Mr Alfred Robinson is 85- year-old and lived happily with his wife for 50 years in a London inner city borough. They had no children but got on well and socialised with friends and neighbours. Mr Robinson’s wife, Lucy, recently passed away. Alfred seems to carry on with his life as usual, going to bingo, having lunch twice a week with friends and doing gardening.
Six months after the wife’s death, he seemed less communicative, unkempt and frail. He confided in Susan, a family friend, that he was missing his wife, having no appetite, and feeling tired all time.
After discussion, Susan volunteered to accompany Alfred to his GP for a check up. Mr Robinson was diagnosed with chest infection and admitted to hospital. Within a short time he had two further admissions, one with dehydration, and weight loss, and the other with a fall which affected his self-caring ability and confidence to walk. Three hospital admission, Mr Robinson needs were met holistically by different health and social care professionals through an inter-professional working teamwork and he always made good progress.
Using relevant literature, observations made and experiences gained during my clinical placements, this essay will discuss the case of an 85-year old frail and widowed man, Mr Alfred Robinson, who appears to be grieving from the loss of his wife, has suffered a chest infection, suffering from loss of appetite and weight and has had a fall which has affected his self-caring ability and confidence to walk. In addition to discussing interprofessional working, this essay will identify three health and social care professionals, and their roles within the interprofessional working team in their quest to restore Alfred’s health. The essay will next focus, in greater detail, on one of the professionals and will cover issues such as accountability, responsibility, legal, moral, ethical and statutory regulation of the professional body to which the individual belongs. The essay will then reflect on how engaging in group discussion and presentation helped in writing this piece, and then conclude with a summary of the main points raised.
Interprofessional working, simply put, means working and learning together and sharing knowledge to achieve a common goal in relation to a patient care. As specialization grows in all the healthcare professions, so too does the need for the simultaneous development of practice that encourages working together. As Bleakley et al (2006, p467) have pointed out, there is a growing body of evidence to suggest that interprofessional practice offers greater benefits for patient care and safety than multi-professionalism. Hutchings et al (2003) opined that it is impossible for one professional to possess all the skills, knowledge and resources needed to meet the total healthcare needs of the society. Quality care and effectives services are the product of good team and these aspirations should be central in clinical guidelines, position statements or standard of practice. In spite of the apparent benefits of interprofessional practice, there are obstacles to interprofessional working. Headrick et al (1998, p773) have identified some barriers to interprofessional working. These include: differences in history and culture, historical interprofessional and intra-professional rivalries, differences in language and jargon, varying levels of preparation, qualifications and status, fears of diluted professional identity and accountability, as well as concerns regarding clinical responsibility.
Three health and social care professionals this essay has chosen to collaborate in order to restore Mr Alfred Robinson’s health are: a bereavement counsellor, a dietitian and a physiotherapist.
The bereavement counsellor’s role is to help Alfred to adapt to the death of Lucy, his wife for 50 years. Alfred’s response and reaction to the loss (grief) of his wife includes physical, psychological, social and spiritual components. Alfred appears to be experiencing more complicated grief reactions to his bereavement and loss (Doka, 2006) and lack of progress towards psychical assimilation after passage of time and appears to be exhibiting the presence of maladaptive behaviours (Freud, 1917).
The bereavement counsellor will assist in healing of Alfred’s grief psychically in order that he experiences a less psychologically painful living without Lucy. The counsellor will also assist Alfred to have within the self an inner awareness of movement through his grief and towards a more adaptive relationship with Lucy (Fenn, 2011).
A dietitian is a healthcare professional who focuses on proper food and nutrition in order to promote good health (WHO, 2010). Dietitians assess, diagnose and treat diet and nutrition problems at individual and wider public level. Uniquely, dietitians use public health and scientific research on food, health and disease which they translate into practical guidance to enable people make appropriate lifestyle and food choices (The British Dietetic Association, 2011). Working in consultation with other health care givers, a dietitian was involved in the diagnosis and dietary treatment of Mr Robinson. As Mr Robertson had poor appetite and had lost weight, the dietitian would have advised and provided a nutritional plan based on a comprehensive needs assessment of Mr Robinson, against which progress was monitored and outcomes evaluated in order to optimise his nutritional status and prevent re-infection and further weight loss. For instance the dietitian would have prescribed special diet, and nutritional supplement and Mr Robinson’s weight reviewed regularly to ensure that the desired progress was being made.
