The Aspects OF The Best Patient-Centered Care - Essay Example

The aim of this reflection is to discuss my involvement with a particular service user who was admitted to hospital due to her non-compliance with her medication in the community. I will discuss the importance of working inter-professionally within a multidisciplinary team, to achieve the best patient-centred care. The reflection will demonstrate developments achieved, and the knowledge gained around this area along with the benefits of working in partnership. Again, to maintain confidentiality and protect autonomy, the patient’s name has been changed to Jessica and the hospital as Royal Ground Mental Unite. This complies with the NMC professional code of conduct (2008). The Royal College of Nursing (RCN 2007) argues that Inter-professional collaboration looks at teamwork, communication, professionalism and modern issues that influence practice at present. According to Kendall & Lissauer (2003) various health care professionals have a range of expertise and skills different from others and their experiences and insights into situations capture dissimilar care needs. It therefore enables the patient Like Jessica to receive the best care. Working in a multidisciplinary team can help different professionals to collaborate with each other in order to benefit the patient and deliver person-centred care. (DOH 2004). The government decided to implement a plan to reform the National Health Services in 1997. That included both inter-professional collaboration and patient-centred care (The plan aimed to offer mutual participation in a shared decision-making partnership (Antai-Otong 2006). This would offer a patient-led National Health Service that would work closely with the social services providing patients like Jessica with social support once discharged from hospital.  (Department of Health and Royal College of Nursing 2003). Whilst on placement I accompanied Ms. B from my team to undertake a CPA review at Royal Ground Mental Unite hospital. On our way, Ms. B took the lead by explaining Jessica’s mental health state. She informed how long she had been involved in her care. Also, she told me the type of intervention that she may need to be put in place while Jessica is either in hospital or discharged. As our discussion continued to prolong, Ms B alerted me about CPA processes and procedures and how the professionals involved with Jessica’s care were aiming for her improvement so that she could be discharged soon. The information shared with me was very interesting as Ms B was discussing the reasons behind her non-compliance, her lifestyles and the purpose of the meeting. Moreover, I took the opportunity to learn from Ms B as this would be part of what I will be doing when I complete my training. So I was happy that I was offered the opportunity to participate in the multidisciplinary discussion. While still in the care, on our way to the hospital, I demonstrated effective communication by engaging and paying attention to what she was saying. I demonstrated non-verbal skills by keeping quite, listening attentively by nodding at what she was saying. I gave her eye contacts and clarified information. If I was unsure I would ask openly. For examples, some of my questions asked would be: how long Ms B has known Jessica, the reasons why she was sectioned, who were working with her and her background history and the like. Also I asked the types of illness she had suffered from and if there was any diagnosis. Again, I asked if she was prescribed any medication, the types of medication and their side effects. At the same time, I was observing how Ms B was addressing my questions considering that I was a student. Her tone of voice was at a very good pitch as she was speaking slowly, addressing each questions one at a time. In other words, she demonstrated her clinical knowledge with evidences. She asked me to read some of Jessica’s files to gain more understanding of what was likely to be discussed at the meeting. And again, the use of her language while she was addressing Jessica’s problem with me was good and calm. Meanwhile, as professionals we need to mind the type of jargons and languages used while describing or talking about service users to other professionals as it could be otherwise, seen as discriminating especially when they are from different cultures from ours. (ANTAI-OTONG, D, 2006). As we both arrived at the hospital, approaching the way to the waiting area, I observed how Ms B was communicating with Jessica asking how her day was and things she had been doing while she was in the hospital. This gave me the confidence to approach Jessica. I shook my hands with her and sat opposite to her so that I could engage in conversation with her as well. Jessica is from a White English Background. She is 25 years of age and has a son age 3 years old. Jessica does not leave with her child’s father as she has lost the rights to look after her son and the father is the one with the custody who has the right to look after the child. Jessica has severe leaning disability which is impacting her health as she does not like to take her medication. Her key worker has to visit twice a week to make sure that she is complying. When she does not take her medication she will go on the street causing fights for, she thinks that people are jeering at her. Again, as we were all still sitting in the waiting room, I leaned forward to further engage in conversation with Jessica and to keep the day passing for it was getting boring as every one was sitting quietly waiting for the consultant and the doctor to arrive. At first instance, she seemed finefor talking and making me laugh. She was telling me all sorts of things she liked doing. She told me that she likes meeting new people, has lots of friends, always wanted to look best and could plait her own hair, loves going out shopping and enjoys wearing lots of make up. Suddenly, after few minutes she kept quite again. Due to her non-verbal skills, the place went quite, she started feeling distressed as she kept grinding her teeth and moaning about the waiting hours as it was too long. In fact, she was becoming agitated and worried. She kept saying “I want to go home, I want to go home, and I hate being here”. In fact, I understood the reason for her acting that way to get her freedom which I respected. On another occasion too, she kept quite to herself not engaging with anyone. Ms B asked her if she was fine and she did not reply her. She started looking outside the window and in my mind I knew that she was upset as her facial expression was unhappy. I didn’t let her non-verbal skills get in my way. So, I kept on smiling at her, giving eye contact and trying not to stare at her as it could be perceived as intimidating. In fact, I wasn’t sure what to do for, her mood and action was not very impressing. So I kept quite as well. In the waiting room, my involvements with Jessica started from asking her open and closed questions before keeping quite. While speaking with Jessica, I was aware of confidentiality issues as Ms B and her key worker was around. I did want to ask