Scenario
Marjorie Stevens, an eighty-six year old single mom, decided to move into a large, well-equipped aged care facility (ACF). Her recent stay in respite care resulted from a fall, which led to a hip fracture.
While Marjorie’s family has moved some of her belongings to the ACF, she requires an ambulance to transport her from the respite center to the ACF. Something upset Marjorie during the ambulance ride to the facility. Upon her arrival at the ACF, the Health Service Manager of the facility calls for a case meeting to plan Marjorie’s care.
Players
Respite Care to ACF
This section covers the interaction related to events that transpired during the ambulance ride from the respite care to the ACF. The players involved are Paramedic – Joe, and Marjorie Stevens.
The paramedic arrives at the respite care facility. They check for vital signs and perform a set of tests before they transfer Marjorie from the facility to the ambulance. The paramedic ignores the patient’s request to meet with her religious practitioner as well as administering an alcohol based drug against her wishes.
Arrival at ACF
This section deals with the interactions that take place after Marjorie’s arrival at the ACF. The players involved are Physical Therapist – Joshua Simmons, Occupational Therapist - Leonard Swanson, and Marjorie Stevens.
Marjorie’s Therapists
Joshua Simmons meets Marjorie and briefs her about the plan of treatment. Leonard Swanson wants to start the session right away without allowing Marjorie time to settle in.
Health Service Manager Meeting
This section pertains to interactions during the Health Service Manager’s meeting regarding Marjorie Steven’s plan of treatment. This section includes an appearance from Marjorie via video conference. The players are Healthcare Service Manager - Brian Rogers, Paramedic – Joe, Physical Therapist – Joshua Simmons, Occupational Therapist – Leonard Swanson, Diet Technician – Linda Carmichael, Podiatrist – Andrew Jenkins, and Marjorie Stevens
Meeting Agenda
Brian: “Good Morning everyone. The agenda for the meeting is to ascertain the present medical condition of Marjorie Stevens, charting a course of treatment, branching the days to accommodate the different physicians, addressing the concerns of Marjorie Stevens (if any) and formulating a plan that will serve as a model in future.”
Occupational Therapist Assessment
Brian: “Leonard, let’s start with you. What do you think we have here?”Leonard: “Marjorie Stevens was leading an active life prior to her fall. She seems eager to get out of bed as early as possible. Her motor functions are good. She is quite mobile for an eighty-six-year-old hip fracture patient.”Brian: “So what do you plan to do for her?”Leonard: “It’s hard to determine that right away. We will have to wait and see how things progress.”Brian: “That sounds vague. I was sure you could do better than that.”
Physical Therapist Assessment
Joshua: “I am sorry Brian, Leonard if this seems out of line. My concern is her fractured hip. Her fall contributed only to 20% of the damage. The fracture itself was caused by deterioration of bone density. The physician that examined her at the respite care states that her chance for a full recovery is almost non-existent.”
Linda: “Elderly, who suffers hip injuries, have a 37% chance of fatality if operated upon. They not only have blood pressure levels that act in a frenzy during surgery, the drugs used during the surgery also affect liver and kidney functions.”
Joe: “These levels might not affect an average individual however can be fatal for someone as old as Marjorie.”
Joshua: “I don’t remember asking for either of your opinions, however, thank you for the insight.”
Brian: “Josh”
Joshua: “Okay Brian I get it. I want to add that we also do not have specialist orthopedic or cardio vascular surgeons at hand, should we have an emergency.”
Brian: “Without surgery how are we going to fix this?”
Diet Technician’s Input
Linda: “We can give her a staple diet of fruits, vegetables, milk, yoghurt and sardines to start during her treatment for hip fracture.”Leonard: “Also 400 to 600 mg of Vitamin D. Although, UI is better preferred to popping pills”Brian: “Alright everyone, there’s one last thing to do. We will patch into Marjorie’s room and brief her about the plan of action. Her family is also present at this time.”
Marjorie’s concern
Brian: “Good Afternoon Marjorie. I have the team that is”
Marjorie interruptsMarjorie: “It is not a good time at all Brian. In all the time I spent this morning, no one seems to want to know what I need. First it was the ambulance staff with no regard for my religious sentiments and then your staff at the facility. This attitude is most disappointing.”Brian: “I noticed the discomfort, and we will do everything to make this go away. Please tell us what happened.”Marjorie: “I am a follower of Christian Science and twice your ambulance staff refused me basic rights. Hardly anyone seems to listen to what I have to say.”Brian: “Marjorie, I want to apologize to you for the hardship caused. We will look into the events and get back to you with a plan in the evening. Please rest now.”Marjorie: “Okay Brian. I appreciate it.”Video uplink goes offline.Brian: “What was that all about?”Joe: “She kept mentioning some science and that she was a Christian.”Brian: “Let’s hear it from the start, shall we?”Joe, Josh and Leo narrate the events of the morning.Brian: “Okay. Don’t we have a Christian Scientist resident in block S?”Linda: “Mr. Armitage?”Brian: “Yes. That’s him. Let’s arrange a meeting between him and Marjorie. Let’s keep the family involved in the entire process as much as we can.”
Podiatric Intervention
Andrew: “So you believe that you can actually supplement surgery with diet alone? Did it occur to any of you that this is a hip fracture? Avoiding risk is not going to save the day.”
Brian: “If you thought otherwise, you should have voiced it earlier Andy.”
Andrew: “Oh I wanted to check if anyone noticed the only orthopedic field expert in the room before intervening.”
Brian: “Okay Andy, what would you do?”
Andrew: “All the measures that you suggested should follow surgery. The more we delay the surgery, the higher the risk.”
