Springer Publishing's journal Clinical Scholars Review's latest issue is all about the topic of Doctor of Nursing Practice (DNP) degrees and their role in comprehensive care. In the coming days, we will be posting several Q&A with authors whose work is published in this issue; for more, the journal can be read online here.

 Leadership for the Integration of Comprehensive Care and Interprofessional Collaboration

by Patricia L. Starck, PhD, RN, FAAN and Laura L. Rooney, DNP, APRN, FNP-BC, DCC, FAANP

 Why is integrated comprehensive care such a crucial concept in nursing?

Nurses have responsibility to care for the whole patient, and often the coordination of different aspects of care falls to the nurse as the integrator. If nurses don’t help patients and families put together fragmented aspects of care into a coordinated whole, this task often goes undone with potentially disastrous effects.  Nurses are also concerned with the entire scope of care, not just amelioration of the current presenting problem.  Nurses are concerned with what happens to the patient after episodic care, and with prevention and health promotion.  Comprehensive care is the only way to achieve quality, safety, and cost effectiveness.

How is our healthcare system fragmented? What are the problems that can result from one profession being siloed off from another?

The delivery of health care takes place in many different settings: from inpatient (hospitals) to outpatient (clinics) to long-term care facilities. Lack of communication between providers and health care settings leads to duplication of testing, partial or misinformation, and missed follow up care.  The end result is a costly healthcare system with poor patient outcomes. Patients today are more complex and this presents a need for specialty care. However the specialist has a limited focus. Therefore, the need to coordinate the care (across a continuum) that takes place in these various settings and delivered by these various providers becomes paramount. Care coordination reduces the cost of healthcare by reducing duplications, attending to preventive health and improving long-term outcomes, and creating a complete record of care available to all members of the team.

Relying on the strength of a multidisciplinary approach and using the recognized strengths of several professions results in a more comprehensive plan of care. This team approach reduces cost, reduces the risk of medication error, improves the outcomes for patients, and creates a healthier population.

You write about a particularly successful nurse-managed clinic-what makes it such a strong example of integrated comprehensive care?

The successful nurse-managed clinic is a strong example of integrated care. The clinic utilizes established processes to enhance communications with professionals of multiple disciplines through coordination of care. Coordination of care improves and expedites the overall delivery of care to the individual. As an example, when a patient is referred for testing, a member of the clinic healthcare team provides the patient with referral information. The referral coordinator will then follow up with the patient to ensure the referral has taken place, completing the process by obtaining all documentation regarding that referral and diagnostic decisions. This enhances the communication not only between providers, but between the provider and the patient, placing the patient at the center of the healthcare delivery process.

How can interprofessional teams be trained in comprehensive care?

The very fact that different professionals with delineated roles come together, brings richness to problem-solving situations.  The synergy created by different types of expertise helps to guarantee comprehensive care.  Training in comprehensive care, as in many aspects of professional education, can be achieved by didactic learning as well as clinical simulation, but it only comes alive with participating in actual clinical situations.  Students learn from role-modeling, and seeing is believing. Therefore, it is important to select clinical learning opportunities where comprehensive care and team work is the standard.  Debriefings after a clinical situation is also valuable learning, always ending with “what can we do better next time?”  The didactic portion of interprofessional, comprehensive  care consists of skills in communication, conflict resolution, situational awareness, and other topics important to working in teams.