Interprofessional Working on Patients with Learning Disability - Essay Example

?Interprofessional Working on Patients with Learning Disability Introduction Inter-professional working is itself a challenge. Various knowledge and goals merge on one situation that involves one case. Yet the situation becomes more complicated when the patient has certain disabilities such as the case of Tom (Case 2) with multiple learning disabilities suffering stomach disease and experienced delayed if not totally ignored medical attention. • Why did you choose this story? I have chosen the story of Tom because he died in his supposedly prime of youth at the age of twenty which all the more highlights the wrong done on him and his family by those who should have acted professionally and with compassion. The health care sector provides not only mental but also physical and emotional relief by the patients who seek the service. Instead, Tom and his family experienced agonising moments as well as neglect despite his condition which should have been instead provided with understanding and immediacy. This essay will explore the interprofessional working environment’s challenges, solutions to barriers and problems, as well as how these scenarios have been translated or could have been avoided on the case of Tom. Discussion Case Summary: Tom had a profound and multiple learning disabilities and attended a residential special school. One year prior to his death, a hospice consultant recommended an investigation by a gastroenterologist but the medical assessment promised during the NHS assessment never materialised. Tom’s parents relayed their concerns based on Tom’s expressions of pain on numerous occasions but it the social services workers did not heed the reports. The school interpreted Tom’s discomfort as dislike for school even whilst his parents insisted he needed medical investigation. When brought to a hospice, the consultant suggested his digestive system be further investigated. During the discussion with his GP, Tom’s parents were not included and the GP decided that a PEG feeding tube will not be tolerable and that there was unclear direction as to how Tom could receive adequate nutrition. After leaving school, the professionals also decided there was nowhere suitable for Tom to go to. Instead, he was placed into an NHS psychiatric assessment unit. His parents were only promised of medical assessment but it never happened. His health deteriorated, he lost weight and started acting unusual such as gouging his head of which his parents interpreted as experiences of pain. By the time a place for social services residential home became available for Tom, it was also then that his health was acted upon and he was confined in a hospital. It was found Tom had ulcerated oesophagus and that he was inserted with a PEG in order to be fed by tube prior to an operation. However, it has been too late because Tom was already extremely weak and died in the process. Ethical and legal issues It was apparent on the case of Tom that there was serious negligence on the part of the general practitioner (GP) to act accordingly by making a decision without consulting or including Tom or Tom’s parents in the process. It was already obvious that a health consultant recommended the need for Tom to be inspected by a gastroenterologist. This should have been pursued and provided in a timely manner. The GP as the gateway for Tom’s more specific medical needs shares the biggest responsibility in the process. In addition, there is the Disability Discrimination Act which called for the full application of human rights principles on the case of Tom and others who have disabilities. The human rights concept is “key to the development and improvement of healthcare for people with learning disability,” (Jacques and Strank, 2009, 439). This calls for treatment and respect with equity of outcomes in healthcare the patient with disability receives. Additional support, in fact, is required because their disability increases the difficulties they experience and increases their rights instead of being diminished. Aside from this, national policy on learning disability services already placed service user involvement as the focus of its development (Jacques and Stranks (2009). This gives Tom and patients like him to have choices and be equally responsible in making decisions about their healthcare and the need for proper services. The concept of making a choice provides them a variety of treatment options including timely and proper treatment and essential to good practice (Jacques and Strank, 2009). As Jacques and Strank (2009) emphasized, “The range of treatment options also needs to be clearly and accessibly explained to the patient, so that informed choices can be made about what treatments/therapies the patient wishes to proceed with, and explained in a non-paternalistic way,” (p 439). The social worker and the special school which catered to the needs of Tom also were culpable. Where symptoms of pain and sufferings were seen from Tom, the social worker and the school should have summoned their own physician to serve as Tom’s health care gateway. Instead, they have left the decision-making on the parents of Tom who seemed to have been overwhelmed by the lack of expert understanding on the experiences and case of Tom. Tom;s parents did right by seeking a health consultant and even the GP. But the correct direction was stopped short by the lack of motivation, ethical working practise and concern by the GP. Instead of pursuing his stomach pain complaints, Tom was assigned to