5081 Inter-professional Reflective Essay

Introduction
Inter-professional health care practice (IPHCP) involves “partnerships between a team of health
professionals and a client in a participatory, collaborative and coordinated approach to shared
decision-making around health and social issues” (Orchard, King, Khalili, & Bezzina, 2012, p. 58).
IPHCP has numerous benefits for patients in many different healthcare settings, including error
reduction (Morey et al., 2002), better patient outcomes (Archer et al., 2012; Holland et al.,
2005; Sommers, Marton, Barbaccia, & Randolph, 2000; Young et al., 1997), and an improved
patient experience (Gabel, Hilton, & Nathanson, 1997; Hearn & Higginson, 1998).

Despite substantial evidence that IPHCP has beneficial outcomes for patients, there are many
professional issues which hinder the implementation of effective IPHCP, including differing
communication styles (Foronda, MacWilliams, & McArthur, 2016; Woodhall, Vertacnik, &
McLaughlin, 2008; World Health Organization, 2010), contrasting approaches to patient
management (Clark, 1997; Foronda et al., 2016; Hall, 2005; Pecukonis, Doyle, & Bliss, 2008;
Reeves, Lewin, Espin, & Zwarenstein, 2010), lack of inter-professional awareness (Baker, Egan-
Lee, Martimianakis, & Reeves, 2011; McNeil, Mitchell, & Parker, 2013), and unequal power
between professions (Engel, Prentice, & Taplay, 2017; Hall, 2005).

This paper aims to discuss the benefits of IPHCP as well as the professional issues that are a
hindrance to its implementation. My thoughts and reflections from the Inter-professional
Workshop (IPW) will also be integrated into the discussion of the professional issues.

Benefits of inter-professional health care practice

Error reduction
In the emergency department setting, Morey et al. (2002) found that the implementation of
formal teamwork training, structures, and procedures led to a significant reduction in observed
error rate (from 30.9% to 4.4%). Scope of observed errors included things like non-action on
significant vital sign measurements, non-adherence to contact precautions, and incomplete
administration of medication (Morey et al., 2002).
Patient outcomes
When looking at outcomes after major surgery, Young et al. (1997) found that surgical services
with high levels of collaboration between doctors, nurses, allied health staff, and administrative
staff had lower rates of mortality and morbidity (i.e. post-operative complications), as compared
to surgical services where collaboration between staff was lacking. One example of
collaboration in action at one surgical service included consistent postoperative handovers
between the anaesthetist and the surgical intensive care unit’s (SICU) nursing unit manager or
charge nurse (Young et al., 1997).

Patient experience
In the palliative care sphere, a systematic review by Hearn & Higginson (1998) found that when
treated by a multi-disciplinary team (MDT), patients were more likely to die in their preferred
setting. Moreover, care involving an MDT was associated with higher levels of satisfaction from
both patients and their carers (Hearn & Higginson, 1998).

Barriers to inter-professional health care practice

Differing communication styles
In general, physicians and nurses have different communication styles, with the former trained
to be concise and the later trained to be descriptive (Rodgers, 2007). These differences can lead
to frustration from both sides and impede effective inter-professional communication (Foronda
et al., 2016). In a review by Foronda et al. (2016, p. 37), some complaints from physicians
regarding communication with nurses included, a “delay in getting to the point”, “lack of
preparation to answer questions”, and “inclusion of extraneous or irrelevant information”.
Conversely, nurses lamented that they were “unsure how much or how little detail to provide”,
and that physicians seemed “inattentive” and “unwilling to discuss the goals of care” (Foronda
et al., 2016, p. 37).

One method that can be implemented to improve inter-professional communication is to use a

standardised communication system such as ISBAR (Weller, Boyd, & Cumin, 2014; Woodhall et
al., 2008). ISBAR is a simple-to-use tool which allows health professionals to convey information
in a consistent and structured way (Weller et al., 2014; Woodhall et al., 2008). Moreover, the
use of ISBAR standardises health professionals’ expectations in regards to the information they
are required to provide as well as the information they are going to receive (Berwick, as cited in
Woodhall et al., 2008, p. 314). I found this notion to hold true during the handover station at
the IPW. Using the ISBAR framework made it easy to provide and receive a thorough patient
handover in a structured way. I believe it was the main reason that we were able to retain a
majority of the information despite it passing through three handovers.

