Function of Multidisciplinary Teams - Essay Example

?PORTFOLIO MENT Portfolio Index Please tick Identified and evaluated personal aims Outcome v Outcome 2 v Outcome 3 v Outcome 4 v Evidence to support claims against outcomes Outcome 1 v Outcome 2 v Outcome 3 v Outcome 4 v Final course evaluation v I confirm that this portfolio contains original material prepared by myself in all of the areas listed above. The written component of the portfolio consists of a minimum of 3000 original words. Portfolio completed by: ………………………………………………………………………… Dated:………………………………………. PORTFOLIO INDEX LOCATION Page no. FORM OF EVIDENCE 9 INTRODUCTION 9 9 10 10 11 LEARNING OUTCOME ONE Multidisciplinary teams – critical analysis Psychiatrist Care Coordinator Advanced mental health practitioner 12 Personal reflection on Multidisciplinary teams 13 References 14 14 LEARNING OUTCOME 2 Critical Analysis of the use of Reflection in professional learning 15 References 15 Use of Primary Care Models to enhance care delivery 16 References LOCATION FORM OF EVIDENCE 16 18 LEARNING OUTCOME THREE Ethics 19 References 19 21 LEARNING OUTCOME FOUR Diversity 22 References 22 FINAL REFLECTION ON THE MODULE Course Outcome Number 1: The multi-disciplinary team Reflect on and critically analyse the roles, responsibilities, collaboration and inter-agency working within the multi-disciplinary team. PERSONAL AIM (Course Outcome 1) This first section is concerned with what YOU want to achieve and is based on personal aims that you identify at the start of the module. My personal aim in relation to this outcome was: To comprehend how multidisciplinary teams function and how they establish a coordinated plan of care to meet the patients multiple needs. Please complete one of the following: Where your personal aim was achieved? Please describe how achieving this aim has influenced your practice. Yes it was achieved, and I was able to understand how multidisciplinary teams work with each other and how their different skills when combined eventually achieve favorable patient outcomes. Where your personal aim was not achieved? Please state why you think this aim was not achieved. I believe that my personal aim was not achieved in terms of my assertiveness as part of the team. I did not try a more assertive approach during meetings and was not able to express my role as a member of the team. ACTUAL OUTCOME (Course Outcome 1) This second section concerns what you have achieved, in relation to this learning outcome. It should demonstrate, as comprehensively as possible, how your practice is different as a result of this module. Please list all the evidence that is included under this outcome and where it may be found. How does the evidence support your claim that you have achieved this outcome? What form does the evidence take? Location I established a critical assessment discussing the importance of multidisciplinary teams and to establish a personal reflection of an incident I witnessed while in my placement. References are also indicated in order to support the evidence I used. Critical and reflective accounts and references Page 9-13 Course Outcome Number 2: Nursing Theory Critically analyse the use of reflection in professional learning and the use of Nursing models to enhance care delivery. PERSONAL AIM (Course Outcome 2) This first section is concerned with what YOU want to achieve and is based on personal aims that you identify at the start of the module. My personal aim in relation to this outcome was: To comprehend the importance of reflection and the role of evidence in the establishment of effective nursing practice. Please complete one of the following: Where your personal aim was achieved? Please describe how achieving this aim has influenced your practice. My personal aim was accomplished because I was able to critically assess the importance of reflection and how it can enhance my practice and learning. The assessment of the self-care model also helped me realize the importance of helping patients become more self-sufficient. Where your personal aim was not achieved? Please state why you think this aim was not achieved. My personal aim was not achieved because I was not fully able to ensure that my patient would be able to care for himself. There are still other details I need to teach her in order to gain independence. ACTUAL OUTCOME (Course Outcome 2) This second section concerns what you have achieved, in relation to each course outcome, through attending the course. It should demonstrate, as comprehensively as possible, how your practice is different as a result of this module. Please list all the evidence that is included under this outcome and where it may be found. How does the evidence support your claim that you have achieved this outcome? What form does the evidence take? Location I have written a critical assessment on the application of reflection in the clinical setting I have also reflected on the application of the self-care model in the care of the patient. Critical analysis and reflective account Page 16-19 PERSONAL AIM (Course Outcome 3) This first section is concerned with what YOU want to achieve and is based on personal aims that you identify at the start of the module. My personal aim in relation to this outcome was: I wanted to be understand how to handle ethical dilemmas and to make the decisions based on the capability of the patient Please complete one of the following: Where your personal aim was achieved? Please describe how achieving this aim has influenced