any leading questions as she may not be comfortable to share with me, for, she does not know me very well. Again, Mr B added to my knowledge that I would need to be aware of sensitive issues and as they can awaken their hidden pain. Also, she liked the way I was building my rapport with Jessica as to build a relationship of mutual trust. Ms B made me realise that my interaction with Jessica reflected a respect for her autonomy. This allowed me to be more receptive to the things Jessica was disclosing about her lifestyles. A study by Rogers in 1967 cited in Moroney Natalie & Knowles Charles (2006) stated that “the core therapist attitudes of empathy, congruence and unconditional positive regard are both necessary and sufficient for effecting therapeutic change in clients” - an attitude still upheld today which is fundamental to patient-centred care. Furthermore, while still waiting, a staff who worked on the ward came and informed us that the doctor and the consultant were ready to start the meeting. We followed the staff member and she led us to the meeting room. On my way to the meeting, Jessica was shivering and her hands were shaking. She was anxious and I wondered what could possibly be going on in her mind. I guess that Ms B must have seen her. She asked her if she was feeling good. Jessica replied Ms B that she is scared of what the outcome of her review might be as she does not want to stay in the hospital anymore. I empathised with her but did not want to make any promises but told her things were going to be o.k. At the review meeting were all different professionals sitting and waiting for Jessica. The professionals present were the doctor, the ward manager, consultant, key worker, community nurse and I. I sat facing the doctor and the consultant, Jessica sat in between me and Ms B and her key worker sat on my left hand side. The publication of the White Paper ‘Caring for People’ (1989) cited in Department of Health (2009) states that Valuing people benefits collaboration between primary health and social services. It stressed the importance of partnership and proposed that local representatives should be involved in both primary care groups and health authority meetings The meeting began with everyone introducing themselves. I introduced my self by saying my name, who I am and the organisation and university I was from. Every one had a goal and said who they were as well. The consultant chaired the meeting and I watched her closely, observing how she was leading the meeting. For this end, the Government introduced common learning goals in their education program as their main target for pre-registered students to integrate inter-professional training into their curriculum, enabling students to develop transferable skills that will facilitate communication and collaboration (DOH 2001). Throughout, it became evident that the Jessica was at the forefront of all the discussions between the professionals at the meeting. What was discussed was Jessica’s discharge package, including her coping situations at home if she leaves the hospital. I observed how the consultant was sharing knowledge with other professionals by clarifying information and engaging others in the debate as whether or not they should discharge Jessica. This gave me a holistic view of Jessica’s competencies and needs. Holland et al (2007) recommend that a plan for a patient’s discharge should begin when the patient is first admitted to the ward and it is imperative that the discharge coordinator has good communication and organisational skills which helps build a trusting relationship with the patient and has an understanding of other health professionals and services in order to benefit the patient. Again, I observed how Ms B was asking the consultant questions regarding Jessica’s medical and emotional recovery file during the time she was admitted at the hospital. She needed to glance through the file to help her make her clinical decisions. I feel it was a good practice and it made me understand that I am accountable for my actions, so any clinical decisions I make will be held against me. So Ms B’s need for Jessica’s file was an evidence based practice to help her make the right decisions. RCN (2007) states that the key to multidisciplinary care is collaboration. And the unity of health and social care professionals developing a collective understanding require effective coordination, a flattened hierarchy and transformation of leadership trial. Again, when communications fails between a multidisciplinary team there can be serious consequences that may affect the health and well being of the patient. (Sonia Chambers 2003). On analysis, the overall experience was good for me and was also an opportunity to attend a Multidisciplinary Team (MDT) meeting on a hospital ward for people with mental health illness. The meeting gave a brief overview of Jessica and how they thought she was progressing or deteriorating, this included evidence from the staff members on the ward she was admitted and her key worker. Ms. B expressed her views of how she felt Jessica was improving compared to her response during the time of admission at the hospital. To evaluate the scenario, the whole collaborative experience was enlightening and portrayed excellent communication skills; everyone involved was satisfied with the positive results from the meeting. The experience facilitated my understanding, knowledge and awareness of what each service could contribute and what levels of care they can give as a team or individually. On reflection this has been an excellent learning experience that has not only benefited my studies but also my future as a qualified nurse. Rattay and Mehanna (2008) recommend that as students we should make an effort to attend MDT meetings. Furthermore if I had known Jessica better, my input as a student nurse to engage in the discussion would certainly be welcomed. An opportunity was offered to when Ms B gave me eye contact during the discussion to check if I had anything to say. As I didn’t really know her very well I could not say much. So I sat and watched everyone contributing which I think was vital for me to learn. Over all, this reflection has highlighted the importance of health professionals to work in multidisciplinary teams. This experience has enabled me to see how the inter-professional collaboration provides a positive outcome for patients like Jessica. The communication between the professionals had more meaning to me, thus making the discussions more valuable and more understandable to my learning experiences. I now have an understanding of the different professionals within the National Health Service and have realised how closely they must worke together to achieve the best results. Communication plays a vital role in relation to inter-professional collaboration. Consequently some people stated that returning Jessica to home would promote her independence and enable her to return to her friends and families, thus reducing her anxiety. I believe that there are still plenty of knowledge and experiences to be gained in order for me to develop further. Read More