IPW In Stroke Care

This paper aims to discuss, using appropriate literature, the concept of inter-professional working (IPW) in light of a chosen scenario. I will provide a brief introduction whilst examining the issues, key players and challenges presented by the scenario by comparing, contrasting and evaluating my findings in order to make recommendations for future practice.
Øvretveit et al (1997) suggests IPW is a multifaceted collaboration of professionals from diverse disciplines working as one to achieve optimum care. According to Morgan (2009) the development of IPW was brought about by ever influencing needs of society whereby there has been a call for closer communication and collaboration between all healthcare professionals to share responsibility
for patient care. In light of high profile cases such as the Bristol Inquiry (DH, 2001b), Victoria Climbie Inquiry (DH, 2003) and recently Lord Laming’s report on Baby P (Telegraph, 2011) a convincing rationale for IPW is widely accepted by the NHS.
IPW has become a commanding force, which according to Leathard (2003) has been spear-headed by government objectives to improve working partnerships. Legislation promoting IPW such as Making a Difference (DH, 1999) suggests effective care is the product of IPW, testifying professionals who work collaboratively provide care to meet patient needs. This concept was further promoted with the publication of The NHS Plan (DH, 2000) aimed at creating a service designed around patient needs whilst The National Service Framework for Older People (DH, 2001) identified eight standards aiming to ensure older people are treated as individuals and receive optimum care to meet holistic needs, therefore promoting the importance of IPW for future practice. The government white paper Our health, Our Care, Our Say (DH 2006) further promotes IPW whereby health and social care professionals are encouraged to work together in partnership to meet patient needs. This shift in attitude towards healthcare is instrumental in shaping the way in which IPW is viewed today (Leathard, 2003).
The chosen scenario enabling a discussion on the importance of IPW can be seen in appendix 1. In relation to this scenario research by the RCN (2006) highlights effective IPW has the ability to improve stroke care; as each professional plays a vital role in the patients’ journey. The NHS Plan (DH, 2000a) uses this evidence to promote IPW and close working partnerships, however Leathard (2003) argues IPW may pose issues in itself.
Qualitative case studies by Baxter and Brumfit (2008) explore issues impacting on function, team relationships and communication. Saks (2000) proposes healthcare professionals face ongoing issues in establishing position and status, furthermore, a literature review by Larkin and Callaghan (2005) describe communication and decision making as fundamental issues for effective IPW, with Cook et al (2001) proposing decision making fails as consideration of the purpose, aims and context of IPW is not taken into account. Consequently, in relation to the scenario; communication, leadership and decision making are essential issues to be addressed to meet the physical, emotional and psychological needs of the patient. This can be achieved by promoting interprofessional learning through education which Morgan (2009) highlights is essentially being implemented in Universities today.
The scenario relates to a patient who has had a stroke, therefore for this assignment research has been based on the importance of IPW in stroke care. In 2007 the National Stroke Strategy (NSS), (DH, 2008) made recommendations for IPW in stroke care, aided by current guidelines and systematic reviews, as a result the Department of Health (DOH) commissioned an analysis of the evidence to identify areas needing further research (Wolfe, 2008). The findings highlighted, though the NSS endorsed IPW, optimal configuration of the IPW team was not specified, as a result the Intercollegiate Stroke Working Party (ICSWP, 2008) recommended an effective IPW team for stroke care should include a Physician, Nurse, Physiotherapist, Speech and Language Therapist, Occupational Therapist, Neuro-radiologist, Dietician, Clinical Psychologist, Pharmacist and Social Worker. I therefore propose the IPW team for the scenario should consist of the aforesaid players, however due to additional co-morbidities of diabetes and poor wound healing I shall also include the Diabetic Nurse and Tissue Viability Nurse.
Having established the key players we need to understand the challenges and benefits presented by IPW (Daly, 2009). Baxter and Brumfitt (2008) acknowledge challenges include professional differences, described by Beattie (1995) as tribalism, whereby ascribed and perceived occupational status, occupational knowledge and fear of perspectives of others impede IPW, which Fitzsimmons and White (1997) attribute to different training approaches. In addition, Larkin and Callaghan’s (2005) research on perception of professionals regarding IPW note professionals are clear about their individual roles however perceive their roles are not appreciated or understood by others; Norman and Peck (1999) reinforce this suggesting ambiguous roles have detrimental consequences for achieving effective IPW, which for the scenario, these findings have considerable implications. Thus clarity of role is essential in preventing confusion, tension and rivalry within the IPW team. I have therefore provided a definition of the key players in appendix 2 alongside the function in appendix 3.
