Describe and discuss interprofessional issues in the case scenario, including the issue of collaboration with users and carers.

To answer this question fully, firstly there will be clear definitions of interprofessional practice and then a clear and coherent argument through-out the rest of this essay.

“Interprofessional is collaboration between professionals, who may not share a common professional education, values, socialization, identity and experience” (Interprofessional Collaboration 2005: 6).

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“….occasions when two or more professionals learn together with the object of cultivating collaborative practice” (CAIPE 1997).

Professionals collaborating and working interprofessionally benefits not only the professionals, but also users and carers.

It can allow and help agencies to:

* Have a shared professional competence and experience.

* Deliver co-ordinated packages of services to individuals.

* Tackle complex problems that cross traditional agency boundaries.

* A better and increased use of resources.

* Align services provided by all partners with needs of service users.

* Stimulate more creative approaches to problems.

(Taylor 2005: 4)

The professionals within this case scenario attempted to work collaboratively and gain these advantages. However, there were a number of contributory factors (barriers) which restrained them from doing so.

The key contributory factor was communication. Communication is key and essential to interprofessional practice. It may have benefited the professionals in the case scenario even by them just giving a basic knowledge of their own profession, as it provides a framework for communication which can increase professional involvement, and can save repetition of actions and tasks. This then leads onto an improvement in the service given to users and carers.

Subsequently, within the case scenario it was identified that there was basic communication, but was little and ineffective. There was no clear, coherent information given, but rather a rough sketch of what was believed Joe Jacob’s needed, without an explanation.

“The referral from the hospital asks the Community Mental Health Team (CMHT) to support Joe when he is discharged from hospital in a week or so”.

(Case Scenario)

The professionals in the case scenario could have improved the lack of communication, simply by creating an alliance amongst themselves from part of the everyday functioning of organisations, whereby professionals may convey thoughts and feelings on service users to colleagues and especially to their managers. Communication is a key concept of negotiating, problem solving and empowerment for users and carers. It can bring recognition and respect for the users and carers skills, knowledge and experience they can bring to their problems to allow assistance in their own preferred solutions, immediate actions and pathways to success. If communication was clear, concise and coherent, important information regarding Joe Jacob’s would have been given to all professionals. Therefore, the Housing Association would have the relevant information to provide appropriate care for Joe Jacob’s instead of not being clear of his circumstances and his needs. It all requires good networking.

“A worker from the Housing Association has also contacted the CMHT wanting to clarify if Joe will be returning to the flat and under what conditions”.

(Case Scenario)

There also lies a problem within communication, and that is confidentiality. There may be important information which Joe has a right to keep confidential and also the Pastor under the law. This can also hinder the communication process and also the ability to provide Joe with appropriate care and to allow his carer Mrs Williams to provide and sustain this.

Interpersonal communication and decision-making are the skills and attitudes needed for professionals to collaborate interprofessionally. If these skills are not present, then you get a result of the case scenario whereby each profession is unaware of the service user’s needs and wants and are not communicating effectively and efficiently to promote this. The service user and carer then get left out of the picture and there becomes a focus shift to broader issues unrelated to the original problem. A critique to this view is a source on interprofessional collaboration which believes the focus would shift to the individual rather than the issue, but in contrast, in the case scenario the focus is on the overall issue and personal professional agendas and the thoughts and feelings of the individual were left out.

Nurse: “Joe speaks seldom and then usually to say he wants to go back to his flat”

Decision: It was decided that Joe would be discharged initially to the care of his family before returning to his flat.

“Joe was discharged to the care of Mrs Williams. However, after a couple of weeks, he has left her home and appears likely to be living on the streets”.

(Case Scenario)

If there was efficient interprofessional communication, this decision would never have been made. Although there may have been differing professional views, if Joe’s viewpoint was taken into consideration, or even communicated amongst the professionals, it may have resulted in an entirely different outcome. Joe Jacob’s is also not communicating with the professionals. This not only gives them a problem due to un-vocal participation in care, but Joe Jacob’s may feel alienated which is why he “speaks seldom” (Case Scenario).

“The alienation felt by most black people is usually seen as their problem (and this often leads to ‘treatment’ aimed at suppressing their feelings) rather than a problem for society as a whole”.

