Discharge coordinators are the allocated bodies that now communicate with the patients and families to gain a broader view of the patient’s requirements, during and after discharge. Their aim is to work closely with nurses and patients on a day to day basis; this allows the coordinator to keep a track of their patient's length of stay and their condition. This information is then used as a vehicle for coordinating and controlling the work of other health professionals including: social services and physicians. They communicate information to these professions who undertake the discharge of the patient in a timely manner. (Geist and Hardesty 1992)
Whilst on placement I had the opportunity to spend a day with the discharge coordinator. It became apparent from this day just how person-centred her role was. Throughout, it became evident that the patient was at the forefront of all the discussions regarding their discharge, including their coping situations at home. After gaining the information it was discussed with other healthcare professionals, thus gaining a holistic view of the patient’s competencies and needs. Holland et al (2007) recommend that a patients plan for discharge should begin when the patient is first admitted to the ward and based around the Roper Logan and Tierney’s activities of living to provide a person-centred discharge plan and facilitate safe and effective discharge outcomes. It is imperative that the discharge coordinator has good communication and organisational skills, which builds a trusting relationship with the patient and has an understanding of other health professionals and services in order to benefit the patient. Introduction of the discharge coordinator has allowed the care team more time to tend to the patients medical and emotional needs that are essential in assisting their recovery progress.
The discharge coordinators role informed me, meeting elderly patients that in the past would not have had the opportunity of returning back to their homes, now were being involved with making decisions about their future. It became apparent to me the challenges the co-ordinator experienced, at times there must have been frustration when some elderly patients refused help offered to them. This resulted in further organisation, additional assessment of the patients need (could they let this patient return home without help), negotiating and possible delay in their discharge.
The practicality of one person communicating with other professionals is definitely a benefit to the health service and patients. It has provided the discharge process with a structure that is being organised professionally and timely, allowing patients to return home earlier, consequently reducing the NHS cost, minimising the risk of hospital acquired infections, promoting independence and enabling patients to return back to their families, thus reducing patient anxiety.
Recently I was given the opportunity to attend a Multidisciplinary Team (MDT) meeting on a neurological ward. The team consisted of a consultant, doctor, physiotherapist, occupational therapist, speech and language therapist, psychiatrist, two nurses from the ward and me. The meeting was lead by the patients named nurse who gave a brief overview of the patient and how they thought they were progressing or deteriorating, this included evidence from the family members. The other specialists gave recommendations of how they felt the patient was improving and the interventions that they propose to put in place. The whole collaborative experience was enlightening and portrayed excellent communication skills; everyone involved was satisfied with the positive results from the meeting. The experience has facilitated my understanding, knowledge and awareness of what each service could contribute within a discussion and what levels of care they can give as a team or individually. On reflection this has been an excellent learning experience that has not only benefited my studies but also my future as a qualified nurse. Rattay and Mehanna (2008) recommend that as students we should make an effort to attend MDT meetings. Having different professionals, for example, radiologists or pathologists explain their radiographs, scans, or slides may help us understand patient conditions. They also comment that at the same time, ethical dilemmas and psychosocial drawbacks of various treatments for a patient may be discussed, which are not usually mentioned in textbooks. Furthermore if we know the patient, our input as a medical student will certainly be welcomed. As the opportunity was offered to me within my second year I could see the benefits of the MDT meeting and the goals. This direction obviously improved the care of the patient as it took a holistic approach to the patients needs.
West (1994) state that the key to multidisciplinary care is collaboration, the unity of health and social care professionals developing a collective understanding, this requires effective coordination, a flattened hierarchy and transformation of leadership trial. For successful outcomes the members should feel that they are an important asset to the group, their contributions are identified and all participants should be in unison with the goals they want to achieve.
Halm et al (2003) talks about a trial that took place at a London hospital, which introduced a multidisciplinary approach to ward rounds. The team consisted of no more than ten members; this ensured that the patient’s privacy and dignity was respected. The study was such a success that the surgical wards within the hospital adopted the system. The system has seen many benefits; an increase in patient involvement, a development of nurses and greater job satisfaction also an improvement in MDT relationships. Scott et al (2003) states that all these have improved ward culture and created a happier working environment. Moreover that staff retention and absences have improved too.
Since the publication of the White Paper ‘Caring for People’ (1989), the benefits of collaboration between primary health and social services has been emphasised. It stressed the importance of partnership and proposed that local representatives should be involved in both primary care groups and health authority meetings (Glendinning, Rummery and Clarke 1998). However, this did have problems and these were identified by Dale et al (2001) as matters of hierarchy, leadership, and professional boundaries.
