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PREPARING FOR PRACTICE
A nurse is an important member of a multidisciplinary team in a health care unit. Such team care is key features of modern health care settings. General practitioners as well as other care professionals give care to the patients (Health.nsw.gov.au, 2015). In such unit, professionals of various disciplines work together for delivering comprehensive care so that many needs of the patient is addressed. Many people working as a team under the same umbrella makes it possible (Bowen, 2014). The professionals are brought together as the team (Saini et al., 2011). As per the changes of the conditions of the patient, the team’s composition changes and it reflects the psychological and clinical needs of that patient. The personnel involved are practices nurse, general practitioners, health burse, allied professionals of health care like physiotherapist, dieticians, occupational therapists, psychologists, social workers (Eller, 2015). They convey several advantages to the patient and other members of the health care system. Health outcomes are improved, and there is enhanced the satisfaction. There is the advantage of efficient use of resources. There is a need for negotiation and proper definition for the optimum functioning of such teams. There has to be trust and respect between the team members. Skill mix has to be used at its best. Structures of clinical governance have to be structured (Pinnentti, 2015). As a part of such multidisciplinary team, a nurse has a vital function. Patient recovery is achieved by support from the whole care unit especially the nurse. It is the duty of the nurse to bring together all the services of from the different members of the multidisciplinary team (Hopkins & Worboys, 2012). The nurse has the responsibility and accountability for planning and then administering the care needed for a patient along with the other personnel of the care unit. If there is no proper communication between the nurse and the other members of the team, it is difficult to achieve satisfaction on the part of the patient (Overman JA, 2015).
The following writing is a reflective report on the functioning of a multidisciplinary team of which I have been a member. Critical reflection is done on the actions and how the experience of working with the professionals of the multidisciplinary team had an effect on the professional clinical development, understanding of professional relations and communication skill. I have reflected on two particular events that happened, which highlighted different aspects, both positive and negative of such teamwork involved in the multidisciplinary team, and its impact health management of patients.
Reflective writing is the examination of personal action and thoughts (Kenninson, 2012). To a nurse, it means to focus and interact with the present environment to get a proper view of her behaviour. It is a process by which a nurse can understand themselves in a better way and also understand the functioning of the multidisciplinary team she is working with. Strength can be built from it, and necessary actions can be taken from it. The benefit can be gained in some ways from the reflection of experiences one has in her nursing practise. Immense help is achieved from such work (Naber & Wyatt, 2014).
I am reflecting on two experiences I had while working with a multidisciplinary team.
The first incident on which I would like to reflect was the first experience that I remember with importance during my placement as a nurse. It was my experience with a multidisciplinary team in palliative care. The patient concerned was Mrs. Martha Johnson, a 40-year-old patient having metastatic breast cancer. Metastatic cancer is the stage when the cancerous cells move to any vital organ of the body, and there is threat to life. The areas affected mostly are a brain, lungs and liver (Chen, 2012). Eight cycles of adverse chemotherapy were applied on her before referring he to palliative care management team. There was metastasis on her lumbar, cervical-dorsal and pelvic bones. She had suffered immense pain in neck and head when in the out-patient department. She was then admitted to palliative care because of vomiting and nausea. However, the process was long because there was a lack of smooth coordination between the outpatient department and general ward in in-patient department. Analgesic titration was also needed. Medicines for sickness were used already on her. Proton pump inhibitor was used for further management. Eating patterns and diet was also sorted out for her. According to WHO pain ladder, the pain of the patient was managed. MRI was done. The specialists in the radiology department were very helpful and adjusted their working procedures for the patient as she was in immense pain. Usually, MRI is a time-consuming process, and the patient needs to have much patience (Teasdale, Howard & Cox, 2014). The technicians helped to keep the patient in place. It was discussed holding up a cross-disciplinary team meeting. The radiologists clarified the progression of the disease in the patent. The appropriate ways to improve the condition of the patient was discussed, and a decision was taken to provide radiotherapy as a palliative care. To this, the team of physiotherapists gave valuable suggestion on the improvement of movements of her neck and head. They also recommended a neck brace. Social problems had started when she was first ill. She left her job and lost valuable income. Her family lost valuable time in taking her to the hospital. Her children were away from her. In this situation a charity organisation came. They ran a hospice. It provided care to her, as she had nothing to get further from life because of cancer. The psychological pain was there in the patient. I and the other members of the team were sympathetic towards her. Along with the other members of the multidisciplinary team, I provided support to her. To my great surprise, all the other team members gave emphasis on empathy and communication. It was more than what I had heard from others about the care given by other such teams in other hospitals. I was highly pleased with this and made sure that I continue to do such care for the patients who need psychological immensely. The family of the patient started giving her time, and there was an ongoing support to her. I understood that if each one of the multidisciplinary team works at his best, such positive results could be achieved.
