Calls for increased emphasis on “teamwork“and co-operation have been a feature of a multitude of government reports, most recently Bristol Royal Infirmary Inquiry (2001), and yet the reality of relationships in the field has not altered scientifically. I have learned that professional ethics is a force which impels the reform of interproffesional relationships and helps the establishment of “team “approaches to service delivery (Irvine 2001). Ethics lies at the heart of good health care. According to the NMC “The Code: Standards of Conduct, Performance and Ethics (2008), “You must work co-operatively within the teams and respect the skills, expertise and contributions of your colleagues”. Irvine (2001) emphasised that all modern health, welfare and educational professionals, are positioned at the same point on an ethical continuum which is based upon the universal claim: to be committed to an ethical stance which stresses the primacy of the client’s needs and interests over their own. The realisation that one’s profession or agency alone can not provide for all the clients healthcare needs have placed professionals under the moral obligation to co-operate with others who may share a responsibility to relieve hardship and suffering in individuals, families, groups and communities.
The government has initiated a new rationalization in policy since 1996 (DOH) that put the patient at the centre of care. Patients are now being empowered to make informed decisions about their well being (Day, 2006). This is important to me as with the higher expectations of patients a more sophisticated approach to health care is necessary. Since the needs of service users are promoted as one of the mayor justifications for the new arrangements, the failure to include a significant user perspective “must be seen as a mayor oversight” (Glasby and Lester, 2004). After the conference, I am more aware of the importance of patient-centred IP collaboration, which involves all members of the multidisciplinary team recognizing and understanding each other’s strengths, skills, and limitations and using their diversity and strengths to work together with the patient’s health as their common goal (Day, 2006).
I have learned that in order to provide a comprehensive care approach, a holistic assessment of a patient’s needs is needed (Barrett, 2005). Each individual is unique (NMC, 2002) and it is crucial that professionals understand “difference” and “diversity” as these are important aspects of promoting equality. The thoughts, feelings and actions at individual level can have a significant bearing on equality (Cortis, 2003). This is particularly the case when the individuals concerned are in a position of power, as nurses often are. If nurses want to promote equality through practice (NMC, 2002), they and others professionals need to learn from each other to develop their understanding of inequalities, discrimination and oppression and increase awareness of the significance of such issues.
In the second part of this essay I will explore the relationships between health and social care professionals. It will drawn on personal IP education and also from personal practical experience placements and reflect on those to improve my IP with others professionals and also my IP collaboration with social care professionals in the future.
Interprofessional team working has become one of the main important issues in the field of health and social care. The separation of health and social care remains a problem. The Nursing Standard (2001) article called “Counting on Co-operation” shows the results obtained after a mayor survey carried out regarding nurses and social worker opinions of each other by Nursing Standard and Community. The survey shows that despite stereotypes still being alive in nursing and social care there is also a high degree of agreement about each other’s efficiency. Both nursing and social care staff agrees that more resources would improve the services. However nurses believe that this could be done by bringing health and social care together into one agency while social care staff preferred closer joint working. Nurses also believed that good communication made relationships between nurse and social staff better, while social care staff focused on co-operation/working together. These findings suggest that closer working between nurses and social staff will emerge from joint training and most of the nurses and social staff from this survey agreed with the idea. However, this doesn’t appear to be the answer to the problem of achieving closer working. The results from this survey indicated that there is not much evidence that such training has much influence on attitudes. According to Nursing Standard (2003) the answer could come from the idea of work experience in each other’s areas, from crossing professional boundaries. Working in a multidisciplinary team requires many skills, which involves understanding not only one’s own role but also the role of other professionals (Atwal, 2006). Current legislation requires professionals to find ways to move across boundaries between health, education and social care. The concept of joint working underpins many recent policy documents and several white papers (Department of Health, 2006). According to Abbott (2005) working in a multi-agency teams can change how professionals perceived their own roles and their sense of professional identity. Revans (2003) argues that the “blurring of boundaries” synonymous with joint working between health and social services can contribute to the erosion of the social model of care as social workers’ independence diminishes. Barrets (2005) suggests that role clarity is also important to give individuals identity which they feel is sometimes lost during IP working, especially with loss of responsibility.
.
The conference held in Bath changed my perceptions of some professions and after conversing with social work students and learning about their complex systems and constraints, I now have a more sympathetic view of the profession, whereas before I felt frustration toward them. On my first placement, working with elderly patients, I could see how many patients ready to be discharged from hospital had to stay longer, sometimes even for three weeks, until social services staff had set up all the patients package of care. As I could see at my placement, better co-ordination of care is necessary, failed IP collaboration can be costly for professionals. Patient’s may need expensive residential care when, due to misunderstandings and lack of co-operation the agencies fail to support service users in their own homes (Means 1997). In the future, I would feel more confidence and a more positive attitude when working with social services staff. According with Tunstall (2003) pre-qualifying Interprofessional learning is beneficial in increasing confidence in professional relationships as qualified practitioners. Abbott (2005) advised that roles can also be blurred if expectations are not clearly defined, which can lead to conflict or even mistakes. It is essential that individuals learn about the other professions in the team and their procedures and constraints in order to understand the pressures or problems that exist. In practice in the future, it would be useful to find out about the roles of the individuals in my IP team to give me a clear understanding of the chain of communication and responsibilities.
