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EIP GROUP PRESENTATION
Katarina, Joyce, Nichola, Rachel
(GROUP A3)
INTRODUCTION
Male
83 Years old
OVERVIEW
Myxoid Spindle Cell Sarcoma
September 2018- September 2019
TREATMENT
Treatment overview
Negatives:
District Nurses- forceful/ bullying
Poor communication
District Nurses didn't listen
Diagnosis- terminology and poor explanations confused the service user causing fear and apprehension
Positives:
According to the service user the care was "ALL RIGHT"
Feelings and wishes were considered
Effective and supportive Hospice Specialist Nurse
Good rapport
OT- provided advice and let the service user have autonomy
Service user determined
INTER-PROFESSIONAL
COLLABORATION
ANALYSIS
"Effective inter-professional collaboration promotes the active participation of each discipline in service user care." (CFAR et al 2015, 7)
“Strategies to improve interprofessional collaboration between health and social care professionals may slightly improve patient functional status, professional’s adherence to recommended practices and the use of healthcare resources. Due to the lack of clear evidence, we are uncertain whether the strategies improves patient – assessed quality of care, continuity of care or collaborative working” (Reeves et al 2017,9).
QUOTE
The concept of General Data Protection Regulation (GDPR, 2018) states...
GDPR
"ensured compliance with data protection law, to make sure health and care data is always collected, stored, analysed and shared securely and legally’’ (NHS Digital, 2019,1).
SWOT ANALYSIS...
STRENGTHS:
- Service user's wishes were listened to and actioned
- Cohesive service
- Collaborative working
- Service user participation
- Different skill bases from each professional
- Hospice Nurse
ANALYSIS
WEAKNESSES:
- Service not always available out of hours
- Information not conveyed in service user friendly terms
- No support offered to the daughter
- Lack of budget- no night sitting only day
- Wife's care needs not considered
- Paperwork for syringe driver had "DYING PATIENT" written on it
- Continuity of care
THREATS:
- Non-communication
- Not valuing professional opinions
- Sticking to professional groups and not sharing
- Poor coordination of care from healthcare professionals
...
OPPORTUNITIES:
- Gather and communicate service user information
- Needs and wishes of service user are adhered to by all professionals
- Share knowledge to solve problems
- Respect differences in professional opinions
- Provide out of hours care
MODELS OF INTER-PROFESSIONAL WORKING
MODELS
MODELS
HISTORY
(Educational Theory and Practice, 2020)
INTER-PROFESSIONAL WORKING
GEARS MODEL
(Mulvale et al 2016)
CONTINUUM MODEL
(Morley and Cashell, 2017)
VANGUARD MODEL
(Lewis, 2016)
NEIGHBOURHOOD TEAMS
“In line with government policy, NT’s and health and social care integration more generally, are also expected to support patients/users and the wider community to take an active role in protecting and managing their personal health and wellbeing, choosing appropriate treatments where necessary, and managing long-term conditions” (NHS England, 2017).
CONCLUSION
INTERVENTION
(Lincolnshire Health and Care, 2020)
CODES OF CONDUCT
Social Work England- Professional Standards Guidance 2019
Standards 3.6, 3.8 and 3.9
EVALUATION
NMC Code of Conduct 2018
Standards 5.4, 8.1-8.6, 9.3 and 13.2
HCPC Code of Conduct 2018
Standards 2.5 and 2.6
ACKNOWLEDGMENT
Bradley Joseph Stevens
Gamekeeper
4th August 1935 - 9th September 2019
CREDITS
Katarina- Presentation/graphics, Neighbourhood Teams research, SWOT, proof reading, editing/finalising
Joyce- Vanguard model research, SWOT, proof reading, referencing
Nichola- Coordinator, script, Continuum model research, SWOT, proof reading, narrator, editing/finalising
Rachel- Case study, Gear's model research, SWOT, proof reading, narrator, editing/finalising
CREDITS
Total audio length: 14 min 49 sec
REFERENCES...
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Interprofessional practice
Online Presentation – Rachel, Joyce, Katarina, Nichola
This presentation will discuss, using relevant literature, observation and experiences, the interprofessional and collaborative working of health care professionals in the care of an 83-year-old male diagnosed with terminal Cancer. The service user was diagnosed in September 2018 and passed away a year later in September 2019. The care plan was agreed with the service user and family for palliative care to be undertaken at his home. He was deemed to have capacity to make this decision under The Mental Capacity Act (2005), professionals from Multi-Disciplinary Teams worked together to facilitate this. From the perspective of the service user the care provided was “all right”, due to having his wishes and feelings listened to and acted upon. Interprofessional working therefore should have been cohesive, this turned out not to be the case since the daughter had to coordinate, organise and take charge of the professionals, and if this had not been done it could have turned out very differently.
