Dimensions of Interprofessional in Nursing Practice - Essay Example

? THE DIMENSIONS OF INTERPROFESSIONAL IN NURSING PRACTICE BY Introduction Inter-professional collaboration is significant in the provision of quality care in the healthcare system. Even though, there are numerous ways to describe inter-professional collaboration in the provision of health services, for the present paper collaboration of health service providers can be defined as “working together with one or more members of the health care team who each make a unique contribution to achieving a common goal. Each individual contributes from within the limits of her/his scope of practice” (Canadian Physiotherapy Association 2009). It refers to situation when a number of professionals work with one another to enhance cooperation and the quality of care (Canadian Physiotherapy Association 2009). The collaborative process has also been defined as a dynamic process which requires that professional boundaries be surpassed if each participant is to contribute to developments in patient care while appropriately bearing in mind the qualities and skills of the other professionals (Canadian Physiotherapy Association 2009). However, nurses have long held the view that failure to implement inter-professional has led to the fragmentation of care, patient dissatisfaction and poor outcomes (Leathard, 2004). Therefore, there is a need for inter-professional working in nursing practice to deliver integrated quality healthcare services, improve patient satisfaction, and save more lives. Inter-professional working in nursing practice refers to the collaboration of the healthcare team to ensure the delivery of high quality patient care services. It was acknowledged by the General Medical Council that healthcare is increasingly provided by multidisciplinary team and this collaboration brings more improvement to patient care (WHO, 1999). The present reflective commentary is based on a HIV positive patient who was admitted to my ward via A&E. Using this patient; I will analyze and evaluate the contribution of nursing and other members within the inter-professional collaboration process. Gibbs reflective cycle will be used to reflect my experiences of working in an inter-professional team. The cycle will help me identify the decision making and problem solving processes and discuss the effectiveness of the contribution of each member in the inter-professional practice in the light of existing relevant literature. Description I was performing my duties in the ward on a morning/afternoon shift with my mentor when a 32 years old, Vietnamese female immigrant, named Mrs. Yiu Suh was wheeled in from A&E. Mrs. Yiu Suh is a pseudonym for the patient in accordance with the 2008 Professional Code of Conduct on confidentiality promulgated by the Nursing and Midwifery Council (NMC 2008) which states that all names and identifying trace to the patient must be changed. Therefore, any resemblance to a ward, person, relative or trust is purely coincidental. In order to gain Mrs. Yiu Suh’s complete medical history, an initial admission process was carried out. This was undertaken by reviewing the patient’s medical notes which revealed that the patient had diarrhoea and a mouth thrush that failed to heal despite trying several home remedies. The report also provided information which suggested that the patient had not been eating well due to her mouth condition and had lost a lot of weight within a very short period of time. Three weeks prior to her admission to the ward, the patient visited her General Physician (GP) in the community for the same complaints. Her GP treated her and advised her to visit again in case there was no improvement. Mrs. Yiu Suh refused to visit her GP again as she was given leaflets on HIV and was recommended an HIV test, which she ignored. Later on the patient confessed to me that she feared the worst because she had been a commercial sex worker. It was during the course of her sex trade that she met her husband, Mr. Charles Robbins, who brought her to England. Mr. Charles Robbins is a 54 years old British man who lives in an affluent part of Chigwell. The patient also confided that before she got married, she took an HIV test, but the result was negative. The patient further revealed that a year before experiencing these symptoms, she had travelled to Thailand to visit a sister who was still in the sex trade. During that short visit she was lured back to commercial sex when an American tourist offered her a tempting sum of $5,000.00 for three nights of sex. Her customer used condom throughout, but on one occasion the condom burst after which the patient did not bother using the condom with him as her customer appeared to be ‘clean and decent’. Three months after Yiu Suh’s return from Thailand, she suffered from a bout of serious cold which was just put down as a reaction to the change of environment. However, Yiu Suh had been generally unwell since her return and had been downplaying the seriousness of her condition to herself and her loving and caring husband. After gathering the patient’s complete personal and medical history through the initial assessment, it became evident that further tests were required to ascertain the right diagnosis for the sign and symptoms and to determine the appropriate interventions. According to World Health Organisation (WHO), the importance of an early diagnosis of HIV cannot be overstated, therefore, HIV testing is the first step when trying to find out whether a patient is HIV positive or not as symptoms alone can never provide with a