Collaborative Working Social Work Essay

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New how does an interprofessional approach enhance patient care

How does an Interprofessional approach enhance patient care?

This essay will explore the Interprofessional working relationship between two healthcare professionals working on a urology ward. An Interprofessional approach is the relationship between two or more professionals working together, combining their skills and knowledge to enhance the package of care given to the patient or client. (Barrett et al 2005)

The case in question involves a staff nurse and a dietitian, it will look at their roles, the bodies that govern their professions and the competencies and standards that they have to adhere to. It will determine whether they followed the standards set out in their codes of conduct and consequently whether the package of care given to the patient was enhanced by the cooperation and collaboration demonstrated.

The role of the staff nurse is the promotion and maintenance of health, the prevention of ill health and to provide care during illness, rehabilitation and dying. (Hinchcliffe et al 2003). Nurses have to be registered with the Nursing and Midwifery Council (NMC) and they have to follow the NMC code of professional conduct, performance and ethics (2004).

Dietitians identify problems with nutrition, assess the nutritional status of patients, develop care plans and monitor the effectiveness of dietary changes. The title Dietitian is protected by the Health professions Council (HPC) and they have to comply with the HPC Standards of Conduct, performance and Ethics (2003) and the standards of proficiency: dietitians (2003). A dietitian is one of the thirteen protected titles governed by the HPC. (The British Dietetic Association 2006)

In accordance with the NMC code of Conduct (2004) and to protect the innocent, the names of the patient, staff and the hospital trust will remain anonymous. For the purpose of this essay the patient will be known as John.

John was admitted to the ward for a procedure called a transurethral resection of the prostate (TURP) this is to reduce the size of an enlarged prostate. (Shannon, 2000) In the staff nurse’s initial assessment she established that John had lost a significant amount of weight since the recent death of his wife. As part of the hospital trusts’ risk assessment policy she discovered that his nutritional score was eleven, (see appendix 1) which put him at high risk. John also had a grade three pressure sore on his sacrum, from a previous hospital admission. The staff nurse documented that John’s skin was to be examined once a day and he was to have a pressure reducing mattress. The nurse explained to John that she was referring him to a dietitian for further nutritional assessments and advice, this follows Department of Health guidelines set out in a paper called The NHS Plan (2000, p.4) which stated "The NHS will shape its services around the needs and preferences of individual patients, their families and their carers."

The dietitian visited John on the ward the next afternoon, during the assessment the dietitian screened John and found that he was at risk of developing malnutrition. The Concise Medical Dictionary (1992) defines malnutrition as a condition caused by an imbalance between what an individual eats and what is needed to maintain health. The dietitian also took into consideration the pressure sore John had on his sacrum as this would increase body metabolism, which, if left untreated could result in further weight loss. (DeSanti 2000) After identifying John’s dietary likes and dislikes the dietitian prescribed fortified sip feeds, these are nutritionally complete drinks given under medical supervision to help patients who cannot benefit from a normal diet (Nutricia Clinical 2006)

The dietitian and the staff nurse discussed John’s condition and they agreed to keep a full and strict food diary of everything John ate and drank (see appendix 2), the dietitian also asked for John to be weighed daily and measurements of his mid upper arm circumference were to be taken twice a week and documented.

Throughout John’s hospital stay the nurse and the dietitian continued to co-operate effectively to aid his recovery. They both adhered to their respective codes of conduct, by doing this they minimised any risk to the patient, they demonstrated integrity and professionalism, showed respect for the autonomy, dignity and privacy of the patient and always gained his consent before any care or treatment was delivered. They illustrated a duty of care and acted in the best interest of the patient at all times.

John and his family were also successfully involved in his plan of care, thus following the government guidelines highlighted in the Making a Difference paper in which they stated, "Collaboration and partnership needs to extend to patients, their families and carers."(DoH 1999, p.71) Encouraging John to be actively involved in his care plan and allowing him to make decisions enabled him to feel in control and assured him that he was receiving optimum care and treatment. The staff nurse also adhered to The NMC Guidelines for Records and Record Keeping (2005) by accurately documenting all treatment and care given to the patient.

The successful collaboration between the staff nurse and the dietitian enhanced the package of care delivered to the patient. A mutual respect for each others professions was clearly apparent as they successfully crossed their traditional boundaries, working closely together, sharing knowledge and skills and learning from each other in order to aid the recovery of the patient. As a student nurse on my first clinical placement this was an outstanding example of Interprofessional working in which I have learnt that communication and collaboration is the key to successful and seamless delivery of care, I have gained knowledge about other professionals’ and their involvement in caring for patients.

In conclusion, this essay has looked at the Interprofessional working relationship between a staff nurse and a dietitian. It showed that they both followed their respective codes of conduct and standards of proficiency. It has demonstrated that by working together, sharing their knowledge and combining their individual specialities the package of care delivered to the patient was greatly improved. As a result the preparation and consequent recovery from the operation and the gradual healing of the pressure sore was a complete success, thus agreeing with the statement in the DoH Making a Difference paper (1999, p.70)

"Effective care and treatment is the product of team effort."

