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How the Service Users Needs Impact Interprofessional Working

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Stephanie Oliver

on 7 April 2014

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Transcript of How the Service Users Needs Impact Interprofessional Working

How the Service Users Needs Impact Inter-professional Working
Presented by
Jane Butler: 1304833
Maria Igboji 1204594
Allyson Wood 1301820
Stephanie Oliver 1303107
Nnamdi Ofuani 1301617
Sophie Wickham: 1305043
NHS Constitution (2012):
Principles that underpin core NHS Values

Shared by all professionals
Highlights ‘working together for the patient’

NICE guidelines (2010):
The Evidence Base

NICE (2011b)
recommend that ‘team should be familiar with the service user and a continuous relationship’. However, Mandy the Physiotherapist had only just met Nathan in the case study.
Nathan’s needs blur the assigned roles of trained professionals who provide input into various areas of Nathan’s life.

Health Professional Council (HCP)

OT, Physiotherapist, Paramedics and radiographer: must work within their scope of practice

Understand the need to work in partnership with other professionals and build relationships and collaborate as a member of a team.
Know the limits of their practice and seek advice from other professionals when needed

College of Occupational Therapy, The Chartered Society of Physiotherapy, British Paramedic Association
UK Policy & Governance

Explosion of policy documents: (Department of Health 2000, 2004, 2014)

Blurring traditional roles to increase joint working between practitioners (Oxtoby 2009)

Professions develop separately

Hugman (1991): Different professional allegiances with different professional knowledge-each claiming to a particular knowledge base distinguishing each one apart.

Hall (2005): Professions looking at the same thing but not seeing the same thing

Humphris & Masterton (2000): The clients needs and workforce requirement requires a whole system approach to role development.

Baxter (2008): Role Confusion
UK Policy & Governance
Nice Guideline (2011b) offers the best practice on the care of adults with schizophrenia.

Patient Centered Care
Patient inclusion in their care.

Patients and health care professionals have rights and responsibilities as set out in the NHS constitution of England.

This Guideline explains the impact of good patient experience in adult NHS services following  the above mentioned. Holistic patient centered care and patient inclusion impacts on the inter-professional working practice in that the patient (service user) needs are considered holistically in line with their care package taking into consideration the patients best interest.

Communication with family, MDT and patient- most important service of all involved within a multi-disciplinary team.

Breakdowns in communication have drastic effects with lasting emotional impact (Thompson 2007). Affects care delivered from MDT
Living with a chronic respiratory disease- greatly affects social life, self perception and relationships (Kelly and Lynes 2008).

Physiological aspect of disease has impact on psychological effects- need to be at the forefront of MDT, along with potential for social exclusion.
Nathans Personal Needs
Health related quality of life and active daily living tasks are significantly reduced in patients with COPD- increase in potential care required from MDT (Miravitlles et al 2009).

Anxiety and depression have strong links with progression of COPD (Gore et al 2000).

Alleviation of symptoms can be through strong family relationships- this can also include members of MDT (Delambo et al 2004).

An interdisciplinary community-based COPD management programme has the potential to greatly improve disease-specific quality of life (Hoogendoorn et al 2010).
Nathans personal needs
The Interprofessional Team
Freeth et. al, defined the inter professional team as
“ Two or more professions working together as a team with a common purpose, commitment and mutual respect.” (Freeth et al. 2005, cited in Dunston et al., 2009, p. 6).
The NHS constitution, policies and codes of conduct highlight the importance of interproffessional learning to good patient care.
Interproffessional team work is a fundamental aspect of good clinical practice and central to optimal patient care
Nathan’s Case Study
53 Year Old man from East London

After school, he worked as a labourer, regularly resided in squats or on the streets

Moved in to a flat with Betty in 1980, when they had their son Saul

Betty was killed in a car accident in 1982

Nathan currently lives in Colchester and is housebound.

Social History

Past Medical History

1982, admitted to an inpatient psychiatric unit where he was diagnosed with Schizophrenia.

Receiving monthly visits from the Community Psychiatric Nurse who has been administering him with 40mg of Dexipol to manage his schizophrenia.

In 2005, diagnosed with Chronic Obstructive Pulmonary Disease (COPD)

Clinical Language: how it Impacts on Interprofessional working
According to NICE (2011a), interdisciplinary team members are known to use clinical languages and terminologies when delivering care to service users.

This practice impacts on the interdisciplinary team when they are unable to understand or interpret the terms used.

