Interprofessional Education - Essay Example

Your Your Introduction. Every year brings a new set of discoveries in the world of surgery that promise to improve and extend the quality of life for the world’s ill. With these new discoveries come new technologies, new skill sets to learn – and new things to fail at. Because the learning curve has increased, and will continue to increase in the field of medicine, the need for interdisciplinary learning and for multiprofessional education will only continue to grow. As pressures come onto medical professionals from all sides – patient and family expectations, financial controls from hospital administration and from insurers – the only way to ensure a continued improvement in hospital care is to make sure that all members on surgical teams are on the same page, trained to focus on the same priorities and to work together to increase patient satisfaction and reduce instances of morbidity and mortality. Overview of Reflective Scenario. With obesity one of the primary health concerns in Western medicine, restrictive operations are becoming increasingly popular. These are designed to make the stomach smaller, with the result that the patient will feel full sooner, and so consume fewer calories. For patients who are morbidly obese, these operations can serve as a last chance to lose the weight that will end up killing them early, or giving them years of health problems. One of these restrictive operations involves stomach stapling. As is widely known, a small incision is made in the abdomen, and surgical staples and a plastic band are used to make a small “stomach” at the top of the existing stomach. After the operation, the patient will only be able to eat ½ to 1 cup of food before feeling quite full. This open surgery usually requires a stay in the hospital of two to four days, and a three to five week cessation of normal activities. This may sound like a simple procedure, but, even so, 3 people in 200, or 1.5%, die from complications to this surgery. The risks include infected incisions, peritonitis, or a pulmonary embolism (Restrictive Operations 2005). Clearly the benefits of this operation outweigh the risks: to be a candidate for stomach stapling, you have to have a body mass index of over 40, or over 35 with other medical complications, and have had no success with any other method of weight loss. So, among the 200 people who have the surgery, many of them were headed to a very early demise because of their obesity. However, no one checking in for this surgery expects to leave on a gurney, and so the challenge to a surgical team would be to ensure that each candidate for surgery leaves happy and healthy, beyond the risk of infection and satisfied with the way he or she was treated during his or her stay in the hospital. It is this interdisciplinary work that we will revisit during this analysis. Critical Analysis. One of the key standards of proficiency for an ODP involves the ability to “understand the need to build and sustain professional relationships as both an independent practitioner and collaboratively as a member of a team” (Standards of proficiency 2004). Even for a relatively minor surgery like stomach stapling, there is a vast network of professionals that will need to work together. In the perioperative realm, this includes nurses, surgeons, anesthesiologists, and possibly physical therapists, depending on the patient’s difficulty in recovering the ability to resume normal functions. In a multicultural society, this ability becomes even more important – as the standards also indicate, an ODP should be “aware of the characteristics and consequences of non-verbal communication and how this can be affected by culture, age, ethnicity, gender, religious beliefs and socioeconomic status” (Standards of proficiency 2004). And so, it would be very easy for a brusque, older European doctor to, in the course of his own pre-surgical consultation, irritate his younger nurse of African descent and outrage the religious sensibilities of a devout Muslim man whose wife has a great deal of trouble controlling her weight, to the point where it has become a health issue. If the ODP and his nurse have previously developed a solid working relationship, it will be easier to assuage the concerns of the patient and her family; however, if he has not taken the time to build this rapport, it will quickly become a difficult session for him. This is one reason why the interpersonal standards of proficiency for nurses are somewhat similar. To be considered a level one nurse, one must be able to “demonstrate fairness and sensitivity when responding to patients, clients, and groups from diverse circumstances” (Standards of proficiency for pre-registration nursing education). It is often patient anxiety about communication with the practitioner, in fact, that leads many patients to forego advance discussions of their upcoming procedures with their surgeons. Given the perception that hospital-based physicians beyond the primary care provider often need to communicate with the patients about advance directives to be followed in case of disabling outcomes, in order to maximize the possibility of successful procedures, as well as patient preparation for adverse outcomes, researchers at the University of California-San Francisco School of Medicine conducted a study measuring the effectiveness of a short discussion (five to ten minutes in length) in a preoperative evaluation clinic between the anesthesiologist involved and either the patient or the patient’s proxy. This study randomly chose English-speaking patients who were age 65 or older to receive a short informational session about the importance of end-of-life care between patients and their proxies. The control group only received the standard information that goes along with preoperative anesthesia screening. The results were significant: the experimental group reported 87% of their participants discussing end-of-life care with their proxies, as opposed to 66% of the control group. (Grimaldo, Wiener-Kronish, Jurson, Shaughnessy, Curtis & Liu 2001) As a result, one could conclude that doctor-patient communication significantly affects patient attitudes and actions. In the case of the stomach stapling surgery, preoperational discussions could lead to increased patient awareness of end-of-life care as well, but also the importance of proper nutrition and eating habits to maintain the effectiveness of the newly smaller stomach. And so we see that doctors, working as a team, can effectively increase patient knowledge about crucial matters of health. Some researchers are moving toward a more automated communication process, particularly in the more mechanical parts of the preoperative screening process. The Cleveland Clinic Foundation analyzed the effectiveness of a preoperative outpatient assessment software package called HealthQuest in making elective surgery a more efficient process. Over three years, the study involved 50,967 patients who used the HealthQuest program as part of their preoperative screening. Over 35% did not have to meet in person with the anesthesiologist until the day of the surgery, since the anesthesiologist was able to use the results of the HealthQuest screening to prepare for the day of the surgery. Given that the volume of same-day surgeries went up over 35% during the three years of the study, it became imperative that processes become more efficient. (Parker, Tetzlaff, Litaker, & Maurer 2000) Tests can be a positive factor, or an unnecessary cost, however. While the HealthQuest software package seems to have worked as an efficient timesaver, there are other practitioners who order tests just for their own sake, or to run up