Participating with the Health Care Team and Meetings in Relation to Child Protection - Research Paper Example

 Multidisciplinary teamworking (MDT) is an approach which uses the skills and experiences of individuals coming from various fields of discipline, and each discipline approaches the patient from his own perspective (Jessup, 2007). Most of the time, this approach covers distinct cases or consultations which may occur in a one-stop-shop fashion with all cases being seen as part of single appointments on a single day (Jessup, 2007). MDTs often meet regularly, even with the patient not being around, in order to conduct a case-conference and discuss possible future decisions in the patient’s care. In interdisciplinary (also known as interprofessional) team approach, there is an integration of separate disciplines into one single consultation. The history-taking, assessment, diagnosis, interventions, management goals are conducted by the team, at one time, and together with the patient (Jessup, 2007). The needs of the patients are the focus of health services and the health professionals working together in order to ensure the health of patients and to involve the patients and their families in the prevention, promotion, and the management of health problems (CNA, 2005). The patient is actively involved in the discussions in relation to his care and there is a common and comprehensive view of all the different aspects of the patient’s care (Jessup, 2007). The patient is empowered as part of the decision-making process and the members of the various disciplines are encouraged to question and discuss with each other, to explore alternatives, and to step out of “discipline silos to work toward the best outcome for the patient” (Jessup, 2007). This approach is focused on the team working as one in order to come up with remedies which eventually improve patient outcomes. The interdisciplinary or interprofessional approach has some advantages over the MDT approach because it is patient-centred (Jessup, 2007). It is focused on what is best and what is preferred by the patient. It makes possible a stimulating workplace where the staff can learn from each other and learn how to conduct their assessments and interventions which are sometimes carried out by other disciplines (CNA, 2005). It is a very efficient means of operating because it is cost-effective and is less time consuming for the team. It helps the roles and responsibilities of the workforce evolve and help to identify gaps in the system which may not always be identified in multidisciplinary teams (Jessup, 2007). The interprofessional team working is about working collaboratively with each other through regular meetings in order to discuss patient status and plan of care. The MDT work in order and the medical record is the main method of communication (von Gunten, et.al., 2001). In the interprofessional working, decisions are shared and leadership is flexible and the members of the team still have roles which are separate and distinct from the other team members. This makes the interprofessional working team more advantageous as a means of operating, as compared to the multidisciplinary team. After considering and differentiating these two terms, the interprofessional means of working will be used in order to come up with a thorough analysis and evaluation of the current case. This paper shall first briefly describe the scenario or the case which will be analysed. After such description, the different roles of the nurse within this scenario shall be discussed. This role and discussion shall consider the nurse in relation to team work, leadership, clinical governance, and health policy. It shall also consider the perspectives of other professionals, their roles, power issues, possible role tensions, role boundaries, and role overlaps seen in the current case. This study is being conducted in order to seek an understanding of the nature, importance, and the complexity of interprofessional working; to acknowledge the role and responsibilities of the registered nurse in the context of interprofessional working; to gain insight into the roles of other health professionals; and to understand and apply the relevant knowledge from the biological and behavioural sciences as well as nursing and the humanities in order to assess the clinical scenario. Facts of the case This case involves a female child, four months-old, who was brought to the Accident and Emergency Unit (A&E) by her parents at 4 o’clock in the afternoon. The child was crying and was in obvious pain. There was a bruise on the child’s left leg which was also starting to show signs of inflammation. The child’s leg was tender to the touch and it obviously pained the child every time her leg was moved. The parents were incoherent and inconsistent in their responses when they were asked to narrate how the incident came about. The mother said that she left the baby lying on the floor for a few seconds when she heard a thud and the baby’s pained cries. When she rushed to her baby’s side she saw that a large ornate picture frame fell on her baby’s foot. In contrast, the father narrated that it was the table which overturned and hit her baby’s foot, not the picture frame. A full skeletal survey of the baby showed findings of a femoral fracture and rib fractures of unknown origin. The rib fractures and other fractures in the child’s body did not match the