Developing Capability for Effective Collaborative Services

Developing Capability for Effective Collaborative Services

This assignment will focus on the perspective of the patient and carer, regarding interprofessional working, considering the strengths and limitations of interprofessional working. The factors that contribute to collaborative working, the formation of safe environments and services for patients and carers will also be explained. This will be accomplished by reflecting and using examples of my own experiences which have been observed through clinical placements and study during Interprofessional Education week. This will show my personal involvement and therefore I will be able to evaluate my own strengths and weaknesses regarding working collaboratively with other professionals. The Interprofessional Capability framework will be used to evaluate, and I have developed an action plan, detailing goals for the year ahead. In adherence with the Nursing and Midwifery Council (NMC code of conduct, 2015) all reflections will be amended so to respect confidentiality.

Patient and Carer involvement

The services for healthcare are developing everyday just like the professional’s roles who work within the services.  This will in turn improve patient centred care and will be more cost effective for health care services (Cross, 2006). There have been various recommendations for what would be most effective in order to improve our services; it is suggested that the people using our services are the focus and not the professionals (McCutcheon & Gormley, 2014).

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The Francis report explained the findings of the public enquiry into the staff and services at the Mid- Staffordshire hospital trust. It showed what can happen when significant factors in providing patient centered care aren’t present. The Francis report displayed a list of recommendations in order to improve the services and ensure that patient experience was to a high standard, working interprofessional to collaborate with others and making sure professionals communicated effectively (Francis, 2013).

Collaborative working can be identified as the joint establishment of services that are available by different providers. It creates bonds between different professionals who have different values and views on how care should be given and how they achieve patient centered care. By working alongside other professionals, it adds new skills, knowledge, improves communication and beliefs in order to accomplish goals that are set (Dawson, 2007).

To work professionally in any health and social care setting, it is essential that professionals collaboratively work together. According to (Williams, 2017) he suggests that it is vital that professionals work collaboratively as it is an influential resource. This is because funding for the NHS does not compete with the increasing population which in turn means that the NHS will be reliant on collaborative working.

Communication can be a multifaceted, but it requires skills and knowledge to make sure its effective as it is a key competence for the best delivery of care for patients using the service. Through communication we can outline the discussion of information, feelings and thoughts amongst people using verbal and non- verbal communication. As nurses we need to be able to interact with patients, which is a two-way process (L. Kourkouta, et al 2014).  An important subject is that healthcare professionals are educated in healthcare services and inter- professional working. This ensures that professionals know how to interact with each other on placement or at university (K. McPherson et al 2001). There are numerous barriers to communication, one being when the message does not reach the person it was intended, thus creating error (K.E. Rosengren 2000).

The Francis report (2013) highlighted the poor communication between professionals, patients, carers and families. This has promoted change, underlining how important it is to have patient and carer involvement and for professionals to strive for patients to have a choice in their care. By having patient choice, it actively includes the patients in their journey, they can have a say in their treatment and care plan. By including families and carers in the patient’s journey it makes it more effective. Thomas, J (2017) contends that this is an imaginary theory rather than professionals applying it to practice in everyday life, however through my experiences on placement I disagree as I feel the patients feel as though they are being treated as a person rather than just another patient.

During placement I have witnessed how collaborative working and patient involvement has a massive impact on how services run. Consequently, potential barriers are removed through positive interactions. This year, I was placed on a Gynecology ward which collaborates with the Early Pregnancy unit. They provide ultra- sound scans for patients on the ward, also ensuring education, advice and support.

I have had the opportunity to witness scans and the challenges that arise when working with a specific patient group for the patient, their family and the nurses involved. For example, the patient could receive good news where everything with the pregnancy is progressing well but on the other hand a patient could receive bad news for example an ectopic pregnancy could have occurred where the pregnancy is growing in the wrong place. Subsequently, I have learnt that effective communication is the basis for a therapeutic relationship to be formed between the patient and nurse (L. Kourkouta et al 2014). Being told you don’t have a vital pregnancy can be a very difficult time for both the patient and their partner and I noticed that they require a lot of support and advice from the nurse.