I was highly pleased with the type of conduct all had. I got enough enthusiasm from the different specialists on giving care to such patients. I was convinced that if all members of a team work together, a patient could be made to feel better. I learnt from the situation that no matter what the specialisation is of the health care professional, sympathy is the thing that can be given to all patients.
All of the help and support was of value because for a cancer patient about to die, being with her family means a lot. Working between the different disciplines gave a good amount of support to the patient.
This experience was an experience with a team of cohesive relation and structure. There was a limitation of the whole incidence. It was that only a single centre was doing all the work, and greater education is needed for advocating multidisciplinary care. Also, a smooth process has to be present between the out-patients department and general ward. When a patient is suffering from pain, she must be immediately admitted to the respective ward (Khayyam et al. 2015).
After my experience with such a good multidisciplinary team, I made sure that I continue to do such care for the patients who need psychological immensely.
Another instance was when a new consultant had been recruited in the multidisciplinary team. The person was the in-charge of the present medical team. The person was a very strict one and had a strong hold on all matters. He thought his views and opinions to be the most important one did not pay much attention to what others had to say. His considered his decisions as the final word. The occupational therapists, social workers, physiotherapists and nurses asked less for orientation and opinions. The consultant had higher incidences of giving opinions and asking for any orientations. On an incidence where the patient was critical, problems had aroused due to the arrogant nature of the consultant. The patient was a 74-year-old man Steven Jacob, who had several complications. He had pneumonia and cardiac problems. The main reason for his admission to the care unit was that he had suffered a fall fractured his legs. His requirements were very much elaborated, and he needed the support from the whole team who could have given him care from different approaches. In such a case, the therapists, social worker and nurses were very much reluctant to give their opinions in the multidisciplinary team. The ego and self-esteem of these professional were holding them away from giving the required valuable care to the patient. As a result, the care provided to the patent was not up to the mark. I, on my part, did all the necessary things for providing relief to the patient. I had a positive attitude and went on to discus all maters in details with the consultant.
What I felt from the situation was a sadness from a personal front and determination from the professional point. I felt that patience is needed to work in a multidisciplinary team. One should have leadership qualities in himself to work in such an environment. As a nurse, my feelings revolved around being outspoken to take care of patients in an effective manner.
For a good health care team, coordination among all is needed. All should have the same hold on giving solutions and recommendations (Findley & Sergio, 2014). As this was not the case in the present situation, the health care given was not up to the mark.
There could have been a better position if nurses raise their voices against injustices. Therapists, nurses and social workers should give their opinions in the teams in a more effective manner for being committed and competent practitioners who are patient-centred (Mitchell, Golden & Wynia, 2015).
I would implement the lesson I got form the incidence in my nursing practice and will always give my valuable comments and suggestions so that the patient care is not neglected.
Both of the incidences were immensely valuable as they showed me the two sides of a coin, the positive side and the negative side. The advantages and the problems related to the functioning of a multidisciplinary team and its effect on nursing practise were understood. The first incidence left a good impression that multidisciplinary teams can function together to make the work of the nurse easy and effective. From the second incidence, I learnt that nurses should always hold up their valuable suggestions and ideas regarding the care of a patient even so if the feedback she gets is not good. A nurse should never compromise in a multidisciplinary team and make all the other members of the team realise her importance. Reflecting back on the years of my placement, I had different impressions of the multidisciplinary teams that a nurse has to work with during her practise. I feel that having a good understanding of separate professionals in such multidisciplinary environment and the role they play will provide me with benefit in the future. I will be able to give care to the different service users if I take valuable lessons from my experiences.
There are some advice I would like to give to a nursing student to contribute to a multidisciplinary team as a nurse.
