Inter Professional Working

Introduction

The corresponding reflective essay would be deliberating about the significance of the properly undertaking inter-disciplinary and inter-professional collaboration based teamwork within the perspective of a particular case of administering care. This particular case study has involved the performing of the Cerebral Angiogram test to determine the effects of cerebral stroke within a particular patient. The evaluation of the personal reflection associated with such a case study would be based on the elements of inter-disciplinary teamwork and communication and collaboration based care planning performance demonstrated by the health professionals associated with the specific case study. The reflections of my experiences as a healthcare intern would highlight the factor of the necessity of improvement in the endorsement and promotion of the choices of the patient.

According to Mitchell and Ford (2019), the characteristic of interdisciplinary healthcare team functionalities could be understood to be the coordinated collaboration in between professional care service providers belonging to diversified healthcare disciplines with extensive variation of knowledge, skills and experiences. The intention is always to develop specific health intervention processes to accomplish a shared and necessary objective in terms of the prevailing health and social care settings (Harrison, 2018). MacIntosh (2019) has thus observed that the inter-disciplinary team functionality based healthcare operations could prove to be effective in terms of benefiting both the patients and the healthcare professionals through preclusion of erroneous treatment. Inter-professional team collaboration based healthcare operations could as well contribute to reduction of healthcare costs and the associated workload to a great extent which could further entail the achievement of improved outcomes for the patients. Fragkos (2016) has stated that inter-disciplinary teamwork could also foster greater communication efficacy amongst the care providers and the patients and could instil confidence within the patients regarding the perception of having proper control on the proceedings of care and treatment. Nursing and Midwifery Council (2015) have stated that communication could be performed through three different modes, namely, the verbal, the non-verbal and the written format.

In a similar manner, reflective study of the earned experiences in the nursing discipline could be envisaged as a method to develop self-induced learning and comprehensive capability of the nursing professionals. Apart from these, Casimiro, et al (2015) have highlighted that the process of reflection could be recognised to promote the ability within the nurses to develop effectiveness of utilisation of their professional skills which is of greater significance regarding the complications associated with the evolving healthcare systems. This is closely related to the assessment of practical abilities of the health professionals by themselves. Furthermore, according to Heckemann, Schols and Halfens (2015), reflection could as well assist in the process of evaluation and comprehension of the measure of self-abilities through which care service imperatives could be achieved. This format also becomes assistive towards enabling the enterprising and innovative care personnel with enough insight into the conditions of patients to take proper health initiatives. In this context, Hunter (2016) have observed that it is of utmost significance that therapeutic engagement and relationships with the patients should be consistently improved through enhancement of the standards of care and in the skill of the healthcare management personnel. These could be achieved through the management of the cognitive effects of experiences in the context of provisioning of patient care.

According to McLeod (2019), the Hierarchy of Needs theory of Abraham Maslow has illustrated the aspect of self-actualisation to be indicative of the highest necessity of the human psychology. This could be better delineated as the exploitation of the human potential regarding accomplishment of particular objectives. Kolb (2014) has highlighted that it is necessary for a nursing intern to be cognisant of the self-capabilities and limitations so that credible performance goal could be developed.

According to Sherwood and McNeill (2017) the utilisation of any reflective model of learning generally could enable the operating nurses to ensure that the most standardised care facilities could be delivered to the patients. This could also entail the establishment of a supportive functional framework through which proper guidance for the future clinical nursing operation could be developed. The reflective model of learning has been further defined by Johns (2017), as the dynamic and formative method through which reflective realisation and evaluation of learnt experiences could be structured. In this context, the Reflective Cycle of Gibbs would be applied for the purpose of utilising a diver approach in terms of observing different a particular situation which the student nurse has experienced. Furthermore, according to Gibbs (2019) the Gibbs Reflective Cycle could effectively convey learning ability on the nursing students in greater measure in comparison to the other reflective realisation based learning models such as the Kolb learning model.

