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Physician-Nurse
Collaboration The concept of physician-nurse collaboration has been around for decades. The nature of this relationship has evolved as nursing has evolved as a profession. As nurses move away from the role of simply assisting the physician and toward a more independent role in patient care, the physician-nurse relationship has needed to evolve also. The traditional hierarchical relationship has changed to a more equally balanced, collaborative relationship in which each member is respected for his or her unique contributions to patient care. This change; however, has met with some resistance, by both physicians and nurses. I wrote a paper during the course of my graduate studies on this issue of doctor-nurse collaboration, the barriers to change, and the efforts necessary to overcome these barriers. I thought I would share some of what I learned with all of you. Historically, physicians have relied on nurses to assist them in patient care. Nurses were the ones at the bedside 24 hours a day, carrying out physician orders and providing physical comfort for patients who were unable to care for themselves. As the years have gone by, nurses have asserted more authority and gained more autonomy in practice. Nursing has developed into its own profession, with a unique set of skills and knowledge to care for people and their responses to health and illness. This change in nursing has necessitated a change in the physician-nurse relationship. This change has come about slowly, and not without conflict. In one study conducted by Stein in 1967, it was found that nurses would make covert recommendations to doctors while appearing passive, so that doctors would appear to remain in control when they acted on these suggestions. Another study done more recently identified four patterns of interaction. These were (1) unmitigated subordination, (2) informal covert decision-making, (3) informal overt decision-making and (4) formal overt decision making. Another study also found that nurses who work in areas of higher patient acuity, such as intensive care units, perceive a higher level of collaboration with physicians versus lower acuity areas such as general medical wards. One of the barriers to collaboration is employment status. Nurses are usually paid employees and physicians generally function as independent contractors. Other barriers include status differential, educational level, gender differences, practice control between physicians and nurse practitioners, reimbursement issues, and poor communication. Factors that enhance physician-nurse collaborative relationships include mutual respect, trust, understanding and high levels of communication. Nurses and physicians need to make a conscious effort to overcome the barriers listed above. They need to work together to create a supportive working atmosphere in which all parties feel they make valuable contributions to patient care. Patient benefits of collaboration include shortened hospital stays, reduced hospital charges, and improved access to care. Benefits to the physician and nursing staff also exist in the form of job satisfaction, mutual respect, and strong commitment to patient care. As physicians and nurses come to understand the unique knowledge and abilities of each other’s profession, we are more able to function as a cohesive team to provide optimum care to our patients. In our own office, we have multiple examples of physician-nurse collaboration. In addition to assisting with patients who are scheduled to come in to the office to see Dr. Paustian, our nursing staff runs anticoagulation clinics, pacemaker clinics, and Carvedilol dosing clinics. Dr. Paustian reviews the reports from these visits which are generated by the nursing staff, and plans of care are discussed. In addition, there are always patients who drop by the office with questions or concerns that are fielded by the nursing staff and relayed to Dr. Paustian. Communication is maintained with Dr. Paustian via intra-office email, telephone calls, and face-to-face conversations. Dr. Paustian can also review lab values, reports and vital signs through our office computer database. Utilization of nursing staff as an extension of the physician enables our office to care for more patients in a more timely fashion while at the same time providing high quality care. Dr. Paustian diagnoses and treats each patient’s specific health concern. The nursing staff then functions to help the patients gain a deeper understanding of their health or disease state and monitors their medication and treatment plan as prescribed by Dr. Paustian. I believe our office has a high level of physician nurse collaboration, and this is due mainly to the high degree of mutual trust and respect that exists between Dr. Paustian and the nursing staff.
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Recently, The Clinic purchased a small portable device for cardiac and vascular ultrasound. It is made by the same company that produced the current unit we have had since 1996. Weighing about twenty pounds, equipped with the necessary transducers and software, it can do regular and stress echocardiography as well as carotid ultrasound. The whether there is a leaky valve, or weakness of the heart muscle. We also now have a back-up unit in case the main ultrasound unit is down for repairs, eliminating rescheduling and the associated inconvenience to the patient.
