Person Centred Care and Inter-Professional Practice Assessment - Coursework Example

Person Centred Care and Inter-Professional Practice Assessment Introduction: This assignment is a reflection on an experience gained from practical experience during training postings in clinical settings. The reflection of the incident will focus on patient centred care, taking into consideration what patient centred care really ought to be and whether it is a reality in clinical settings. It will also take into consideration the roles and responsibilities of the different healthcare professionals that are part of the clinical care delivery system and critically examine the manner in which patient centred care is delivered through inter-professional teams in clinical settings. The Nursing and Midwifery Council (NMC), 2004, Code of Professional Conduct requires that confidentiality and anonymity is maintained in confidential information of patients and when using them for any kind of study purposes. In keeping with this strict confidentiality is being maintained in the case study and any other part of this assignment that relates to the patient and the professionals involved. Case Study: A thirty-two year old Asian female patient was admitted to the surgical ward for appendectomy with severe abdominal pain. The surgical procedure for appendectomy was successful and the post-operative care included the objective of early ambulation, as a means to avoid any potential risks that could develop from immobility. Appendectomy is a simple surgical procedure and no problems were envisaged with attempting early mobility, since clinical experience has demonstrated that patients normally move out of bed a day after the surgical procedure and become capable of looking after their physical needs and hygiene within a few days of the surgical procedure. Contrary to expectations the patient just wanted to sleep throughout the day and could also hardly stay awake when her family visited her during visiting hours. She required assistance to move to the toilet and resisted any moves by the physiotherapist to make her move around and increase her mobility. Communication with the patient was not easy as her grasp of the English language was limited. The physiotherapist put down her attitude against any form of moving around to being lazy. The nursing professional in charge of the ward however thought differently and called for a meeting with the surgeon and the physiotherapist during rounds the next day discussed the case. The surgeon examined the patient and reassured the patient that she was fine and that she would be up and away in a couple of day’s time. The surgeon admonished the nursing professional for making an unnecessary fuss, confirmed that the physiotherapist’s finding of laziness as the cause of unwillingness to move around and left it at that. Two days went by and the patient demonstrated the same want of sleep and resisted any attempts to make her mobile. The nursing professional then mustered courage to call for a medical opinion of the condition of the patient. The medical tests and examination showed that the condition demonstrated by the patient was the result of a liver condition that had been exacerbated by the use of anaesthesia during the surgical process. The objectives in the care of the patient now needed to be changed by including managing her liver condition along with the recovery process from the surgical procedure. Patient Centred Care: Patient centred care has become a term much heard about as an essential and integral part of the healthcare delivery system in clinical settings. To ascertain whether this patient received patient centred care it becomes necessary to understand what the term really means and its implications in clinical settings for the healthcare professionals involved in the delivery of the required care. There are several definitions for patient centred care. A simple definition according to Bauman, Hardy and Harris, 2003, patient centred care involves the sharing of the management of the illness between the patient and the healthcare professionals involved. Nothing new and sounds easy to achieve, yet patient centred with all its implications is not easy to achieve. Though definitions of patient centred care may be differ, there are three key elements to it namely Communication with patients Developing partnerships Focusing beyond the specific conditions to promote the health of the patient. (Bauman, Hardy & Harris, 2003). In essence patient centred care calls for a thorough explanation of the situation the patient is in and in addition an exploration of the feelings, beliefs and expectations of the patient. (Bauman, Hardy & Harris, 2003). Patient centred care in clinical settings needs to be within the framework of the ethics of healthcare delivery system as a whole. In simple terms the ethics on which care delivery in the healthcare system is founded on is to do good, do no harm, justice and autonomy. Among these four principles the evolving of efficient care to patients has called for emphasis on the autonomy principle. The implication is that the do good and the do no harm principles are from the perspectives of the patient and not from the perspective of the healthcare professionals involved in the care of the patient. Viewed from this perspective patient centred does not run contrary to the framework of ethics involved in healthcare and to the contrary is strongly supported by this framework. Hence there can be no claim by any of the health professionals involved in the care of the patient that the use of any of the other principles of the ethics of healthcare delivery prevents patient centred care (van Ooijen, 2003). The National Health Service (NHS) in its benchmarks for patient centred health promotion looks upon the meaning of the term as “activities