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Student no.: 09018509 Interprofessional Module 3

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Briefing Paper 1

This briefing paper is about the importance of professionals role differences in an

interprofessional team with the constraints they have in terms of time and other

responsibilities to provide quality care.

The demands of patients are steadily evolving and due to this the call for flexibility

and expectancy from professionals are increasing (DoH, 2010; Skills for Health,

2006). Professionals have to possess knowledge and ability to distinguish a

professional from another to be able to work in a team effectively (Baxter et al,

2008). Jefferey et al(2005) emphasises this idea by expressing his belief in sharing

knowledge and understandings between team members. Consequently, role

delegation will be more effective thus the care that will be provided will be efficient.

However, according to the research by Pethybridge (2004), there are times when

professionals are pressured into providing immediate care without any proper

consultation with the rest of the team. A study conducted by Davoli and Fine (2004)

shows that effective interprofessional working is also about where the professionals

see themselves. It can be as part of their profession or primarily as part of a team.

As well as this, organisational factors such as the frequency of team meetings and

the size of the team as one of the factors behind the provision of quality care (Pellatt,

2005). Equally, the exchange of knowledge and skills between professionals may

alleviate any role blurriness between team members (D Amour & Oandasan, 2005).

Alongside all the points that have been underlined above, the issue about power and

hierarchy still pose a problem. The medical role seemed to be closely linked to this

issue and decision-making (Hugman, 2003). This may be for the reason that of when

a patient gets admitted, they are automatically put under the care of the consultant.

But this has not always been the case with non-medical professionals reaching an

agreement between themselves that might influence the decision being made. This

is supported by Payne (2000) by stating that power is merely a perception not

certainty. This issue might be confused with leadership. Vroman and Kovachich

(2002) define a leader as the one responsible in facilitating processes, focusing the

team and structuring goals. It can be argued that a properly led team is better than

a hierarchy. This is supported by Entwistle & Watt (2006) by stating that the final

decision would be moulded by the whole team using their own knowledge and skills

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given that everything was based on the best interest of the patient and the patient

provided consent.

In conclusion, all the elements that have been identified above have to be taken into

consideration when structuring an interprofessional team. This will result to the

patient getting all their needed care at a high standard of quality. This might not

always seem to be the case however due to the said constraints in the beginning of

the paper. Further studies about achieving an effective interprofessional team are

still required. Although, getting all the features said above are vital to the success of

an interprofessional team and the services that they will provide.

Briefing Paper 2

In this briefing paper, I am going to further look at the importance of professionals

role differences in an interprofessional team with the constraints they have in terms

of costs and other responsibilities to provide quality care.

Professional practice involves complex clinical reasoning (Higgs & Jones, 2000) and

encompasses implicit knowledge (Rogers, 2004). These elements are underprofessional differences.

Professional role differences are about changing healthcare professionals traditional

roles in order to promote collaborative working. This is inevitable as policies and

legislations are constantly changing (Skills for Health, 2006). However, according to

Baxteret al(2008), there is lack of clarity as to how these changes can affect how

professionals work and provide care. They did a study about role differences in

healthcare. This study showed a variety of themes. Focusing more on the aim of this

paper, themes such as role substitution, professional identity within the team and

role boundaries came up. This shows that every professional is different in terms of

their perception of boundaries between professionals. These rooted boundaries may

have most likely been formed during the socialisation process of their training which

solidified their unique philosophical approaches supporting their profession

(Fitzsimmons & White, 1997; and Hall, 2005). These themes may make it difficult for

professionals to work effectively with the current changes the health service isundergoing giving professionals extra pressure to work more efficiently. A recent

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survey of the National Health Service executives showed that patient care is

suffering as a result of cost-cutting (Laurence, 2006). But with the right elements in

hand, it will make significant influence in staff functioning. With reference to Baxteret

als (2008) study, own professional knowledge and skills and also professional role

and identity may affect how successful an interprofessional team can be. Drawing

from my own experience, a lot of nurses have extended roles which therefore made

them relatively useful in an interprofessional team; but this has its disadvantages

such as not being able to provide all of your responsibilities with regards to patient

care within the set time frame the team has agreed upon. Again, this will have an

impact on costs.