To explore collaborative working this presentation will discuss the Gears Model, a concept of collaborative workflow, the Vanguard Model and the Neighbourhood Teams model, and how these could have been applied to the case study.
TRANSCRIPT
...
Day (2007, 21) postulates that interprofessional practice is found in social, economic and political context and does not occur in isolation. This links into the strategy for improving the experience of the service user in this scenario. After reviewing the literature we decided that the Neighbourhood team’s model would be a good way of improving the experience of everyone involved. We will discuss this in further detail later when we talk about the models.
According to Nester, (2016, 130)
“The terms “multidisciplinary care” and “interdisciplinary care” have been replaced by the more contemporary term “interprofessional practice and education” (IPE), which occurs when individuals “from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes.””
Interprofessional working can be difficult to implement as the service user-doctor relationship is given precedence over interdisciplinary working, it also talked about professionals being afraid of change or were resolute about current practice (O’Reilly et al 2017, 9). Even if strategies are introduced there is evidence that this only slightly improves the care for the service user. As the quote on the slide shows.
...
The professionals who implemented the care, in our scenario, included, district and hospice nurses, social worker, physiotherapist and occupational therapist.
All the professionals involved throughout the care process are bound by GDPR.
Kings fund (2018) acknowledged that service user’s information is not only used for managing data in the NHS. It plays a vital and significant role in the context of planning service user’s health care, diagnoses and treatment in the line with organisational policy.
We looked in depth at the interprofessional practice and collaboration within our case study as a SWOT analysis. We explored the strengths and weaknesses as seen on the slide, what stands out is there is a considerable number of weaknesses in comparison. Looking at the opportunities and threats we can see that there are multiple areas of improvement where we can apply our models.
Historically Interprofessional practice has been discussed and attempts to implement it have been made since the foundation of the NHS. The slide shows a timeline of some of the influential historical reports and acts, from the Beverage report to the Health and social care act.
The following slides will show our research and application to the case study of our chosen models.
...
The Gears Model looks at how professionals work together. It identifies the various stages of collaborative working as seen on the diagram. (Mulvale et al., 2016)
Identifying who had the input within this case study. The external input was from the service user, the daughter, the wife and friends ensuring wishes and feelings of the service user were given to professionals and carried out. This is in line with the Social Work England Code of Practice (2019, 1) to:
“Promote the rights, strengths and wellbeing of people, families and communities”
“Act safely, respectfully and within personal integrity”
The team input was identified as the hospice specialist nurse and team, community nurses, cancer specialist, consultants, GP, Pharmacist, OT, Physio and social worker.
Collaborative working ensures that each professional from teams in the community work together in cases that are complex and need multiple disciplines. This case study is about palliative care and the intricate workings of a community team and their support. Welfare of the service user was looked after by the health professionals, this was by identifying need, monitoring vital signs, addressing pain management and ensuring he was comfortable. There were issues around how the health professionals had separate agendas and the service was not as cohesive as it should have been. The daughter steered the service by liaising with different services and ensuring all her father's social and medical needs were met.
The quality of the services varied, voluntary services delivered a more person-centred approach, the care package was tailored to the service user, and it showed empathy and compassion whilst being professional. In contrast statutory services lacked the person -centred approach and were time managed, lacked empathy and less compassionate to the needs of the service user and his family.
The gears model looks at the output in respect of cost, this was measured in two ways in this case study. The financial cost of multiple services being co-ordinated was seen when the care staff would only come in for 2 half hour visits that were not beneficial and did not ask for the night sitting that was needed to support the family due to budgeting and provider’s policies. The cost to the Daughter was that she was emotionally as well as physically drained and just wanted time with her father in his dying days.
...
Working together can highlight the professional differences in the teams and their conflicts, The Gears model clearly defines that the input at the macro level is the Government policies and these will shape the working dynamics of the collaborative team, these policies underpin how a service is delivered, and which professional body would be implementing these to the service user. Health professionals would be guided by Nice Guidelines, suspected cancer recognition and referral overview, NHS Long Term Plan (LTP) ambitions for cancer, which was published in January 2019 and the East Sussex.
This model might not fit in our scenario fully as we are unsure as to the other service users that are under the care team. It can viewed from a singular service user point of view. We can class the functional units as the individual healthcare professionals.
In the serialised workflow one professional completes their care and hands over the service user to another professional for them to complete their care. (Morley and Cashell, 2017)
...
In the collaborative workflow the professionals work with and around each other seeing the service users as needed and not awaiting a handover from another professional. This also allows for changes in service user diagnosis and care as each professional can see their service user when needed, whereas with the serialised workflow the service user would be rotated around professionals and the professional would have to wait until the service user came back to them. The professionals work in a harmonious fashion, supporting and depending on each other in a way that enables the patient to get the care they need from each professional as they need it, instead of waiting on a rotation of professionals as with the serialised model.
