Interprofessional Collaboration in Practice (IP2) Conference
What have you learnt from working with in your team and throughout this module?
This teamwork was an intense exercise in learning the practical dynamics of working with people from different medical disciplines and backgrounds for me. As a novice student nurse with otherwise little experience of a platform where I could clearly witness such interactions, I had always wondered if such collaboration could have its good, bad and ugly aspects. Certainly the first thing I observed during the conference was that it took people quite a while to “break the ice” before they decided to warm up to the idea of working with strangers from different cultural and professional backgrounds. Despite the vast amounts of literature we had gone through on our course module syllabus (see for example the works of Lindsey and Connelly (2002)) expounding the virtues of interprofessional collaboration as a learning experience, I felt that this experience was much more transparent in unveiling the actual realities of medical practice. I noticed that first and foremost, professional egos, the need for honesty and other human emotions like envy and bias needed to be addressed more fully during such collaborations (Davies, 2000). There seemed a visible tension between the two main broad categories into which the medical profession is often divided: doctors and nurses. As a nurse, I witnessed my own peers unhappy with the tendency for the ‘doctors’ (inclusive of physicians and surgeons) coming in late due to an alleged superiority complex. I, however, did not feel that such an approach or attitude was healthy at all or even conducive to team success.
I also felt that, since we were so keen during on providing lip service to meet the needs of the patient in terms of holistic care, there seemed to be a gap in understanding the simple factum that such care was impossible without forging an undeniably solid partnership between the health and social care sector (Davies, 2000). It was possible to see, however, that the traditionally dominant role of doctors over other health professionals such as nurses had not just been evened out on paper (DOH, 2001) and a new co-operative attitude was emerging in the profession. This was evident from the nurses being aware of their more involved alleviated role and the fact that successful health delivery could no longer be delivered in isolation from interprofessional cooperation in integrated health environments (Horrocks et al, 2002).
One of the most valuable conclusions that I was able to reach during my experience at the conference was the stereotyping of the image of the patient, the nurse and the doctor. Examining the “person-centred” approach entailed, as we brainstormed during our sessions revealed that it would be wrong to perceive the patient as a sick helpless person at the mercy of the health staff. Due to the increasingly end-user and consumerist nature of public health service delivery, it would be fair to assume that the patient was a like a customer/consumer/service-user of such resources and certainly deserved an equal standing and a knowledge of his or her rights (Alcolado, 2000).
The other issue that was widely discussed, (and it was something that meant a lot to me as a student nurse), was the age-old rift between the attitudes of the doctors and nurses. Some of the valuable conclusions from this discussion were the observation that the problem often lay at the root of doctor / nurse training and education. Some of the participants from the nursing profession were of the opinion that, due to the increased standards in the training of nurses and the increasingly shared nature of the responsibility by health workers (Darzi, 2008) it would be more conducive to have a generic health professional which would basically merge the gender and status based biases into a more functional role combining both professions (Kinnersley et al, 2000). For many academics and policy makers, this merger is inevitable in the coming few years and the emerging health policy reveals the same in connection with the continued reorganization of health delivery (Darzi, 2008). It was suggested that much can be gained by shared training between doctors and nurses; this would be the first step towards preserving the traditional divide between both health care roles as separate professions (Zwarstein and Reeves, 2000). Applying this observation to my own personal experiences during my two placements at surgical wards, I felt that if such positive attitudes are reinforced during the early years of doctor/ nurse training and such biases are controlled there and then, it could actually prevent negative inter-professional attitudes in the future (Wanless, 2002). In the past, there have been controlled studies to actually assess and recommend a similar merging of training between medical, nursing and midwifery students (Kinnersley et al, 2000)).
