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interprofessional working, self appraisal

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Interprofessional module 2 Self Appraisal Assignment

GROUP NUMBER: 14

Group Goal

What barriers prevent effective development of an IP team and how to overcome them?

Learning outcomes

Transferable skills - promote and establish effective communication and working in teams to achieve inter-professional collaboration.

Work constructively and productively as a member of a group to agree and understand group goals.

Statements

  1. Trust is an essential attribute of collaboration
  2. Effective time management
  3. Unified form of communication between professionals
  4. Cultural differences
  5. Stereotyping
  6. Good understanding of other professionals roles
  7. Regular MDT meetings
  8. Co - operation
  9. Cohesion and positive attitude within the team
  10. Respect
  11. Holistic approach to meet the patients individual needs
  12. Personalities
  13. Communication verbal and non verbal
  14. Hierarchy

In order to do my assignment I visited IPE level 2 on UWE on line every workday from the day after the Interprofessional Conference on the 5th of October, the reason to do this was to find information on how to do the self-assignment and to check new announcements, to check course materials, where many of the conference’s speakers put their presentation which make it easier to work, to check the facilitator announcements, and to check my table team communication. We have in total 89 messages but I think only very few of them were really useful. I only contributed five times on my table discussion board. After the conference, we tried to meet on line but that was impossible as we have different schedules. Then some of the group’s members wanted to change the statements that we already had agreed and decided at the conference. I felt that some members of the group just wanted to do the essay their way, making statements of what they were going to do instead of sharing information. They were not accepting others views, this put people away, and that is why I did not feel welcome in the group, not by everyone, I didn’t feel that my arguments were listened to by some of the group members.

 Within my group, we were nine very different people, although it was easy to agree in everything when we were together, it was almost impossible to do anything together via online. I think it is very difficult to maintain good relationships within a team when we can not see each other and regularly meet to discuss new ideas (Molyneux, 2001). I think communication is crucial in IP education as well as IP working, I realise that without effective communication the relationships within the team deteriorate, and effective communication means to understand each others strengths, skills and limitations and respect each other.

List of documents shared in the group:

www.studentbmj.com

www.campus.manchester.ac.uk

http://careerfocus.bmj.com/cgi/content/full/329/7465/99

http://www.bmj.com/cgi/content/full/310/6983/882

www.blacwell.com

http://www.in-bc.ca/docs/critical_review_of_evaluations_of_interprof_education.jet_review.pdf

http://www.nmc-uk.org.uk/aArticle.aspx?Article

http://www.bmj.com/cgi/content/full/316/7133/771

Nursing Standard (2003) “Counting in co-operation”.

Word count 456

2. The conference gave me the opportunity to work closely with eight other students of different professions; radiographer, physiotherapist, children’s nursing, mental health nursing, adult nursing and medical students. Before this conference I only had limited knowledge of some of these professions, after two days working together I have a better understanding of their roles. This would help for the commitment of professionals to effectively work together in the future and respect different points of view(Barrett et al, 2005).

I was very interested to know about how medical students have structured interprofessional collaboration in their course, although it only contains a very small IP module in comparison with nursing students. It was a good opportunity to work with different professions, the conference changed my perceptions of some professions, especially doctors, who I have always perceived unapproachable, working with them made me realise that everyone is equal no matter what skill or experience.

We had a clear team goal and we all contributed to set up our statements and learning outcomes, the team approved open communication, with enquiry based learning, each member of the team could choose which seminar to attend and feed back to the team (Cook, 2001). Although not all team members participated fully in relaying of information, with more time, better definitions of roles and expectations would have achieved increased IP collaboration (Molyneux, 2001).