(Fernando 2001: 8)

In conclusion, Freeth (2001) published an article which has given me a basic understanding of problems and issues which can arise during professionals attempting to work interprofessionally and collaborate. Freeth describes challenges, differences and what is needed to collaborate effectively.

“The particular challenges of sustaining interprofessional collaboration centre

around addressing: structural differences between organisations, conflicting organisational and professional agendas, resource requirements, more complex communication demands, replacing former team members, inducting and forming strong links with new team members, regular evaluation and shared planning of the team’s shared goals and progress” (Freeth 2001: 8).

Therefore the challenges professionals can embark upon, and the ones which are most apparent through-out the case scenario when attempting to work interprofessionally are not uncommon.

“Any interprofessional group will bring strengths and resources as well as possibilities for conflict and difference; because of that, systemic ideas can be applied to the interprofessional group setting – whether in child protection or mental health” (Davies 2002: 154).

The networking and communication of agencies is most important and beneficial to the user and carer and also agencies. If this networking breaks down, this leads to interventions which are aimed at suppressing users and carers thoughts and interventions which lead to a worse case scenario.

Describe some of the ways that theory and research about interprofessional work help understanding of the interprofessional issues in the scenario.

Research and theory can help us to develop a solid foundation for understanding the social structures and problems which confront social work.

The Oxford English Dictionary provides a definition of research which underlines its relevance to social work:

* The act of searching;

* A search or investigation directed to the discovering of some facts by careful consideration or study of the subject;

* A course of critical and scientific enquiry.

(Davies 2002: 415)

There are many theories and research surrounding Interprofessional Practice. Theories help us to understand the foundation to why and how professionals act and research backs up theories, knowledge and understanding.

The theory of power plays an important part in the way professional structures develop. Power is seen as socially constructed. It is not only about behaviour or conflict between groups of people, but it is seen by Lukes (in Hugman, 1991) as operating at three different levels. The professionals in the case scenario were exercising power over Joe Jacob’s due to him being sectioned under Section 3 of the Mental Health Act 1983. Although Joe Jacob’s and Mrs Williams may have been unconscious of their powerlessness, the power dynamics in the case scenario rendered them invisible and silent.

Lukes (in Hugman, 1991) and his 3 dimensional concept of power, backs-up my thought on the user and carer being rendered silent and invisible in the case scenario. The power dynamics in the case scenario would come under a three-dimensional view. It helps us understand the way in which the professionals behaved and how the power difference was apparent. A three-dimensional view of power looks at the influence of social structures and ideology on setting the agenda and the suppression of conflict, and on the situation of latent conflict between those exercising power and the real interests of those subjected to power. Under this power theory, the professionals were excluding the thoughts and opinions of the user and carer due to the structure of their place (Taylor 2005: Power Hand-out).

The third dimension of power can also be reached when the social agenda is already set. Power is exercised to manipulate people to desire particular outcomes. This can be seen where the hospital institution, policy and structure set the agenda. In these circumstances the desire could be that it is a priority to get Joe out of hospital. Hospital policies may dictate that patients should be moved back into the community as soon as possible as this has a positive effect on their targets and budgets. But, it could be argued that this could be harmful to Joe. The hospital exerts power upon Joe, the CMHT and others concerned manipulating them to see Joe’s discharge as desirable.

Lukes shows that power is not just at one level and it can be exerted by people and over people whether they are aware of it or not. The hospital exerts all three dimensions of power over the CMHT. Ultimately, and most importantly, this does not create the best provisions for Joe Jacob’s.

The issue of power links in with research by Vanclay in 1996 when he considered collaboration between GPs and social workers. Power is dangerous to interprofessional practice, but it can also sustain it. Vanclay claimed that collaboration is sustained by similar factors to those important for first developing collaboration, namely:

* understanding of roles and responsibilities;

* sharing information about structures and procedures;

* regular face to face contact, named link social workers, joint working on local projects or specific topics;

* and support from senior management.

Factors that were seen as threatening sustained collaboration were:

* Rapid changes and conflicting organisational priorities;

* Dependence on key individuals already committed to collaboration;

* Lack of clarity or defined lead responsibility for ensuring collaborative development process is sustained;

* Lack of responsibility for ensuring ongoing funding.

