Partnership and Interprofessional Practise - Essay Example

? Partnership and Interprofessional Practise Partnership and interprofessional practise though presently utilized, still have certain aspects that remain ambiguous and which merit deeper exploration. The present paper likewise presents the theories currently applied to these. This paper explores the partnership and interprofessional practises related to the case of Marilyn Hall. The writer intends to examine her case and determine the extensive support needed by the subject based on the implications suggested by the data. It also aims to identify the composition of the team that will address the different concerns of the subject and the competency of each member. Additionally, an overview of the key principles governing partnership and interprofessional practise, its positive and negative aspects, and the importance of working effectively within a team, are encompassed in the paper. A study was conducted on a 33-year old homeless British woman who had been admitted for treatment in a psychiatric hospital due to severe depression and a series of suicide attempts as a result of the past abusive relationship she had gone through. The preliminary findings suggested that the subject had been dependent on drugs and alcohol which made her even more vulnerable to exploitation. She also possessed erratic and antisocial behavior, suffered from sleep disturbances and was prone to self inflicted pain. There was also limited information on her family background. To further lay premise on the case study, it is imperative to discuss the component of interprofessional practise (IPP). IPP have been referred to as a practise where several professionals of different expertise and functions work together as team to render improved services on health care. The focal point of this is the significance of pooling practitioner competencies and working in partnership with other sectors of the society to generate positive results that would be beneficial to the healthcare patients overall (Barr 2005). One of the strong points of IPP is that the treatment framework of the team may effectually vary as the requirements of the patient change. Practitioners may even work beyond the scope of their professions. To cite an example, practising nurses or medical assistants can carry out the duties of a general physician as the need arises. IPP focuses on the wellbeing of the patient rather than the individual practitioner’s line of work (Stone, Waller, Smith, Fuller, Bull, & Playford 2007). IPP may involve medical practitioners such as physicians, nurses, therapist to social workers to policy makers (Stone et al 2007). The contributing factors for the success of IPP are cooperation, commitment, assertiveness, shared responsibility, communication, autonomy, coordination and governance. Basically, these elements refer to teamwork, dedication, open expression of ideas, the ability to deduce or see a health situation from the point of view of other health practitioners, and efficient organisation (Lindeke and Block 1998). Based on the case scenario, the composition of the team which may address the issues of Marilyn Hall are as follows: general physician, mental health nurse, clinical psychologist, psychiatrist, psychotherapist, occupational therapist, social worker and spiritual adviser. It was noted that the subject suffered physical abuse from her past relationship and aborted pregnancy; thus, a general checkup is recommended to evaluate her health condition. Seeking the service of a psychiatrist for counseling and treatment of severe depression is also recommended. Consultation with a clinical psychologist is also advised since the subject had committed several suicide attempts. Professional help from a psychotherapist is needed to address her dependency on drugs and alcohol. The mental health nurse may provide assistance to ensure that the needs of the subject are effectively provided. The social workers can provide the necessary support outside the institution after the subject was discharged. Occupational therapist was deemed necessary to motivate the subject to be productive. The spiritual advisers can continue to provide guidance to her in terms of values and moral principles in life. The need to form this team was very important as the need of the subject became complicated. It was improbable that a single health professional would meet all her present and future care needs. It is also intended to recognise the prospects for joint care of the members of the team. The organisation of this team mahy allow for the disagnoses and implementation of health care plans for Marilyn Hall. The General Physician (GP) will conduct a thorough examination and diagnosis on the subject in relation to her physical condition, having been subjected to abuse by her past partner and pregnancy termination. After evaluating her condition and given the needed medications, the GP may refer her to the clinical psychologist owing to the suicidal attempts made by the subject. The general physician recognises the importance of counseling in addressing her depression. The psychologist may tackle the issue of suicide, being fully aware of the relationship between the physical abuse and her depression. He may present a clinical assessment and may recommend apt treatment based on his findings. His reports may provide the therapist with the relevant information on relevant interventions. The GP and clinical psychologist may continue to mutually supervise the subject and to coordinate with a local mental health team for additional support. Marilyn’s progress may be reviewed by the mental health nurse and may further be evaluated by a psychiatrist. The assessment of the psychiatrist may require one-on-one sessions with the subject as part of her recovery programme; the process aims to surface her issues on sexuality and abuse (Dunn and Abulu 2010). Marilyn should also be referred to a psychotherapist for her drug and alcohol dependence. As Pilgrim (1997, p. 97) described in his book, Psychotherapy and Society, psychotherapy is "a type of personal relationship entailing a series of negotiated meetings containing conversations". It covers a wide range of psychological and social support; psychotherapists typically deal with the treatment of alcohol dependence and substance abuse. People experiencing anxiety and tension due to unfavorable situations may resort to heavy drinking as a coping mechanism (Sillaber, Rammes, Zimmermann, Mahal, Zieglgansberger, Wurst, Holsboer, & Spanagel 2002). Because of the subject’s dependency on alcohol and drugs, she was exploited because of her needs to acquire these addictions. Substance abuse is closely related to sexual and physical abuse on women (Brady, Dansky, Saladin, and Sonne 1996). Marilyn should thus be made to undergo series of therapies and individual