Contrasting approach to management

Physicians generally employ an objective, scientific, structured, and succinct approach to patient
management, whilst nurses tend to adopt a holistic, humanistic, and systems-oriented approach
(Clark, 1997; Foronda et al., 2016). Further, social workers tend to focus on relationships and
the psychosocial and economic aspects of the illness experience (Clark, 1997). Accordingly, the
concept of good health and successful treatment varies between each health profession (Clark,
1997; Pecukonis et al., 2008). These divergent approaches to patient management arise from
professional socialisation and acculturation experiences that occur throughout work and
training, ultimately leading to the propagation and entrenchment of attitudes, values, beliefs,
behaviours, and customs between members of the same profession (Hall, 2005; Reeves, Lewin,
Espin, & Zwarenstein, 2010). These contrasting views and behaviours have potential to impede
IPHCP (Hall, 2005).

During the IPW tasks I did not perceive any notable differences in the approach taken by
students of different faculties. This was probably due to the fact that the tasks were not hugely
focused around patient care, and thus did not trigger respective approaches that have been
instilled into us through our training. However, I can easily foresee the development of
divergent approaches to patient management as we embark along our respective training
pathways and acculturation experiences.

Lack of inter-professional awareness

Sharpe and Curran (as cited in McNeil et al., 2013, p. 298) found that few health professionals
are appropriately knowledgeable regarding the scope of practice and skills of other health
professionals. Similarly to communication style (Rodgers, 2007) and approach to management
(Hall, 2005; Reeves et al., 2010), Sharpe and Curran note that the lack of inter-professional
awareness arises predominantly due to the socialisation that occurs within health disciplines (as
cited in McNeil et al., 2013, p. 298). In a small study by Baker et al. (2011), nursing and allied
health staff referenced physicians’ poor knowledge regarding the scope of other health
professionals; noting that, apart from leading to inappropriate consults, the lack of inter-
professional awareness was perceived by some as disregard for other professions.

In contrast to Sharpe & Curran (as cited in McNeil et al., 2013, p. 298) and Baker et al. (2011), I
found that during the profession-role matching station there was a generally high level of
knowledge regarding the scope of different health professionals, with about 80% of domains for
each profession correctly identified. Overall, there was greater knowledge regarding the scope
of doctors, nurses, and physiotherapists, and less for the scope of occupational therapists and
pharmacists. It is quite possible that the high level of knowledge was because students took
responsibility for allocating their own profession’s post-it notes. Nevertheless, despite the
methods employed by others, our group divided up the post-it notes in such a way that students
were responsible for allocating scope of practice for a profession other than their own. In
particular, the nursing students allocated scope for doctors and the medical students allocated
scope for nurses. Using this method, we displayed a comparably high level of inter-professional
knowledge. At this stage of our education, the high level of inter-professional knowledge that I
observed may be related to the increasing focus on interprofessional education at the university
level for health-related professions both in Australia and internationally (Aston, Mackintosh, &
Orzoff, 2010; Boyce, Moran, Nissen, Chenery, & Brooks, 2009; Jacobs et al., 2013).

Unequal power between professions

In short, Clegg et al., note that power affords privilege, influence, and authority (as cited in
Engel et al., 2017 p. 205). Continuing today, medicine is often viewed as the dominant
profession over nursing (Engel et al., 2017). This is likely a result of historical views of both
professions (Hall, 2005; Price, Doucet, & Hall, 2014). In the clinical setting, unequal power can
manifest itself in unproductive ways, including feelings of disempowerment (Baker et al., 2011)
and hesitancy in communication due to fear of being incorrect or humiliated (Foronda et al.,
2016). Similar to the previously discussed professional issues, Orchard et al. have described how
the respective socialisation of health professionals results in ways of thinking that contribute to
unequal power between professions (as cited in Engel et al., 2017, p. 204-5).

During the IPW, through no volition of thought, I found myself ascribed to the idea of medical
students as ‘superior’ to myself and the other health students. I find it really unfortunate that
such an idea comes so automatically to me, but I feel there is ample reason as to why it does. In
my life; family, friends, and the media have always elevated doctors on a pedestal, portraying
them as highly intelligent, wise, leaders, influential, and wealthy, with nurses as their helpful
sidekicks. Merton and Kitt (as cited in Aston et al., 2010) support this notion of individuals
acquiring knowledge and opinions about different professions via informal experiences
throughout childhood. It is difficult for me to bring doctors and medical students back down to
earth when such a high-flying picture has been imprinted in my mind. Changing this belief is
something I am actively working on.

Conclusion
It is evident that we should strive for IPHCP as it has many benefits for patient care including
error reduction, better patient outcomes, and an improved patient experience. However, in
order to implement IPHCP, there are many professional issues that must be addressed,
including differing communication styles, contrasting approaches to patient management, lack
of inter-professional awareness, and unequal power between professions.

One overarching recommendation would be to augment the nature of socialisation and

acculturation occurring in general society as well as within various health professions, as the
current milieu is leading to a highly segregated approach that is incompatible with IPHCP.

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