The practice of nursing has various aspects that nurses can engage in while working towards ensuring better services in clinic. Nurses operate under these aspects independently and in unity to achieve a certain goal in the health sector. These aspects include multidisciplinary teams, nursing theory, ethics, and diversity in the health sector. This paper examines the roles, responsibilities, collaboration, and inter-agency of multidisciplinary teams (MDT) in the field of nursing and the use of reflection in professional learning as well as that of nursing models to enhance care delivery. The paper also analyses the ethical issues that confront nurses in their practice of nursing such as abortion, restraint and control, child/adult protection, blood transfusion, and consent. Finally, the paper analyzes the impact of culture, gender and stigma on professional practice in nursing and examines the ways of promoting equality and diversity in the working environment.
Roles, Responsibilities, Collaboration and Inter-Agency in Multidisciplinary Teams
According to Housley (2003, p.21), the essence of forming a MDT in healthcare sector was to bring together medical practitioners with various skills to contribute to the provision of medical services to the patient. MDT members work in multifaceted situations that are difficult and those that require a wide-ranging response and which provide the ultimate chance of treating the patient. In an ideal situation, a MDT is compost of medical practitioners like physicians, nurses, pharmacists, dieticians, and health educators, social service, and mental health providers ( Lane, 2007, p.17). Included in this group also is the patient who is actually the center of the focus for the other members. Notably, the roles of MDT team must not overlap to be able to give maximum attention to the welfare of the patient.
Lane (2007, p.27) observes that the essence of a MDT is to give the patient maximum attention which may include a specialized follow up by a special professional person even to the home of the patient. The approach is solely to address medical problems from a holistic angle. This means that each member must have a defined role to play. Such roles must contribute to achieving a stated goal. As such, in complicated situations, the family and social workers in the community may be included in the team especially where family issues hinder the patient from following the prescription of the doctor.
As a team of professionals, each member of a MDT is drawn from dissimilar areas to come together for the common good of the patient. The member must therefore work in accordance to the needs of the patient. The responsibilities of the members revolve around treating the patient. Martin (2004, p.28) observes that since the team is made up of professionals from different disciplines, each member has a role of providing assessment of the situation from their professional point of view. The result of the assessment must therefore be coordinated and harmonized through communication to ensure that the patient gets a unified prescription on how to address the medical problem. Thus, members of a MDT ensure that their individual assessments, interpretations, and arrangements gears toward the welfare of their patient. Members also have a responsibility of communicating their assessment to their patient to avoid situations where the patient adopts his or her own interpretation of the problem.
Moreover, a MDT focuses on certain set objectives that are supposed to be realized at the end of their work. The medical professionals in the team have the responsibility of ensuring that they put their specialized skills and knowledge to give the patient the best treatment and care through personalized and detailed engagements and follow-ups to the patient. As such, the medical practitioners have the responsibility of ensuring that their patient enters high quality and appropriate clinical assessments through their expertise, knowledge, and skills. Similarly, the MDT member must offer informational support to the patient in his or her respective area of specialization in ensuring that that patient is able to cope with the medical condition that the team is addressing.
In addition, a MDT is responsible for continuity in the care that the patient needs. In this regard, members have the responsibility of giving their individual care to the patient even in situations where different professionals are also giving their care. However, this must be done in coordination to avoid giving conflicting services to the patient as this might worsen his or her situation. This kind of service requires a high level of discipline and consultation within the team members, with the view of avoiding conflicting care to the patient. As such, the MDT member also has the responsibility of consulting other team members through meetings where conflicting services are discussed. This means that members of the team must ensure concerted and well-articulated communication from the primary caregiver to the tertiary caregiver (Smith, 2007, p.3).
An important responsibility of a member of MDT is the skills and capacity to do research with the view of presenting facts to other members during the meeting. This will avoid a situation where the rest of the team does a good work in their part and one member gives wrong information to them, which might result in worsening the condition of their patient. The ability to carry out continuous research by each member is a responsibility that none of the members should avoid since a single mistake can affect the whole team.
