Collaboration in Professional Practice
Collaboration is key to providing good quality *patient/client/service user centred care”… Discuss The aim of this assignment is to explore the importance of effective interprofessional collaboration in quality patient/client/service/user centred care. The author works as a children’s nurse, and in the field of paediatric nursing the main area of concentration is on patient-centred and family-centred care, therefore this essay will mainly focus on exploring these areas.
Firstly it will discuss the government policies and background of the introduction of Interprofessional practice, and will then talk about the importance of patient centred care and team working, and about the significance of reflection in developing self-awareness as a collaborative worker, including the importance of action plans. Next it will identify individual and team communication within the practice setting, and the usage of discussion boards.
Collaboration in Professional Practice Essay Example
Finally, using practice experience, the necessity of professional behaviour and responsibilities will be discussed, followed by an overview of organisational models in health and social care in relation to practice. Following the election of the new Labour government in 1997, the Department of Health (DOH) have published many White Papers, promising a new and improved National Health Service (NHS) with a desire to put patients first (DOH, 2006). These Papers have recognised and highlighted the importance of teamwork and interprofessional working both between and within health and social care provision.
The proposals tend to focus on improving overall health in general, emphasising on preventative care (Day, 2006). The Acheson report followed in 1998, and in its recommendations in section 39. 1 stated that to address health inequalities, there should be joint working between the NHS and regional government, local authorities and other agencies (Acheson, 1998). Another report that highlighted the need for effective interprofessional working arose from the tragic death of Victoria Climbie – a failed child protection case.
Victoria was only nine years old when she was subjected to months of torture from her aunt, and eventually died in February 2000. During this time she was admitted to hospital several times, visited by social services, health visitors and other professionals, and alerts from relatives were also highlighted. The Victoria Climbie Report (2003) highlighted that there were at least twelve occasions when professionals could have intervened, and to have maybe prevented her death. (Victoria Climbie Report, 2003).
More recently, the Department of Health funded a three year project called ‘The Creating an Interprofessional Workforce Programme’ (CIPW), which was hosted by the South West Peninsula Strategic Health Authority. This project covered all aspects of interprofessional learning and development in Health and Social care in England, in close collaboration with the UK Centre for the Advancement of Interprofessional Education (CAIPE), to improve undergraduate and post-graduate education for nursing, allied health professionals and medicine. (CIPW 2006).
Family-centred care is a collaborative approach to making decisions and the giving of care, where everyone respects each others knowledge, skills and experience that everyone can bring into a health-care situation. Both the health care team and the family, collaboratively assess the needs of the patient and the development of the care/treatment plan. (The Institute for Family Centred Care). The concept of family-centred care in health has developed over the last fifty years, and is still very significant in children’s nursing today. Glasper and Richardson 2006). This has stemmed from research and awareness of the importance of psychosocial and developmental needs of children, and the part that the family play in their child’s health and well-being. (Eichner et al. 2003). Many studies were carried out on the effects of separation of hospitalised children from their families, the work of John Bowlby on Attachment is probably the most well known. Bowlby focused on the effects of mother-child separation, and produced a shocking film ‘A Two Year Old Goes to Hospital’.
The conclusion of his works shows devastating effects of maternal separation, and led to families being able to visit their children in hospital. Coyne (1995) states that parental access to hospitalised children and their participation in the child’s care, are viewed as central aspects in family-centred care. (Lindsay 2001). With regard to family centred care and its importance in the children’s welfare, many hospitals adopted policies that welcomed families to stay with their child throughout their stay, and encourages them o participate in the child’s care. Shelton et al (1987) developed a comprehensive framework, in collaboration with parents to provide family-centred care to families with children that have special health care needs. This framework has been revised and updated in the last ten years, putting the nine main elements in order of importance – the first being respect for the family as the constant in the child’s life, and second family/professional collaboration.
The name given to all of the professionals involved with the patient is ‘the multidisciplinary team’ (MDT). It is important that the MDT work together to give the patient the best treatment available that is acceptable to them. To enhance collaboration between all involved, multidisciplinary team meeting should be held regularly to keep each other up-to-date with the plan of care.
The MDT in paediatric care could include any mixture of nursing staff, medical staff, surgical staff, specialist nurses, support staff, audiologists, child development workers, child psychotherapists, dieticians, occupational therapists, ophthalmologists, pharmacists, social workers, speech and language coordinators, ultrasonographers, radiographers and more, depending on the patient and their needs. MDT meetings are very important in paediatric nursing, due to possible child abuse and neglect cases.
In such cases, the police may also be involved, and treatment would be aimed at the family and the child – not just the child. (Blumenthal 1994). Many authors have tried to define family-centred care, they all seem to agree that implementation of family centred care involves not only the nursing staff, but the entire health care system. (Moules and Ramsey 1998). To be an effective collaborative worker, it is important to know yourself and your capabilities, to understand what makes us do the things we do and why we do them, also to be self-aware. Self-awareness is a vital aspect of professional development.
