The aim of this assignment is to explore how the culture of individual professions can present barriers to interpersonally working in relation to my clinical experience. The essay will discuss professionals and define interpersonally, multidisciplinary and professional culture it will then examine issues of the effectiveness of interpersonally working in my clinical experience and discuss how professional culture can present barriers that hinder teamwork. Finally the essay will identify what changes could be made to enhance current and future practice. Traditionally doctors, lawyers and clergymen were perceived as professionals.
Nurses and social workers were not observed as professionals because they were seen to have limited knowledge, that has all changed and these days they are considered to be professionals who possess a wide body of knowledge which is usually gained from academic studies. Leathered (2003) indicates that a professional has a certain expertise that Justifiably entitles them to the role of practitioner, who is bound by a code of ethics. Cook et al (2001) found that professionals highlighted trust as an important factor in facilitating open discussion and successful role negotiation, both important features of interpersonally working.
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The terms interpersonally and multidisciplinary are the most commonly used words that many professionals employ in practice. Freeman et al (2000) defines interpersonally to be where a group of professionals interact with each other across boundaries for the benefit of the patient. Another term used in place of interpersonally is multidisciplinary, this term was used more frequently in the sass’s and ass’s where as defined by (Day 2006) is a group of professionals working together with little collaboration.
Both groups share a common purpose which is to contribute to patient care. Surgeons et al (1991), suggests that the terms teamwork and collaboration are both used to describe the function of multidisciplinary working. Members of each group have their own view of what skills and solutions would be needed to the health care problem presented to them (Soothing teal 1995). Reid teal (2000) define a team to be a group of people who work together towards an agreed common goal. Teamwork is essential if interpersonally working is to be successful.
The concept of interpersonally working is having a group of professionals work together for the benefit of the patient, by bringing together multiple skills and expertise with emphasis on seamless care for the patients. According to (Kenny 2002) interpersonally working is a concept that has an impact on nursing and the care delivered. There are many professionals who contribute to patient care some of these include nurses, doctors, physiotherapists, occupational therapists, social workers, pharmacists, dieticians, speech & language therapists amongst others. For about what they wish to achieve (Loosely 1997).
Effective collaboration requires mutual support and space for disagreement of different views to take place (Houston et al 2002). Loosely (1997) describes occupational culture as members of a team who share assumptions, customs and practice, which sets boundaries between those in the team and those outside. Each professional group has its own culture which encompasses a particular set of beliefs, values and norms (Barrett et al 2005). According to (Irvine et al 2002) because culture influences all aspects of our lives, it therefore influences our unconscious perceptions of others.
The development of this culture brings with it many challenges to interpersonally working. Interpersonally working has gradually become more important within the health ND social care setting and there has been an increased drive from the government for health and social care professionals to work together. These views are stated in the Government White Paper “The New NASH: Modern Dependable” (Secretary of state for health, 1996), this paper acknowledges the fact that health and social care professionals should be encouraged to work with each other and across organizational boundaries.
During my clinical placement on a stroke ward I learnt a lot and witnessed effective teamwork and barriers to collaboration between the interpersonally team. The am members involved in the care of these patients comprised of doctors, nurses, speech & language therapists (SALT), physiotherapists, occupational therapists, social workers and A&E staff. These different professionals need to work collaboratively in order to meet the needs of the patient’s; they use their professional Judgment and are accountable for practice.
Many professionals are covered by a regulatory body, where all professionals are accountable for the standards they set and the way in which they are enforced (Swage 2001). These bodies are set up to safeguard the public and to roved guidance to practitioners regarding the appropriate conduct to the profession (Kenilworth et al 2002). The patients on this ward would have given consent to treatment. The Code of Professional conduct (NC 2002) states that professionals must obtain consent before any treatment is given and confidential information must be kept confidential.
So even though patients may give consent to treatment, they must also give consent for disclosure of information regarding their treatment be shared with other members of the team. Kenilworth et al (2002) believes that with consent it is acceptable for nurses to pass some patient information to other members of a health care team in order to provide effective health care. Many of the patients on this ward were admitted through the Accident and happening to them and may not be able to seek medical help.
What was effective in this instance was that the A nurse would bring the patients to the ward and handover to the nurses on the ward. The Audit Commission (1992) stated that nursing handover was critical for maintaining continuity of client care. The A nurses would usually make an assessment of the patient’s condition and pass this information onto the ward nurses. Collaboration between these nurses was vital for continuity of care. Interpersonally team members sometimes experience blurring of boundaries and must share varying amounts of responsibilities.
This confuses professionals as there is uncertainty to where their boundaries begin and end (Marino, 1999). Working with different professionals can present problems if there is inappropriate communication and collaboration. Sometimes patients would be admitted to the ward and the nurses would have assessed a plan of care for them, then the doctors would see them and adopt a different plan of care. Soothing et al (1995) suggests that these professionals may cross traditional boundaries in order to deliver services to the patients needs, but collaboration needs to take place to prevent overlapping of roles.