Building a therapeutic relationship with patients and having exemplary communication skills plays a crucial part in this role. A couple of weeks into my placement I observed a patient who had come onto the ward for an operation. The patient’s first language was Lithuanian, and she had very poor English. She communicated through her daughter. By doing this, it overcame the communication barrier and it worked successfully. It became evident that it was harder to create a therapeutic relationship with this patient due to the language barrier.

Effective collaboration for safe and effective services

When working within a team of professionals it is vital that people communicate effectively, listen, work as part of a team, respect each other’s opinions and have a shared understanding of one another in order to have active collaborative practice. An important factor is that all professionals have goals, and everyone follows the same guidelines and protocols. To make the patient experience the best it can be, professionals need to ensure that when referring patients to other teams and services, for example; about the patient’s background to create a picture of what the problem is. Team work can only be achieved if every member understands their role and everyone else in the team’s role. For a team to achieve goals they need to certify that they have an objective they are aiming towards (Mosser and Begun, 2014).

On the other hand, effective collaboration cannot always be achieved. Greatrex (2001) states that the hierarchy of staff, for example: band 5 nurse to a band 6 sister can sometimes be a barrier to working collaboratively as people do not always want to work as part of a team. Dawson, S. (2007) suggests that the absence of collaboration affects the result of the patients experience and staff often segregate themselves from each other. When team members can’t communicate with one another it affects the way services are run and makes them less safe for the patients and staff. The Francis report (2013) stated that communication was one of the most important factors when communicating with patients and families in order to achieve a partnership.

I have seen the difference between poor collaboration and respectable collaboration. Poor collaboration can lead to problems arising such as miss- communication and information not being relayed from other interventions between professionals. The most reliable way to document patient records would be for all services to use the same system but this differs depending on what trust you work for. A ward may use Lorenzo, but the patients GP may use system one which means the nurse won’t be able to access any of the patient’s information from the contrasting system. This results in miscommunication between primary and secondary care.

The patient in question was referred after an appointment at their GP practise. When my mentor was reading the referral, it was evident that there wasn’t a lot of information about the patient’s problem or their medical history. The patient was 6 weeks pregnant, dehydrated and vomiting. The medical term for dehydration in pregnancy is hyperemesis. The patient was unsure of the cause or problem, subsequently my mentor explained. Hyperemesis is known to be caused by a sudden increase in the hormone called human chorionic gonadotropin (HCG).  Anti- emetics and IV fluids can be given to patients suffering with hyperemesis (MedLine Plus, 2018).

The patient was unaware she should be drinking on average 10 cups (2.3 litres) of water a day (Desjardins, E. 2016). My mentor relayed this to the patient and contacted the consultant to come and examine the patient. She admitted the patient providing 2 litres of fluid before allowing her to go home.

This observation was a good learning experience as I saw how working together with the patient and the multi- disciplinary team can support management in pregnancy and it shows how the theory of relationship centred care is used in practise. I also witnessed how uneducated people are and how a lack of confidence can affect how they participate fully in their care during pregnancy. In the future I will reflect on this observation, when referring patients to other professionals and teams and how essential patient and relationship centred care is for the professional, patient and their families regarding managing their symptoms or illness.

Service environment & policy drivers for collaborative practice

For services to work there needs to be some guidance, this is where policies come in. Policies allow professionals to work together safely and effectively. Policies set standards that professionals need to abide by, ensuring best patient centred care. The Department of Health aimed for the NHS to have a plan to ensure that practises across the UK were modernised by putting the patient first. (Department of Health, 2000). By having greater choice and more control over their care (no decisions being made without their consent) supports the concept of patient choice and involvement by giving them more options, which will result in a better outcome. Policy drivers are used to aid staff in healthcare so that all needs of the patient are met.

The environment in which we work has an impact on how professionals work collaboratively. For example, on a ward issues that can arise are, access to scans, the size of the ward, staffing levels and the services available. If issues are present it creates potential barriers to care (Renate, A. 2014). One thing I have picked up on in practise is the way the ward is laid out. There are a certain number of bays and single rooms to make sure staff and patients are protected from infection. By having fewer patients in bays and single rooms available it makes the patients stay more private.

A further observation is that staffing levels need to be maintained for the ward to be safe for both patients and staff. On numerous occasions, the ward has had no capacity for more patients as there hasn’t been enough staff present, this can also increase the work load of nurses on shift resulting in poor time management.

