Reflection On Inter-Professional Working In Healthcare

Importance of patient involvement in communication

An operative teamwork is important for the safety of the patients as there is a minimal occurrence of adverse events. These events might be as a result of misunderstandings and miscommunication among the health specialists when caring for the hospitalized individuals. The patients are required to be part of the process of communication as their healthcare is of interest; the patient’s prompt and throughout participation in communication has helped minimize possible adverse outcomes as well as errors (Durham and Alden 2008). Reflection is considered as a good exercise in the medical education, reflection advances the practice in the disciplines associated with public health. Reflection also contributes to learning, and the learning is thought to contain social and emotional dimensions as well as intellectual dimensions (Jeffs et al 2013).   The Gibbs’ Model is a theoretical reflective cycle that students use as an outline in reflective writing coursework. In this reflective writing essay, I will use the six stages of the Gibbs’ Model to describe my experience during the trial placement in two hospital wards in the west of London, the stages are: Description – I will explain what happened, feelings – I will narrate my thoughts and feelings about Inter-professional working, evaluation – I will state what is good and dad about the experience of working in an Inter-professional learning set, analysis – I will describe the sense I derived from the Inter-professional learning set situation, conclusion – describe what else I would have done and action plan – narrate what I can do if the situation of Inter-professional working arose again (Scaife 2014).

I was part of the students’ group that undertook a trial placement in two clinical wards west of London from August to November 2017, this placement comprised of ten rounds each taking a period of two weeks. Our group had 25 participants; eight nursing students, seven medical students, 3 nutrition student, 4 pharmacy students, 1 social work student and 2 occupational therapy students. During the daytime shifts, two teams of students one for a nursing student in the third year and the other for a medical student in the fifth year were accountable for the management of patients in the two ward beds that dedicated in each of the settings. I was part of the nursing team, we were supervised by a clinical education facilitators from both the nursing and medical disciplines and they had been trained in teaching inter-professional working (Sullivan and Garland 2010). We planned and managed care, assessed the patients as well as conducted referral, investigations and discharge. We handed the responsibilities back to the healthcare staff at the end of the day, the organizers then held a student interrogation (Graban 2011).

Application of theory to practice

A total of 8 nursing students and 7 medical students participated in this placement trial, in the rehabilitation ward where I was assigned, we (the main nursing students) were helped by the other professional students when the need arose and when it was advisable this enabling provision of safe and quality care to the patients. This placement also involved other 10 students from various professional fields (pharmacy, social work, occupational therapy, and nutrition). A registered nurse organizer was responsible for overseeing us during our patient management process (Sullivan and Garland 2010). We (students) participated in the unit meetings and medical rounds and the formal response was offered to each student via case presentation and debriefing.

I felt so privileged at the time, attending such an educative placement with my fellow pr student professionals provided a clear understanding of quality and safe health care for the patients. Interacting with the medical students as well as students from the other professional fields offered a clear view of the patients, their requirements and how to involve the patients in communication to avoid adverse health outcomes (Morse 2016). I felt confident interacting with the medical professionals and was able to figure out the various aspects associated with error occurrence when nursing the patient and how this aspect can be avoided to ensure effective patient care. I felt an urge to start a campaign asking the medical professionals to enhance inter-professional working not forgetting the involvement of the patients in their treatment process to reduce or eradicate the cases of adverse medical outcomes. I also felt the need for more teamwork participation and training programs for inter-professional working to enhance my inter-professional working skills (Benner, Hooper-Kyriakidis and Stannard 2011).