Similarly, Smith (2007, p.3) indicates that as a team MDT members ensure that there is a good working relationship among themselves in order to guarantee job satisfaction in the team. This will make each member to work effectively and responsibly. A good working relationship will equally contribute to improving the condition of the patient since the person will see the coordinated work that the team is offering. This working relationship can be fostered through adherence to the rules and guidelines that the team sets up before embarking on the work. These rules encompass best practices in clinical, social, and medical practicing.
However, one of the challenges of running a MDT has been the issue of resources. In every sector, resources are scarce and therefore must be used sparingly. For a MDT to operate optimally, members need to be responsible for the available resources that the team is using. Resources include the time available and the finances that the team has. As such, members must use the time allocated to them to do a particular duty effectively and efficiently to enable both the team and the patient meet their goals (Smith, 2007, p.3).
Use of Reflection Professional Learning and the Use of Nursing Models to Enhance Care Delivery
According to Jasper (2007, p.22), nurses need to focus on the conditions that define their work especially when they are giving care to the patient. These conditions include the patient, the environment that they are working in, the health status and the goals, roles, and finally the functions that they want to achieve. As such, reflective learning becomes a vital tool in ensuring that the nurse is focused on the four conditions in his or her delivery of care. However, reflective learning cannot be done in exclusion of the four conditions and this means that the process occurs while the nurse is discharging his or her duties. The nurses themselves may not be conscious of this process but instead use instinct and subconscious mind to engage in the learning process. Nevertheless, reflective professional learning can and should be done consciously to enable the nurse to reflect on the decisions that are made out of this process with a view of documenting it.
Jasper (2007, p.24) further observes that nurses are presented with “a set of concepts, definitions, relationships, and assumptions or propositions.” Such come from different models in nursing as a profession and other disciplines that require nurses to be critical thinkers while discharging their services to the patients. The medical profession is unique in nature because of its position of dealing directly with human life. This is the reason why nurses need to be systematic and panoramic in their approach to different clinical conditions. Such conditions require them to describe, predict, or explain the prescription to the patient. Thus, as noted by Reed and Shearer (2007, p.11), nurses and other medical practitioners need to give great attention while executing their responsibility in hospitals. As such, the ability to approach a patient’s condition with reflection and reflexes is one major distinguishing characteristic that sets apart nurses and other medical practitioners from the rest of the professionals.
Bandman and Bandman (2002, p. 12) observe that one major challenge that nurses and other medical practitioners face today is the increasing complexity of the medical conditions that they are getting each day. Nurses and other medical professionals are said to be students always. This is because they need to continuously learn and carry out research on various medical conditions if they are to provide better services. According to Alligood (2010, p.32), nurses and doctors need to adapt to reflective practice to remain versed with the situations that they encounter in the field. This gives them the ability to think over the action with the view of embracing a continuum in their learning process. Thus, this process sets them apart with other people who are not doctors or nurses. The situations that nurses encounter in their work require a critical approach using the applicable values that form the foundation of their professional practice. They do this through reflection and insightful thinking by utilizing a developmental approach that increases their capacity to do their work.
Alligood (2010, p.35) further argues that through reflective professional learning, nurses are able to acquire better skills in describing and explaining the conditions of the patient thus enhancing the functionality and relevancy of the medical prescription and care that the patient gets. As such, reflective professional learning makes the nurse to be a better professional and therefore is able to deal with future problems that may be similar to the problem at hand. Reflective professional learning is also important because it gives the nurse the capacity to distinguish different nursing practices thus avoid giving conflicting and detrimental services to the patient. The nurse is able to learn more on what he or she knows in their field through informed decision-making approach hence helping in maintaining professional boundaries in nursing.
Reed and Shearer (2007, p. 40) observe that reflective professional learning for nurses is the most important source of information because nurses are able to learn from their own experiences. This is because the process does not rely on the knowledge transfer or the teaching that characterizes the formal way of learning. Arguably, reflective professional learning is the most important source of a personalized approach to professional development as it gives the learner an opportunity to engage in intuitive decisions based on personal judgment since the learner is gaining from the experience that he has gathered along the way. Through this approach, the nurse puts himself or herself in a better position to deliver care services to the patient without any doubt.