(Vanclay, 1996, p. 28)

The main interprofessional issue in the case scenario identified, was communication. According to Gregson et al. (1993) there are five collaborative gradings of communication which he identified in his research. This helps understanding of the communication difficulties in the case scenario. According to Gregson (1993) the professionals in the case scenario would be at stage one, where there is no direct communication. The professionals working interprofessionally in the case scenario did not meet-up together, which is the main theme of interprofessional working, and also they did not talk or write sufficiently to one another. Gregson et al. (1993) would see this as the lowest communication grading any interprofessional team can acquire. In order to get a clear understanding of the interprofessional issues in the case scenario, Gregson et al. (1993) has given us a collaborative grading to mark against the professionals of where they should be. This is collaborative grading five. This he called Multi-disciplinary working. Here he identified the involvement of all professionals in case work and the setting of agendas. The professionals drew on all ethics, values, experience, knowledge and insight of all the professions and pooled them all together. In relation to the case scenario, the interprofessional team did not do any of these. They were not aware of the different skills each person could bring to the case work. It would therefore take complex communication, strong links between professions and shared planning of goals to incite this.

A multitude of factors encourage or discourage interprofessional collaboration. For collaboration to be sustained the balance of these influences must be such that each collaborating party can identify sufficient benefits to outweigh the disadvantages of interprofessional collaboration. The particular challenges of sustaining interprofessional collaboration, centres around addressing: structural differences between organisations, conflicting organisational and professional agendas, resource requirements, more complex communication demands, replacing former team members, inducting and forming strong links with new team members, regular evaluation and shared planning of the team’s shared goals and progress (Taylor 2005:9). Although there are disadvantages to research and theory, they still provide a clear and coherent understanding of the conflict which can arise attempting to work interprofessionally, and how this determines the behaviour of professionals.

Describe some of the ways that professionals might develop successful interprofessional intervention to support Joe and his carers.

Successful interprofessional intervention relies on successful interprofessional working. In order for professionals to intervene successfully to provide care and support to Joe and his carers, they must improve their interprofessional working to a higher standard which involves:

* Complex and dynamic communication.

* Avoiding organisational defensive routines.

* Taking users and carers views into account.

* Understanding changing organisational cultures.

* Understanding key components of effective dialogue.

* Taking account of success factors as having a clear strategic purpose of partnership.

* Develop supportive internal infra structure.

* Take account of key issues such as governance arrangements, performance management, information systems, workforce issues, changing policies and complaint procedures

(Taylor 2005: 4).

In order for the professionals to have a successful intervention to support Joe Jacob’s and his carers, they must promote a relationship where they are not only working in partnership with other agencies, but also with Joe and Mrs Williams to ensure the best service for them, and plans for interagency cohesion around family-centered support initiatives. The professionals would need to adopt a partnership-based approach, whereby they assess the situation in close co-operation with Joe and where appropriate Mrs Williams view to be included (Taylor 2005: 1). They must recognise and respect the knowledge, skills and experience that Joe and Mrs Williams can bring and also what the professionals from all disciplines can bring. Trust is centre also to a collaborative relationship. There must be trust to ensure open communications, so that professionals and Joe and Mrs Williams feel free to express themselves.

In the case scenario, Mrs Williams believed that the church pastor may have been some help and assistance to Joe. In order for Mrs Williams to be able to bring this to the professionals, they must be able to create an atmosphere in which cultural traditions, values, and the diversity of users and carers are acknowledged and honoured.

Freeth (2001) believes that it has been widely recognised that the needs of most clients are beyond the remit and expertise of any one profession. In order to provide a user-centred service, which would bring about successful intervention for Joe, there needs to be interprofessional collaboration and most importantly effective teamwork. Within the case scenario there seems to be no team-working. There are just individuals working independently, with their own agendas and not committing to working as a team. For an intervention which would focus solely on Joe, the professionals need to deliver efficient and comprehensive care which meets the needs of Joe (the client group).

In relation to successful intervention to support Mrs Williams, the interprofessional team would have to be more collaborative and communicative. Different professions could have brought a different viewpoint to the situation. The Carers (recognition and services) Act 1995, introduced assessments for carers providing regular and substantial care. Why was Mrs Williams not assessed on her ability to provide appropriate care for Joe Jacob’s? Most carers feel they may remain hidden due to their gender, ethnicity and sexual orientation.