parent’s accounts. Due to inconsistencies in the parent’s accounts, and due to possible signs of child abuse, the social services were called in. The child was later turned over to them. Discussion Interprofessional team work In order to resolve the scenario as an interdisciplinary team, the team has to integrate their separate roles into one single consultation. The history-taking and assessment has to be done as a team with each member assessing the patient based on his responsibility in the team. The nurse would make her assessment based on child’s general physical condition; the doctor would make his assessment based on the child’s history and deeper organ functions and affectations; the pharmacist would make his assessment based on the child’s medication allergies, age, and weight; social worker would make his assessment based on the family situation and the general mental state of the patient and her family; and the police, when called in, would make their assessment based on the actions of the parents and the criminal implications of their actions. Information gathered would be collated and relayed to the rest of the team. The data-gathering process from the child and her parents is also done with most members of the team present. The diagnostic process is also done in coordination with the members of the team. This process will be carried out in a meeting of the team after the assessment process has been laid out. All the pertinent details needed to make a diagnosis of the child’s physical and mental health shall be considered by the team. The doctor would make his diagnosis regarding the child’s illness and medical condition; the nurse would come up with a nursing diagnosis, most likely in relation to nursing care; the pharmacist would make his own diagnosis based on recommended medications based on the child’s needs, weight, and age; the social worker would make his diagnosis based on the patient’s mental state; and the police officers would make their own decisions based on possible criminal charges which they would bring against patients. The priority in this case is the patient and all the decisions and the interventions which are to be carried out have to be based on what is best for the patient. The patient is an infant and cannot relay her feelings of pain and her preferred interventions. A paediatrician can make the best suggestions which would be appropriate for the child’s physiology and the orthopaedist can also make the best recommendations based on the child’s injuries. As a team, these interprofessional team working can come up with the best possible care for the infant despite the patient’s inability to express his feelings. In caring for the child as an interprofessional team, regular meetings would have to be held in order to discuss the patient’s status and plan of care. There is no clear leader in this team because leadership is shared and is flexible – depending on what interventions have to be carried out. If the interventions relate to surgery, then the orthopaedic surgeon will take the lead, when the care is related to dealing with the child’s pain symptoms then the physician and the pharmacist would have to share leadership. General Procedure Pierce (2007) discusses that a paediatrician with particular expertise in child protection is often called in to lead clinical investigations for child abuse cases. The care of the child very much relies on the coordination between the clinical team and the carers. It is important for the clinical specialist in the hospital to address the situation because he can actually do so with the most objectivity. In most hospitals there is usually a doctor and a nurse assigned for child protection cases and they are often in charge of contacting social services in cases on child abuse (Pierce, 2007). The coordination of the interdisciplinary team is important in order to ensure that preliminary investigations are properly undertaken. The involvement of the police authorities will help identify if there are existing criminal records of child abuse against the child’s carers and in order to ensure that the necessary forensic examination on the child can be initiated (Pierce, 2007). The members of the team are also obliged to conduct meetings as early as possible in order to come up with a joint decision on the possibility of abuse and for interventions to be implemented for the child. Social services are part of the team as they help invoke the Children Act in order to initiate investigations on the case and to possibly secure the other children that the couple may have (Pierce, 2007). It is also important for the members of the interdisciplinary team to watch out for the possible signs of child abuse which include the following: delay in seeking medical advice; vague or inconsistent account of the incident; discrepancy between history and injury; multiple bruising; finger tip bruising over upper arm, trunk, face or neck; injuries of differing ages; sharply demarked burns in unusual site; cigarette burns; tearing of the central fold behind the upper lip; bizarre injuries (bites, cigarette burns, or rope marks); perianal or genital injury; bleeding inside skull or brain; interaction between child and parents is abnormal; lack of concern for child; and x-ray indication of old or current fractures (Pierce, 2007). Specific roles of the members of the team The Nurse As a member of the interprofessional