Interprofessional Collaborative Practices in Chronic Kidney Disease Management

This article discusses the importance of interprofessional collaborative practices in managing chronic kidney disease (CKD). It explores a case scenario of a nephrology patient and the interprofessional team involved in their care. The article also highlights the competencies required for effective collaboration and evidence-based strategies that enhance interprofessional collaboration in CKD management.

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Evidence-Based Nursing Research
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Interprofessional collaborative practices
Introduction
Interprofessional collaborative practices can be described as practices by a multi-
disciplinary team of healthcare professionals who work together to manage the treatment and
care of a patient. The Canadian Interprofessional Health Collaborative describes it as an alliance
between health care providers and the patient, where they all work in collaboration in decision
making processes regarding health concerns. It can also be defined as the process of decision-
making that incorporates health care professionals with different specialties and skills (Bridges et
al, 2011). The aim of interprofessional collaborative approaches is to provide optimal quality
care to patients. This paper will discuss the case scenario of a nephrology patient who is
diagnosed with chronic kidney disease, the interprofessional collaborative approaches required in
their care, the competencies related to use of a collaborative approach, evidence-based strategies
that would enhance interprofessional collaboration, outcomes of these strategies and implications
of collaboration practices on professional growth.
Case Scenario
An elder man of sixty diagnosed with chronic kidney failure and has a history of diabetes
mellitus and hypertension will be the focus of this paper. His care must be provided by an
interprofessional team to manage and treat his illness. Patients with chronic renal failure risk
developing other conditions like anemia, cardiac arrhythmia, hyperkalemia among other
conditions (Bartaula et al, 2019). They, therefore, need specialized care from a health care team
consisting of a nephrologist, general physician, a nutritionist and a cardiologist in some cases.

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During my clinical experienced, I witnessed this man receive coordinated care from all these
health care professionals.
Chronic kidney disease comes with a huge burden of care, with patients spending more
time hospitalized. It is also associated with high healthcare costs and higher rates of premature
fatalities (St Peter, Farley, and Carter, 2011). In the hospital, the team involved in the care
included advanced practice nurses, dieticians, social workers, physicians, nephrologist and
pharmacists. The patient is also included in decision-making strategies regarding treatment
options and care. More focus is put on patient education and preparing them psychologically for
end-stage renal disease.
The relevance of CKD case study
Chronic kidney disease predisposes the patient to cardiovascular events, high economic
burden and poor health outcomes (Webster et al, 2016). For optimal management of CKD, an
interdisciplinary team has to work in collaboration both in and out of the healthcare setting. One
of the most significant areas in the management of CKD has been patient education, which is
usually extensive. The care for CKD patients has led to a discussion about interdisciplinary
clinics and their role in improving health outcomes for these patients. Their role is patient-
centered care of CKD patients through the collaboration of interprofessional health care workers
and preparation of patients for End-stage liver disease.
Nephrologists and other health care providers consult with each other and with the
patient with the aim of coming up with an effective care plan for the management of disease
through evidence-based guidelines. The complicated nature of CKD requires a team of

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healthcare workers working together with the patient and the family to ensure the best patient
outcome.
Interprofessional collaborative framework
Key competencies of Interprofessional collaboration in CKD management used in this
paper include communication, Patient involvement, role clarification to avoid disputes in the
plan of care, Conflict Resolution, Team effort, Collaborative leadership, and reflection
(Sunnybrook Health Sciences Center, n.a).
Communication involves efforts from every member of the interprofessional team to
provide updates in a timely manner. All the team member should be up to date with relevant
information about the patient and any medical findings that may impact their care. When
information is communicated in a timely manner, care providers are able to take relevant steps
towards patient care. Documentation is the most common mode of communication in a
healthcare setting. Team members should ensure all information regarding patient care is
updated in real time to allow easy access by other members.
Patient involvement refers to team collaboration that includes the patient and family in all
aspects of care. The interprofessional team should ensure that the patient’s goals, needs, and
values are put into consideration when making a plan of care. The patient is also encouraged to
be as independent as possible, while the family is encouraged to provide psychological,
emotional and physical support (Yang, et al, 2014). The health care team should ensure that the
environment they create for the client and family is safe and private where they feel at ease
sharing their needs and preferences, and where they receive trust and confidentiality. Every

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update in the plan of care should be communicated to the patient in an understandable way.
Every member of the team should be ready to answer and discuss any concerns with the client.
The other domain is role clarity. Every member of the interprofessional team should
understand their role in the team and the roles of their colleagues in order to establish boundaries
and appreciate information from other team members (Sunnybrook Health Sciences Center, n.a).
All members should embrace the diversity in professions within the team and engage each other
in inter-professional education to build knowledge that enhances care. Every team member
should recognize their own shortcomings and engage other members in consultations to ensure
the best plan of care is outlined. New and updated models of care should be discussed based on
skills and knowledge. In addition, role clarification should be clear enough to enhance the
transition of care in a timely and convenient manner
Conflict resolution is vital for productive collaboration within the interprofessional team.
Professional constrictive criticism should be encouraged with all members remaining open-
minded to suggestions about care provision. Difficult issues within the team should be
proactively and extensively discussed and solutions that are mutually agreed implemented.
Respect and professionalism should always be maintained. Tools for conflict management like
institutional guidelines and ethical frameworks should be used to resolve any conflicts and come
up with the best outcomes for the client. Potential sources of conflict within the team such as
power differentials and role overlaps should be identified and addressed proactively to ensure
healthy working relationships (Sunnybrook Health Sciences Center, n.a).
Team effort encompasses teamwork dynamics within the team to ensure quality care
provision. Team guidelines should be integrated and followed by all team members. The team
should support each other and promote confidence within the team to enhance morale. Decisions

