Public Health and Social Policy

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Public Health and Social Policy

In the beginning , God created nursing

He (or She ) said , I will take a solid , simple

significant system of education and an adequate

applicable base of clinical research , and

On these rocks , will I build My greatest gift

to Mankind - nursing practice

On the seventh day , He - threw up His hands . And has left it up to us

.MARGRETTA M . STYLES

Nursing is often pictured as the heart of health care . But being a nurse

requires much more . It needs efficient decision making and ability to cope situation which can only be attained through postgrad education Certainly , nursing has long been a repository of the psychosocial approach to health care . These professionals provide a significant component to any collaborative health care team (Reeves , S , Meyer , J Glynn , M . and Bridges , J . 1999 . Furthermore , nurses are often used to functioning as part of a team , and they are perceptive students of group /team process . Their discipline has amassed years of relevant primary care experience that they can bring to the collaborative health care effort

Therefore , Nurses in effective collaborative practice meet the needs of such patients , who bring a wide range of problems to their physician

As collaborative approaches to health vary and multiply , several key ingredients can be identified within the multitude of final applications . These key ingredients are vital to all cultures of collaboration , no matter what the particular ecosystem . The exact "recipe " within each system may vary . Like recipes for chocolate chip cookies , some may be more labor-intensive some may call for more classy ingredients and sometimes a shortfall of ingredients might call for more creativity on the part of the baker . The same is true for collaboration the key ingredients could be mixed in a variety of diverse ways depending on the context , what is available , and individual preferences . Competing demands will certainly shape and change the ultimate form of future collaboration in health care , though certain primary ingredients should remain the same (Molyneux , J . 2001

To be effective , the challenge for health teams has been not simply to be able to offer relevant services and to focus on specific objectives but also to protect an appropriate team composition to retain morale and a sense of belonging among staff . Primary care teams have in the same way become gradually complex , according to the needs of patients and general practice developments . Amongst the various health and welfare teams that have developed (e .g , for palliative care , community learning disabilities and for older people ) primary care has been in the front position of team developments over time . Subsequent the reorganization of general practice in late sixties , opportunities for teamwork became a prospect for most professionals drawn in

By the mid nineties , teamwork in general practice-based primary care had turned out to be well developed in the UK , but one district of tension still lingered for the general practitioner (GP ) in the obvious shift away from the personal doctor who offered first contact , continuing and comprehensive care (Stott 1995 . The challenge has been to retain the continuity in personal care as well as to attain effective teamwork through shared vision , objectives and protocols , while making certain adequate resources and cost-effectiveness

Effective collaboration needs contemporary knowledge and skills of health care providers working in hospital settings . The role of Practice Nurse and the District Nurse is completely diverse from what it was a few years ago (Williams , G . and Laungani ,

. 1999 . Traditionally , the primary role has been to take referrals from physicians and help out in planning for the patient 's discharge , often without considerable input from the rest of the team . The skills of nurses should expand if they are to be doing well . Now nurses need to be supple enough to form different roles and move across departmental lines easily . They require being assertive and confident in the worth of their input . They need to distinguish the numerous different customers they serve patients families , providers , third-party payers . It is significant for nurses to be self-assured in carving out a job role that matches the requirements of the situation and in providing direction as an equal team member relatively than only taking directions . The capability to think about and ease the effective functioning of the health care team in relationship to the patient is just as imperative as the traditional role of a discharge planner

Further , collaboration is the partition between structures and services in hospitals that make it hard to obtain needed consultation in an appropriate fashion . Wayne Katon , a leader in the consultation-liaison (C-L ) fields of psychiatry , feels that mental health consultation is characteristically requested too late in a patient 's hospitalization to be effective . Katon feels that treatment would be more incorporated and satisfying to both providers and patients if mental health care providers were drawn in potentially difficult situations early in the process . C-L services are most effectual when the psychiatrist and the team have developed a relationship over time . It is easier under this arrangement for the mental health professional to be implicated early If that person is present at all staff meetings , the association between providers develops (Douglass , C . 2001

Moreover , empowering nurses also plays very a significant role in collaborative care . The goal of empowerment is to make the patient an essential participant in health care decisions . In fact , outside the biomedical world the term "client " or even "consumer " is used in place of "patient " since "patient " frequently connotes a passive , one-down position (Allen , D . 1997 . The nurses ' role is to help patients become more dynamic in their own health care and to empower them to take more accountability for their overall health . On the provider side empowerment promotes certain attitudes about power distribution amongst health care providers and attitudes about spheres of influence "turf and working together . A viewpoint of empowerment replaces rigid hierarchy with differential expertise

Directions with consensus and conformity with cooperation , and it rely on trust , respect , and a spirit of working together . Since power is a key element in any relationship , the locus of control is a fundamental feature in any collaborative relationship , be it between health care providers or between health care providers and patients and their families

Thus , collaboration is also restricted by its resource requirements and the eagerness of participants to prioritize this action over other calls on their attention . For instance , in her study of teamwork , Cott (1998 divulged that collaboration was often stalled by a lack of formal methods for information-sharing between professionals and support workers . This shortfall often resulted in contemptible communication between these multi disciplinary team members

