Working With Different Cultures in the Clinical Setting - Essay Example

Working With Different Cultures in the Clinical Setting Introduction As different professions come together to work in a clinical setting the relationships with patients can be difficult. Each profession has its own idea of how patients should be treated and bias can occur when one profession things they are the one that should be followed exclusively. What is critical to good patient care is that all parties involved understand how to work together so that they effectively meet the needs of the patient. I am a second year student nurse (adult branch) and a March cohort. Last year I worked on a neuro-surgical ward where we had people coming in from various countries including the Philippines, Africa, Asia and Europe. We also had people coming from different professions including social service, general practice, billing and insurance. Each of these areas has a different way of dealing with a patient and sometimes they come into conflict because they have different rules. Interprofessional working brings together these elements to find the common grounds where they can effectively collaborate and become more flexible and skilled towards meeting the patients needs (British Medical Association 2005, par.1). When these factors come together, the team is able to more affectively cross "traditional" roles and find ways to substitute roles within the framework of working together. Barriers to Interprofessional working When people come together from different professions there are several issues that happen. Some of them include: 1. Different professions have different rules. 2. Professionals working in these fields are instructed on the rules for their professions and not others. 3. When they come together as a team some professionals are not certain what to do and others dominate the situation. 4. The patient may not get the appropriate care because the team is not well constructed. 5. The team fails the patient. These are the major challenges to interprofessional working and they create barriers to the patient. A study done by Elston and Holloway (2006, p. 20) showed the potential conflict between three different groups: nurses, managers and general practitioners. When asked what "interprofessional working" meant to each group, they found that GPs and managers were focused on their individual practices while nurses were able to see the relationships between all professions. The study further found that GPs thought they were ultimately responsible for everything in the study and nurse practitioners tended to work as doctors in the primary care setting. Managers saw an overall idea of the group than other practitioners. The final aspect of this study pointed out that all participants saw that there were specific challenges in working together: …between the different professions there are different priorities, GPs and nurses tend to focus on different aspects…I think it is going to be quite a challenge, but if it works them you could end up with something better, you could end up with a real representative view. (Nurse 2 as cited in Elston and Holloway p. 21). This nurse also pointed out that there would be challenges with understanding the differences between educational backgrounds and the socialisation process that lead to different identities within the individuals, and "the danger of stereotyping other professions was identified" (Elston and Holloway p. 21). It is clear that there are a variety of issues that come into play when a team of people from different backgrounds come together. Cowley, Bliss et. al. (2002, p. 32) noted different barriers to interprofessional working that included: Lack of an effective relationship between social services and health care providers High numbers of local service providers in different service configurations The separation of purchasing and provider roles Health authorities not taking the lead in need assessment and other important areas They created four cases studies to see whether facilitation would improve these barriers. The results of the study were to create a list of those things that worked within the interprofessional framework of palliative care. They suggested that bringing people together geographically in both structures and locations and having them work collaboratively to create a joint practice would create stronger links in communication and sharing information (Cowley, Bliss, et.al. p. 36). Working in a team is sometimes difficult because a team needs a leader. When the leader is not clearly defined the group may not be certain how to proceed. When the group comes together with a clear leader and everyone knows their part in the process, the group can work more effectively together. Hyrkas (2003) studied team member reactions to supervision within a multiprofessional teams and found that there were several areas where team members were affected by supervision: "togetherness, communication and expression of opinions, team relationships, teams working methods and work motivation"( Hyrkas, 2003, p. 192). In two of the teams, the solidarity was most important relationship that developed during supervision but the other three teams felt no solidarity occurred in their area. From the supervisors perspective, the major issue that developed was the need for a solid identification of multiprofessional team supervision and collaboration was because most participants had different views. There was definitely a need to have this explored in the beginning of teams coming together (Hyrkas, p. 195). Another area that must be discussed when looking at the area of multiprofessional working is the area of cost because it can become a barrier to the success of a program like this or it can stop the program all together. Litaker, Mion et. al. (2003) developed a study that examined the cost effectiveness of working with multiprofessional teams in helping patients manage their pain. They particularly focused on diabetes mellitus and hypertension. They looked at this study through the eyes of a nurse practitioner -physician team and the purpose was to compare a new program for pain management with an older one. They also looked at the cost for the new program. They found that the new program was more cost effective and by putting a multiprofessional team together, they were able to work together and share their expertise. Since nurse practitioners have a vast background, they were able to complement physician based programs (Litaker, Mion, et. al, p. 234). It seems that the issue of interprofessional working has been studied by a variety of different programs. As this research has seen to this point there are many different aspects of this issue to involve oneself in and there are many opportunities to understand the process. This has become such an issue that there were a variety of settings that studies were reviewed within. Another such area was infant hearing. Young, McCraken et.al. (2005) presented information from a study that was done at the beginning of the introduction of the newborn hearing screening programme (NHSP). Their information was part of a national study that was done to