Collaborative Practice

Professional Understanding Collaborative practice (Sadler 2004) is at the forefront of health and social care training. For me, like many nursing students, the first steps in collaborative practice were the IPL (interprofessional learning) modules at university. This has been described as two or more professions being taught together as away of cultivating collaborative practice (Caipe. 2010). These modules consisted of student nurses studying different fields, OT’s, radiographers and midwifes.

This was the first opportunity I had to meet other professions, who as in any project are the ones who collaborate not the institutions (UKCR 2007). Since then all the IPL modules I have completed have been with adult nursing and midwifery students, unfortunately these groups tend to keep together in there sub groups rather than as a multi-professional group. A lack of understanding of other professional pathways can lead to missed opportunities. Day(2007) states, by having a clear understanding of each others responsibilities and roles we become more effective, with members providing different but complimentary skills.

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When I compared this to what I saw in practice I noticed similarities. Within our IPL groups, I started to recognise the other pathway roles and responsibilities. Now as a second year student I realise I could have made more of this. Maybe this was because it was the first year or maybe because the students didn’t know there own roles and therefore couldn’t explain them to the other members of each group. On reflection I found at such an early stage it was difficult to understand what my role was and as the aim of the group work was to finish exercises, mine and the groups focus was task related.

A vital part of a nurses pre-registration education is good quality practice learning (NMC 2008) and by working alongside other professions exposes students to experiences greatly valued by patients(Johnson et al 2009). The IPL modules emphasised developing an understanding of the dynamics of working within groups of different professionals. Areas we were encouraged to explore were awareness of other people’s perspectives, whether team members (Tuckman 1965) or patients. As healthcare is constantly evolving, boundaries can get blurred and roles and responsibilities change.

To help me as a nurse I need to understand my role within the larger healthcare environment and not forget that the service user is at the centre of all we do. Reflecting on my first modules and placements I can see how far I have come, but also realise how much better I could do the same things now. Having experienced shared experiences with other professionals and service users, has helped to make me a better student nurse now. A benefit of the team approach is the support that can be offered and the joint decision making (Bond 2008).

I have witnessed nurses in practice contacting other professions for patient advice and notifying different agencies of change. While role and responsibilities need to be defined, challenges and tasks can be shared (Davis 2009). Hall and Weaver (2001) showed that the introduction of collaboration, communication and congruence improved the quality of care provided. Whatever the goals of the team or group they must be defined so everyone is aiming for the same target ( Edwards 2008). Within the tasks completed in the IPL modules, the strong emphasis on communication appeared to be the single most important factor.

As Benner (et al. 1996) theorised, for the development of expert clinical reasoning thought and skill acquisition are essential. So working alongside other professions could be seen as advantageous for the pooling of resources and expertise, aiding in the decision making process. An example of this is when an elderly lady who was clearly upset after undergoing a multitude of investigations. My mentor explained the reasons behind them in a factual empathetic way, alleviating some of her worry. If she hadn’t known other professions roles and aims she could not have provided this understandable view.

As Shaw (2005) suggests clear direction from staff can help support patients and their families. Too develop my understanding of how other professionals work, I will focus on IPL group work and listen to others perspectives. During future clinical placements I will try and spend time with other professions and see how they operate as a service provider. From this I will be able to gain a greater understanding of patient care. This collaboration between disciplines and the resulting improvement for the patient was identified by Hill (2006).

Since I have started working within the NHS over the last year, I have had more opportunities to work with members of different professions both in the NHS and voluntary sector. This experience has helped me develop a better understanding of how patient care is made up of a multitude of smaller parts. Word count 779 Second Patch. Team Working By using the artwork of the fantastic four (John Haward 2001) Appendix 1, I will explore how a team is different from a group. For this I will describe an award given to me as part of a team while working in a nurse led minor injury unit (MIU).

By comparing the differences I shall highlight what makes a team effective rather than a collection of people. A group as Blanchard (2005) states, does not necessarily constitute a team and by working at an MIU I can understand how this can be true. The MIU was run by two senior nurse practitioners skilled in assessing patients and experienced in calling in particular specialists, if required. The unit had back up on site, supported by phone and video link. For staff dedication, increase in patient numbers and satisfaction the team was nominated for a ‘STARS’ award within the trust.