People are born into different backgrounds and are different in their ways, motivations, thoughts and beliefs; however as a professional, it is important to recognise how these affect others to be able to establish and maintain therapeutic relationships with patients. (Swapna 2007) Knowing our own thoughts and feelings, strengths and weaknesses gives us the ability to guide us in our decision making, and also helps us to become more self-confident in our approaches (Roper et al). . Reflection is a tool that can aid the development of self-awareness, allowing us to gain a greater degree of control in our practice.
As stated by Jane Day (2006) the work of Donald Schon (1983) is widely regarded to be the most influential on the subject of reflection. (Day 2006). Schon (1987) differentiated between reflection-in-action and reflection-on-action. The former takes place during practice whilst the person observes, interacts, and alters their reactions and behaviour whilst working. The second occurs after the encounter, when the details are remembered and reconstructed in the mind, to gain fresh insights and to make amendments if necessary to benefit future practice. (Taylor 2004) (Smith 2001).
We can learn a lot from experiences, and by reflecting on them we can improve on our actions in the future, this process is called reflective practice. Reflective practice became a concept for learning in the 1980’s, and is now positively encouraged for all health care professionals. (McQuaid, Huband, Parker 1996). There are three components of reflective practice, things (experiences) that happen to a person; the reflective processes that enable that person to learn from those experiences, and the action that results from the new perspectives that are taken. Jasper 2003). For nurses, it is a statutory requirement for registration with the Nursing and Midwifery Council (NMC) to identify one’s own professional development by engaging in activities such as reflection, in and on practice. (NMC 2004). Over the years, various frameworks have been developed for use and guidance in the reflection process; however these can be adapted or adjusted to suit different circumstances and personal preferences. Two of the most widely used models are Gibbs Reflective Cycle (1988) and Johns Model of Structured Reflection (1994).
In the author’s opinion, Gibbs (1998) reflective cycle is the easiest one to remember, as there are only six headings – description of the event, feelings, evaluation, analysis, conclusion, action plan – therefore an ideal one to use with reflection-in-action. John’s model (1994) on the other hand is more structured, has five cue questions, which are then further divided into more focuses, to promote a more detailed reflection – making this model more suited to reflection-on-action. Reflection can be a personal experience, or can be used as part of a team discussion. Using a discussion board, our group members were able to eflect on experiences that had happened to them in their practice placements. I found this an extremely useful experience, in which we could help others by discussing scenarios that we had all encountered as students. In relation to my experience, my first placement was on a children’s ward at a local district hospital. Here I had a really good opportunity to use a patient on whom I was able to reflect on, and to use my self-awareness. The child, a girl of eight years, had been brought in by ambulance and was admitted to our ward with an extremely severe asthma attack.
A short while after her admission her condition worsened and the doctors decided to transfer her into the High Dependency Unit. This frightened me as I had recently bereaved a friend’s daughter of nine years, who had died from asthma, and was frightened that this patient was also going to die. I didn’t know if I could cope with this, so I decided to briefly warn my mentor of my predicament, and we decided that if I felt I couldn’t cope, that I should just quietly leave the room. I found that by reflecting on my past experience, I was able to predict how I might react to the situation.
With this self-awareness, I was able to confront my fears and it made me stronger and more confident about facing similar scenarios in the future. Good communication in health care leads to better care for the patient. (Lloyd, Bor 1996). Communication is only effective when it is a two way process, and an effective response from the patient will ensure that they receive an accurate diagnose and the right treatment. There are three main types of communication, written (eg email or letters), verbal (eg words spoken) or sounds and non-verbal (eg facial expressions, body language, or touch).
In the writers opinion the key to good communication is listening. Egan (2002) devised an acronym to aid listening and communication skills – ‘SOLER’ – this practice is used to help clients or patients to trust the care-giver and to feel safe. SOLER is – S to Sit Squarely in relation to the patient; O to have an Open posture, L to Lean towards the patient; E to maintain Eye contact; and R to stay Relaxed. (Egan 2002) This process ensures good communication, helps the client/patient to trust the care-giver and to feel safe.
In paediatric nursing, there are many barriers to good communication – the age of the child, language, shyness, fear and even families can be perceived as barriers. Use of appropriate communication for age is essential, and could use benefit from the use of toys or books. Another problem I have frequently encountered on my placements is the barrier of language, as some families may speak little or no English at all; to overcome this barrier completely a translator must be called upon, however I have managed to communicate sometimes by using body language or pointing to items or drawing pictures.
In addition to working and communicating with the patients and their families, the role of a children’s nurse, is to collaborate and work in partnership with other health professionals. (Roper et al) Lingard et al (2005) reported that when medical errors take place, the reasons for the error are often traced back to breakdowns in communication between members of the healthcare team. The department with the highest error rates was found to be in the surgical areas, leading to wrong site surgery taking place. (Lingard et al 2005).
