Enhancing Patient Care Through Collaborative Working

The National Center for Biotechnology Information bookshelf (NCIB) defines 'Collaborative Working' in various ways. In the healthcare field, it pertains to the cooperation of health care professionals who have complementary roles. They actively collaborate and share responsibility in problem-solving and decision-making for patient care plans. This collaboration increases awareness among physicians, nurses, and other healthcare professionals regarding each other's expertise, ultimately enhancing the quality of decision-making.

For successful collaboration, it is vital that all team members are willing to participate and trust their fellow healthcare professionals.

This trust and willingness are crucial for achieving a shared goal, which is the wellbeing of the patient (Thomas et al, 2005). Fostering interpersonal collaboration and facilitating effective teamwork relies on these fundamental aspects of willingness and trust. Professionals must have faith in each other, be open to learning new skills, and embrace new responsibilities without holding onto negative emotions. All of this requires an attitude characterized by both willingness and trust.

In order to ensure optimal patient care, healthcare professionals must collaborate and work together.

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This necessitates mutual respect among team members to prevent conflicts that could negatively impact patients. According to Thomas et al (2005), confidence is crucial for successful collaboration as it enables professionals to adapt and work together without envy or intimidation. Moreover, confidence fosters leadership skills and builds trust within the team, establishing a supportive and reliable environment for effective collaboration.

According to Thomas et al. (2005), the terms interprofessional, multiprofessional, and interdisciplinary all describe collaborative work in healthcare. The prefix 'multi' signifies the participation of staff from various professions, while 'inter' implies cooperation in decision-making.

This indicates that consultants, nurses, social workers, and community staff collaborate in order to deliver excellent care and attain optimal patient outcomes.

Having diverse colleagues with different skills and knowledge from various backgrounds benefits the team. This diversity enables them to provide excellent service and fulfill their responsibilities to patients by having specialists from different areas collaborate. Collaborative working involves interaction between different groups or professions to achieve a shared goal, such as patient care in healthcare. This problem-solving approach, along with an open and flexible attitude towards individual roles and tasks, results in a more patient-focused healthcare experience.

The purpose of this essay is to determine the necessary skills and knowledge for successful collaborative work. I will illustrate this through a care pathway, which involves the care provided to a patient by various services that I was involved in.

Working with people is a necessary aspect of the healthcare profession. As stated by Goodman & Clemow (2010), regardless of whether you work in a community or hospital setting, interactions with individuals are constant in order to evaluate and provide care. Nursing, according to Goodman and Clemow (2010), mainly involves working with people, whether through one-on-one patient care or team-based care.

The idea of a care pathway is to propose the most suitable care needed to meet the patient's needs. Middleton & Roberts (2000) explain that care pathways are evidence-based care given to the patient by the appropriate person at the right time and in the correct setting. They also mention that integrated care pathways are used to establish interdisciplinary practice based on guidelines for specific patients. According to the Royal College of Nursing (RCN) 2014, care pathways are also known as integrated care pathways, expected recovery maps, critical pathways, or care maps.

Effective communication is crucial in healthcare, as it ensures that patients receive appropriate care according to their needs (Royal College of Nursing (RCN) 2014). Communication is also important in various aspects of society, including learning, work, and leisure. However, in healthcare, good communication becomes even more essential due to patient vulnerability and anxiety. It plays a significant role in ensuring safe, coordinated, and effective delivery of healthcare services among teams. On the other hand, a lack of communication among team members can lead to conflict and friction that hinder optimal patient care.

The Royal College of Nursing (RCN) emphasizes the significance of effective communication within teams for achieving clear and holistic goals. In 2014, they stated that this communication can be verbal or non-verbal and highlights the importance of listening. The RCN also stresses that failure to communicate properly among healthcare professionals can negatively impact patient well-being and lead to errors.

Communication issues can arise when different professions use unfamiliar terminology. To prevent confusion and reduce the risk of mistakes, it is crucial to share communication in a manner understandable by all team members. This may involve using language lines, interpreters, or professionals proficient in the required languages.

In order to adhere to the NHS Code of Practice on Confidentiality (2003), I will protect my patient's identity throughout this essay by using a pseudonym, Mr A.