your practice. Fulfilling the aim helped me to establish that there is a need to respect patient confidentiality at all times, especially when it is expressly stated by the patient Where your personal aim was not achieved? Please state why you think this aim was not achieved. My personal aim was not achieved because I did not understand why the patient had to conceal his condition from his children when he actually needs his children’s support in going through his ordeal. ACTUAL OUTCOME (Course Outcome 3) This second section concerns what you have achieved, in relation to each course outcome, through attending the course. It should demonstrate, as comprehensively as possible, how your practice is different as a result of this module. Please list all the evidence that is included under this outcome and where it may be found. How does the evidence support your claim that you have achieved this outcome? What form does the evidence take? Location Based on this outcome, I felt more confident in the decision I made and the importance of balancing the welfare of the public and the good of the patient in making ethical decisions. Critical assessment of ethics and the reflection of the actual scenario, supported by the narration of the incident and the references applied. 19-21 Course Outcome Number 4 Reflect on and critically analyse the impact of culture, gender and stigma on professional practice. Examine ways of working with diversity and the promotion of equality. PERSONAL AIM (Course Outcome 4) This first section is concerned with what YOU want to achieve and is based on personal aims that you identify at the start of the module. My personal aim in relation to this outcome was: I wanted to comprehend the importance of diversity in the workplace and in the clinical setting and applying equality in the assessment issues related to the patient’s care Please complete one of the following: Where your personal aim was achieved? Please describe how achieving this aim has influenced your practice. My aim was achieved because I was able to comprehend the patient’s situation and the importance of treating everyone with respect, regardless of any subjective considerations. Where your personal aim was not achieved? Please state why you think this aim was not achieved. My personal aim was not achieved because I still had doubts on whether the patient may become aggressive towards the visitor. ACTUAL OUTCOME (Course Outcome 4) This second section concerns what you have achieved, in relation to each course outcome, through attending the course. It should demonstrate, as comprehensively as possible, how your practice is different as a result of this module. Please list all the evidence that is included under this outcome and where it may be found. How does the evidence support your claim that you have achieved this outcome? What form does the evidence take? Location I wrote a reflection of the video and tried my best to understand it. I then references it and evaluated how it would apply to the rest of the paper. Reflective account and an attachment of references. Page 22 Portfolio INTRODUCTION With this portfolio, the author now seeks to critically evaluate and reflect on the function and applications of multidisciplinary teams, nursing models, ethical practices, as well as diversity in the clinical setting. In order to protect the confidentiality of patients as indicated by the NMC Code of Conduct (2010), real names and places shall not be used. Assumed names and pseudonyms shall instead be utilised. LEARNING OUTCOME 1: MULTIDISCIPLINARY TEAMS Most disciplines and professions include the cooperation and coordination of teams. With the combined expertise of member, multidisciplinary teams are often formed. These teams include a conglomeration of professionals from varied disciplines who congregate together in order to secure the delivery of complete services for patients (Piechnik and Corbett, 2004). According to Coyler (2004), team members have different skills and functions and their contribution to care is often based on the needs of patients and the disease being managed. Teamwork in the multidisciplinary setting is one of the main processes by which health care is secured under the National Health Services (NHS, 2001). Multidisciplinary working helps ensure various benefits for patients and for the team as it helps provide knowledge and opportunities which are often beyond an individual’s learning and skills (Atwal, et.al., 2005). Advantages also include improved planning, improved services, patient-centred care, reduced duplication of services, and less fragmentation in services (van den Hout, 2003). With these elements in place, multidisciplinary working helps ensure more efficient delivery of health services. PERSONAL REFLECTION ON WORKING OF MDT Reflecting on a multidisciplinary meeting she participated in for the planning of a patient’s care provided enlightening elements of care. The patient is Maria (not her real name) who recently suffered the loss of her husband. Maria is 65 years old and lives with her daughter who is also her main carer. She has been married for 45 years until two months ago when she lost her husband to lung cancer. She has lost appetite and seldom eats, as a result, has lost a lot of weight. She also has withdrawn from any social activities and often prefers to be by herself. She is often in her room crying and at times, has expressed her wish to die. This student met Maria in the mental health ward after she was admitted