roles played by nurses and other professionals in the team
This essay is meant to throw light on the importance of having an inter professional team that would make the service delivery to patients easier. In this essay I will discuss the roles played by nurses and other professionals in the team. The essay will reflect the efficiency of such a team and their work distribution and involvement. I will highlight the ways in which a team of professionals will work together to take proper decisions during emergency situations and tackle them effectively. The essay will also critically evaluate the various concepts of inter professional team work.
An interprofessional team is a group of people who have a certain common goals or objectives which drives them to work together by setting aside individual goals. Inter professional team can be defined as "a dynamic process involving two or more health care professionals with complementary backgrounds and skills, sharing common health goals and exercising concerted physical and mental effort in assessing, planning, or evaluating patient care, accomplished through interdependent collaboration, open communication and shared decision-making, and generates value-added patient, organizational and staff outcomes" (Xyrichis and Ream 2007). Freeth et al (2005) defined inter professional team work as "when two or more professional learn with, from and about each other to improve collaboration and the quality of care.
The healthcare sector started showing interest in the interprofessional working during the early 1990. (Institute of Medicine, 1998;O'Neil and Pew Health Professions Commission 1998;Â Pew Health Professions Commission 1995a,Â 1995b,Â 1998).
"The Association of American Medical Colleges", "the Accreditation Council for Graduate Medical Education", "the American Association of Colleges of Nursing" suggested that the graduates must have enough knowledge in interprofessional collaboration (Varkey, Reller, Smith, Ponet, & OsbornÂ , 2006). Varkey et.al (2006) also pointed out that there should be enough cooperation between the various professionals in healthcare field for the success of this profession. But unfortunately this fact is not included in the curriculum of the different medical schools in USA. Inter professional teams are more effective in rehabilitating the patients than individual health care professionals. The number of patients having positive impact by the inter professional service is larger than those by individual service providers.
A very strategic role played by nurses is highlighted now. The nursing tutors face the dual challenge of preparing their students enter into nursing profession as well as equip them to cooperate effectively with other health practitioners (Lattuca, 200l;Â Newell, 1998).
An interprofessional team is working to provide service in a properly planned and systematic manner. In the health care sector inter professional teams are meant to develop groups that works towards efficiently rendering care to the patients. These teams include nurses, doctors, and other health care professionals. For a team to be efficient role clarity to inevitable and this will help them define their own duties and responsibilities avoiding conflicts (West and Markiowicz, 2004). A team essentially will have a team leader who will lead the team and motivate them to render good service working together (Martin and Rogers 2004). A health care team will work effectively if there is stability in the team, this will make the team member in the group work with shared trust and understanding (West and Slater (1996); Gair and Hartery, (2001)).
Interprofessional teams are of various types, they include multidisciplinary, interdisciplinary etc. In case of multidisciplinary teams the members are from various teams. These members set their own discipline specific goals and work towards achieving it. But ultimately the result is calculated as the total of all the disciplines (Dean and Geiringer 1990). The position of team members in the team hierarchy will affect the way in which the team functions and how it will render the service (Cott's, 1998). In case of a multidisciplinary team there exist subgroups of doctors, social workers, therapists and also subgroups which had nurses and other junior staff. Her study also unveiled the idea that the different subgroups had different perceptions about the inter professional teams.
Inter professional team work is highly essential in operation theatres and intensive and trauma care units. Since these are the emergency units of a hospital the situation of such units cannot be predicted and thus highly challenging. The interprofessional team may have to work highly efficiently and together. There exists a high rate of tension and stress in the team members in such emergency situations.
According to McWilliam et al (2003), interprofessional working is a very difficult task for health care professionals. The patients didn't get the full benefit of interprofessional working due to the misunderstanding between the health care professionals regarding the policies and procedures in it.
Mistreatment of elders is a serious issue and it's growing day by day. It is the responsibility of nurses to identify and prevent such occurrences (Baker & Heitkemper, 2005). The nurses have a variety of roles to play in an Inter-professional elder mistreatment team. At present the roles involve screening and assessment, mandatory reporting, direct care, and complaint investigation. Elder mistreatment (EM) is a very complicated issue and can be effectively solved through inter-professional association.
Critics like Bion (1961) say that the interprofessional teams fail to focus on the real task they should be doing. The primary tasks for which they have come together is forgotten most of the by the interprofessional teams. Whenever there is an issue the teams to fail to reach at a consensus and they do not take proper decisions on the issue (Strokes 1994). The meetings conducted in order to take decision on the matter are just a waste of time. These assumptions are based on the work group mentality theory. Critics of interprofessional team have questioned the values of the team. It is said that the teams are not well managed and they do not work properly and responsibily.
Negotiation theory puts forward the perspective of negotiating the personal and professional goals. (Strauss, 1978) The negotiations by professionals in the health care field have played a critical role in molding the characteristics of an interprofessional team. Loss and change theory reiterates that the health care professionals like doctors and nurses lose their professional identity as they are working in a team, this will lead to developing an improper relationship and improper behavior in the team (Atkins, 1998). Thus it critically points to the inter professional teams in that it wouldn't serve the purpose of forming a team the unhappiness of the team members can lead to inefficient functioning. The increase of cost in hospitals will also result if there is lack of proper communication between the professionals like doctors, nurses and staff and also if they are not coordinated well (Gavett, Drucker, McCrum and Dickinson, 1985).
The roles played by nurses in the interprofessional teams are fast evolving. The importance of specialist skills for nurses is now recognized and new role have come up. The Macmillan nurse is an example of such new roles and they possess skills in palliative care and are expected to look after patients with terminal illness. Another group called night practitioners literally run the hospitals at night. They are skilled to assist any department and are sometimes considered better than junior doctors too (Martin & Rogers, 2004)
While working in an interprofessional team, there is an increased chance of conflict between the team members regarding the superiority in the team. The truth is everyone is equal while working in a team and nobody should themselves subordinate to anyone. But sometimes the nurses and their opinions are ignored in an interprofessional team. Such events makes them reluctant to be a part of such teams (Martin & Rogers, 2004).
