Analysis of the Positive and Negative Problems of Irish Primary Health Care - Case Study Example

Critically Discuss the Positive and Negative Challenges of Multidisciplinary Team working within the Irish Primary Healthcare Introduction Public Health is defined as an 'organised social and political effort, and health promotion for the benefit of populations, families and individuals' (Mason and Clarke, 2001). Public health tend to face several challenges in nursing and health care including difficulties in information sharing, and problems associated with multidisciplinary team working processes. This discussion is based on identifying the goals of public health and health promotion initiatives and highlights the role of public health nurses, general nurses and other health workers in Ireland. The importance of nurse or health worker patient communication and working as a multidisciplinary team highlights the need for adequate policies that would make public health services suitable for meeting the unique needs of individuals, either through long term palliative care or short term emergency care. Public Health Challenges -Multidisciplinary Team working The public health challenges in the 21st century are substantial and quite diverse and complex and according to Clarke (2004) the importance of health workers in public health settings highlights society's efforts to tackle these challenges. The nurses are a force for health and a social model of health focuses on the environment, historical, political, cultural and social structures. Clarke (2004) discusses public health in Ireland and the challenges of multi disciplinary team approach as well as communication and the need for a stronger political and social structure within the public health systems. Clarke's work is presented through examples from public health work and he also discusses future developments in care and management in Ireland. Chavasse (1998) discussed the role of key players and processes that tend to influence public policy in Ireland and highlights the need or lack of policy in healthcare. According to Chavasse (1995), the lack of specific policies in healthcare can have a detrimental effect on primary health care and nursing values with emphasis on fewer appropriate policies. The emphasis is on getting public health workers more involved in policy making and to ensure that policies reflect values and concerns of the health care workers and are recommended to the Irish Government's Commission on Nursing (Chavasse, 1998). Public health nurses or PHNs work as part of a multidisciplinary team within community care services in the Republic of Ireland and Hanafin and Cowley (2003) suggest that proper interdisciplinary communication is vital for offering the best care to patients. A national survey of PHNs has been reported on families and infants and the public health nurses report good working relationships with other professionals such as speech therapists, medical officers and community welfare officers. Working with multidisciplinary teams is an important part of public health system and a broader social healthcare system and the PHNs admitted that they do receive feedbacks from GPs, eye specialists and social workers. A positive statistical correlation was found between working relationships and frequency of feedback from different health professionals. Communication and team working are two primary elements of health care in the Republic of Ireland. Thus not just within nursing, but multidisciplinary team working approach is encouraged within the entire health care system and is largely associated with communication. Hanafin et al (2002) bring out the policy and conceptual basis of public health service provision in Ireland in an international context and also proposes a new model of public health service provision to provide an understanding of service delivery through vertical equity. The public health nurse for instance has wide responsibilities in the areas of primary, secondary and tertiary care at the levels of individual, family and community life. There are many expectations and demands on the public health service in Ireland as public health service tend to go beyond clinical nursing service and the main focus is on the needs of the community as communities differ in epidemiology, environment, history, composition and demography (Hanafin et al, 2002). Hanafin et al claimed that a multidisciplinary locally based public health service could be based on vertical equity and more flexible and responsive to local needs and the needs of the community. Teamwork and multidisciplinary working skills are important within clinical settings (Scott et al, 2006), as for home nursing and private care, communication with patients would be of primary importance. Thus teamwork, multidisciplinary approaches and challenges as well as communication challenges between professionals and between patients and health professionals would be the major issues in healthcare. Within the framework for integrated teamwork, there is a need to develop management initiatives in public health that is aimed at strengthening management and leadership capability of a clinical setting. Public Health Challenges -Communication The important part of public health service seems to be the health worker -patient communication as well as communication between the health professionals. Communication is a basic component of the health worker - patient relationship, and other organizational factors that aids in delivery of quality health care. However according to McCabe (2004) nurses are described as poor communicators and very few studies have actually examined how patients and nurses communicate. McCabe interviewed patients in Ireland using unstructured interviews and data analysis was considered to be a reflective process with description and interpretation of themes and their results showed indications of lack of communication, empathy and friendliness. The study indicated that nurses are not good at communicating with patients although communication is very good when a 'patient centered approach' is used. The value of using communications effectively in patient centered approach has been