From our case study it seemed that the care undertaken was trying to be collaborative but ended up with many serialised elements with the daughter chasing professionals to work together (Morley and Cashell, 2017).
...
In 2015, NHS England designed a new strategy with an agenda of how to promote a better care service across England (National Audit Office, 2018). The Vanguard’s design was to promote the effective change in relation to service users' needs and financial pressure (NHS England, 2014).
Jones (2015) suggested that it is important for professionals to support service user’s to maintain independence during of end of life care. It is highlighted in the case study that some of the professionals worked better collaboratively, for example, the specialist palliative nurse provided a higher quality of care and worked with other professionals more effectively. It is essential for all professionals to work in collaboration to promote quality care as stated in the NICE Guidance (2017). This supports the assertion of ‘’Working together for service users’’ (NHS England, 2015, 1). There was clear evidence that the professionals were not communicating effectively when liaising with each other in order to support the service user. Kings Fund (2015) proposed that it is important for professionals to share end of life information to their family to enable them to understand the process of bereavement and the meaning of end of life care. It is evident in the case study that the family’s voice was not fully heard, as the daughter was not offered information regarding possible outcomes at end of life. According to Kings Fund (2015) inter-professional workers should understand and recognise the role of service user’s family members, by ensuring they value their decisions in terms of the care package.
...
The main aims of the neighbourhood model were to create a multidisciplinary team which encompasses a core network of health and social care professionals such as GP’s, nurses, social workers, physios, OTs etc. The purpose of this model ensures that people with multi morbidities can retain their independence, achieve a good quality of life and avoid unnecessary hospital admissions. (George et al 2017)
The central part of this model is the integration of services in order to provide person centred care that appears seamless to the service user. The multidisciplinary working enables different professionals to bring their unique skills and insights to the table and combine them with the other members to tackle the challenges that arise. Information about the service user should be shared between professionals to ensure everyone works together, thus decreasing the stress for the service user as they do not have to repeat and relive their experiences to every health care professional they encounter (George et al 2017).
Currently there does not appear to be a neighbourhood model in place in Sussex. Although parts of this model would have been utilised within the case study as the service user was able to fulfil his wish and have his care and end of life care carried out at his home.
An issue with the care the service user received, was the lack of communication between the healthcare professionals. The service user had a competent daughter who took charge and organised the care to ensure there was no impact on the service user meaning he was happy with the care he received especially since it allowed him to live at home instead of in a hospice. The neighbourhood model could have been used to resolve this as it would take the pressure of organising the care away from the daughter and thus lessen the emotional and mental stress placed on her in an already difficult situation.
...
In conclusion, from the service user’s perspective, they received the care they needed in order for their wish of end of life care to be undertaken in their own home. The negative to this was the fact that it took the daughter to coordinate with the healthcare professionals for this to happen. We felt that a specific appointed coordinator from within the healthcare profession would provide better care from the family’s point of view as it makes their lives easier enabling them to concentrate on the service user and removing the pressure of care coordination.
The model that would fit this criteria is the Neighbourhood Teams Model. It is a sociamedical care model and encompasses medical and social factors of care, it is a holistic assessment of the service user. It would still ensure our service user stayed at home, and out of a hospice. It would cause the least restrictions on him and his family thus decreasing stress leading to greater emotional wellbeing of everyone involved whilst being respectful of his wishes and feelings. It allows for greater service user autonomy.
The neighbourhood team’s model works well as it is not just about the end of life care, it includes other health conditions and allows professionals to work together towards shared service user goals. A Neighbourhood team knows the community, it allows for better local and faster access to services which enables earlier care, this also has financial implications as resources can be collectively focused and shared reducing costs, this would free up funding so that the family could have the overnight care they wanted.
...
The model has a named healthcare coordinator, usually a GP. The coordinator ensures that service users do not get lost within the system, they keep accountability of care with their respective healthcare professionals and ensure that everyone is working together for the benefit of the service user. The coordinator would replace the daughters input and coordinate care between Statutory and non-Statutory healthcare workers.
It works similarly to the collaborative workflow diagram from earlier where healthcare professionals work around each other in order to benefit the service user, the only difference is that there is a central coordinator to ensure that the best interests of the service user are met where they feel that they are empowered, respected and retain dignity.
To further reiterate the point that the Neighbourhood Teams model would be effective, it is now being implemented within the East Sussex region where this case study took place (George et al 2017).
...
Interprofessional practice is very important as it ensures that the service users receive the best quality of care. It makes up an integral part of healthcare education and is underpinned and embedded in the professional body standards. Miller et al (2001) states that there are over 40 different professional bodies responsible for Health and Social care professionals and all of them are supported and have statements on interprofessional working. Our professional bodies for the team members on this presentation are NMC, HCPC, and Social Work England. The common theme is the need for sharing information and working collaboratively with other professionals to ensure service user centred care.
We hope you found this presentation as informative and interesting as we did.