which are based on what is important to a person from their own perspective and which contribute to their full inclusion in society. Person centred planning discovers and acts upon what is important to a person. Person centred approaches design and deliver services and supports based on what is important to the person”. The running theme throughout the person centred care benchmarks of the NHS is the upholding of the supremacy of the ethic of autonomy of the patient. Patient centred care becomes better understood when it is realized that it calls for an indivisible whole of a healing relationship between the professionals in the clinical care delivery system and the patient. This wholesome healing relationship from the perspective of the patient according to Little et al, 2002, is patient centred care, which (a) explores the patients main reason for the visit, concerns, and need for information; (b) seeks an integrated understanding of the patients worldthat is, their whole person, emotional needs, and life issues; (c) finds common ground on what the problem is and mutually agrees on management; (d) enhances prevention and health promotion; and (e) enhances the continuing relationship between the patient and the doctor”. In this perspective of patient centred care lies its true meaning for nothing happens to the patient without the patient being involved in the decision making process (Davis, Schoenbaum & Audet, 2005). Patient Centred Care in the Case Study: From the understanding of patient centred care that has been arrived at it is quite clear that the patient in the case study did not get patient centred care from the health professionals responsible for her care. The physiotherapist made no genuine effort in making any kind of communication with the patient to come to understand the difficulty that the patient was encountering because of the lethargy that the patient was feeling and arrived at his own conclusion that the cause of the problem lay in the laziness of the patient. The Gynaecologist finding no cause for alarm in the prognosis of the surgical procedure that the patient had undergone and relying on the medical history of the patient agreed with the patient and paid little heed to the concern voiced by the nursing professional, leading to a delay in the identifying the underlying cause to the lethargy that the patient was feeling. The attitude of the gynaecologist typifies the attitude of many medical professionals, who believe they have seen it all and know what is best for their patients. From their point of view doing good for the patients and not doing harm is from their perspective and not from an understanding of the patients, their perceptions of what they are suffering and what they believe is the care needed for them. It is when this happens, that most often the concept of patient centred care fails, as it did in this case (Wilkins, 2006). Lack of time is an essential feature that plays on the mind of many healthcare professionals. This may have been another reason why the gynaecologist opted to go with the physiotherapist, thereby not wasting the time of the gynaecologist and the physician that would have to be called in. These attitudes are not patient centred care attitudes and work to the detriment of effective care to the patient (West, Barron & Reeves, 2005). The only healthcare professional to show a better sense of patient centred care was the nursing professional. An examination of the evolving role of the nursing professional, with care as an inherent ingredient will explain the reason for the greater concern shown by the nursing professional for the patient and the failure of the nursing professional to run the role of the nursing professional to the full, which caused the failure of the three healthcare professionals as a multi-disciplinary team to provide patient centred care. Nursing as a profession evolved from caring, and has remained embedded in caring, but being a dynamic and challenging profession has in its development brought about the need for a merging of critical thinking skills and theory based practice into the character of caring of individuals, families and communities that face a disparate range of developmental and health-illness transitions (Philosophy). The question does arise as to the importance of caring to the nursing professional. The answer to that lies in the accepted fact that caring is an essential facilitator for curing and healing and with the nursing profession steeped in trying to bring about curing and healing the importance of caring in this role becomes clear (Ott, Al-Khaduri & Al-Junaibi, 2003). Inter-Professional Practice: Evolution and change is an essential component to the healthcare system. Developments in various aspects having an impact on providing more efficiency within the healthcare system create the need for changing and developing concepts of the healthcare delivery systems. Such developments and changes come from increased demands of efficiency, cost-effectiveness and quality of the healthcare provided. Inter-professional collaboration or cooperation has been the result of the demands for increased efficiency and quality of the healthcare delivery system (Liendke & Sieckert, 2005). Inter-professional collaboration has had a positive impact on some areas of the healthcare delivery system. Preventable adverse events, as in the present case do occur within the healthcare delivery system and inter-professional collaboration is capable of reducing such adverse events. This can be seen by the reduction of adverse events in the emergency departments through collaboration between different professions. This positive impact is yet to pervade to all areas of the healthcare delivery system, as was seen in this case. (Grimes, Thornell, Clark, & Viney, 2007). To examine whether inter-professional