The Tuberculosis (TB) Services provide convenient access to healthcare professionals in both community and hospital settings. Their important role is to raise awareness about TB and ensure prompt referrals for investigations, diagnosis, treatment, and support in controlling the spread of the disease. Patients can access the TB service through various routes such as GP surgeries, accident and emergency departments, laboratory microbiology facilities, hospital wards, and other specialties including HIV (Gum clinic), rheumatology, and pediatrics. The TB services have a designated referral number, fax, email address, and contact address. The care pathway for patients with TB symptoms involves several investigations including a Mantoux Skin test where Purified Protein Derivative (PPD) is injected into the arm with results read 48/72 hours later. Additional tests may include a chest x-ray, sputum samples or bronchoscopy.

Once the investigations are completed and active tuberculosis (TB) is confirmed, treatment will begin, lasting from six months to two years depending on the type of TB. As a Support worker for the TB team, my role involves helping patients understand and accept their diagnosis. I also ensure that they receive the correct medication from nurses and monitor any potential side effects. If any side effects occur, I promptly inform specialist nurses who provide further guidance or consult senior consultants to develop an appropriate care plan.

In addition to medical assistance, I am responsible for assisting patients with welfare and social issues such as housing, immigration matters, and social benefits. As a patient advocate, I establish a strong rapport to facilitate open and honest communication while connecting them with necessary services. This approach ultimately contributes to our shared objective.

The following text describes a patient scenario:

Mr A arrived at the accident and emergency department displaying common signs of tuberculosis (TB) including chest pains, lethargy, weight loss, coughing, and night sweats. An x-ray of his chest showed fluid accumulation in the left pleural cavity, indicating pleural effusion. The sputum sample he gave tested positive for TB bacteria, confirming his contagious state. Furthermore, his Mantoux test displayed an 18mm induration which further bolstered the diagnosis of smear positive pulmonary tuberculosis.

Mr A, a Romanian national, arrived in the UK in 2009 and initially lived in a shared house with other Romanians for three months. However, they were later evicted by the police on suspicion of squatting, leaving Mr A without a home. Since then, he has been living on the streets without a fixed address and lacking strong connections in the UK. Additionally, Mr A faces challenges such as limited communication options, financial resources, and a limited understanding of the English language.

Mr A was referred to the TB Service by the consultant on the respiratory ward. A Romanian interpreter was needed because Mr A had limited English language skills. I contacted the hospital interpreting service to schedule a Romanian interpreter for the assessment. The TB assessment took place on the ward with the presence of the Romanian interpreter. The TB assessment form was completed using Roper et al (2000) Activities of Daily Living, which considers various aspects such as social, physical, psychological, and medical concerns that are related to the patient's needs. According to Roper et al (2000), this model provides a comprehensive understanding of an individual beyond their illness and also recognizes how cultural, environmental, and economic factors can impact one's health and well-being (Barrett et al, 2012).

I was contacted by the Infection control nurses before our assessment on the ward. They informed us about the patient's sputum results, which showed that the patient was infectious due to smear positivity. As a result, the patient was moved to a negative pressure side room, which is used to prevent the spread of TB. The National TB Centre defines a negative pressure room as a room where more air is pulled out than is supplied, ensuring that infectious particles are contained inside the room. A continuous air current is pulled into the room under the door, preventing airborne particles generated inside the room from escaping into the corridor.

During the assessment, I discovered that Mr A was without any income and experiencing homelessness. As a Support Worker, it is my responsibility to assist patients with welfare and housing matters. To seek guidance on Mr A's situation, I made a phone call to the hospital social services and had an extensive discussion with the advisor. We agreed that reaching out to Greenwich Social Services for additional advice was necessary. Greenwich Social Services informed me that Mr A didn't have access to public funds upon entering the UK, thus rendering him ineligible for assistance.

I communicated with my colleagues at Find and Treat regarding Mr A's situation. They informed me that Mr A may qualify for accommodation and sent me a referral form to complete with my patient. Find and Treat is a Department of Health Organization affiliated with Public Health England. Their mission is to offer comprehensive, preventive, and stabilizing assistance to homeless individuals undergoing TB treatment who do not have access to public funds. I sent the completed referral form back to Find and Treat via fax.

I received a phone call from Find and Treat notifying me that the referral had been approved at the homeless shelter. The next stage is an interview with the shelter's manager and assigned case worker to determine if the patient's needs will be met during their stay. In my presence, the case worker, manager, and interpreter assessed the patient on the ward based on the information and facts we provided.

After the meeting, I communicated with the discharge coordinator on the ward to let them know that Mr A had been accepted at the shelter home. Before he was discharged from the ward, the TB nurse examined his TB medication and arranged transportation for him to go to the arranged accommodation, which happened on the same day. The next day, I phoned his case worker to inquire about Mr A's progress and adjustment at the new place. According to the report, he was settling in nicely and had no issues.