Bond (2008) describes a co-operative group who acknowledge each others contributions as a team. Like the fantastic four there was four main staff in the MIU. It wasn’t till we were nominated for an achievement reward I understood how we were a team. Being a care support worker I initially felt that I was not part of the award, and only agreed to go to the award ceremony as support for my clinical lead. It was him who made me realise that I was an important part of the team and it made me feel good that I had worked hard and enabled the nurse practitioners to concentrate on their roles.

I had always enjoyed working within the team and now I felt really proud. Maybe the team functioned well because we knew each others roles and responsibilities. Reis and Gable (2003) promotes the need to sustain positive relationships in organisations. I felt we came across as trustworthy and approachable, for a service user this is something a healthcare professional should always be. Like the fantastic four we worked well together. Davis (2009) suggests a team is group of people linked by a common purpose. The fantastic four, like a multidisciplinary team bring there own unique skills to the mix.

Even though there skills are very different they have common goals which motivate them as a team (Adler et al 2003). Like the MIU team there strength is most potent when they work together . The members of the MIU have acquired their skills from education, training, working and following policy and guidelines. While the fantastic four received their skills by going through a cloud of electrically charged space dust. By working as a team there understanding of each other develops. In healthcare when we lack the understanding of another team members role we can sometimes duplicate a task or even miss it which is detrimental to the service user.

Like the fantastic four conflicts can arise when values and priorities differ, in the MIU, this could undermine cohesion (Hann et al 2007) and become a barrier in maintaining team spirit. Lyubomirsky (et al 2005) agrees when explaining the need for negotiation and conflict resolution, less conflict more cooperation. Unlike the fantastic four who thrive on unknown situations, the MIU memebers who are informed, familiar with guidelines and equiptment try to minimise the unknown for the patient (Saxon et al 2000). Small teams as Holmstrom (1982) suggests are better at observing colleagues nd sharing information. Members of a team need to create an environment were members can realise their own potential (Wheelan 2010). Common values and goals are not only the values that healthcare professionals have in there delivery of care but also the glue for holding them together. The fantastic four have an unofficial leader, like the clinical lead that coordinate the care. With reflection I can now see that the relationship, friendship and social bonding that we formed at work spilled over into our external life. These relationships had a positive effect on performance in the unit.

Job satisfaction is associated with better performance in organizations (Patterson et al 2004). Unlike the fantastic four who rush into stressful situations, team work within the unit was based around communication and the reduction of stress and the pressure of the working environment (Atwal & Caldwell, 2005). The fantastic four are forever adapting in there never ending struggle with evil. Too adapt they need to communicate well (Hargie & Dickson 2004). Communication within the MIU was vital, especially when dealing with other professional bodies.

In future I will try to remember the lessons I have learnt, not only in my communication within the team but with the service user. The teams goal was to deliver effective care safely, Edwards (2008) states every team member has a role in the promotion of safe practice. Unlike the fantastic four who seem to thrive on dangerous situations, Staines (2009) suggests that team members are responsible for identifying issues involving patient safety. While Cromwell ( 2000) detailed the value of co-operation and smooth running within healthcare teams. Word count 806 Third patch.

The collaborative approach to care incorporates sharing not only the workload, the decision making but the collective responsibilities(Xyrichis and Ream 2008). In the previous patches, reflection was used to discuss professional roles and responsibilites and the benefits of effective team work. The following review will incorporate these and analyse how relationships and communication within collaborative practice can also help the service user. Care does not evolve around just the medical issues, to be holistic other issues have to be factored in and one profession on there own may not provide this.

Complex is one way of describing relationships within collaborative practice (D’Amour ; Oandasan, 2005). Group relationships rarely remain static, members therefore need skills to develop, change and evolve over time (Lindeke ; Sieckert, 2005). Interprofessional education is seen as key in the building of the skills (Maton, Perkins, ; Saegert, 2006). “Students of two or more professionals associated with health or social care, engaged in learning with, from and about each other” is one definition of interprofessional education (Barr et al 2005). The development of professional ttitudes during health and social education, has been identified as positive foundation for later collaborative practice (Nnidun 1995). Improved attitudes about how other disciplines work and the respect of each others roles are fundametal in collaborative education (Karim ; Ross 2008). Claims made of interprofessional education must be analysed and evaluted criticaly to understand there relevance to practice (Young et al 2007). Students are encouraged to reflect on group activities and the obstacles that can help or hinder effective practice.