When communications fails between a multidisciplinary team there can be serious consequences that can result in death of the patient. This is evident from the Victoria Climbie investigation and case, which identified a lack of leadership and poor communication. Sonia Chambers (2003) stated that the public inquiry uncovered many failings in the British child protection services. It questioned who was too blame within the case as social workers blamed doctors, nurses blamed management, management blamed the government and it kept going around in spirals and nobody accepted the blame in this tragedy.
To conquer these problems the Government introduced common learning goals in their education program, this was aimed at all health professionals. Their main target was pre-registered students and their aim was to integrate interprofessional training into their curriculum, enabling students to develop transferable skills that will facilitate communication and collaboration (DOH 2001). This is already in practice throughout the universities and many students are benefiting from studying along side other professions within modules such as interprofessional learning and collaboration in professional Practice.
Within the first year of my studies, two weeks were dedicated to Interprofessional learning, which gave me an insight into their roles and responsibilities. At present my collaboration group consists of social workers, child nurses, learning disability nurses and occupational therapists. As a team we communicated well, enhancing our collaborative working. I found last years interprofessional learning module beneficial and the team I was placed with interacted well both face to face and through the online discussions. I had an understanding of the different professionals within the National Health Service but never realised how closely they worked together. Whilst on placement the practicality of bringing us together on this module dawned on me when I was introduced to other professionals on the wards and given opportunities to work with them, this enabled me to see how the interprofessional collaboration provided a positive outcome for the patients.
I was very optimistic that this year’s group would be the same as last years, and so far I have not been disappointed. The communication between this years group has had more meaning to me, thus making the discussions more valuable and more understandable to my learning experiences.
Throughout the week we worked in our selected groups as a multidisciplinary team, this gave us an insight into how each of us looked at the care of a patient within our individual roles, and what different stages of care we could provide. I believe that I have progressed since the first year but feel that there is still plenty of knowledge and experiences to be gained in order for me to develop further. As second year students I still feel that we are finding our feet, discovering where we belong within our profession and what we can offer within a multidisciplinary team. This I have documented within my action plan (Appendix 1) which states that I need to develop an awareness of the roles and services provided in the interprofessional team. I feel that this is one of my main weaknesses which I am hoping will become my strength as I progress through my final years of training.
The action plan was designed for the first part of the collaboration in professional Practice module as a formative assessment. By utilising The Combined Universities Interprofessional Learning Unit’s ‘capability framework’ (CUILU 2004) and conducting a self assessment of my own capability as a collaborative worker, it enabled me to produce an action plan that acknowledged my learning needs and emphasised where I need to develop myself to become the professional that I am striving to be.
I feel that reflection has been a big weakness for me, both through my studies and practice. This too I have documented within the action plan. Reflecting is something that health professionals and students should do whenever they participate in patient care. Johns (2003) states that reflection is the window through which the professional can view and focus self within the context of their own lived experiences in ways that enable them to confront, understand and work towards resolving the contradictions within their practice between what is desirable and actual practice. I know that I have reflected and often asked myself questions of why we do certain things, how they made me feel and what I would do differently next time. Yet, I have not asked the professionals themselves or researched the answers. Therefore, if a situation ever arose which previously made me feel uncomfortable or incompetent because I had not understood, I would probably feel very anxious and this would affect my professional performance.
Other learning needs were identified within the action plan these were; two different stages of knowledge in practice and ethical practice. I feel that all of the learning needs identified are valuable to my professional training. The action plan also allowed me to see that I have strengths, and not just weaknesses. Within my previous profession I was a support worker for people who had profound and multiple learning disabilities, this has aided the development of my communication skills in many different forms: verbal, non-verbal, body language, sign, facial expression and active listening skills. These skills I have utilised on placement to communicate with patients and other health professionals and feel that they have benefited me in relation to gaining their trust and friendship.
Another part of our collaboration in professional practice module was to discuss, within our groups scenarios that were presented to us on line. The first scenario (Appendix 2) related to a prisoner and anti-oppressive practice. I found that through my first placement I had gained some of knowledge on the protocol that surrounded the admission of a prisoner to a hospital. The discussion was a big success and enabled me to become aware of how other professional felt about the situation and the intervention they would put in place to deal with it.
In conclusion, this assignment has highlighted the importance of health professionals to work in multidisciplinary teams. Moreover, the need for them to continuously develop with the ever changing requirements and training to provide a service that is person-centred. The Department of Health have implemented plans that will assist with the development of the multidisciplinary teams and standards that will overcome the problems that were highlighted. As indicated within this assignment, communication plays a vital role in relation to inter-professional collaboration.
The utilisation of the capability framework grid has helped me to reflect on my practice and become aware of my learning needs and the areas that I need to develop in. This has facilitated my understanding and given me goals that I feel will be achievable with study and determination.
References
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Appendix 1 Action Plan
Appendix 2 Online Discussion
The Prisoner and anti-oppressive practice.