 One of the statements I am going to discuss is:

5. Stereotyping.

 I realised that this is a big barrier for interprofessional working; we must avoid stereotyping each profession, although the differences of approaching the patient are important (Drinka et al, 2000). We, as professionals, prioritise differently and our values bases are different (Foreman, 2007). Stereotyping is a natural human process and can have both, positive and negative outcomes, positive outcomes is when health care professionals interact having accurate views of each other and making easier the interaction in an interprofessional group. Negative outcomes happen when the professionals are expecting certain attitudes and/or behaviour from each other (Hean et al, 2006). It has been advised that putting students of different professions together during interprofessional education will battle the establishment of negative stereotypes that might show later in practice (Leaviss, 2000). Interprofessional education happens when two or more professions learn from, and about, each other to improve the quality of care (CAIPE, 1997). One of the advantages of this joint education is that it will minimise stereotypical thinking in between professions (Nursing Standard, 2006), but stereotypes can still occur in between professionals. In a major survey carried out by Nursing Standard and Community Care on more than a thousand social workers and more than six hundreds nurses, the results weren’t good in terms of fighting stereotypes. Of the seventy two per cent of social workers who agreed with the statement that nurses do what doctors tell them, all of them have had joint training, the same happened for the sixty six per cent of nurses who agreed that social workers place too much emphasis in political correctness, they all have had joint training (Nursing Standard, 2003). This is why interprofessional education is playing a crucial role for a good IP working.IP working is no longer optional, it is mandatory (DoH, 2004) and it is clear that for successful collaborative working professionals need to be educated.

In my table group, we discussed, via online, some of our experiences when we were on placement, I realised that there is still a lot of stereotyping, mainly due to a lack of knowledge and values of other professions (Stapleton, 1998).

  Another of the statements named above that I want to discuss is: 9.Cohesion and positive attitude within the team.

Since 1997 the government has started new policies to put the patient in the centre of care (DoH, 1998). Patients have the right to make decisions about their own health, this is important to me as patients will have higher expectations of the health system and more sophisticated holistic approach to health care is necessary (Foreman, 2007). I am aware of the importance of patient-centred IP collaboration, especially with the demographic change in the UK (Leathard, 2006). In order to improve this holistic approach to the patient, interprofesssional teams need to work effectively. Having a balance within the group, having mutual respect and knowing each other’s qualities will lead to a positive working relationship (Molyneux, 2001). It is essential that health and social care professionals realise the important of IP working as it has now been recognised that a single profession can no longer deliver the complex patient care that is demanded nowadays, a holistic approach is required (CAIPE, 2007), but this can also bring conflicts or mistakes between professionals, Abbott et al (2005) advise that roles can also be blurred if expectations aren’t clearly defined, personal qualities of the individual need to be considered for competent collaboration (Barrett et al 2005).  Attitudes within the team are a barrier to IP working; Stapleton (1998) stated that traditionally hierarchies place more power to the medical profession, the traditional independence of the medical practice is an extra barrier to establish collaborative working: collaboration can only occur when all parties recognise its values and a positive attitude come within the team. Robinson et al (2005) also says that status can caused distress within the team; it may feel for some members that they are not being listened to or that their opinions are not as important as other colleagues. In a study carried out with nineteen nurses in acute health care ward, it is spotted that in multidisciplinary meetings not all the professionals involved in the care of a patient are invited and that nurses did not regularly attend the meetings. Another conclusion of this study is that nurses not always express their opinion for fear of being made scapegoat, the result from the research show as well, that consultants and medical staff usually speak first and with more confidence on all issues (Atwal et al, 2006). This reveals that roles and responsibilities of all team members need to be clearly defined and understood to work effectively, this will help the team to cope constructively with professional conflicts. Larkin et al (2005) recognise that some conflict in role definition exists, may be due to a lack of understanding of other professions.  Communication within the team is also an important issue to a good collaborative working, developing ways to communicate and to work together is the key for successful IP working (Abbott et al, 2005).

Word count 1083

3.  This essay will explore the significance of IP education and how this will lead to successful IP working. It will focus on personal IP education and from personal practical experience in placements and reflect on how to improve IP collaboration in the future. Finally I will identify a barrier to IP working and what changes could be made to make IP working more effective.

Since 2004 it has been a requirement that pre-registration health and social care students in England must receive IP education opportunities. The main objective for this is to guarantee students:

“…learn with, from and about each other…to aid collaboration in practice” (CAIPE, 1997).

Interprofessional education helps to improve each profession its own practice as well as to understand other professions. It helps to enhance IP collaboration so it will help to increase the quality of care and increase professional satisfaction (Barr et al, 2005).

Changes have been made in the whole structure of the NHS in order to facilitate IP collaboration. The introduction of the National Service Framework (NSF) e.g. NSF for older people recommends a single assessment care package can be put together for the service user across primary, community and hospital settings (DoH, 2001).