Communication breakdowns can also be detrimental in the community, as was discussed previously in the case of Victoria Climbie. Victoria died as a result of communication breakdowns no less than twelve times. I have witnessed and felt part of good communication whilst on placement. On a medical ward setting, I was looking after a baby with cystic fibrosis who needed a strict diet regime and physiotherapy twice daily. I noticed that the physiotherapist usually arrived just after a feed, and the baby was likely vomit if she had her physiotherapy carried out at this time.
We discussed how we could help the baby and each other, and we devised a plan that I would bleep the physiotherapist after the baby had fed, and then she would try to come at least one hour after that time, to allow the baby to digest her feed. The same baby was also under the watch of social services, as a failure to thrive. The mother was only sixteen years old and although she was very loving to her baby, she could not cope with the feeding and medication regime away from the hospital setting.
Each time she was discharged the baby was soon readmitted due to weight loss. Weekly MDT meeting were held with doctors, dieticians, ward nurses, cystic fibrosis nurses, social services, the parents and grand-parents, however after two attempts of sending the baby home with her mother, it was decided that it was in the best interest of the child to give care to the paternal grandmother. Patient handovers were also very important on this ward and took place at each staff changeover, behind closed doors, due to patient confidentiality, staff.
My current placement is on Post Anaesthetic Recovery Unit, and I find that this area requires extremely good interprofessional communication. The wards hand over to the surgeons/anaesthetists, they then hand over to my department in recovery, and then we hand back over to the wards. We need to listen very carefully to the surgeons to find out what has been done, what needs to be monitored and what medication they have had – and then relay the same information and any new information about the patients recovery, back to the ward.
Members of the MDT must be professional at all times. They are highly skilled and competent persons and must act in such a way not to damage their professions reputation, and they must be accountable for their actions at all times. Roger Watson (2002) states that accountability is the very essence of professionalism (Tilley, Watson 2004). Nurses are accountable to the NMC, and have to abide by the NMC Code of Professional Conduct.
Failure to comply with these rules is deemed unprofessional and would lead to the offender being struck off of the register, never allowed to practice again. The NMC states that as a professional, one must respect the patient/client as an individual; obtain consent before giving any treatment or care; protect confidential information; cooperate with others in the team; maintain your professional knowledge and competence; be trustworthy and to act to identify and minimise risk to patients/clients. (NMC 2004).
One area of responsibility for a nurse is in drug administration. I did however, on one of my placements, witness an accidental drug overdose, by my mentor. This was purely human error due to a Doctors poor handwriting, and although it was double-checked by the Sister of the ward, the dosage was still given incorrectly. As soon as my mentor noticed, she followed the correct procedures, notified the Doctors and later filled in an incident form. I felt terrible for my mentor, but I admired her responsibility and professionalism throughout.
I have also been subjected to an unprofessional attitude from a member of staff, where I was told off in the middle of a corridor, in front of parents, for being late in due to a migraine, despite the fact that I’d telephoned to explain – I was told that my behaviour was unprofessional and that if I am ill then I should take the day off and not come in late. On this occasion in my opinion, I believe that the nurse was the one being unprofessional. The situation ended up with me going home in tears.
I reflected on this episode and when I have to mentor students, I will never put them through an embarrassing moment like that. If I do have to talk to someone, I will make sure that it is in an office with a closed door. Not only was it upsetting for me, I also think that it was an unpleasant experience for the parents in the corridor – firstly, they would think I was a bad student nurse, and secondly they would see the nurse as being stern, and not as a caring person.
Overall, my experiences of interprofessional practice on my three placements so far have been good ones and everyone has been friendly between the MDT. My first placement was on a children’s ward at a district general hospital. The only meetings as such that I attended were the daily handovers between staff at change-over. Here we would discuss patient’s conditions and treatments, and it was always behind closed doors due to the confidentiality of the patients. MDT meetings were called on an ad hoc basis, such as child protection cases.
My second placement was on a children’s hospital medical ward for babies of up to three years. It was very similar to my first placement, although I did find that there were MDT meetings once a week and they were always on the same day. This time was set aside in the professional’s schedules to enable them to be free to attend meetings if necessary. Of the two placements, I do feel that the second one had more of a collaborative working practice and they seemed to have more MDT meetings, so maybe this creates a more effective collaborative environment.
My third and current placement is by far the most collaborative department I have worked in. We work closely with a number of professionals, all in the same department – Doctors, surgeons, x-ray, nurses and specialist nurses, anaesthetists, operating department practitioners, admin, support workers, porters and more. We all share a kitchen and a recreational lounge as well, which enables us to get to know each other and discuss both work and play. In conclusion, this assignment has explored the necessity of, and the key points of interprofessional learning and collaboration in professional practice.
I have experienced both good and bad collaboration and have seen the outcomes of both. In a healthcare setting, it is essential to be professional and to work as part of the team – even more so with my area of paediatric nursing, as the child and family look upon the nurse to be their advocate. I have included appendices of my collaborative discussions with other members of my team, and also of my action plan, which I devised to help me to work towards becoming an effective, interprofessional, collaborative worker.