This essay aims to discuss the main aspects of what I have learnt after attending the IP2 conference held in Bath and my learning after the group work I undertook with students from different professions. In the second part of this assignment I will discuss and reflect upon my personal experience working with social services and others professionals and look at how my IP learning could be applied to improve interprofessional collaboration.
The conference held in Bath “Interprofessional Collaboration in Practice” gave me the opportunity to work with another students from different professions; social work; adult nursing; children’s nursing; physiotherapy; occupational therapy; mental health nursing; radiotherapy; learning disability nursing; diagnostic imaging; and finally medical students. After attending the conference I gained a much better understanding of these roles and, in addition I would feel more confident when interacting with them in the future (Dickinson and Carpenter, 2005).
Our group bonded and worked well together. The majority of us were motivated towards the activities we undertook together as a team, such as discussion the themes, sharing relevant placement and work experience, and making decisions and agreeing to group statements. Most of the members of my group showed height levels of engagement and reflection on critical incidences from practice (Gilmartin, 2000). Also, they encouraged the more inhibited members of the group, including myself, to express themselves freely.
Despite the fact that all of us engaged in the team work, some of us, due I believe to a lack of self confidence, showed a low level of participation when sharing feelings or practice experiences with others members of the group. I believe our team established effective dialogue and allowed for open communication (Cook, 2001) and given this, each member of the team was permitted to choose which seminars to attend and feedback to the team. All members of the team respected one another’s opinions and it was interesting to learn different viewpoints and experiences of IP working.
Regarding appraisal of my own actions, I believe I could have improved my own contribution to the team with critical analysis of the information discussed. I have learned that if the concept of interprofessional working is to succeed in practice, professionals need excellent team working and communication skills. Good communication, as we have staged in our group statements, is crucial in the effective delivery of patient care and poor communication can result in increased risk to the service users (Conway, 2003).
I have learned the valuable skills required for good communication and will transfer these into practice by adapting to the local communication procedures. The NMC advices that at the point of registration students should have the necessary skills to communicate effectively with colleagues and other departments to improve patience care (NMC, 2004). The conference also changed my perceptions of some professions, especially doctors. Before I attended the conference I have always perceived doctors to be near the top of the hierarchy and unapproachable.
I learned that holding stereotypes of different HSC professional is not uncommon (see Carpenter, 1995a, 1995b; Carpenter & Hewstone, 1996). Students may hold this view even earlier, when entering their training (Hind, 2003; Tunstall-Pedoe, 2003). According to Leaviss (2000) bringing together students of different professional groups during interproffesional education at an undergraduate level will combat the formation or reinforcement of negative stereotypes that may inhibit interproffesional working in practice.
Baldwin, (1983) suggests that another factor that may play a role in the public image of a professional group can be the legislation governing the responsibilities of that professional group. I learned at the conference that there has been a change of tone in the GMC publication from 1995, 2001, 2003, and 2006 which illustrated their changing stance on Interprofffesional working (Mumford, 2008). Medical policy has been re-shaped after the Bristol Enquiry (2001) in a new direction.
In 1995 the inference was that the doctor “led the team”, whilst in 2006 the direction has changed completely to a collective ethic of respect for and communication with colleagues. However, IP collaboration is viewed by some professionals as a threat to their personal identity, fearing that traditional boundaries will disappear. Abbot (2005) and Glasby (2004) argue that even though the extension of roles and increased flexibility normally benefits many professions, other professions see this as a treat to their own interest and power base.
This is more evident in those professions at the top of the hierarchy with doctors been the most resistant to IP collaboration, as they believe they should have the most responsibility (Abbot, (2005), Glasby (2004), Molyneux (2001). A possible strategy to overcome this potential source of conflict is for each profession to be explicit about philosophy and share values (Day, 2006). At the multidisciplinary meetings time should be allocated to explore and discuss the diverse philosophies, values and procedures.
According with Freeth, (2001) open discussion will help develop the team and recognize the value and diversity that the professionals bring to the team. 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. ).