-Willie A.Wilcox, R.C.S. Coumadin
Connection Like more than two million other Americans, I take an oral anticoagulant, known as Coumadin. As I began therapy thoughts of how I would manage “this” raced through my head, “I didn’t want to bleed to death”. Knowledge about Coumadin therapy was my answer to remain safe and benefit the most from the treatment. Coumadin or Warfarin’s chemical name is C19 H15 NaO4. It is commonly used as an anticoagulant, inactivating Vitamin K, a key player in the body’s clotting game. Without Vitamin K, the liver cannot activate proteins necessary to form and maintain a clot. A person may be placed on Coumadin for various conditions, including venous thrombosis, pulmonary embolism, and prevention of systemic embolism in patients with acute myocardial infarction, tissue heart valves, mechanical heart valves, atrial flutter, and lastly atrial fibrillation. The above mentioned all have the ability to allow a clot to form somewhere, dislodge and then get stuck somewhere creating a problem such as a stroke or heart attack. Coumadin comes in a pill form and should be taken the same time each day with a full glass of water. How much you take depends on the results of a blood test called “PT” and “INR”. At the Helena Cardiology Clinic, a finger stick provides us with the information needed to determine your dosage. Your blood is usually checked every 4-6 weeks once your dosage has been established. The most important information to remember about Coumadin therapy includes the following:
The clinic
checks “PT” and “INR” Tuesday and Thursday mornings
from 8:30-10:30am. We are always ready to assist you with your Coumadin therapy.
- Susan V. Bodner, R.N. Pulmonary
Hypertension and Its Effect on the Heart Pulmonary Hypertension is elevated blood pressure of the arteries that carry blood from the heart to the lungs. Normal pulmonary artery pressures range from 15 to 25 mm Hg systolic (top number) and 8 to 15 mm Hg diastolic (bottom number). Blood pressure readings for these arteries are much less than systemic blood pressure because they are only going from the heart to the lungs and not the entire body. Some of the causes of Pulmonary Hypertension is the use of drugs or toxins including weight-reduction medications/appetite suppressants, cocaine, and amphetamines, hereditary factors, low oxygen levels in arterial blood because of lung disease, obstruction of the pulmonary circulation by blood clots (thromboemboli), congenital heart defects such as ventricular or atrial septal defects, heart valve conditions such as mitral valve stenosis, collagen vascular disease like scleroderma or unknown reasons. No matter what the cause, Pulmonary Hypertension leads to enlargement of the right ventricle of the heart because it is trying to pump against abnormal pressure in the pulmonary artery. If the ventricle can’t overcome the resistance the pressure will also increase in the right atrium and systemic venous system leading to signs and symptoms of right-sided heart failure. Symptoms of Pulmonary Hypertension include shortness of breath, fatigue, dizziness and syncope. Swelling of the legs or ankles, bluish discoloration of the lips and skin and chest pain occurs more often later in the disease. Because the lungs are not getting enough blood to oxygenate, the body compensates by producing more red blood cells to try to carry more oxygen. This leads to thickening of the blood which is harder to pump and increases the risk of developing clots. This is why the patient may be on a blood thinner. Tests to diagnosis this disease may include a 12 lead electrocardiogram (ECG), echocardiography to estimate pulmonary artery pressure and a chest x-ray. A heart catheterization is the most definitive test to diagnose and determine the severity of Pulmonary Hypertension. A heart catheterization can measure the pressure in the pulmonary circulation, the right atrium and ventricle as well as look at valve function. Pulmonary Function Tests can help identify or rule out other lung diseases that can cause shortness of breath. Arterial Blood Gas analysis may be done to evaluate oxygen levels in the blood. Other blood tests that should be done as well are a Complete Blood Count to look for anemia or polycythemia (increased red blood cells), a Comprehensive Metabolic Screen to check kidney and liver function and identify electrolyte imbalances. A thyroid profile may also be drawn because thyroid dysfunction is common in patients with Pulmonary Hypertension. Treatment for Pulmonary Hypertension may include supplemental oxygen therapy, agents to help your heart pump better, diuretics (water pills) to help reduce excess fluid retention, and medications to lower your blood pressure. Additionally, the patient should be treated with antibiotics before certain dental or surgical procedures. In certain instances lung or heart-lung transplants are indicated. Patients with Pulmonary Hypertension should never stop any of their medications without approval from their treating physician. Even though this disease cannot be cured with early diagnosis and treatment, many patients can have favorable outcomes.
- Lisa R. Cummings, L.P.N. With the holiday season upon us
soon we would like to extend our greeting for a safe and happy holiday
season. Again this year we will
have limited office hours for the Christmas Holiday so the staff can enjoy time
with their families. The office
will be closed on Friday, December 24th and Friday, December 31st.
The office will be open from  Upcoming Event Please mark your calendar for
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