Team Member Spotlight: Dawn Bourne, DNP, RN, FNP-BC

Dawn Bourne, DNP, RN, FNP-BC

In addition to her day-to-day duties as a nurse practitioner in the Department of Family Medicine, Dawn Bourne plays an integral part in two UVAHS programs designed to enhance patient experience throughout treatment at the Medical Center and after discharge.

The first, the Ethics Consult Service at UVAMC, was a natural fit for Dawn to become involved with: Her research and dissertation as a DNP (Doctorate of Nursing Practice) student at UVA School of Nursing was on moral distress in primary care providers. “Ethical issues often arise in patient care when a provider knows the appropriate action to take, but is prevented from taking it because of something outside of their control,” explains Dawn.

As a branch of the Ethics Consult Service, the Moral Distress Consult Service addresses ethical issues that arise which are not specific to one patient. “We meet with the entire team,” says Dawn. “For example, we go to several ICUs on a regular basis and talk about issues that happen in the unit – we try to help troubleshoot what we have the power to change.”

In contrast, individual ethics consults most often involve specific cases and are noted in patient charts, with follow up like other consult services. The issues at hand are generally complex and emotionally charged, such as the withdrawal of life sustaining treatment and surrogate decision maker questions. The service is available 24 hours per day, 365 days per year thanks to the individuals who make up the on-call team: an interdisciplinary group made up of 8-10 consultants including physicians, nurses, a chaplain and social workers. “In many systems, the ethics committee is physician-only”, says Dawn. “It’s really important to UVA that this is an interdisciplinary team because everyone brings something to the table when it comes to these ethically, clinically and socially complex issues.”

Dawn also plays a vital role on the Family Medicine Transitional Care Management team, which follows patients after discharge. Within two days of their leaving the Medical Center, a patient is contacted by a RN Care Coordinator to review their case and tie up any loose ends in preparation for their follow-up visit. “This helps patients understand why their follow-up appointment is important, so they attend more often,” explains Dawn. She adds, “This is a truly collaborative effort because it has formed a more robust bridge between the inpatient and outpatient teams to address all aspects of patient care including social workers and clinical psychologists. There are many social determinants of health that having an interdisciplinary team helps address.”

The success of the team’s efforts are reflected in readmissions data: Between September 2016 and February 2017, 30-day all-cause readmissions were reduced from 31% to 6%.

 

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