Exploring Inter-Professional Collaboration and Service User Involvement

Introduction

This essay will reflect and analysing an experience of inter- professional working and service user involvement in my clinical practice, that occurred in renal ward during my placement. The learning episode identified on placement was end of life patient, whom cared for with help from my practice assessor (PA) been the teacher. However, for confidentiality purpose the name of the PA, multidisciplinary team and family members will not be mentioned (Nursing and Midwifery Council (NMC, 2018). This is according to the requirements for General Data Protection Regulation (GDPR, 2018). As such, I will refer to myself as student nurse (SN).

Throughout my reflection, I will use the Gibbs reflection model/cycle. The Gibbs cycle includes 6 stages: a description of what happened, my initial gut reaction, an evaluation whether it was a good or bad experience, analysis- what I made of the situation, a conclusion of what I have learnt for the future, and finally an action plan of what I would do again if the situation arose again (Gibbs, 1998). In the process, I will apply the theories behind this reflection process with the application of critically analysis.

In the process of reflection, this essay will discuss the clinical experience of working with patients, clients, and service users involved in the care such as family, support workers, health and social care practitioners, all who work within a team to deliver safe and effective practice. This, this essay will entail an observation of teamwork experiences, communication skills and professionalism within the team using the Gibbs reflection model. In the end, the essay will have a conclusion on the key issues that have been explored, identifying key areas of future development to improve my practice as an Adult health nurse.

Professor Graham Gibbs developed his reflective cycle from an educational perspective (Jasper et al 2011). However, the model has been helpful in professional reflective practice to help professionals across many fields make sense and learn from their everyday situations. Gibbs’ reflective cycle encourages systematic thinking about daily experiences. It contains six stages and poses a key question to consider at each stage. It seeks a clear description of the situation, and then leads an individual through the reflection and learning, and to plan what they would do if the situation arose again (Gibbs 1988).

The aim of the model is to challenge an individual’s assumptions, and to explore different or new ideologies of doing or thinking about things It also allows one to promote self-improvement by looking at strengths and weaknesses while addressing improvements for both. Through the model, it is easier to identify the most appropriate actions to take if you were in the same position again. This cycle action you take you in the final stage will give feedback into first stage, beginning the process again.

However, critics have claimed that the possible limitation of Gibbs reflection model is that it may encourage superficial reflection, with less contribution to professional or personal development. According to Jasper et al (2011), this is because it does not encourage the reflector to identify the assumptions or values that form the basis for their action, nor does it encourage them to evaluate if there is any association between other experiences and the current event. The other limitation pointed out by Jasper et al (2011) is that it is only limited to the reflector’s perspective.

Personal Reflection

Throughout my placement, I was privileged enough to experience first-hand and learned, different aspects of working under intense pressure. I realised that no two days are the same; let alone encountering challenging situations that have led pushed me out of my comfort zone. I was working on a renal ward, which apparently has now been turned into a COVID-19 ward. Nonetheless, during my shift I was caring for an end-of-life service user under the supervision of my PA.

One of the most eye-opening experiences I had was during patient handover, when I was told by my PA that I was to deliver most of the caring task to Mrs C and make her as comfortable as possible. I delivered all the personal care tasks including assembling the toiletries, towels, and bowls to facilitate her care, while always ensuring her privacy whenever I was attending to her. For instance, as required by the NMC guidelines (NMC, 2015), I ensured all the curtains were closed to maintain Mrs C’s privacy and dignity, all under the supervision of my PA.

A key aspect of person-centred care that I observed was that of patient and family engagement. According to (ddd), it is defined as “a relationship between health care providers working together to promote and support active patient and public involvement in health care and to strengthen their influence on health care decisions at an individual and collective level’’ (Coulter, 2011, p35).

As her prognosis was poor, we rang the family asking them to come as we were told by the doctor that the patient had hours to days to live.

It has taught me to remain self-motivated and passionate to push myself even further to succeed in a caring profession. According to Watson (2009) caring relationships between the nurse and patient is developed through personal connection, which in turn, leads to a feeling of professional satisfaction by the nurse. Contrariwise, non-caring relationships results in burnout and depression.

I managed to pick up tips and learned different types of skills, including effective communication skills and teamwork. Mrs C was on pain relief, until palliative care team came and advised us to initiate syringe pump intervention. In the process of administering this intervention, we collaborated with doctors and family members. But because the patient was deteriorating, we saw it wise to invite her family members to come and be with her during her last moments. According to NMC guidelines (NMC, 2015), it is my duty to keep and uphold the standards and values set out in the code. Mrs C passed away during my shift and had to inform the Doctor and immediate family, before witnessing the Doctor certifying the patient’s death. In nursing documentation and recording plays an important role as evidence that the care is consistent, planned, appropriately reviewed and assessed (Cuthbert and Quallington, 2008).