counseling. The occupational therapist may aim to enhance the self respect, confidence and sense of productivity of Marilyn. Social workers may work to accord strong social support, providing Marilyn with shelter and decent living conditions after being discharged. Family support issues will have to be addressed as well. Spiritual guidance should be strengthened once outside the institution. Based on the case, the subject finds comfort with the presence of a pastor. This can boost her morale and will help in her values formation following discharge. In the conduct of interprofessional practise as in the case of Marilyn Hall, strict discretion will have to be practised. Regular discussion among the professionals handling her case must be scheduled so that they may confer about ongoing treatment and recovery status. Coordinating with local groups to ensure social support for the subject may also be carried out. While successful health care can be attributed to interprofessional practise, barriers have also been cited (Manthorpe, Iliffe & Eden 2003). Team members may have conflicting perceptions and interpretations of the situation at hand. Since the members come from different fields of expertise, their knowledge and perspectives correspondingly differ from one another. Miscommunication may arise due to variation in language and terminology, and restrictions in time, space and focus (Pietroni 1992). Varying leadership styles may also exist within the team, and may not be consensually approved by team members. Such differences may lead to dispute and negatively affect the effectiveness of the team (Marshall, Preston, Scott, and Wincott 1979; McGrath 1991; Ovreitvet 1990). To address these drawbacks, effective and constant communication must be encouraged for better understanding of the roles of each team member. Interprofessional practise and partnership is governed by several theories that serve as guiding principles. One of the theories currently applied to interprofessional practise is the cooperation theory developed by Axelrod (1984). This theory states that parties involved in the collaboration team should act as one and failure to do such would result to inefficiency (Axelrod, 1984). This theory can be applied to the case of Marilyn Hall since her situation warrants the coordination of the professionals composing the team. The efficiency of the whole team will be negatively affected if one of the members does not function as expected and fails to mutually contribute. With this inadequacy, Marilyn’s recovery would be hampered. As a supporting example, Marilyn Hall’s condition will be worsened if her need for a proper psychiatric help is not met. Her severe depression may lead to a worse case of mental disorder if not properly addressed. Another theory that can be applied to the case of Marilyn Hall is the Relational Awareness Theory proposed by Drinka, Miller, & Goodman (1996). This theory examines how behavior of each member of the collaboration team changes under certain circumstances. This theory can be effective in the handling of Marilyn Hall’s case since she had been described as resistant to the treatment and evaluation. The members of the team should learn to be ‘altruistic-nurturing’ under normal conditions and ‘analytic-autonomizing’ during times of conflicts (Drinka et al., 1996). The discourse Theory as stated by Foucault (1972) provides the understanding of different languages, cultures and behaviors of individuals belonging to a particular social group (Foucault, 1972). This can be applied in Marilyn’s case because knowledge of her culture and the behaviors of individuals under the culture she belongs to would contribute to a better understanding of her case and personality, thus, proper treatment and understanding of her case will be simpler. The Power and influence theory developed by French & Raven (1959) emphasizes power that leaders have over their subordinates. (French and Raven 1959) This theory applies to the interprofessional relationships of the leader with each member of the collaboration team. The leader of the team handling Marilyn Hall’s case could use this power to effectively lead the team for the proper implementation of methods and treatments needed by the subject. Handling of cases entails good leadership for the effectiveness of the team. To cite an example, a leader that exhibits an authoritarian approach towards his subordinates, instead of gaining respect from his colleagues, would most likely fail to get the cooperation of the members. Freidson’s (1970) professionalization theory asserts that exclusivity of expertise and knowledge of the professionals. (Freidson, 1970) This theory is important in the subject’s case since she exhibited various complications concerning her mental condition. This is mainly the reason why the services of different professionals have been recommended. For instance, the composition of the proposed team that will handle the subject’s mental health condition are the clinical psychologist, psychiatrist and psychotherapist. Although they basically come from the same field, they have different specializations. To further explain, the clinical psychologist will be necessary for the diagnosis of the mental disorder possessed by the subject. After evaluating the subject, referral to the psychiatrist will be made for the latter to give prescriptions necessary and recommend therapies. The psychotherapist then would be consulted in matters relating to the alcohol and substance dependency of the subject. The theories discussed form part of the interventions needed by Marilyn Hall . These theories serve as a guiding principles for the treatment and recovery process of the subject. The consideration and application of these theories likely make professional collaboration successful in the case of Marilyn Hall. There are various policies implemented by the government in relation to partnership and interprofessional practise. The Department of Health and Social Security during the late 1970, specifically urged Mental Health Teams to prevail over the impediments over the partnership of health and social services.These factors include communication problems, unwareness of each one’s task, ability and views (DHSS 1978). As Kingdon (1992) discussed, this policy requires teamwork among service providers, avoiding repetition of work, and mutually contributing each one’s knowledge on his/her field of expertise. Under the 1990 NHS and Community Care Act, the mental health teams should include general practitioners, mental health nurses and social workers. As of present time, among those added were psychologist, psychiatrist, counselors, therapist and pharmacist. Other sectors like housing, education and legal have also been added (Kingdon 1992). Assessing this policy, implementation can be beneficial to service users because their health needs can be