Summary<\/strong>: Keywords<\/strong>: Participatory medicine, nursing. As a novice nurse in the late 1960s, I entered the nursing profession passionately committed to “taking good care of my patients.” I studied hard, passed my boards, selected my first patient care unit, and anticipated becoming the all-knowing independent resource and advocate for my patients undergoing cardiovascular surgery and their families.<\/p>\n Fortunately, I had selected a work setting that was fundamentally based on collaborative relationships between nurses and physicians and with patients and their families. I did not need, nor would it have been advisable, to think I would be the sole resource and advocate.<\/p>\n What I witnessed instead was the exquisite collaboration between the head nurse and chief surgeon as they modeled collaborative decision making; jointly creating an extraordinary program that saved the lives of thousands of patients and families and shaped the professional careers of hundreds of nurses and physicians. As an example of lasting impact, in September 2008, 45 nurses and physicians returned to the medical center for a reunion to celebrate those days.<\/p>\n What I also learned was how to work with patients and their families and how to help them to be full partners in their care. For example, 40 years ago, we were teaching patients and their families how to monitor the patient’s prothrombin times and anticipate what the physician would do, given a certain result. Rocky Schmitz, our head nurse, would remind us: “Who has more at stake than the patient for understanding what’s going on and preventing a mistake?” That lesson of including patients fully as partners in all aspects of their care was ingrained in me early in my career.<\/p>\n In short, I learned that information is power, but relationships are the key. My approach to describing a nurse’s perspective about participatory medicine is to elaborate on mutual participation between nurse and physician as two key components of the health care team, and then to describe nurses partnering directly with patients.<\/p>\n Those early years in critical care were challenging, often difficult, but there was a spirited relationship among nurses and physicians. Fairman and Lynaugh,<\/a>[1<\/a>] prominent nurse historians, recalled:<\/p>\n “<\/span>To gain expertise about the care of complex patients, nurses learned through experience and from physicians. Although many physicians were equally unskilled in the care of physically unstable patients, physicians provided much of nurses‘<\/span> postgraduate education through formal lectures and informal conversations. Nurses learned through slow periods in the intensive care area. During these times, residents (usually) and nurses in the intensive care unit discussed patients in detail, each learning from the other. When cardiac monitors were introduced at one hospital, a nurse remembered, nurses and physicians grouped informally around the monitor screen in ‘<\/span>pick-up‘<\/span> sessions…Unusually close camaraderie developed between nurses and physicians in the units because of the small areas, shared sense of adventure in the new setting, and the selection of the ‘<\/span>expert nurses,‘<\/span> usually young and ‘<\/span>energetic,‘<\/span> to staff the unit. ‘<\/span>We (nurses and physicians) were all in this together,‘<\/span> one nurse noted. ‘<\/span>We all learned from each other‘<\/span>.<\/p>\n<\/blockquote>\n In 1999, Tom Gilmore wrote a small piece about productive pairs<\/span>, or individuals who come together and develop a partnership to accomplish a shared goal.<\/a>[2<\/a>] Characteristics of these partnerships include:<\/p>\n Most nurses inherently value the concept of partnership, of complementary expertise, of collaboration. This stems from our service orientation and our holistic view of situations and solutions. As nurses, we also value the recognition that we bring unique skills and characteristics, what I term the nursing lens<\/span>: an ability to view patients holistically in the context of their environment and daily experiences; to establish therapeutic relationships with a wide variety of individuals; to think in terms of systems and the big picture; to have a scientific basis for practice and a pragmatic view of what works.<\/p>\n Decades of research have shown us that collaboration yields more than nurse\/physician satisfaction. Morbidity and mortality, length of stay, and other very quantifiable outcomes can also be affected by how effectively nurses and physicians work together.