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The first part is this one (part A). It includes a practice scenario which I have been exploring in classroom sessions, to be discussed in terms how a policy like'our health our care our say'', which influences service user involvement and integration of services; and how this relates to interprofessional working.
For the second part (part B), a self-assessment of my level of development is required, using the provided self-assessment document which is related to the Interprofessional Capability Framework through reflections.
''Our health our care our say'' is the National Policy that I am going to examine in this assignment, to show how it influences interprofessional working with service users. It was published in January 2006 and it is aiming for more effective health and social care services outside hospital. Its logo is 'This policy is a new direction for community services'. It sets out the governments vision for 'high quality support meeting people's aspirations for independence and greater control over their lives, making service flexible and responsive to individual needs.'' That means that it targets for a person-centred environment in the health and care area.
The scenario that I chose concerns Jane, a single young mother of two children, who was diagnosed with locally advanced carcinoma of the cervix. She underwent a radical hysterectomy with pelvic lymph node sampling and she is currently undergoing radiotherapy and chemotherapy. Jane habitually smokes and drinks. In the following part, the consequences of this patient's behaviour are going to be analysed, since it seriously influences the results of her health care.
As it was previously stated, this assignment is about the service user involvement and integration of services. A service user is essentially any individual who receives the impeccable, selfless and person-oriented service from the health and social care policy; if that policy is as perfect and person centred as they claim it to be, is a topic that will be analysed further along in this assignment. The level of the user's involvement is heavily fluctuated. People should be encouraged to be involved in health care at levels that they are comfortable with, but at the same time be empowered through information, training and other support to get to the level of involvement to which they may aspire. (session) 'the service user should be able to make choices from a range of options. They cannot do this if they do not know what is available and whether they are entitled to it''.
For effectively delivering health and social care services, it is essential that professionals must work collaborative and the service user to be involved in their care. According to Hippocrates in the 5th BC; the role in the patient care is not exclusively part of physicians' work, but patients must also participate in order for a smoother and less problematic cure to take place. This argument can be explicitly justified when observing a patient that displays non-compliance behaviour, since it makes the work for the cure of that patient almost impossible. In this case, Jane is the service user since she has been through a variety of services (assessed and treated by a physiotherapist, join a local smoking cessation group which is run by a small team of nurses and physiotherapists to support her in giving up smoking on a permanent basis, begin radiotherapy treatment and chemotherapy with cisplatin). Though, she is not active at all. With her attitude like missing her appointments in the radiotherapy treatment, stop attending in the local cessation group for giving up smoking, she shows that she doesn't want to understand the importance of her treatment and how much is going to help her the cessation group to become well, in order to raise her children.
Through interprofessional and collaborative working, professionals can take on a number of roles to promote this involvement.
Collaborative working is about engaging in partnership with other professionals and those we care for (Whittington, 2003). Furthermore it can be argued that no profession by its own can meet all the needs of its service users. Nevertheless, by using the skills and expertise of all members of the multiisciplinary team in an integrated way, it can be ensured that all the needs of those people using the services are met. The significance of mutual respect in a working environment, as well as understanding and co-operation, with the combination of good communication and collaborative working is really important. It inevitably offers a person-centred environment, in which users of services experience high quality care that minimises risk and prohibits as far as possible serious mishaps and service breakdown.