a psychiatric ward. The negative experiences of people with learning disabilities had been highlighted previously by Mencap’s report Death by Indifference of which patients were denied choice, rights and control of the healthcare provided to them. The report indicated the failure of health care professionals to design their services that showed understanding to their patients’ needs over treatment. Another highlight of the report has been that the organisational powers were rarely questioned. Whilst this system requires professionals and their organisations to incorporate the patient experience and perspective into their design and services development, the need has been seen as very important (Mencap, 2007). • Critically discuss the implications of the failures identified above. Tom’s situation was a very difficult one for both his parents and the professionals attending to him. On his part, difficulty was double, because it cost him his life. He was not able to properly send a message about his experiences of pain and he could not equally understand how to respond or act on the actions and recommendations of the professionals around him. Aside from this, he cannot even express himself near to the truth to his parents. The difficulties, however, could have been diminished had the professionals working with Tom acted timely and accordingly. The expression of physical pain on the part of Tom was not seen as urgent. There was dilly-dallying as there was only recommendation but no actual placement of appointment with the proper health professional – the gastroenterologist. Other several failures that can be glimpsed on the case of Tom were also present. First and foremost was the neglect of his GP to refer Tom to the gastroenterologist whereas already, a consultant has already request so. How the lapse happened was unclear as upon referral to a gastroenterologist, a schedule should have been sought not only by attending GP, nurse, or any health care professional assigned on him, but also by his parents. Tom’s parents also showed lack of certainty on what actions to be taken. It could be their lack of understanding on the learning disabilities of Tom. While they were sure Tom was experiencing pain and a health consultant already recommended a proper action, his parents could have insisted from their GP for the immediate and proper action for Tom to be inspected by a gastroenterologist. Their failure to follow-through the proper course of action might also be the cause of the delayed action. Interprofessional working It is clear that it was not only health care workers but also social services workers were involved in the case of Tom. Throughout the years, there had been problems and challenges in interprofessional collaborations and these are caused by different training, roles, interests, traditions, and beliefs. Modernisation and developments in the health care and social services sector have encompassed inter-professional working cultures and practices, teamwork, and collaboration (Soothill et al, 1995). To improve the practice, initiatives include the examination of roles and boundaries of different professional groups in order to define expectations as well as collaborative practices to bring out the best possible results. The Standing Medical and Nursing Advisory Committees (1996) provided seven principles for professional collaboration as follows: Empowering patient and carer Commissioning process Collaboration of various agencies Teamwork Professional education and training Communication and sharing of information Continuing research and development. However, despite lofty goals, reality as suggested by Riley (1997) presents several barriers to interprofessional collaboration that includes Communication of which poor communication is described as the lack of effective system and channels leading to unmet goals. On the case of Tom, it was clear that the GP was not clearly informed on the recommendation of the health consultant to have Tom be inspected by a gastroenterologist. Instead, the GP delayed the medical process needed by Tom. How Tom ended up in a psychiatric unit showed that there was also non-belief as well as lack of professional and ethical behaviour on the part of the GP for not properly consulting Tom’s parents who were the best representation for the patient. This communication negligence was tantamount to denying the patient his right to receive proper medical care. Motivation and leadership. This organisational lapse has been seen across professional groups (Riley, 1997). This has been traced to heavy workload among professionals aside from the perception that teamwork is time consuming. This obstacle is addressed through emphasis among professional groups that common goals between them bring better results when compared to individual efforts (Riley, 1997). On the case of Tom, the lack of motivation and leadership can be seen on the absence of a person in-charged with Tom’s case. Since Tom had been diagnosed to have learning disabilities, it could have been possible that a social worker was assigned on his case to follow-on through his progress not only at school but other behavioural issues. Had the worker been more careful in his or her observation and reports of Tom’s parents on Tom’s experiences of pain, the social worker could have also assisted in seeking proper medical attention for Tom. Education and training. Various professionals are presented and trained with different expertise and goals. In the process of working with other professionals, conflict arises such as in the case of Tom where