team, the nurse cares for the sick and the injured in the hospitals and the health care setting. They are also often called in to care for patients outside these settings, but more importantly, in the clinics and health care centres, they help doctors in diagnosing and treating illnesses; they help in the dispensation of medications; and they assist in surgeries (World Health Organization, 1985). As a part of the health care team, they help carry out procedures in coordination with the doctors and the other members of the team; they coordinate with the patient and the patient’s family in order to ensure that the patient is cared for and receives the best possible care. The nurse’s role in the Accident and Emergency unit is to assist in the treatment of minor injuries and illnesses. For children, they are there to administer effective treatment, child and family-centred care, and specialized care (Department of Health, Social Services & Public Safety, 2000). As members of the interprofessional team, they have to have the skills in dealing with cases in the A & E. It is important for the nurse to be equipped with skills which help ensure that children are evaluated using observational techniques with the use of analgesia if needed (Department of Health, Social Services & Public Safety, 2000). In this case, nurses have to be aware of the possibility of abuse and neglect among the children being admitted in their unit. In these cases, “effective procedures for communicating with GPs, community nursing staff and social services staff between primary, secondary and tertiary care must be in place” (Department of Health, Social Services & Public Safety, 2000). As a member of the interprofessional team, the nurse in this scenario would be the first medical health professional to face the patient. At this point, the nurse has to be astute in picking up inconsistencies and discrepancies in the parents’ accounts of the incident. She has to be skilled in picking up “discrepancies in the history of the incident, incompatibilities between the alleged mechanism of injury and the actual injury, and the usual interactions between the child and the carer” (Dolan & Holt, 2008, p. 291). In this case study, the role of the nurse is to be the child’s advocate, to speak for the child, to protect her, and to intercede in her behalf. The child is possibly a victim of child abuse and the nurse, as part of the interprofessional team, must step up in the child’s behalf. Her role is to primarily care for the child in coordination with the other members of the health care team. She is there to make the sure that the child’s pain is minimized as much as possible; that the child is fed, clothed, and bathed; that the child is comforted; and free from further injury. As a member of the interprofessional team, she is there to help the laboratory technicians in the conduct of laboratory exams and to comfort and reassure the child during these tests. The doctor/attending physician In general, the doctor’s functions as a member of the interprofessional team, in cases of child admissions is to provide ongoing assessment for those who are responsible for the child’s care before and after hospitalization (Percelay, 2003). The attending physician is responsible for the child’s care and has to follow the bylaws and regulations of the hospital as well as his profession. He is also obliged to refer the child to a specialist or a subspecialist if the child’s care requires it (Percelay, 2003). Doctors in Accident and Emergency Departments are experts in Emergency Medicine and take on the challenge of diagnosing and giving patients’ treatment in the soonest possible time. Time, in this case, is crucial to the outcome of the patient. After making their assessment of the situation and initially stabilizing the patient, they can now refer the patient to the proper specialists in the hospital (University of London, 2007). In caring for the child abuse patient, the doctor has to first order the medication to relieve the child’s pain. This process will require his coordination with the pharmacist for proper dosing and proper determination of medication for the child. The doctor would have to coordinate with the nurse in the administration of the medications and in the precautions which have to be taken in behalf of the patient. Once the patient is stabilized, the A & E doctor has to call on the expertise of orthopaedics and paediatricians who have the necessary expertise and training in caring for the injured child. The doctor also functions as a child protector. “Doctors play a crucial role in detecting abuse and neglect and in providing expert advice to the statutory bodies and courts in investigating and acting on allegations” (Children’s Guidance Consultation, 2007). Once the child is admitted, the nurse has to inform the doctor of possible signs of abuse. Although the assessment process in the interprofessional team is carried out as a single consultation, the doctor still has specific functions and specific ways in carrying out the assessment process. The specific assessment process which is to be carried out by the physician must be related to assessing for signs of abuse and these concerns have to be coordinated with the social worker who shall have his own role to play in the interprofessional team. In this possible child abuse case, the doctor’s function now is to physically assess the child for visible and