Wittington states in his work that, if there is no collaborative working between the health care professionals 'service isolation and fragmentation can result in lack of co-ordination, poor communication with service users, users spending longer periods away from home and increased service costs'. (Wittington, 2003)
Subsequently, for the Governments' drive to shift the ideology from the requirements of the service to needs of the user, various key policy advancements have been established during the last few years, that altered the structure of the health and social care. Each development has greatly influence the manner that health and social care professionals conduct their service, the way the provision of services is provided and the experience of this service for the service user
'Our health our care our say' is aiming to achieve four main goals. Firstly, it is aiming to provide better prevention services with earlier intervention in the health and social care services. This is going to be achieved by collaborative practice between the GP and Primary and Care Trusts (PCTs) with local government services, by having a personalised service which is going to advice and support the public (Makely, 2005). For example, cancer support services are providing advice and support, not only in the cancer patients but also to their families. In the cancer support services, there should be work specialist who can provide individual support. Secondly, it aims to give to people more choice and a louder voice by providing them the ability to choose and influence social and primary care. Briefly, one of the suggestions is to present a GP practice list to the public, thus giving them the choice to get the information they want and understand what services are available in their area. For the people who are not so confident using this list there are going to be GP practices to offer face to face communication in opening times. According to the NHS website (NHS The National Centre for Involvement, 2008), on April 2008 the LINks (Local Involvement Networks) was set up. These are networks that are run by local people and groups, who inquire people's opinion, whilst monitoring the delivery of care and using their authority to oblige service to account on their actions. This is helpful in the better understanding of what the community necessitated from the commissioners and the managers of health and care services. The other aim is to try to do more on tackling inequalities and improving access to community services. That means that local health and social care commissioners will work together to understand and address local inequalities. Again, forums, websites and networks like the LINks are going to help these care providers, allow councils to access a wide range of views, helping to develop care pathways and with this way is going to improve the services and help people who need specific care and support such as people with particular needs like mothers, ethnic minorities, people at the end of their lives and others to get the service that they require (NHS The National Centre for Involvement, 2008). And the final aim is to support more the people with long-term needs like people with disabilities. Because they need to have a clear understanding of their condition and what they can do, so they are more likely to take control of their lives. This aim is going to be achieved by developing a programme which is going to give the information that the people with long'term health and social care needs and by developing assistive technologies to support these people in their own homes. For this aim, collaborative working will be necessary, since they have to deal with not only with health problems of the people with long-term needs but also with social problems. (Makely, 2005) A variety of professionals like psychologists, physicians, social supporters, counsellors are going to contribute in the best support of these people.
'Our health our care our say' policy explores a variety of aspects on Jane's story. It mostly covers general health and social issues. For example, the fact that Jane is a single mum and she does not work, the above policy is aiming to help these kind of people, by supporting them and finding them the appropriate service to help them. Despite the fact that Jane believes that she does not need any help from any support worker, I think a guidance and some financial support, will enable her to trust the system and make her keen in listening the professionals. Moreover, Jane smokes and drinks which aggravates her health problems considerably. It has been suggested to her, to go to local cessation group which was running by small team of nurses and physiotherapists, but she stopped attending to that appointments. Collaborative working between the services is necessary since they inform each other that Jane does not attend to that local group and in the radiotherapy treatment she misses a lot of appointments. The professionals that have worked with Jane, observed that changes mood and she sometimes goes to treatment drunk and she has an non- compliance behaviour. All this information is probably going to be discussed in MDT meetings, so they find some ways to help this mother so that she can realise the importance of her treatment. From Jane's story, it is evident that even the radiotherapists want to help her, but they cannot, because as a free-will individual she demonstrates her unwillingness to not follow the instructions of the professionals and not listening at all what the professionals are telling her.
It is evident therefore that, for effectively delivering health and social care services, is vital that professionals must work collaboratively and the service users to be actively involved in their own personal care. This position has been empirically accepted as a better method for conducting health and social care. The abovementioned, can be observed in the advancements made during recent years, as a result of carefully driven policies which tend to support public awareness of their medical condition, and encourages patient involvement in the process of their care. These policies also sustain that local inequalities should be eradicated, mainly through giving a stronger voice to patients; in this way enforcing patient involvement in their personal care. Nonetheless, despite the fact that these reform policies have introduced a considerable level of improvement towards a better health and social policy, the idea of a service user receiving the impeccable and ideal health care (mentioned in the begging of the assignment) is still a long way to go. This is proven by genuine case studies like Jane's, which is a great example of the ineffectiveness that some parts of the social and health care currently display. But one must take into account the progress of these policies, and anticipate even more improvement in the health care plan with the introduction of new policies, so that people like Jane can enjoy an effective health care.
REFLECTION ON MY DEVELOPEMENT NEEDS
DOMAIN: Collaborative Working
Description: During my placement, I had been asked to take an old lady in the transport services, since the support workers were busy. In the way to the transport services, the old lady said that she was feeling sick, and she threw up. At the same time a radiotherapist came and she asked me to help her with the care of this patient. I brought her some medication from the pharmacy. The radiotherapist then assigned me the responsibility to stay with her and take care of her, because she was needed to work back in the treatment machine. When I was sure that the patient could be left alone for a couple of minutes, I went to the reception and informed them on what happened and made sure that they were going to contact the transport services. The transport services arranged it and when the patient felt better, they took her home.
