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Foundations of Learning and Collaborative Working Essay

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“Discuss the concept of collaborative working within your professional area” To be able to understand the rationale, the different factors influencing the outcome of collaborative working and how this can be applied to Perioperative practice, it is important to have a sound understanding of the concept “Collaborative Working.” This concept has many terminological variations, one of the more frequently used is “Inter-professional working.” Hornby and Atkins (2000) state that collaborative working is “a relationship between two or more people, groups or organisations, working together to define and achieve a common purpose.

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” Barrett et al (2005) declares that inter-professional working is “the process whereby members of different professions and/or agencies work together to provide integrated health and/or social care for the benefit of service users.” Disregarding what is seen as the correct/incorrect terminology, the common denominator here is that all health care staff/ agencies’ are working together to provide the best healthcare possible for patients and service users.

There have been many debates about the variation in terminology, Leathard (1994:5) refers to it as “terminological quagmire” that has been created due to rapid developments in practice, and in her analysis of terms, Leathard (1994:6) prefers to use the term multi-professional as it “infers a wider group of professionals.” In this instance the term “Collaborative working” will be used. Over the years there have been many drivers behind the rationale for collaborative working dating as far back as the 1960’s in the USA, where Henderson (1966) reports that “one hospital has weekly inter-professional ward conferences.” The idea of collaborative working is therefore not a relatively new concept. In recent years increased emphasis has been placed on collaborative working and the need to work together due to changes in technology, accountability and government reports. Technological advances such as telecommunication is now used by surgical staff to live feed surgical procedures to other parts of the world. This has aided remote-area surgeons in their own practices (Shields & Werder 2002)

Similarly, the introduction of the National Health Service (NHS) direct advice line has created a way in which doctors can consult patients over the telephone. However a study by the Economic and Social Research Council (2005) concluded that “telemedicine is disappearing” compared to NHS direct advice line. The introduction to new machinery which takes blood pressures automatically rather than manually, this and other technological advances have all required healthcare staff to change the ways in which they work collaboratively. On the other hand, Government reports also change the way in which healthcare professionals work as they are often mandatory measures. The NHS Knowledge and Skills Framework (KSF) was introduced in 1999 under the Agenda for Change. Day (2006) claims that the use of KSF will “enable team leaders to identify gaps in the knowledge and skills of their inter-professional teams.”

KSF is an essential requirement carried out every year to ensure pay progressions. Collaborative working is also brought about by accountability. All healthcare professionals are governed by a professional body such as the Health Professions Council (HPC) in which it is their duty to ensure compliance with the legislation on the use of protected titles (HPC, 2008) Not only are registrants accountable to the HPC they are also accountable to statutory and criminal law which means healthcare professionals must interact with patients and staff on an acceptable level at the risk of being prosecuted for their actions. Another driver for collaborative working is seen through the ever scrutinizing media. A recent news report by Hughes (2011) titled “Emergency surgery patients’ lives at risk, say surgeons” is one of the many examples of negative media that is putting more pressure on healthcare professionals to work more collaboratively. On the other hand, many of the public viewers do not see the bias in the majority of these news reports and many examples of good collaboration is missed.

Resulting from the rationale behind why people work together it is important to understand the ways in which people do work together. Safe Surgery Saves Lives was an initiative that arose in 2006 by the World Health Organization and in 2008 a Surgical Safety Checklist was released globally. Research proved that “postoperative complication rates fell by 36% on average” and the checklist has also “improved communication among the surgical teams.” (Haynes, B.A et al, 2009, Pg: 496) Many trusts also have a theatre list policy and this ensures that staff are working collaboratively to ensure the lists are correct, accurate and the most important procedures have been prioritised. The idea differentiates among the trusts, but is most commonly referred to as a “Group hug.” This is carried out each morning before any surgical procedures commence and it is a chance for staff to collaborate and share any ideas or concerns over that day’s list.