During the placement, the experience of inter-professional learning was greatly explored through teamwork. The evaluation focused on the type of the inter-professional prospects available, how patient care and different healthcare professional understanding might be advanced, and the contribution of the learning experiences to the developments of the professionals (Sherwood 2011). From this learning set of inter-professional working, I was able to understand the bad and good of the experience of working in an Inter-professional learning set. During my placement, I was able to gain a better understanding of inter-professional learning and its significance in the medical field, this was through the discussions of the learning options we might consider as students, and the practical experience gained through the presentation of patient cases as well as the formal response provided to each student during the debriefing session. On the latest day of the trial placement, we were asked to give feedback of the entire learning experience through a questionnaire and a focus group, we were then requested to finish a satisfactory review; the Inter-professional Clinical Placement Learning Environment Inventory (Lemieux-Charles and McGuire 2006).

Benefits of inter-professional working

The good of working in an Inter-professional learning set

As we discussed the common goals for the patient cases and how we could achieve a better goal for patient care, a number of benefits of the experience were discovered this include:

1. Increased knowledge of the role of each one of us in contributing towards patient care
2. Students are comfortable with the joint learning experience

• Students’ better understanding of when and how to refer to the other medical disciplines (Choi and Pak 2006)

1. Improved team approach and multidisciplinary working
2. Students’ better reflection on inter-professional practice educational teams as part of the students’ evidence portfolio. As a nursing student, I will use the evidence to subsidize the achievement of my proficiencies and outcomes.
3. Increased effective care and better communication, precisely in the planning of the care and discharge (Bridges et al 2011).

The bad of working in an Inter-professional learning set

The inter-professional learning experience had some failures, which include:

1. Failure of some students to make use of the available opportunities
2. The challenge of the availability of the facilitators for the students undertaking the inter-professional educational experience

• Difficulty in finding opportunity and time to gather all the students with an organizer to reflect the students’ experiences

1. Students undertaking different disciplines may not be available on the placements concurrently for a long time (Finkelman and Kenner 2009).

From the inter-professional learning experience, I was able to gain various aspects that enhanced my sense of thinking and understanding of the patient care (Freeth 2010).

Team-Based Health Care principles

In my experience during the inter-professional learning, I think the principles that make a successful healthcare team include;

1. Service users: I presume that the service users are the medical professionals, the social workers, and the patients. As the service users, for effective inter-professional practice, we are expected to be honest with each other there should be transparency within the team members for development of a mutual trust. From my point of view the service users are expected to be disciplined and stick to their protocols and standards, the users should also have a high sense of humility and be able to understand that mistakes can be made therefore we should recognize a way to avoid failures. Effective communication is another crucial aspect we are expected to follow for successful teamwork, we should continuously refine and prioritize our communication skills (Lewis and Stone 2007).
2. Leadership: from my point of understanding the leaders coordinate, facilitate and coach the other members of the team, therefore, an active leadership is a crucial characteristic of an operative team. Our team leaders are expected to state and describe the accountabilities, functions, and responsibilities of each member in the group and ensure that there is a fair division of labour which is followed by all members in the group to the later (Meads et al 2008). The leaders also lead the members in encouraging and accepting a variety of thoughts among the team members. I also believe that the leaders should ensure there are discipline, honesty, and effective communication among the members and set punishments for those who go against the policies of inter-professional working (Edmondson 2003).

Empowers team members, increased emphasis on inter-professional work in practice; associates of the medical team for the patients such as radiologists, social workers, specialists from other medical disciplines, EMTs and nurses are empowered to give endorsements on patient care (Chappell 2014).

Teamwork Closes communication gaps when all health-care and medical specialists are collaborating, an efficient communication environment is attained. Increased collaboration has enabled medical practitioners to interact at a more personal level, working together and brainstorming on how to treat patients, this ensures continuity of patient care (Von Fragstein et al 2008). 

Teamwork enables complete patient care, collaborative working with professionals ensures comprehensive patient care, as there is improved understanding of the needs of the patients. Teamwork also minimized readmission rates, reduction of communication gaps and improved patient care outcomes for the admitted patients have been better. Inter-professional collaboration minimizes problems associated with patient care, increased inter-professional collaboration has enabled effective patient treatment in the first round (Glasby and Dickinson 2014).

