There are many different ways to define ‘Collaborative Working’. According to The National Center for Biotechnology Information bookshelf (NCIB) Collaboration in health care is defined as health care professionals assuming complementary roles and co-operatively working together, sharing responsibility for problem-solving and making decisions to formulate and carry out plans for patient care. Collaboration between physicians, nurses, and other health care professionals increases a team member’s awareness of each other’s type of knowledge and skills, leading to continued improvement in decision-making.
To work collaboratively it is also important for all team members to be willing to take part and trust other health professionals to accomplish a collective outcome, which is the health and wellbeing of the patient. Thomas et al (2005) mentions that willingness is one step of developing interpersonal collaboration and trust has been seen as a vital part to assist the development of effective team working. All professionals need to trust each other and learn new competencies and be able to take on new roles without resentment, as this requires a willing and trusting approach.
Therefore, to give the patient the best possible care, it is imperative to work in conjunction with other healthcare professionals to meet the needs of the patient. Each professional has to show mutual respect for one another in order to be able to work together or else there will be conflict in the team and the outcome of the patient will suffer. Thomas et al (2005) continues to say that confidence has been pointed out as an important feature in collaborative working as professionals who are confident in their own roles have the ability to work flexibly into other boundaries without feeling jealous or threatened. Confidence shows leadership and allows others to trust the work of that individual, therefore creating a trusting environment for them all to work together.
The terms interprofessional, multiprofessional and interdisciplinary are all related to collaborative working, Thomas et al. (2005) defines the prefix ‘multi ‘ as the participation of staff from different professions, and the prefix ‘inter” means collaboration in the areas of decision making thus indicating that healthcare professionals, be it consultant, nurses, social workers or community staff work together to provide a high quality care and to achieve the best outcome for the patient.
With skills and knowledge coming from these colleagues that major in different backgrounds, overall the team can provide an excellent service and duty to patients due to having specialists from different areas working together in the same team. Collaborative working involves interaction of various groups or professions to accomplish a general goal, which normally in the health care setting is the care of the patient. As a result of problem solving, an open and flexible approach to the roles and tasks of individual team members provide a more patient focused healthcare.
The aim of this essay is to establish what skills and knowledge are required to work collaboratively successfully. I will describe a care pathway, which will look at the care a patient received from different services in which I participated.
In the health care service, working with people is a part of the working day. According to Goodman & Clemow (2010), working with other people is a fact of everyday life, whether you will be working the in community or in a hospital environment you will be constantly interacting with people to assess, plan implement and evaluate care provided. Goodman and Clemow (2010) go on to say Nursing work is primarily people work, be it one-to-one patient care or team care.
The principle of a care pathway is to recommend the most appropriate care required to meet the patient’s needs. According to Middleton & Roberts (2000) care pathways are evidence based care which is delivered to the patient by the correct individual at the specific time and the suitable environment. Middleton & Roberts (2000) continue to say that integrated care pathways are used to determine multidisciplinary practice based on guidelines for particular patients. According to the Royal College of nursing (RCN) 2014, care pathways are also known as integrated care pathways, anticipated recovery maps, critical pathways or care maps.
Communication is very important in the healthcare service to ensure that the patient will receive the correct care plan to meet their needs. According to the Royal College of Nursing (RCN) 2014, communication is at the heart of everything we do in our society. It’s central to our learning, our work and our leisure interests. It is vital in health care, where patients/clients can feel vulnerable, isolated and anxious, therefore teams need to rely on good communication to help them deliver safe, coordinated and effective healthcare. Without communication between certain individuals in the team, it can cause conflict or friction between some colleagues therefore delaying the goal of impeccable patient care.
Communication shared amongst teams can achieve a holistic goal that is clear and in which the outcomes are met amongst the team (RCN) 2014. Communication is not only verbal, it is also non-verbal and listening also plays a part. If health professionals are not working together then there is a failure of communication and errors will occur and the wellbeing of the patient will suffer. This may also happen when health professions used different terminologies within their profession, which others may not understand. This demonstrates the need for communication to be shared in a manner which all members can understand to avoid confusion and reduce the risk of mistakes happening, i.e. language line, interpreters and other professionals who understands the language.
Due to the importance of patient confidentiality I will be keeping the identity of my patient as anonymous and a pseudonym will be used for the purpose of the essay to protect the patient. This complies with the NHS Code of Practice on Confidentially (2003). Throughout this essay my patient will be referred to as Mr A.