Another aspect of professional differences is power and status. Payne (2000)

defines power as an awareness not reality. This is most apparent in an acute setting

when a patient is under the care of the consultant which automatically gives the

medics the decision-making power. Loxley (1997) applied several theories of joint

working into this and it proved to be quite difficult to identify any benefits from the

abrasion of the status and power of medical professionals. A study carried out by

Cook et al(2001) about decision-making in secondary care. This study showed that

nurses are developing in primary care in terms of what they do and how they caninfluence decisions being made about their patients. This indicates that the issue of

power and status in primary care is less evident. However, this study also showed

that although General Practitioners (GP) appreciate the improved contribution from

nurses and other professionals, some GPs had difficulties accepting the power

redistribution between the team. Due to this, tensions arose between team

members. But, provided that teams are able to overcome barriers with regards to

power and status, it proved that they can focus on identifying patient needs and

structure a patient-centred care. In association with the constraints put on

professionals, trying to sway decisions about patient care can be quite difficult

especially to professionals reluctant to grip the idea of joint working. Consequently,

patient may receive care that they do not necessarily need or they might not even

receive care that they actually need. It may also be that they are receiving all the

care that they require but not in the standard that the government expects.

In conclusion, the subject of role differences is an area that needs to be furtherstudied as, basing it from this paper, will have a significant impact on the

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effectiveness of an interprofessional team. During this process, issues may arise that

needs addressing as well. Barriers that have been identified throughout this paper

has to be taken into consideration to improve joint working and to be able to achieve

outcomes set within the team whilst ensuring that the services being and will be

provided is in high quality. This, however, does not warrant complete success

because, as stated above, cutting costs within the health service is the main problem

at present. Thus may hinder any process on going or any outstanding research to

carry out to better collaborative working.

Main Critique: Hannah

This briefing paper provided sound knowledge regarding the decision-making

process of a team and how hierarchy and shared power affect interprofessional

teams. Its aims were clearly stated at the beginning of the paper which helps readers

to foresee what the paper is about. It was clearly structured in terms of introducing

facts into the paper. For example, when talking about decision making, it firstly

defined what it is and then went into its implications to practice while reflecting it into

personal experience. This was very helpful as readers may able to create their ownpicture of the chosen subject. Ethical implications and confidentiality were

considered as no patient name was mentioned. Although, there was not an account

of this but expected due to the limited word count. After this, the author went into

explaining another point. This shows that the author considered the flow of topics

within the paper. However, the topics that were discussed in this essay do not

particularly answer the trigger question proposed. The author did not associate

chosen areas of interprofessional working to the economic constraints professionals

are experiencing. The author could have linked how the pressure of making

decisions fast to be able to discharge patients faster; or how sharing power between

professionals in a team can help alleviate constrictions put on them.

The author showed skills of analysis throughout this paper. For example, when

talking about shared power, the author talked about its advantages and

disadvantages and then discussed factors that can hinder its process. Afterwards,

the author proposed ideas that can overcome the barriers identified. The presence of

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analysis showed that the author was unbiased and tried to look at all perspectives of

an area to be able to provide readers thoughts into the subject.

The author did not state whether there are any further research needed or if there

are any gaps in literature that can help professionals to gain better knowledge in

effective team working considering the barriers that have been highlighted. If this

was provided, it may make readers look if there are any available researches

present to be able to expand their understanding about this subject. Although, a

discussion of the findings value in practice is present in the paper.

The author provided a reference list with accurate Harvard Referencing. The author

also used a range of resources. However, more references and more recent

resources could have been used to explore areas which may help with discussion

and further analysis to provide readers better quality information. For example, the

subject of transferring information between professionals in a big time was touched

upon. The author could have looked further into this in terms of how professionals

can overcome it and then, linking it to the economic constraints. This will then

answer the trigger question. All the sections in this paper are consistently relevant to

the topic of the paper.

Overall, this paper provided good amount and quality information; and analysis to

give its readers an adequate insight of problems and potential ways to effectively

work as a team. It was definitely worth a read.

Team contract contribution:

As agreed during our initial meeting with the rest of the group, the points that have

been made to structure this contract were all reasonable and valid. However, I

suggest adding another point and this is: getting constant support from other team

members.

Highlighting Cheryl's post regarding leadership and its importance, being able to see

the difference between having a leader and the start of a hierarchy is important. This

is because having a two-way exchange of information (effective collaborative

working) rather than a top-down exchange of information (hierarchy) is moreeffective in interprofessional working (Fagin & Garelick, 2004; Warelow, 1996).

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According to the research conducted by Rice et al(2010) medical hierarchies can

have a significant impact on the effectiveness of interprofessional working in terms of

the quality of care given to patients.