Inter-professional working promotes a patient-centered care, inter-professional collaboration begins with inter-professional education, training health-care and medical students on effective working ensure their collaboration and the workplace. Teamwork also promotes team mentality, professionals working together support one another and brainstorm with one another, this encourages and raises the morale of companionship (Mitchell et al 2012).

From my point of view, I think a successful team is made of;

1. Curiosity: the members are devoted to reflecting upon the ideas learned in their everyday activities.
2. Honesty: effective communication is crucial to the team and this includes transparency about the decisions, mistakes, uncertainty, and aims in the practice. Honesty is essential in developing and keeping the mutual trust that is a requirement for a team that is high-functioning.
3. Humility: the team members rely greatly on each other for the recognition and avoidance of failures, irrespective of their position in the hierarchy.
4. Discipline: there is great discipline among team members for development and maintenance of their protocols and standards (Mitchell et al 2012).
5. Creativity: the team members are motivated in tackling emerging complications creatively. They view errors and unexpected adverse effects as possible improvement opportunities.

From my understanding, I think the roles of the team have a greater impact on inter-professional practice, these team roles are;

1. A discussion I conducted with my team members revealed that responsible, collaborative and responsive communication among the team members as well as honest and open communication is important and one of the main factors of the team. Professionals are required to account for each other’s point of view, be dignified, respectful and to listen to one another without criticizing each other. Constructive criticism is required to be accepted together with constructive encouragements and suggestions and this should be conducted when the other specialists are interested (Bajnok et al 2012). Active listening is considered a vital skill, in order to identify and reply to conversations an individual has to listen actively. As a nursing student, I should learn other new ways of sharing information with the other professional sets such as by the use of communication and information technology
2. From working with my team members, I discovered that the team members should value and integrate the patient in the treatment process as the patient’s health is of great interest, the family members should be involved too. Patients give a clear direction of how they are feeling and this will allow the nurse understand on how to take care of them, the prompt and continuous contribution of the patient in the treatment process enables avoidance of some adverse outcomes and potential errors. The team members shoved effectively involve themselves and the others as well as the patient’s family and the patients themselves in addressing emerging disagreements to avoid adverse outcomes (Secretary of State for Health 2008).
3. Team members should comprehend their roles and that of the other specialists and apply this knowledge properly to develop and achieve better outcomes for the patients. I believe that each specialist has the role to play in patient care, therefore, the team members should collaboratively work on ensuring all the requirements are given to the patient by the relevant professional. The team members should also recognize and apply the principles of leadership that support the cooperative practice, they should understand the shared decision-making principles and be able to conduct collaborative working in the determination of the appropriate team leadership at any given circumstances (Marquis and Huston 2009).

What happens in teams for instance; change of decision, risky shift, obedience, conformity, and groupthink.

I presume that Group Think introduces a risk; this is because decisions are based on what all the team members know and individual ideas are inhibited. Therefore, the opposition is discouraged, and the team tends to approve greater risk decisions than in the case of an individual, this is referred to as “risky shift”. The leaders in the team tend to come up with strong arguments and are able to voice the arguments, the comments, therefore, are based on forming the opinions and the development of the discussion’s framework (Adair 2007).

Failures of inter-professional working

The size of the group should be enough to ensure the fair and adequate division of labor for effective patient care. I think enough nurses and other professionals ensure adequate patient care allowing prevention of nurse-sensitive outcomes (for instance the UTIs and hospital motility rates) that may be associated with the staffing level (Drinka and Clark 2000).

Team values and motivation encourages Interdisciplinary teamwork, which ensures the improvement of the quality and continuity of healthcare, and this has resulted from shared learning and multi-professional working. It occurs to me that, the increasing complication of knowledge and skills needed to provide a comprehensive patient care encourages the creation of team values and motivation. The growing specialization within the health specialists and the corresponding division of disciplinary familiarity that leads to no-one healthcare specialist encourage the interdisciplinary teamwork for the provision of quality patient care.  I think power and status have some impact on inter-professional practice as the policies created to make the team members comply with the requirements of teamwork (Neumann et al 2010).