Carwell (2004) suggests that operational policy can sometimes cause confusion in Interprofessional working as may be interpreted in different ways by different professions, giving different priorities, which may have a negative affect on IP collaboration. I believe it to be important that every member of the team works toward patient centred care with the same objectives (DOH, 2001). On placements I will endeavour to communicate any changes to relevant members of the IP team immediately to avoid delay, converse with all of the IP members and make myself better know, by introducing me to all members where possible. This will build relationships and trust within the team (Molyneux, 2001).
Day (2006) also argues that accurate record keeping is essential for effective IP working. Everything must be documented in a timely, professional manner. At my first placement there seemed to be a lack of continuity in record keeping. Some members of the team use paper patient notes and others enter onto the electronic notes; this lead to information been lost or missed out, which could be detrimental for the patient. I believe the system needs to be changed so that there is only one method of recording patient notes. Larking (2005) found this to be very effective. According with Day (2006) for joint commissioning of health and social care services, we need to learn from past mistakes. Excellent Inter-agency communication is a paramount. So is meticulous record keeping and effective tracking and follow up.
To conclude, I believe that from my IP learning I have learnt the sufficient knowledge to realize the benefits of IP and how they impact on health and social care. I realise the importance of building patient-centred IP relationships. I feel confident in developing these skills whilst in practice and have the ability to recognize bad practice. I appreciate the importance of service user’s being at the focus of care (Caipe, 2007) and the complexity of care which crosses over professional boundaries. I have learnt that when communication and join training contribute to making interprofessional work better, what really does make a significant difference towards the achievement of positive interprofessional working was crossing professional boundaries which enable professionals to gain an understanding of one another’s role (Nursing Standard, 2003). Positive and co-operative working between different professionals will come from changes in the traditional roles and boundaries in which each professional could maintain a positive identity as well as a flexible and adaptability attitude that will facilitated a more holistic and patient-centred approach to care. Also I have learned that the old medical order has changed in our day. Health care is now characterised by a complex and varied mix of professions and practices which creates conflict and confusion but also has created new possibilities for the construction of social and professional groups with different meaning and significance. What these opportunities will mean for the delivery of heath care and for the social and moral construction of the professions, is something that will emerge in time (Irvine, 2002.).
STATEMENTS
Theme 1: Communication
1. Communication is an integral part of Inter-professional working and there are barriers and facilitating factors involved in effective communication which can determine this integrated working.
2. Every patient/client/service user has the right to have their voice heard and there needs to be a clear, single point of contract where this can be achieved successfully.
Theme 2: Contrasting professional’s perspectives/ values.
- Different professional’s perspectives occur as a result of specific routes of training and experience which create particular tribes and these perspectives and professional culture among differing fields effect the care given to the patient.
- Different health and social care professionals need to have an understanding of their colleagues’ roles, philosophies and limitations in order to work together and provide effective patient centred care.
Theme 3: Power and Professions
- Power exists between professionals for a variety of reasons, partly routed in history and how people have been taught. This can have positive and negative effects on care delivery but should be utilised only as a benefit for the service user and to ensure professionals work effectively together to provide the best care.
- Quote: “It is the patient’s body and patient’s life; we cannot always know what is right for them without asking them.” Ford, Luise. Children’s Nurse 2008 Bath, IPE Level 2 Conference.
References
Abboutt, D; Townsley R & Watson, D. ( 2005 ) Multi-agency working in services for disabled children: What does it have on professionals?. Health and Social Care in the Community. 13. (2 )p 155-163.
Atwal, A. Caldwell, K. ( 2006 ). Nurses’ perceptions of multidisciplinary team work in acute health-care. International Journal of Nursing Practice. 12: 359-365.
Baldwin, H. J.;Richmond, V. P.; Mccroskey, J. C.; & berger, B. A. ( 1983 ) Understanding ( and conquering ) communication apprehension. Patient Counselling Community Pharmacy, 2, 8-12.
Barnes, D.; Carpenter, J.; & Dickinson, C. ( 2000 ). Interprofessional education for community mental health : attitudes to community care and professional stereotypes. Social Work Education, 19, 565-583.
Barret G; Sellman D & Thomas, J. ( 2005 ). Interprofessional Working in Health and Social Care: Professional perspectives, Basingstoke, Palgrave Macmillan, Ch 1. Pp 7-15 & Ch 2 pp18-30.