By using a shared decicision making approach perspectives from all professions can be considered in care planning (Vazirani, Hays, Shapiro, ; Cowan, 2005). The problem focused approach and shared decision making process are seen as ways of understanding the challenges of induvidualising care for the service user (D’Amour, & Ferrada-Videla, 2005). Because of this decision sharing process in theory, collaborative practice is nonhierarchical (Yeager, 2005). Within this sharing process the servcice user is central to all decisions and interventions undertaken.

Support is essential in collaborative work and all participants need to feel supported (Atwal & Caldwell, 2005), this can come as administrive and organisational. This has been described as of primary importance and essential for success (D’Amour et al, 2005). The Laming report (2009) highlighted the need for greater understanding of not only the roles and responsibilities of health care providers, but the need of understanding of what the service user’s needs are from each agency.

Effectively working together requires communication and cooperation, important attributes in collaborative practice (Baggs, Norton, Schmitt, ; Sellers, 2004). Other qualities required for interprofessional relaitionships to suceed include trust and mutual respect, espescialy in relation to valuing different opions and shared decisions (Wachs, 2005). Cooper ; Spencer-Dawe (2006) point out that role awareness especialy towards skill, perspective and knowledge of other disciplines was also an important factor. Wachs (2005) noted that literature on collaborative practice recognises these areas as being essential for positive development.

Policies outlined in the NSF for older people (DOH 2001) and Way to go home (Audit commission 2000) have highlighted multiprofessional working as beneficial to the service user. Kenny (2002) suggests the achievement of improved patient outcomes are beyond control of any one member of the different discipline members. The language, culture and traditions of each discipline that compose the team may look at the service from there own perspective (Mandy et al 2004). In this complementary process, contribution from each discipline can be important and unique (Lindeke ; Sieckert, 2005).

This could be seen as making the assumption that the achieving of the desired outcomes would not be possible if an independent approach was used (Oliver, Wittenberg-Lyles, ; Day, 2006). Wadsworth ; Fallcreek (1997) also highlight the integration of expertise and the understanding of other disciplines roles in the functioning of collaborative teams. Mann et al (2006) discuss the evidence relating to error reduction when enhanced communication is effective in interprofessional teamwork. Each member of the team must be able to understand there own role and esponsibilities, as well as recognising, understanding and valuing the others roles (Bronstein, 2003). Understanding other professions, shared values and team building are now educational techniques to enhance interprofessional working (Jones 1986). Professional enhancment and job satisfaction (Lindeke ; Sieckert, 2005) along with reduced burnout, personel retention and improved moral are positives mentioned in collaborative research (Yeager, 2005). Training, resources, educational development and the use of reward incentives are areas highlighted as organisational support (Baggs et al,2004).

Desire, commitment and the individuals belief that effective, quality care strategies can be produced by the collaboration process are also important (Bronstein 2003). Many barriers to interprofessional working have been documented, areas that have been highlighted include terminology(Crouch ; Johnson 2003). If we are not speaking the same language, then we are not communicating at the best of our capacity. For effective communication Cooper ; Spencer-Dawe (2006) suggest verbal and non-verbal information needs to be conveyed between individuals. D’Amour et al (2005) describe this as ‘open communication’.

Managing conflict, negotiating techniques and respecting other viewpoints are essential skills for effective communication ( Hall 2005). For succesful collaboration, ‘deliberate action’ is term used to desribe the practice, maintaining and effort required (Cooper & Spencer-Dawe, 2006). This could suggest that all aspects of care could be covered, producing a more holistic approach for the service user. But there maybe a flaw in this idea if one or more disciplines dominate the decision process, or other members feel there ideas are not heard (Kenny 2002 a).

Enhanced patient care and quality of the care provided are areas that have been positively identified by service users(Lindeke & Sieckert, 2005). This cordination of services has positively enhanced healthcare, benefiting patients in continuing preventing fragmentation of care and holistic care promotion (Atwal & Caldwell, 2005). Statistics have shown reductions in length of stay, readmissions and decreased mortality rates as possible consequences of collaborative practice, allthough observatiional support for this is limited (Zwarenstein & Bryant, 2000).

For the service user, care provision can be enhanced by a team approach. The focus on a team problem solving process is designed to meet the challenges and goals of individualised care. Communication and understanding have been recognised as important factors in effective team functioning. This shared communication process also enables the service user to know what options are available to them at every step of the care process. Word count 1071 Total Word count 2598 References Adler, Ronald B & Rodman George (2003) Understanding Human Communication. Fort Worth, Harcourt College Publishers

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