The Interprofessional Working - Essay Example

HOW DOES INTERPROFESSIONAL WORKING IMPACT ON PROFESSIONAL RESPONSIBILITY AND ACCOUNTABILITY IN THE CLINICAL SETTING Instructions: THE INTERPROFESSIONAL WORKING The aim of this essay is to discuss how inter-professional working impacts on professional responsibilities and accountability. The rationale for this topic is to report on the impact of inter-professional clinical settings in healthcare delivery. The author will define inter-professional working and outline the concept of multi-disciplinary care, interpret the professions that make up the team and how these professionals engage to provide the care for a person with a history of myocardial infarction at a North London NHS Trust, where the author gained an advanced level of experience from his practice placement as a student nurse. The patient will be referred to as Mr. X to maintain confidentiality as stated in the nursing and midwifery code of professional conduct (2007). The author’s interest in Mr. X is based on his clinical experience and reflection of his involvement in the delivery of his care. The positive and negative aspects of inter-professional team will be discussed. Also, the author will use appropriate literature to examine how responsibility and accountability can be enhanced through inter-professional working. According to Alan (2007), Inter-professional working is defined as a practice where a number of professionals with different qualifications come together to meet a particular target. Some of their characteristics include direct service delivery, good professional relationship, collaboration and communal trust. Further, Matrix and Weeds (2007) describe Inter-professional working as a group of professionals with complementary skills, who are committed to a common purpose and hold themselves mutually accountable for its achievement. Inter-professional working includes collaborative practice, multi-professional working and team working. This is supported by Mickan and Rodger, (2000a) who describe teamwork as shared and agreed responsibilities, decision making and problem solving. The members of an inter-professional team communicate effectively in order to provide quality patient care. According to Braine (2006), clinical governance should be viewed as an opportunity to improve care delivery in the aftermath of some highly publicised failures in the NHS in the 1990s. The most notable of these was the Bristol Royal Infirmary Inquiry (2001) which accounts for 23 deaths of cardiac surgical paediatric patients. Other notable cases were the Royal Liverpool Children’s Inquiry (Alder Hey Inquiry), the case of the GP Harold Shipman (Smith 2005), and the trial of the nurse Beverly Allitt in 1993 (Clothier 1994). All of these caused widespread public and political concern. Emerging policies focused on the prevention of such failures and the need to build confidence in the NHS. Clinical governance formed part of this reform to improve healthcare quality through effective teamwork. Not only is multidisciplinary collaboration within a team important, but so too is interdisciplinary collaboration throughout the organisation. ‘Making a Difference’ (Department of Health 2006), suggests that effective care is the product of interagency working. Professionals working in collaboration provide care which is designed to meet the needs of the patient. This concept was further promoted with the publication of the NHS plan (DH2002) as a ten year programme of reform practice. The NHS Plan outlines the vision of a health service designed around the patient. This vision includes- a new delivery system for the NHS, changes between health and social services, changes for NHS doctors, nurses, midwives, therapists, other NHS staff, and patients and in the relationship between the NHS and the private sector, and encouraging professionals to work together to meet the needs of the patient and their families. In order for professionals to provide effective care for their clients, they are expected to develop in their fields. This is achieved by participation in continuing professional development (CPD) which will enhance competences to practice and maintain registered professional status. This is supported by the statement from the Department of Health (DOH, 1998) that CPD is a process of lifelong learning for all professions. This has become one of the key components of the government -intended framework to ensure that high quality services are delivered in the health and social care services. This was integrated with the intervention of the National Service Framework (NSF) of (2001). The focuses of the service were to root out age discrimination, provide person -centred care, promote the health and independence of the elderly and venerable children and fit services around peoples’ needs. Whilst I was on clinical placement, Mr X was admitted following a diagnosis of myocardial infarction or ‘heart attack’. Mr X presented with a chest pain and went to his general practitioners who referred him to the hospital. According to the British Heart Foundation (2006), a heart attack occurs when the heart muscle is prevented from receiving a blood supply usually by a clot blocking off one of the coronary arteries. As the muscle becomes starved of blood and oxygen an infarct occurs. Symptoms of myocardial infarction include chest pain, sometimes accompanied by a clammy cold sweat, acute breathlessness, sickness/ nausea and palpitations. Complications include heart failure because sometimes a heart attack can cause more severe damage to the heart decreasing the pumping action of the heart. Also some patients can continue to experience angina (heaviness or tightness in the chest when they exercise) because there is still narrowing of the coronary arteries. The team responsible for Mr X’s care delivery included a cardiologist, a cardiac nurse, a physiotherapist, an occupational therapist, a dietician, pharmacists, a general cardiac rehab, a clinical nurse specialist, a general practitioner, a phlebotomist, porters, health care assistants, a student nurse, Mr X and his family. The Department of Health (2001) emphasized that planning of care should start with the individual’s best interest and not that the purpose of NHS is to offer people fast and convenient care delivered to a consistently high standard. Services will be tailored to suit an individual’s needs. On arrival to the ward, the cardiac nurses performed an electrocardiogram (ECG). This records the rhythm and electrical activity of the heart. It can detect if you have a heart attack, either recently or sometime ago. The phlebotomist gained consent from Mr X prior to obtaining blood sample for Troponin and other blood test. Troponins are released when the heart muscle is damaged. A series of blood test was taken over a couple of days. In Mr. X’s case it came back as positive indicating that he had a heart attack. A review followed of Mr. X’s diagnosis with the multi professional team. This included the consultant, doctors, cardiac nurses, the physiotherapist, cardiac rehab nurses, the pharmacist, the occupational therapist and dietician. The agreed plan was for Mr. X to perform a stress test. This test is used to assess many symptoms, most commonly chest discomfort and shortness of breath. Mr. X walked on a tread mill after ten stickers were placed on his chest and he was attached to the monitor. His heart tracing was monitored throughout the test. During the stress test Mr. X