Addiction/Screening and Assessment (Case Presentation).         

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by expanding on your colleague’s post or suggesting an alternative viewpoint/perspective on the experiences described by your colleagues.

1. Intra- and interdisciplinary collaboration is undoubtedly one of my highest priority areas of interest a Doctor of Nursing Practice (DNP) student, and eventual practicing DNP. Throughout my nursing career, I have experienced a wide variety of collaboration styles; some within the same company but in different outpatient locations or departments, and other collaboration styles that were implemented as a company-wide initiative. Unfortunately, I have perceived many of these collaborative efforts as poor.

            Prior to completing my psychiatric-mental health nurse practitioner education with Walden, I worked in a variety of mental health settings including inpatient and outpatient mental health treatment that would also include dual diagnosis substance use treatment. Many of these settings offered collaboration that was purely transactional, and provided the minimum information required to complete the engagement. Often intradisciplinary, these were nurse-to-nurse shift handoffs or patient transfer calls to coordinate the delivery of a patient from the emergency department up to the psychiatric floor. Many aspects were involved in the quality, or lack thereof, of the communication that would take place. The essence of time was always and has been shown to be one of the most common barriers to effective care coordination at any level, as well as providers unfortunately passing the responsibility of initiating the contact (Šanc & Prosen, 2022).

            In my most recent position as a psychiatric nurse practitioner, there have been company-wide initiatives to ensure the presence interdisciplinary collaboration. The support from all levels of management has encouraged follow through of these initiatives, modeling importance and engagement in the practice (McEwen & Wills, 2019). Communication has been supported by assuring quick connection between a patient’s individual therapist and their psychiatric prescriber, with access to an internal instant messaging system providing a more casual and convenient platform for collaboration while cutting back on emails. Approximately nine to twelve months ago, the medical director was attending a weekly meeting with all the individual therapists and was available for additional consulting if needed. As the psychiatry team rapidly grew from five to ten prescribers, this became a daunting number of patients for the medical director to quickly review and answer questions for on-the-spot. I was happy to be a part of a problem-solving initiative introducing a consult hour, where individual therapists can schedule ten-minute Zoom meetings with a mutual patient’s psychiatric provider for additional consultation during a dedicated block of time each Friday between noon and 1pm EST. This has provided a great opportunity to collaborate in a more personal manner, offering spoken-word collaboration rather than electronic communication as the company covers approximately twenty-five states.

            In addition to weekly clinical consult hour, the psychiatry team meets weekly for one hour to offer time for intradisciplinary collaboration. This meeting is utilized to review patient cases where a diagnosis may feel unclear, or the prescriber may be seeking additional professional recommendation on a direction for medications. While the Henry et al. (2018) case study offered collaboration from individuals with varying specialty backgrounds, the weekly psych team meeting offers similar benefits as many of the psychiatric nurse practitioners have prior nursing experience in critical care which has been immensely supportive when ruling out or assessing physical health implications of a mental health diagnosis. Despite all prescribers specializing in psychiatry currently, there remains a vast array of experiences throughout advanced-practice as well including substance use treatment, severe-persistent mental illness, and specialization in neurocognitive disease. Collaborating with all different areas of psychiatry provides an even more in-depth evaluation of a specialty area and further improves patient outcomes.

As a Registered Nurse with 16 years of experience working in the field of inpatient psychiatry and substance use disorders, I have been a member of many different interdisciplinary treatment teams.  It is easy to say that some teams were more effective than others.  The most successful interdisciplinary teams, in my experience, place a high value on the importance of communication.  There was a recent study conducted by Ansa et al. (2020) whereby 551 staff members of a large medical hospital from varying disciplines answered survey questions related to interprofessional collaboration.  The staff members ranked communication as the top indicator of a successful team, followed by knowledge of role limitations and trust/mutual respect.

            Intradisciplinary collaboration can be defined as “a relational and respectful process among nursing colleagues that allows for the effective use of the knowledge, skills, and talents of all nursing designations to achieve optimal client and health system outcomes” (Canadian Nurses Association, 2020).  More succinctly, it means working towards a common goal within a single discipline rather than joining many disciplines together to achieve a goal.  While both of these approaches have value, it is essential to consider which collaboration style will yield more successful results for a given problem.

Personal Experiences with Inter versus Intradisciplinary Collaboration

 One of my previous organizations had an issue with the nursing admission workflow.  In this case, we took an intradisciplinary approach in order to brainstorm solutions.  We invited only those from the nursing discipline who wanted to participate to join leadership in the conference room to determine how we could improve the workflow.  While we were able to come up with a solid solution for this workflow gap, we neglected to factor in the roles of the direct care staff, admissions coordinators, and providers, which meant we had to go back and do so after the fact.

 2.           I worked for another organization that valued the importance of interdisciplinary collaboration very highly.  Treatment teams were created, and all other workflows stemmed from these teams.  The teams consisted of a Psychiatrist, a Social Worker, a Registered Nurse (RN), and a Mental Health Worker.  These teams would round on their patients together to ensure communication and collaboration were clear for the patient as well as within the team.  Treatment team meetings occurred after rounds and highly involved and extremely patient-specific treatment plans were developed and executed to ensure best patient care.  A recent case study determined that “combining students from different professions in the student-designed case study process supported a structured opportunity for socio-cultural learning, which is considered key to interprofessional learning” (Henry et al., 2018).  I believe that the same is true for healthcare.  By employing an interdisciplinary approach, communication and mutual respect are improved, which allows teams to solve problems together while considering each person’s unique perspective and skillset thereby improving patient car