I have seen how professionals work depending on their environment and how the use of policies benefit or limits staff in certain situations regarding helping a patient’s experience be enhanced. As mentioned before the ward works closely with The Early Pregnancy unit. Often patients get admitted to the ward if they need further blood tests or they need to be seen by a doctor. I oversaw admitting this patient onto the ward, which an easy process as the ward is connected to the unit, so the patient was reviewed by a doctor and a plan was put in place. The patient was informed of everything that was being discussed throughout the process.

The care plan I have used is for patients on the gynaecology ward with cancer; e.g. ovarian cancer and cervical cancer. Patients come to the ward for either pain management or end of life care. All professionals contribute to the care plan for the patient ensuring collaboration. Challenges can arise for professionals when dealing with an end of life patient; however, it is essential for the patient and their family to know that the professionals caring for them understand each other’s role so that no mistakes can occur (Alsop, 2010).  A patient’s family member could inform one of the nurses that the patient is in pain and needs some analgesia. The nurse can then look in the care plan and see what regular medication the patient is on and how their pain is controlled. The care plan is there for guidance for each professional that deals with the patient. The environment is a big part regarding patient safety and comfort. All cancer patients that are admitted to the ward are given a single room, so they have privacy and it allows family members to stay over. They are also isolated from other patients which makes the patient less prone to infection. Patients during end of life care need as much support as they can get which is why having the opportunity for family to stay makes their journey more bearable. 

 

Personal development

Mosser and Begun (2014) suggest that it is a vital part of education that students have the correct interpersonal skills needed during their training. During my academic learning it has been highlighted that due to the separation between placement and university, student’s team work skills suffer. During IPE week we had seminars where we were able to find out about different professions and what their role entails. After these sessions our lecturer asked us to reflect on what we thought our strengths and weaknesses were when working in a team (linking it to placement and relating to the tasks in IPE week). The capability framework is a learning utensil where students can highlight weaknesses and strengths, they think they have regarding team work and their professional development. I have reflected on my IPE assignment from last year and found that I feel I have more knowledge this year secondary to a ward placement.

I was able to use the skills I have learnt on the ward and apply my knowledge when delivering care to patients. I can identify my strengths and weaknesses during placement, for example, I noticed that a patient had only passed 50mls of urine through her catheter in 4 hours. Following the correct protocols, I informed a senior as a patient should be passing 30mls per hour. I was nervous to bring this to their attention, but I had to think of the patient. Last year I wouldn’t have had the confidence or skill set to do this (Domains OC2 and CW3 from my action plan are related to this scenario).

During IPE week we were put into groups which were made up of students from different professions. The goal was to develop a presentation. I wasn’t looking forward to this as I don’t like talking in front of large groups. There were some strong characters within my group and one was allocated the team leader role. I didn’t know my place within the group as our roles were not discussed with each other which did aggravate me when trying to get my opinion across. As time went on, I still didn’t know what our finished product was going to be, so I continued to get on with my part (discussing a nurse’s role in a case study we’d been given). After we had presented, I felt there was areas I needed to improve, for example, talking louder. On the other hand, if there had of been a clear structure for me to follow, I would have felt more comfortable. From this experience I learnt that I need to have the confidence to speak up and be involved in making decisions. Domains R1 and R3 (see capability framework) can be applied to this experience.

For me to personally develop and continue to work collaboratively as part of a team I have created an action plan which reflects on my time on placement and in university (seminars and lectures). I have also used the inter-professional capability framework (CUILU, 2004).

Action Plan

Personal objective relating to Interprofessional capability

Priority

Target date

What specific actions/resources are needed?

Evidence of success

Review date

Collaborative working capability R3

To gain more confidence to contribute and voice my opinion in group tasks, IPE week and on placement.

High

On going

Practise speaking to small groups first to gain confidence, then enhance the size where I can. Speak up in front of a group of people I don’t know e.g. IPE group.

I will ensure that I will be confident in handing over patients to the next nurses on shift.

Ensure that I try to voice my opinion and management skills to other members of staff whilst on placement.

 Personal diary of the goals I have achieved throughout the year.

Testimonies from members of staff.

Contributing towards conversations with senior members of staff.

Beginning to hand over patients in second year to get ready for my third year.

Visits to different clinical areas to show my own initiative.