CAIPE ( Centre for Advancement in Interprofessional Education), ( 2002), Interprofessional Education-a definition ( online). London. CAIPE. Available from: ( Accessed 2 November 2008 ).
Carpenter, J. ( 1995a ). Doctors and nurses: Stereotypes and stereotype change in Interprofessional education. Journal of Interprofessional Care, 9, 151-161.
Carpenter, J. ( 1995b ). Interprofessional education for medical and nursing students: Evaluation of a programme. Medical Education, 29,265-272.
Carpenter, J; & Hewstone, M. ( 1996 ). Shared learning for doctors and social workers: Evaluation of a Programme. British Journal of Social Work,26,239-257.
Carwell, R. & Buchanan j. 9 2004 ). Effective Practice in Health and Social Care. A partnership Aproach. Open University Press, Berkshire.
Cook, G ; Gerrish, K. and Clarke, C ( 2001) Decision-making in teams: issues arising from two UK evaluations Journal of Interprofessional care, 15 (2), p141-151. Available from: ( Accessed 3 November 2008 ).
Cortis J ( 2003 ) Managing society’s difference and diversity. Nursing Standard. 18, 14-16, 33-39.
Day, J. ( 2006 ). Interprofessional working; an essential guide for health and social care professional. Nelson Torres.
Dickinson. C and Carpenter. J ( 2005 ) Contact is not enough: An intergroup perspective on stereotypes and stereotype change in Interprofessional Education. The Theory-Practice Relationship in Interprofessional Education. Occasional paper 7 The HE Academy Health Sciences and Practice subjet centre ed Colyer, Helme and Jones.
Department of Health ( 2004a ) Public health White Paper. Choosing Health: Making Health Choices Easier. Ch1, p1. ( online) London, Department of Health. Available from:
http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PpublicationsPolicyAndGuidance/PublicationsPAampGBbrowsableDocument/fs/en?CONTENT ID=4095034&chk=bgAk0t.
( Accessed 9 November 2008 )
Department of Health ( 2004 ). Changing Times: Improving services for older people. Report on the work of the Health and Social care Change Agent Team 2003/04 ( online). London Department of Health. Available from: 4090014 ( Accessed 7 November 2008).
Department of Health ( 2006 ) Our Health, Our Care, Our Say: a new direction for community services ( online ). London. Department of health. Available from: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_
4127453 ( Accessed 5 November 2008 ).
Freeth D. 9 ( 2001 ). Sustaining interprofessional collaboration. Journal of Interprofessional Care Volume 15, No 1/ February 1, 2001.
Gilmartin, Jo. Psychodynamic sources of resistance among student nurses: some observations in a human relations context. Journal of Advanced nursing, 2000,32(6), 1533-1541.
Glasby, j; Lester, H ( 2004 ) Cases for changes in Mental Health: partnership working in Mental Health Services. Journal of Interprofessional Care. Vol18. ( 1 ) p7-16.
Hind, M; Norman, I; Cooper, S; Gill, E; Hilton, R; Judd, P; & Jones, S. C. L. ( 2003 ). Interprofessional perceptions of health care students. Journal or Interprofessional Care, 17, 21-34.
Irvine, R.; Kerridge I.; Mcphee, J.& Freeman, S. ( 2002 ). Interprofessionalism and Ethics: consensus or clash of cultures?. Journal of interprofessional Care, vol 16, no 3.
Larking C, Callaghan P. ( 2005 ) Professionals’ perceptions of Interprofessional working in community mental health teams. Journal of Interprofessional Care 19 ( 6) 537-546.
Leaviss, J. ( 2000 ). Exploring the perceived effect of an undergraduate multiprofessional educational intervention. Medical Education, 34, 483-486.
Means, R.; Brenton, M.; Harrison, I. & Heywood, F. ( 1997 ) marking Partnerships Work in Community Care: A Guide for Practitioners in Housing Health and Social Services Bristol: Policy press.
Mumford, D. ( 2008 ) Good Medical Practice. Bath, IPE level 2 Conference.
Molyneux J ( 2001 ) interprofessional team working: what makes teams work well?. Journal of Interprofessional Care. Volumen 15, Number 1/ 2001.
Nursing and Midwifery Council ( 2002 ). Code of Professional Conduct. London, NMC.
Nursing and Midwifery Council ( 2008 ) The Code: Standards of Conduct, Performance and Ethics. Section 2-2a.
Anonymous ( 2003 ) Counting on co-operation. Nursing Standard. February 26/ vol 17/no 24/ 2003.
Revans L. ( 2003 ). Pioneers together. Community Care 3-9 April, 28-30.
Tunstall-Pedoe, S. Rink, E. & Hilton, S. ( 2003 ). Student attitude to undergraduate interprofessional education. Journal or Interprofessional Care, 17, 161-172.