for major depressive disorder and was about to be discharged with care to be continued in the community setting. She was ready for discharge but the health professionals were concerned about her home care because her daughter is working during the daytime. They instead wanted to have Maria admitted first to a mental health unit for psychotherapy before discharge. Major depressive disorder is a major issue and among elderly patients, there is a high risk of suicide especially where inadequate care and assistance is not available (Durand and Barlow, 2009). The patient’s multidisciplinary team includes her psychotherapist, her family physician, her nurse, her social worker. The patient and her daughter were not present during the meeting and the student nurse was only observing the meeting. PSYCHIATRIST Psychiatrists or in this case psychotherapists are consultants to general physicians, mostly in relation to mental health affectations, including patients with depression, schizophrenia, Alzheimer’s disease, and similar mental health issues (Royal College of Psychiatrists, 2008). Where patients require specialized mental health care, psychiatrists are often called in as main caregivers. Patients experiencing depression, schizophrenia, bipolar disorder, and other mental health illnesses are entitled to care from psychiatrists (Royal College of Psychiatrists, 2008). These doctors diagnose and manage mental health issues then consult with general physicians on the best care and treatment of the patient. In Maria’s case, the psychiatrist became the leader of her health care team (Royal College of Psychiatrists, 2008). He advised Maria on the need to undergo psychotherapy and discussed options with her on her primary care and related options. CARE COORDINATOR The care coordinator is the mental health nurse. The function of mental health nurses is to primarily act as patient advocates within the MDT, ensuring that the interests of the patient are secured and that the planned care is also patient-centred (Skillings and MacLeod, 2009). Being a patient advocate implies that the nurse seeks to empower the client and maintain his independence in so far as it can be secured. Patient advocacy also involves the process of providing information to the client and expressing the patient’s preferences and decision to the rest of the team (Hewitt, 2002). The care coordinator was made part of the meeting because she has been caring for the patient for a longer period of time, as compared to the rest of the team. She was able to completely assess the patient and knew how the patient felt about her care and what she preferred (Skillings and MacLeod, 2009). The nurse was also privy to how the patient was coping with her daily activities. APPROVED MENTAL HEALTH PRACTITIONER The approved mental health practitioner who was also the social worker is important because social workers help to coordinate and mediate between the professionals, patients, as well as their families (Institute of Psychiatry, 2011). She was there to ensure that the patient’s care was not restrictive, and that the patient was not a danger to herself and to society (Mental Health Act, 2007). The AMHP indicated that the patient was a suicide risk and might not continue with her anti-depressants when discharged. In coordination with the MDT, she recommended that a community treatment order be planned. The team agreed that a holistic care was needed by the patient and that periodic follow-ups must be carried out when the patient would be discharged to the community. The AMHP worker wanted to ensure that Maria had sufficient time with the MDT. Based on the NICE (2003), patients who may not be managing well in the community must be admitted to the collaborative setting. PERSONAL REFLECTION ON THE MDT MEETING The team was able to establish that Maria had to be admitted to a mental health care unit for a few weeks first before being discharged home and managed through community care. I was able to understand the importance of MDT and team working especially in the care of patients with various needs. Through the MDT, I was able to observe how the various knowledge and skills of the team enabled a better understanding of the patient’s symptoms, condition, and needs. Patients in the mental health unit require a significant amount of psychotherapy in order to help manager to improve their coping and to help them live a normal life. The student considered this as a good option for Maria as it would help improve her coping and prevent any issues in relation to her activities of daily living. She needs to regain independence and to improve her coping skills before she can be discharged to her home and the mental health unit can ensure that she would have the necessary skills to be independent. The team found it difficult to coordinate with each other at first, however, in time, they were able to find merits in the strong and open communication they established with each other. The author was also able to understand the importance of MDTs and what the other functions of professionals are. References Atwal, A. and Caldwell, K., 2005. Do all health and social care professionals interact equally: a study of interactions in multidisciplinary teams in the United Kingdom. Scandinavian Journal of Caring Sciences, 9(3), 268–273. Department of Health, 2000. The NHS Plan: A Plan for Investment. A Plan for Reform [online] Available at: http://www.dh.gov.uk/PolicyAndGuidance [Accessed 13 July 2012] Durand, V. And Barlow, D., 