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regarding treatment plans and care of the patient should be done collaboratively. In addition, the
team should always make efforts to integrate evidence-based practices that promote collaborative
approaches to optimize care. When the team is under pressure, members should collaboratively
act to seek a solution suitable to support team goals.
Collaborative leadership ensures that the team supports contributions from every team
member and supports shared decision-making and equity in leadership depending on the issue at
hand. Every team member’s expertise should be considered before going forward with plans of
care through inter-professional discussions. All members should identify every team member’s
expertise and role in collaborative care to facilitate service delivery through integration.
Reflection is a vital part of the framework as it addresses evaluation of assessments and
evaluations should be done to ensure the team is performing optimally and providing quality
care. A team evaluation tool that incorporates all components of the framework should be
implemented. It enables in the identification of gaps in care provision and provides the
opportunity for team members to improve on their weak points (Sunnybrook Health Sciences
Center, n.a). Team achievements should be celebrated and poor outcomes discussed to allow for
improvement. Individual pressure on any team member should be collaboratively discussed and
understood well enough and the best solution sought.
In-Depth Analysis of case scenario with the interprofessional collaborative framework
Progressive kidney disease requires advanced care planning which includes dietary
counseling, patient education, dialysis access placement, coordination of transplant and
medication adherence (Shi et al, 2018). The interprofessional team includes an advanced
practitioner to educate the patient on treatment option of Chronic Kidney Disease, a dietitian to

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provide dietary counselling and recommendations on fluid management, a pharmacist who will
review the medication including adherence, dosing and provide education to patient on
importance of adherence, a nephrologist to determine the care plan depending on prognosis of
disease, a transplant team, to provide patient education on transplant option, requirements and
what to expect, a geriatrician to discuss palliative care options with the patient and help them
cope with the disease and a social worker to ensure essential needs like transportation to the
hospital and housing are available for the patient.
Other health care professionals that are important include a surgeon who monitors the
patient’s access for dialysis and an interventional radiologist who is needed when there is an
immature or non-functional AVF. They ensure there is access flow to start dialysis.
The healthcare team needs to ensure effective communication to enhance care provision.
For instance, the nephrologist should work in collaboration with the pharmacist and the patient in
order to ensure medication adherence and to monitor adverse effects of medication. In case of
adverse effects, the prescription may be changed by the nephrologist, who must then update the
pharmacist to ensure the correct medication is given.
Despite their different specialties, the inter-professional team caring for the patient must
all engage in patient education. It has been proven that patient education enhances the
preparedness of treatment options, leading to improved patient outcomes and reduced hospital
stay (Narva, Norton and Boulware, 2015). In addition, the inclusion of the patient in the plan of
care is vital in order to asses their needs and preferences which allow the team to plan
accordingly. A dietitian or nutritionist may be required to provide patient education about dietary
modification. However, this may not be effective unless the patient is included in planning their

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diet. This is because the patient may be limited financially which may also affect their ability to
change their diet.
Interprofessional collaborative care also enhances the transition from chronic kidney
disease to end-stage renal disease, thereby reducing morbidities and mortality rates that are
brought about by dialysis treatment. Other issues that often affect a CKD patient are
psychological that include stress and anxiety and depression. Psychological support should,
therefore, be incorporated within the interprofessional team to allow the patient to cope with
stress.
Evidence-based strategies that promote effective collaboration relevant to CKD
According to (Harding et al,2017) management of CKD must include coordinated care
from different specialists with outlined goals to avoid role overlap and duplication of effort.
They suggest that primary care providers should work in collaboration with endocrinologists to
manage diabetes, lifestyle modifications like diet and hypertension. However, complications
from CKD like bone disorders should be handled by a nephrologist. They also add that when
CKD reached later stages, the nephrologists should also focus on lifestyle modifications in
collaboration with a renal nutritionist. This would ensure that the primary care physician works
in close collaboration with the endocrinologist without role overlap and ensures a smooth
transition of care when a patient is in end-stage liver disease.
Another strategy is the use of interdisciplinary clinics as outlined by (Johns et al, 2015) to
delay the progression of CKD to end-stage renal disease, thereby reducing mortality rates.
Interdisciplinary clinics are described as healthcare institutions that provide coordinated care for
CKD patients, including patient education and preparation for end-stage renal disease. The

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interdisciplinary clinics usually have a nephrologist, pharmacist, social workers, advanced
practice professionals, physicians and dieticians, all working in collaboration to provide patient-
centered care. These clinics focus mainly on CKD patients, which ensures that the
interdisciplinary team is only focused on one condition, allowing for more efficient care. In
addition, a study by (Yee and Campbell, 2017) concluded that Interdisciplinary chronic kidney
disease clinics work effectively especially due to the comprehensive medical records that are
easily shared by the multidisciplinary team in the clinics, easing communication and enhancing
care. The care in these clinics is not fragmented as in other healthcare institutions, improving
effectiveness.
This analysis provides insight into the collaborative working of an interprofessional
medical team in providing patient-centered care. In chronic conditions like CKD,
interprofessional collaboration, when done effectively, ensures optimal care is provided to the
patient and transition is smooth depending on prognosis of the disease.

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