Going by this, it will be beneficial for the whole team team to get support from others

regardless of the amount of engagement they will do in a particular issue. This will

lead to less pressure and increased productiveness from all team members (Rice et

al, 2010).

I acknowledge that sharing responsibilities can slow the decision-making process.

However, this is where cost-benefit analysis comes in. Medical decision making is a

frequent fact of life in our careers. It has significant costs; however, it will have a

great impact on a patient's quality of life (Zikmund-Fisheret al, 2010). But would it be

reasonable to decrease this quality to reduce cost?

A 'leader' in an interprofessional team, as Cheryl defined, is someone that will

"facilitate processes, presenting organisational structure and goals, focusing the

team and managing the logistics" (Vroman & Kovachich, 2002). They do not decide

what is going to happen. The final decision would be moulded by the whole team

using their own perspectives of the case (Entwistle & Watt, 2006) - given that it is notan emergency situation.

I completely agree with what Cheryl is saying. I think that the difference between a

leader and a hierarchy has been emphasised and explained quite well by some team

members.

I think that replacing the title 'leader' with 'facilitator' will lessen the confusion. This

was highlighted by Pethybridge (2004) by stating that it is crucial to illuminate who

will be co-ordinating the whole process. As we all agreed, instead of an individual

making the final decision, we will establish a rapport and make the decision from

there.

We should vote for who can be the facilitator during the construction of our critiquing

framework after we have submitted our first briefing papers.

I will be adding the rule regarding facilitating if you all agree with it.

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Critiquing tool contribution:

According to the Higher Education Academy (2011), students that engage in peer

assessment will help them learn how to evaluate learning and be able to interpret

assessment criteria. However, one of its disadvantages is fear of being critical.

Basing my idea on this, we all should not be afraid of criticising others' work given

that the feedback that you will give is constructive. But, this is a two-way system so

we should all be open-minded; take the feedback given and use it in the future to

create a better piece of work.

To add to the critiquing tool that we are structuring, when analysing a briefing paper,

we should look at how the person organised the paper. Was it constructed clearly?

Does the paper 'flow'? Was the paper supported by a contemplated conclusion?

(Norton et al, 2002).

With reference to Rebecca's idea of sectioning specific questions, we could do this

by, for example, knowledge and understanding - then picking a certain critiquing

question that would go under it; then we could go onto to analysis and so on.

Nathan, thank you for your input. Extracting a definition from Oxford dictionary by the

Oxford University Press (2011), hypothesis is a proposed explanation for further

investigation whilst a conclusion is a summed-up judgement of an arguement

(Oxford University Press, 2011). So going by this, hypothesis would fit best in an

introduction of an essay.

Reflective writing: Prompt question 1

All the points Cheryl have made are all valid. However, looking at it in a different

view - it is vitally important for other group members to give the rest a heads up on

why they are not posting as much as needed or why they are not posting at all. But,

obviously, referring back to the point of lacking computer skills, this might be a

problem. To explore this issue further, a study conducted by Col et al(2011) about

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shared decision-making in an interprofessional team revealed it is crucial that each

team member knows their responsibilities. Adapting this to our case, if you are not

computer literate, it is your responsibility to seek support or help from your

colleagues or take advantage of the resources available.

Interprofessional (IP) working is about learning with from and about each other to

able to develop teamwork and quality of care (Barret al, 2005).

It is apparent in our group looking through all the activities that we are doing and that

have been done, some people are contributing more than others. However, I believe

the team members that have more involvement do not dominate the discussion but

they have more to say to prompt more discussions and debate. Saying this does not

mean that we are getting out all the possible potential from the group. This is

supported by Thannhauser (2010) by stating that actually engaging in collaborative

practice differs from being involved in an interprofessional team. Basing it on this,

every professional in an IP team will have to put forward perspectives and share

their expertise to be able to effectively deliver high quality care. A research carried

out by Kvarnstrom (2008) about difficulties in collaboration showed that one of the

reported problems in IP working is the lack of consensus when other team members

are not present so as a result, the team cannot carry on with the decision-making;

which in our case, little contribution towards activities. I have been frequently

witnessing this during my placements. Some professionals would not turn up during

multi-disciplinary meetings so therefore it delays everything for the patient and the

professional. They usually updates them over the phone or personally but there is

still a chance that important information will be missed. Due to this, another theme

came up in this study and it is the uneven distribution of current knowledge this is

about all team members not getting all the essential current information that leads to

ineffective collaborative working. In our case, not everyone is sure what needs to be

done or what to write so therefore this might inhibit them from participating. I have

also witnessed this in placement. The implications of this are professionals carry out

same tasks which wastes time and resources. This shows the imperative

significance of information sharing between team members.

