How does an Interprofessional approach enhance patient care?
This essay will explore the Interprofessional working relationship between two healthcare professionals working on a urology ward. An Interprofessional approach is the relationship between two or more professionals working together, combining their skills and knowledge to enhance the package of care given to the patient or client. (Barrett et al 2005)
The case in question involves a staff nurse and a dietitian, it will look at their roles, the bodies that govern their professions and the competencies and standards that they have to adhere to. It will determine whether they followed the standards set out in their codes of conduct and consequently whether the package of care given to the patient was enhanced by the cooperation and collaboration demonstrated.
The role of the staff nurse is the promotion and maintenance of health, the prevention of ill health and to provide care during illness, rehabilitation and dying. (Hinchcliffe et al 2003). Nurses have to be registered with the Nursing and Midwifery Council (NMC) and they have to follow the NMC code of professional conduct, performance and ethics (2004).
Dietitians identify problems with nutrition, assess the nutritional status of patients, develop care plans and monitor the effectiveness of dietary changes. The title Dietitian is protected by the Health professions Council (HPC) and they have to comply with the HPC Standards of Conduct, performance and Ethics (2003) and the standards of proficiency: dietitians (2003). A dietitian is one of the thirteen protected titles governed by the HPC. (The British Dietetic Association 2006)
In accordance with the NMC code of Conduct (2004) and to protect the innocent, the names of the patient, staff and the hospital trust will remain anonymous. For the purpose of this essay the patient will be known as John.
John was admitted to the ward for a procedure called a transurethral resection of the prostate (TURP) this is to reduce the size of an enlarged prostate. (Shannon, 2000) In the staff nurse’s initial assessment she established that John had lost a significant amount of weight since the recent death of his wife. As part of the hospital trusts’ risk assessment policy she discovered that his nutritional score was eleven, (see appendix 1) which put him at high risk. John also had a grade three pressure sore on his sacrum, from a previous hospital admission. The staff nurse documented that John’s skin was to be examined once a day and he was to have a pressure reducing mattress. The nurse explained to John that she was referring him to a dietitian for further nutritional assessments and advice, this follows Department of Health guidelines set out in a paper called The NHS Plan (2000, p.4) which stated "The NHS will shape its services around the needs and preferences of individual patients, their families and their carers."
The dietitian visited John on the ward the next afternoon, during the assessment the dietitian screened John and found that he was at risk of developing malnutrition. The Concise Medical Dictionary (1992) defines malnutrition as a condition caused by an imbalance between what an individual eats and what is needed to maintain health. The dietitian also took into consideration the pressure sore John had on his sacrum as this would increase body metabolism, which, if left untreated could result in further weight loss. (DeSanti 2000) After identifying John’s dietary likes and dislikes the dietitian prescribed fortified sip feeds, these are nutritionally complete drinks given under medical supervision to help patients who cannot benefit from a normal diet (Nutricia Clinical 2006)
The dietitian and the staff nurse discussed John’s condition and they agreed to keep a full and strict food diary of everything John ate and drank (see appendix 2), the dietitian also asked for John to be weighed daily and measurements of his mid upper arm circumference were to be taken twice a week and documented.
Throughout John’s hospital stay the nurse and the dietitian continued to co-operate effectively to aid his recovery. They both adhered to their respective codes of conduct, by doing this they minimised any risk to the patient, they demonstrated integrity and professionalism, showed respect for the autonomy, dignity and privacy of the patient and always gained his consent before any care or treatment was delivered. They illustrated a duty of care and acted in the best interest of the patient at all times.
John and his family were also successfully involved in his plan of care, thus following the government guidelines highlighted in the Making a Difference paper in which they stated, "Collaboration and partnership needs to extend to patients, their families and carers."(DoH 1999, p.71) Encouraging John to be actively involved in his care plan and allowing him to make decisions enabled him to feel in control and assured him that he was receiving optimum care and treatment. The staff nurse also adhered to The NMC Guidelines for Records and Record Keeping (2005) by accurately documenting all treatment and care given to the patient.
The successful collaboration between the staff nurse and the dietitian enhanced the package of care delivered to the patient. A mutual respect for each others professions was clearly apparent as they successfully crossed their traditional boundaries, working closely together, sharing knowledge and skills and learning from each other in order to aid the recovery of the patient. As a student nurse on my first clinical placement this was an outstanding example of Interprofessional working in which I have learnt that communication and collaboration is the key to successful and seamless delivery of care, I have gained knowledge about other professionals’ and their involvement in caring for patients.
In conclusion, this essay has looked at the Interprofessional working relationship between a staff nurse and a dietitian. It showed that they both followed their respective codes of conduct and standards of proficiency. It has demonstrated that by working together, sharing their knowledge and combining their individual specialities the package of care delivered to the patient was greatly improved. As a result the preparation and consequent recovery from the operation and the gradual healing of the pressure sore was a complete success, thus agreeing with the statement in the DoH Making a Difference paper (1999, p.70)
"Effective care and treatment is the product of team effort."
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