Reflection using the Gibbs reflection Model

Description of the event

Mrs C is a 65-year-old lady who was diagnosed with terminal renal illness. She received an emergency admission. Her prognosis was poor, and her family was invited to be there to help support her in her last moments. The consultant delivered news to the family in a quiet room that she would not survive for long, and both myself and another nurse were present. Indeed, Mrs. C’s family were devastated upon receiving this news.

Feelings

This incident significantly impacted me because it was the first time, I was experiencing a case where bad news was being delivered to the patient’s family; despite my natural apprehensiveness prior to the event. On seeing how Mrs. C’s family reacted to the news, I felt like I had lost a strength of my own emotions and found it hard to control my tears. Grappling with a feeling of helplessness, I could not do anything to relieve their suffering. Similarly, I had a feeling of awkwardness, as if I was intruding into their family matters at a time when I should have allowed them some privacy to grieve. Nonetheless, these feelings quickly vanished, and I soon regained the drive to do my best in ensuring Mrs C received the best possible end of life care and to provide support her family.

Evaluation

The doctor broke the news to Mrs C and her family in a proper way, drawing from his considerable professionalism and practice experience to handle the situation by show of sensitivity and empathy. By choosing a quiet room rather than an open space in the hospital provided a proper environment that offered the patient’s family the privacy to receive the news. While delivering the news, the consultant used both verbal and non-verbal communication techniques such as sitting down on their level as opposed to standing, maintain eye contact during the conversation, using a soft voice tonality and using an open body language. Similarly, I note dhow the consultant did not rush into breaking the news and instead, took time to explain the patient’s prognosis and diagnosis in a manner that clarified the information for easier understanding. Similarly, the consultant was careful not to give unrealistic responses to the difficult questions asked by the patient’s family. He was instead as open and honest as possible while still being optimistic.

As the consultant was conversing with the patients, the other members of the healthcare team paid a close observation to the patient and their family’s reaction to identify any non-verbal clues to their feelings and thoughts, quickly stepping in to place their arm around the client as she began to cry, clearly comforting her. Nonetheless, a significantly negative aspect of this incident is my feeling that having a consultant and two nurses was excessive and could have unsettled the family, gravitating the matter further.

Analysis

Effective communication

Being my fist time to engage in a matter like this, I was generally an observer. However, this was still a perfect opportunity for me to learn and develop my verbal and non-verbal communication skills by observation. I have a feeling I should have controlled my emotions, but I realised I was unprepared for the strength of Mrs. C and her family’s devastation. Nonetheless, the consultant, together with support from other staff, played a significant role in handing the situation, all of whom had considerable experience in palliative care. I realised that clearly, the consultant together with the rest of the team had gained Mrs. C’s trust during other consultation sessions. Ideally, trust is a significant component of a successful relationship between patients, healthcare professionals and other carers Brenner et al (2020), and this created a more effective way of communicating the whole situation.

Multidisciplinary teamwork and collaboration

It is important to acknowledge that effective communication between members of the multidisciplinary team in palliative care is an important aspect of delivering safe and quality care. According to Kauppi et al (2020), achieving an effective teamwork and collaboration may be challenging because for example, different team members have their own philosophies of delivering care. However, an important recommendation of the NICE guidelines (NICE, 2003) on palliative care is that processes must be implemented to ensure effective interpersonal communication between the multidisciplinary teams. During Mrs C’s end of life care, I worked closely with other members of the team to consider their perspectives and communicated effectively with them through regular meetings that were important in creating a forum where difficulties could be solved.

One of the most significant roles of the palliative care teams is to care for the patient and their family. According to Dhadphale & Baugham (2018), palliative care teams should adopt the philosophy that both the patient and their family are recipients of care rather than the patients alone. This implies that the palliative care team must understand the relationship between patients, their family, their community and the medical team involved in caring for them. While the consultant doctor was responsible for offering direct care for Mrs. C, the role of the other team, me included, was to coordinate the work of interdisciplinary team. Meanwhile, we all participated in conducting a comprehensive assessment of Mrs C and her family throughout the course of her care.