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I acknowledge the difficulty in trying to engage in a discussion when other people

have more to say. But, as we are all aware, every one of us has an open-mind to

whatever it is other people are trying to put across. So it is sensible to voice out your

opinion whenever you can. A study carried out by Bakeret al(2011) showed that

socialisation during training affects how professionals perceive themselves. This

study revealed that nurses and other allied healthcare professionals see themselves

as 'team members' in comparison to physicians who see themselves as 'leaders' and

'decision makers'! Using this as basis, we should all be perfectly capable of

contributing towards discussions.

Referencing to Rebeccas post regarding mature students, I totally agree with this as

I think they have more life experience, probably more clinical experience that

younger students. This helps them look at things in a different perspective most of

the time. Every professional will develop their rooted boundaries (Baxteret al, 2008).

Hall (2005) believes that these rooted boundaries may have most likely been formed

during the socialisation process of their training. This supports the fact that different

professionals look at things differently and that different professionals will have

different ways of learning. The learning methods that we use are all be different, if

not, slightly similar. However, I think that mature students would have polished theirs

so they maximise learning while younger students would be in the process of

improving theirs.

Bandura (1986) developed a theory called social cognitive theory. This theory

describes learning as on-going dynamic interactions between individuals, their

behaviour and environment (Mann et al, 2009). Applying this to interprofessional

education (IPE), it could guide our development as healthcare professionals to

consider factors such as learning context; factors that contribute to learners and also

factors affecting teach. In our case, some people might not be as interested in this

module (motivation?) which may be the reason why they are not engaging as much.

With regards to factors affecting teaching, as said by Cheryl, lack of computer skills

and even when Blackboard is down can affect our learning. In terms of issues that

can affect learners, this can be the lack of engagement from all team members.

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I am with you with having negative stereotypes put on younger students. But I think

that with lesser clinical and life experiences, we have limited resources into how we

look at things. We are quite restricted with journals, books and other literature to

base what we are saying. However, this come its advantages. Basing most things

around evidence is good. It is in the Nursing and Midwifery Councils (NMC) code of

conduct (NMC, 2008). Obviously, this is only looking at the nursing perspective. I am

unsure whether other professionals have this expectation from their governing

bodies (I am quite confident you have though!). Stating things with evidence to back

it up ensures that what you are suggesting is credible and sound.

Higgs and McAllister (2005, p 156) stated that a great deal of the success of clinical

education rests on the shoulders of clinical educators, their own abilities and

personal attributes, and the preparation and support they receive. Clinical educator

refers to mentors in placement. This statement illustrates that what information we

get from placement are the ones that stick to our minds. Therefore that is what we

put forward to others. However, according to Heale et al(2009) lack of preparation,

disconnection between theory and practice; time constraints and demands, etc. are

factors that can hinder learning. Consequently, this will set us back from being able

to engage and stimulate discussions.

Reflective Writing: Prompt Question 2

Cooperrider and Srivasta (1987) developed a framework called appreciative inquiry.

This is about initiation or management that focuses on positive personal and

organisation qualities that may fuel change. Dematteo and Reeves (2011) believe

that appreciative inquiry promotes empowerment and can be used as a change

management tool. They also consider its benefits with regards to sharing stories that

can create deep connections between professionals. As a result, this forms trust

between them and also a mutual vision that may contribute towards positive change

(Carter, 2006). In relation to receiving and giving feedback, using the appreciative

inquiry framework, professionals would be able to confidently and comfortably

provide constructive feedback to colleagues given that they trust each other and that

they have shared vision. These two components greatly help with being able not only

to help yourself and colleagues in improving skills, but also ensuring that patientsunder your care will receive the best possible care. However, according to Grant and

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Humphires (2006), for this to work there should be a good amount of self-reflection

and critical evaluation from professionals, If these are not present, appreciative

inquiry will not be able to give professionals an insight into the complexity of human

actions.

During my nursing placements, I have worked with a range of professionals from a

physiotherapist, an occupational therapist to a GP. I strongly believe that this has

given me an adequate insight into collaborative working. As part of my own learning

and also a requirement of my course, I asked all the professionals that I have worked

with for feedback. It greatly helped me improve my practice.