conclusive HIV diagnosis. HIV testing is the single most effective way of determining the infection, therefore, it is essential that all positive point of care test results is confirmed with a conventional blood test. For this purpose, the British Association for Sexual Health and HIV (BASHH) has produced a guideline on point of care testing. Thus, the patient consented to taking blood samples for an HIV test among other tests but insisted that her husband must not be informed of the various tests being carried out due to the sensitivity of the issue. I called my mentor to ensure that the patient understood the tests she was consenting to, her counselling needs and the impact of a positive HIV test result on her and her family her (NMC, 2008). The Role of the Nurse While awaiting the result of the laboratory tests, the patient was treated for her mouth thrush with acyclovir and a Naso-gastric tube (NG tube) was inserted temporarily to give her nutritional supplements and fluid for hydration. As the ward nurse, I made sure that the patient’s dietary and fluid requirement was given at the right amount and at the right time. The results from the test revealed that in addition to being HIV positive, Yiu Suh was 16 weeks pregnant. On learning this information, Yiu Suh was devastated and very upset. Counselling sessions were conducted to help her cope up with her anxiety and life with HIV, however, she still insisted that her husband must not know of her situation. She was scheduled for another HIV test to confirm the result. As, the National Standards for HIV Clinical Care (2007) recommends that all patients who test positive in any setting are booked into a specialist HIV Clinic within 14 days of diagnosis to have their results confirmed and for further assessment and management; therefore, Yiu Suh was immediately referred to the facility to effectively manage her recovery. In order to help in the recovery of Yiu Suh, my mentor and I arranged a meeting with the ward manager who requested my mentor for an arrangement of a professional/partnership meeting with the consultant in sexual health, the patient’s GP, midwife, health visitor, social worker, child protection nurse, HIV nurse specialist, and a nurse interpreter. The meeting was held in the ward’s MDT room, in the presence of the mentioned professionals including the ward manager, my mentor, and myself as the ward nurse. Yiu Suh was informed of the inter-professional meeting to which she fully consented. Her concerns were at the centre of every decision of the professionals collaboratively involved in her care. During the meeting, my mentor acted as an advocate for Yiu Suh because nurses must act as advocate for those in their care (NMC, 2008). Norman and Ryrie (2009) also support this fact by stating that nurses are the ones who spend more time with the patients than any other professional. The importance of nurses within inter-professional health and social care team cannot be overemphasised (DoH, 2000) as nurses play a vital role contributing to the inter-professional team. This is evident from the fact that the nurse immediately relayed sensitive information to the Consultant during the ward reviews regarding the patient’s contemplation over the termination of her pregnancy. As the Department of Health (2006) requires nurses to take the responsibility of coordinating and ensuring the best standards of care and of leading the nursing workforce as part of the multidisciplinary tea, therefore, immediate education and counselling sessions were scheduled with Yiu Suh which resulted in her keeping her child. The World Health Organisation (1999) states that working alone with no regular exchange of information can no longer be considered professionally satisfactory, instead, team working enables professionals to solve complex issues that cannot be adequately dealt with by one profession alone. Therefore, during the initial meeting with the inter-professional team, Yiu Suh’s medical history and records were sent to the ward where all the team members had easy access. The patient’s progress along with all the outstanding investigations was reported by the Consultant in inter-professional meetings and ward reviews. The Consultant also ensured that all the members of the inter-professional team remain updated on the ongoing interventions to Yiu Suh’s conditions. The patient, during the meeting, was visited by the sexual health consultant who ordered further blood tests and scans to detect any complications or changes that might have an impact on the development of the baby. Her medication was constantly reviewed and her blood was monitored regularly for viral load and CD4 counts to determine whether there was a reduction in viral load per mml of blood, which would indicate the effectiveness of the medical regimen. As the NSF (2006) requires patients to be referred to specialist services for further assessment, treatment and care if required and be able to access specialist care when needed, therefore, in order to promote health and prevention of further illness, Yiu Suh was visited by an HIV Specialist Nurse who offered practical advice regarding compliance with her medication regime and safe sexual life (NHS, 2010). The HIV Specialist Nurse also informed the patient that the key to putting a halt to the HIV epidemic is prevention which can only be achieved through safer sex (DoH, 2000). The HIV Specialist Consultant and HIV Specialist Nurse assigned to Yiu Suh’s case monitored and adjusted the medication (NICE 2006) and provided a reliable source of information regarding the clinical