Effective communication is essential for IP collaboration. The NMC (2004) advises that at the point of registration students should have the necessary skills to communicate effectively with colleagues and other departments to improve patient care. Cook et al (2004) identify that communication and decision making are very important for teams. Larkin et al (2005) argue that teams who do not regularly hold meetings for policy making and resolutions of differences, should not be considered a team, these findings are also emphasized by Molyneux (2001) who states that communication is supported with weekly case meetings in order to evaluate and plan patient centred care delivery. In the past while on placement I have seen some negative working relationships and professional tribalism (Cook et al, 2001) with certain professions who rarely attend IP meetings and other professions which do not go to multi-disciplinary meeting and just meet with the patient and relatives and after one meeting with the patient and relatives could make a decision without talking with anyone else of the team, this can lead to a delay in patient care and patient discharge. Lack of co-operation between agencies has led to a failure of service, e.g. mental health services (Glasby et al, 2004). In practice in the future I believe it to be important that every member of the team works towards patient centred care with the same objectives (DoH, 2001). On placement I will try to communicate any changes to relevant members of the IP team to avoid delay. I aspire to make myself better know to all members of team, this will build relationships and trust within the team (Molyneux, 2001).

Role clarity is also important to give individuals identity, as they may feel lost sometimes during IP working, especially with loss of responsibility (Barret et al, 2005). In practice in the future, it would be useful to find out about the roles of every person in the team and have a better understanding of the responsibilities of the individual and the team to avoid blurring of the professions within the team.

Record keeping is essential for effective IP working; Molyneux (2001) found that integrated documentation systems were favourable to IP working. They avoid duplication, help communication and allowed each team member to view and check the patient notes at all times. On my last placement, there seemed to be a lack of continuity in record keeping which leads to big misunderstandings, conflicts and problems, e.g. there was a book for all the members of the team to write if they have appointments with patients. If the physiotherapist wanted to go to the gym in the morning with the patient or if the occupational therapist wanted to do a kitchen assessment with the patient, that should be in the book. What happened was that not everyone knew about the book, or some other team members prefer to write in the medical notes, nurse’s notes or call to the ward in the morning before nurse’s handover for them to get the patient ready for them. Sometimes the OT and the Physiotherapists arrived at the ward at the same time looking for the same patient, some other times the patient was in the gym with the physiotherapist and the psychiatrist arrived looking for the patient. These situations were difficult for everyone even for the patient because sometimes he/she have to stop doing something and start doing something else without a break or telling him/her what was going on. I felt really distressed and disappointed when this happened, this wasn’t a good working environment, all the team felt anxious; some member’s main aim was to look for responsible people for the situation, for me it was more important why this happened, why we didn’t check the book, the medical motes and the phone messages. I learned that it is more important to make sure of what you have to do when you get on duty than rush to get jobs done without thinking about the rest of the team. In the future I will make sure all members of the team and the rest of the staff know the system that it is being used for keeping records. I will ensure that all team members have agreed how, when, where and what things are going to be done (Gibbs, 1988).

A possible barrier for IP working is professional tribalism (Hewison, 2004), this is mentioned as well by Molyneux (2001). IP collaboration is viewed by some professionals as a threat to their personal identity. Abbot et al (2005) argue that even though the development of roles and increased flexibility is usually a benefit to many professions, other professions see this as a threat for their own interest and power status. Molyneux (2001) and Abbot et al (2005) explained that the professions which feel more threatened and are more resistant to IP collaborations are the ones at the top of the hierarchy. Open discussion will help develop the team and recognise the benefits and the diversity that the professionals bring to an IP team (Freeth, 2001).

To conclude, there are obvious advantages to IP working. IP collaboration not only improves coordination structurally, but also develops commitment and helps to overcome professionals’ barriers (Robinson et al, 2005). I believe that from my learning I have enough knowledge to realise the necessity for IP education and the benefits of IP working. I feel confident to put in practice my knowledge, and develop my skills while in placement. I have learned the skills required for effective communication and will transfer this into practice. I realise the importance of patient centred care delivery and appreciate the importance of the patient at the focus of care. Therefore it is essential to provide a single seamless service for all users.