Joe: “We can’t simply rush her into the operating theatre in the next two hours. What about her ”
Andrew: “Her vitals? We have to stabilize them by tomorrow morning 08:00 and prepare for surgery. I want to invite Dr. Alden McIntyre to perform the surgery and Dr. Ian Thompson owes us a favor. His specialty is cardio vascular.”
Brian: “Are you sure about this Andy? There is no turning back and you know it. Don’t you?”
Andrew: “I know and this is what we have to do. Dr. McIntyre will perform a procedure known as Hemiarthroplasty. He will replace the femoral head with prosthesis. I will act as his assistant. Joe needs to be in the theatre along with Dr Thompson.”
Brian: “How long after the surgery can Josh and Leo start their work?”
Andrew: “Right away. We have to get Marjorie mobile at the earliest possible date. This aspect is essential to her surviving this injury.”
Joshua and Leonard look at each other skeptically. Linda and Joe look away.
Andrew: “I will ensure to check and treat disorders of the foot related to vascular disorders, foot problem combined with walking problems that cause falls and cutting her toe nails after the surgery. Upon healing progress, I will educate Marjorie on how to check skin and wash feet, cutting toe nails correctly, what movements to avoid and choosing the right kind of footwear.”
Brian: “Thank you Andrew. Let’s take a ten minute break and then roll out the plan.”(A place for mom 2014)
Health Service Manager’s Plan
Team members take their seats.
Brian: “I know that all of you are specialists in what you do, and I respect that, however, all that will be a waste if we do not cooperate in delivering what’s best for the patient.”The others agree in unison.
Brian: “The plan for Marjorie progresses in three phases and all of you will play a vital role in it. First, we have to establish trust with the patient. Joe and Lowry will apologize to Marjorie for the rough ambulance ride, the shot and denying her meeting with McMillan.”Brian: “The plan is set for motion in three phases. I will use the whiteboard for better understanding. Please take note that will not administer any alcohol based shots for Marjorie.”The members of the team acknowledge and agree with Brian.
(Moran CG 2005)
The assessment of the inter-professional communication of the above team is termed immature. There are a lot of opinions thrown around on how to treat a patient without considering the cultural or religious background of the patient. The professionals also were looking to exhibit their skills than seek a resolution that would suit the patient rather than their individual beliefs or work styles. It is apparent that this team lacked some basic skills. Let’s look at the skills lacking for each of the team members.
The Paramedic
- Lack of knowledge in cultural diversity
- Lack of comprehension
- Listening skills(Palmer 2014)
The Therapists – Occupational and Physical
- Comprehension
- Paraphrasing
- Articulation(Brandon 2014)
Podiatrist
- Participation
- Discussion Skills
Healthcare Service Manager
- Strategizing - Did not consult podiatrist
- Planning – Did not have all the facts on the table(Kokemuller 2014)
The Team Member Role
The role of individual team members is vital as long as the operation focus remains intact. There is room for exhibiting expertise to other team members however; it should not be an obstacle to hearing out ideas from other professionals. Treatment for a patient constitutes to actions of various professionals in sequence of the patient’s response. The table below contains the roles of each team member in healthcare.
(Hypothesis Journal 2010)
What strategy worked
The team leader in this scenario, Brian the Healthcare Service Manager instills importance to all the roles played by the team. Brian then gathers all the information pertaining to the case. He then outlays a systematic plan to follow a sequence of treatment based on the response to treatment by the patient. The three phase plan contains clearly articulated roles.
Selling the plan across the table
A plan drawn for a team needs to articulate the sequence of events without conflicting with the treatment provided by another team member. The plan drawn speaks to the team in terms of
- Treatment planning
- Self Management of treatment advised
- Consultations
- Challenging assumptions
- Enhancing cultural awareness
- Avoiding jargon use to avoid confusions
- Systematic review of patient’s condition
Skills set recommendation
The following skill set is an additional requirement for effective communication amongst healthcare professionals.
- Effective interpretation of information
- Asking the right questions
- Constructing meaningful sentences
- Taking notes – Listening skills
- Decision-making skills
- Delegation skills
- Discussion skills
- Articulation skills
- Using words in common usage instead of jargons
- Awareness of other medical therapies
- Awareness of medical procedures
- Conversational skills
Conclusion
This paper outlines the sequence of events that transpire the actions of various healthcare professionals. It also underlines the need for healthcare professionals to work together. Effective care giving relies on the interlaced procedures and support of different streams of medicine.
References
Palmer, Kimberly (2014). Paramedic. Retrieved from: http://money.usnews.com/careers/best-jobs/emergency-medical-technician-and-paramedic
Brandon, Emily (2014). Physical Therapist. Retrieved from: http://money.usnews.com/careers/best-jobs/physical-therapist
Steinberg, Stephanie (2014). Occupational Therapist. Retrieved from: http://money.usnews.com/careers/best-jobs/occupational-therapist
Kokemuller, Neil (2014). Duties of a Health Care Manager. Retrieved from: http://work.chron.com/duties-health-care-manager-14079.html
A place for mom (2014). Hip Fracture in the Elderly and Assisted Care. Retrieved from: http://www.aplaceformom.com/senior-care-resources/articles/hip-fractures-in-the-elderly
Hypothesis Journal (2010). Communication in Health Care: Considerations and strategies for successful consumer and team dialogue. Retrieved from: http://www.hypothesisjournal.com/?p=885
Moran CG, et al (2005). Early Mortality After Hip Fracture: Is Delay Before Surgery Important? J Bone Joint Surgery. Rosemont, Illinois. p483-489. Print.