Carers need to feel recognised, have recognition and also support. Mrs Williams was not given support in her caring role. Therefore she would not have felt skilled, confident and knowledgeable in this role. There was also no sense of shared responsibility. Therefore, management of physical/practical tasks was not maintained. Also, Mrs Williams was not able to define the limits of her role. Why was this? It was due to her not been given a clear definition of her role and what was expected of her.

On the other hand, although interprofessional intervention can be achieved by successful interprofessional working, factors which can affect it not working need to be addressed.

Beattie (1995) drew attention to the conflicting loyalties and concerns about potential loss of identity, which may trouble professionals engaged in interprofessional collaboration. The feelings of the professionals involved in interprofessional working needs to be addressed also. They are the participants and also the implementers, so their thoughts and feelings need to be recognised through-out the whole process.

“Roles and boundaries have been challenged and changed, and the autonomy of the most powerful professions have been curtailed”.

(Freeth 2001: 45)

It has been identified that the professionals needed to improve their interprofessional working, in order to intervene successfully. It can also be argued that they also would need to have clear goals, agendas and possible outcomes (a care plan) which would have to be agreed mutually. They would have to work together as a team to ensure the best intervention, which entails support, guidance, knowledge and understanding for Joe and his carers.

Reflect on the work of the study group presentation and your contribution to it.

The type of team role I adopted and was appointed in this study group presentation, determined the outcome and my overall contribution. At the beginning of the group work, I tried to adopt a Plant / Resource Investigator role, where I was full of knowledge in regards to personal experiences, which could be related to the case study and was willing to share these and explore new ideas. By the end of the group presentation, I had been allocated a role of completer finisher. I had no choice by the end of the group work, but to deliver. I felt as though I was pushed into a role, which I have never adopted and felt very uneasy and uncomfortable with this. Due to power dynamics in the group between the “younger and older” generation, I already had expectations and stereo-types surrounding me.

The important part about the group process and my contribution to it was what I learnt and what I can bring to other groups I encounter. The most important part of the group process which I learnt, was that I have to be able to adapt to different personalities. There were some very strong personalities in the group which I was not used to, and I found this extremely hard to adjust. Also with the strong personalities, came this sense of power. I believe when people enter any type of group setting we are all equal. I found that within this group process, people believed they had power over certain members. This has inevitably taught me, to stand back and assess the situation first. Not to go in with this pre-conceived idea, that everyone will be thinking and feeling how I am.

I think that I put a lot of time and effort into the group presentation, but did not show this at all times. This caused conflict in the end, as it was assumed I had not contributed enough. I have now learnt that showing what you have researched and any vital information towards the presentations of a group cannot be viewed as negative. I have found that there are certain negative ideas I have to address before I enter my new group process surrounding my shyness, quietness and inability to speak-up.

I have also learnt that group work is a team process. It takes all individuals to put in the same time, effort and commitment. A team cannot run without any negotiating and communication skills. I ended up working independently as I felt I was pushed off from the whole group process due to my inability to address certain issues I had. In the end, I found out when it was too late, that if you have a issue its best to bring it up straight away, rather then allowing it to affect the way in which you work. Overall, the group process was a success. My overall contribution was a success also. I performed and delivered when it was necessary, which can be viewed as a negative, as I may have made people feel uneasy, but also as a positive as I came through in the end.

Bibliography

Beattie, A. (1995). War and peace among the health tribes. London: Edward Arnold.

CAIPE. (1997). Interprofessional Education – A Definition. London: CAIPE.

Davies, M. (2002). Companion to Social Work. 2nd edn. London: Blackwell.

Fernando, S. (2001). Mental Health in a Multi-ethnic Society – A Multi-disciplinary Handbook. London: Routledge.

Freeth, D. (2001). ‘Sustaining interprofessional collaboration’, Journal of Interprofessional Care, 15 (1), 8.

Interprofessional Collaboration. URL: http://www.utexas.edu.html/ [accessed: 01/06/2005].

Leathard, A ed. (2003). Interprofessional Collaboration; From Policy to Practice in Health and Social Care. Hove: Routledge.

Taylor, I. (2005). Power and Interprofessional Collaboration. Partnership Working. Partnership and Interprofessional Practice. Brighton: Sussex University.

Vanclay, L. (1996). Sustaining collaboration between general practitioners and social workers. London: CAIPE.

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