May 2019

Collaborative working capability CW3

When on placement ensure I have back ground knowledge and use the resources from members of staff i.e. books to enable me to speak confidently with patients and their families.

High 

On going

Arrange visits to gain more knowledge, e.g. visit gynaecology clinic so I have a range of knowledge surrounding my placement area.

Ensure I access all the relevant opportunities that arise for me to go on, i.e. training days whilst on placement.

Certificates of achievement.

Reflections from placement regarding thoughts and feelings towards experiences I have encountered.

Visit pages filled out to show attendance of different visits I planned.

Ensuring that I continue to read up to date research on my clinical area.

February 2019

Collaborative working capability CW2

To ensure I contribute when I can in giving other professionals information in regard to patients to enhance communication skills.

Medium

January 2019

 Ensure I go on ward rounds with the consultants and doctors.

Refer patients to other clinical areas.

Discharge patients where I can and explain what medication they are going home with and why.

I have gained feedback from other professionals e.g. when discharging patients.

Making notes of what I thought I’ve done well and what I could improve.

March 2019

Collaborative working capability OC2

To improve my teamwork skills and have a clear understanding of the roles of the members involved.

High- Medium

On going

Introduce myself to the team as I won’t have met them before.

Find out how different roles collaborate when working with the same patients.

Answer any questions the team may have.

Face to face feedback from mentor and other staff members from different professions.

Testimony on my progress from my hub mentor.

Testimonies from other staff members to go towards my portfolio.

February 2019

Collaborative working capability OC3

To develop my management, leadership and critical thinking skills to prepare for final year.

High

January 2019

Work alongside my mentor to delegate staff member’s tasks and teams to work with when required

Ask for help and advice when unsure.

Have

responsibility of

looking after my

own patients and

their care

pathway under

the supervision

of my mentor.

Testimony from mentor on how she thinks I’ve conducted myself.

Patient testimonies on how well I’ve worked with them.

January 2019

Action plan word count: 543

References

Alsop, A. (2010). Collaborative working in end-of-life care: developing a guide for health and social care professionals. International Journal of Palliative Nursing. 16, 3,120–125.

Communication in nursing practise L. Kourkouta et al 2014

Cross, S. (2006). Supporting an evolving nurse role. Practice Nursing. 17,9, 420–422.

CUILU. (2004). Interprofessional capability framework. Sheffield Hallam University

Dawson, S. (2007). Interprofessional working: communication, collaboration…perspiration! International Journal of Palliative Nursing.

Dawson, S. (2007). Interprofessional working: communication, collaboration…perspiration. International Journal of Palliative Nursing. 13,10,502–505.

Department of health (DH). (2000). The NHS plan. Retrieved from: http://navigator.health.org.uk/content/nhs-plan-plan-investment-plan-reform-2000

Francis, R. (2013). Francis Report. Retrieved from: http://webarchive.nationalarchives.gov.uk/20150407084003/http://www.midstaffspublicinquiry.com/sites/default/files/report/Executive%20summary.pdf

Greatrex, B. (2001). Infection surveillance scheme: collaborative working practices. British Journal of Nursing. 10 ,5, 306–311

How much water should you drink during pregnancy?BY ELLEN DESJARDINS, M.H.SC., RD, PUBLIC HEALTH NUTRITIONIST | AUG 11, 2016 https://www.todaysparent.com/pregnancy/how-much-water/

         How nurses and their work environment affect patient experiences of the quality of care: a qualitative study (2014)

Hyperemesis gravidarum – https://medlineplus.gov/ency/article/001499.htm

McCutcheon, K & Gormley, k. (2014). Service-user involvement in nurse education: partnership or tokenism? British Journal of Nursing. 23, 22, 1196–1199

Mosser. & Begun, J, W.(2014). Understanding teamwork in health care. McGraw-Hill Education. London, New York

NMC (2015). The code.   https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf

Renate AMM Kieft, Brigitte BJM de Brouwer, Anneke L Francke,and Diana MJ Delnoij

SHEFFIELD HALLAM UNIVERSITY (2014). Inter Professional Capability

Thomas, J. (2017). Setting up recovery clinics and promoting service user involvement. British Journal of Nursing. 26, 12, 671–676 

Williams, H. (2017). Collaborative working will enhance patient care. Journal of Kidney Care. 2, 3,132–132.