Shoshanna (2002) has found that receiving conflicting information, specific terminologies or messages that are unexplained, make provision of services to patient difficult.

In Nathan's case, the terminologies and languages may have impacted on them positively or negatively when delivering care to Nathan.

This will be discussed in the table below...

Since the aims of the interdisciplinary team are to share goals, values and learn from
each other (Mental Health Commission 2006), professionals should be mindful
of how they use abbreviations and terms in the information they pass onto team
members. NICE (2011a), advise professionals to ensure that clinical language
and terms used during joint working should be explained and ensure
colleagues have an understanding. Sharing different
information and ideas from different professionals helps
to widen opportunities in understanding patient’s needs
(Shoshanna 2002).



Diagnosis of SMD, MDT, ADLs, COPM & SF36

Terminologies/ Clinical Language
Wife died in ‘RCT’, Schizophrenia, Depixol (40mg), COPD, Nebulizer, Productive Cough, and Sputum.
Nathan's case Summary
Mental Health Nurse
Diagnostic Radiographer

A&E, AP, PA,
Respiratory Physiotherapist
Pulmonary Rehab, Cyanosed Peripherally,
Fruity Cough, Nebuliser, Pulse Oximetry, Oxygen Saturation,
Occupational Therapy
One Aspect of Evidence Base
Strength and weaknesses of Interprofessional Working
Bajnok I, Puddsters D, Macdonald CJ, Archibald D & Kuhl D (2012) ‘Building positive relationships in healthcare: Evaluation of the teams of interprofessional staff interprofessional education program’
Contemporary Nurse
76–89 Available through Albert Sloman Library [Accessed on 07 March 2014]
Barwell, J., Arnold, F., Berry H. (2013) 
How interprofessional learning improves care
Online at http://www.nursingtimes.net/nursing-practice/clinical-zones/educators/how-interprofessional-learning-improves-care/5059052.article ( Accessed 07/03/2014)

Baxter S K & Brumfitt S M (2008) ‘Professional differences in inter-professional working’
Journal of Interprofessional Care
22 (3) 239-251 Online at: http://eprintswhiterose.ac.uk/10569/ [Accessed 5 March 2014]

Burzotta L & Noble H (2011) ‘The dimensions of Inter professional practice’ British
Journal of Nursing
5: 310-315 Available through Albert Sloman Library [Accessed on 12 February 2014]

Delambo K, Levers-Landis C, Drotar D and Quittner A (2004) 'Association of observed family relationship quality and problem-solving skills with treatment adherence in older children and adolescents with cystic fibrosis'
Journal of Paediatric Psychology
, 29
: 343–353

Department of Health (2012)
Liberating the NHS: Developing the Healthcare Workforce
Online at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216421/dh_132087.pdf [Accessed 6 March 2014]

Department of Health (2004)
The NHS Improvement Plan
Online at http://pns.dgs.pt/files/2010/03/pnsuk3.pdf [Accessed 6 March 2014]

Department of Health (2000)
Meeting the Challenge: a strategy for the allied health professions
Online at: http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/publicationsandstatistics/Publications/Publicationspolicyandguidance/DH_4025477 [Accessed 6 March 214]

Dunston, R., Lee, A., Lee, A., Matthews, L., Nisbet, G., Pockett, R., Thistlethwaite, J., & White, J. (2009)
 Interprofessional health education in Australia: The way forward.
Online at :http://www.rilc.uts.edu.au/pdfs/wayforward.pdf ( Accessed 01/03/2014)

Gore J, Brophy C and Greenstone M (2000) 'How well do we car for patients with end-stage chronic obstructive pulmonary disease (COPD)? A comparison of palliative care and quality of life in COPD and lung cancer'
: 1000–1006

Hall P (2005) ‘Inter-professional teamwork: professional cultures as barriers’
Journal of Inter-professional Care
May (Supplement) 188-196

Hugman R (1991)
Power in the Caring Professions
London: MacMillan Press

Hoogendoorn M, van Wetering C, Schols A (2010) ‘Is Interdisciplinary Community-based
COPD management (INTERCOM) cost effective?’
European Journal of Respiration
35: 79-87.

