“Describe the roles and responsibilities of four members of the Multidisciplinary Team who you have observed planning and implementing care for one child and family. ” The majority of practitioners who work in healthcare are trained to function both independently and autonomously (Soothill et al 1995).
There can be many challenges when working as part of a team, Soothill et al (1995) acknowledges this by stating, “learning to work with many different types of professionals in a multidisciplinary team can be extremely difficult” (pg 5). However, before going further, it is first of all important to define, what is meant by inter-professional working (or multidisciplinary teams)? Barrett et al (2005) states that inter-professional working requires that individuals from different professions and agencies to work together.
However within the context of health care, the service user is the patient. Hoffman et al (2007) describes inter-professional care as being “a patient-centred, team-based approach to health and social care and it is through this synergy that the strength and skills of each contributing health and social worker is maximised, thus increasing the quality of patient/service user care” (pg 2).
Research, as identified by Hoffman et al (2007) supports the idea of inter-professional collaboration by stating that “it lowers patient mortality, improves patient safety, improves health services, reduces hospitalisation and associated costs, enhances patient satisfaction, improves levels of innovation in patient care, increases staff motivation, well-being and retention” (pg2). However, as highlighted before, effective inter-professional working can be difficult to achieve.
Barriers such as lack of recognition or respect for another professionals’ occupation, poor knowledge within own occupation, fear and even lack of trust of the perspectives of other occupational groups can hinder inter-professional working (Soothill et al 1995). In the Working Together: Securing a Quality Workforce for the NHS, published by the Department of Health (1998), a strong emphasis is placed upon the government’s aim to break down barriers between organisations, as to provide integrated services by pulling together the right teams to meet the needs of users of the National Health Service.
Barrett et al (2005) suggests six principles for effective inter-professional working. These are knowledge of other professionals’ roles, willing participation, confidence, open and honest communication, trust and mutual respect and power sharing. It is important to be aware of these principles when working within a multi-disciplinary team as if not it can cause the team to break down and can potentially result in detrimental consequences for the patients whom their care is being managed (Soothill et al 1995).
An example of this can be seen in the Victoria Climbie case. Poor communication could be viewed as the main factor for the breakdown in the management of her care. The speech by Lord Laming on the 25th January 2003 highlights the core problems of the care she received. Issues such as inadequate recording of information and actions, assumptions and expectations that ‘things would happen’ or be ‘taken up by someone else’ demonstrates the need for health professionals to share information and to ensure that agreed actions are carried out (www. ictoria-climbie-inquiry. org. uk). As it has now been clear to understand the meaning of inter-professional working, how it can affect the patient, the professionals within the care team and also the principles of effective inter-professional working, this now lays the foundation for the purpose of this assignment. In this assignment, a patient with a health need, whose care was observed in practice, will be utilised in order to explore the roles of four specific members of the multidisciplinary team (MDT) in this patient’s care.
The roles of these members will be described, how they addressed the needs of the patient and how these professionals worked together to meet the needs of the patient will also be described. In accordance with the Nursing and Midwifery Council (NMC) requirements concerning confidentiality (NMC 2008), a pseudonym has been used throughout this assignment and all identifying features have been amended to protect the identities of all of those involved. Daniel, an eleven-year-old boy was admitted to the accident and emergency (A&E) unit of a northwest children’s hospital after slipping and falling from a high wall near his home.
According to the Prevention of childhood injury publication by the Department of Health (2002), it confirms that childhood falls are a major cause for both hospital admissions and A&E attendance. Daniel lived in an inner-city suburb in council housing with his mother. Research suggests that injuries disproportionately affected children living in the most deprived environments (DoH 2002). Meaning that children living in local authority (council) housing usually have significantly poorer health than those who do not (DoH 2007).
His mother, who is his main carer, accompanied him by ambulance to the A&E department. Upon arrival, medical and nursing staff met them, and immediately Daniel was diagnosed with a lower leg fracture. Lippincott (2005) describes a fracture as a break in the ‘continuity’ of bone. He was taken to the radiography department for an x-ray of his right lower leg in order determine which bones were broken and the extent of damage as this would determine whether or not he would need surgery.
Upon viewing his x-rays, the doctors confirmed that he had sustained a transverse fracture (straight across the bone) midway down his leg and that there was no visible damage to his fibula. Because of the position of the break in his bone, it would be described as a closed fracture because there was no break in the skin or visible open wound at the site of the fracture (Hockenberry & Wilson 2007). Therefore this meant that Daniel would have to undergo a closed reduction under general anaesthetic.
Hockenberry & Wilson (2007) acknowledge that a closed reduction is necessary for those patients who sustain closed fractures as the bony fragments are brought together into apposition (ends in contact) by manipulation and manual traction to restore alignment. At this point, Daniel was transferred to the hospital’s specialist orthopaedic surgical ward, where he was prepared for surgery. From a brief overview of Daniel’s episode of care as a result of his sustained injury, it is very apparent to see that he came into contact with close to ten separate professionals.