2009. Essentials of abnormal psychology. London: Cengage Learning, Feb 13, 2009 Hewitt, J., 2002. A critical review of the arguments debating the role of the nurse advocate. Journal of Advanced Nursing, 37(5), 439–445. Institute of Psychiatry, 2011. Mental health professionals [online] Available at: http://www.mentalhealthcare.org.uk/mental_health_professionals [Accessed 13 July 2012]. NICE, 2003. Clinical Guideline 8; Multiple sclerosis: Management of multiple sclerosis in primary and secondary care [online] Available at: http://www.nice.org.uk/nicemedia/pdf/cg008guidance.pdf [Accessed 13 July 2012]. Piechnik, S. and Corbett, M., 1985. Reducing low birth weight among socioeconomically high-risk adolescent pregnancies successful intervention with certified nurse-midwife-managed care and a multidisciplinary team. Journal of Nurse-Midwifery, 30(2), 88–98. Royal College of Psychiatrists, 2008. Psychological therapies in psychiatry and primary care [online]. Available at: http://www.rcpsych.ac.uk/files/pdfversion/CR151.pdf [Accessed 13 July 2012]. Skillings, L. and Macleod, D., 2009. The patient care coordinator role: an innovative delivery model for transforming acute care and improving patient outcomes. Nursing Administration Quarterly, 33(4), 296-300. Van den Hout, W., Tijhuis, G., Hazes, J., and Breedveld, F., 2003. Cost effectiveness and cost utility analysis of multidisciplinary care in patients with rheumatoid arthritis: a randomised comparison of clinical nurse specialist care, inpatient team care, and day patient team care. Ann Rheum Dis, 62, 308-315. LEARNING OUTCOME 2: NURSING THEORY a) CRITICAL ANALYSIS OF THE USE OF A REFLECTION IN PROFFESSIONAL LEARNING Reflective practice highlights the fact that humans have the ability to evaluate activities they are involved in and then adjust these same activities in the future. The NMC (2010) declares that nurses have to account for all their actions and reflection helps them assess their performance. Bulman, et.al., (2008) declares that the elements of reflection in nursing education motivation to perform well, open-mindedness, and self-confidence (Burton, 1999). A person’s individual self-concept must also be well-established if the critical assessment of values is to occur, however, support from nurse academicians will sometimes make the transition easier for students and learners (Burton, 1999). Ely, et.al., (2007) declares that the benefits of reflection have been seen during the learning process for student nurses. Guided reflection is the process which helps guide a person towards effective practice and is also an important part of professional development. Reflection establishes directions towards person-centred care (Hannigan, 2001). Moreover, it allows for clinical supervision and humanized care. As student nurses reflecting on the practice, students can benefit by knowing which areas they need to improve more. Guided reflection via reflection models also help practitioners specify areas where more skills and evidence-based learning and processes are needed (Mantzoukas, 2006). Disadvantages in reflective practice have also been seen. For one, research does not seem to have a place in reflective practice and theories which are often required in practice are difficult to apply and assess because they are embedded in the activities (Mantzoukas, 2006). Reflection is sometimes also not consistent in its assessment of practice. Criticisms have also been expressed on the means by which it is sometimes incorporated into nursing education. Wigens (2006) declares that using critical incidents as tools of reflection cannot always improve practice. Sometimes, students may not always write their actual experience, but are more likely to write what they should have done. For nurse educators, the challenge seems to lie in them securing means to promote reflection in ensuring effective practice. The above discussion supports the notion that nurses must involve themselves in reflective practice. Nurse education must also involve a primary role in assisting learners in the development skills in reflection and critical reflective practice (Simpson, 2004). Problem-based learning has been established as a means of securing effective learning and application of skills. Despite issues in its application and in critical reflection, it still secures various goals which cannot be secured in other learning practices and tools (Morse, 2006). References Bulman, C and Schultz, S., 2008. Reflective practice in nursing. Oxford, United Kingdom, Blackwell Publishing. Burton, A., 2000. Reflection: nursing's practice and education panacea?. Journal of Advanced Nursing, 31(5), 1009-1017. Ely, C. and Scott, I., 2007. Essential study skills for nursing. Philadelphia, Butterworth publishing. Hannigan, B., 2001. A discussion of the strengths and weaknesses of reflection in nursing practice and education. Journal of Clinical Nursing, 10, 278-283 Nursing and Midwifery Council, 2010. Standards of proficiency for pre-registration nurse education. NMC, London. Morse, M., 2006. The politics of evidence. Qualitative Health Research, 16, 395–404. Simpson, L., 2004. Evidence-based nursing offers certainty in the uncertain world of healthcare. Nursing Management 35, 10–12. Wigens, L., 2006. Expanding nursing and health care practice. United Kingdom, Cheltenham Publishing. b) CRITICALLY ANALYSE THE USE OF PRIMARY CARE MODELS TO ENHANCE CARE DELIVERY Nursing models are considered to be standards or frameworks by which the nursing practice