Multi-agency Working In Nursin Essay

This essay has a total of 2858 words and 13 pages.

Multi-agency Working In Nursin


This essay will focus upon a critical incident analysis in the context of multi-agency
team work and inter-professional working. The details of the incident will be drawn from
the authors recent experience with the Community Housing Support Team, in particular from
Care Programme Approach meetings. The names of both clients and staff, as well as details
pertaining to their locale have been changed or omitted to comply with the UKCC's Code of
Professional Conduct, Clause 10, (UKCC, 1992).


The situation used within this assignment is based upon two clients who co-habit in a
first floor maisonette as common law husband and wife. Mr Client has a diagnosis of
paranoid schizophrenia which is controlled with xenobiotics and is the main carer for Mrs
Client who has a diagnosis of chronic schizophrenia also controlled by xenobiotics that
are administered by Mr Client. Mrs Client also has a prolapse of the uterus which causes
her to suffer from double incontinence. Arrangements have been made for Mrs Client to have
the required operation to repair the problem, however prior to admission Mrs Client
becomes very anxious and has twice refused to have the operation. Both clients have a poor
dietary intake, poor personal hygiene, high caffeine intake, and a heavy smoking habit.


The conditions that the clients are now living in due to the above being ongoing for some
time are now less than satisfactory, and to that end the present situation and what should
be done about it, has become the primary focus of the various professionals and agencies
involved in care of the clients. Each client has their own keyworker representative from
the agencies and professionals involved in their care, these are a community psychiatric
nurse (CPN), social worker, and a member of the housing support team (HST). Both the
clients have home care workers visiting as part of the social work input, and they also
share the same general practitioner (GP), and psychiatric consultant.


Housing support team input was on a daily basis with both clients and their role was to
assist the clients with shopping and encourage the clients to use leisure facilities and
local transport. The housing support team although referred to separately within this
essay are officially part of the social work team, as this is the source of their funding.
The social work keyworkers roles were to visit the clients on a regular basis and to
assist with benefits, finances etc, as well as assisting the clients in conjunction with
the rest of the care team if a crisis arose. The social work department had also arranged
for home help to visit on a regular basis to assist with housework and hygiene. The
clients community psychiatric nurse's role was to monitor medication and mental state.
These are the defined roles as the author understands them, however the care team as a
whole interchanges, shares, or crosses over roles as a matter of course throughout the
care deployment.


In order to properly analyse the inter-professional working of the clients care team, it
is important to collate the differing aims of each profession involved. Mr and Mrs
Client's keyworkers from the housing support team were of the opinion that the client's
accommodation had reached the stage where it was posing a health risk for both the clients
and other residents in the building. Because the housing support team had daily input with
both clients they were also able to pick up on various other aspects of care that appeared
to require revaluation, such as medication and mental state, and had encountered such an
issue with Mr Client giving Mrs Client the incorrect dosage of medication. Taking into
account the issues raised the housing support team felt that they were maintaining a poor
quality of life for the clients, and that alternative sheltered accommodation, and care
approach should be discussed as this was unacceptable. The social work keyworkers in
addition to their normal visits had arrangements for further visits outside of the care
plan agreement as there was a recognised need for more intense support at this time. It
was felt that placement in a nursing home as a couple with continuing input from the
housing support team and community psychiatric nurse, would improve the clients quality of
life. The clients general practitioner and consultant had made a referral to residential
services. Both clients community psychiatric nurse felt that the clients mental state did
not warrant an admission into hospital, however further arrangements should be made
regarding medication and accommodation.


These various agencies and professionals come together, in this case every six months, to
partake in a care programme approach meeting (CPA). The care programme approach was first
considered in nineteen eighty-nine then again in nineteen ninety in a Department of Health
circular, before being implemented in nineteen ninety-one as an official guideline.
However inter-collaborative working has been an aim of government policy in mental health
services since the nineteen seventies, (COUCHMAN, 1995). Its target group being
psychiatric clients in hospital, community or other specialised mental health service. The
aim of the guidelines were to encourage greater efficiency and co-operation between the
various agencies and professionals involved in the care of a client or clients. This was
to be done by systematically assessing all the clients needs and the agency or profession
that could best meet those needs, the appointment of a keyworker from one of the agencies
or professions involved, to reach agreement between the carers involved and the client,
and then to implement, monitor and set regular review dates, (COWART & SEROW, 1992), In
addition to the care plan approach meetings there is almost daily interaction between the
agencies and professions involved. In addition to this there are meetings within each
individual agency or profession, usually on a weekly basis, concerning the most
appropriate delivery of care within the role of the individual agency or profession. The
diagram in Appendix A shows the ways that clients enter the psychiatric services, and
where inter-professional collaboration happens, it also shows that this care team is a
hybrid parallel pathway team.


Efficient inter-professional collaboration exists only where there is good group dynamics
and working relationships, both within the care team and within the government who's laws
and guidelines that care team follows. However when reviewing the history of British
social policy it is easy to become pessimistic, Webb, (1991) points out, "exhortations to
organisations, professionals and other producer interests to work together more closely
and effectively litter the policy landscape, yet the reality is all to often a jumble of
services fractionalised by professional, cultural and organisational boundaries and by
tiers of governance". In order to overcome these problems they must first be identified
and then strategies devised to overcome them. Whilst in the community with the housing
support team the author observed that the main problem or cause of problems was
communication, whilst ironically, most if not all of the problems encountered could have
been avoided or solved more efficiently with effective communication. However the author
feels this may be viewed by many as an over-generalisation, and so will break this down
further into some of the ‘sub' problems. A key difficulty is that working together
appears to be the logical way forward, yet it is the authors experience that little
consideration is given to the effects of such an activity, (CARLING, 1995). From an
agencies or professions point of view collaborative activity raises two main difficulties
first it looses its freedom to act independently when it would prefer to maintain control
over its domain and affairs. Second, it must invest scarce resources and energy in
developing and maintaining relationships with other organisations, when the potential
returns on its investment are often unclear or intangible, (HUDSON, 1987).


The main sources of conflict within an organisation and inter-professional collaboration
are communication, power, goals, values, resources, roles and personalities. As mentioned
previous a major source of conflict is the misunderstanding or breakdown of communication.
However communication can also be used as a tool for clarifying opposing views. It is the
authors observation that most values within an organisation are internalised and are
therefore difficult to change, but they can be clarified through communication so as not
to become a barrier. This kind of logic is a skill that can only be learnt through the
application of common sense and the wisdom of experience, (BILLIS & HARRIS, 1996).
Conflict situations often arise suddenly, the author has observed that the more people
that attend a meeting or that are involved in a decision regarding care organisation the
more potential there is for conflict to occur.


Power causes conflict when there are relationships within organisations between
individuals of unequal power, the classic example being the doctor/patient relationship,
or the nurse and the consultant. This can cause additional conflict where there are
differently structured organisations working together as the power differences between
individuals then become unclear. For example the power relationship between the community
psychiatric nurse and the social worker.


Continues for 7 more pages >>