The other equally important role that me and other members of the interdisciplinary team played in Mrs. C’s care was to care for each other. Ideally, as per Walter et al (2019), an effectively functioning team recognizes that each team member contributes a unique skillset and that no team member can single-handedly meet the patient and their family’s needs. Having understood this, I practiced my duties to my fullest potential and improved the care provided to Mrs. C while reducing any extra burden of care held by other team members. In doing so, I ensured that I executed all my shifts so that no team member would have to step in form me when I am absent. In this regard, Sinai-Gavrilov et al (2019) argued that in an interdisciplinary palliative care setting, each team member must understand the roles of each team member and know when it would be beneficial to involve or consult them. According to Doukanari et al (2021), this mutual trust and respect provides an opportunity for the team members to openly discuss the challenges they face, to grieve when the patient is in a bad condition and to celebrate when the patient’s health improves.

Against this backdrop, an interdisciplinary team model is a key concept of practice in palliative care that necessitate the development of strong teams and allowing each team member to exercise their duties to the fullest potential. According to Lind et al (2018), developing a strong relationship within palliative care interdisciplinary team allows the team members to not only take care of the patient and their families but also take care of each other. In the case of Mrs C, adopting an interdisciplinary teamwork, through effective communication facilitated the delivery of quality care for the patient and her family. Through interdisciplinary teamwork, we were able to coordinate the delivery of various care needs and ensure Mrs C receives the best quality end of life care.

Reactions to receiving disheartening news in palliative care

After breaking news to the patient, practitioners must be prepared to deal with various forms of reactions and responses including anger, collusion, blame and guilt. According to Dhadphale & Baugham (2018), denial is a comping mechanism for individuals (or even patients) who are unable to face the reality that their disease progress over time. On the same note, Sinai-Gavrilov et al (2019) observed that family members may encourage the patient to stay in denial because this will delay the time for facing and discussing difficult issues. While in some cases there is a collusion between healthcare professionals and family to conceal specific information with the aim of protecting the patient, open and honest communication with the patient can promote a level of knowledge and understanding that reassures them about their condition while accepting the realities at hand. Patients and their family react emotionally to bad news and that anger may be misdirected towards the healthcare professional as the ones who have delivered the news (Lind et al 2018). However, as per Walter et al (2019), it is important to identify and address the cause of this anger. We were also responsible for providing care to Mrs. C and her family on the initial and ongoing assessments. In the process, any team member that identified an unmet need of the patient or their family would contact the appropriate team member for assistance, especially during our regular interdisciplinary team meetings.

Conclusion

The use of a team-based approach to palliative care is considered an effective approach for delivering high-quality care for patients like Mrs. C who was on and of life care. An active collaboration that promotes the delivery of person-centred palliative care is an important part of a team-based model of care that I have focused on in this reflection essay. For patients who are in their terminal stages of their illness, palliative care provides an effective care setting for assessment, diagnosis, symptom management. Members of palliative care team, which consist of consultant doctors, nurses, social workers and non-medical staff; work together to satisfy the patient’s individual needs and the needs of their families. This variety of disciplines that form a palliative care team ensure that the patient and their family receive a full range of care. therefore, an interdisciplinary team approach to palliative care delivery is a significant feature of care that can improve the wellbeing of patients, their families and the professionals involved.

Reflective practice is an essential element of both continuing professional development and learning process for nurses. As such, the Gibbs model reflection presents an effective opportunity for student nurse to logically and structurally move through the reflective process. That said, effective communication is an important aspect in palliative care practice. Nurses and other professionals involved in patient care must develop effective communication with patients and their families as a means of understanding their care needs and coordinating the delivery of those care needs through other members of the interdisciplinary team. Nurses play a significant role in supporting the delivery of palliative care and they therefore must develop effective verbal and non-verbal communication skills. Breaking disheartening news such as the one given to Mrs C is one of the most challenging responsibilities for healthcare professionals, regardless of their professional experience and skills. Therefore, it is important that such situations are professionally handled – especially with sensitivity and empathy.

Action plan

The incident I described in this reflective essay has provided me with important learning points to use when I am faced with similar situations in future. To this point, I feel much ready to deal with similar situations. For example, I have learned that selecting a suitable environment to break disheartening news to patients and their families is a big step towards ensuring that the situation does not go out of hand. Similarly, I have learned that instead of only relying on verbal communication, I should be more aware of non-verbal methods of communication especially appropriate touch. I have also become more aware of ethical issues surrounding the delivery of disheartening news in palliative care setting, whereby there is a need to be honest and open with the patient and their family.

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