This commentary reflects on my experience of collaboration within the inter-professional team during my placement. It critically analyses the contribution of various members of the multidisciplinary team and their unique roles in a patient’s holistic care. In my placement, I had the opportunity to engage in service delivery in an inter-professional team which included a Physiotherapist, Psychiatrist, Occupational therapist and Nurse, working to provide holistic care to the patient.
Gibbs (1988) proposes a flexible and easy to follow framework for the conduct of a reflective exercise. It encompasses reflection upon and incorporation of knowledge, feelings and action towards better understanding and development of knowledge for future utility (Jasper, 2003). It is guided by the questions: What happenedWhat was my responseHow did I actAre the feelings good or badAre they justifiableWhat can be learned from them(Boud, et al., 1985; Moon, 2004) This approach has been employed to structure this account.
In compliance to the Nursing and Midwifery Council (NMC) Code of Professional Conduct (2008), names and details herein are referred to using pseudonyms. While in placement practice in the acute ward which covered a period of six weeks, I took care of Lucy a 66 year old patient diagnosed with dementia as a result of the death of her husband. Worden (1993) suggests that with the loss of loved ones, people can have a protracted experience which may include changes in mental health, impairment in the activities of daily life, and loss of mobility. Lucy lived with her 16 year-old granddaughter helping her out in the activities of daily life but her condition had deteriorated, was always confused and could no longer do anything by herself.
During an initial meeting to discuss care plans (Care Programme Approach (CPA) meeting), I noticed that Lucy and her family were absent despite the Department of Health (2007a) categorically stating that CPA meetings should have in attendance all professionals and family involved in the patient’s care. The CPA meeting is an opportunity for all involved to discuss care plans, and successes from which decisions and changes to programs can be made to attain quality outcome/care (Department of Health, 2004; Barker, 2009).
The answer from my mentor to my inquiry on the absence of Lucy and her relatives was that the decision was taken to avoid distressing the patient in her fragile state, allowing the team members to discuss Lucy’s care without such a concern. I was not in a position to insist upon the inclusion of Lucy’s relatives and had to accept the decisions as made by the team.
My feelings and thought
The common goal for the inter-personal team was to ensure enhanced care for Lucy, in line with the nursing duty to care to safeguard and promote the health and comfort of those under care (John, 2000; Nursing and Midwifery Council, 2008). With this basic tenet, I was dissatisfied by the decision not to involve Lucy and her relatives in the CPA meeting. I felt that her family, also as her caregivers, needed to be made aware of requisite care plans. In support of my sentiment, Webster (2002) states that it is paramount to engage all parties to achieve successful assessment and subsequent treatment.
However, I was pleased with the engagement of the inter-professional team with each member having clear tasks and specifications of duties. Their contribution of diverse strengths and skills (Webster, 2002) assured a positive outcome and holistic care for Lucy.
Nurses are integral to the professional team; initiating, assessing and suggesting interventions. They assume a pivotal role in ensuring holistic care by the entire team; (Barret, 2009; Hudson, 2002). Without regard to my concerns the entire team involved in Lucy’s care had effective communication throughout which enhanced overall efficiency. Members updated information and shared their individual understanding of Lucy’s situation to the benefit of all present and read her progress note frequently. This became a significant source of communication towards her enhanced care.
Hornby and Atkins (2000) and Webster (2002) suggest that sharing of knowledge and expertise is among the significantly beneficial aspects emerging from inter-professional engagement. The collaboration of the team was essential in expanding the collective understanding and ensuring efficiency in coordination to attain the required assistance and support (Webster, 2002).
All professionals in the team were systematically and efficiently engaged in Lucy’s care. The psychiatrist assessed Lucy holistically and prescribed medication, and through time, educated her about her course of treatment. The Occupational therapist assessed Lucy for her capacity for independent life and assessed the level of support required in her road to recovery, which was a fundamental guide to the team’s care plan. The Physiotherapist assessed Lucy and decided upon a treatment plan to assist her with movement, providing passive exercises as Lucy was initially quite reluctant to get out of bed.
The patient’s nurse and I were involved in the daily care and support, implementing the directions in the plans as prescribed by the other professionals in the team. We took the lead of the workforce utilising the unique nursing role to build a strong therapeutic relationship with patients, identifying and advocating their needs (Jack and Smith, 2007). The nurse, John, 2000 outlines, makes unique contributions towards patient care are broad and varied encompassing assessment, coordination of care, enhancement of overall communication, physical and technical care, integration of various prescribed therapies, emotional support, as well as the empowerment of patients and their families for active participation in the delivery of care.
Later, with the marked improvement of the patient and enhanced mobility, the Occupational therapist prescribed and we helped engage her with Activities of Daily Living (ADLs) and leisure activities such as art, cooking and relaxation sessions (Roper, et al., 2000). These activities played an important role helping Lucy to enhance her socialization, meeting and engaging with other people and thereby building her confidence and self-esteem.