issues and continued as a point of support for both patients and non-specialist staff. Furthermore, the HIV specialist Nurse worked collaboratively with the other nurses to monitor the side effects of the drugs and educated Yiu Suh on how to achieve best result on these drugs. The HIV specialist Nurse in liaison with the Health Visitor and Social Worker gave their recommendations and advices on how best to support Yiu Suh upon discharge and were constantly reminded about confidentiality issues. Similarly, the Social Worker could also help access available support group and services. The assigned Child Protection nurse worked closely with Yiu Suh and helped her to understand the rights of the unborn child with regards to HIV protection. Together with the midwife, both ascertained Yiu Suh’s antenatal needs and planned about her delivery. Both made sure that Yiu Suh complied with her HIV medication regime and that the unborn child is protected and cared for in relation to HIV. The effectiveness of a team depends on the members’ clear understanding of their roles and responsibilities as conflicts often occur when roles and expectations are not clearly defined. Constructively working with colleagues and managing inter-professional conflict have been identified as key factor in providing effective nursing care. Due to the fact that the inter-professional team came from different professional background and diverse value system, each may have a different way of approaching a known condition. It is important to work collaboratively at all times and conflicts should be resolved immediately to prevent it from escalating into a major obstacle to effective nursing care. Therefore, there was a good relationship amongst all the professionals involved in Yiu Suh’s case. All the professionals that I had worked with understood their roles which made referrals easier to manage. As, respect for the individual is one of the principles of the National Service Framework (NSF, 1999), therefore, everyone respected each others’ contribution and appreciated the value of professional diversity which made working together more productive. According to Wigens (2006), effective communication is paramount to patient care. The fact that Yiu Suh was from Vietnam, a non-English speaking country, sometimes made it difficult for the team to understand her. To facilitate effective communication between the working team and the patient, an interpreter, who was also a nurse, was invited to join the team and was present during all review meetings. He visited the ward daily to ask and understand her concerns and needs. All the information was communicated to the entire team in charge of Yiu Suh’s care. Managing knowledge and information is a key element in the development of the workforce (DoH, 2011). According to the NMC (2008) code of professional conduct, it is mandatory for nurses to communicate effectively and share knowledge or expertise with other team members when so required for the benefit of patient and clients. The White Paper entitled, The National Health Service: A Service with Ambition (DoH, 1996) pointed out that sharing relevant information amongst inter-agency professionals is essential for inter-agency care to function effectively. The General Medical Council (GMC, 2001) also directed doctors to communicate effectively within and outside the team. The code of conduct for social workers (GSCC, 2002) also emphasised the need for social workers to work and respect the role and expertise of other agencies and to work in partnership with them. In Yiu Suh’s case, there was a free flow of information amongst the professionals as nurses were prepared to share information with the team members of the inter-professional collaboration. Information was not hoarded and this free flow of information amongst all members in the team resulted in the effective delivery of seamless care to the patient (Wigens, 2006). These propositions are spelt out in the NHS workforce strategy (Department of Health, 2000) which calls for multi-professional education and training to promote teamwork, partnership and collaboration between professions, between agencies and with patients. This training also allows skill mixing and flexible working between professions and provides for opportunities to switch training pathways in order to expedite career progression. There were weekly reviews regarding Yiu Suh’s care with full attendance by each professional at these reviews. The patient was given plenty of time to air her views, concerns and fears and was ensured that the team’s discussions were focused on her care. Wigens (2006) stated that effective communication with patient and other care givers is considered essential for effective inter-professional teamwork to ensure the delivery of quality patient care. Therefore, communications with her and interventions were properly documented in her medical notes and submitted to the GP and other healthcare professionals in charge of her care. The NHS Plan (Secretary of State for Health, 2000) in the White Paper calls for collaboration and cooperation at all levels of the healthcare team to ensure borderless patient centred care. Similarly, the General Medical Council acknowledges that healthcare is increasingly provided by multidisciplinary team and this collaboration brings benefit to patient care (WHO, 1999). However, there are barriers to effective inter-professional teamwork in terms of meeting the patient’s needs. One of these barriers, as highlighted by Brems et al. (2006), is the lack of resources or reduced resources, which ultimately