Feelings: I felt proud for myself since I acted responsibly. I used my interpersonal skills and communicated successfully with the reception, so the transport services would be aware of the situation in time and arrange transport for the patient.
Evaluation and analysis: Feeling the need to take the responsibility and take care the old lady, shows that I am more confident about myself and my skills. Also, the fact that the radiotherapist assigned me the care of the patient, demonstrates that she knew my skills and she believed in me. By accomplishing successfully this task I showed that I develop my interpersonal skills by communicate reception and make sure that the lady will go home safely without causing any trouble to other patients. Now I am able to say that I met the capability CW2 L1 Recognises the need for effective interpersonal skills to enhance person focused service. In the action plan (appendix) I introduced a series of actions to accomplish the Level 3 of this capability.
Description & Feelings: I was observing, a radiotherapist doing a first day patient chat when the radiotherapist realised that the patient was not well informed about the side effects of the treatment since the doctor never talked about it. I was annoyed , when I realised that the patient signed the consent form but he did not know about the side effects since it is a big impact in patient life during and after radiotherapy, so I asked the radiotherapist after the patient left, why the doctor did not inform the patient and if that was appropriate. The radiotherapist told me that the specific doctor does it, because he knows that the radiotherapists are going to repeat the side effects. But it is still not appropriate since the patient must be well informed and fully aware before signing anything.
Evaluation and analysis: I was aware of what the patient should know about his treatment when he is coming for the first day chat, is because I have seen a variety of first day chats and I had been in the clinics for a while with the doctor and the patients will they were signing the consent forms. It is showed that the experience I had help me to critical appraise the situation and ask for explanations why the patient was not aware properly. After this incident, I can prove that I am able to say that I met the capability R2 L1 Is aware of evidence-based practice in service delivery.
DOMAIN: Cultural Awareness & Ethical Practice
Description: A patient needed a translator to communicate with us in the department. It was the first time I was in that situation and I observed what everybody did for that. They were using body language while they were speaking slowly. I was the one who brought the patient in the room. I was not aware of the situation of the patient and when I realised that he did not know any English I was shocked, however I did not show it and I waited to see how that situation would continue and how the staff and doctors would react. I escorted the patient into the room and identified him (Name, date of birth and first line of his address).
Feelings: In the beginning, I did not know how to react in this kind of situation. When I was identifying the patient, I did not know where I should look at when I was making the questions, the patient or the translator? So I thought carefully what was more appropriate and I tried to watch both of them while I was identifying the patient, but mostly I was looking the patient since he was the service user.
Evaluation and analysis: I found it quite a nice experience, mainly because it was surprised me the whole situation. In clinic room I was observing carefully what is going around me and how everybody was reacting so by the end of the meeting between the patient and the doctor, I would know how to react properly, too. I liked the way I reacted when I realised that the patient was not speaking English. I stayed calm and I reacted the way I was going to react with every other patient. I checked his ID and asked how he was feeling. I just felt a little uncomfortable when I didn't know where to look, the patient or the interpreter, so I was trying to look both of them. From the way that the doctor was reacting I learnt that I should look directly at the patient and talk to him. Nevertheless, there is a need to speak slower with more pauses so that the interpreter can translate correctly. Now I am able to say that I met the capability CAEP2 L1 Recognises examples where participation and informed decision are critical in promoting the well being of people who use services and I have made an action plan for further development.
DOMAIN: Organisational Competence
Description & Feelings: Last year, in the IIP module we worked through some activities. One of the activities was to get a scenario of a patient story and from there to conclude which services the patient should visit. With this activity, every member of the team was identifying his role in the scenario and from there we understand each other's role in order to treat the patient. I was surprised by the knowledge that I gained with that activity. I learnt about the other professions' role in the health and care community.
Evaluation and analysis: It was satisfying gaining knowledge through activities. Now I am able to suggest to a patient which of the services to use to get the appropriate care for his/her problem. In addition for further development of my skills I made an action plan. (appendix). I met the capability OC2 L1 Is aware of team structures within the community of practice.