<\/a>[3<\/a>]<\/a>[4<\/a>]<\/a>[5<\/a>]<\/a>[6<\/a>]<\/a>[7<\/a>]<\/a>[8<\/a>] In a partnership relationship between colleagues, nurses and physicians have the opportunity to advance their best ideas, to create new solutions, and to grow professionally. They can be a productive pair accomplishing shared goals. Physicians and nurses working successfully in partnership form a terrific foundation for effective participatory relationships with patients and families.<\/p>\n According to Virginia Henderson, a nursing leader from the last century revered by some as much as Florence Nightingale, “The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge.<\/a>[9<\/a>]” This requires that the nurse work within another partnership relationship\u2014with each individual, sick or well\u2014to determine each patient’s strengths, will, and knowledge, and to develop personalized approaches to augment them as indicated. This is patient-centered care.<\/p>\n Over the years, however, the definition of patient-centered care has become muddy, ranging from the patient as decision maker and\/or full partner in care decisions, to what one physician described as ” patient-centered care\u2026I take care of patients.” Fortunately, this is changing. In 2001, the Institute of Medicine (IOM) urged patient-centered care, ie, “Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.<\/a>[10<\/a>]” In 2003, the IOM proclaimed that, “All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics.<\/a>[11<\/a>]” The nursing competency in this area, as outlined in the Quality and Safety Education for Nurses (QSEN) project funded by the Robert Wood Johnson Foundation, is to “\u2026recognize the patient or designee as the source of control<\/span> and full partner<\/span> (italics added) in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.<\/a>[12<\/a>]”<\/p>\n With the launch of this journal, a new vehicle has emerged for enriching partnerships among health care providers and with individuals, their families, communities, and populations, to improve health. The goal is appropriate and timely: “A cooperative model of health care that encourages, supports, and expects active involvement by all parties (health care professionals, patients, caregivers) in the prevention, management, and treatment of disease and disability and the promotion of health.<\/a>[13<\/a>]” The approach is essential: building an “interdisciplinary field of inquiry and practice.<\/a>[14<\/a>]” This is a goal and approach that everyone providing care or receiving it can support.<\/p>\n How will we evaluate success? What will be in place or what will we see if participatory health care between care providers and with individuals and their families becomes a reality? Here are some indicators that would reflect success among health care providers:<\/p>\n Participatory health care does not<\/span> require everyone meeting together to jointly do all of the work. Rather, it takes advantage of differential areas of expertise and capitalizes on a shared commitment to achieving jointly determined goals.<\/p>\n For success in partnering with patients and families, the following indicators from the QSEN project could be assessed:<\/p>\n The current environment within health care has been described as VUCA — volatile, uncertain, chaotic, and ambiguous. Gone are the days when patients stayed in the hospital for weeks for simple procedures such as coronary artery bypass, or when nurses gave patients bags of supplies to take home with them so they wouldn’t have to worry about paying for them. But the benefits of being part of a collaborative team\u2014which includes patients and their families\u2014that works together, values each other’s knowledge and contributions, and can make a profound difference in people’s lives, both their patients’ and their own.<\/p>\n <\/a> Fairman J, Lynaugh J. Critical Care Nursing: A History<\/span>. Philadelphia: University of Pennsylvania Press; 1998:85. \u21a9<\/a><\/p>\n<\/li>\n <\/a><\/p>\n <\/a> Gilmore T. Briefing notes: productive pairs. Philadelphia: Center for Applied Research, University of Pennsylvania; 1999. Available at: http:\/\/www.cfar.com\/Documents\/prodpairs.pdf<\/a>.\u00a0 Accessed October 19, 2009. [Google Scholar]<\/a> \u21a9<\/a><\/p>\n<\/li>\n <\/a><\/p>\n <\/a> Knaus WA, Draper EA, Wagner DP, Zimmerman JE. An evaluation of outcome from intensive care in major medical centers. Ann Intern Med. 1986;104:410-418. (Medline<\/a>) [Google Scholar]<\/a> \u21a9<\/a><\/p>\n<\/li>\n <\/a><\/p>\n <\/a> Baggs JG, Ryan SA, Phelps CE, et al. The association between interdisciplinary collaboration and patient outcomes in a medical intensive care unit. Heart Lung. 1992;21:18-24. (Medline<\/a>) [Google Scholar]<\/a> \u21a9<\/a><\/p>\n<\/li>\n <\/a><\/p>\n <\/a> Baggs JG, Schmitt MH, Mushlin AI, et al. Association between nurse-physician collaboration and patient outcomes in three intensive care units. Crit Care Med. 1999;27:1991-1998. (Medline<\/a>) [Google Scholar]<\/a> \u21a9<\/a><\/p>\n<\/li>\n <\/a><\/p>\n <\/a> Henneman E, Dracup K, Ganz T, et al. Effect of a collaborative weaning plan on patient outcome in the critical care setting. Crit Care Med. 2001;29:297-303. (Medline<\/a>) [Google Scholar]<\/a> \u21a9<\/a><\/p>\n<\/li>\n <\/a><\/p>\n <\/a> Vazirani S, Hayes RD, Shapiro MF, Cowan M. Effect of a multidisciplinary intervention on communication and collaboration among physicians and nurses. Am J Crit Care. 2005;14:71-77. Available at: http:\/\/ajcc.aacnjournals.org\/cgi\/reprint\/14\/1\/71<\/a>.