can be adjusted in order to fit the provision of patient care (Whall and Fitzpatrick, 2004). The theoretical frameworks assist in evaluating and interpreting patient information and later establish a plan of care. In other words, they help in the decision making process (Whall and Fitzpatrick, 2004). For this learning outcome, the author seeks to reflect on care administered to a patient she encountered as a practice nurse. The patient shall be referred to as Ruth, a 34 year old patient with bipolar disorder. Ruth lives with alone, with occasional visits from her daughter and a nurse who comes twice weekly to check on her. She is often depressed, with manic events of hyperactivity. Care was being administered to her by the practice nurse based on the self-care model. Her bipolar disorder has limited her social activity including her ability to work due to the fact that she can sometimes display manic symptoms at work or give in to bouts of weeping when she is depressed. Self-care is being encouraged for Ruth because it would also encourage her to recognize moments when her mental health is not compromised. Self-care helps people regain control of their lives and to minimize hospital admissions (Riegel and Dickson, 2008). Through the self-care model, Ruth was encouraged to take her medicines and to take general care of herself. A plan of care was established for her and this plan was closely monitored by the practice nurse and by her psychiatrist. Ruth was given a list of her medicines and symptoms which may indicate the worsening of her symptoms. She was also educated about the cause of her disease and instances which trigger moments of depression or mania. Ruth was very much willing to try out her plan of care however, she said that she may have trouble actually following it. However, with time and encouragement, she was able to follow the plan and to be more mindful of her symptoms. She was then referred to a support group in her community who were also suffering with various health issues and who needed to manage their mental health. After a month, her disposition was improved and she became indeed more conscious of her mental health. She did not experience any changes in mood and she was able to gradually return to work and to her social activities. The student nurse realised that Ruth was more active and happier in her life with the decreased burden of her disease and improved coping. Experts declare that with continued support, people can be empowered to change their lives and to prevent the worsening of their illness (Taylor, et.al., 2000). In the end, a better quality of life is often experienced. Ruth was able to understand that with the self-care model, she was able to gain the necessary knowledge and skills in order to improve her life as well as her coping and decision-making. Ruth’s willingness to cooperate also helped make this model successful. Individuality, client education, and client/nurse cooperation are important elements of nursing models and are crucial elements to their successful application (Barnason, et.al., 2011). Nursing models, in general, support the planning and delivery, as well as the assessment of care (Teel, 2007). The student believes that the self-care model met the patient’s needs and helped to establish a holistic type of care. There are however different problems and issues encountered for nursing models. For the self-care model, there is a general acceptance on the acceptability of the model (Berkman, 2003). However, this may not be true for all patients because issues like poverty, poor access to resources, and low self-esteem can undermine the efficacy of this model (Berkman, 2003). After this experience, the student learned that patients and their carers can only consider self-care if it is already chosen by the patient himself. There are various options of care and these may be more suited to the patient, and so these models must be evaluated in relation to a patient before any plan of care or model can be applied (Taylor, et.al., 2000). References Berkman, B., 2003. Social work and health care in an aging society: education, policy, practice, and research. London: Springer Publishing Company. Barnason, S., Zimmerman, L., and Young, L., 2012. An integrative review of interventions promoting self-care of patients with heart failure. Journal of Clinical Nursing, 21(3-4), 448–475. Riegel, B. and Dickson, V., 2008. A situation-specific theory of heart failure self-care. Journal of Cardiovascular Nursing, 23(3), 190-196. Taylor, S., Geden, E., Isaramalai, S., and Wongvatunyu, S., 2000. Orem's self-care deficit nursing theory: its philosophic foundation and the state of the science. Nurs Sci Q., 13(2), 104-10. Teel, C., 2007. Intervention fidelity assessment: self-care and caregiving. Midwest Nursing Research Society [online] Available at: http://hdl.handle.net/10755/160001 [Accessed 14 July 2012]. Whall, A. and Fitzpatrick, J., 2004. Conceptual models of nursing, analysis and application (4th ed). London: John Wiley & Sons. LEARNING OUTCOME 3: ETHICS Ethics is concerned about the application of right and wrong in terms of decisions and actions (Schneider and Ramos, 2012). Establishing what is ethical can be a subjective and relative process for nurses and health practitioners because there are varied circumstances which can surround an action or a decision (Schneider and Ramos, 2012). Student nurses have to uphold morals and duties which are crucial to the nursing practice however this may be easier