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In order for an individual to receive holistic, high quality health and social care services, effective communication and multi disciplinary working between professionals is imperative (Ashcroft et al, 2005). I will discuss my personal experience of interprofessional working, both in regards to the conference and the on line group work undertaken. I will also explore how the module relates to my own experiences in practice, drawing on literature and policy of both a political, professional and social nature.
The team of which I was a member consisted of students studying adult nursing and medicine. I was the only group member studying social work which initially did create a barrier in respect of the perception held by the other group members of what a social work practitioner's role is. It was clear, following initial introductions, that some group members held a stereotypical view of social workers and were very dismissive of the work carried out by practitioners. It is essential, when working interprofessionaly that practitioners are mindful of the various methods employed by associated health and social care professionals and vital, therefore, that practitioners become aware of their own possible prejudices, through reflection on their practice. This reflective process assists to ensure potential negative stereotyping does not hinder the outcome of the work carried out by the team and have a detrimental effect on the care provided to the service user ( Fook, 2002).
Through discussion it transpired that much of this stereotypical view had been constructed through the influence of the media's portrayal of social workers. During the conference group members cited television documentaries in which social workers failings were highlighted. Lombard ( 2009) argues that this type of media attention is damaging not just to social work but to all allied health and social care staff, attributing it to a possible lack of comprehension of the profession. Earlier this year a national advertising campaign was introduced. This aimed to draw attention to the role social workers play in safeguarding children and adults and to achieve a more positive, public perception of the profession ( McGregor, 2010).
The perceived lower professional position of social workers, held by other health professionals, however, is argued by Barbour (1985) as being a source of high anxiety for students studying on social work courses. However, it became apparent as the conference continued and discussions were held, that as a social work student I had gained experience of a wide range of practice settings and of working interprofessionally in order to achieve the best possible care provision for the service user. These practice experiences enabled me to reflect on both positive and negative factors of working with other professionals and to contribute to the group discussion with examples of interprofessional work in which I had participated. An example of which is regarding a case I care managed whilst working within a hospital social work team. In order to facilitate a safe discharge home for an older person with dementia, input was required from various disciplines. Occupational therapy support was necessary to ensure the home environment would still be suitable and assessment from the community psychiatric nurse was also completed in respect of service provision to maintain the emotional and mental well- being of the service user.
Ongoing communication between involved professionals was therefore essential, for an effective outcome for the service user to be achieved. This illustrates the highly significant role of interprofessional education for students studying to practice in the health and social care field. Reeves et al (2009) argue that interprofessional education has impacted notably on patient care in, for example, the improved knowledge and expertise of staff providing care to individuals with mental health issues.
The discussion of practice experience, I feel, added positively to the group and perhaps began to reduce the preconceptions held by other group members of lack of professional competency executed by social workers
(Carpenter & Hewstone,1996). Through the process of exchanging opinions, discussions and working as a group, the potential to overcome stereotypical views and facilitate change was engaged in (Mullender & Ward, 1991). Being a member of a group can determine a sense of familiarity, group members may have experiences in common and this sharing of situations can act as a supportive, cathartic procedure ( Johnson & Johnson, 1994). A fundamental element of effective interprofessional partnership, therefore, is trust. If facilitation and engagement in open debate and sharing of ideas between professionals is to occur, this must be apparent ( Cook et al, 2001).
The example of interprofessional working in respect of facilitating a safe discharge home from hospital, also raised further discussion regarding the role of input from the service user and their carers. They should be seen as part of the group, not externally from it and involved fully in the decision making process. This was challenged by one of the group members studying medicine, who felt that the responsibility to make decisions about care provision should be held solely by the professionals involved. Payne (2000) argues, however, that a focus on the interactions between the professionals can undermine the participation of the people who use the services. Involvement of service users, family and carers and recognition of their role as being experts by experience, may begin to create equality of power between professionals and the individuals they are supporting ( Domenelli,1996).