Giving feedback to others can be linked to practice evaluation. For example, Barr

(2005) emphasises this point by stating that evaluation is a crucial part of developing

an effective team. This is supported by McLellan et al(2005) by creating a 'learning

team' in which they have an appraisal tool for each professional. This tool is

designed to support the team's culture and ethos while taking into consideration

factors that signifies good management. Linking this to our prompt question, by

being able to provide and receive feedback, it will help the team evaluate how theymanaged a patient. This may help them in the future to be able to provide better

quality care. Feedback and evaluation not only will improve your practice but also the

rest of your team. Consequently, you will be able to provide patients with quality

care. But obviously, it is still up to the professionals within the team how they are

going to use the feedback that they have received. Some professionals might take it

for granted or some of them might take it personally. Overall, however, feedback is

part of health care therefore it is essential for every professional within this sector to

be able to feedback's potential.

Mini-critiques:

Critique for BP2: Hannah

You have explained how power in decision-making can influence an

interprofessional team. However, the trigger question is about how can an IP team

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work more effectively under the increasing economic constraints. I recognise that

you have linked decision-making and how it can help an IP team to be more

effective; but in order to answer the trigger question, you could have linked your

focus to the economic constraints; then you could have gone into how these

limitations can be overcome and if done effectively, you could consider its

implications to practice. You have used a range of references but it seems that most

of them are outdated. There may be updated versions of them? Overall, it is a good

piece of work and you have showed good analysis and evaluation.

Critique for BP2: Nathan

This briefing paper has come up with valid points regarding how economic

constraints affect interprofessional working. You have looked at the points you have

made and explored it. However, I feel that there was not enough analysis done. For

example, you said unspoken professional value systems can expose obstacles that

appear invisible to team members belonging to other disciplinarians. You could have

included an account to how they are going to do this and then going onto its

implications to practice to show more analysis and evaluation. I acknowledge the

limited amount of words but you could have focused on a couple of things in detail.

Overall, this is a good piece of work with relevant, up-to-date and range of

references.

Critique for BP2: Rebecca

Your explanation of role blurring was very detailed. You considered things that have

to go with it (e.g. professional knowledge) for it to be effective. You looked at how it

can be successfully achieve and its potential implications to practice. You have also

managed to look at it in a different perspective in terms of difficulties that may arise

(e.g. overlap) when this process is implemented. In addition to this, suggested ways

to overcome said barriers. You have included a range of resources which obviously

helped to produce a great amount of analysis throughout the paper. Overall, this is a

great briefing paper.

4, 397 words

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education and collaboration. Journal of Interprofessional Working. 24 (4), 336-349.

Vroman, K and Kovachich, J (2002) Computer-mediated Interdisciplinary Teams:

Theory and Reality. Journal of Interprofessional Care Vol. 16 (2).

Zikmund-Fisher, B.J., Couper, M.P., Singer, E., Levin, C.A., Fowler. The

DECISIONS study: A nationwidesurvey of United States adults regarding 9 common

medical decisions. Medical Decision Making, 30, 20S34S.

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Appendix

Team Contract:

Everyone to contribute

Respect other people's opinions

Ensure 'group' discussions, avoiding ongoing debates between a couple of

people

Explain professional jargon

Check blackboard regularly (suggestion: once every three days)

Reference any points made so that others can find the source

Bring a positive attitude

Have clear start and end points of discussions

Ensure that there would be a facilitator during a discussion/process

Provide support to other members if needed.

Critiquing Tool:

Knowledge and understanding:

Does the paper relate to/answer the trigger question?

Has the author identified with the ethical implications of confidentiality and in

doing so, has avoided referring to individuals by their real names?

Has the author constructed their paper clearly, considering the flow of topics

and by supporting it with a contemplated conclusion?

Analysis:

Has the author used skills of analysis by challenging the ideas they have

touched upon?

Is the paper balanced and unbiased and does the author discuss opposing

arguments?

Evaluation:

Has it been acknowledged that further areas of research could beinvestigated; if so, what are the implications of this?

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Does the writer discuss the overall value of the report findings?

Have the writer discussed how much literature are about which supports their

arguments?

Have the writer discussed gaps in the literature and what further research

needs to be done?

Transferable Skills:

Has the author provided an accurate reference list by encompassing Harvard

Style referencing to show wide reading and to lend credibility to the

arguments?

Within the structure, do the sections refer to the same idea and are they

consistently relevant to the topic of the paper?

Are the references still relevant and is there any new research available?

Is there good level of correct spelling, grammar and punctuation?

ip3 - final

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