Collaborative Practice PAGE \* MERGEFORMAT 6
Collaborative Practice in the Neonatal Intensive Care UnitJean MatscheUniversity of PhoenixBSN013; NUR402Kathleen Jordan, MS RNJanuary 21, 2007Collaborative Practice in the Neonatal Intensive Care UnitCollaborative practice in health care occurs when a member of the health care team consults with another member to provide patient care. Collaboration most often occurs between doctors and nurses. "Collaboration is defined as a relationship of interdependence; the ability to work together involves trust and respect not only of each other but of the work and perspectives each contributes to the care of the patient" (Phipps and Schaag, 1995, p. 19). ...view middle of the document...
Those on this team included the neonatologist, nursing staff, respiratory therapy staff, dietician, social services, case management/discharge planning nurse, pediatric sub specialists in; surgery, gastroenterology, psychology, optometry, and radiology, and the family.This infants' course in the NICU was complicated by: 1) extremely immature lungs requiring conventional mechanical ventilation, high frequency oscillating ventilation and after extubation, nasal continuous positive airway pressure, 2) Recurrent episodes of necrotizing enterocolitis (NEC) that eventually led to intestinal perforation, and 3) Small germinal matrix hemorrhage with subsequent Periventricular Leukomalacia (PVL).The infant was discharged home with her mother after four months in the NICU. Home care equipment included oxygen, monitors for heart rate, respiratory rate and pulse oximetry, continuous nasal gastric feedings and total parenteral nutrition (TPN) through a central venous catheter (CVC). Discharge diagnosis included, bronchopulmonary dysplasia (BPD), immature retina, short bowel syndrome and high risk for cerebral palsy secondary to PVL.This case had extensive collaborative practice from admission throughout the hospitalization and followed through with special discharge needs and home care. The collaboration is based both on the medical diagnosis and nursing diagnosis that involve collaboration with the medical and ancillary staff.Nursing Diagnosis and Collaborative ProblemsCollaborative care is essential in the NICU. Collaborative problems are detected from the nurse's assessment of the patient. Management of collaborative problems did include implementing physician prescribed and nurse prescribed actions to curtail escalation of the problem and preventing patient harm. From the nurse's assessment, a nursing diagnosis is formulated. The nursing diagnoses are stated in the form of the problem, the etiology, and the symptoms that the nurse observes. Nursing diagnosis can include a current or potential problem, an at risk problem, or a wellness diagnosis. Nursing diagnosis provides the framework from which the nurse begins to devise a plan of care (POC) and nursing interventions. The POC needs to incorporate collaborative practice.Inadequate nutrition is a common nursing diagnosis in a premature, but nurses are not the experts in nutrition. The presence of an active, experienced neonatal nutritionist is vital to maintaining a comprehensive, consistent approach to optimizing nutritional practices in the NICU (Kuzma-O'Reilly et al., 2003). In this case, collaboration with the nutritionist was needed not only to optimize growth in the NICU, but also for the discharge plan of an infant being discharged on a specialty formula with alternative feeding requirements.The recurrent bouts of NEC this infant suffered were first observed by diligence on the nurses part with minor feeding intolerance that the nurse reported to the physician. The bowel perforation required the...