We explored this further through discussion within the group and I felt concerned by some of the group members attitudes towards the notion of making a decision as professionals, whilst excluding the service user from this process. This is an oppressive way to practice and the empowerment of individuals through maximization of control and choice, should be striven towards in all provision of health and social care services ( Banks, 2006). Respect for the individual choices and interests of the service user should always be paramount throughout provision of health and social care and the assessment process, as detailed in the National Occupational Standards for social work (2009).
Ongoing communication has been actively engaged in during my personal practice experience. However, throughout the module there was very little online participation from the team via blackboard. This was disappointing, as through the proactive exchange of ideas from the varying professionals perspectives, a more cohesive and beneficial learning experience may have been achieved. Indeed, the centre for the advancement of interprofessional education (1997) has documented that there are significant benefits in students from varied fields, learning together.
In contrast to the team work which took place at the conference, my experience of working alongside allied health and social care professionals in practice has been extremely positive. An example of which is in my previous employment within an adult care community team in which I attended weekly meetings with the district nursing team and local G.P's. enabling effective sharing of information to take place. This communication enabled all involved professionals to gain knowledge of changes in service users health and care needs and provided a forum for any concerns regarding safeguarding issues, to be shared and explored further.
Within the conference team, therefore, further discussion and exploration of the differing views regarding this topic was carried out. The conclusion of which was the establishment of one of the teams sentences as "be open minded and willing to accommodate other professionals values, within a team working environment."
The ideologies of interprofessional working are not always apparent in practice however, resulting in catastrophic failings in care. Victoria Climbie died after suffering serious abuse whilst under the care of the NHS and social services. Lord Laming (2003) reported a lack of sharing of information between professionals and argued that when practitioners did raise child protection concerns, there was a lack of feedback and little or no further communication between agencies.
The death of Baby Peter Connelly also sadly highlights concerns regarding how professionals work together. The serious case review reports that at a significant case conference held regarding Baby Peter, there was poor attendance from professionals, with neither doctors, police or lawyers turning up ( Laming, 2009). This illustrates that even after the reported failings in communication between professionals in the Victoria Climbie case, interprofessional working does not always appear to be fully engaged in.
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Discuss how you would take what you have learnt about Interprofessional working into practice.
Attendance at the conference provided an opportunity to explore the process of working effectively with other professionals. In practice, the active joint working between health and social care professionals and the voluntary sector has become increasingly important with the introduction of the personalisation agenda, as detailed in the social policy 'Putting people first: a shared vision and commitment to the transformation of adult social care' (2007). The personalisation of social care services enables service users to take increased control of their own support packages and provides a high level of empowerment.
I will discuss this further in relation to interprofessional working and it's application in practice.
Service users are now provided with the option to choose from which provider their care is sourced ie, from the private, pubic or voluntary sector. In 2004 the strategic concurrence between the NHS, Department of health and the voluntary sector of 'making partnership work for patients, carers and service users' (2004) was formed, which indicated a dedication to interprofessional working and a fully person centered approach to practice. However, the change in government this year and recent significant cuts in funding to the welfare state proposed by the coalition government may impact significantly on the initial goals set out in this policy ( Dunning, 2010).Significant changes in how funding is allocated impacts greatly on social care practice. On qualification as a social worker I will endeavor to carry out effective interprofessional practice, however with increasing reductions in front line staff and higher caseloads it raises concerns regarding how achievable this will be.
My own experiences of working within an adult care management team have been of positive interprofessional working. I have attributed this to the comprehensive, ongoing sharing of information between social work practitioners and community nursing teams, which took place. The desire to strive towards a common goal and achieve the best possible care for the service users, provided an effectual construct for professionals to practice within. The recognition of individual differences regarding ethnicity, culture and relationships by all involved professionals enabled truly anti-oppressive practice to take place (Dominelli 2002).
However, during the conference, team members voiced concerns regarding how engaging in interprofessional working may cause their specific professional identity to become vulnerable. This has been identified by Frost et al (2005), who postulates that the fusion of professional margins can create apprehension and resentment between practitioners. This discussion was an interesting aspect of my personal learning within the group. As a social work practitioner the opportunity to engage in joint working with other professionals is embraced and is essential to effectual, safe practice. The varied perspectives between group members however, has provided a deeper insight into how other professionals may view this method of working and I will be mindful of this in future practice.