A big part of collaborative work, especially in peri-operative care, is about recognising each other’s skills and importance thus the idea of “inter-professional learning.” Kenward & Kenward (2011, pg; 35-39) outlines the importance of mentors, stating that “mentors should act as role models for students of all professions.” Further promoting this the General Medical Council (2006) document on Good Medical Practice propounds that doctors also act as role models to try and “inspire and motivate others.” It is evident that there are many ways in which healthcare staff work together, however major issues are still identified around the factors that influence the outcomes of collaborative working. Miscommunication has been identified as a reoccurring problem. Certain behavioral patterns among peri-operative staff which included ignoring requests they did not understand, failing to seek clarification, failing to speak loudly enough to be heard and communicating information to the wrong person. (Gardezi et al 2009, pg: 1390-1399)

This can be fatal especially in the case of Elaine Bromiley who had undergone a routine sinus surgical procedure. Due to a breakdown in communication between surgeons, Elaine unfortunately died. A video titled “Just a routine operation,” (LaerdalMedical, 2011) released after the death of Elaine Bromiley, identifies the breakdown in communication between the surgeons and the theatre nurses who had actually witnessed the surgeon’s distress and suggested an alternative method to intubating the patient which was ignored. This concept has been previously recognised as “professional separatism.” D’Amour et al (2005) argued that because professional groups are educated separately they are then socialised into “discipline-specific thinking.”

Research concluded that 69% of respondents to a questionnaire they set out reported disagreement between surgeons and nurses. And that 53.4% reported experiencing aggressive behavior from consultant surgeons (Coe and Gould, 2008, Pg: 609-618) Thus meaning the outcomes of collaboration will suffer if all professionals do not interact and recognize the importance of other professionals’ skills. It is evident that collaboration and inter-professional working largely exists but with the constant changes in peri-operative practice as mentioned previously and the way healthcare is constantly observed, especially by the media, it is evident that collaborative working is a continuous development or a lifelong learning process. As technology changes and government policies are continually released it is inevitable that the ways in which healthcare professionals work together will also change and develop.

References

Barret, G, Sellman, D and Thomas. J (2005) Inter-professional working in Health and Social Care: Professional Perspectives. Basingstoke: Palgrave Macmillan. Coe, R and Gould, D (2008) ‘Disagreement and aggression in the operating theatre.’ Journal of Advanced Nursing. Volume: 61, Issue: 6, Pg: 609-618. Day, J (2006) Inter-professional working: An essential guide for health-and social-care professionals. Cheltenham: Nelson Thornes. D’Amour, D, Ferrada-Videla, M, San Martin Rodrigues, L and Beaulieu, M (2005) ‘The conceptual basis for inter-professional Collaboration: Core concepts and theoretical frameworks.’ Journal of Inter-professional Care. Supplement: 1, Pg: 116-131. Economic and Social Research Council (2005) Telemedicine revolution is ‘disappearing’ from the NHS. [Online] Available at: www.esrc.societytoday.ac.uk. (Accessed: 8 October 2011) Gardezi, F, Lingard, L, Espin, S, Whyte, S, Orser, B and Baker, G.R (2009) ‘Silence, power and communication in the operating room.’ Journal of Advanced Nursing. Volume: 65, Issue: 7, Pg: 1390-1399. General Medical Council (2006) ‘Good Medical Practice guidelines: working in teams.’ [Online] Available at: http://www.gmc-uk.org/guidance/good_medical_practice/working_with_colleagues_working_in_teams.asp (Accessed: 9 October 2011) Haynes, B.A, Weiser, G.T, Berry, R.W, Lipsitz, Sc.D et al (2009) ‘A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population.’ The New England Journal of Medicine. Volume: 360, Issue: 5, Pg: 496. Health Professions Council (2008-09) Continuing professional development annual report. [Online] Available at: http://www.hpc-uk.org/publications/reports/ (Accessed: 8 October 2011)

Henderson, V (1966) The nature of Nursing: A definition and its implications for practice, research and education. New York. Macmillan. Hornby, S and Atkins, J (2000) Collaborative Care: Inter-professional, interagency and interpersonal. Oxford: Blackwell. Hughes, D (2011) ‘Emergency Surgery patients’ lives at risk, say surgeons.’ BBC news. [Online] Available at: http://www.bbc.co.uk/news/health-15098114 (Accessed: 8 October 2011) Kenward, L and Kenward, L (2011) ‘Promoting Inter-professional Care in the Perioperative environment.’ Nursing Standard. Volume: 25, Issue: 41, Pg: 35-39. Proquest [Online] Available at: http://proquest.umi.com/ (Accessed: 9 October 2011) Laerdal Medical (2011) ‘Just a Routine Operation’ [Online] Available at: http://www.youtube.com/watch?v=JzlvgtPlof4 (Accessed: 9 October 2011) Leathard, A (1994) Going Inter-professional: Working Together for Health and Welfare. London: Routledge. Shields, L and Werder, H (2002) Perioperative Nursing. Cambridge University Press.

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