Humphris D & Masterson A (2000)
Developing New Clinical Roles
Edinburgh: Churchill Livingstone

Kelly C, and Lynes D (2008) 'Psychological effects of chronic lung disease'
Nursing Times
, 104
): 82-85

Leathard A (2003) In A. Leathard (Ed.)
Interprofessional Collaboration: From Policy to Practice in Health and Social
Hove Bruner-Routledge

Mental Health Commission (2006) Multidisciplinary Team Working: From Theory to Practice, Discussion Paper: fostering and promoting high standards in the delivery of mental health services Online at http://download.idea4.org/m/multidisciplinary-services-s10/ [Accessed 15 March 2014]

Miravitlles M, Soriano J, Garcia-Rio F, Munoz L, Duran-Tauleria E, Sanchez G, Sobradillo V and Ancochea J (2009) 'Prevalence of COPD in Spain: impact of undiagnosed COPD on quality of life and daily life activities' Thorax, 68: 863-868
Molyneux J (2001) 'Interprofessional teamworking:' what makes teams work well?’ Journal of Interprofessional Care (15) 1: 29-35 Available through Albert Sloman Library [Accessed on 07 March 2014]

National Institute for Health and Clinical Excellence (2010) Perspectives on Evidence Based Practice Online at:http://www.nice.org.uk/aboutnice/whoweare/aboutthehda/evidencebase/evidence_base.jsp [Accessed 20 February 2014]

National Institute for Health and Clinical Excellence (2011b) Psychosis and Schizophrenia in Adults (CG178) Online at: guidance. nice.org.uk/CG1 [Accessed on the 20 march 2014]

National Institute for Health and Clinical Excellence (2011a) Service Users Experience in adult Mental Health: Improving the Experience of Care for People using Adult NHS Mental Health Services Online at: http://guidance.nice.org.uk/QS14 [Accessed 15 March 2014]

Oxtoby K (2009) 'Professional Roles are Blurring' BMJ Careers Online at: http://bmjcareers.mobi/careers/advice/view-article.html?id=3181 [Accessed 7 March 2014]

Thompson D (2007) 'Interprofessionalism in health care: communication with the patient's identified family' Journal of Interprofessional Care, 21(5):561-3.

Bokhour BG 2006 'Communication in interdisciplinary team meetings: What are we talking about?' Journal of Inter professional Care: 20(4): 349 – 363 Available through Albert Sloman Library [Accessed on 21 February 2014] 

Health Professions Council (2008) Standards of conduct, performance and ethics London: HPC

Hoskins R (2012) 'Interprofessional working or role substitution? A discussion of the emerging roles in emergency care' Journal of Advanced Nursing 68(8), 1894– 1903 Available through Albert Sloman Library [Accessed in 07 March 2014] 

Priest HM, Roberts P, Dent H, Blincoe C, Lawton D and Armstrong C (2008) 'Interprofessional education and working in mental health: in search of the evidence base' Journal of Nursing Management 16, 474–485 Available through: Albert Sloman Library [Accessed on 09 March 2014]
Reeves S & Freeth D 2002 'The London training ward: an innovative inter professional learning initiative'
Journal Of Inter professional care
Available through Albert Sloman Library [Accessed on 07 March 2014]

Scho¨n D (1983)
The Reflective Practitioner: How Professionals Think in Action
Basic Books, New York.

Shoshanna S (2002) 'Qualitative Research Method':
Journal for Quality in Health Care
Zolnierek (2013) ‘An Integrative Review of Knowing the Patient’
Journal of Nursing Scholarship

1: 3–10 Available through Albert Sloman Library [Accessed on 09 March 2014]

‘Research project conducted in 2001 that “explored how and why” relationships between the inter professional team develop ’ (Molyneux 2001).
Research project to “evaluate the impact of inter professional team development” ‘(Bajnok et al.2012)

Qualities of each professional


Creative Approach

Transferring learning
Team Growth
Individual Growth
Professionals perception of
key strengths
Relationship and Awareness
Professionals perception of
key strengths
…Strength and Weaknesses
(Communication identified in both categories?)
Weaknesses in relation to Nathan’s case

Strengths in relation to
Nathan’s case

Communication and lack of team meetings

There is a lack of this communicative bond between professionals within the respiratory physiotherapist documentation

e.g 1. where John Stresses the difficulty of seeing a patient who is new and is not aware of the patients normal PAR observations

Team were able to utilise individual professional skills, bringing these together as a group to provide quality care

E.g Communication between the respiratory physiotherapist (John- CPN) rings Mandy the Physiotherapist with concerns on Nathan’s breathing

How does this relate back to the research finding from two projects?

Possible Solutions

In accordance with NICE (2011d) ensure up to date record keeping.

Standardised terminology across all Trusts in the NHS

Collaborative reflective practice within clinical practice

Inter-professional education in universities- knowledge of role responsibility
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