care was successfully implemented in this case it becomes necessary to examine the principles and framework of inter-professional collaboration. Among the many principles, those involved in this case include the requirements of the individual patients need to be the focus of the healthcare delivery system. Health professionals involved in the care of the patient have to cooperate together to bring about optimal delivery of health and well-being of the patient taking into consideration the individual perceptions of health and well-being. The right service is made available at the right time and at the right place. Trust and respect for each of the professions that are involved in the care of the patient, as each professional brings along knowledge, skills and clinical experience from different angles that when combined together provide more effective care. There is the willingness to listen and communicate effectively so that information is made available and can be shared for decision making (INTERPROFESSIONAL COLLABORATION). In essence the inter-professional collaboration calls for team work with the objective of providing more efficient and improved quality of healthcare. The success or failure of such team work amongst the different professionals involved in the care of the patient depends on the effective manner in which each of the professionals is capable of interacting and working with the other members of the team. In a complex environment of the healthcare delivery system there are a variety of professions interacting within the concept of inter-professional collaboration with different aspects of knowledge, clinical experience and working methods. Putting all this together to provide an efficient, effective and satisfying experience for the patient has not been easy and that is why from time to time the principals involved in inter-professional collaboration are flouted and deficient service is provided to the healthcare seeker (Martin-Rodriguez, Beaulieu, D’Amour, & Ferrada-Videla, 2005). In addition to this another reason for witnessing failure in inter-professional collaboration is misplaced belief that all professional involved in inter-professional collaboration have enough knowledge of the principals and theoretical frameworks involved in inter-professional collaboration or in other word know what the whole concept actually means. Policies that are put in place to promote inter-professional collaboration often mistakenly assume that shared understanding and collaboration exists, instead of verifying it and working to achieve it before promoting inter-professional collaboration (Lewin & Reeves, 2004). Inter-Professional Care in this Case: An examination of this case shows that several of the principles involved in inter-professional care were absent. The patient was hardly involved in the decision making for early mobilization, with the possible cause being her lack of proper grasp of the English language. There should be cooperation between the professionals involved in providing inter-professional care. Rather than cooperation there was more of subservient attitude by the nursing professional deferring to the orders and admonishment of the surgeon involved. The superior attitude of the surgeon is clearly seen, with the physiotherapist showing lack of concern for any problem that the patient may have had towards early mobilization. There was no trust and reliance on the knowledge, skills and clinical experience of the nursing professional that made the nursing raise concerns on what was happening to the patient. Instead there was greater belief in the knowledge, skills and clinical experience of the other two professional involved in the care of the patient. This situation led to the patient not receiving the right service of the medical consult at the right time and caused a two day delay in action being taken to relieve her of the problems she was facing due to an undiagnosed medical condition. The medical condition not being serious enough to cause mortality or sever morbidity led to the recovery of the patient, but the delay and the additional unnecessary suffering that the patient underwent demonstrates a clear failure of the inter-professional involved in the care of the patient to provide an effective, efficient and satisfying healthcare experience for the patient. Improving the Situation: A proper evaluation of a given healthcare situation, besides analysing the events and their consequences, also needs to provide possible solutions to prevent the recurrence. Particularly more so, as there is growing evidence that there is lack of collaboration between professionals involved in inter-professional care (Zwarenstein, 2007). Collaboration cannot be achieved overnight and can only evolve over time. This means time becomes an important element in the development of inter-professional collaboration. On one side clinical successful clinical experiences among the inter-professional collaborators build up confidence in one another over a period of time and improve the collaborative relationships and spirit, with the greater realization and reliance on the abilities and capabilities of one another within the inter-professional team. Inadequate time to build such a relationship works to the detriment of the success of inter-professional collaboration. The environment that the professionals from various disciplines work in will have to provide for this. There are means to supplement these efforts and that again calls for providing time and conveniences for the professionals to discuss and talk over the successes and failures in providing efficient, effective and satisfying experiences to patients. It is only through such interactions that there can be a reduction in time required n the development of team work in clinical settings, instead of solely