Dimensions of inter-professional practice

Introduction

Inter-professional practice is an essential part of modern healthcare, enabling new models of healthcare delivery to be established (Martin et al. 2010). It allows the team to use unique disciplinary knowledge in a complementary manner to offer patient centred, holistic care on an individual basis (Castelli, 2011). Inter-professional working was defined by Pollard (2005) as a process where members of different professions and/or agencies work together to provide integrated health and social care for the benefit of service users. Leathard (2003) defined inter-professional as a group of professionals from related professions engaging in interdependent collaborations with mutual respect in order to provide integrated health and social care for the benefit of clients, Reflective practice has been shown to be an invaluable learning tool in nursing care (Royeen et al. 2011).

Successful patient care is dependent on good team-working and the inter-collaboration model of healthcare delivery is vital part of the contemporary healthcare system (Humphris and Hean, 2004). Effective team-working creates positive patient outcomes; however, ineffectual team-working is a factor in negative patient care incidents (Grumbach and Bodenheimer, 2004; Korner 2008).

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For this assignment I have chosen Gibbs Reflective framework (1988) to enable my personal reflection on inter-professional practice and I will use the findings from this analysis to improve my future nursing practice (Boyd and Fales, 1982; Kumar, 2011). In order to comply with NMC Codes of Practice (2008), the name of the patient has been altered to comply with confidentiality regulations; the patient will be called Agnes.

Case history

Agnes, a 65 year old female, presented at the hospital with kidney failure. She is diabetic and obese and in recent years has been admitted to hospital for a variety of health issues. This was a complex case and would require a team of clinical professionals to successfully treat her. Holistic care relies on good inter-professional teamwork (Hinchliff et al. 2003).

Description

Agnes had been a regular visitor to the ward, her case was already known to the doctor and he called for an inter-professional meeting to ensure Agnes received appropriate treatment. Due to commitments of some of the team members, it was a few days before the meeting took place. The team comprised of the doctor in charge of her case, the ward nursing staff (my mentor and I), a diabetic nurse, a dietician, a nutritionalist, and a psychotherapist.

During the meeting the doctor in charge of Agnes’ case took the role of team leader. He began by briefing the team on her condition and my mentor gave additional details from our daily observations of Agnes. The doctor asked the dietician and nutritionalist to work together to develop a diet to address her immediate health issues of obesity and diabetes, using the nutritionalist’s assessment of her condition and dietary requirements, which was complimentary role to the dietician who would be in charge of producing a diet that would suit Agnes whilst following the requirements of the nutritionalist. The diet needed to be complimentary to the drugs that she would be receiving for her other health conditions and the diabetic nurse would ensure that her insulin requirements were controlled. There was some debate during the meeting on the best way to ensure support for these needs with respect to medication and diet.

Feelings

I felt that the meeting was a necessary to ensure that Agnes received good holistic care, but I also felt frustrated on behalf of the patient as her care could not start until the meeting occurred and due to prior commitments from some of the members attending, the meeting was delayed. I was unsure why the psychotherapist was involved in the meeting as they had no input during the meeting. I thought that the doctor who had taken the role of team leader should have ensured that all members of the team participated. During the meeting I added very little to the proceedings and wished that my mentor had involved me more in the meeting as I felt more like a spectator than a member of the team. During my time on the ward I had spoken to Agnes and knew some of her dietary dislikes, but I was too nervous to interrupt and offer this information.

Later, when I saw the dietician again I mentioned Agnes’ had some dietary dislikes. The dietician thanked me for the information and said that it could prove useful in ensuring Agnes had a diet she would follow.

Evaluation

Evaluating the meeting, I believe it was necessary to have waited until all clinical staff involved with Agnes’ care could be present and that although it had caused the meeting to be delayed, on a positive note it had ensured that all relevant team members had an opportunity to be involved in the care plan. I found the meeting challenged my perceptions of inter-professional collaborations as I believed that everyone would simply add what they knew about Agnes and her case and then they would discuss the best course of action using all the facts gained from all members of the team to ensure that everyone was involved within the care of the patient. However, on evaluation of this, I realise that this could have increased the time it would take to generate a care plan for Agnes as well as reducing the number of patients that the team members could see, which would increase the time before other patients started their treatment. I realised that if a clinician had information to add they should simply add it if it is appropriate to the discussion, which reduces the time needed to have meetings and increases the amount of relevant information gained within the meeting, and if you have nothing to add that is relevant, then you should sit quietly but absorb the information being given as this may have bearing on your own treatment if the patient requires your input at a later date, as the psychotherapist had done. I also realised that having information about Agnes’ dislike of vegetables would have been useful to know in the meeting as this would affect the diet she was given and the chances of her following it when she returned to the community.