Reference List

BARRETT, G. SELLMAN, D & THOMAS, J (2005) Interprofessional Working in Health and Social Care. Palgrave Macmillan. UK

CONCISE MEDICAL DICTIONARY (1992) Oxford: Oxford University Press

DEPARTMENT OF HEALTH (1999) Making a Difference: Strengthening the Nursing, Midwifery and Health Visiting Contribution to Health and Healthcare. DOH: London <http://www.dh.gov.uk/assetRoot/04/07/47/04/04074704.pdf> (Accessed 3rdApril 2006)

DEPARTMENT OF HEALTH. (2000)

The NHS Plan: A Plan for Investment. A Plan for Reform. London: DOH <http://www.dh.gov.uk/assetRoot/04/05/57/83/04055783.pdf>

(Accessed 1st April 2006).

DEPARTMENT OF HEALTH (2001)

Working Together – Learning Together: A Framework for lifelong learning for the NHS.

London: DOH < http://www.dh.gov.uk/assetRoot/04/05/88/96/04058896.pdf>

(Accessed 30th March 2006).

DESANTI. L. (2000) Involuntary weight loss and the non-healing wound. Advanced Skin and Wound Care, 13,1 pp11-20

HEALTH PROFESSIONS COUNCIL. (2003)

Standards of Performance and Ethics: Your duties as a registrant .London: HPC

<http://www.hpcuk.org/assets/documents/1000062CHPC034HPCA5_Standards_of_conduct_performance_and_ethics.pdf> (Accessed 19th April 2006).

HEALTH PROFESSIONS COUNCIL. (2003) Standards of Proficiency: Dietitians <http://www.hpcuk.org/assets/documents/1000050CStandards_of_Proficiency_Dietitians.pdf> (Accessed 12th April 2006)

HINCHCLIFFE, S. NORMAN, S & SCHOBER, J Nursing Practice and Health Care. 4th ed., London: Hodder Arnold

NURSING AND MIDWIFERY COUNCIL. (2004) The NMC Code of Professional Conduct: Standards of conduct, performance and ethics. London. NMC

NURSING AND MIDWIFERY COUNCIL. (2005) The NMC Guide for Records and record Keeping. London. NMC

NUTRICIA CLINICAL (2006) Sip feeds <http://www.nutriciaclinical.co.nz/pages/a_standard.asp?aid=-779303793> (Acessed April 19th 2006)

SHANNON T (2000) Transurethral Resection of Bladder Tumours

<http://www.hollywoodurology.com/pages/turbt.html> (Accessed 12th April 2006)

Source: Essay UK - http://www.essay.uk.com/coursework/new-how-does-an-interprofessional-approach-enhance-patient-care.php


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Working in Partnership in Health and Social Care essay part 2

Working in Partnership in Health and Social Care essay part 1

Finally, there are private health and social care models that are funded entirely by private investors. In such a case, the health and social care lies under the full responsibility of privately owned organisations but the government agencies still have the right to monitor their performance to prevent the risk of the violation of human rights of patients or their abuse.

However, as a rule, private health care organisations that also provide social care services are responsible because they are interested in the maintenance of the positive public image to attract more customers. Such health and social care organisations often have their own system of monitoring and control to ensure that their health and social care professionals provide patients with care of the high quality. Nevertheless, the government regulatory and controlling agencies should still keep such health and social care under control because there is still a probability that they may develop a negligent attitude toward their professional duties that may lead to such cases as was the case of the Mid Staffordshire NHS foundation trust and Adult A.

Furthermore, today, the partnership in health and social care are regulated by the Health and Social Care Act of 2012, which regulates health and social care services and creates legal conditions for partnerships in health and social care. However, the Health and Social Care Act of 2012 focuses on setting regulations that will enhance the quality of health and social care with the prioritization of the unification of health and social care. In other words, the current legislation focuses on the merger of health and social care, while they used to develop separately in the past.

Moreover, the mid Staffordshire NHS foundation trust and Adult A case has triggered the public debate and forced legislators to launch legal changes to protect patients, in case of professional negligence and under-performance of health and social care organisations and professionals working in those organisations. D. Cameron proposed to improve patient care, increase accountability of hospitals and tackle a culture of “complacency” in the National Health Service. He proposed establishing the new post of chief inspector of hospitals (Limentani, 1999).

In such a way, new legislative initiatives aim at the enhancement of the government monitoring and control over health and social care and partnerships in this field (Davis, 2006). In this regard, the current legislation provides the basis on the ground of which the further enhancement of the government control and monitoring should be implemented at the legislative level. Organisations operating in health and social care partnerships should be under the government control that decreases the probability of such cases as the Mid Staffordshire NHS foundation trust and Adult A.

At the same time, it is worth mentioning the fact that differences in practices and policies in health care and social care have a considerable impact on the collaborative working and partnerships. In fact, the difference in practices and policies lead to substantial communication gaps and misunderstandings between health care and social care professionals.