The Tuberculosis (TB) Services must be accessible to all health care professions in the community or hospital. An important part of the role of the TB service is to promote awareness of TB and ensuring that all suspected cases of TB are promptly referred for investigations, diagnosis, treatment, support to control the spread of TB. The most common pathway by which patients can access the TB service includes referrals from GP surgeries, accident and emergency, laboratory microbiology, hospital wards and other hospital specialties such as HIV (Gum clinic), rheumatology and paediatrics. TB services have one designated referral number, fax, email address and contact address. The care pathway for patients who show signs and symptoms of TB will require a number of investigations, which will include a Mantoux Skin test, when a small amount of Purified Protein Derivative (PPD) is injected into the arm and the results will be read 48/72 hours later, a chest x-ray, sputum samples or a bronchoscopy.
Once these investigations have been completed and if the results are positive for active TB, the patient will be commenced on TB treatment. This treatment will be for a minimum six months to two years depending on the type of TB diagnosed. My role as the Support worker for the TB team is to assist patients, to help them understand and come to terms with their diagnosis. In addition to this I will ensure that they receive the correct medication as distributed by the nurses, monitor any side effects and bring them to the attention of the specialist nurses who will give further advice or discuss with the senior consultant who will be able to decide on an appropriate care plan if needed. I also support patients with any welfare and social matters such as housing, immigration and social benefits. My role involves acting as the advocacy for patients and links them with the required services. In order for this to work, I have to build a very good rapport with my patients, and I feel that this enables them to become open and honest with me, which results in us achieving our desired goal.
Mr A was admitted via accident and emergency complaining of chest pains, lethargy, loss of weight, cough and night sweats, the typical symptoms of TB. His chest x-ray showed left sided pleural effusion and sputum sample results were smear positive, indicating that he was infectious, His Mantoux result was 18mm and was diagnosed with smear positive pulmonary tuberculosis.
Mr A was born in Romania and entered the UK originally in 2009. He was house sharing with other Romanians for three months until they were evicted by the police as they were possibly squatting and he became homeless. He was of no fixed abode with no clear connections in the UK. He has been living on the streets ever since being evicted. He has no means of contact, no money and has very limited understanding of English.
Mr A was referred to the TB Service by the consultant on the respiratory ward. Due to his lack of English language, a Romanian interpreter needed to be booked to allow sufficient communication between staff and Mr A. I made a telephone call to the hospital interpreting service to book a Romanian interpreter to assist with the assessment. The TB assessment was carried out in the ward with the Romanian interpreter present. The TB assessment form was completed using Roper et al (2000) Activities of Daily Living. This assessment model looks at the patient’s needs as well as any possible problems connected with the patient i.e. social, physical, psychological and medical. According to Roper et al (2000) this model will give a holistic view of the individual instead of just the illness. This model recognises the impact of cultural, environment, and economic factors that affect both health and well-being (Barrett et al, 2012).
Prior to our assessment on the ward I received a telephone call from the Infection control nurses to inform us of his sputum results. The results of his test were smear positive and this indicated that the patient was infectious therefore he was placed in to a negative pressure side room. A negative pressure room is used to prevent the spread of TB. The National TB Centre describe a negative pressure room as a room where more air is drained than is supplied, so infectious particles are contained within the room by continuous air current being pulled into the room under the door. Therefore, when the negative pressure room is used airborne particles generated in the room cannot escape to the corridor.
During this assessment it was brought to my attention that Mr A had no income and was homeless. My role as the Support Worker is to help patients with any welfare and housing issues. I was able to make a telephone call to the hospital social services for advice on Mr A and had a long conversation with the advisor. We agreed that I needed to contact Greenwich Social Services for further advice. I was informed by Greenwich Social services that Mr A was not entitled to any public funds because of his no recourse to public funds on entry to the UK.
Due to Mr A’s situation, I spoke to my colleagues in Find and Treat who informed me that Mr A might be eligible for accommodation, and a referral form was faxed to me for completion with my patient. Find and Treat is a Department of Health Organisation within Public Health England that works alongside TB services to provide holistic, preventative and stabilising support to homeless people who are on TB treatment and have no recourse to public funds. The completed referral form was faxed back to Find and Treat.
I received a telephone call from Find and Treat to inform me that the referral had been accepted at the homeless shelter and the next step was an interview with the shelter home manger and his allocated case worker to meet the patient to ensure that all his needs were met whilst in their care. The case worker and the manager met the patient in the ward in my presence with the interpreter to complete their full assessment for placement in view of the referral information and facts we presented.