results in not fully meeting the demand for quality care. In some cases, budgetary constraints or overstretched budget and reduced professional involvement negatively affects patient care and services. Similarly, overloaded staff may already be experiencing some work stress thus, undermining their professional competence. Robinson and Wiles (1994) also identified dilution of individual professional responsibility on the patient and possible personality clashes between colleagues as potential disadvantages of team work in healthcare. The lack of ongoing training due to lack of funds, unsupportive senior management and inadequate or incompatible resources have also been identified by Allen, Lyne and Griffiths (2001) as being some of the possible obstacles to effective inter-professional teamwork. While conducting Yiu Suh’s initial admission assessment, I kept wondering what could be wrong with her. My presence in the ward at the time of Yiu Suh’s admittance was quite timely because she was quite apprehensive when she was first admitted but I was able to clam down her fears with my caring and empathetic approach towards her condition (Roper et al., 1980). By respecting her dignity, I gained her trust after which she provided me with information that proved highly valuable during the course of her treatment. I explained to her in simplest English that in order to take care of her properly, being a student; I needed to tell a staff what she told me, to which she consented. This was documented in her notes. I believe that I gained her confidence such that she confided to me vital information. The fact that I spoke to her in a way she could understand best, before an interpreter could come, helped in the speedy diagnosis of her condition. As a result, treatment commenced without any further delay. After Yiu Suh’s test results came out, I was shocked to know that her viral load was almost 300,000 per unit of blood while her CD4 count was below 200. I was petrified knowing that she was pregnant as I thought she might lose the baby or opt for termination. I was also apprehensive that she might have complications and might pass away. Being a student nurse, with limited knowledge and expertise, I could only empathise with my patient and provided her with the support she needed. I wondered how Yiu Suh’s problems will be resolved because HIV is a very challenging disease that affects the body in different ways. However, a better understanding of how HIV operates and what it does to those afflicted with the disease, helps in determining the provision of emotional support care of the special needs of these patients. A thorough understanding of HIV guides all the professionals in their respective roles in caring for HIV patients, and in helping them to take control of their illness and enjoy productive lives despite their afflictions. Evaluation and Analysis There was a sense of urgency in organising the inter-professional work team to respond to the immediate and critical needs of Yiu Suh. It was very impressive to note that there was no conflict or misunderstanding amongst the inter-professional team. The proper delineation of responsibilities to each individual professional in the team and the effective line of communication amongst them contributed to the positive outcome of the strong inter-professional collaboration and this helped in administering timely medical intervention and professional counselling that helped save or eased the afflictions of Yiu Suh. Thus, information sharing among professionals is very relevant in ensuring effective working of the inter-professional team (Miller et al., 1999). Even though, the importance of compliance by patient to medication cannot be over emphasised, it was the effective counselling that helped Yiu Suh overcome her fears and was able to tell her husband about her HIV status. In the case of Yiu Suh, the support and understanding of her family, particularly her husband, helped her in facing life with HIV. As it turned out, Suh Woo’s fear of loosing her husband was unfounded as he has become even more supportive and caring of her wife. The husband’s knowledge of his wife’s situation provided the professional team with the freedom to involve the patient’s immediate family through empathetic education and counselling. He was invited into the team and cooperatively attended all inter-professional reviews and meetings. Yiu Suh’s husband played a significant role in the patient’s healthcare regime as he made sure that her wife took her medications as prescribed. Words of encouragements from him helped Yiu Suh regain a positive outlook in life despite her HIV status. The husband tested negative for HIV, however, he was informed that another test will be required in 3 months. Continuous test and assessment would also be needed for Charles protection. As Yiu Suh was discharged from the hospital, members of the inter-professional team continually kept in touch with the couple and the patient’s GP was designated as the first point of contact. They were also informed that they could access the sexual health clinic anytime they needed. Similarly, the social worker in the team made sure that the couple had access to HIV support groups and receive invites to attend health promotion and health education seminars organised specifically for people with HIV. Conclusion In the final analysis, inter-professional practice in this instance worked for the betterment of the patient, Yiu Suh and her husband, Charles Robbins. This was made possible by the cooperation and effective professional collaboration of the