Clinical Integration:

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NRSG355 Clinical Integration:

Towards Professional Practice

Module 2 – Collaborative and Therapeutic Practice

Introduction

Welcome to Module 2 for NRSG 355 Clinical Integration: Transition to Professional Practice. This is the second of the on-line modules and will focus on the areas of Collaborative Practice, the Multi- Disciplinary Health Care Team and Therapeutic Practice. This relates very closely to the three other modules: Critical Thinking, Professional Practice, and Provision and Coordination of Care.

As you enter your final semester of your nursing degree the content within this unit and the modules will not be new to you. Although, the real test of knowledge is in how we apply it. With that in mind, each of the theoretical concepts within this module are only briefly addressed. The bulk of the work is how you apply it to some hypothetical clinical scenarios.

Collaborative Practice

Collaboration is when several health professionals work together for a common goal. Collaboration is not unique to health care but is also part of business and community models for achieving success in any project. In the case of health, success is defined in terms of patient outcomes. A successful outcome for the patient can only be achieved by implementing a coordinated series of interventions from a variety of health professionals and intrinsic to this is the involvement of the patient and their family. Collaboration is essential for such a group to keep the patient as the central focus, ensure the roles within the team are clear, ensure all aspects of the health issue and its impacts are accounted for and the care plan is aimed at achieving common goals (Crisp & Taylor, 2009, pp 43).

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A collaborative approach to health care reflects the multidimensional nature of illness. For the individual, illness often impacts on several body systems as well as having effects on family and friends. The end result can be personal, social and occupational malfunction. This pathological complexity means that health care intervention requires a complex response. In the course of your studies you have been exposed to terms such as ‘holistic care’ to describe a series of interventions aimed at treating physical, psychological, emotional and spiritual care to describe this complex response. Each member of the team contributes to the care but merely having the same goals does not guarantee a smooth process or successful outcomes. You will all have had experience working in groups within your studies, on clinical placements, at school and with other group projects you may have been involved with.

Multidisciplinary Health Care Team

The multidisciplinary healthcare team, by definition, includes members from a variety of disciplines. From your clinical experiences to date you should be familiar with most of the common members of a health care team. The most important and sometimes neglected member of the health care team is the patient and their family. While we acknowledge this as health professionals it can sometimes be lost in the pressure of delivering quality health care with a finite resource base.

ACTIVITY 1

Reading:

Weller, J. (2012). Shedding new light on tribalism in health care. Medical Education, 46, 132-142.

Please read this article and answer the following questions:

1. What does tribalism refer to? 2. How do tribalism and power inequities impact on information sharing? 3. What are the five key dimensions for a well-functioning health care team?

Reading:

Kalishman, S., Stoddard, H. & O’Sullivan, P. (2012). Don’t manage the conflict: transform it through collaboration. Medical Education, 46, 926-934.

Please read this article and answer the following question:

1. What benefits does the author suggest are there to conflict within groups?

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Therapeutic Practice

The aim of any health intervention is to address the cause and symptoms of illness. These interventions are designed to deliver the best possible outcome for the patient and their family. The implementation of these interventions is what constitutes therapeutic practice. Therapeutic practice incorporates a range of nursing skills, knowledge, communication skills and attitudes. A therapeutic relationship is one based on mutual trust, respects confidentiality and focuses on patient self-care (Berman et al, 2008, pp 496). Therapeutic relationships have been described as both a helping relationship and an interpersonal relationship. During your clinical practice you will have had the opportunity develop therapeutic relationships with your patients and engage in therapeutic practice within your own scope of practice.

The real focus of this unit is about knowledge application so to prepare you for your role as a member of a health care team working collaboratively we have developed a series of five (5) theoretical scenarios for you to comment on.

While you need to work on all 5 case studies, please choose one and upload the answers on your e- Portfolio on LEO. This forms part of your assessment for this unit.

CASE STUDY 1 Grant Thompson was a fit 37 year old man, a father of two young children and married for 14 years to Georgina. Grant was a truck driver who was involved in an MVA 6 months ago and suffered extensive injuries to his leg and a mild head injury. His recovery has been slow and he relies heavily on the use of a wheelchair but can now walk for short distances with the aid of a walker. Georgina wants Grant to come home and rehabilitate there. She has made some modifications to their home, ramps put in, handrails in the bathroom and toilet. The health care team is meeting to discuss this option. The team consists of the treating doctor, physiotherapist, and occupational therapist, NUM of the rehabilitation unit, social worker and psychologist. There is disagreement among the team as to whether Grant would be better to stay in hospital a bit longer or go home. The physiotherapist and the occupational therapist both feel that Grant still requires intensive treatment which can only be provided as an inpatient. The psychologist and the social worker have noted that Grant’s separation from his family and home

ACTIVITY 2

Reading:

The “MND Australia Fact Sheet on Multidisciplinary Teams” outlines professional groups who could make up a multidisciplinary health care team for a patient with motor neurone disease (MND). Please read this fact sheet, answer the following questions, and upload your answers on your e-Portfolio on LEO. This forms part of your assessment for this unit.