Upon reflection, I feel that the way in which the multidisciplinary team was involved and the effective utilization of all skills and input available was integral to the attainment of the objective of care which is a positive outcome (Webster, 2002). It is however noteworthy that sometimes, as was in this case, input from some members of the team is often overlooked due to a number of varied factors among which is seniority, communication, as well as an appreciation and understanding of their roles. (Hornby and Atkins, 2000).
The Mental Health Act (1983) later amended in 2007 (Royal College of Psychiatrists, 2009) empowers psychiatrists to make decisions regarding the mental ill. This was the basis for the decision to exclude Lucy and her family citing her potential distress (Vostanis, P., 2007). With this realization, it would have been an unnecessary hindrance to clamour for the involvement of the patient and her family against the advice of the professionals. The patient’s distress, as envisaged, would have affected the outcome of her treatment and care (Malkinson and Ellis, 2000).
With the need in Lucy’s case for a multidisciplinary approach to get her a favourable therapeutic outcome, I noted that it was essential to understand and appreciate the different roles of professionals particularly in healthcare (Department of Health, 2007b), effective teamwork to deliver the essential aspects of healthcare across the boundaries of varied roles (Department of Health, 2007a; Hornby and Atkins, 2000).
With the entire team agreed upon the decision not to involve relatives in the best interests of the patient and the required positive outcome, the team was able to run through the patient’s care plan as envisaged, effectively and with notable efficiency. The patient’s condition was successfully resolved and, in time, she realized marked improvement, mobility and was able to engage socially with others.
It was integral that each member of the inter-professional team through efficient and effective collaboration contributed to the high quality care and outcome. For this collaborative effort, communication was paramount.
Through this reflection, I was able to identify and establish factors that could be significant in improving my future career. Healthcare is inherently multidisciplinary and requires collaborative effort of diverse professionals (Barret, 2005; Webster, 2002). It is important to understand and appreciate the different roles played by various professionals.
Through this placement, I gained an understanding of the import of effective collaborative efforts of diverse professionals in healthcare that enable the realization of positive outcomes for patients. Enhanced placement opportunities covering such multidisciplinary tasks, and the inclusion of inter-professional collaboration scenarios during training is essential to acquire such an appreciation.
I also realized the essential place of nursing practice, playing an integral and pivotal role in ensuring holistic care by the entire team and enabling the success of the collaborative process.
There should also be an elaboration of ethics and studies into appropriate instances for the exclusion of mental patients and their families from such programmes as CPA in the opinion of a psychiatrist. This would enable better understanding and consensus in scenarios such as in this particular case.
Barker, P., 2009. Psychiatric and Mental Health Nursing: The Craft of Caring. 2nd London: Oxford University Press
Barret, P., 2005. Collaborative Practice. London: Oxford University
Boud, D., Keogh, R., Walker, D., 1985, Reflection: Turning Experience into Learning, Kogan-Page, London
Department of Health, 2004. The Ten Essential Shared Capabilities: A Framework for the whole of the Mental Health Workforce. London:DoH
Department of Health, 2007a. Learning for collaboration practice. London
Department of Health, 2007b. Best Practice in Managing Risk. London: HMSO
Gibbs, R., 1988. Learning by changing: A guide to teaching and learning methods: Oxford Further Education Unit: Oxford Brook University.
Hornby, S., and Atkins, J., 2000. A relational approach to collaboration. eds. Collaborative Care: Inter-professional, Interagency and Interpersonal. London: Blackwell
Hudson, B., 2002. “Inter-professionalism in health and social care: The Achilles’ Heel of Partnership.” In: Journal of Inter-professional care. 16(1), 7-17
Jack, K., and A., Smith, 2007. Promoting self-awareness in nursing to improve nursing practice. Nursing Standard, 21, 32, 47-52
Jasper, M., 2003. Beginning Reflective Practice: Foundation in Nursing and Health Care. London: Nelson Thornes
John, C., 2000. Becoming a Practitioner. A reflective and holistic approach to clinical nursing: Practice development and clinical supervision
Malkinson, R., and A., Ellis, 2000. The Application of Rational-Emotive Behaviour Therapy (REB) in traumatic and non-traumatic loss.
Moon, J. A., 2004. Handbook of Reflective and Experiential Learning: Theory and Practice, Taylor & Francis.
Nursing and Midwifery Council (NMC), 2008. The Code of Professional Conduct: Standard for conduct, performance and ethical protecting the public through professional standard. London: NMC
Roper, N., W., Logan and A., Tierney, 2000. The Roper-Logan-Tierney Model of Nursing Based on Activities of Living. Edinburg: Churchill Livingstone
Royal College of Psychiatrists, 2009. Role of Consultant Psychiatrist in Psychotherapy. London: RCP
Webster, J., 2002. Team working: Understanding multi-professional working. Nursing Older People. 14(3):14-9
Worden, W., 1993. Grief Counselling and Grief Therapy: A handbook for the Mental Health Practitioner. 2nd ed. Routledge: London
Vostanis, P., 2007. “Mental health and mental disorder.” In Coleman, J., and A., Hagell, eds. Adolescence, risk and resilience. Against the odds. Chichester: John Wiley and sons