NU 726 Unit 6 interprofessional collaboration analysis example

One Patient, Seven Disciplines: Collaboration Around an 84-Year-Old With Pneumonia and New Delirium

Student Name

Department of Nursing, Herzing University

NU 726: Professionalism and Leadership for Advanced Practice

Instructor Name

February 26, 2026

One Patient, Seven Disciplines: Collaboration Around an 84-Year-Old With Pneumonia and New Delirium

The Patient and the Team

Mrs. A., a composite 84-year-old retired seamstress who lived alone with daily help from her daughter, was admitted to a medical unit with right lower lobe pneumonia. On the second night she became agitated and confused, pulled out her intravenous line, and did not recognize her daughter the next morning. Her stay lasted eight days. Seven disciplines were involved: the hospitalist, who led medical care; me, the unit's geriatric nurse practitioner, consulted for delirium on day two; the bedside registered nurses across shifts; the clinical pharmacist; a physical therapist and an occupational therapist; a speech-language pathologist; and the case manager. The unit uses structured interdisciplinary rounds each weekday morning, a format associated in one teaching unit with improved teamwork climate (O'Leary et al., 2011).

What Each Discipline Brought

The hospitalist managed the pneumonia, ordered antibiotics and oxygen, and made the final call on discharge timing. The bedside nurses noticed the first sign of delirium, a change in attention the evening before the agitation, and carried out most of the delirium prevention measures around the clock. The pharmacist found that Mrs. A. had been given diphenhydramine for sleep on her first night from a standing order set and that her home medication list included oxybutynin. The physical therapist got her walking on day three with a walker and recommended against discharge home alone. The occupational therapist assessed her ability to manage her medications and meals, finding that she could not yet sequence a simple meal task. The speech-language pathologist evaluated her swallowing after she coughed with thin liquids and recommended a modified diet. The case manager arranged insurance authorization for a skilled nursing facility and talked with her daughter about options.

How the Team Actually Communicated

Communication ran through four channels, and each carried different information. Morning interdisciplinary rounds, 15 minutes at the unit's workstation, brought together the hospitalist, charge nurse, pharmacist, case manager, and whichever therapist had seen the patient; I joined from day two. Rounds carried decisions. Secure messages carried urgent updates between rounds, such as the night nurse's message about Mrs. A.'s agitation. Progress notes carried each discipline's assessment but were read unevenly; the physical therapist's note recommending against discharge home was not seen by the hospitalist until it was raised aloud at rounds. The whiteboard in Mrs. A.'s room carried her daily goals, her nurse's name, and her walking schedule, and was the only channel her daughter could see. The gaps in this case occurred where information lived in one channel and was needed in another.

Where Roles Overlapped

Two decisions were claimed by more than one role. First, medication review. The pharmacist and I both reviewed her medications on day two and both identified the anticholinergic drugs. We had not coordinated, and the hospitalist received two separate recommendations with slightly different wording, one to discontinue diphenhydramine and one to discontinue both diphenhydramine and oxybutynin. The overlap was settled at rounds on day three, where the pharmacist and I agreed on a single recommendation, stopping both, and the hospitalist wrote the orders. The overlap was useful, because two independent reviews reached the same finding, but it cost a day.

Second, the swallowing assessment. A bedside nurse performed the unit's nursing swallow screen on admission, which Mrs. A. passed; the speech-language pathologist's formal evaluation on day three, prompted by coughing, found aspiration risk with thin liquids. The nurse's screen and the therapist's evaluation are designed for different purposes, a screen to catch obvious risk and a formal evaluation to characterize it, and the team agreed that a failed or changed swallow after admission should trigger a new referral rather than reliance on the admission screen.

Where a Decision Nearly Fell Between Roles

The decision about who would tell Mrs. A.'s daughter that her mother would probably not return home directly almost went unmade. The physical therapist's recommendation, the occupational therapist's findings, and my assessment of her cognition all pointed toward a skilled nursing facility. The case manager assumed the hospitalist would raise it; the hospitalist assumed the case manager would, since she was arranging the placement. On day five, the daughter asked a nurse when her mother was going home and was upset to learn, informally, that placement was being arranged. The team then agreed at rounds that I would lead a family meeting that afternoon, with the case manager present, because I had assessed her cognition and could explain why the recommendation was being made.

What the Advanced Practice Nurse Contributed

Three contributions were specific to my role. First, I ran the delirium assessment with a validated tool and led a multicomponent prevention plan, including reorientation, sleep protocol without medications, early mobility, hearing aids and glasses at the bedside, and hydration, the approach shown to reduce delirium incidence in hospitalized older adults (Inouye et al., 1999). The nurses delivered most of it; my role was to set it up, keep it consistent across shifts, and track her daily score. Second, I integrated the findings of four disciplines into a single picture for the family: why she was confused, why it would probably improve but slowly, and why a short rehabilitation stay was safer than going home. Third, I began a goals-of-care conversation, which none of the other disciplines had time or role to lead, and her daughter's preferences were recorded before discharge.

What the Case Shows About Collaboration

Overlap here was a finding, not only a problem: two roles independently reached the same medication recommendation, which increased confidence in it. The near-miss was the gap, where responsibility for the family conversation belonged to everyone and therefore to no one. The interprofessional core competencies describe exactly this: working with other professions requires clarity about roles and responsibilities, and team communication that makes those roles explicit (Interprofessional Education Collaborative, 2023). A review of interprofessional collaboration interventions found modest improvements in outcomes, with evidence limited in quality, suggesting that structure helps but does not guarantee collaboration (Reeves et al., 2017). The unit has since added a standing question to rounds for every patient with a likely change in discharge destination: who will talk with the family, and when.

References

Inouye, S. K., Bogardus, S. T., Jr., Charpentier, P. A., Leo-Summers, L., Acampora, D., Holford, T. R., & Cooney, L. M., Jr. (1999). A multicomponent intervention to prevent delirium in hospitalized older patients. New England Journal of Medicine, 340(9), 669-676. https://doi.org/10.1056/NEJM199903043400901

Interprofessional Education Collaborative. (2023). IPEC core competencies for interprofessional collaborative practice: Version 3. Interprofessional Education Collaborative.

O'Leary, K. J., Buck, R., Fligiel, H. M., Haviley, C., Slade, M. E., Landler, M. P., Kulkarni, N., Hinami, K., Lee, J., Cohen, S. E., Williams, M. V., & Wayne, D. B. (2011). Structured interdisciplinary rounds in a medical teaching unit: Improving patient safety. Archives of Internal Medicine, 171(7), 678-684. https://doi.org/10.1001/archinternmed.2011.128

Reeves, S., Pelone, F., Harrison, R., Goldman, J., & Zwarenstein, M. (2017). Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews, (6), Article CD000072. https://doi.org/10.1002/14651858.CD000072.pub3