Reflective Piece 2
This reflective piece uses Rolfe et al's model of reflection to consider an inter-professional working situation.
What
I responded as part of a two person paramedic ambulance crew to an elderly male experiencing symptoms of a cerebro-vascular accident (CVA). Following initial assessment and treatment we removed the patient to the nearest receiving accident and emergency department (AED), courtesy of an 'amber' grade pre-alert, having confirmed the presence of CVA symtpoms, to allow the receiving AED to prepare for our patient's arrival. Upon arrival the triage nurse was informed, who, having a cursory glance at our apparently stable patient, informed us we were to wait in the queue. Following my senior colleague reiterating the presenting complaint and pre-alert a strong and badly natured debate arose between them regarding the merits of pre-alerting the AED for a patient whose condition was stable. Carrying the relatively new and agreed guidelines on hospital pre-alert systems, I was able to intervene in the argument to show that the pre-alerting system had been used appropriately. This was still not positively received, but it brought an end to an unprofessional display in front of staff, our patient and others in the AED. The inflammatory attitude of the receiving triage nurse, and the defensive response from my colleague led to an interchange that was uncomfortable, unprofessional and embarrassing.
So What?
Upon reflection I am resolute that the care our patient received was full and appropriate. Patient pathways are agreed as the result of effectively organised care, and it is now widely accepted that expedient care of a victim of a CVA results in improved patient outcomes. Where the patients journey faltered however was in the breakdown of a professional relationship after arriving at hospital. My procedural awareness in this instance allowed me to prevent the escalation of a difficult situation which seemed to arise from a combination of issues, notably ignorance of accepted treatment pathways and fragile temperament, arguably the result of a highly pressurised working environment in a busy department. Anecdotally it is frequently the case that inter-professional relationships break down during relatively simple exchanges during episodes of high pressure.
Now What?
Discussions with inter-professional staff often reveals a lack of awareness of each other's policies and procedural guidelines, and it seems evident that this was a key factor in this incident. With respect to this, in the discharge of my daily responsibilities I have made redoubled efforts to discuss variations and updates in practice and procedure with not only immediate colleagues but the various professions with whom we have regular contact. This is regularly done in person with my colleagues but i have also engaged with open forums online using social media. This has revealed itself to be a positive means of sharing information and good practice in an environment of mutual learning. Such open learning environments would be no doubt supported by an increased effort from employers to identify and disseminate information from other health care providers pertinent to the discharge of each other's role. Good patient outcomes could be encouraged by promoting a more cohesive treatment pathway from the beginning of the patient journey to the end, rather than being treated by a sequential set of health care professionals, as is the intent of many of our guideline pathways.
What
I responded as part of a two person paramedic ambulance crew to an elderly male experiencing symptoms of a cerebro-vascular accident (CVA). Following initial assessment and treatment we removed the patient to the nearest receiving accident and emergency department (AED), courtesy of an 'amber' grade pre-alert, having confirmed the presence of CVA symtpoms, to allow the receiving AED to prepare for our patient's arrival. Upon arrival the triage nurse was informed, who, having a cursory glance at our apparently stable patient, informed us we were to wait in the queue. Following my senior colleague reiterating the presenting complaint and pre-alert a strong and badly natured debate arose between them regarding the merits of pre-alerting the AED for a patient whose condition was stable. Carrying the relatively new and agreed guidelines on hospital pre-alert systems, I was able to intervene in the argument to show that the pre-alerting system had been used appropriately. This was still not positively received, but it brought an end to an unprofessional display in front of staff, our patient and others in the AED. The inflammatory attitude of the receiving triage nurse, and the defensive response from my colleague led to an interchange that was uncomfortable, unprofessional and embarrassing.
So What?
Upon reflection I am resolute that the care our patient received was full and appropriate. Patient pathways are agreed as the result of effectively organised care, and it is now widely accepted that expedient care of a victim of a CVA results in improved patient outcomes. Where the patients journey faltered however was in the breakdown of a professional relationship after arriving at hospital. My procedural awareness in this instance allowed me to prevent the escalation of a difficult situation which seemed to arise from a combination of issues, notably ignorance of accepted treatment pathways and fragile temperament, arguably the result of a highly pressurised working environment in a busy department. Anecdotally it is frequently the case that inter-professional relationships break down during relatively simple exchanges during episodes of high pressure.
Now What?
Discussions with inter-professional staff often reveals a lack of awareness of each other's policies and procedural guidelines, and it seems evident that this was a key factor in this incident. With respect to this, in the discharge of my daily responsibilities I have made redoubled efforts to discuss variations and updates in practice and procedure with not only immediate colleagues but the various professions with whom we have regular contact. This is regularly done in person with my colleagues but i have also engaged with open forums online using social media. This has revealed itself to be a positive means of sharing information and good practice in an environment of mutual learning. Such open learning environments would be no doubt supported by an increased effort from employers to identify and disseminate information from other health care providers pertinent to the discharge of each other's role. Good patient outcomes could be encouraged by promoting a more cohesive treatment pathway from the beginning of the patient journey to the end, rather than being treated by a sequential set of health care professionals, as is the intent of many of our guideline pathways.