The purpose of this assignment is to explore the various roles of the Multi Professional Team (MPT) within health care provision
The purpose of this assignment is to explore the various roles of the Multi Professional Team (MPT) within health care provision, and further examine the importance of effective communication between its team members with relation to the delivery of health care to clients.
The assignment will concentrate on two specific areas; firstly, the concept of the MPT will be discussed, along with a brief outline of the professional bodies involved and the nature of their input. Subsequent to this, the assignment will provide a reflective account of the role provided by such a team, with specific reference to the delivery of its care to a specific client. This section is intended to provide a factual case by which the MPT's input can be demonstrated, and will further concentrate on the importance of effective communication between both the MPT and the individual, exploring some of the concepts and benefits of such practice, again using examples from experience.
In recent years, the move towards multi-professional approaches has been encouraged by a number of government reports (Department of Health, 2000) with the purpose of improving the quality of health care provision. To appreciate this trend, it is necessary to examine the principles that provide the fundamental basis of health care today.
The concept of holism has a firm home within health care provision, and the theory of holistic care is seen to be an amalgamation of many concepts and practices within this area (Hinchliff, Norman and Schober, 1998). Over the past decades, the health profession has placed great emphasis on the relevance of holistic approaches. Holistic is here described in the sense originated by the philosopher Jan Smutts, and explained by Patterson (1998), in which 'the whole is greater than the sum of its parts'. Instead of reducing the person into functional parts, the individual is considered as a 'whole'.
If such a model is to be functional, it is necessary to focus on all aspects of health that are relevant to the patients' well being, and not solely their immediate medical problem. This is where the importance of the MPT is demonstrated. A MPT consists of a number of professionals from various disciplines, working together towards a common goal. Whilst reviewing MPT work in the US, (Kane, 1975, cited in Morag and McGrath, 1991:2) suggests that despite variations in definition, MPT's share three common elements. Although each team member has a distinct role, the team members have shared aims, whilst working within 'a structure that facilitates joint working and communication'.
The range of disciplines working within a MPT will vary between individual patients', dependant upon their individual needs, however, any of the professions that contribute to a patients care are implicated. For example, beginning with the most obvious are doctors, nurses and nursing assistants. However, the team spans much further than this, encompassing professionals such as physiotherapists, occupational therapists and social workers. These health professionals are those commonly encountered within a hospital setting, although some further disciplines which may be taken into consideration are paramedics, pharmacists, speech therapists, phlebotomists, dieticians and radiographers amongst many others.
In order for such a team to function effectively, communication between its members is essential. Consequently, it is important for members of the MPT to hold a broad understanding of the role of each of their colleagues. Hogston (1999) indicates that contributions from within the team must be accorded with a mutual trust and respect for effective collaboration to take place.
The patient role in the communication process is also vitally important, and Gillis (1988) comments that without good communication, as nurses we are unable to derive from patients their needs, 'nor can we guide or instruct them'. Stewart (1996) takes this view further by stating that studies have shown the employment of effective communication has proven to have had a positive effect on the rate of a patients' recovery (cited in Wilkinson, Gamble and Roberts, 2002).
In the UK, the model of nursing used most predominantly is that of Roper et al, (1980), which bases its principals on a model for living, and within one of its five components are the Activities of Daily Living, (ADL). One of the elements of ADL is communication. The ADL of communicating is an integral part of human behaviour, and can be classed as verbal or non-verbal .
Gillis (1988) agrees that there are two basic methods of communication. Language, which may be referred to as verbal communication is a tool we use daily. It gives us the ability to give form to thoughts and then transmit these concepts as such. However, this method of communication encompasses more than merely the words used, but also paralinguistic features such as intonation, tone of voice and conversational flow. All such characteristics give the ability to convey additional information.
In addition to verbal methods of communication are non-verbal channels that can be equally as effective in conveying information ...
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Gillis (1988) agrees that there are two basic methods of communication. Language, which may be referred to as verbal communication is a tool we use daily. It gives us the ability to give form to thoughts and then transmit these concepts as such. However, this method of communication encompasses more than merely the words used, but also paralinguistic features such as intonation, tone of voice and conversational flow. All such characteristics give the ability to convey additional information.