In conjunction, Kalra and Walker (2009) indicate, political drivers directly impacting on IPW in stroke care.
The NSS (2008) highlights quality markers recommending early supported discharges (ESD) for stroke patients, this is supported by Walker (2007) who confirms rehabilitation of stroke patients has become a national priority, driven by evidence based research. Economic drivers in ESD highlight financial incentives for reducing hospital stay of stroke patients which according to the DH (2007b) is based on tariff periods whereby low tariff periods result in higher turnover of patients therefore financial savings for the trust. A speech by Andrew Lansley however, stating plans for the introduction of financial penalties if the patient is readmitted for emergency treatment within 30 days of discharge, present renewed pressure for the IPW team, as according to Daly (2004), it is not unusual for health care professionals to feel caught between government drives based on targets and patient care. As a result IPW teams may focus on meeting targets rather than the needs of the patient. However it can be argued it may encourage the IPW team to take a more patient focused care pathway perspective (Kalra & Walker, 2009). The results are yet to be
seen.
In contrast research indicates there are benefits of IPW, which according to Barr (2001) include having committed individuals who play a key role in team development. Wilcock and Headrick (2000) note IPW teams who share information improve quality of care, Morgan (2009) supports this stating perceived improvements include a comprehensive approach to care whilst creating realistic goals. Barr (2001) also points out interprofessional working enables professional benefits, with opportunities for the IPW team to experience areas of work outside thier own remit whilst experiencing levels of improved job satisfaction and increased levels of confidence in dealing with difficult situations. Importantly for the patient in the scenario who is suffering from right hemiplegia and low mood, research by Farris et al (2004) note patients receiving care provided by an effective IPW team see a greater improvement in physical and mental health than those who do not.
Once establishing these challenges and benefits we are able to ascertain areas whereby IPW management is not effective, this would have a significant impact on the duty of care to provide holistic and quality care in regards to the scenario (RCN, 2006).
Therefore managing change as noted by Lancaster (1998) is core for today’s nursing managers. Thomas, et al (2009) notes this can be addressed by implementing change theory which was theorised by Lewin as a three stage model, known as the unfreezing-change-refreeze model (Lancaster, 1998), which according to Thomas, et al (2009) is unfreezing the current state ineffective state and moving on to a new state, which Shein (1999) describes as refreezing. However in order to implement the change management must ensure the IPW team is willing to participate change which Molyneaux (2001) describes as central to effective IPW, for this to happen, Russel and Hymans (1995) propose there must be a recognition that no one discipline can meet optimum
care.
The next stage is identifying the change needing to be made to promote efficacy of the IPW whilst enabling the provision of a service to the patient (Kritsonis, 2005). In the case of the scenario this would include suggesting a multidisciplinary team meeting of all professionals involved in the care of the patient in the scenario, along with the patient and his wife, taking into consideration; rehabilitation needs to ensure safety of movement, nutritional needs to ensure sufficient nutritional intake whilst enabling better management of his diabetes, physical needs to enable promotion of independent daily living activities, social needs including gardening and possibly outings to the pub to improve low mood which has already been seen to improve with an efficient IPW team. Finally respite care or a home package of care to meet the needs of the patient whilst also minimizing the anxieties expressed by his wife concerning her ability to cope must be taken into consideration.
Implementing change to address these needs holistically would include communication, it is the backbone of effective change, as Lancaster (1998) explains, everyone must be kept informed, therefore to ensure efficacy of the IPW weekly multidisciplinary meetings for all members should be a requirement, as according to Ruhstaller (2006) one resulting decision from a multidisciplinary team is more accurate and effective than the sum of all individual opinions.
In Conclusion, from the research explored throughout this discussion it was evidential how important IPW is in providing holistic care. It is clear IPW may face many barriers along the way, and forever changing political drivers will make IPW challenging; however by having the ability to think beyond their own individual roles and incorporate a sense of role blending IPW has the opportunity to be effective throughout the NHS. This is paramount as healthcare becomes more integrated with social care and moving out of hospitals into the community and the wider area.