The intention of this essay is to explore inter professional working and the impact it has on the quality of health care delivered within a mental health setting. For this purpose I have reflected on a previous placement where I worked in an acute mental health treatment ward and on the formative assessment assigned to me within this module.
Inter professional working in a health care setting involves different health care professionals working together in a collaborative fashion, this ensures the highest quality of care is delivered to service users (Day, J 2005).
It is suggested that the collaborative nature of inter professional working will lead to information and knowledge being shared amongst professionals within a team, which will ultimately lead to improved judgement when providing care and creating a higher bench mark for quality care (DOH 2007).
In the NHS, it is stated that quality is defined by doing the right thing in the right way at the right time in the right place with the right result (NHS 2012).
Lord Darzi’s High Quality Care for all (2008) states that delivering quality healthcare includes providing patients and the public with effective safety, cleanliness, delivery of care as well as a good patient experience and the consideration of patient dignity and respect . To assure that quality care is being provided, quality is externally and internally measured and evaluated.
Within a healthcare setting it is measured at three levels. The national level includes audits, staff surveys, patient surveys and mortality and morbidity rates. The strategic level includes clinical governance, benchmarking and meetings amongst high level staff. The clinical level includes protocols, care pathways, complaints made by patients and infection control (CQC 2011). Within the NHS another element in the provision of quality, is the implementation of national service frameworks. These are implemented to make sure clear quality requirements are set and that the most up to date evidence based practice is working effectively in a given setting (DOH 2011).
Following exploration of the literature for interprofessional working, three key issues identified are communication, culture and knowledge of professional roles (Pollard, K et al 2005). In regards to communication with in the team, to be able to provide holism in regards to a patients care all professionals within the team must engage in clear and open communication (Ellis. R et al 2003). It is essential that all of the professionals’ views and perspectives are heard and taken into consideration when implementing care. Although there are clear advantages to open communication there are often barriers that inhibit this practice.
Lack of knowledge or the stereotyping of other professions can lead to ideas, recommendations and perspectives of an individual not being heard or taken into consideration. This can ultimately affect the quality of care delivered to a service user (Barret,G et al 2005). In order to overcome such barriers, trust and respect of fellow professionals must be present. If the environment is lacking in trust and respect, it may result in professionals protecting their roles and justifying actions. This can then result in a closed working environment, where professionals do not learn from shared experiences and constructive criticism is not welcomed. Collectively this can impede on the holistic and collaborative nature required in the delivery of healthcare (Day, J 2005).
In order to approach care holistically, each member of the interprofessional team must have awareness and knowledge of the different professional roles within the team. This is due to the fact that conducting a holistic assessment is beyond the scope of any individual professional. Lack of knowledge of the roles of other professions and the boundaries of an individual’s role can lead to specific areas of care not being delivered to its highest quality (Wilcock, M et al. 2009).
Professional culture can affect the delivery of quality care as the norms and values of different professional groups maybe in contrast with one another. This can lead to a disagreement or conflict when discussing and planning the approach when devising a plan to deliver patient care. However these differences between professional s can have a positive effect on the formulation and direction of service delivery (Day, J 2005). Taking into account the different ideals and perspectives can lead to a comprehensive and thorough assessment of a service user needs thus optimizing the quality of care provided. Within professional cultures there is often the use of unique jargon. Amongst an interprofessional team this can lead to barriers to effective communication which could ultimately lead to a lesser quality of care delivered. In order to overcome this obstacle members within the interprofessional team need to be self-aware of the language they are using to avoid causing confusion amongst professionals (Ellis. R et al .2003).
On consideration of my placement in an acute psychiatric ward, I reflected on the interactions amongst the members of the interprofessional team. The role of the acute psychiatric ward was to provide treatment to service users aged eighteen to fifty five with conditions ranging from schizophrenia, bipolar disorder, schizoaffective, depression, mania, eating disorders and borderline personality disorders. Due to the wide range of disorders and the complex care that is often required to treat service users holistically there were often more than one professional within the interprofessional team that was involved in a service users care (NICE 2011).