In addition to verbal methods of communication are non-verbal channels that can be equally as effective in conveying information to the recipient. Kagan and Evans (1998) state that non-verbal communication is not separate to verbal communication but related to it. Further to this, they state that it can 'enhance the meaning of what is being said, synchronize conversation, obtain feedback on what is being said, signal interest and attentiveness, replace or contradict the verbal message' (Kagan and Evans,1998: 26). The features of non-verbal communication can be broken into components that often occur simultaneously: head movements, body posture, gestures, facial expressions, eye contact or eye gaze, proximity and touch (Williams, 1997).
In order for professionals to relate to others, understand and value them, they should develop self-awareness. According to Arnold and Boggs (1995), the concept of self-awareness identifies the individuals' knowledge and understanding of self-concept. Burnard (1992) believes that being self-aware is not being self-conscious.
To be self-aware is to explore honestly the behavioural, psychological or physical aspects of the self. The result of this exploration is a personal development and an interpersonal understanding.
All of these concepts are ultimately theoretical implications of communication with others, and can be demonstrated in more detail by being examined in the context of a specific case study. For this purpose, communication within the MPT will be examined with relation to the health provision of a patient who will be referred to as Miss. B.
Miss B, a 34 year old woman who lives with her parents was admitted to hospital on the 18th December 2002. Her admission came as a result of her being discovered on the floor by her parents in a collapsed state and unresponsive. She was transported to the local hospital by ambulance. On arriving at the hospital, Miss B was taken into Accident and Emergency department, and immediately designated a named nurse, who would admit Miss B. The purpose of this was to gather as much information as possible in regards to her personal details and medical history. Due to the nature of Miss B's condition at that particular time, it was necessary to collect this information from her parents. Inquiries revealed that Miss B. was an insulin dependant diabetic. She suffered from morbidly obesity weighing 26st, which had resulted in limited mobility. Miss B. was also reported to suffer with learning disabilities. Once sufficient details had been collected, a senior house officer was assigned her case and was to make an evaluation of her condition and subsequently make a diagnosis based on his observations.
Initial examinations suggested that Miss B. had suffered a stroke and was referred to the specialist stroke research team, which consisted of Clinical Nurse Specialists whose nursing expertise was in the field of strokes. The function of this team was to examine the patient specifically for symptoms of a stroke, confirm the preliminary diagnosis and ultimately implement a plan of care as soon as possible.
A bed on the Acute Stroke Unit was immediately made available for Miss B, where she was to spend the following nine weeks. After a couple of days, Miss B. gradually became more responsive, and a number of scans revealed she had suffered from a cerebral infarct. By the third day, the stroke had fully evolved and any consequent effects could be assessed. The assessment made on Miss B. revealed the stroke had resulted in a weakness of the right arm and leg, dysphagia and aphasia. Miss B. appeared to show signs of mental alertness, however, she appeared to be only sporadically capable of responding to verbal instruction.
The next stage in Miss B.'s recovery would involve a range of disciplines whose aim was to concentrate on rehabilitation which would aim to restore as much function as possible. After the initial observation of Miss B.'s return to consciousness, I approached her bed and introduced myself. Sitting on the edge of the bed, I became very conscious of her vulnerable disposition, so I made a conscious effort to keep the tone friendly and relaxed. Due to her history of learning difficulties, I was aware that there was a potential to present myself in a patronizing manner, due to possible stereotypical perception. Martin and Chai (1985) believe that such forms of labelling can affect an individual even after their recovery. Consequently such perceptions may be detrimental to a patient's recovery due to the potential mental affects. Therefore a conscious effort should be made in regard to the appropriateness of tone and manner when addressing a patient.
In such instances, non verbal signals such as negative body language, for example crossed arms can give a patient an impression that is contrary to any verbal information that is conveyed to them, therefore, it was important to present myself in a positive confident manner. Gillis (1988) surmises that to project such an attitude gives a patient reassurance and confidence in your abilities. Additionally, Gillis supports gestures such as maintaining good eye contact, which signalled my attentiveness. This approach was important if Miss B. was to feel that her contribution and involvement was valued.
Once I had sat in a comfortable position, facing Miss B. I proceeded to discuss her forthcoming plan of rehabilitation. Due to Miss B.'s dysphasia, the conversation could become somewhat one sided on occasion, however I ensured that I frequently paused during conversation in order to allow her to digest the information she was receiving. This also presented opportunity for her to indicate whether she had anything she may have wanted clarifying.