Another aspect which was thought provoking for me as we went through the daily discussions was the apparent failure to communicate and co-operate between health and professional workers during situations where it is not just the physical ailments plaguing the patient but also his mental health and social circumstances (Alcolado, 2000). One of the participants actually brought up the case history of a severely ill old man from India who had remarried without the knowledge of his first wife and the doctors without the knowledge of his history and culture ended up informing both wives at once of his sudden illness. Later, the man’s death occurred after severe stress emanating from the clashes between both women, and it was felt that if the social worker responsible for his health and welfare had been informed beforehand and consulted, in order to understand the cultural sensitivity at stake here, this tragic death might have been avoided altogether.
It was interesting to note how the videos involving the subjective feelings of patients and social workers were so thought provoking: the common theme quite often was the negative impact of power struggles between all those concerned in modern multidisciplinary NHS organizational settings. It was possible to see that while academics were keen on singing the praises of interprofessional collaboration and its virtues, the paradigm of an intense failure to communicate has never been practically addressed at its root. According to Nyatanga B. (2002:1) it is possible the virtues can become a convenient and ‘professional myth supported by rhetorical statements.’ rather than having any truth attached to them.
However, it is not just the attitudes within interprofessional learning groups in practice but also the poor quality of finances, internal politics and accountability issues which stem from the lack of understanding that the modern UK health sector actually runs on managerialist and professional paradigms (Lindsay and Connelly, 2002). The way ahead for better interprofessional learning, as I observed from the novice eyes of a student nurse, was that instead of conflict-ridden phenomena, interprofessional collaboration could actually be viewed as a melting pot bringing together a variety of skills and experiences to deliver the highest standard of health services instead of the obvious temptation of succumbing to a form of negative professional “ethnocentrism”. According to Nyatanga (2002). such professional “ethnocentrism” is the “belief that one’s own professional group is superior and better than all the others” (Nyatanga (2002:1) and can actually downgrade the effectiveness and quality of health services in the public sector.
Finally, just as I was able to form some firm friendships in my IPL group during the conference, and learn and experience new things, I do believe that in practical life doctors, nurses, social and health workers can forge closer bonds for better health care service delivery for the patient whose betterment should be the sole focus of this entire exercise. It has been observed by the National Institute for Clinical Excellence (Nice, 1999) that no one group of professionals can hold all the knowledge and skills to be able to treat a patient on their own due to the fast changing medical world. This mandates the need, more than ever, for better interprofessional co-operation.
Discuss how you would take what you have learnt about IP working into practice.
As a current student nurse, I feel that I still have a significant journey to undertake between theory and practice. The conference which I attended was an eye-opening experience for me and it was a pleasure to mingle, debate with and have discussions with senior participants. In my future and upcoming practice, I intend to forge a much more friendly and understanding atmosphere with my physician colleagues and social co-workers. This is necessary as I have learnt to ensure the overall health and wealth of the end-user of the health care which is the ordinary patient who comes into the public health faculty with a lot of hope and confidence in the care he might receive there (McKenzie, 2002).
It is necessary for an IP collaboration to exchange, share and use information regarding a patient and ensure that if there are any major issues of confidentiality they are addressed at the earliest to avoid any future problems in terms of the patients’ private life. This concern is supported by the aspect of confidentiality as embodied within the Nursing and Midwifery Council Code (NMC, 2008) which actually lays down a strict duty of confidentiality on nurses and connected health professionals to protect confidential information of a patient and to respect a patient’s right to privacy and confidentiality (The NMC Code, 2008). I feel that better communication between health professionals will allow a better assessment of whether certain information and how much of it is to be shared between the team and the families of the patients. The code states that the criteria are that disclosure should be avoided unless the patient is at a grave risk of harm otherwise (para 5.3 The NMC Code, 2008). The role of the member of an interprofessional collaboration is indeed based on his or her ability to manage, share and communicate concerns for the patient’s mental and social welfare so a patient can be given the security and care he deserves.