According to Chong (2009), the reflective cycle of Gibbs consists of 6 different evaluative inquests through which the following essay could be structured to learn from it. These evaluative inquests have been what had actually occurred during the experienced care episode (which implied the specifics of the case study), the experienced thoughts and feelings (my reflective analysis), the evaluation of whatever positive and negative could have taken place within the entire situation of imparting patient care (utilisation of my learnt lessons), analysis of the understandings which could be derived from the actual situations (synthesis of my derived experiences to have greater insight regarding my experiences), realisation of what could have been done and the measures which could be undertaken to formulate an effective plan of actions for the future to determine what could be done in completely different manners during similar care episodes. Casimiro et al (2015) have stated that the establishment of the Multi-Disciplinary Team functionality based care management would be performed through the utilisation of the Reflective Model of Gibbs as well as the teamwork development theoretical constructs of Belbin and Tuckman (Hilliard, James and Batt, 2017). Furthermore, the endorsement and promotion of utilisation of such theories would be established through the clarification of the rationale behind the application of such an option.

Description

Under the purview of the stipulations of the NMC Code of Professional Conduct (Nursing and Midwifery Council, 2015), a pseudonym of Mr. Albert has been utilised for the purpose of maintaining confidentiality. Mr. Albert, the 71 year old patient, had been brought to the rehabilitation centre after suffering a cerebral stroke which had further caused consistent problems such as seizures, nausea, difficulty in organised physical movement and falls. Mr. Albert had been suffering consistent complications in properly balancing himself which had been leading to occurrence of injuries. The general practitioner of Mr. Albert had referred the person to the stroke rehabilitation centre regarding the necessity to address such physical movement difficulties. This necessitated the evaluation of the exact nature of stroke which Mr. Albert had experienced. The resident physician had been off the view that to determine the affected regions of the brain of the patient, it was necessary to conduct Cerebral Angiogram (CA). The prevailing logic for such a procedure was perceived to be that through the CA test, apart from establishing the regions of the brain of the patient which could have been affected by the stroke, any probability of existence of other causes for such complications such as cerebral tumours, could be identified with clarity.

According to The Royal College of Nursing. (2019), Cerebral Angiogram is utilised as an invasive examination procedure to diagnose the complications which could have occurred within the arteries of the brain or neck of the patients. This required the insertion of a flexible catheter within the groin of the patient through making a small incision and then guiding the tube towards the vertebral and carotid arteries so as to inject a colouring dye within the arteries. The intention had been to make the internal conditions of such arteries visible through X-ray based imaging. This procedure is effective in providing the most detailed visibility of the blood arteries within the brain and neck of the cerebral stroke affected patients.

Thus, the opportunity was presented to me regarding following and learning from the care administration of the relevant patient. Following the admission of the patient, my mentor and I had been assigned to monitor the physical conditions of the patient by the Chief Nurse. The general state of health of Mr. Albert was evaluated to determine if the vital signs of his were stable or not and to determine any hitherto unidentified health concerns prior to the commencement of the CA test. The utilisation of the medical questionnaire for the purpose of obtaining and compiling of the medical history of the patient in brief was then undertaken after the patient had been admitted with the stroke rehabilitation and nursing department. The communication of the developed plan to conduct the Cerebral Angiogram to the Manager and the Team Leader had been instantaneously undertaken. It was a satisfactory internal communication process.

However, during the documentation analysis procedure, it was detected that the consent form, which was presented to the patient, had been left unsigned by the patient. Mr. Albert had been apprehensive about the Cerebral Angiogram on part of the fact that he did not have any prior experience regarding undergoing the influence of general invasive therapeutic examination and Mr. Albert was apprehensive regarding the discomfort and physical pain which he expected to experience while the Cerebral Angiogram could be in progress. It was apparent from the assertions of the patient that Mr. Albert has not been updated about the details of the CA test procedure prior to the presenting of the consent form to him.