Where meeting together is not probable synchronous collaboration can be conducted by telephone . This interaction is typically limited to a one-to-one exchange of concerns and recommendation , or one-to-one discussion and planning . However , much collaboration at a aloofness is asynchronous (or time-delayed , taking place through the written word for instance , shared patient notes , letters between primary and secondary care and reports between health and social care . Effectual collaboration for the benefit of patients or clients relies on the judicious exchange of accurate , related information . Time lags can lessen the effectiveness of care and waste resources in the figure of duplicated effort or inapt interventions (Kettler , H . 2001

If we want to develop collaboration , we require looking at ways of increasing the efficiency of collaboration and also the means of improving enthusiasm for this activity . Already diverse terms have been used to point out the framework of health and social care professionals working together . However , within a global arena , terminological disparities become even more prevalent . For instance , lead from the America have recently defined an interdisciplinary team as a group of colleagues from two or more disciplines who synchronize their expertise in giving care to patients (Farrell et al 2001

Though , the current trend in health care is away from high-technology hospital-based medicine . Yet , patients continue to require hospital care . Such care must be provided in a diverse way in to meet the current expectations concerning cost and care-effective services Collaborative care is an ingenious means of pursuing this goal (Hudson B . 2002 . There are following suggestions for collaborating in hospital settings to have more accountability and confidentiality

1 . Keep abreast of the current trends in hospital care . Understand particularly the projects that encourage patient-centered care . Be an advocate for paying more attention to processes that add patient and family input and synchronize provider services

2 . Approach areas within the hospital setting that logically comprise biomedical and psycho social concerns . These include cardiac treatment dialysis , and infectious diseases . Learn as much about the disease processes in these settings as possible

3 . Maintain an open recommendation system so that any staff member can ask you for help . If you keep referrals limited to physicians , you might be missing cases that need attention . If you get a referral from any team member , consider how the rest of the team can be involved

4 . be responsive of the potential for splitting when multiple providers are involved in patient care . Try not to take sides with patients and families against medical providers , or with medical providers in opposition to patients and families . Supporters for the whole team . Keep communication open between you , the medical team , and the patient and family

5 . Cultivate mutual networking skills . Coordinating services and getting the right people to speak to each other at the right time may be the most curative strategies

6 . See physicians and other health care practitioners as clients for your services . Be practical in responding to their needs , but do not get on tasks that are inapt or should be shared

7 . Participate in hospital ethics committees and remain abreast of the ethical issues involved in hospital care . One role you can plug on the team is asking questions in difficult situations to facilitate clarify the ethical issues involved

8 . Maintain a twofold identity with the team of health /mental health care providers and with your professional restraint

Conclusion

To underline the significance of collaboration for the next generation of health care professionals , supporting bodies must distinguish the impact that health care changes are having on the needs of professionals in-training . Several family therapy training settings distinguish the importance of preparing family therapists to work in managed care (Patterson Scherger , 1995

Lareau and Nelson (1994 ) cite the probable advantages of the health care and physician team . They persuade all health professionals organizations , and licensing boards to link with health insurance companies to set up for the future . Professional accrediting bodies must take up this mandate and prepare health and mental health professionals for the changing health care scene . The Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE , for instance , is considering requiring specific course work in this district for all ascribed degree-granting and postgraduate family therapy training programs

Lacking changes in how they are trained , mental health professionals physicians , and nurses will not be geared up for the demands of new health care systems . Patients and families will obtain collaborative care of their multifaceted problems simply if the professionals caring for them are trained to give it

References

Allen , D (1997 'The nursing-medical boundary : a negotiated Sociology of Health and Illness 19 , 498-520

Cott , C (1998 'Structure and meaning in multidisciplinary teamwork Sociology of Health and Illness 20 , 848-73

Douglass , C (2001 'the development and evolution of geriatric assessment teams over the past 25 years : a cross-cultural comparison of the US and the UK , Journal of Interprofessional Care 15 (3 ) 267-80

Farrell , M , Schmitt , M . and Heinemann , G (2001 'Informal roles and the states of interdisciplinary team development , Journal of Interprofessional Care 15 (30 , 281-95

Hudson , B (2002 'Interprofessionality in health and social care : the Achilles ' heel of partnership , Journal of Interprofessional Care 16 (1 7-17

Kettler , H (2001 ) Consolidation and Competition in the Pharmaceutical Industry , London : OHE

Lareau , M Nelson , E (1994 . The physician and licensed mental health professional team : Prevalence and feasibility . Family Systems Medicine , 12 , 37-45

Molyneux , J (2001 'Interprofessional team working : what makes teams work well , Journal of Interprofessional Care 15 , 29-36

Patterson , J Scherger , J . E (1995 . A critique of health care reform in the United States : Implications for the training and practice of marriage and family therapy . Journal of Marital and Family Therapy 21 , 127-135

Reeves , S , Meyer , J , Glynn , M . and Bridges , J (1999 'Co-ordination of interprofessional health care teams in a general and emergency directorate , Advancing Clinical Practice 3 , 49-59

Stott , N (1995 'Personal care and teamwork : implications for the general practice based primary health care team , Journal of Interprofessional Care 9 (2 ) 95-9

Williams , G . and Laungani ,

(1999 'Analysis of teamwork in an NHS community trust : an empirical study , Journal of Interprofessional Care 13 (1 ) 19-28

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