The effectiveness of this team working is dependant upon a common objective that is understood and accepted by all members, a clear understanding by each team member of the role, function, skills and responsibilities of other team members and a mutual respect for each other. The cumberledge report (1986) concluded that unfortunately many disciplines did not possess these skills.
The Audit Commission (1997) also found this kind of teamwork elusive and recognized rigidity amongst PHCT members was a common problem, with individuals adhering to narrow dimensions of their roles and concluded that multidisciplinary working is particularly difficult in primary care as there are many barriers, which include separate management, diverse objectives and professional demarcation which all may play an important part in limiting effective collaboration On reflection whilst working in my community placement I did find that poor collaboration did occur. During a home visit the information that the district nurse received was that the patient had a leg ulcer which would require twice weekly dressings.
On arrival to the patients home we found the severity of the ulcer was a lot worse than anticipated, it was also leaking profusely, so much that the patients dressing and bed were completely saturated. District nurses have stated that patient care can often be missed and/or repeated unnecessarily. This means that there have been communication breakdowns (Aitken et al 1999). Ovetviet (1993) says that an everyday communication problem is that too much information is necessary therefore the significant information often gets “watered down” in the bulk of it all. Information overload can be equally a barrier to effective communication as insufficient information.
Whilst working alongside the district nurse, I observed that the communication was excellent between the nurse and the patient, however I feel it lacked communication between other members of the primary care team. A minor example was when there was a problem in ordering dressings to get them in on time, I also observed some issues with respect to referrals from the hospital. It maybe the staff in the hospital are not fully aware of the specific need of information which is crucial to the district nurse.
Whilst visiting a patient who had several agency inputs the district nurse identified the communication breakdown which affected patient care either by omission or duplication. This then enabled a communication to be developed. The procedure was held in a ring binder and formed part of the patient care plan. There were however some positives I was able to take from my assignment with the Primary Health Care Team.
Reflecting on my experience of working in this context I did see the advantages of collaborative working through being able to provide continuity of care when a patient was admitted or discharged from hospital providing what I would describe as providing a seamless patient journey. I could see the benefits of continuity of treatment and the essential transfer of information.
The greatest benefit for me was the sharing of clinical knowledge and patient understanding and that patients could benefit from combined knowledge and skills in the new developing services giving them increased confidence in the services and reassurance that the patient needs are met. There are still barriers rooted in history and a “them and us” culture which means it comes to a head from time to time as the different agencies have different priorities.
A lack of resourcing in General Practitioners can bring blockages in the care process. The G P had competing pressures from the community, hospitals, patients and Patient’s families. My Primary Care Trust assignment brought me into contact with a couple of G. P. s in the area and through my interaction with them an seeing competing pressures at work I was able to form this view.
On attending a staff meeting with the district nurses, G. P. and social workers I felt it was an excellent opportunity for them to discuss problems, Roberts (1997) says rather than communicating via telephone conversations, maybe it would be more effective to have joint visiting, face to face interactions and regular meetings: communication was seen to be an important factor for collaborative working. The best experience for me on reflection was during my time spent at the walk in centre. These are centres that are nurse led where people can get advice for minor illnesses and minor injuries without an appointment. The idea is to help people to make the best use of health care services by educating and redirecting them to the most appropriate level of care.
The nurses that worked here had a broad range of nursing skills an experience, had excellent communication skills, where autonomous and had a good knowledge of the community and primary care issues. I feel that although staff here had developed excellent assessment skills, nurse training is very different to the training of what a doctor receives and that if mistakes were made it may leave them open to litigation. If anyone was unsure of a patients problem, all members would work extremely well together in order to decide either what was wrong or the
best course of action to take and where to refer them onto. Although Sinnes et al (2002) suggests a common criticism of walk in centres is that they duplicate existing services, the DOH state they are designed to provide a service that is complimentary to the service provided by G. P. s and are not intended to replicate or duplicate existing primary care services. Another positive example for me was Sure Start, Sure Start is a radical an innovative national strategy to improve services for children under four and their families.
Sure Start in North Huyton is a trailblazer programme and was established following approval of the delivery plan in January 2000. The intention of sure start is to build on and add value to local services for families through the provision of a more co- ordinated approach to the planning and delivery of health and social care for parents an carers where families are in great need, sure start will provide further support and advise on parenting, primary health, early learning, play opportunity and childcare.
Sure start schemes also involve parents in supporting literacy, numeracy and life skills training which can improve future employment prospects (Home Office 1998) and are premised on all agency collaboration. In accordance with the White Paper (DOTL 1997) it builds on existing local services and partnership working between voluntary and statutory agencies, local business, parents, community, voluntary primary health care teams, education and other care professionals within the community, provide an integrated service that concentrates resources on those in greatest need and promotes social change by addressing the deficiencies associated with law social economic status (Whitehead 1992. ).
I found sure start to be a help to families, single parents and foster parents. It can benefit the children in terms of education and can bring parents all in different situations together. I went along to baby massage, this was a group of mothers and their babies being taught the technique of baby massage, developing confidence in responding more sensitively to their children’s needs, and aiding attachment.
During this group session all the mothers were getting to know on another, one couple had met a few weeks previously and had exchanged phone numbers, they had now become good friends. I found this an excellent opportunity for the parents to make new friends. I also went along to an aqua tots group were all parents, sure start reps, and children played in the pool and sang songs which is educational for the younger children. In conclusion, clearly collaboration has many benefits and during my placement within the primary care I gained evidence to believe this. I feel that although there has been a range of legalisation which places a great deal of emphasis on a
commitment to partnership between multi-professional teams there is still confusion surrounding the boundaries of different services. Although the role of the nurse is changing to fully and actively engage in collaborative practice it is essential that they develop an understanding and awareness of the dimension and limitations of the dimensions and limitations of other members of the multidisciplinary team. During my placement, on the whole the experience was one of effective communication and collaboration but there is obviously room for improvement.