relying on the interaction that takes place in the stressful environment of a clinical setting (Gardner, 2005). In addition to this benefit, spending time talking and discussing reduces inter-disciplinary rivalry that a serious problem in inter-professional collaboration (Landua, 2002). Thus policy makers and administrators have a role to play in improving the functioning of inter-professional teams. Instead of merely framing policies to promote inter-professional collaborations within clinical settings, they need to create the atmosphere for the development of inter-professional collaboration. This calls for providing the facilitation of discussions and meetings between the professionals involved and most importantly providing adequate time and the environment for such discussions and meetings to be rewarding towards the development of collaboration among the different professionals. (Gardner, 2005). It is within the portals of the educational institutions of the different professionals involved in inter-professional collaboration that the foundation and theoretical knowledge of inter-professional collaboration is provided. This by itself is proving to be deficient, as can be seen from experiences in clinical settings. (Taanila, Purola, Larivaara, 2006). Theory by itself does not lend to practice in professional environment and it is for this reason theoretical knowledge is supplemented with practical experience. Thus it becomes useful to provide practical experience of inter-professional collaboration, which is becoming a significant of healthcare delivery, at the time of providing knowledge and skills to the professionals. This means besides providing clinical experiences related to their profession at the time spent in the educational institutions, practical experience of inter-professional collaboration is also provided. This would allow the student professional to analyse and reflect on what actually constitutes inter-professional collaboration for efficient, effective and satisfactory delivery of inter-professional collaboration and deliver the same in their active professions (Jones, Hutching & Hobson, 2007). Literary References Bauman, A. E., Hardy, J. H. & Harris, P.G. 2003, ‘Getting it right: why bother with patient-centred care?’ The Medical Journal of Australia, vol. 175, no. 5, pp. 253-256. Davis, K. Schoenbaum, C. S. & Audet, A. 2005, ‘A 2020 Vision of Patient-Centered Primary Care’, Journal of General Internal Medicine, vol. 20., no. 10, pp. 953-957. Gardner, D. B. 2005, ‘Ten Lessons in Collaboration’, Online Journal of Issues in Nursing, vol. 10, no. 1. [Online] Available at: http://www.medscape.com/viewarticle/499266 Grimes, C., Thornell, B., Clark, A., & Viney, M. 2007, ‘Developing Rapid Response Teams: Best Practices Through Collaboration’, Clinical Nurse Specialist, vol. 21, no. 2, pp. 85-92. ‘INTERPROFESSIONAL COLLABORATION’, Position Statement, CANADIAN NURSES ASSOCIATION [Online] Available at: http://www.cna-nurses.ca/CNA/documents/pdf/publications/PS84_Interprofessional_Collaboration_e.pdf Landua, R. 2002, ‘Ethical dilemmas in general hospitals: social workers’ contributions to ethical decision-making’, Social work in health care, vol. 32, no. 2, pp. 75-92. Lewin, S. & Reeves, S. 2004, ‘Interprofessional collaboration in the hospital: strategies and meanings’, Journal of health services research & policy, vol. 9, no. 4, pp. 218-225. Liendke L. L. & Sieckert, A. M. 2005, ‘Nurse-Physician Workplace Collaboration’, Online Journal of Issues in Nursing, vol. 10, no. 1. [Online] Available at: http://www.medscape.com/viewarticle/499268 (accessed on June 18, 2007). Little, J. et al. 2002, ‘The patient should be the judge of patient centred care’, BMJ, vol. 322, pp. 444-445. Lloyd-Jones, N., Hutching, S. & Hobson, S. H. 2007, ‘Interprofessional learning in practice for pre-registration health care: Interprofessional learning occurs in practice – Is it articulated or celebrated?’ Nurse Education in Practice, vol. 7, no. 1, pp. 11-17. Martin-Rodriguez, L., Beaulieu, M., D’Amour, D. & Ferrada-Videla, M. 2005, ‘The determinants of successful collaboration: A review of theoretical and empirical studies, Journal of Interprofessional Care, vol. (Suppl) 1, pp. 132-147. NHS. 2006, ‘Essence of Care: Benchmarks for Promoting Health’, Department of Health, [Online] Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_075613 (accessed on June 18, 2007). Ott, B. B., Al-Khaduri, J & Al-Junaibi, S. 2003, ‘Preventing Ethical Dilemmas: Understanding Islamic Health Care Practices’, Pediatric Nursing, vol. 29, no. 3, pp. 227-230. ‘Philosophy’. Nursing Student Handbook, Clayton State. [Online] Available at: http://healthsci.clayton.edu/nursstud/Program_Information/phil.htm. (accessed on June 18, 2007). Taanila, A., Purola, H., Larivaara, P. 2006, ‘Nurses learning family-oriented interprofessional collaboration’, International journal of circumpolar health, vol. 65, no. 3, pp. 206-218. ‘The NMC code of Professional conduct: standards for conduct, performance and ethics’. 2004, NURSING & MIDWIFERY COUNCIL, [Online] Available at: http://www.nmc-uk.org/(pjy3krzs3xr0wn45rqvvpd55)/aFramedisplay.aspx?documentID=201 (accessed on June 18, 2007). van Ooijen, E. 2003, CLINICAL SUPERVISION MADE EASY, Churchill Livingstone, Edinburgh. West, E., Barron, D. N. & Reeves, R. 2005, ‘Overcoming the barriers to patient-centred care: time, tools and training’, Journal of clinical nursing, vol. 14, no. 4, pp. 435-443. Wilkins, L. 2006, ‘The experience of a practice nurse’, in Fundamental Aspects of Community Nursing, ed. John Fowler, Quay Books, London. Zwarenstein, M. 2007, ‘Interprofessional education: effects on professional practice and health care outcomes’, Cochrane Review Abstracts, [Online] Available at: http://www.medscape.com/viewarticle/486108 (accessed on June 18, 2007). Read More