Moreover, such partnerships cannot integrate into their organisational structure that means that health care organisations remain disintegrated from social care organisations because of the differences in their practices and policies. The lack of the integration has a negative impact on the performance of organisations. In such a situation, patients cannot count on stable and reliable health and social care services because some services may overlap, while others may be under-performed.

In such a situation, the effectiveness of the partnership in health care and social care decreases because they cannot work as a homogeneous body employing the same policies and practices. At this point, it is possible to refer to the case of mid Staffordshire NHS foundation trust and Adult A which has proved the ineffectiveness of such partnership and its failure was, to a significant extent, determined by the differences in practices and policies conducted by health care and social care providers.

Section C

In fact, possible outcomes of partnerships in health and social care may be highly controversial. On the one hand, such partnerships have the huge potential. Health and social care partnerships can contribute to the consistent qualitative improvement of both health and social care. Isolated, social and health care services are less effective because they cannot always complement each other. On the contrary, health care organisations offer a set of health care services, while social care organisations offer their services which are not always related to health care services received by patients. In case of partnerships, patients can enjoy health and social care services that complement each other. What is meant here is the fact that patients receiving health care services can also receive those social care services that match their current needs in terms of their health condition, ability/disability, and overall physical or mental health.

On the other hand, the risk of such cases as was the case of the mid Staffordshire NHS foundation trust and Adult A persists. This is why partnerships may lead to the deception of patients, violation of their basic human rights, neglect and even death. In such a context, partnerships in health and social care often confront severe criticism from the part of the public as well as professionals working in both fields, i.e. health care and social care. The major source of criticism is the possibility of avoiding the just legal action, in case of the violation of partnerships or insufficient or ineffective performances in terms of partnerships. At this point, it is also worth mentioning the fact that partners may repose the responsibility on each other. For example, health care organisation may justify persisting health problems of a patient by poor social care services and, on the contrary, social care professionals can explain the failure of their performance by the poor health of clients and under-performance of health care professionals.

The major potential barriers to partnerships in health and social care are closely intertwined with the difference in practices and policies conducted by health care and social care organisations. Many researchers (Coddington, Fischer, & Moore, 2000) point out that the difference in practices and policies persists today and has a considerable impact on the performance of health and social care partnerships.

Furthermore, communication gaps may also raise barriers on the way to the effective partnership between health and social care. In actuality, communication gaps are particularly dangerous for the overall success of health and social care partnerships because the poor communication prevents partners from the effective interaction. As a result, organisations comprising the partnership under-perform. For example, health care professionals may provide incomplete information to social workers on a patient and social workers may fail to meet needs of the patient to the full extent. Similarly, the lack of information on social conditions and conditions of living of the patents may lead to the ineffective treatment since health care professionals cannot take into consideration all factors that may influence the health condition of their patient.

At the same time, barriers may arise in the result of certain overlapping of functions, when health care professionals and organisations may believe that social care professionals and organisations interfere into their domain and vice versa. Therefore, they need to distribute functions clearly. In addition, the overlapping of functions increases costs of both health and social care that is absolutely unacceptable, when the costs of health care services are already high.

Nevertheless, it is obvious that partnerships in health and social care may be effective. In this respect, it is possible to recommend several strategies to enhance such partnerships and make them more effective than they are at the moment. First, health care and social care organisations should eliminate differences in their practices and policies. The elimination of the differences may involve the development of common standards and reorganisation and restructuring that helps organisation to elaborate the common organisational structure, distribute functions effectively and provide clients with health and social care services of the high quality.

Second, the close integration of health care and social care organisation should lead to the steady elimination of the frontline between them that means that health care professionals should be able to deliver basic social care services, while social workers should be able to deliver basic health care services. Such integration of health and social care professionals can help them to understand each other better. Therefore, they will be able to interact with each other better because they will understand what each other do and how they do it.

Third, the enhancement of monitoring and control over health and social care partnership is essential but such monitoring and control should not be bound to the government monitoring and control only. Instead, independent auditing may be needed, including the involvement of auditing agencies as well as public organisations which may monitor the performance of health and social care partnerships effectively and professionally.  The monitoring and control will prevent such cases as the Mid Staffordshire NHS foundation trust and Adult A case. At any rate, the risk of occurrence of such cases will drop substantially, if health and social care organisations remain under the permanent monitoring and control from the part of the government agencies.

Finally, the improvement of health and social care partnership should start with the close collaboration of professionals working in these two fields. Health care professionals should work hand in hand with social workers. In such a way, they will not only share their experience but they will also learn to understand each other better as they know how they work and what challenges they confront. The close cooperation helps health and social care professionals to understand specificities of their job and, thus, understand each other better.

Conclusion

Thus, the case of the mid Staffordshire NHS foundation trust and Adult A reveals the full extent to which the current legislation concerning health and social care in the UK is imperfect. At the same time, the partnership in health and social care is still very prospective. This is why policy makers should consider possibilities of the improvement of such partnerships and enhancement of the government and public control over their performance.

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