presented with significant changes on his ECG tracing. He developed chest pain and became expressively tired and short of breath. The medical staff (consultant and cardiologist doctors accountable for providing medical care and the leaders due to their intense training, status and responsibilities) decided to transfer him to another hospital for an angiogram as this is not performed in my placement. According to BHF (2006), an angiogram is an X- ray picture of the blood vessels which shows where your arteries are narrowed. A fine, hollow tube called a ‘catheter’ is inserted into an artery in your forearm under local anaesthetic and is gently guided through the blood vessel to your heart. Mr. X was inserted with a coronary stent. A stent is a small expandable metal tube that acts as a scaffold to keep the coronary artery open (BHF 2006). During his transfer, a cardiac nurse and ambulance crew escorted him to the other hospital. The role of the cardiac nurse was to make sure effective communication took place. All nursing documentation such as admission, assessment, care planning was done and photocopies were prepared for handing over to the receiving nurses and doctors at the other hospital. A dietician is involved to monitor Mr. X’s weight and support with a reducing diet menu. Cardiac rehab nurses give advice and support on education and exercise. The occupational therapist assessed Mr. X’s physical and social changes. House visiting is arranged to assess his home situation and provide him with the necessary equipment to make him comfortable. Mr. X requested to attend church service in the hospital as he is a practicing Roman Catholic. His beliefs were fully respected and a health care assistant assisted him in a wheel chair to meet the priest to pray and reassured him that God will heal him. The social services dealt with the issue regarding housing provision of carrels, income support and meals on wheels for Mr. X on discharge from hospital. The nurse made referral to the district nurse for continuation of care in the community after discharge. Finally the cardiac rehab program continues after discharge for eight weeks. The programme consists of supervised exercise, relaxation, educational talks related to heart disease and reminder of six weeks visit to the cardiologist as an outpatient. Multidisciplinary team work is vital in providing patient care as evidently cited from the case. The multi professionals worked very hard within their scope in order to provide adequate and effective care for Mr. X. When he got severe breathlessness and his saturation developed to 85% on room air the doctors and cardiologist did not put him on ACE inhibitors post surgery. ACE inhibitors are very effective in the treatment and prevention of heart failure. After a heart attack many patients will benefit from an ACE inhibitor; an example is Ramipril and lisinopril (BHF 2006). The pharmacist and nurses did not pick up the mistake. Mr. X was then given the appropriate treatment that resolved the problem. Priest et al (2006) stated that it is essential to act rapidly within a team to prevent delay. Poor time keeping could have also being a major problem. However the nurse in his effective timing noticed the changes in Mr. X’s condition. Thinds (2007) stated that time keeping should be managed to prevent delays. The multi disciplinary team involved in his care, (the doctors, cardiologist, physician, nurses, and student nurse) took appropriate steps and used effective communication skills to resolve the problem. This is supported by Tused (2008) who states that good communication helps to receive correct information quicker and also helps to build credibility with customers and colleagues. Inter-professional setbacks such as language and values, lack of clarity about roles, and lack of co-operation could hinder the different professionals from working together effectively. Language barriers could hinder the working condition. The different professions could be using jargon which may not be understood by other health professionals. (Duch 2009) supports this by stating that clear and concise professional language should be used when explaining the situation to other professionals. Lack of clarity by different professionals could have hindered the progress of Mr. X’s treatment. However in this situation the team members were clear about their different roles and who should do what at the appropriate time. This is in support with Baxter and Bromide (2005) who stated that specified roles and responsibilities are very important and contribute to peacemaking with a given team. Lack of co-operation within a team can cause delay and hinder progress in Mr. X’s care. This is in line with Nan Arrow (2006) who advised that it is important for professionals to co-operate within the team in order to aid effective results. The positive aspect of the inter-professional team working effectively was that there was a clear and concise goal. Each professional was aware of exactly what their roles and responsibilities were. This made them more committed to their various tasks. The team showed effective communication skills which helped them to carry out their duties effectively. Pollard (2006) claims that effective communication is vital since information is passed on quickly. Using a mix of different skills helped the team to work well to achieve their goals. This is evident in McGrath’s (1991) study (cited in Leathard, 2003 p. 9) which showed more efficient use of staff by enabling specialist skills and maximizing potential for unqualified staff. Ethically, inter-professionals need to agree on standards of conduct within which they are able to work in order to prevent them from being accused of wrong doing as long as they don’t infringe on these standards. Mr. X was treated as a person and not as an object of care. At all times the team maintained the respect for autonomy and justified care by treating Mr. X equally regardless of his race, culture and by allocating the appropriate resources he required. Beauchamp and Childrey (1994, cited in Leathard, 2003, p.71) stated that principles such as justice, beneficence, non-malfeasance and autonomy are the most useful in providing patient care. The multi- professionals are faced with challenges in the health care system as the effect of government policies such as the bed managing policy, target for waiting time and money to improve efficiency are having detrimental effects on health. National Health Service could improve inter-professional working by conducting regular training and education. This will help to improve the skills and knowledge of inter-professional working, which will thus enhance patients care. The inter-professional team needs to abide by clear rules and regulations. This will help the professional to work collaboratively with each other. There should be regular reviews from each professional manager and reflection sessions and feedback for the professionals to know how well they are doing. In conclusion, this essay has improved my knowledge and effectiveness of working as a team. It has helped me to understand that inter-professional working brings together academics, professionals and researchers to assess the implication for all the professionals involved in care delivery and the practical development in hospital, general practice and community care. This module has made me fully understand each professional role and the advantages and disadvantages of working as a team. Read More