Furthermore, the NMC Code of Conduct (2008, para 5.1) also requires all nurses and student nurses to “treat information about patients and clients as confidential, and use it only for the purposes for which it was given” (NMC, para 5.1), and that a nursing professional, “must guard against breaches of confidentiality by protecting information from improper disclosure at all times” (NMC, Para, 5.1). When these promising guidelines are applied to real life problems during our placements and later on in life during medical practice, it is possible to see that the typical patient is likely to hail from all walks of life and can potentially be a drug addict, sex offender or a person with suicidal tendencies. Such a possibility then brings about the concern for better communication and information sharing with the social worker assigned to the case of that person who would know the cultural and personal history of that person. For example, many people come to health facilities with the sole purpose of posing illness and getting a prescription for controlled drugs, which have a tranquilizing effect similar to recreational drugs. Similarly, a doctor prescribing Prozac to a mentally disturbed woman should be able to understand what her history at home is and report the case to a social worker if he suspects abuse, domestic violence or suicidal tendencies (Esterhuizen, 2006).
It is possible to note that The United Kingdom is a multicultural society of many cultures and religions, especially in its cities. This mandates sensitivity to a patient’s ethnicity and religion to maintain the quality and integrity of the medical profession. A nurse working in an interprofessional or multi agency setting might be faced with a number of dilemmas in practical situations, particularly where urgent and emergency care means that decisions have to be taken quickly and fairly after getting a swift and honest opinion of the professionals involved. For example, it might be necessary to induce an abortion for a woman who has been admitted with a serious risk to life and saving the baby would mean endangering her life. In such a situation it is necessary to know the marital status and the economic and cultural circumstances of such a woman. This reminds me of the time during my placement when an Arab man whose wife was pregnant with a son and her life was in danger, kept on insisting that the baby be saved as he already had 6 daughters and having a son was very important in his culture. It was only after he was threatened with serious action against him by the government authorities during his abusive and threatening behaviour to the doctors and nurses that it was possible to save the woman’s life. The nurses were only informed much later about the abusive nature of this man and that his wife had registered with a social worker many months ago to keep a check on domestic violence issues. Had such information been provided to the health professionals by the social services before, perhaps much better care could have been provided to the patient.
In other instances there are more complications involved, especially in rape and violent crime or murder cases where the police agencies might want to undertake some urgent queries from a patient (Kirkland, 2008). This is where there is a clear provision in the NMC to encourage nurses to turn towards the entire interprofessional team for advice and to frequently consult with their senior colleagues, or any other UK medical governing body, to make better decisions while balancing the interests of justice and patient welfare (The NMC Guidelines, 2008).
Finally, what I would like to carry ahead from my experience towards my future medical practice is the effort to make an individual effort at the grass roots level and to follow clear protocols of the organisation (Kirkland, 2008). The IPL teams must be clear at the outset about the people who can be allowed to access a patient’s personal history and supplemental records, and in what circumstances (Fulbrook, 2007). A member of an IPL team has to realise his or her duty of co-operating with other colleagues even with in off-duty hours and the duty of ensuring the dignity and integrity of a patient.
The medical professional is made privy to a lot of confidential information during the treatment of patients. Such details should be protected even from spouses who may be fellow medical professionals and cannot be treated as gossip (Esterhuizen, 2006). The most disturbing aspect of my experience as a student nurse has often been the politics and arm-twisting that often goes on within an IPL team and the failure of the team leaders to prevent this. It pains me to see a patient’s previous history discussed between the medical staff with no regard for the patient’s integrity and self-respect.
For McKenzie (2002), the concept of confidentiality within medical care, “as applied to information obtained by health professionals has ethical, legal and clinical dimensions…. (Has) three basic ethical principles relating to confidentiality: autonomy, duty of care and non-maleficience” (2002:1). Basing my future practice on these principles, I will try my best to follow an ethical discourse during the decisions I take on my own and also as a member of an IPL team.
To achieve the practical application of such values, I intend to motivate my IPL team to be friendly, co-operative and professional by acting in a similar fashion myself. Since I strongly support freedom of women and freedom of people to choose their sexual orientation, I intend to take better care to protect women from conservative cultures from unfair disclosure of their sexual or abortion related history. It is also necessary to stop any bias against people who have a history of opting for sex change operations unless such information is necessary to ensure the health of the patient or justice for some victim in the future.
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