The nursing student must know how to put forward her thoughts and ideas. She must be able to make all the other members of the team understand that the opinions of a nurse hold very much significance. Further reading (Munhall, 2012).
I would recommend the nursing student to give her best efforts in her work. She must be aware of all ethics in the nursing profession and abide by them. Further reading (Stuart, 2014)
I would suggest to coordinate and corporate with all the other members of the team while working with a multidisciplinary team. Further reading (Potter, 2013).
I feel by doing this reflective writing, I can enhance my teamwork and communication skills, which will help me significantly, in my professional life. I have been able to achieve a sense of providing holistic care for the patients along with my multidisciplinary team. Working with a multidisciplinary team was a completely different experience all together. The functioning of the multidisciplinary team and the role of the nurse in such a team is clearer now, and I shall implement my understandings from the two experiences in my daily practice as a nurse.
Bowen, L. (2014). The Multidisciplinary Team in Palliative Care: A Case Reflection. Indian J Palliat Care, 20(2), 142-145.
Chen, E. (2012). Mitochondrial dysfunction and cancer metastasis. Journal Of Bioenergetics And Biomembranes, 44(6), 619-622. doi:10.1007/s10863-012-9465-9
Eller, A. (2015). Maternal Morbidity in Cases of Placenta Accreta Managed by a... : Obstetrics & Gynecology. LWW. Retrieved 10 August 2015, from http://journals.lww.com/greenjournal/Abstract/2011/02000/Maternal_Morbidity_in_Cases_of_Placenta_Accreta.19.aspx
Findley, S., & Sergio, B. (2014). Community Health Worker Integration Into the Health Care Team Accomplishes the Triple Aim in a Patient-Centered Medical Home: A Bronx Tale. Journal Of Ambulatory Care Management:, 37(1), 82-91.
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Kenninson, M. (2012). DEVELOPING REFLECTIVE WRITING as Effective Pedagogy. Nursing Education Perspectives, 33(5), 306-311.
Khayyam, K., Behera, D., Patra, S., Sarin, R., & Snigla, R. (2015). A STUDY ON OVERCROWDING OF OUT-PATIENT DEPARTMENT OF A TERTIARY CARE TUBERCULOSIS INSTITUTE IN DELHI. Indian J. Prev. Soc. Med, 45(1), 87-90.
Mitchell,, P., Golden, R., & Wynia, M. (2015). Core Principles & Values of Effective Team-Based Health Care. Retrieved 10 August 2015, from https://nationalahec.org/pdfs/VSRT-Team-Based-Care-Principles-Values.pdf
Munhall, P. (2012). Nursing research. Jones & Bartlett Learning.
Naber, J., & Wyatt, T. (2014). The effect of reflective writing interventions on the critical thinking skills and dispositions of baccalaureate nursing students. Nurse Education Toady, 34(1), 67-72.
Overman JA, e. (2015). Role of the nurse in the multidisciplinary team approach to care of liver transplant patients. - PubMed - NCBI. Ncbi.nlm.nih.gov. Retrieved 10 August 2015, from http://www.ncbi.nlm.nih.gov/pubmed/2664364
Pinnentti, M. (2015). "Clinical outcomes of multidisciplinary team management in patients sup" by Mamatha Pinninti, Nasir Z. Sulemanjee et al.. Digitalrepository.aurorahealthcare.org. Retrieved 10 August 2015, from http://digitalrepository.aurorahealthcare.org/cardiosurg/3/
Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2013). Fundamentals of nursing. Elsevier Health Sciences.
Saini, K., Taylor, C., Ramirez, A., Palmieri, C., Gunnarsson, U., & Schmoll, H. et al. (2011). Role of the multidisciplinary team in breast cancer management: results from a large international survey involving 39 countries. Annals Of Oncology, 23(4), 853-859. doi:10.1093/annonc/mdr352
Stuart, G. W. (2014). Principles and practice of psychiatric nursing. Elsevier Health Sciences
Teasdale, J., Howard, R., & Cox, S. (2014). Functional MRI Study of the Cognitive Generation of Affect: American Journal of Psychiatry: Vol 156, No 2. American Journal Of Psychiatry, 56(2), 209-215. Retrieved from http://ajp.psychiatryonline.org/doi/10.1176/ajp.156.2.209
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