Following his patient journey, the first link with health care services is that of the call by his mother to the national emergency service (999). The operator who dealt with her call identified that Daniel’s injury was serious and required immediate attention. As a result of this, ambulatory services were notified and information was passed to the ambulance team concerning Daniel’s age, current condition and most importantly his home address. Upon arrival, the ambulance would have secured his leg with some sort of splint, safe enough to travel with and driven his mother and himself to the nearest A&E unit.
At this point, he was met by nurses and doctors who diagnosed him with a fractured leg. With the aid of radiographers in the x-ray department, the exact location of the fracture was confirmed and he was then transferred to the children’s hospital ward. It is here that he met his named nurse (changed on a daily basis due to shift patterns). After this a hospital porter later took him to theatre. In the anaesthetic room, he met the anaesthetist and other theatre nursing staff. Once anaesthetised, he was transferred to the theatre room where a doctor (consultant) commenced the intended procedure.
The roles of four members of the multidisciplinary team who cared for Daniel that will be discussed in greater depth are that of the Doctor (surgical), the nurse (on the ward), physiotherapist and the play specialist. How their roles came to be significant for the care of Daniel will then be identified. Before proceeding, it is important to note that all medical and health professionals are regulated in their practice by regulatory bodies; these professional bodies have certain responsibilities.
These include, maintaining the register of the qualified registered professionals, setting standards that all professionals must meet including a code of conduct, making sure that the public, other health professionals and employers are aware of the professional standards required and finally resolving concerns about a professionals fitness to practice. Throughout Daniel’s care, from the moment he was admitted to the A&E department, it was inevitable that he would come into contact with a doctor.
The role of a doctor or a medical practitioner as defined by Barrett et al (2005) is to diagnose and treat people who develop or experience ill health. The medical practitioners’ role involves examining the symptoms presented by a patient, and considering a range of possible diagnoses of their cause. The diagnosis must be tested, decisions on the best course of treatment made and the progress of the patient monitored (www. nhscareers. nhs. uk). The General Medical Council (GMC) regulates doctors in the United Kingdom. The GMC’s (2001) publication on Good Medical Practice sets out the duties and responsibilities of doctors.
It stipulates that all patients are entitled to good standards of practice by their doctors. Daniel encountered doctors at two stages when admitted to the hospital; the first instance was during his time in the A&E department and also later on when he underwent his closed reduction under general anaesthetic. It is important to know that doctors can specialise in specific areas, for example as in Daniels case, there were two doctors present during his surgery, these were the anaesthesiologist and the surgeon. The doctor in Daniel’s case that will be reflected upon in terms of his care team will be the surgeon.
Once Daniel was taken back to the ward, the surgical doctor still had a major role to play in terms of his care. It was the doctor that made the decision concerning what form of treatment was appropriate for Daniel’s injury and this was only decided upon after x-rays from the radiology department confirmed the type and location of the fracture. Once the procedure had finished, the doctor was then the person who specified important medical interventions such as pain relief and how this should be administered including the dosages.
The doctor also wrote in the post-operative notes, guidance for the attention of other members of the MDT regarding issues such as mobilising Daniel. This sort of information was very valuable for the Nurse and the Physiotherapist. Upon exploring how the doctor helped to address Daniel’s needs, one can note that it appears as though the doctor is almost central to the care of him. It is the doctor who provides medical intervention and almost advised other health professionals on how to care for Daniel based on specific restrictions (for example, mobility).
Barrett et al (2005) acknowledges that doctors have tended to be the leaders of multi-disciplinary teams because of their training, status and their responsibilities. However, the status and training of other health care professionals has been enhanced and particularly in MDT working, it has become less hierarchical (Barrett et al 2005). Soothill et al (1995) actually goes on further to say that the nurse-doctor relationship is at the centre of healthcare practice and delivery. This association is made with the view that it has always been the urse giving prescribed care based upon the orders of the doctor (Soothill et al 1995). However, as stated by Baldwin et al (2007), “because of the changing nature of medical problems- from acute infectious diseases requiring short term interventions to chronic degenerative diseases requiring multiple contacts and long term planning- requires the collaboration of an increasing array of specialised information, skills and personnel” (pg 2). Moving on from this, it is then possible to explore the role of the nurse within Daniel’s care, as this was the next member that was encountered in his care after his surgical intervention.
The definition of nursing as provided by the Royal College of Nursing in their Defining Nursing publication (2003 pg3) states that, “nursing is the ability to use clinical judgement in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death. ” The view of Soothill et al (1995) concerning the nurse being responsible for providing care on the basis of orders from the doctor is not really far from true.
In fact, during Daniel’s time on the orthopaedic ward following his surgery, it was the nurse’s job to ensure that Daniel’s prescribed pain relief was working effectively and to monitor his recovery by conducting observations and recording their findings. These observations included, checking the circulation in Daniel’s leg, taking his temperature, blood pressure, pulse and respiration. All these observations were carried out at specific intervals. Because of this responsibility, it is important for the nurse to have a broad knowledge of signs of deteriorating health.