recognized and ensures the delivery of quality patient care. The task centered approach to patient care is associated with health care management should ensure that patients receive quality nursing care. Patient centered communication is essential to encouraging and supporting health care workers to enhance their communication skills especially with patients. Management development programs and initiatives are important for development of team working and communication within a clinical setting. Leadership and management programs share the principles of management and clinical development with focus on interactive learning, management tools, evidence based decision making, individual feedback, support for networking, life long learning ad teamwork (Setliff et al, 2003). One of the main areas where teamwork is necessary and can also provide a challenge to health care professionals would be long term palliative care and McIlfatrick (2007) assesses the palliative needs of the adult population and healthcare provider organization in Ireland and highlights the viewpoints of patients and health care providers. Palliative care is especially an important factor in health service planning and involves multi professional multidisciplinary approach to care as health care professionals work with social workers, and psychotherapists to provide comprehensive holistic care to the patients. However some of the difficulties identified in providing such care services would be problems in communication and information exchange as well as fragmented coordination between services (McIlfatrick, 2007). Providing social and psychological support to patients, and providing choice and information through communication could only be possible with multidisciplinary approach to patient care and this has been highlighted in several research studies. According to McIlfatrick, all patients should be able to access palliative care and comprehensive support according to individual needs and an integrated approach to care with team working and information exchange should be emphasized. Conclusion The discussion here highlights not just the challenges to public health care in Ireland but also the multidisciplinary team working approach and communication problems that could pose both positive and negative challenges to health care units and professionals within Ireland. The positive challenges in team working would be to improve services for better or quality care and adequate information exchange can only help in improving and meeting these challenges. The challenges could be considered positive when they help in general improvement of the public health care services. The negative challenges are lack of support from patients or even the health department that deteriorates the quality of care provided. Inadequate information technology facilities, inadequate infrastructure for communication facilities, poor equipment that affects team working and inappropriate information exchange would be some of the negative issues that have to be tackled within the public health care department in Ireland. References Byrne, G. Brady, A. Griffith, C. MacGregor, C. Begley, C. (2006) The Community client Need Classification System- a dependency system for community Nurses Journal of Nursing Management 14, 437-446 Clarke, J. (2004) Public Health Nursing in Ireland A Critical Overview Public Health Nursing 21(2) 191-198 Clark, J. (1999) Revisiting the concepts of community care and community health nursing Nursing Standard 14(10), 34-36 Chavasse, J. (1995) Public Health Nursing in the Republic of Ireland Nursing Review 14(19) 4-8 Chavasse J. (1998) Policy as an influence on public health nursing education in the Republic of Ireland Journal of Advanced Nursing, Volume 28,Number 1, pp. 172-177(6) Department of Health (1998). Report of the Commission on Nursing: a blueprint for the future. Dublin: Stationery Office. Government of Ireland (1998) Report of the Commission on Nursing a blueprint for the Future Dublin, Government Publications Hanafin, S. and Cowley, S. (2005) Service configuration and quality of Irish public health nursing Community Practitioner 78(12) 433-436 Hanafin, S. Hoston, A. and Cowely, S. (2002) Vertical equity in service provision: a model for the Irish public health nursing service Journal of Advanced Nursing 39(1), 68-76 Hanafin, S. and Cowley, S. (2003) Multidisciplinary communication in the Irish public health nursing service: a study British Journal of Community Nursing 8(12) 544-549. Hanafin, S. (1997) Health Promotion: an analysis of possible approaches and contributions of the Pubic Health Nurse Nursing Review 16(1) 14-17. Hanafin, S. (1997) The role of the Irish Public Health Nurse: manager, clinician and health promoter Health Visitor 70 295-297 Leahy Warren, P. (1998) Community Nursing - An International Perspective. A report prepared for the Commission on Nursing (edited by McCarthy Haslam, G. Dublin: Government Publications Mason, C. and Clarke, J. (2001) A Nursing Vision of Public Health Nursing All Ireland Statement on Public Health and Nursing Belfast; Department of Health and Social Services and Public Health Policy. McCabe C. (2004). Nurse-patient communication: an exploration of patients' experiences. Journal of Clinical Nursing, Volume 13,Number 1, pp. 41-49(9) McIlfatrick, Sonja (2007). Assessing palliative care needs: views of patients, informal carers and healthcare professionals. Journal of Advanced Nursing, Volume 57,Number 1, pp. 77-86(10) National Council for the Professional Development of Nursing and Midwifery (2005) Agenda for the future professional Development of Public Health Nursing Dublin: National Council for the Professional development of Nursing and Midwifery. Scott, P. A. Hayes, E. MacNeela, P. (2006) Community Nursing in Ireland An exploration of core nursing elements of care provided by RGN with the community setting Dublin: School of Nursing, Dublin City University. Setliff R, Porter JE, Malison M, Frederick S, Balderson TR. (2003) Strengthening the public health workforce: three CDC programs that prepare managers and leaders for the challenges of the 21st century. J Public Health Manag Pract. Mar-Apr;9(2):91-102. Read More