The values in the professional culture of doctors will possibly differ from the nurses where (Loosely 1997) believes that different professional groups identify themselves with diverse values and priorities. What sprung to my attention was that the doctor- nurse relationship seemed to be quite strained, there seemed to be a lack of mutual respect and conflict between each other. Doctors would be bleeped and would not respond or they would examine patients and not handover to the nurses or document their findings, whereas nurses lacked the courage to provide information related to specific areas of practice (Houston et al 2002).
This hindered interpersonally working as support and collaboration are necessary for effective patient care. Currie et al (2002) recognized that clinical staff identified hierarchy still existing between nursing and medicine, where nursing is seen as subordinate. The culture between the two professionals was evident on this ward and it brings halogens to interpersonally working. The doctor is more focused on diagnosing diseases in order to treat it whereas the nurse is more supportive of the patients being able to go home and be with their family.
This interpersonally way of working was to ensure appropriate continuity of care for patients while the doctor-patient relationship is more inclined to influence authority and focus on action and outcome more than on relationships (Reese et al 2001). Within an interpersonally team, these disparities amongst the various professionals are possible causes of conflict and may hinder effective interpersonal working (Day 2006). For teams to work more effectively, all members need to have mutual trust and respect for each others contributions (Houston et al 2002). Interpersonal team is through the patient’s records. Good record keeping is an important part of nursing it should be accurate and is essential for professional practice. Most patient records are handwritten and this sometimes presented barriers because some professionals used meaningless phrases, abbreviations and jargon which were difficult to comprehend. Brooke (2005) acknowledges that the SE of Jargon is a way of making professional status known, however Kenilworth et al (2005) points out that as patients have a right to view their records it should be written in a way that they can understand.
On this ward the patients needed specialized care from various professionals, and the outcome would depend on the collaborative working of the interpersonally team, which worked well with some members. The speech and language therapist would assess patients who had swallowing problem (dysphasia) because of the stroke. They would recommend a feeding regime, whether thickened food was accessory or if a instigators or PEG feeding would be needed.
The dietician would then advise on the types of food the patients will need so that they receive all the nutrients they require and the physiotherapist will give advice on comfortable positioning and exercises to maintain Joint function such as supporting weak limbs with pillows (Brooke et al 2005). This in turn will assist the nurse with their daily delivery of care to the patients. Because the team identified clear boundaries regarding what tasks to share and on what occasions, interpersonally working can be successful (Rusher et al 2002).
To assess a patient’s suitability for discharge the occupational therapist, physiotherapist, community nursing services, social services and the family will need to work with the nurses (Brooke et al 2005). For this to be effective (Workman et al 2003) indicates that discharge planning should be started once the initial assessment is complete, on observation this was not the case on many occasions and the nurses found themselves overwhelmed with paperwork, making numerous telephone calls and chasing agencies.
When effectively planned the nurse communicated with the community team for continuity of care. The occupational therapist was contacted and a referral was made to social services. The Tot’s role was to assist the patients by visiting their homes before discharge to check for availability of basic equipment they may require such as stair rails, commodes or walking sticks and they may engage with family members to enable maximum functional independence for the patient (Webster 2002).
The TO and physiotherapist also liaised with each other to establish the mobility of the patient and to determine what equipment would be needed. A person-centered care plan developed in collaboration with the physiotherapist and occupational therapist will assist the team approach which maximizes recovery (Mitchell et al 2004), although according to (Booth et al 2002) there maybe role overlap between Tot’s and physiotherapists whilst working in a stroke unit. Hospital by promoting independence and an acceptable quality of life.
They will communicate with the patient and members of the family to assist with social benefits and offer information about organizations which may offer support. The members of the Interpersonally team would meet regularly at the multidisciplinary team meeting (MAT). (Day 2006) states that MAT meetings are plopped to ensure that all the relevant professionals play a part in the care of patients on their Journey through the system. These meeting can create various challenges as most of the time a considerable amount of different professionals need to attend so time constraints can cause potential problems.
The meeting consists of all the members in the team and are extremely beneficial for all involved as several patients care are discussed at these meetings. This is where good communication skills will need to come into play. Each professional group has it own culture which includes its own values and beliefs ND determines how people work together and what attitudes they share, this can present barriers within interpersonally working. Brooke (2005) recognizes that these values and beliefs are learned and can influence all we do which can lead to stereotyping.
Day (2006) believes that these barriers can be broken down by open discussion between the team members, whereby each professional group are prepared to share and discuss its different philosophies and values. According to (Houston et al 2002) if conflict is aired within a team and individual members share differing views then steps can be made to clear mutual goals. Team meetings provide an opportunity for these discussions to take place. This will enable each member to view problems from the perspective of other professionals in order to work together more successfully.