1. Identify factors that determine which healthcare professionals are required to be involved in a health care team?

2. Who should lead the health care team? 3. Who is the most important member of the health care team?

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environment has been having a negative effect on Grant, Georgina and their children. The treating doctor feels that we could treat Grant as an outpatient but it would mean he has to attend regular physiotherapy and occupational therapy sessions. You are the team designated leader of the health care team. Discuss the following questions

1. What are the key issues in this dilemma? 2. What outcomes would be best for Grant and his family? 3. How would you guide the group in achieving this best outcome?

CASE STUDY 2

Norma Ellis is a 76 year old widow who recently had a fall at the nursing home she has lived in for the past 7 years and fractured her hip. She has subsequently had a hip replacement and has been rehabilitating well and is now due for discharge back to the nursing home. Norma has an extensive medical history including postural hypotension, rheumatoid arthritis and impaired mobility. She mobilised within the nursing home using a walker. Her son is demanding that his mother be kept in the ward as an inpatient as he feels the nursing home staff were negligent and wants his mother to be placed elsewhere but has not arranged this yet. The treating team consists of the doctor, physiotherapist, NUM of the rehabilitation unit, social worker and NUM of the Norma’s wing at the nursing home she was in prior to the fall. You are the designated team leader. The doctor feels there is no need to have Mrs Ellis on the ward as he feels that her rehabilitation has been maximised, this is an opinion shared by the physiotherapist. Norma wants to go back to the nursing home as she has made many friends there and feels at home there.

Discuss the following questions

1. What are the key issues in this dilemma? 2. How would you deal with Norma’s son? Are his objections warranted?

CASE STUDY 3

Robert Hughes is a 52 year old male who was injured in a bicycle accident two months ago where he suffered fractures to his (R) tibia/fibula and (R) radius. Robert is intellectually impaired and was living with his elderly mother until the accident. Robert has been known to engage in verbally aggressive outbursts towards staff and other patients. His mother who is now 75 years of age feels she can no longer look after Robert. You are the NUM of the rehabilitation unit that is admitting Robert for his ongoing rehabilitation. You are required to gather together a health care team to determine immediate and long term care options for Robert.

Discuss the following questions

1. What are the key issues in this situation? 2. Who would be included in the health care team and what role would they play?

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* e-Portfolio Assessment Re-cap

Your mandatory assessment requirements for module one include

1. Complete Activity 2 and upload your answers onto your e-Portfolio. 2. Choose one case study and upload your answers onto your e-Portfolio.

Please remember that this forms part of your assessment for this unit.

CASE STUDY 4

You are working in a health care team on a busy rehabilitation unit. Team meetings and patient reviews are conducted weekly. There has recently been a turnover of staff in the Physiotherapy department and a new representative from physiotherapy has joined the health care team. You notice although that this new member of the team members is often absent, fails to provide patient updates and when challenged on these issues is exceptional confrontational. This behaviour is not only impacting on the effectiveness of the health care team but also on patient outcomes. You are the designated team leader and need to find a resolution.

Discuss the following questions

1. What are the key issues in this situation? 2. What strategies would you employ to address this situation?

CASE STUDY 5

You are the NUM of a Mental Health Unit where case reviews are conducted every 4 weeks. You are the designated team leader and the team members include the medical officer, resident psychiatrist, patient case manager, social worker and employment officer. Several of the team members approach you after the meetings and voice concerns about how the meetings are being dominated by the medical staff. The general feeling was that the medical team dominated all clinical care decisions and most of them felt they did not have a voice at the team meetings. As the designated team leader you are responsible for ensuring equity exists in decisions about ongoing care.

Discuss the following questions

1. What are the key issues in this situation? 2. What strategies would you employ to address this situation?

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References: Module 2

Crisp, J. & Taylor, C. (Eds). (2009). Potter and Perry’s fundamentals of nursing, 3rd edn. Elsevier, Chatswood.

Berman, A., Snyder, S., Kozier, B., Erb, G., Levett-Jones, T. Dwyer, T….& Stanley, D. (2010). Kozier and Erb’s fundamentals of nursing, First Australian Edn. Pearson, Frenchs Forest.

Kalishman, S., Stoddard, H. & O’Sullivan, P. (2012). Don’t manage the conflict: transform it through collaboration. Medical Education, 46, 926-934.

http://ezproxy.acu.edu.au/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm &AN=2011685473&site=ehost-live

MND Australia (nd). Australia Fact Sheet on Multidisciplinary Teams

http://www.mndaust.asn.au/Get-informed/Information-resources/Living_better_for_longer/WEB- MND-Australia-Fact-Sheet-EB3-Multidisciplinary.aspx

Weller, J. (2012). Shedding new light on tribalism in health care. Medical Education, 46, 132-142.

http://ezproxy.acu.edu.au/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm &AN=2011421221&site=ehost-live

Image:

Medical team conversation retrieved from: http://www.gettyimages.com.au/detail/photo/hospital- staff-discussing-patient-charts-royalty-free-image/132265940