Interprofessional education (IPE) is an "occasion where two or more professionals learn with, from and about each other to facilitate collaboration in practice" (CAIPE, in Freeth et al 2002:11). Barr (2005) noted that the level of care given to service users was adversely affected by the prejudice and ignorance some professionals brought with them when working together. IPE seeks to address this.
Carpenter (1995) writes how IPE was therefore devised to improve the breakdown in trust and communication between professions. Service users have needs that cannot be covered by one profession alone (Means, 2010) hence the need for effective collaboration. The two day conference provided an opportunity for collaboration between a range of health care professionals
There were a large number of nurses on my group table and I decided to make this experience a positive one and develop my learning to benefit my future practice. It appeared as though all members of the group were confident speakers and I briefly wondered if we would allow each other the opportunity to be heard or give each other time to talk. However, we all had space to talk, were listened to and valued for our contributions. I felt this was a positive start to the group work.
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We discussed the stereotypes attached to our professions, there were more for social work than there were for other professions, although I heard nurse's described as 'rough' and 'loud'. Unfortunately one of the nurses in our group acted as judged when she had an argument on the second day with another nurse, in view of all attending the conference. Sellman, cited in Pollard, et al (2000:156:171) writes "People have fixed ways of behaving and act consistent with their characters. He also voices how influences from a personal, professional and structural perspective can affect whether practitioners seek to be willing, trusting or leaders in interprofessional working. The behaviour of this student allowed others to see an unprofessional side of her and may have re-inforced prejudice.
Mandy et al (2004) write about how the delivery of healthcare is affected by interprofessional stereotypes, rivalry and tribalism. It was refreshing to hear of the positive experiences some of the nurses had with social workers.
Some nurses thought that social workers had a rough deal; a comment from one of them was "It's so unfair; you are dammed if you do and dammed if you don't, but I think you people are to be admired for all you do". It made me realise that not all professions have a negative impression of social work.
Whilst working on our group sentences (See Appendix), language differences were discussed. I felt confident to challenge the word of the use 'patient' since social workers are employed in a number of settings, therefore the use of the word 'patient' would not always be appropriate. Dalrymple and Burke (2006) and Martin and Henderson (2001) illustrate the terms used to describe those in receipt of services will always be a source of discussion and change, but it could be argued that the terms that professionals use can have negative connotations for the person. Bruce and Borg (2002) discuss the term 'patient' reinforcing the sick role and creating the idea that the individual needs to be taken care of. The group agreed collectively to use the term 'service user', however Heffernan (2005) draws us to recognise that this term can be damaging to the ethical practices of social work. Heffernan proposes that labelling individuals with this term could disseminate their sense of dependence on services. Upon reflection I realised that as professionals we need to be sensitive to the preferences of the individual.
Communication and service user involvement were issues discussed at great length within the group. The use of jargon between professions and illegible handwriting meant it was difficult to access information relating to care and made it problematic for service users to contribute. Reeves et al (2010:65) provides a devastating example of poor communication- a patient having "wrong site surgery". We discussed situations that had poor outcomes for service users and its links to ineffective communication. On reflection, the absence of effective communication and constructive relationships within the interprofessional team impacted on the ability to work collaboratively. Hirokawa cited in Royeen et al (2009:49) highlights communication is "the key component" to interprofessional working and Tomlinson et al (2008:108) puts communication central in order to provide a non-discriminatory service that is "promoting linguistic competence".
Knowledge and clarity of roles is an element key to successful interprofessional teams. Reeves et al (2010:62) considers how "Clear roles help define the nature of each team members tasks, responsibilities and scope of practice". She clarifies that where each member's role is seen as essential and there are clear team goals teamwork is effective. Sargent et al (2008) adds to Reeves discussion, by making professionals aware that in learning about the roles of other disciplines, you need to be aware of how they complement your own practice, in order for effective teamwork to happen.
The play by the Dramatic Voices drama group "Up to here", allowed an insight into the perspectives of service users, carers and professionals and the tensions and conflicts within those roles (e.g. needing a break from caring, pressures of targets) whilst highlighting the frustrations when one feels unsupported. The DVD 'Alison Ryan's Story' by Patient Voices (2010) emphasised the importance of carers and their expertise of a condition, so should be listened to and more fully involved. Cooper and Spencer (2006) explain in their article the important contribution service users can make to IPE for students at the beginning of their training. "Service users provided the students with real life examples of how they had learnt through experience, enabling them to become 'experts', and as such stakeholders within the interprofessional team".