Nursing models on the other hand are important in helping the nurse to deal with specific problems that may have been handled elsewhere. Jasper (2007, p.21) observes that nursing models are particularly important tools of effectively service delivery by nurses through representation of the interaction amongst and connecting concepts that exhibit patterns. He further contents that models are vital where the nurse is presented with a situation that is unique and which he or she must handle nonetheless. Thus, through nursing models, the nurse is able to apply concepts that are new to him or her successfully. This is particularly important where the situation is life threatening and the nurse is the only available person who can save that life.
Ethics in Nursing
Ward (2012, p.2) observes that nursing is one of the professionals that have continuously presented ethical dilemmas to the practitioners in this field. Each step that a nurse takes in her or his practice as a legal practitioner is punctuated by situations that presents dilemma to the nurse in terms of ethical implications that are involved. Nursing is a profession that is full of obligations and rules that the nurse is bound to regardless of his or her values and lifestyle, the nature of the patient, or the repercussions of their actions.
Such ethical issues have continued to expand with increase in knowledge among human beings and especially the patients themselves. As such, nurses are exposed to all risks that come with their practice including prosecution in a court of law if they discharge their duties in a wrong manner. Among the issues that continue to stalk nurses include; abortion, restraint and control, child protection, blood transfusion, and consent. As argued by Ward (2012, p. 3), abortion has probably been blown out of proportion as nurses are the greatest suspects whenever an abortion is reported. What people normally fail to notice is that the nurse is presented with a situation that means choosing between two lives and this mostly occurs when the life of the mother is in danger.
Such situations calling for tough decisions normally arise whether a nurse is either a pro-life or a liberal who believes that people should have the right to make their own decisions, whether those decisions are going to harm them or not. As human beings, nurses are also capable of being influenced by the values and beliefs that they hold. However, they are obligated to the laid down rules of clinical practice which in most cases considers that the patient is always right. This only excludes situations where it is established that the patient is insane and therefore incapable of making sound decisions. For instance, a nurse with a pro-life stand should not care for patients who have had abortion yet this will be regarded as denial of service that can attract punishment from the institution where the nurse works. The nurse will ultimately be infringing on the right of the patient to choose her decisions.
Similarly, Alexis (2005, p. 30) observes that nurses continue to face the challenge in the area of freedom and control especially when they are dealing with children or stubborn adults. It is common knowledge that some children may simply refuse their medicines. Nevertheless, the nurse is expected to give the medicine to the child without failure. In such situation, the nurse forces the child to take medicine thus infringing on the right of the child to choose. Another situation that present ethical dilemma to the nurse is where a patient wants to perform an action that is going to be harmful to himself/herself. For instance, a patient is likely to stop from eating with the intent of starving to death. The ethical issue arises here over the decision that the nurse is supposed to take. However, whichever the step that the nurse takes, whether to report the patient’s case to the hospital or simply keep quiet and watch as the patient dies has ethical implications. Therefore, the nurse works in an environment that exposes him or her to ethical dilemmas that she/he must bear whether he/she likes it or not. They do not have an option of making their judgments without eliciting the question of ethical practice in nursing.
Furthermore, the nurses continue to wrestle with the issue of consent from their patient to offer services that are essential to the welfare of the patient. Some patients become incapable of making decisions after an ailment and in such situations, they require assistance. Equipped with this right of decision-making, for instance, a patient can ask the nurse to perform a service that would be harmful. As a professional practitioner, the nurse is supposed to make evaluation of the requests made by patients and their conditions before administering the request. Nevertheless, the nurse is expected to conform to the wishes of their patient; failure to which they may be liable for punishment because of their negligence to listen to the patient. On the other hand, nurses who grant such wishes are also reliable for prosecution for causing death to the patient (Alexis, 2005, p. 32).