social workers may have been concerned with Tom’s attitude towards his school, thus, the suggestion that he already disliked school, whereas the GP sought the psychiatric ward instead of pursuing the help of the gastroenterologist. The action, however, of the GP belied his education and training about ethical consideration on the case of Tom. This problem, according to Sams (1996) could be addressed through team building skills, profile development, clinical supervision, continuous professional development, individual performance review preparation, communication and inter-personal skills development. Research and evidence-based practice. Previous practices lacked focus on multi-disciplinary research instead of emphasis on other professionals in consideration of their integral role in interprofessional environment. Had there been ready information clearly disseminated in interprofessional environments, a more collaborative approach should have been taken on the case of Tom and did not foster inclusive decision-making by the GP. Existing management and organisational policy. The organisational environment highlights hierarchical and medical dominations that influence police and management decisions. This refers to the work GPs attitude of excluding Tom and his parents in the decision-making process. Isolation. One of the most stark on the case of Tom, isolation was experienced by tom and his parents as they seem to have been left groping in the dark, on their own, as the health consultant, the school, the social worker, and the GP made decisions for them. Professional territories. This situation is highlighted on the part of the health consultant who suggested the need for an gastroenterologist. After his suggestion was made, he did not follow-up or ensure that an appointment was made and assumed that Tom has been taken cared of afterwards. His decision was the most crucial in the situation yet it was as if done in the passing and did not post any significance on the part of Tom due to its seemingly minor role in the health care process. Working in partnership Partnership or collaboration between and amongst the carers and professionals involved in Tom’s case could have saved Tom’s life. The social workers should have advised Tom’s parents to ensure Tom’s medical attention so that the parents’ focus was only on seeking medical attention and not stray on Tom’s after-school issues. The focus should have been on the experiences of pain instead of unknown psychiatric conditions. The health consultant established that Tom needed the attention of a gastroenterologist. How the GP decided that the PEG tube was out of the question without Tom’s parents were inconceivable and downright violation of Tom’s rights. SCOPME (1997) also enumerated several advantages of professionals working properly together and these are: Easier access of patients to the most appropriate professional Collective sharing of responsibility Better management of risk Multiprofessional clinical audit and research Enhance professional skills Develop new ideas, roles, and ways of working Avoid isolation Sharing of education, expertise and resources Enhancement of communication for greater cohesiveness and effective organizations. This means that interprofessional working environments are not only challenges but professionals but opportunities where they could enhance their skills, networks, resources, as well as share and explore common and betterment of goals. Conclusion The case of Tom provides stark reality for patients with learning disabilities. Experience in health care highlights that policy should focus on protecting the welfare of persons with disabilities to ensure that they are accorded equal access and timely service. In consideration of the case of Tom, this paper concludes that interprofessional working involving people with disabilities should employ a specialist who is concerned and focused on the proper and timely service delivery for the patient. Whilst there are already many positive developments in the interprofessional working relations between professionals, dealing with the disabled remains a taxing and demanding situation as there is a need to properly assess the message being sent across by the patient, his or her parents, as well as the need to deliver them in a timely and clear manner to the proper professionals. The person assigned to Tom could have pursued the gastroenterologist service for Tom where Tom’s parents and his GP failed. A single person assigned for the welfare of Tom will engage other professionals in a timely manner that Tom’s parents may fail to deliver. Reference: Jacques, Ray and Strank, Simon (2009).Choices, rights and control: what services users expect from their healthcare. The Social Context of Learning Disability. Psychiatry 8: 11. MENCAP (2007). Death by Indifference. Riley, Rebecca (1997). Review: Working together: inter professional collaboration. Journal of Child Health Care 1: 191. Sams, D. (1996). Clinical Supervision: an oasis for practice. British Journal of Community Health Nursing 1 (2): 87-91. Standing Medical and Nursing Advisory Committees (1996). In the patient’s interest: multi-professional working across organisational boundaries. London: Department of Health. Standing Committee on Postgraduate Medical and Dental Education (SCOPME). (1997). Multiprofessional working and learning: sharing the educational challenge: London: SCOPME Soothill, K., Mackay, L., Webb, C. (1995). Interprofessional relations in health care. London: Edward Arnorld. http://www.lr.mdx.ac.uk/lib/pdfs/fsbibss.pdf Read More