inter-professional team members. Open communication, well-managed flow of information, proper documentation, regular ward reviews and well-attended team meetings highly contributed to the efficiency of the working team. Every member of the inter-professional team knew their roles and responsibilities and if ever there was any conflict, it was not manifested at all, because the members did not allow such conflict to interfere or affect their work ethics and professional conduct. The inter-professional team did not lose focus on the fact that they needed to work effectively as a team towards their mission of delivering the best quality of healthcare care services to Yiu Suh, thus saving her life and that of her baby. Each member worked on the individual role and delivered specific professional expertise towards the realisation of the identified objectives of the team in relation to the patient, working as individual in their own special fields and at the same time together as a team to achieve the same goal. The collaborative partnership worked effectively in solving complex problems related to total patient care. Legal frameworks and policy requirements over the past years have required health and social care agencies to work collaboratively in partnership with service users (DOH, 1999). Evidence of good collaboration amongst the members is the free flow of communication, respect for each other’s role and expertise and making contribution and input count by giving due recognition. Even If I was only a student nurse, the team, through my mentor recognised my contribution by listening to what I had to say with respect to the information I had directly gathered from my direct contact with the patient. My experience in this setting will go a long way in developing a more positive attitude positively towards inter-professional teamwork to save lives. It taught me that even a student nurse’s contribution counts to the success of the professional team. I appreciated the value of good listening skills and the importance of winning the patient’s trust and confidence by respecting their dignity (RCN, 2009). I learnt that conflicts can easily be resolved if everyone in the team is unified in the goal of saving lives. All of us were praised for doing a good job in swiftly acting on Yiu Suh’s healthcare needs and for achieving commendable results. Recently, I learned from one of my colleagues that Yiu Suh delivered a baby Boy and both the mother and baby are doing well. The baby is up till now testing negative for HIV and Yiu Suh is complying with her and her baby’s medication, and regularly attends clinic sessions and support group activities. The inter-professional team is still working with her to improve the quality of life and help Suh Woo in her struggles with HIV. A new educational curriculum will give everyone working in the NHS the skills and knowledge to respond effectively to the individual needs of patients with the implementation of a possible joint multi-training across professions in developing effective communication skills, documentation skills, listening skills, and NHS inter-professional organisation principles and code of conduct. NHS can also look into the feasibility of coming up with a joint foundation program that will help nurse students and professional staff appreciate the significance of inter-professional team work in the delivery of superior healthcare services. References Allen, D., Lyne, P., Griffiths, L. (2001) ‘Seamless health and social care: nice services if you can afford them’, Nursing Times 97(26): 36-7 Brems, C., Johnson, M. E. Warner, T. D., & Roberts, L. W. (2006) ‘Barriers to healthcare as reported by rural and urban Interprofessional provider’, Journal of Interprofessional Care, 20(2): 105-18. Canadian Physiotherapy Association. (2009) Position Statement. [Online]. http://www.physiotherapy.ca/PublicUploads/222537Position%20statement%20IP.pdf [Accessed 8 July 2011] Department of Health (1991) Department of Health (2000) Department of Health (2003), Effective Sexual Health Promotion. Department of Health (2004) .The Essence of Care. London: DOH Leathard, A. (2004) Interprofessional collaboration: from policy to practice in health and social care. 4th ed. Philadelphia: Brunner-Routledge Manual of Clinical Nursing Procedures. 7th ed. Chichester: Wiley-Blackwell. Miller, C., Ross, N., & Freeman, M. (1999) Shared Learning and Clinical Teamwork: new directions in education for multi-professional practice, The English National Board for Nursing, Midwifery and Health Visiting, London. National Institute of Clinical Excellence (2006) National Service Framework (NSF) (1999) Norman, I., & Ryrie, I. (2009) The art and science of mental health nursing. London: Open University Press Nursing and Midwifery Council (2008) Standards of professional conduct, performance and ethics for nurses and midwifery. London: NMC Roper, N., Logan, W. W., & Tierney, A. J. (2000) The Roper-Logan-Tierney Model of Nursing: based on activities of living. Edinburgh: Elsevier Health Sciences The British Association for Sexual Health and HIV (BASHH) The National Standards for HIV Clinical Care (2007) The NHS Plan (Secretary of State for Health, 2000) The White Paper, The NHS Plan (Secretary of State for Health, 2000) Wigens, L., & Day, J. (2006) Expanding nursing and healthcare practice: inter-professional working. Nelson Thornes. Wiles, R., & Robison, J. (1994) ‘Teamwork in primary care: the views and experiences of nurses, midwives and health visitors’, Journal of Advanced Nursing, 20: 324-330. World Health Organisation (WHO) (1991) Read More