With increase blood transfusion practices in health sector, nurses are supposed to ensure that the blood that a patient is given is free from any other diseases. However, cases have occurred where the nurse is not the one testing the purity of the blood for transfusion and therefore contaminated blood end up being transfused to a patient. A case in point is the prevalent cases of people who have become HIV positive after undergoing a blood transfusion. In such cases, the nurses are the first culprit of negligence and unprofessional practice yet the act of transfusing blood in the first place was intended at protecting the life of the patient. Other examples include cases where the patient dies because there is no blood in the blood bank yet the nurse can contribute the blood to treat this patient. As pointed out by Freshwater (2002, p.11), nursing as a profession is full of ethical issues because of its direct interaction with the life of human being and differences in beliefs and practices that define the variety of patients that the nurses deal with in their work environment.
Freshwater (2002, p.11), further observe that nurses are also exposed to the dilemma of deceiving their patients of telling them the truth about their medical conditions. Some patients suffer from terminal diseases that they have slight chances of surviving the condition. The nurse may thus be under pressure from the patient’s family not to disclose the actual condition to the patient with the reason that revealing the condition may worsen the situation of the patient. The nurse remains at the crossroad of either telling the truth to the patient or hiding it according to the wishes of the family members. In such circumstances, the integrity of the nurse is supposed to be to the patient yet when he or she reveals the information, the situation may worsen and the family blames him or her. Additionally, granting the wish of the family denies the patient the right to know, which is ethically and morally wrong. Thus, the nurse remains trapped between telling the truth and hiding it from the patient.
Nevertheless, nurses can approach ethical dilemmas in their work places by following simple steps that will give them the direction on what to do in such situations. They need to know whether the situation at hand is an ethical dilemma by gathering all the information, examining the information gathered and determining whether the situation presents any challenge to their values. They can then talk to the relevant people that are concerned and consider various options that are available to them. This consideration can involve negotiation of the outcome after evaluating the action.
According to Kaye & Lingiah (2008, p. 12), people from distinctive groups more often than not hold similar cultural practices and beliefs that defines their associations in family, health, and cultural practices. Most people who come from diverse cultural groups experience difficulty in defining a professional approach to health related issues. This may be a result of a sudden change in the practice of healing. Many people who are stigmatized have a problem of accessing medical facilities and if they get to access those facilities, it is normally too late and therefore present a challenge to the professionals that serve in those facilities. Furthermore, different cultures have different illnesses that are uniquely identified with a particular culture. Thus, the professionals that are in the health facilities are taken back to the drawing board to try to diagnose the illnesses that people from dissimilar cultural setups bring with them.
The concepts of culture profiling, gender biasness, and stigmatization continues to attract attention in many professional practices such as nursing. The characterization of patients in health-related matters come from within the profession itself and from without. The ability of social wellbeing to be affected by such characterization has raised eyebrows from the public. This may be as a result of most illnesses that people suffer coming about because of cultural practices, gender biasness, and stigmatization. From within the profession itself, doctors and nurses can be allocated duties and responsibilities of attending to patients as per their culture or gender.
On a different level, Freshwater (2002, p. 9) found out in his research that most nurses who care for people living with diseases like HIV and Aids face stigmatization from their communities. This indicates that culture can negatively influence the personal and professional lives of both the practitioners and the community from which they come from. This is through altering their perceptions and emotions as they relate to their families. The influence of culture is even more pronounced in cases where the professional is a woman in which case she, may be stigmatized because of the professional work that she does and her gender. As such, Lane (2007, p.7) argues that there is need to design intervention mechanisms to assist female nurses in coping with the problems that come because of their professional work.
Nevertheless, Kaye & Lingiah (2008, p. 35) argue that gender stigmatization in nursing is not only directed to female nurses but also to male nurses. This is because nursing as a profession is more or less considered as a feminine profession in many cultures. Thus, men who choose to practice nursing are seen as not men enough and therefore are avoided by their colleagues from their communities. Similarly, some patients, especially women find it awkward for a male nurse to attend to them because they have been conditioned to believe that nursing is a woman’s work and therefore female nurses should serve them. In such cases, the blame is on the cultural upbringing because their community has brought up these women in that manner.
In conclusion, nursing is a profession which requires the incorporation of all the stakeholders right from the practitioners, patients, and the community as a whole. Only this way will the practitioners be effective in the professions as they will be able to solve the issues as they arise. Additionally, adherence to the nursing ethics and commitment to reflective learning must not be abandoned by any nurse.