Interprofessional working has many benefits for all involved. It can eradicate barriers between professionals, whilst highlighting the value each profession has to offer. Combining the needs, skill and expertise from all professionals means that needs are identified sooner, leading to earlier and more effective intervention. A package of care that is focussed around the individual and is more co-ordinated with a faster deliver time should result in better outcomes. Tirrito et al (1996:31) examines the benefits; "The client benefits from the collective wisdom, professionals benefit from the support of colleagues and society benefits from the elimination of duplicate services".
Conclusions from inquiries and current policies have summarised that interprofessional education and working are essential to good practice. The National Service Framework for Mental Health (DH, 1999), The National Service Framework for Older People (DH, 2001) and The National Service Framework for Children (DH, 2004), Partnership in Action: New Opportunities for Joint Working Between Health and Social Services (DH, 1998) and the Laming Report (2003) have insisted practitioners to encompass an interprofessional attitude to their work.
Despite the guidance regarding interprofessional working, there are regrettably cases where this has not occurred resulting in preventable deaths of children. Victoria Climbie's death led to Lord Lamings report (2003), identifying the failures of professionals to protect her. Irrespective of this, Baby Peter in 2007 and Khyra Ishaq in 2008, die whilst under the care of several professionals. Serious case reviews from Haringey and Birmingham (2009 and 2010 respectively) regarding their deaths emphasise inadequate communication (amongst other failures) between professionals as well as missed opportunities for intervention. The Government green paper 'Every Child Matters'(2004) recommended changes to policy regarding information sharing to ensure all agencies obtain a full picture of a child's life. Following from this the government has released a new guideline 'Working Together to Safeguard Children' (2010) which provides a national framework for individuals and professions. It sets out ways of working together to safeguard and promote the welfare of children. This includes working together with an agreed plan of action, information sharing and recording and ensuring that their work is child-centred, that the focus is always on the child. This should ensure that further tragedies are avoided at all costs.
DISCUSS HOW YOU WOULD TAKE AWAY WHAT YOU HAVE LEARNT ABOUT IP WORKING INTO PRACTICE
The interprofessional conference was an immense learning opportunity for me. The importance of service user involvement, person-centred planning and communication within interprofessional teams highlighted in the conference gave me a lot to consider for future practice.
Upon reflection of the conference, I was aware that I could be working with people who have not had IPE, so considered how I could collaborate with those that are not willing to encompass interprofessional working. This led me to contemplate previous experience, my previous placement experience, my next practice placement and where IPW fit into this.
Every Child Matters (2004) require that all practitioners will be involved in information sharing that welcomes all views as equally valid; however I witnessed a situation that had the opposite effect.
In my previous experience as a nursery nurse, I had raised concerns following a disclosure from a child. To summarise, the social worker dismissed my opinion, saying that I was unqualified to make any comment as I was "just a nursery nurse". The reality that I had a lot of contact with this child was disregarded. Nurse (2007) discusses the difficulties in interprofessional working where one professional believes that only they have the expertise and knowledge to make a judgement regarding concerns. In the future as a SW in an interprofessional team I may be outnumbered by other professions, but I will present confidence in my profession and my role in order to be heard and will respect the view of other professionals regardless of job title or qualification.
My previous practice placement allowed me to see an interprofessional team in action. I was able to observe a team meeting for a mental health team. There were professionals represented from health and social care backgrounds. All professionals were given time to address any concerns they had regarding a service user and were able to seek/offer advice from others. Medical and social perspectives were taken into account, allowing all professionals to work from their own theoretical base but working in partnership to provide continuity of care. Martin et al (2001) recognise how the sharing of background and experience while identifying people's roles within the multidisciplinary team allows the members perspectives to be explored. This becomes a source of strength, with this integrated practice having benefits for service users and patients. I was grateful of the opportunity to witness the outcomes of effective interprofessional working.
I am hoping for my next placement to be in a hospital setting. In order for my experience of IPE to be extended I will attempt to devise an action plan to maximise my learning opportunities and experience of interprofessional working. I would ask about the opportunities where professions interact and ask to be an observer to this (e.g. discharge planning meeting). I would ask for the opportunity to meet other students from other professions at the placement in order to share our learning experiences, professional policies and procedures in order to recognise similarities. I would arrange time shadowing other professions, in order to get a fuller picture of their role. I would also request time with my placement supervisor in order to reflect on IPW and its challenges, difficulties and benefits.