billables. Tests are not an automatic substitute for interaction with a physician; in fact, the New England Journal of Medicine has argued that unless preoperative assessments by physicians become more common, the result will be more adverse outcomes from surgery, and higher recovery costs over time. (More Preoperative Assessment 2000) As obesity becomes more and more of an epidemic in Western society, restrictive procedures will also increase in frequency, and it will be important to make sure that the process is safe, healthy, and efficient. Other issues involve the length of stay for a patient. In countries with publicly controlled medicine and in countries with private insurers alike, financial administrators charged with keeping costs in line are often those who make decisions on approving which surgeries to perform, and how long those surgical patients should receive covered residential care. Compressing the time that a patient may stay in the hospital makes improved communication among the interdisciplinary members of the care team even more important. As hospital stays of three or four days become one or two days, as general anesthesiology becomes epidural in more and more cases, costs and risks will be more effectively managed, if the communication among medical care personnel is professionally done (Kehlet & Wilmore 2002, p. 639). This communication is harder to come by than one would think. For practitioners to work collaboratively, it requires the surrendering of personal prestige, and the subjugation of one’s ego to the greater good of the patients involved. Kopp and Shafer point out the different levels on which language and work in the medical profession. Because the medical practitioner has so much control over the quality of life of the patient, the language that the practitioner uses gives him or her “the power to modify life’s circumstances like no other species” (Kopp & Shafer 2000, p. 548). This is true especially in the case of those practitioners whose communication with the patient is highly limited, like the anesthesiologist. Even when there is a preoperative conference, the anesthesiologist’s time with the patient is relatively limited. The key to successful communication in this interaction hinges on the anesthesiologist’s decision to treat the patient as another person to knock out for a predetermined period of time, or someone toward which to show concern. While the anesthesiologist may be thinking about an argument with her husband that morning, or about a school conference for her child right after this consultation, or her dinner plans, the patient is focused on one thing: the dangers of surgery. In the case of the stomach stapling patient, a lifelong journey of obesity has the chance to end, but the prospect of being unconscious while someone is cutting open one’s stomach is an intimidating one, and the anesthesiologist needs to be sensitive to that. The challenges are similar for nurses, who are expected by standards of proficiency to be able to “provide for a supervising registered practitioner, evaluative commentary and information on nursing care based on personal observations and actions” (Standards of proficiency for pre-registration nursing education). The implications are daunting in the operating theater, where nurses and doctors must be able to handle overlapping responsibilities, particularly the monitoring of the patient before, during and after surgery, and communicating well to determine the optimal course of action. Finally, and perhaps most importantly, building a professional environment based on collaboration and interdisciplinary ownership of the surgical process will give practitioners the freedom to feel like they can be honest about situations that go wrong: even when all the administrative wrinkles are ironed out of the surgical system, patients will still die. Clots will still form, blood vessels will still fail, because the material that doctors deal with is the human body. Katz and Lagasse did a study through the State University of New York at Stony Brook concerning the reporting of adverse perioperative outcomes involving the anesthesiologist. They took a three-year window and analyzed reports of these outcomes, which came from three sources: from the anesthesiologists themselves, from chart reviewers working in the hospitals, and personnel incident reports. The three-year window included 37,294 cases where anesthetics were used. 734 (1.9%) resulted in adverse outcomes. Out of these adverse incomes, 71% were identified by the anesthesiologists themselves, 38% by chart reviewers, and 9% by incident reports (there was some overlap due to the fact that some adverse outcomes were caught by more than one source). (Katz & Lagasse 2000) Interestingly, the primary motive for anesthesiologists to report adverse outcomes was to improve quality of future patient care. The research also found that self-reporting was more accurate than chart review or ancillary personnel reporting, because chart reviewers tended to act based on the severity of the outcome or of the patient’s condition, and the incident reports tended to focus on human error, to the point of missing adverse outcomes based on pre-existing conditions. (Katz & Lagasse 2000) If a patient came in looking for stomach stapling to be done, a collaborative working environment among the medical professionals will ensure the safest procedure possible for the patient. Conclusions. Let us assume that our stomach stapling patient has emerged successfully from her surgery. She is fully aware of the need to stay away from high-calorie liquids, such as sodas, and the fact that eating more than one cup of food at a time may make her vomit, initially, but may later cause her staples to move, ruining the effectiveness of the procedure. She also is aware of the nutritional deficits that may arise from eating so much less, and of the need she will have to consume nutritional supplements to stay healthy. Over the next months, she will bring her body mass index down into healthy levels and lose enough weight to be able to raise her level of activity significantly. This successful patient has benefited from the surgical skills of a highly talented practitioner. However, the surgeon is not the only one who deserves credit for this medical success story. For many patients, restrictive surgery to correct obesity is just another step in a long, harrowing, humiliating journey that has lasted almost all of their lives. The first nurse who welcomed them and performed the initial screening may well have been the person who gave the patient the comfort level to go ahead with the procedure. The anesthesiologist had the responsibility of making sure the patient was both safe and comfortable during the operation. The nutritionist who met with the patient after the surgery to go over healthy diet and regimen also contributed to the patient’s recovery. The physical therapist who helped the patient get up out of bed in those early days after the surgery and who helped her find her balance and be able to return to work is also part of the story. Because all of these professionals worked together on this success story, it is vital that they be trained to work together, to interact successfully, and to build rapport among one another and with incoming patients and families to ensure that the medical profession continues to improve in terms of accessibility and public trust. Works Cited About our health, our care, our say. Retrieved July 28, 2006, from http://www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/Modernisation/OurHealthOurCareOurSay/OurHealthOurCareOurSayArticle/fs/en?CONTENT_ID=4127375&chk=Eq%2BTr5. 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