As the conversation moved along, the subject of exercise was raised. I informed Miss B. that she had been referred to the physiotherapist who would be joining her shortly to begin the process of strengthening her weakened limbs and transferring out of the bed and into a chair. This information was greeted by a shout of refusal from a rather reluctant young woman. I was aware that Miss B.'s excessive size was likely to discourage her from wanting to participate in any energetic activity, especially given the fact that she would now also have additional weakness in her limbs. Nevertheless, I persisted on the subject and rather than offering out advice on those things she must do to aid mobility, I described the benefits of the physiotherapists input, and highlighted the fact that any exercise would be approached at her own level of ability, and would progress gradually.
This approach seemed to receive a much better reception from Miss B. and I was able to appeal to her reason by using a degree of persuasion and altering the way the subject was presented. As indicated by Kagan and Evans (1998) different types of persuasive appeal is required to communicate different opinions to different audiences, and on this occasion I was able to convince Miss B. my suggestion was not quite as daunting a prospect as first imagined.
Physiotherapists see human movement as central to the health and well being of individuals. They can identify and maximise movement potential through health promotion, preventive healthcare, treatment and rehabilitation. In the case of Miss B. the physiotherapists' role was to begin the process of mobilization. Initially, the physiotherapist also complete a moving and handling assessment to determine which equipment will be most effective in transferring her.
Over the course of the next few days, the physiotherapist worked regularly with Miss B. however the level of progress was minimal as her reluctance to mobilize remained. This was not helped by the fact that a particularly large and painful pressure sore on Miss B.'s sacrum was not healing as successfully as had been hoped. It was suggested by the physiotherapist a home visit by the occupational therapist should be arranged due to some concerns about Miss B.'s long term potential for mobility.
The occupational therapy department also provides much input within the MPT, and their specific role is to assess and treat a range of physical and psychic conditions by promoting 'independent function in all aspects of daily life' (NHS careers, 2000). The purpose of the home visit was to get a indication of how the family would cope if Miss B. returned home, and practical issues such as wheelchair access and safety in the kitchen was the focus.
In light of some of the issues raised during the week, a MPT meeting was arranged to discuss the position of the patients on the ward, and in particular Miss B.'s. Those in attendance were the wards consultant, occupational therapist, physiotherapist, social worker, a tissue viability nurse, nurse in charge and myself.
The home visit that occupational therapist had requested was arranged, and I was given the opportunity to accompany them. The main consideration of the home visit was to assess how easy Miss B. found it to mobilize within the house and what obstacles may be encountered. The visit did not provide the results hoped for, and on further examination it was established that conditions in the family home, for example adequate bathing facilities, were not available. Furthermore, the equipment that would be required to support such weight in safety was not available.
The multi professional meeting itself was a relatively informal affair. The atmosphere was relaxed, and all staff members appeared to be comfortable in each other's company. The opening of the meeting was introduced by the nurse in charge who gave a report on Miss B.'s condition, recent developments and concluded by stating that in terms of medical care, there was little more that could be provided for Miss B.'s primary condition. Miss B.'s consultant agreed with this, and added that her prognosis was not likely to alter dramatically. The only other issue was that of Miss B.'s pressure sore, which the tissue viability nurse confirmed she would review but was not overly concerned. The only reason preventing Miss B.'s discharge was purely on social grounds.
In regards to Miss B.'s home visit, the physiotherapist and occupational therapist were in agreement that to discharge Miss B. directly to her home was not a viable option in terms of her safety, and concerns raised about her elderly parents' ability to continue as carers put the team in agreement that a home discharge would not be appropriate.
The social worker also often feature largely within the MPT, and their role involves providing practical assistance for a range of needs. For example benefits advice or provision of services within the home, i.e. meals on wheels. In Miss B.'s situation, the social worker dealing with her case informed the team that she had spoken to the family in regards to the issue of discharge, and they had agreed that within the circumstances, securing residents in a nursing home would be the most suitable option for Miss B. It was agreed that a nursing home place would hopefully be secured within the week and Miss B could finally be discharged from hospital.
In this instance, the social workers input was vital to the effective functioning of the team, and provided the finalities needed in order to discharge Miss B. By providing effective channels of communication, all the necessary information that is common to a specific patient, but provided by different disciplines can be correlated in order to provide a comprehensive profile of care containing all the required information.
Effective communication between a MPT is of vital importance, as all records concerning a patient's treatment should be available to any health care professionals involved in a patient care. In situations were there is a lack of effective communication, it is quite often possible for treatments and important decisions to be delayed due to lack of information across disciplines.