This practice could promote relationship building for the future, as well as accentuating how other professionals can support my role as a social worker. It would allow me to identify and develop appropriate skills in my practice. Hostility between professions could be reduced and collaboration and team dynamics could be increased and improved as those who are not familiar to IPE can see it demonstrated in their students.
The importance of service user involvement was highlighted in the conference. The Children Act 1989, National Health Service and Community Care Act 1990, and the Community Care (Direct Payments) Act 1996 were among the first pieces of legislation related to service user involvement. Policy guidance, practice guidance and service standards have developed from this. For example, the GSCC (2002) and Skills for Care (2002) provide guidance for social workers related to service user involvement.
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I had witnessed examples of poor practice in the past where the service user had no decision regarding their care (e.g. a woman who speaks Bengali having her treatment discussed about her with no translator sought to explain it to her). Service users now have more power to challenge decisions and refuse care should they wish, as they are now "experts by virtue of their experience" (Tanner et al (2008:6). Lishman (2007:270) reminds practitioners that holding meetings with individual service users, case conferences, advisory committees (to name a few examples) are power sharing structures in relation to decisions but the level of active listening by social workers and other professionals ensure the service users voice is heard and valuable to the decision making process. Wallace and Cooper (2009) highlight the importance of putting the service user at the centre and the organisations of services with and around them in order to break down the barriers of the organisation we work in.
I recall on my previous placement a situation that provides an example of person-centred care. I was at a day centre of adults with dementia and was a observing a group of gentleman playing dominoes. Upon recognising a gentleman observing not playing, I discovered he couldn't remember how to play. Through joint reminiscing of our elders playing dominoes and allowing the gentleman to recall himself playing when he was in Jamaica, triggered his memory so he was able to play again.
Brooker cited in Innes et al (2006:6) signpost four elements essential to providing person centred care, one of which is "a positive social environment to enable the person with dementia to experience relative well-being. Providing culturally appropriate conversation, as well as time for this gentleman to reminisce allowed him to remember a part of his cultural identity that was of importance to him and through remembering how to play dominoes, was able to socially interact with other members of the centre.
The role of a SW is very much dependant on the setting- assessment, crisis intervention, patient wellbeing and advocacy are just a few of the myriad of roles I could undertake. Holoskom et al (1992) demonstrate the multiple roles a SW could be part of in health care settings. It highlighted the lack of clearly defined role competences specific to social work. Wilson et al (2008) suggest "â€¦social workers are less able to define what their specific contribution to an inter-professional team might be â€¦" .It could be argued however that SW are essential to how care is delivered. As a SW I could be helping patient's problem solve and cope with situation or illness, link individuals with resources and services and promote effective and humanitarian service systems. Carlton, cited in Holoskom et al (1992: 8) stress the significance of the social workers as being the only professional who has the central foundation that a holistic perspective of the service user is of "utmost importance"
I have realised that it is important for me to enhance knowledge of medical issues so that I can be knowledgeable when talking to patients and can participate fully in interprofessional teams. The team will also gain knowledge about my role as a social worker with views, values and perspectives being shared in order for my presence to be visual and effective to the delivery and structure of health care.
I left the conference with a positive attitude to interprofessional working. As one of the next generation of health and social care workers I will ensure that what I have learnt will be used in practice to ensure interprofessional working is at the 'heart of patient centred care'.
I would like to end with a quote that I feel expresses the process of interprofessional working:
"Coming together is a beginning; keeping together is progress; working together is success"
(Henry Ford 1863-1947)
Appendix -Agreed Group Sentences
Communication Issues between Health and Social Care Professionals
Effective communication between the multi-disciplinary team including the service user and their family is paramount to client centred care.
All communication should be clear and concise without the use of jargon or abbreviation to facilitate collaborative working.
Contrasting professional perspectives / values within teams
By considering the perspectives of the service user's and other professionals, practitioners are able to broaden their understanding in order to improve delivery of care.
There are contrasting perspectives and values between professionals but it is our responsibility and duty of care to compromise for the service user's best interest.
Stereotyping, power imbalances and team processes
Although there may be perceived hierarchy's within health and social care professionals, everybody's different skills, knowledge and input is variable to the needs of the service user at that particular time and therefore should not be translated into power imbalances and conflicts with the Interprofessional team.
It is human nature to form stereotypes of others but we must not allow this to impact the care we provide to service users.
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