To this effect, with the assistance and supervision of the senior nursing assistant, I categorically explained to the patient that application of the catheter insertion through the transfemoral arterial pathway would be undertaken and no brachial puncture would be made to insert the catheter so as not to expect heightened physical pain while the examination would be underway. I also explained to the patient that the femoral puncture would be infused with the combination of the effective anaesthetic Bupivacaine in which the opioid Buprenorphine would be added so that Mr. Albert could experience prolonged post insertion pain relief. I also managed to assure Mr. Albert that either verbal or non-verbal communication with the patient would be maintained throughout the CA test since the patient was going to experience only partial loss of consciousness. This was necessary to ensure that any form of discomfort or pain could be prevented. I also notified the anaesthetist Mr. John about the problem and he visited the patient to reassure him and to assuage his concerns. Mr. Albert was provided further explanations by the Angiogram technician regarding the process of catheter insertion. He was given the information that a super-selective and modified end-hole micro-catheter of 4.0 French Gauge (FG) would be utilised so as to make the insertion wound as small as possible. However, I felt certain misgivings regarding the plausibility of such explanations to the patient since Mr. Albert was receiving mostly technical information which was necessarily not much holistic or clarified since it was being furnished by different personnel. Thus, a definitive perception of the patient was needed to be formulated regarding the invasive examination procedure. I communicated my worries to the Manager of the respective department. This led to the Manager undertaking another assessment regarding the condition of the patient as well as the evaluation of any remaining apprehension on part of Mr. Albert. I was provided with the affirmation that the medical consultant would be providing effective explanations to the patient regarding the procedures related to Cerebral Angiogram so that the patent would be contented with such services.

Such assurance resulted in Mr. Albert then confirming his consent regarding the completion of the procedure and signed the consent form and the CA test was performed effectively. As a result, the patient was injected with Alteplase, a tissue plasminogen activator, since the CA test established that Mr. Albert was suffering from Ischemic stroke and certain blood clots were detected at the cerebral arteries. Later, the patient had been slated to receive focused care in the form of Physiotherapy and intensive nursing care so as to address the prevailing concern of falls and physiological issues such as difficulty in maintaining balance and heightened blood pressure.

I concentrated consistently on the monitoring of the comfort level of the patient and the healthcare assistant assisted me in this procedure. The careful focus on monitoring the vitals of the patient was achieved through close co-ordination between the different segments of the multidisciplinary team of health professionals. At the completion of the CA test, Mr. Albert was successfully relocated to the Intensive Care Unit at the recovery section so as to monitor the condition of the patient. The senior staff nurse assumed the responsibility of the patient at the ICU of the recovery section and I was assigned to consistently note the vitals of the patient so as to compare the readings with the normal health parameters.

Feelings

My feelings had been mostly empathetic regarding the condition of Mr. Albert since I could understand that the strain of undergoing the CA test could not be a pleasant one for the patient. This involved concern for the physical and psychological conditions of the patient during the administering of the test procedures. I could arrive at the conclusion that a balanced nursing approach was necessary to be maintained in this perspective. It was certainly necessary for the benefit of the patient to institute proper adherence to the principle of giving priority to the opinions of the patient.

This experience of mine necessitated me to consistently conform to principled stand of putting the patient at the centre of any medical assistance process. I have determined that I was required to challenge the decision of the nursing staff which had been in charge of the entire care episode regarding according the patient with greater opportunity and time prior to undergoing the invasive examination procedure to make sure that the consent had been provided by the patient with adequate understanding of the beneficence of the care services about to be administered. From my perspective, this represented the contravention of the right of the patient to formulate informed choices. It could be construed to be an abject failure on my part in terms of the prevailing duties of care. This implied the endorsement and promotion of the rights of the patient regarding receiving accurate, adequate and discernable information from particular responsible care personnel. This prompted me to request the Manager to intervene so that the perception of the patient regarding the impending medical procedure could be improved. The complete understanding of the medical invasive procedures by the patient and the subsequent consent provided by Mr. Albert required concerted effort by the nursing staff to furnish exact information to the patient which could be understood effectively by someone who was in the physical and psychological conditions of Mr. Albert.