Task shifting is a common practice among the professionals now days (Reeves et.al, 2010). This would help the traditional professionals to relieve of their heavy workload. The nursing practitioners and physician assistants are such roles (Hooker & McCaig, 2001).
The multiplicative effects model of interprofessional working views it more than the sum of its parts. Here the synergy obtained from such work is described (Leathard, 1994). According to this model, interprofessional working improves the contributions of individual team members and thus will help in the overall development of team.
Decision making is an essential in ingradient of all teams; it measures the efficiency of the group. Decision making in case of an interprofessional team also play key role deciding its service delivery process. The usual situation that happens in such teams is the unavailability of proper team leader and also reaching at a common consensus. The decision taken in team has the idea input all the members that needs to driven well in one direction for increasing effectiveness of the work the team does. Most of the important decisions concerning the activities of the team are taken mostly by the Doctors, or the medical staff in an inter professional team in hospitals. Solving important problems and resolving conflicts are the aims of masking decisions (Neil, 1978).
There are a few hindrances for nurses to be part of interprofessional teams. The health care sector has shortages or less number of nurses, and those nurses who are available have increased amount of work. As a result of which there is a limitation in case of inter professional support and collaboration (Mckay & Crippen, 2008). Another barrier that can be highlighted is the disinterest on the part of other departments to participate and actively involve in the team and work together. The culture and hierarchy of the organization also plays a role in the formation of teams in the organization.
According to Henneman.et.al (1995) "Collaboration involves a partnership characterized by mutual goals and commitments in which participants willingly become involved in planning and decision making." Henneman.et.al (1995) also proposed that collaboration "is a process by which members of various disciplines (or agencies) share their expertise. Accomplishing this requires these individuals understand and appreciate what it is that they contribute to the whole."
Many authors have suggested ways to make the intercollaboration more effective. According to Fullan (1993), "effective collaborations operate in the world of ideas, examining existing practices critically, seeking better alternatives and working hard together at bringing about improvements and assessing their worth."Â The National Network for Collaboration (NNC) put forward a frame work for effective collaboration and advocated that it should possess a common vision, problem, a desired outcome etc. NNC also pointed out that the members of the collaboration must share this vision and contribute equally. The NNC sees collaboration as an inclusionary process which should be constantly engaged and must strengthen the commitment and must identify that relationship building and maintaining is the key factor for the success of collaborations and they must try to sustain a 'win-win' relationship. According to Garner (1995) and Hoeman (1996), it should be by means of collaborative communication rather than shared communication that the interprofessional team approach evolves.
Efforts were made from the part of many authors for increasing the literature on interprofessional education for health professional students. But Cooper, Carlisle, Gibbs, and Watkins (2001) pointed out this literature "to be diverse including a relatively small amount of research data and much larger amounts of evaluation literature." There were almost thirty works done on interprofessional education and all of them aimed to increase the level of co-operation and understanding between the members in interprofessional teams as well as to encourage a high quality care for the patients.
There are a number of social science theories that explain the concept of interprofessional team work. Merton (1968) put forward theory in three modules. They are the micro, mid range and macro theories. The social sciences approaches that come under these three groups include:
Micro: psychodynamic perspective by Bion, Menzies, Marris,
social psychological perspective by Tejfel and Turner, Brown
Interactionism by Goffman and strauss
All the above approaches that come under the micro group are of the rational type that consolidates the team functions, identities and interactions.
Midrange : Activity theory by Engestrom
Institutional influence by DiMaggio and Powell
Professionalization by Freidson
These three approaches or theories are processual, organizational and contextual. Their task is to understand team activities, relation and performance, the relations between professions respectively.
Macro: Discourse theory and surveillance theory by Foucault
They are of the contextual type that deals with the impact of society and social interaction of with respect to the interprofessional team work.
There are a set of models supporter by theories that help provide the inter professional education well in the health care sector that enables the health care professionals perform well and deliver quality service. These models are whilst behaviorism, cognitivism and constructivism (Schunk D 2003).
I will working for the betterment of the service provided to a patient using the things I learned. Working in an interprofessional team is has made me get involved with the Doctors and other professional in the field and has helped to build a strategy that elevates the level of service rendering process. As a nurse am able to act in the right way a right direction in case of any emergency and otherwise. From now I will be able to put into practise the concept I learned.
The model that I would use is the Kolb's model of reflection. It is "a process whereby, individuals, teams and organizations attend to and understanding their experiences and consequently modify their behaviour".
The model mainly has 4 important aspects:
Experiencing - means really doing the task and experiencing the whole process.
Reflecting- in this step the work is reviewed in terms of experience and the real process.
Conceptualisation- here the various important occurrences and tasks are analysed and their connections among the events are noted.
Planning- the events that have been understood will be analysed well in order to envisage the occurrences in future. This will help to prevent any improper events happening and build a proper strategy to do the next task.
The Kolb's reflection model if one of the best models for teams. In case of a team there are aspects like:
Doing- same as experience, where the team does the task or the action.
Reflection- after the action, the team members openly discuss the whole process and share their views and experience.
Interpretation- the members of the team now work with common identity and culture and as a team by leaning behind individual interests.
Planning- in the final step team works according to the joint decisions and plan out ways to committing the action.
Finally I would say that in any sector especially the health care there is an elementary requirement of having an inter professional team. The team in all ways will help in providing superior service since the decisions are taken as a team and under common grounds.
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