Analysis

Analysing the overall meeting, I believe the doctor in charged worked towards the best possible holistic care for Agnes, rather than simply using a ‘blanket’ approach to her care, he ensured that all relevant professionals had an opportunity to add to her care plan, thus ensuring the best holistic treatment (Martin et al. 2010). Guidelines state that ‘Working Partnerships’ ensure the best treatment and have better prognosis for the patient (Nice guidelines 2005).

Communication is an important aspect of inter-professional working and can ensure a successful outcome (Reeves et al. 2011). Having a team leader that clarified the roles within the team, as the doctor did, is an important part of team working, understanding and clarification of your role within the team is necessary from the onset for good team-working, while failure to correctly define roles can lead to confusion (Ovretveit et al. 1997). Barriers to beneficial inter-professional collaboration include poor communication, lack of understanding of other team members’ roles, work priorities and professional hierarchy, when these issues arise it is beneficial to identify shared objectives and state concerns (Whitehead, 2000).

Inter-professionals should use clinical judgment that encompasses the best and most appropriate of all team members’ professions to provide excellent provision of care and thus improve client wellbeing, which can in turn aid them to cope with their health problems and achieve the best quality of life with their illness (DoH, 2013). Each team member brings a different aspect and focus to an inter-professional meeting and each role is distinctive, the nursing role is unique in that they are closer to what is happening with the patient because they seem them daily and have more ‘human’ contact with them (NMC, 2006).

Conclusion

It is important to remember during inter-professional meetings that health professionals may not have the skills or attributes essential for inter-professional practice and may require education in order to learn how to collaborate (McCallin 2005). Developing inter-professional practice requires a commitment to engage in shared learning and dialogue. Dialogue has the potential to encourage collegial learning, change thinking, support new working relationships, and improve client care.

Looking back I realise I should have mentioned Agnes’ dislike of vegetables rather than worrying that it was a trivial matter and staying quiet, the role of the nurse in an inter-professional meeting is not just to report on daily observations, but also to be the advocate of the patient, as nursing staff often develop closer relationships with the patient as they have more contact with them (RCN, 2010).

Action plan

I will seek to become more familiar with inter-professional team working to ensure than I become an effective member of the team. I will do this by talking to my peers and mentor on their experiences and what strategies they used to become part of the team. I will also find out more about the roles of the other professionals and how what their disciplines work within the inter-professional team. To achieve this aim I will study the general roles of the other team members. I will also work on my assertiveness, as I realise that relevant information should be mentioned in inter-professional meetings, especially if it allows the patient to have a say in their care.

Furthermore, in the future, if I have a student that I am mentoring I will ensure they have a good understanding of how inter-professional meetings can unfold and I will ensure they have a voice in these meetings so that they feel involved in the proceedings.

References

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Castelli, P. (2011). An intergrated model for practicing reflective learning. Academy of Educational Leadership Journal, 15, 15-30

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Martin, J.S., Ummenhofer, W., Manser, T., Spirig, R. (2010) Interprofessional collaboration among nurses and physicians: making a difference in patient outcome. Swiss Med Wkly. 1;140:w13062.

Nice guidelines (2005) Guidelines for establishing and supporting working partnerships of patients and clinicians. https://www.evidence.nhs.uk/document?ci=http%3A%2F%2Farms.evidence.nhs.uk%2Fresources%2FHub%2F15565&q=nice%20guidelines%20on%20interprofessional%20working&ReturnUrl=%2Fsearch%3Fq%3Dnice%2520guidelines%2520on%2520interprofessional%2520working. Accessed 3/5/13

NMC (2008), Code of Conduct, Nursing and Midwifery Council, London

NMC (2006) The role of nurses in interprofessional health and social care teams, The role of nurses in interprofessional health and social care teams Accessed 3/5/13

Ovretveit, J., Mathias, F., Thomoson, T. eds., (1997). Interprofessional working for health and social care. Hampshire: Macmillan Press Limited.

Pollard, K., (2005). Interprofessional Working: an Essential Guide for Health and Social-Care Professionals; England, Nelson Thrones Limited.

Royal College of Nursing (2010) Principles of Nursing Practice. RCN website. Accessed 3/5/13

Royeen, CB., Jensen, JM., Harvan, RA. (2011) Leadership in interprofessional health education and practice. Jones & Bartlett Publishers

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