efficiently provided. Various needs will be handled immediately because of the presence of professionals with specific fields of expertise in the team. The cooperation of sectors other than the medical field provide social needs and support. Joint planning was put into effect under the 1990 NHS and Community Care Act that requires the structuring of care plans by local authorities in consultation with users and representatives from other sectors. According to the analysis of the survey made by Lewis and Glennerster (1996) regarding community care plans, it is suggested that clarifications be made on joint planning. The review ascertained the fact that although the policy was strictly implemented and mandated, it manifested weak effects and was not able to serve its purpose of providing for health needs (Lewis and Glennerster 1996). Based on the supporting evidences gathered, it can be concluded that joint planning has not been successful. According to the review of the 1990 legislation by Lewis (1993), the assessment of health care needs in cooperation with hospital staff is the responsibility of local authorities. The purpose is mainly to authorize the service users and their carers to be attended to at the comfort of their own homes. However, diversity of concerns, organisation and culture lead to complex issues including the refusal to collaborate (Lewis 1993). Although interprofessional practise is considered fundamental for the efficient rendering of health services, the complexities of the issues surrounding this inevitably lead to failure. The significance of Partnership in Action (DoH 1998) was emphasized when the Minister of State and Parliamentary and Under Secretary of State for Health presented that collaborative practise was needed in three points, namely strategic planning, service commissioning and service commission. The Health and Social Care Joint was put up by the Department of Health to bring about the success of putting the partnership agenda into effect bringing health and social service together (NHS Executive 1999). Another initiative under the partnership agenda is the Health Act of 1999 reflecting the flexibility of financial arrangements which propose the chance for modern and advanced approaches for user centered services. From April 2000, the partnership arrangement was based of joint fund and investment plans for mental health needs of adults. Significantly, interprofessional practise and partnership on health care was intended to go beyond the policy of care facilities. Health improvement was the key element in identifying the causes of sickness and local needs (NHS Executive 1999). To conclude, interprofessional practise and partnership is a divergence from the traditional system in the practise of health care. It is not easy to adjust to differences in beliefs, culture and perspectives whether coming from an individual or an institution. It is on this premise that trust and cooperation play an important role. For interprofessional practise to be successful, services being rendered must also be trusted both by the service users and the professionals involved. It is between these two main groups that the most fruitful collaboration should be encouraged and built up. Reflection Partnership and Interprofesional Practise (PIP) encompasses complicated processes of collaboration and coordination between professionals and agencies in health services. Although complexity is one of the key characteristics of partnership and interprofessional partnership, change is inevitable and must be carried out. There is a growing recognition of the importance of this process in addressing health needs. This study is relevant for all people who are interested in health care, from service users to carers. It is concerned with the positive and negative aspects of the policies governing PIP. The effectiveness of teamwork and the benefits of collaboration outweigh its negative aspects. The policies underlying the collaboration practise strengthen the effectiveness of the method. The various government interventions have a great potential in the formulation of the concept of interprofessional practise and its implementation on a wider range. Proper implementation is necessary to ensure the success of the process. Taking into consideration the varying health and social needs of service users, the integration of professionals from different field of expertise into a single team proves to be essential in properly addressing the needs of patients. In the illustrated case of Marilyn Hall, it is suggested that interprofessional practise and partnership plays an important factor in the fast recovery of the subject. The complexity of her conditions warrants the services and support of professionals with differing areas of expertise. The theories serve as guideposts for drafting a recovery plan for the subject. Interprofessional practise reveals how values are formed in the convergence of ideas among the members of a team. The formulation of new theories based on existing ones poses great potential for the betterment of interprofessional practise. Barring the negative factors that go with interprofessional practise and partnership, it can be deduced that the present implementation is serving its purpose of getting things done when it comes to addressing the different concern of people regarding their health needs. Further examination of the topic leads to better understanding of the process itself. The benefits of collaboration are effectiveness of teamwork among professionals, acquisition of collective knowledge, widened outlook, a more conducive work environment and unlimited opportunities for specialized skills and abilities. Service users are likely to benefit from interprofessional practise and partnership because they are assured that their specific needs shall be addressed. The formation of a composite team that will look after their health needs make proper health care plan and implementation more likely. Lastly, inteprofessional practise and partnership should be considered as a means not only to provide proper support to the service users but also to give opportunity to the professionals to interact with practitioners from other sectors and fields. References Axelrod, R 1984, The evolution of co-operation. Basic Books, New York. Barr, H 2005, Effective interprofessional education: Arguments, assumption and evidence. Wiley-Blackwell, Oxford. Brady, KT, Dansky, B, Saladin, M, and Sonne, S, 1996, PTSD and cocaine dependence: The effect of order of onset. Presentation at annual meeting of the College on Problems of Drug Dependency. San Juan, P.R. DHSS (Department of Health and Social Security) 1978, Collaboration in community care- a discussion document. Personal Social Services Council and Central Health Services Council, HMSO, London. 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