examine this area. This was another study that looked at the impact of two organizations from the perspective of the agencies themselves. In this study Social Services and education were the targets. The areas where they looked involved those programmes that were requiring more focus on interagency and interprofessional working (Young, McCraken, et. al, p. 386). The reason infants were being screened was because prior to NHSP, children were not diagnosed with hearing loss until at least 26 months. The study wanted to show a commitment to the "enhancement of multiprofessional services" for families with children from birth to 3 years old (Young, McCraken, et. al. p. 387). They issued surveys to all involved. The results of the survey showed four different ways that teachers of the deaf and social workers worked with parents of deaf children. These for ways were the perception from the group interviewed and from it they saw separate philosophies of interprofessional working that emerged from these perceptions. Their recommendation was that as professionals come together they will need to iron out the challenges that come because of "poorly developed" interprofessional working (Young, McCraken, et. a. p. 394). Conflict management is another barrier that will show itself when working with a team. Vivar (2006) saw the importance of helping health care providers understand conflict management in practice. Since it is inevitable that conflict will come up at different times in the interprofessional working it was seen as something that needed to be talked about because certain levels of conflict are productive. This was also an important study because many people within organizations think that conflict can only be destructive. Conflict between members of a team can create problems for both the team and the patient. Therefore, Vivar thought it was important to examine it within the context of a nurse case study. Some of the study focused on conflict management between superiors and subordinates which is important to examine because this would happen within the role of various team members. Vivar pointed out that differences in conflict style management between subordinates and superiors might create an adverse hierarchical relationship. Sometimes this can also lead to the head nurse feeling abandoned or isolated when she is doing her job. The recommendations from this study were that people must first decide what type of conflict they are dealing with and deal with it in a timely fashion. They give several ways to deal with conflict and suggest that people learn to approach conflict instead of running from it. Ideas and values of individuals coming into an interprofessional working is another potential barrier to team work. Maben, Latter et. al. (2006) studied nurses who were new and coming into the profession. They wanted to see whether nurses acquired best practice ideas and values from their training. They studied nurses in several countries. They found that although nurses came through their programmes with strong values when they went back to their institutions to work they were often unable to use them. In fact, some organizations actually sabotaged these nurses. This gave them a better understanding of why there was such a disparity in what nurses learned versus what they were actually able to put into practice. The final area this paper will examine is the area of language use and patterns of communication within interprofessional working. There are many ways that language can divide a group and this can be through lack of communication or through difficulties with the language. Sheehan, Robertson, et.al (2007) looked at this area through a question that came up in one of their groups. The question was, "Can the language used and the patterns of communication differentiate a multidisciplinary team from an interprofessional team?" (Sheehan, Robertson, et.al. p. 17). They focused on the language used and the patterns within the communication. The results of their study indicated that people within a team identify what they see as "normal in relation to their interactions and their expectations of each other" (Sheehan, Robertson, et. al p. 29). They also found that there was a difference in the approach and in the communication between a multidisciplinary team and an interprofessional team. Conclusion This researcher has found that there are many more barriers to interprofessional work that was originally brought to attention. These barriers can be summarized as being challenges with interpersonal communication and relationships. Many studies showed that when people get into teams they have conflict that can be healthy or destructive. They can also have challenges with the hierarchy between the subordinates and the supervisors. These are areas that can be developed over time. There are also communication challenges. Within the clinical setting that I was in, I noticed many of these issues and through the research I will think about how I can work more effectively with my team. References British Medical Association. (2005). Healthcare in a rural setting: Interprofessional working. Caring for the NHS at 60. 1948-2008. Braine, M., (2006) ‘Clinical governance: applying theory to practice’. Nursing Standard 20 (20) pg. 56-65. Bleakley, A., Boyden, J., Hobbs, A. et al. (2006). Improving teamwork climate in operating theatres: The shift from multiprofessionalism to interprofessionalism Journal of Interprofessional Care 20 (5) 461-470. Cowley, S, Bliss, J, Mathew, A. et al (2002). Effective interagency and interprofessional working: facilitators and barriers. International Journal Of Palliative Nursing 8 (1), pp. 30-9. Elston, S. and Holloway, I. (2001). The impact of recent primary care reforms in the UK on interprofessional working in primary care centres. Howe, A. (2006). Can the patient be on our team? An operational approach to patient involvement in interprofessional approaches to safe care. Journal of Interprofessional Care. 20 (5), 527-534. Hyrkas, K., (2003) Team supervision in multiprofessional teams: team members’ descriptions of the effects as highlighted by group interviews. Journal of Clinical Nursing 12(2) p.188-197. Litaker, D. Mion, L. Planavsky, L., et al (2003) ‘Physician-nurse practitioner teams in chronic disease management: the impact on costs, clinical effectiveness, and patients perception of care’ Journal of Interprofessional Care 17(3) p. 223-238. Maben, J., Latter, S., & MacLeod, J., (2006). ‘The theory-practice gap: impact of professional-bureaucratic work conflict on newly qualified nurses’. Journal of Advanced Nursing. 55, (4), pg. 465-77. Sheehan, D., Robertson, L., & Ormond, T., (2007) ‘Comparison of language used & patterns of communication in interprofessional & multidisciplinary teams’. Journal of Interprofessional Care 21(1) p17-30. Vivar C. (2006) ‘Putting conflict management into practice: a nursing case study’. Journal of Nursing Management 14: pg201-6. Young, A., McCracken, W. et. al. (2005). Interprofessional working in the context of newborn hearing screening: Education and Social Services compare challenges Journal of Interprofessional Care. 19(4) 386-395. Read More