The rest of the essay will focus on physiotherapist, statutory regulatory of the physiotherapy practice, professional body of physiotherapy and the roles of physiotherapist. The rationale for the choice of a physiotherapist is that Mr. Robinson had had a chest infection and a fall which had affected his self-caring ability and confidence to walk. The physiotherapist would have helped restore Mr Robinson’s movement ability and confidence to walk. The physiotherapist would have, in addition, helped treat his chest infection through the removal the excess secretion in Mr Robinson’s lungs, assisted cough, and tried to improve ventilation of the lungs by physical means. All physiotherapists in the United Kingdom have received training on dealing with chest diseases and infections. (The Jennifer Trust, 2009).
As a student nurse, I had the opportunity to observe, explore, interact and collaborate with physiotherapists in delivering quality care to patients during my clinical placement. I was once placed in a stroke rehabilitation unit where I worked closely with other health and social care professionals. These include doctors, nurses, dieticians, physiotherapist, clinical psychologists, occupational therapist, speech and language therapist, healthcare assistants and others. During the placement I had the chance to observe the physiotherapist helping an elderly patient in maintaining his mobility and independence after a fall. I also had a unique chance to assist a stroke patient to walk around under the supervision of a physiotherapist. I also observed a speech therapist helping the same patient to re-discover his speech while a dietitian offer advice on nutrition and diet to the same patient who happened to be a diabetic as well.
The World Congress of Physical Therapy in1999 described the nature of physiotherapy as providing services to people and populations to develop maintain and restore maximum movement and functional ability throughout the lifespan. Besides, physical therapy is concerned with identifying and maximising movement potential within the spheres of promotion, prevention, treatment and rehabilitation, (cited in Hammond and Wheeler, 2008, p3). The Chartered Society of Physiotherapy (CSP) (2002b) defines physiotherapy as a health profession concerned with human function and movement and maximising potential. Physiotherapy uses physical approaches to promote, maintain and restore physical, psychological and social well-being, taking into account of variations in health status. Physiotherapy is science- based, committed to extending, applying, evaluating and reviewing the evidence that underpins and informs its practice and delivery. The exercise of clinical judgement and informed interpretation is at its core (Hammond and Wheeler, 2008 p3).
In the CSP revised Scope Professional Practice (2008), the definition of scope of physiotherapy practice is based on four pillars of massage, exercise, electrotherapy and kindred forms of treatment (cited in Dimond, 2009, p4). With its root in massaging, the therapeutic touching of patients sets physiotherapy aside from other professions. Physiotherapists continue to use massage therapeutically in addition to manual techniques such as manipulation and reflex therapy. Therapeutic handling underpins many aspects of rehabilitation, requiring the touching of patients to facilitate movements (Hammond and Wheeler, 2008, p3).
To practise in the profession of physiotherapy in the UK, one is required by law to be registered with the Health Professions Council (HPC), UK’s statutory regulator for health professions. The titles physiotherapist and physical therapist are protected by the powers of Health Profession Order 2001 and may only be used by persons who are on HPC’s statutory register. The essence of this is to protect patients from unqualified or inadequately skilled healthcare providers. HPC keeps a register for health professional that meets its standards and it takes action if registered health professionals do not meet those standards.
The HPC sets the standards of professional training, performance and conduct for fifteen professions including physiotherapist (HPC 2011). The HPC has since 2006 put in place a system, requiring re-registration at intervals of two years and that all physiotherapists provide evidence that they have been developing and are continuing to develop their skills and knowledge while they are registered. The Continuing Professional Development (CPD) standards require physiotherapist to supply a profile on request demonstrating fulfilment of the CPD standards (tested through sample audit). The standard requires all registrants to maintain a continuous, up-to-date and accurate record of their CPD activities. This is to ensure that registrant’s CPD has contributed to the quality of practice, service delivery and benefits the service user. All registrants are expected to able to demonstrate that their CPD is a blend of learning activities relevant to current and future practice.
Physiotherapists are fully autonomous practitioners and do not require a medical referral in order to see a patient. Patients may access a physiotherapist directly themselves, or may be referred to a physiotherapist by other health professionals.