Interprofessional working was illustrated further during the conference by a presentation from the Bristol Intermediate care team. The team consists of health professionals working alongside social work practitioners, aiming to reduce hospital admissions, providing a holistic approach to practice and enabling service users to remain in the community and to be cared for at home (Drake & Williams, 2010). I feel the cohesive working style of this team, provides the best possible outcome for service users through application of an anti oppressive, person centered approach. This interprofessional method of practice provides for less of a risk adverse approach to practice which can be present in community care teams consisting exclusively of social work practitioners (Roe & Beech, 2005). This may be due to the presence of multi disciplinary professional opinions being readily provided, enabling a more holistic view of a situation and perhaps also the fundamental ethos of the team which is to promote independence. The ethic of empowering others to achieve independence however, is a core value of social work and I endeavor to implement this within my own future practice.
In order to facilitate change in my practice, I will be conscious of the importance of information sharing with other professionals and engaging in the process of reflection on my previous experiences of working interprofessionally (Payne, 2006). An example which occurred whilst working within an adult care management team is regarding an allocated case concerning a couple, living at home in the community, both of which had multivariate care needs. In this circumstance a wife was providing care for her husband who has dementia, however she has limited mobility and depends on him to support her with some physical tasks. Joint working with other health and social care professionals was imperative in order to safeguard the needs of both service users (Meads & Ashcroft et al, 2005).
Combined assessments were carried out by myself as a social work practitioner, the district nursing team and community psychiatric nurse, enabling all involved professionals to be aware of each others role and involvement. This method of working was also highly beneficial to the service users in respect of limiting the amount of assessment meetings which took place and avoiding repetition of the same information to several professionals, which can become exhausting and create further anxiety ( Walker & Beckett, 2003). I did encounter difficulty in interprofessional working when liaising with the GP regarding a requested review of the couple's medication. The GP held the opinion that both service users should be placed in residential care due to their age and health problems and was reluctant to engage in any discussion regarding alternative options. Through joint working between other professionals however, funding for a live in carer was secured to support the couple, alongside ongoing support from the community matron to ensure both health and community care assessed needs continued to be met fully and safely, in accordance with the NHS and Community Care Act (1990).
On reflection this was a challenging experience and I felt frustrated by the apparent disregard of the wishes of the service users and the discriminative attitude exhibited in respect of their age, by the GP. The reluctance to engage further with any of the involved professionals following a case conference in which the GP's opinion had been challenged by myself and others working on the case, highlighted to me the hierarchy which is still in place within health and social care professions. Monlyneux (2001) argues that professionals who are assured in their professional role, are able to explore disparities in opinions and practice outside their own profession's margin without feeling vulnerable. The importance, therefore, of maintaining focus on the service users wishes rather than difficulties in communication between professionals, ensuring their needs are met fully, is paramount. However, this incident demonstrates the difficulties which can occur when working within a team and the need for respect and equality for all members, in order to ensure effective interprofessional working takes place (Conyne, 1999).
The discussions held amongst the team during the conference have highlighted further to me the disparity between perspectives held by health professionals, who apply the medical model of practice and social work practitioners implementing the social model. As argued by Petch (2002), in order to respond fully and positively the uniqueness of the individuals needs should be identified. Through this process, empowerment and equality can begin to be accomplished. Both perspectives, therefore, are valuable when striving towards holistic health and social care provision. These are issues I will be mindful of in my future practice and I will endeavor to continue to practice with integrity and in an anti-oppressive way in order to implement person centered care provision.
To conclude, as a result of my practice experience and learning achieved from the conference, I feel strongly that a critical part of my future role as a qualified social worker is to facilitate the sharing of information between professionals. When appropriate, to advocate the service users individual wishes and to ensure all professionals are aware of these shared common goals. I feel this will contribute significantly to achieving the highest level of care for the service user and aims to support the safeguarding of both adults and children.
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