Evaluation

Timely reporting to the Manager about the impropriety of information sharing to the patient about the medical procedure facilitated patient autonomy, contributed to the development of promotion of the rights of the patient. The variety in the members of the team conformed to the principles of Belbin in terms of existence of such variety for complementary purposes. This had been critical for each professional to be aware of procedures and limitations and the necessity to effectively communicate adequate information to patients. The critical factors were inter-professional leadership, inclusivity and goal orientation in teamwork. The leadership operated on a consultation basis where identification of any problem was followed up by group based decision formulation. This leadership style fostered inclusivity.

Analysis

I could realise that teamwork based decision formulation for problem solving purposes through a collaborationist approach is key in terms of goal oriented functionalities and efficacious communication is vital in this regard. The significance of patient rights endorsement and promotion also became apparent for me especially during periods of anaesthesia administration or invasive surgery. The theoretical format of team development specified by Tuckman also was apparent in terms of the healthcare operational progression as everyone in the inter-disciplinary team learnt about each other during the forming stage of the team development through setting of objectives and accountability based introductions. My responsibilities within the team had been documenting and monitoring the vitals of Mr. Albert. The storming phase brought about development of collaboration based trust and joint operations towards the shared objective.

Further, the performing phase of teamwork development occurred with development of cooperation between the team members regarding task delegation. This resulted in my monitoring of the vital pathological conditions of the patient during procedure and the nursing staff receiving caring for the patient at the recovery section ICU. The outcome was according of assistance to the medical consultant by the nursing staff. Ultimately, the adjourning phase took place through provisioning of the patient centric care with the most beneficial outcome for the patient.

The interdisciplinary teamwork permitted effective outcomes in terms of clinical interventions for patient care. The team leadership was also enthusiastic, careful, objective oriented, assertive and dedicated. Being a nursing intern, I would be ensuring that communication with the patient and monitoring of the conditions of the patient could be improved further.

Conclusion

The significance of each of the members in terms of their responsibilities within the entire team have been emphasised in this reflective analysis. I was required to emphasise with greater effect on the maintenance of interest of the patients so as to ensure the empathetic and accommodative behaviour from the other nursing personnel. I also felt that greater confidence acquisition is necessary from me to address identified errors and shortcomings. I have come to the realisation that advanced planning and careful consideration of different situations during administering treatment or physical examination of patients are paramount in significance. This could improve my learning strategies. I have also learnt about the significance of inter-team working dynamics to formulate openness and positivity in the working environment. Such reflective learning has also assisted me to share knowledge and experiences in the future perspective so as to expand the scope of my thinking.

Action Plan

• Greater effort in working as a team member would be required to become adept in handling different eventualities which could require extensive alertness and ability to scrutinise conditions of patients instinctively.
• Learning better modes of communication would be critical so that patients such as Mr. Albert could be provided with worthwhile and effective information which could be easily understandable.
• Improvement of confidence and assertive abilities while addressing procedural shortcomings. This could be achieved only through gaining the most extensive insight into the patient handling procedures and this requires time.
• Undertaking reference based learning to improve my understanding of the technical procedures associated with such critical medical tests such as Cerebral Angiogram.
• Utilisation of the identified methods of learning improvement into actual practice to achieve further progress in my career.

Essay Conclusion

The aspects of inter-disciplinary teamwork based collaborative effort and the development of communication had been emphasised upon in the preceding reflective analysis. Patient rights endorsement and promotion has been the identified improvement aspect through reflective learning. Further, work is to be undertaken by me in development of the understanding of how professionals from diversified healthcare backgrounds could effectively aid in the continuation of patient functionality normalisation through a patient centric health service delivery approach. The appropriateness of the Gibbs cycle of reflective learning had made it preferred on my part to be utilised in the case study so as to derive greater insight into my learning experience.

Reference List

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