The Chartered Society of Physiotherapy (CSP) is a professional body for physiotherapist. The CSP provides a framework for curriculum of physiotherapy education and approves those physiotherapy programmes that meet the requirements of the framework on behalf of the profession. Additionally the CSP publishes rules of professional conduct and standards of physiotherapy practice derived from within the profession and are in harmony with those of the HPC. Anyone on the HPC physiotherapist register may call themselves a physiotherapist, however, only those who are also members of the CSP, may call themselves as chartered physiotherapist. It is worthy to note that relationship with the HPC is one of registrant; with the CSP it is one of membership.
The breadth of activity and resources that the CSP undertakes and provides seek to establish a level of excellence for the physiotherapy profession. Its education and professional activity is centred on leading and supporting its members’ delivery of high-quality, evidence-based patience care. The CSP is the primary holder and shaper of physiotherapy practice in the UK and works on behalf of the profession to protect the chartered status of physiotherapists’ standing, which is the one denoting excellence (Hammond and Wheeler, 2008, p2).
The CSP sets standard and ideals of behaviours for its members. The CSP’s Rules of Professional Conduct was first endorsed in 1895 (Barclay, 1994) and has been revised and updated periodically since that time. A new Code of Professional Values and Behaviour which will supersede the Rules of Professional Conduct (still valid) is being piloted with members (CSP, 2011). The Rules of Professional Conduct (the Rules) defines the professional behaviour expected of chartered physiotherapists which are intended to safeguard patients. The Rules require chartered physiotherapist to: respect and uphold the rights, dignity and individual sensibilities of every patient; ensure the confidentiality and security of patient information; work safely and competently; not exploit patients; and act in a way which reflects credit on the profession and does not cause offence to patient and carer (CSP, 2002a).
The CSP has since 1990, periodically published CSP Standards of Physiotherapy Practice (the Standards), the fourth edition was in 2005 and currently being revised (CSP, 2011). The Standards describes the professional consensus on the practise of physiotherapy and reflect the collective judgement of the profession. The Standards provides statements about the practical application of the ethical principles set in the Rules. The core standards provide a framework within which all chartered physiotherapist and associate members are required to practise. The core standards play a central role in the delivery of safe and effective physiotherapy to patients. For instance, the Core Standards 2 (CSP, 2005a) states ‘Patients are given the relevant information about the proposed physiotherapy procedure, taking into account their age, emotional state and cognitive ability, to allow for informed consent.’ The expected measurable performance or activity set out for this standard include: the patient’s consent is obtained before starting any examination/ treatment; treatment options, including significant benefits, risks, and side-effects, are discussed with the patient; the patient is given the opportunity to ask questions; the patient is informed of the right to decline physiotherapy at any stage without that prejudicing future care; the patient’s consent to the treatment plan is documented in the patient’s records.
The Standards include clinical audit tools for measurable performance or activity to be assessed against. The clinical audit tool consists of a template for physiotherapist to assess both core and service standards so as to identify areas of good practice and also areas for development work.
The essay will now consider some of the roles physiotherapists play in the health delivery system. Physiotherapists work in outpatients’ department of healthcare institution where they treat spinal and joint problems, accidents and sports injuries. In caring for the elderly like Mr Robinson, physiotherapists help maintain mobility and independence, rehabilitation after falls, treat arthritis and chest infection. In neurology, physiotherapists help restore normal movement and function in stroke and multiple sclerosis in patients. Physiotherapists play important roles in mental healthcare delivery by giving classes in relaxation, improving confidence and self-esteem through exercising. Physiotherapists work in hospice where they treat terminally ill people suffering from ailments such as AIDS and cancer. In paediatrics care, physiotherapists treat injured and sick children as well as those with severe mental diseases and physical deformities and conditions such as cerebral palsy and spina bifida.
This essay was facilitated by the feedback received during the group presentation. It helped me to research more to understand the topic in general and also to plan and structure the essay.
In conclusion this essay has taken a cursory look at interprofessional working, its benefits and challenges in general and specifically how a dietitian, bereavement counsellor and physiotherapist collaborated in restoring Mr Robinson to good health. The essay explored the HPC as statutory regulators of physiotherapy to ensure high standards and to protect patients from unqualified or inadequately skilled healthcare providers. The CSP is the primary holder and shaper of physiotherapy practice in the UK and works on behalf of the profession to protect the chartered status of physiotherapists’ standing, which is the one denoting excellence.