latent injuries. After discovering that there are unexplained bruises on the child and inconsistent accounts from the parents, the doctor must now carefully examine the child’s records and injuries. He must interview the parents to detect for possible clues which would establish possible child abuse. He must check the records of the child with the primary care physician in order to determine the cause of the unexplained bruising and injuries. After proper assessment and data gathering, the physician can now make a decision on whether or not the case is indeed a child abuse case and proper authorities have to be called in. After the initial treatment and stabilization of the child is ensured, a meeting of the interprofessional team has to be called. In this meeting, all the members of the team have to express their concerns about the child. Each member also has to express the type of care which the child would need and what type of care or interventions they would carry out for her. The coordination of care would imply that each member of the team has to listen to each other and note if the type of care they would be implementing for each child would interfere or would need the assistance of the other team members. Since the child cannot speak and cannot express her preferences in the care process, the team has to do it for the child. And as the parents are suspected of physically abusing the child, caution must be taken in asking for their opinion in the care of the child. Social Worker The typical function of the social worker includes working with young people and their families. Their work mostly includes undertaking and writing up assessments with the medical staff; to conduct interviews with service users and their families in order to evaluate their situation; offer information and counselling to service users and their families; recommending and making decisions about the best course of action for a service user; liaising with other agencies; participating with the health care team and in meetings in relation to child protection and mental health; maintaining records in preparation of possible legal actions; giving evidence in court; and participating in training, supervision and team meetings (Bainbridge, Kilby, & Simms, 2009). These functions have to be carried out in coordination with the members of the interprofessional team. As a member of the team, the social worker has to make the necessary recommendations on what would be the best mental health care and the best legal remedies which can be implemented in this case. Police Crimes, like child abuse are reported to police authorities and other law enforcement officers. The powers of the police is on stopping crime and protecting of law-abiding citizens (Home Office, n.d). The powers of the police are based on the Police and Criminal Evidence Act (PACE) of 1984 which was passed in order to balance police power and the rights and freedoms of the people (Home Office, n.d). The provisions of the PACE set forth police powers including those of custody and of stop and search. They work with the assistance of the community support officers in order to implement notices on social behaviour and conduct stop and searches (Home Office, n.d). In this current case, the doctor or the social worker will report to the police officers the abuse which the child has suffered in the hands of her parents. The police officers will then implement their police powers in order to protect the innocent, in this case, the child. They will also have to conduct their independent investigation on the case, reviewing statements and evidence which will be shown by the doctors, the nurses, the social worker, and other pertinent individuals. After investigation, they will also have to charge the parents with the corresponding criminal charges for their abusive practices on the child. Conclusion The care administered to the child in this case was effective. It was comprehensive and it was well-coordinated. The members of the interdisciplinary or interprofessional team were able to work seamlessly with each other. Each member was cognizant of his/her function. The nurse initially cared for the patient and made the initial physical assessment of the patient. The doctor made the subsequent physical examination of the patient, assessing the child’s injuries and ordering the necessary interventions for the child’s care. He also called the attention of the doctor and nurse in the hospital that was in charge of possible abuse cases. The child abuse experts then made their own assessment of the child and the scenario and subsequently called the attention of the child services or social services. The social services made its own assessment of the situation and of the child’s case and injuries. The social services then informed the police authorities of the child abuse case. The social worker also took over the custody of the child. The police authorities did its own investigation of the case and now brought on the necessary criminal charges against the parents for the child’s injuries. Through this interprofessional working, the child’s welfare was secured. She was removed from a life-threatening environment and her parents were properly charged for their violent acts. Through the coordinated activities of the team, future possibilities of abuse have been prevented. Works Cited Adams, B. 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