The professionals that were involved in this wards care whilst I was on placement were Nurses, Occupational therapists, Psychiatrists, Pharmacists, Social workers, Dietitians and Psychologists. Due to the differing nature of each of these professions, unique perspectives of the service user and their needs are assessed and an adequate and holistic care plan could be implemented. Key information was often passed on, an example I observed was in regards to eating plans from the Dietitan passed on to the nursing staff for eating disorder patients.
From my perspective as a student mental health nurse whilst on the ward it became apparent that professional culture and ideologies of the professions often came in conflict with each other. I observed this when decisions needed to be made, there was often a professional that had to compromise their views. Interprofessional working at times also had a negative effect on the service users. In one instance a patient was on continuous observations by two staff due to recent multiple suicide attempts, it was agreed amongst nursing staff that the service user only had essential items and was not allowed anything that could be potentially harmful to herself.
Although this was agreed amongst nursing staff the policy did not state any specifics that were not allowed, it did however state that it would be at the discretion of the professional at the time that is carrying out the continuous observation. This ultimately led to conflict when the occupational therapist allowed the service user to use paints, pencils, and paint brushes. On reflection this was not conducive to the recovery or mental state of the service user due to lack of consistency from staff that were looking after her.
Barrett, G et al (2005) states that the power share amongst the interprofessional team is an important issue as an unequal power share amongst the team could lead to professions oppressed and unable to have a significant input. However it is also argued that without strong leadership and direction there is no true direction to the care being delivered and professionals within the team will rely on others to take charge (DOH 2007). On the acute ward as a student nurse I found that on the surface level there was an equal power share with all the professionals having equal input. However at times it became apparent that if a decision was made that certain professions did not like, the former hierarchy system came to fruition and the grievance was taken directly to the consultant and their decision would be final.
On placement I believe that professional culture was a boundary to effective communication and collaboration amongst staff. Although all patient notes were stored on RIO which is readily available to any staff involved with patient care information was never discussed openly, formally or informally between professions unless something of significance happened. The driving factor for the interprofessional team to congregate was at that point to discuss blame instead of collaborative working. Professional identity also contributed to the quality and the effectiveness of the care given in the placement setting. The very nature of the training of each professional automatically assigns a skill set, codes of practice and standards from their governing body for example the NMC (2012) or HPC (2012). Thus meaning the very nature of this governing body can often conflict with collaborative nature of an interprofessional team.
My personal suggestions for my acute mental health placement would be that there are clear guidelines and policies that need to be implemented in order for seamless clinical care to be delivered amongst the professionals. This could set clear boundaries to the remit of staff’s responsibilities. I would also suggest that time for interprofessional education be available for staff so there is a sound knowledge between the professions which can lead to a greater appreciation of the care that is delivered.
On reflection of my formative group assessment it became apparent that the interpretation of the task at hand was different between each of the four members of the group, this could have been due to the fact that amongst the group there were different specialities of nurses. Once this was realised the group had to meet in order for each member to be fully aware of what was expected of them. Once there was clarity in the roles of each of the members a co-ordinator was appointed for the work to be collected and arranged appropriately for the presentation. It was agreed amongst the group the order of speakers and this translated seamlessly to the presentation. It became evident after the assessment had ended that if we had not of congregated beforehand the presentation would have not been as organised and coherent as it was (appendix).
In conclusion it is clear that interprofessional working plays a vital part in the effectiveness and quality of care delivered to a service user. The literature has stated that in able for quality care to be delivered there must be willing and open participation form all members of the interprofessional team to work collaboratively. Although there are many barriers to effective interprofessional working, regulating bodies such as the NMC and organisations such as NICE have initiatives and guidelines for guidance in overcoming differences and conflicts.
Clearly defined roles is an importance for professionals to be able to deliver high quality care, however he very nature of interprofessional working can sometimes hinder this as the views and perspectives of a situation between different professionals conflict with each other thus potentially leading to lack of clarity when delivering care (Wilcock, M et al. 2009). These factors were often present in my own experience in the above mentioned clinical setting. It became apparent that although there was an interprofessional approach to delivering quality healthcare, there was no clear structure to the composition of the team thus leading to conflict occurring more often than effective collaboration.
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