The NMC, the regulatory body for nurses and midwives, in their code of professional conduct (2008) highlight the importance for nurses to keep their knowledge and skills up to date for safe and effective practice when working without direct supervision. An example of the nurse acting in this manner, was when at one point Daniel was experiencing muscle spasm, she suspected it, called for the on-call doctor to attend the ward, he then confirmed that Daniel’s pain was due muscle spasm and them prescribed diazepam for skeletal muscle spasm prevention (Morton 1998) which was then administered by the nurse.
Amongst all the professionals that Daniel encountered during his episode of care, he spent the majority of time in the care of the nursing staff on the ward. In fact, the ward became the ‘meeting point’ for other members of the MDT. As stated earlier, when there was a suspected problem with Daniel’s recovery, the nurse would communicate with the doctor (via pager or telephone) to alert him on his condition and if medical intervention was required such as emergency surgery, the doctor would then manage his care form this point.
As nurse’s work in shifts and during hospitalisation, nursing care runs through a full twenty-four hour cycle, the nurse is able to monitor Daniel’s progress and feed this back to other members of the MDT during ‘ward rounds. ’ Ward rounds is used to describe the meeting point usually in the mornings where other members of the hospital based MDT come together and go from bed to bed through the nursing wards discussing the treatments and cares of each patient.
The named nurse of the patient is usually present within the ward round and is on hand to feedback to the MDT member’s on information regarding the patient’s progress or lack of progress in rehabilitation. With this information, decisions can then be made on whether to change the course of treatment to which the team feels will be more effective if necessary or just advise the nurses to continue with the agreed care as planned. The Physiotherapist was another member of the MDT that cared for Daniel and whose intervention became increasingly significant as Daniel’s recovery progressed.
The physiotherapist was particularly concerned about Daniel’s mobility as it is acknowledged that any form of fracture to the bone may hinder the individual’s ability to function, particularly during the time of rehabilitation. According to the definition provided by the Chartered Society of Physiotherapy (CSP 2008), physiotherapists deal with the human function and movement and help individuals to achieve their full potential. The main focus is the use of massage, exercise and movement, electrotherapy and other kindred methods to restore and maintain well-being.
The physiotherapist was there to help Daniel maintain the use of his other limbs even though he could not mobilise. This was achieved by frequent visits to the ward, some days after Daniels operation. The physiotherapists helped Daniel by first encouraging him to sit in his bed-side chair during the day and showed him how to get out of his bed without causing more injury. As Daniel’s stay on the ward was coming to an end as the MDT felt it was safe for his cares to be managed at home under the supervision of his mother, it was at this point that the role of the physiotherapist became apparent again.
He was shown how to use crutches (walking aids) properly, shown how to go up and down stairs using them as well as exercises to help maintain the flexibility of his muscles. The play therapist is the final member of the MDT that will be discussed. The definition given by the British Association of Play Therapists (BAPT) states that play is an integral part of a child’s life and plays an integral part in a child’s development and acquisition skills (www. bapt. info). Play therapy can be utilised as a means of expression and is one way in which children can work together to explore feelings and emotions, enabling them to understand and cope with them” (Manchester Children’s NHS Trust: Play Department 2006m, pg 1). Although play may not be recognised as being important for Daniel’s physical recovery, as from the definitions provided, it certainly did serve an emotional purpose. The role of the play therapist in Daniel’s care was particularly significant when he first arrived on the ward.
Daniel was very anxious about being in hospital, as this was his first time therefore he did not know what to expect. The play specialist helped Daniel with his anxiety by supplying him with a computer games console to play on. Also in relation to his pain management, the therapist helped Daniel take his mind off the pain by introducing activates such as drawing, painting and watching films. The play therapist was based on the ward, therefore was present during the day and assisted the nurses particularly with younger children when it came to issues like injections and taking blood.
The play specialst was also usually present in the mornings for the ward handover (this is when nurses from the previous shift feedback the progress of patients during their shift to the new staff who are about to begin their shift). Throughout the exploration of the MDT, how they were involved in Daniel’s care as well as their interaction with one another has been highlighted. The main recurring theme is that of communication. Effective communication enables those members of the MDT to articulate their own perspectives, isten to the views of others and negotiate outcomes (Barrett et al 2005). This was clearly evident during the ward rounds, and team meetings when patient’s cases were reviewed. It was at this review, that it was decided upon for Daniel to be discharged into the community with referral to the plaster clinic for the removal of his cast as well as for attendance at the orthopaedic clinic when required, for review of his leg and then if suitable, complete discharge medical care.
There was never an absence of any MDT member during ward rounds or team meetings and if so, there was always a representative from that profession present, therefore all the members of the team were aware of Daniel’s progress and could amend goals accordingly. Barrett et al (2005) reinforces the importance of effective communication by stating that joint-decision making based upon shared professional perspectives requires those involved engaging in open and honest communication.
Therefore, in conclusion, regardless of the barriers to effective inter-professional working highlighted in the beginning of this assignment, it is certainly evident in Daniel’s case that shared responsibilities, collaborative working and most importantly communication between members of the MDT is crucial for effective patient outcome. References Barrett G. , Sellman D. , Thomas J (2005) Interprofessional Working in Health and Social Care: Professional Perspectives. Basingstoke, Palgrave Macmillan press
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