 2020). Teamwork also enables senior staff to supervise and create a supportive work environment. When engaging with a multidisciplinary team, the primary recommendation is to always ensure that the roles are clear and that the communication flow is seamless.
The RN is responsible for delegating, assigning, and supervising other nursing team members to improve patient outcomes. In the case of Gabby, the nursing team will include assistive personnel and the vocational nurse (“Nurses in collaborative care teams”, 2020). The two must receive the correct instructions on their duties. The assistive personnel can remove the damp dressing on Gabby’s forearm because it will likely cause more wounds and infections (Cummings et al., 2021).
While the RN is supervising, the place should be disinfected and dressed well. The RN has a supervisory role to ensure efficient completion of quality care to the client (“Nursing”, 2022). During supervision, the RN ensures that no medication or documentation error can potentially lead to adverse reactions to Gabby.
Patient and caregiver education is another crucial element of the RN’s job. Given that Gabby is staying at home, where she believes she can continue attending to her husband, her niece is the only other nonprofessional caregiver who can help. Notably, it appears that her husband’s dementia is escalating, as he now has a poor orientation to place, evidenced by not recognizing the hospital. Educating the family members and giving them the responsibility of ensuring that the patient adheres to the treatment regimen can help improve their outcome (Luo et al., 2022). Therefore, Gabby’s niece should come to the hospital so the RN can teach her aunt the best ways to care for her.
RNs’ Leadership Within Multidisciplinary Teams
Leadership ensures that information is effectively relayed to the proper channels for informed decision-making. One study conducted with respondents on noninvasive ventilation (NIV) established that their interactions with nurses had the most impact on their lives, yet the RNs felt incompetent in dealing with them (Farmer et al., 2022). For instance, the RN can explain to the multidisciplinary team some of the complications of COPD among elderly patients. Thus, some key qualities that the RN working with other professions should have include good communication and reporting skills.
Gabby is determined to continue staying home and caring for her husband. However, as the RN, it is important to demonstrate leadership by showing how Gabby’s behavior of not taking medication as directed and tapering the bronchodilators is negatively impacting her health. Notably, the interventions for acute COPD exacerbations include bronchodilators, antibiotics, and systemic corticosteroids (Amin et al., 2021).
As a leader, it is prudent to help other professionals counsel Gabby to adhere to the treatment and consider admission to the nursing home. As with Gabby, integrated care is suitable for people with long-term complex healthcare needs. The downside is that the patient needs clarification with conflicting information when there is fragmentation and disconnect between the healthcare providers (Michielsen et al., 2023). Good leadership ensures that the information flow from the healthcare team to the patient and their relatives is consistent and easy to understand (Ridwan et al., 2019). Therefore, it ensures that despite several professionals working on the same person, the care is personalized to offer the best outcomes.
Roles and Expertise of Other Members in Multidisciplinary Teams
One important team member in the multidisciplinary team is a dietician to help Gabby take the right meal that boosts immunity and maintains a healthy body weight. Studies show that COPD patients with comorbidities such as high cholesterol, diabetes, and osteoarthritis (Keshishian et al., 2019). Gaby may not have an issue with being overweight, but she has started having a significant drop in body mass, evidenced by losing three kilograms within a month. Therefore, the dietitian is critical in ensuring that Gabby eats a balanced diet.
COPD affects the respiratory system, hence the need to have a specialist in that field who can offer effective treatment and management. Gabby should be attended to by a respiratory physician and a rehabilitation respiratory therapist who can help assess the extent of infections and help Gabby with essential breathing exercises (Luo et al., 2022). Gabby should be checked regularly to ensure that there are no bacterial infections that may further complicate her breathing issues. In addition, the respiratory therapist can empower the patient to understand the need to wear the ventilator and non-rebreather mask appropriately.
A psychologist or counselor should be one of the multidisciplinary team, given that Gaby requires emotional management to help manage the stress that comes with late adulthood. Although Gabby has a chronic illness and declining functionality, she insists she wants to live at home and care for her husband. She is worried about the treatment side effects of the drugs and the bronchodilators on her skin.
The psychotherapist can help Gabby understand that it is normal for people in her age group to experience health issues, but with proper care, their quality of life can improve (Chang & Johnson, 2021). The mental health of the patient has a significant impact on their prognosis. Therefore, the psychologist should ensure that the patient is not stressed.
Application of Relevant NMBA Principles
The Australian Nursing and Midwifery Board ensures registered nurses have the suitable training and qualifications to implement safe practices in healthcare settings. The organization recognizes public safety as its priority, which makes it thorough in providing operations licensure to only qualified professionals (NMBA, 2023). When delivering care to patients, the RN and other professionals need to advocate for treatment and management measures that are safe for the patients.
Moreover, they should demonstrate leadership even within informal contexts, such as when the patient is at home, as with Gabby (Boamah, 2018). The leadership and concerns for public safety should be tied to the culture. For instance, if caring for a husband is the most important role for a woman, then effective leadership entails understanding Gabby’s reasoning while weighing public safety options.
Standards of practice ensure that the services provided to patients are uniform, credible, and effective. Twenty-two primary standards of practice can be understood through four domains, including professional practice, nursing care, general practice environment, and collaborative practice (Australian Nursing & Midwifery Federation, 2014). All the standards are relevant to RNs in their practice and when working with a team of other professionals. For instance, evidence-based practice is one principle that nurses should base their care on.
Conclusion
In conclusion, the complexity and chronic nature of some diseases demand that a multidisciplinary team work on one patient. In addition to competently performing their duties, the RN must always be prepared to offer leadership. Other interdisciplinary team members, including the dietitians, physiotherapists, physicians, and psychologists, must have specified roles and communicate their plans to the team to avoid confusion. In the case of Gabby, her caregiver should be involved in the decision-making process and counseling, given that her husband is sick. Efficient communication and coordination will result in improved quality of life for her and reduce the number of readmissions.
References
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