Once the meeting was complete, I had to liaison with the discharge coordinator on the ward to inform them that Mr A had been accepted at the shelter home. Prior to his discharge from the ward, the TB nurse checked his TB medication and I booked transport for my patient to get to the organised accommodation and he was taken on the same day. The following day I made a telephone call to his case worker asking about his (Mr A) progress and how he was settling in. He was reported to be settling in well and had no concerns.
Mr A had been visiting a homeless unit for food and shelter prior to this admission to the ward. Due to his smear positive sputum results; it is a requirement to refer all smear positive index cases to Public Health England (PHE) as TB is a notifiable disease. It is my duty to gather as much information as possible regarding the homeless unit. I completed an incident reporting form with all the information from the shelter unit and faxed it to PHE. I had a conversation with PHE by telephone to arrange an incident meeting between the shelter home, PHE and the TB nurses. Once a date was agreed with all parties we met at the shelter home to identify contacts and organise screening. It was agreed that all contacts who needed to be screened for TB were to be referred to the TB Service.
Collaborative working sometimes may not always work smoothly as expected. Some team members may feel left out or not appreciated, Elizabeth Lark (2006) says to work collaboratively you need to be focused on a two way related dimension. The task that needs to be achieved, in this case the outcome of the patient, and the relationship with and between the people that need to be engaged in it. Therefore it is clear to say that all team members need to feel appreciated and valued in collaboration to make it work professionally. Another factor that may cause problems in collaboration is personality conflict, a lack of understanding in other professionals’ sphere and the influence of hierarchy in job roles within the multidisciplinary teams. Elizabeth Lark (2006) continues to say that these types of conflicts can be resolved by giving team members the chance to discuss their concerns in group meetings to identify clear working responsibilities before implementing the care of the patient.
As a Support Worker collaborative working is very important to me to ensure that a service work as a team to give patients the required care they need
to enable them to be able to return to their normal healthy lifestyle. When caring for patients we need to set standards and be professional regardless of the patient’s background and belief. The importance of my role as a Support Worker in advocacy and linking patients with other service has lead to the recovery of our patients, as many of our patients do not understand the diagnosis and the stigma related to the TB diagnosis. Having access to all these services has made it possible for me to help Mr A on the road to recovery and enable him to live a normal life again where he will be helped and assisted with some form of work and earn a living. Due to his lack of the English language it would have been very difficult for him to access these services by himself as I was the main link for Mr A to receive the correct care.
Mr A was very happy with the care he received from all the different services, he said via the interpreter “I would not have known where to go to get help, I thank you all”. The care given to Mr A was delivered over a period of three months. He remained in hospital for 4 months, during this time I ensured that all of the hospital resources were coordinated to ensure that the highest level of service was delivered and that Mr A could return to living a normal healthy life style. My role as a Support worker in this collaborative working has helped other healthcare professionals such as ward staff, infection control nurses and hospital social services to gain better knowledge of TB and how working together to overcome obstacles to ensure that the patient can receive the correct care needed. We were able to identify the patient’s needs, which allowed the nurses and other services to coordinate and plan interventions to meet the patient’s requirements in regards to his recovery.
It is evident that collaborative working does have the best outcome for patient. Working collectively has enabled me to expand my knowledge and skills required to work along side other health providers and social services. Communication is the key skill required in collaborative working to ensure and accomplish the best outcome for your patients. All services and organisations need to work well together and leave their differences, misunderstanding and challenges aside for the sake of the patient’s outcome. Collaborative working takes away any additional stress and worry for patients who just want to overcome their illness and this was reflected in Mr A’s situation.
Barrett D, Wilson B & Woodlands A, (2012) Care Planning A Guide for Nurses, Second Edition, Essex, Pearson Education limited.
Goodman B & Clemow R, (2010) Nursing and Collaborative Practice, Great Britain, MPG Books Group
Lark E, (2006) Collaborative Advantages – How Organisation Win by Working Together, Hampshire, Palgrave Macmillan
Middleton S & Roberts A (2000) – Integrated Care Pathways : a practical approach to implementation Oxford, Reed Education and Professional Publishing Ltd
Roper N, Logan W & Thierney A J, (2000) The Roper Logan Tierney Model of Nursing Based on Activities of Living, Edinburgh, Churchill Livingstone.
Thomas,J Pollard K C and Sellman D, (2005) Interporessioanl 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
Royal College of Nursing
http://rcnhca.org.uk/communication – First Steps for HCAs
Accessed on 15/10/14
National TB Centre
https://www.ndhealth.gov/Disease/TB/Documents/Infection%20Control.pdf Accessed on 30/10/14
NHS Code of Practice
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