\u00a0 Accessed October 19, 2009. [Google Scholar]<\/a> \u21a9<\/a><\/p>\n<\/li>\n <\/a><\/p>\n <\/a> Rosenstein AH, O’Daniel M. A survey of the impact of disruptive behaviors and communication defects on patient safety. Jt Comm J Qual Patient Saf. 2008;34:464-471. (Medline<\/a>) [Google Scholar]<\/a> \u21a9<\/a><\/p>\n<\/li>\n <\/a><\/p>\n <\/a> Tomey AM, Alligood MR. Nursing Theorists and Their Work. <\/span>St. Louis: Mosby; 1998:102. \u21a9<\/a><\/p>\n<\/li>\n <\/a><\/p>\n <\/a> Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century.<\/span> Washington DC: The National Academies Press; 2001:40. Available at: http:\/\/www.nap.edu\/html\/quality_chasm\/reportbrief.pdf<\/a>. Accessed October 19, 2009. \u21a9<\/a><\/p>\n<\/li>\n <\/a><\/p>\n <\/a> Institute of Medicine. Health Professions Education: A Bridge to Quality<\/span>. Washington DC: The National Academies Press; 2003:45. Available at: http:\/\/books.nap.edu\/openbook.php?record_id=10681<\/a>.\u00a0 Accessed October 19, 2009. \u21a9<\/a><\/p>\n<\/li>\n <\/a><\/p>\n <\/a> Cronenwett L, Sherwood G, Barnsteiner J, et al. Quality and safety education for nurses. Nurs Outlook. <\/span>2007;55:122-131. (Medline<\/a>) [Google Scholar]<\/a> \u21a9<\/a><\/p>\n<\/li>\n <\/a><\/p>\n <\/a> e-Patient Dave. Why the Journal of Participatory Medicine? e-patients.net. October 12, 2009. Available at: http:\/\/e-patients.net\/archives\/2009\/10\/why-the-journal-of-participatory-medicine.html<\/a>. Accessed October 19, 2009. \u21a9<\/a><\/p>\n<\/li>\n <\/a><\/p>\n <\/a> Goethals GR, Sorenson GJ, Burns JM, eds. Encyclopedia of Leadership, Vol. 4.<\/span> Great Barrington, MA: Berkshire: 2004:xxxv. \u21a9<\/a><\/p>\n<\/li>\n<\/ol>\n Copyright<\/strong>: <\/span> \u00a9 2009 Joanne Disch. Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the author(s), with first publication rights granted to the Journal of Participatory Medicine. All\u00a0journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their\u00a0appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.<\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" Most nurses inherently value the concept of partnership, of complementary expertise, of collaboration. This stems from our service orientation and our holistic view of situations and solutions. <\/p>\n","protected":false},"author":74,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_price":"","_stock":"","_tribe_ticket_header":"","_tribe_default_ticket_provider":"","_tribe_ticket_capacity":"0","_ticket_start_date":"","_ticket_end_date":"","_tribe_ticket_show_description":"","_tribe_ticket_show_not_going":false,"_tribe_ticket_use_global_stock":"","_tribe_ticket_global_stock_level":"","_global_stock_mode":"","_global_stock_cap":"","_tribe_rsvp_for_event":"","_tribe_ticket_going_count":"","_tribe_ticket_not_going_count":"","_tribe_tickets_list":"[]","_tribe_ticket_has_attendee_info_fields":false,"jetpack_post_was_ever_published":false,"footnotes":""},"categories":[31,76],"tags":[77],"coauthors":[],"class_list":["post-233","post","type-post","status-publish","format-standard","hentry","category-commentary","category-vol-1-2009","tag-issue"],"yoast_head":"\n
\nMost nurses inherently value the concept of partnership, of complementary expertise, of collaboration. This stems from our service orientation and our holistic view of situations and solutions. As nurses, we also value the recognition that we bring unique skills and characteristics, what I term the nursing lens: an ability to view patients holistically in the context of their environment and daily experiences; to establish therapeutic relationships with a wide variety of individuals; to think in terms of systems and the big picture; to have a scientific basis for practice and a pragmatic view of what works.<\/p>\n
\nCitation<\/strong>: Disch J. Participatory health care: perspective from a nurse leader. J Participat Med. 2009(Oct):1(1):e4.
\nPublished<\/strong>: October 21, 2009.
\nCompeting Interests<\/strong>: The author has declared that no competing interests exist.<\/p>\n
\nPartnerships with Physicians<\/h3>\n
\n
\n
Partnerships with Patients and Families<\/h3>\n
Achieving Participatory Health Care<\/h3>\n
\n
\n
References<\/h3>\n
<\/a><\/p>\n
Open Questions<\/h3>\n
\n