Before his admission to the ward, Mr A had been going to a homeless unit for food and shelter. Because his sputum results showed positivity for tuberculosis (TB), it is required to notify Public Health England (PHE) of all smear positive index cases. It is my responsibility to gather as much information as I can about the homeless unit. I filled out an incident reporting form with all the details from the shelter unit and sent it to PHE via fax. To coordinate an incident meeting involving the shelter home, PHE, and the TB nurses, I had a phone conversation with PHE. Once a date was agreed upon by all parties, we met at the shelter home to identify contacts and organize screening. We agreed that anyone who needed to be screened for TB would be referred to the TB Service.

According to Elizabeth Lark (2006), collaborative working may not always go smoothly. Some team members may feel excluded or unappreciated. Lark emphasizes the importance of focusing on two aspects of collaboration. First, there is the task at hand, such as the patient outcome. Second, there is the relationship among the individuals involved. It is important for all team members to feel valued and appreciated in order for collaboration to be successful.

Another potential problem in collaboration is personality conflicts, a lack of understanding of other professionals' roles, and the impact of hierarchy within multidisciplinary teams. Lark suggests that these conflicts can be resolved by allowing team members to discuss their concerns in group meetings and clarifying their roles before implementing patient care.

As a Support Worker, collaborating and working as a team is crucial in providing the necessary care for patients to help them return to their normal, healthy lifestyle. Regardless of the patient's background or beliefs, it is important for us to set standards and maintain professionalism. My role as a Support Worker involves advocating for patients and connecting them with other services, which has contributed to the recovery of our patients, particularly those who may not fully comprehend the TB diagnosis and the associated stigma. Accessing these services has allowed me to assist Mr A in his journey to recovery, enabling him to regain a normal life and receive support in finding employment. Without my assistance as the main link, it would have been challenging for Mr A, who lacks English language skills, to independently access these services and receive the appropriate care.

Mr A expressed his gratitude for the care from various services, stating through an interpreter that he would have been lost without their help. The care spanned three months while he stayed in the hospital for four months. During his hospitalization, I ensured that all hospital resources were well-coordinated to provide the best possible service and facilitate Mr A's return to a normal and healthy lifestyle. My role as a Support Worker in this collaborative effort aided other healthcare professionals, including ward staff, infection control nurses, and hospital social services, in gaining a better understanding of TB and working together to overcome obstacles in delivering appropriate care. Through identifying the patient's needs, nurses and other services were able to organize and plan interventions to meet his recovery requirements.

Collaborative working is clearly advantageous for patients. By working together, I have been able to enhance my knowledge and skills needed to collaborate with other healthcare providers and social services. Communication is crucial in collaborative working to achieve optimal outcomes for patients. All services and organizations must cooperate and set aside any differences, misunderstandings, and challenges for the sake of the patient's outcome. Collaborative working eliminates additional stress and concerns for patients who simply want to recover from their illness, as demonstrated in Mr. A's case.

References
Barrett D, Wilson B & Woodlands A, (2012) Care Planning A Guide for Nurses, Second Edition, Essex, Pearson Education limited.

The book Nursing and Collaborative Practice, written by Goodman B & Clemow R, was published in 2010 in Great Britain by MPG Books Group.

The book titled "Collaborative Advantages – How Organizations Win by Working Together" written by Lark E. is published by Palgrave Macmillan in Hampshire in 2006.

Middleton S & Roberts A (2000) - Integrated Care Pathways: a practical approach to implementation Oxford, Reed Education and Professional Publishing Ltd

The Roper Logan Tierney Model of Nursing Based on Activities of Living was developed by Roper, Logan, and Thierney in 2000 and is published by Churchill Livingstone in Edinburgh.

Thomas, J. Pollard, K. C., and Sellman, D. (2005). Interprofessional Working in Health and Social Care. New York: Palgrave Macmillian.

National Centre for Biotechnology Information Bookshelf http://www.ncbi.nlm.nih.gov/books/NBK2637/ - Professional Communication and Team Collaboration – Patient Safety and Quality Access on 25/09/14

The Royal College of Nursing's website at http://rcnhca.org.uk/communication provides resources called "First Steps for HCAs". The website was accessed on 15/10/14.

National TB Centre Accessed on 30/10/14

NHS Code of Practice, available at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/200146/Confidentiality_-_NHS_Code_of_Practice.pdf. Accessed on 08/11/14.

Royal College of Nursing http://www.rcn.org.uk/development/practice/perioperative_fasting/good_practice/service_improvement_tools/care_pathways Accessed on 15/11/14