There are however occasions when despite employing the best theories on effective communication, channels between the multi professional tem can break down. For example, hierarchical structures within the workplace can create barriers between professions and levels of experience. Consultants are quite often perceived as the top rank within hospitals and as such, less senior members of staff for example care assistants or student nurses would be reluctant to offer an opinion on a patient's condition. Such perceptions have the potential to have an adverse affect on the delivery of care to a patient, as potentially important information does not get relayed as a result. In the same respect, the issue of age can often cause problems as upbringing and values can differ greatly.
Further to social considerations such as these are cultural barriers, which can also cause problems for communication. A possible means by which communication can fail is as a result of racial issues prejudices or just simply pure ignorance. Language is always an area for consideration, and often, the use of technical terms or jargon can leave the recipient no more knowledgeable than before hand.
To conclude this assignment, is an example of how effective communication strategies can enhance the delivery of care. Whilst working in a care setting it is inevitable that one will encounter an individual who presents irrational or uncharacteristic behaviour. The cause of this is most commonly contributed to fear or uncertainty due to a feeling of vulnerability. On placement, I encountered a lady who had a history of heart failure. One particular night she presented signs of Arterial Fibrillation. Consequently the doctor was paged and meanwhile her heart was monitored by means of an ECG machine. During this time, she became increasingly distressed and as a result her pulse rate began to climb rapidly.
As the doctor had not yet arrived, I became somewhat concerned and went to inform the nurse in charge of the developments. Whilst providing this information I queried as to whether the lady had been informed of what was wrong with her. Evidently in all the commotion, of contacting doctors, it had not occurred to anybody to take the time to stop and give this woman any reassurance. I asked the nurse in charge if it would be appropriate to inform this woman of what was happening, as I was unsure if it would have an even worse effect on her already poor condition.
After some deliberation it was decided to inform her and I returned to the ladies bedside, pulled up a chair, lay one hand over hers and calmly started to chat to her. I explained about the irregular heart pattern that had been detected, and that the equipment was a precautionary measure to monitor her whist we waited for the doctor. Almost immediately her erratic breathing began to slow down, and her pulse rate began to drop. Five minutes later we were chatting like old friends and I was receiving tales of her life. By the time the doctor had arrived the ladies pulse was almost normal again, and she was quite relaxed.
Later on after that encounter I was reflecting on the situation, and a realisation came, that quite often in our eagerness to prove our clinical and medical knowledge, we can forget the simple gestures, like a soft pat or a warm smile that can make a world of difference to a person at a time where medical expertise will provide no comfort.
Bibliography
Burnard, P. (1992)
Effective Communication Skills for Health Professionals. London: Chapman & Hall
Department of Health (2000)
The NHS Plan: Department of Health Report, http://www.doh.gov.uk/nhsplan/index.htm (Accessed 23.01.03)
Gillis (1988)
Human Behaviour and Illness. 4th edn., London: Faber
Hinchliff, S., Norman, S. and Schober, J. (1998)
Nursing Practice and Health Care a foundation text. 3rd edn., Great Britain: Arnold
Hogston, R. and Simpson, P. (1999)
Foundations of Nursing Practice. London: Macmillan.
Kagan, C. and Evans, J. (1998)
Professional and Interpersonal Skills for nurses, 2nd edn., Cheltenham, Chapman and Hall.
Martin and Chai (1985)
'Labelling and Stereotyping in mental health'. Study guide: Peggy Nettleton.
Morag, McGrath (1991)
Multi Disciplinary Teamwork, England: Avebury.
NHS careers (2000)
What does an Occupational therapist do? www.nhscareers.nhs.uk/nhs-knowledge_base/data/4906.html (Accessed 23.01.03)
Patterson, EF (1998)
'The Philosophy and Physics of Holistic health care: spiritual healing as a workable interpretation', J. Adv. Nursing,27, pp.287-293.
Roper, N., Logan. W., Tierney, A. (2002)
The Elements of Nursing, 4th edn., Edinburgh: Churchill Livingstone
Wilkinson,S., Gamble, M., and Roberts, A. (2002)
The essence of cancer care: the impact of training on nurses' ability to communicate effectively', Journal of Advanced Nursing, 40(6), pp731-738
Williams, D. (1997)
Communication skills in practice. A Practical Guide for Health Professionals, London: Kingsley.
Multi-professional Teams and Communication