said than done because of the complex moral choices they may be faced with. Codes of ethics give nurses and also student nurses guidance and direction in their practice; moreover, nurses and student nurses are required to be advocates in their patient’s care (Relf, et.al., 2009). When ethical dilemmas arise, the appropriate principles must be included in the decision-making process. Ethical theories of autonomy, beneficence, non-maleficence, and justice, as well as confidentiality are just some of the ethical theories which must be secured (Matlakala and Mokoena, 2011). David was admitted as a schizophrenia patient at the hospital and this student met him at one of the wards. During care, he requested that his family not be informed of his condition. He said he did not want his children to know that he was schizophrenic, but it was okay for his wife to know. In strictly applying the principle of confidentiality, the patient has the right not to have his diagnoses be revealed to other individuals, unless he consented thereto (Sowell and Phillips, 2010). Patient confidentiality is one of the major rights of patients (Purtilo and Doherty, 2010). Since the patient did not want his children to know, all measures to maintain such confidentiality must be maintained. Protecting such confidentiality helps to promote rapport and maintain a trusting relationship with the patient (Purtilo and Doherty, 2010). He must be encouraged however to reveal his condition to his children, since his children would likely wonder why he is in the mental health setting (Purtilo and Doherty, 2010). His children would likely want to know why he is in the mental health unit and it would be better for his children to hear the news from him, not from any other individual. References Mihyun, P., 2009. Ethical issues in nursing practice. Journal of Nursing Law, 13(3), 68-77(10). Matlakala, M. and Mokoena, J., 2011. Student nurses’ views regarding disclosure of patients’ confidential information. S Afr Fam Pract, 53(5), 481-487. Purtilo, R. and Doherty, R., 2010. Ethical dimensions in the health professions. London; Elsevier Health Sciences. Relf, M., Lavarriere, K., Devlin, C., and Salerno, T., 2009. Ethical beliefs related to HIV and AIDS among nursing students in South Africa and the United States: A cross-sectional analysis. International Journal of Nursing Studies, 46(11), 1448–1456. Schneider, D. and Ramos, F., 2012. Moral deliberation and nursing ethics cases: Elements of a methodological proposal. Nurs Ethics. Sowell, R. and Phillips, K., 2010. Understanding and responding to hiv/aids stigma and disclosure: an international challenge for mental health nurses. Issues in Mental Health Nursing, 31(6), 394-402. LEARNING OUTCOME 4 The Nursing and Midwifery Council (2010) declares that the diversity of nurses is an important part of the practice. Securing diversity also helps ensure that people are valued for their skills and knowledge, not for their race, beliefs, or practices. The NMC (2010) also acknowledges the fact that diversity relates to treating people with respect. The Department of Health has already secured tools, skills, and expertise for nurses in management of adversity and diversity. Nurses and other health professionals must be allowed to consider other forms of basic training, especially in relation to the promotion of equality (Omeri and Raymond, 2009). The author is reflecting on a depressed teenage patient who wanted to call his minister in his hospital room for spiritual guidance. The patient was sometimes aggressive and violent to other health care givers, and visitors were restricted in order to prevent other incidents of violence. Nevertheless, on a rare moment of clarity, the patient requested his minister to visit him. Respect for religious beliefs, even when they are different from one’s own must ensured because it also helps ensure respect for diversity and beliefs (Morris-Thompson, 2011). Spiritual guidance can be effective therapies for patients because it is something familiar to them and it can sometimes calm them and make them more cooperative to treatment (Puchalski, 2006). References Morris-Thompson, T., Shepherd, J., Plata, R., and Marks-Maran, D., 2011. Diversity, fulfilment and privilege: the image of nursing. Journal of Nursing Management, 19(5), 683–692’ Omeri, A. and Raymond, L., 2009. Diversity in the context of multicultural Australia: Implications for nursing practice. In J. Daly, S. Speedy & D Jackson (Eds.), Contexts of nursing: An introduction, Ch. 19, 3rd Edition, Australia: Elsevier, Churchill Livingstone. Puchalski, C., 2006. A time for listening and caring: spirituality and the care of the chronically ill and dying. London: Oxford University Press. Reimer- Kirkham, S., 2009. Lived religion: implications for nursing ethics. Nurs Ethics, 16(4), 406-417. Final reflection on this module: This module helped the student understand the various elements of the practice multidisciplinary teams and how these teams help secure cooperation and collaborative practice. Sharing and communication therefore has been understood better by this student. Reflection also helped this author understand the importance of evaluating one’s decisions in care delivery and how these decisions can be improved. Reflective practice helped the student understand the role of ethical practices, equality, and diversity and patient advocacy in the improvement of patient care, in securing the delivery of quality care, and in improving patient outcomes. Read More