There have been several barriers I discovered, that obstruct strategies for improving teamwork and team working they include:

1. Changing settings – changing the health care nature, for instance, increased delivery of care for conditions that are chronic require the modification of the present teams and the creation of new teams.
2. The individualistic state of health care- healthcare professions, for instance, medicine, nursing, and dentistry require a one-to-one association between the patient and the care provider and this is greatly challenged by the ideas of shared care and teamwork
3. Changing roles- the cases of overlap and change in the roles of various health-care specialists poses challenges to the teams in relations to role allocation.
4. Team instability – some teams are temporary in nature, and they only come together for a particular event, for example, the trauma teams
5. Resolving conflicts and disagreements- the capacity to resolve a disagreement or conflict within the team is an essential aspect of a successful team. This can be of great challenge in highly hierarchical teams or to the new members of the health team.
6. Failing teamwork results in accidents – there are three types of teamwork deteriorations I came to realize when working with my team members and they are; miscommunication, unclear classification of roles and lack of open coordination. This poses a great challenge to inter-professional working (Grol et al 2007).

From working with my team members I came to learn that communication is a crucial element in ensuring an effective and successful teamwork, I believe that effective communication is an essential aspect of ensuring an effective team. There is the need for transparency among the members about the mistakes, decisions, uncertainty, and aims of the care practice. Honesty ensures the creation of a mutual trust and maintenance of the trust within the care professionals.  Effective communication is also crucial in managing and resolving of conflicts within the team, I believe that with clear communication and interactions the team members are able to put behind the stereotypes they have about one another and work together in a peaceful environment (McPherson, Headrick and Moss 2001).

The basis of inter-professional working is inter-professional education through training in the healthcare systems. The significance of collaborative learning has been emphasized by the Government in the NHS plan. Participating in the placement trial enabled me to understand that, inter-professional education significantly enhances the confidence of the pre-registered specialists at the workplace. Inter-professional education is described as students from different professions learning collaboratively from and about each other, this practice is useful in enhancing self-awareness and development in the inter-professional collaboration experience (Reeves et al 2013).

Principles of successful healthcare teams

Personally, I gained a lot of knowledge from the medical assignment and would love to participate in more similar learning experiences to enhance my practical skills in inter-professional working. The informal interactions that occurred amongst me and my fellow professional students helped in the strengthening of our inter-professional education experience as we worked at the medical center. I hope the next time I am able to approach the other medical professionals (apart from the fellow students) within the wards and ask more questions about inter-professional working to gain more knowledge from their point of view as well as have a clear understanding of their specific roles within the medical center and emulate their way of working (Bennett, Blanchard and Fernandez 2011).

Before the next trial assignment, I need to conduct a background study of inter-professional working at the two wards in the west of London and gain a better understanding of the specific roles of each of the professionals (especially the registered nurses in this wards) as well as identify the various barriers hindering teamwork in the wards. I will ask my supervisor of the competent ways of gaining the inter-professional education as it is the key to effective inter-professional collaboration (Koshy, Koshy and Waterman 2010).

The Gibbs cycle has enabled me to make sense of the of the inter-professional working experience reflective discussion, it has allowed me to put my ideas in an understandable manner. The Gibbs module has helped me gain an understanding of the difficult situations in the essay through alleviating anxieties. The module has enabled me to share the ideas of the experience gained from inter-professional learning sets from my point of view with the other professional students effectively (Timmins and Duffy 2011). I have greatly gained from this reflective writing; teamwork and clinical governance are critical aspects towards healthcare quality improvement, as a nursing student I have explored the inter-professional working in detail and by reflecting on the ideas I gained, I have acquired new attitudes and skills.

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