Word count 1162

References

Abbot D., Townsley R. and Watson D. (2005) Multi-agency working in services for disable children: what impact does it have on professionals? Health and Social Care in the Community. Vol 13(2) p155-163

Atwal A. and Caldwel K. (2006) Nurses’ perceptions of multidisciplinary team work in acute health-care. International Journal of Nursing Practice. Vol 10(12) p359-365

Barr H., Koppel I., Reeves S., HAmmick M. and Freeth D. (2005) Effective Interprofessional Education. Argument, Assumption and Evidence. Blackwell. Ch3 pp29-40

Barret G., Sellman D. and Thomas J. (2005) Interprofessional Working in Health and Social Care: Professional Perspectives. Palgrave Macmillian. Ch 1, 2 and 15 pp7-17, 18-31 and 187-197

CAIPE (1997) Centre for Advancement in Interprofessional Education.Interprofessional Education-a Definition (online) London. CAIPE. Available from: http://www.caipe.org.uk/ (Accessed 24 October 2007)

Cook G., Gerrish K. and Clarke C. (2001) Decision-Making in Teams: issues arising from two UK evaluations. Journal of Interprofessional Care. Vol 15(2) p141-151

Department of Health (1998) The Health Nation-a policy assessed.London. Department of Health. Executive Summary. Available from:

http://www.dh.gov.uk/en/Publicationsandstatistics/PublicationsPolicy AndGuidance/DH_4121577  (Accessed 24 October 2007)

 Department of Health (2001) National Service Framework for Older People. Executive Summary. (online). London. Department of Health. Available from:

http://www.dh.gov.uk/en/PublicationsandStatististics/PolicyAndGuidance/HealthandSocialCaretopics/olderpeopleservices/DH_4073597 (Accessed 31 October 2007)

Department of Health (2004) Changing Times: Improving services for older people. Report on the work of Health and Social Care Change Agent Team 2003/2004 (online). London. Department of Health. Available from:

http://www.dh.gov.uk/en/Publicationsandstatistics/PublicationsPolicy AndGuidance/DH4090014 (Accessed 24 October 2007)

Drinka T.J.K. and Clark P.G. (2000) Health Care Teamwork. Interdisciplinary Practice and Teaching. Auburn House/ Greenwood. Ch 4 pp63-85

Foreman K. (2007) Why do IP? Bath, IPE Level 2 Conference

Glasby J. and Lester H. (2004) Cases for change in mental health: partnership working in mental health services. Journal of Interprofessional Care. Vol19(6) p519-546

Gibbs (1988) The Reflective Cycle. Available from: http://www.bolton.nhs.uk/SHA/LLL/resources/reflective/Gibbs

Hean S., Clark J.M., Adams K. and Humphris D. (2006) Will opposites attract? Similarities and differences in student’s perceptions of the stereotype profiles of other health and social care professional groups. Journal of Interprofessional Care. Vol. 20(2) p162-181

Hewison A. (2004) Management for Nurses and Health Professionals: theory into practice. Blackwell. Ch9 pp134-150

Larking C. and Callaghan P. (2005) Professionals’ perceptions of interprofessional working in community mental health team. Journal of Interprofessional Care. Vol 19(4) p338-346

Leathard A. (2004) Interprofessional Collaboration. From Policy to Practice in Health and Social Care. London, Brunner-Routledg

Leaviss J. (2000) Exploring the perceived effect of an undergraduate multiprofessional educational intervention. Medical Education, 34

p483-486

Molyneux J. (2001) Interprofessional Team Working: what makes teams work well? Journal of Interprofessional Care. Vol 15(1) p19-35

Nursing Standard (2003) Counting in Co-operation, 17 (25) p12-13

Nursing Standard (2006) Working Together, Learning together, 21 (11) p62-63

Robinson M. and Cottrell D. (2005) Health professionals in multi-disciplinary and multi-agency teams: changing professional practice. Journal of Interprofessional Care. Vol 19(6) p547-560

Stapleton S.R. (1998) Team-building: making collaborative practice work. Journal of Nurse-Midwifery. Vol 43(1) p12-18

(Accessed 5 November 2007)

Freeth D. (2001) Sustaining interprofessional Collaboration. Journal of Interprofessional Care. Volome 15, No 1/February,2001

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